The Ethics of Medical Homicide and Mutilation

by Austin O'Malley

The effect of an action, the result or product of an effective cause or agency, may in itself be an end or an object or a circumstance, and it has influence in the determination of morality. Sometimes an act has two immediate effects, one good and the other bad. For example, ligating the blood-vessels going to the uterus to stop a hemorrhage and so save a woman's life, a good effect, has also in ectopic gestation while the fetus is living another immediate effect, namely, to shut off the blood supply from the fetus and so kill it, a bad effect. To make such a double-effect action licit there are four conditions which are explained in the chapter on Mutilation.

The doctrine of Probabilism is very important in morality. Any law must be promulgated before it really becomes a law, and promulgation in a rational conscience is sufficient. Sometimes there is rational doubt of the existence, the interpretation, or the application of a law in a given case. Here probability is the only rule we can follow. A law which is doubtful after honest and capable investigation has not been sufficiently promulgated, and therefore it cannot impose a certain obligation because it lacks an essential element of a law. When we have used such moral diligence as the gravity of the matter calls for, but still the applicability of the law is doubtful in the action in view, the law does not bind; and what a law does not forbid it leaves open. Probabilism is not permissible where there is question of the worth of an action as compared with another, or of issues like the physical consequences of an act. If a physician knows a remedy for a disease that is certainly efficacious and another that is doubtfully efficacious, he may not choose this probable cure. Probabilism has to do only with the existence, interpretation, or applicability of a law, not with the differentiation of actions. The term probable means provable, not guessed at, not jumped at without reason. The doubt must be positive, founded on reason, not a matter of mere ignorance, suspicion, emotional bias. The opinion against a law to permit probabilism must be solid. It must rest upon an intrinsic reason from the nature of the case, or an extrinsic reason from authority, always supposing the authority is really an authority. The probability is to be comparative also. What seems to be a very good reason when standing alone may be weak when compared with reasons on the other side. When we have weighed the arguments on both sides, and we still have a good reason for holding our opinion in a doubtful case, our opinion is probable. The probability is, moreover, to be practical. It must have considered all the circumstances of the case.

There is, then, a Supreme Being whom we must obey, who created and owns human life primarily; there is also a moral law. On these facts rests the argument relating to the destruction of human life. How far, then, has a human being dominion over his own life, and, secondly, over the life of any one else?

St. Thomas,[2] Lessius,[3] and others offer as one argument to prove suicide is not licit, that it is an injury to society or the state of which the suicide is part, and to which the use and profit of his service rightly belong. Lessius, while developing this proof, acknowledges its weakness.

If there were only one man in the world, and no society or state, suicide would still be illicit, because its basic deordination lies deeper than society or the state. If suicide were a moral evil solely because it deprives the state of the suicide's life, then for the same reason no one might become a citizen of another state, emigrate, nor might man abandon society and live as a recluse. Moreover, if a man were detrimental to the state rather than beneficial, in this point of view that fact alone would justify suicide, and the state would then be justified in permitting or even commanding suicide; and we shall show later that the state has not this power.

It is true that the injury done the state or society by loss of use and profit, by scandal and similar evils, is a solid argument against suicide, as such injury aggravates the deordination of suicide, but in itself the injury done to the state and society is not the fundamental reason against suicide.

St. Thomas[4] argues against suicide because it is contrary to the charity a human being should have for himself. This is true ordinarily, and suicide takes on part of its guilt just because it is an offence against the rational regard a person should have for himself; yet this argument is not basic. We are told that if one sins against charity in killing his neighbor, a fortiori he sins in killing himself. Yet suppose just what the advocates of euthanasia suggest, viz., that a neighbor is in great agony and incurable: then the act of killing him takes on a quality of charity rather than of uncharity. And so for the suicide: if the patient is willing to be killed, there would be no uncharity; if he were unwilling, then homicide in any form would be uncharitable and unjust. The argument from charity, therefore, is too narrow to fit the whole case; and its very weakness is a source of error for the advocates of euthanasia.

Still another argument is often advanced against suicide, viz., that a man is obliged to love his own life, since it is the foundation, or the necessary condition, to him, of all good and every virtue, and this circumstance makes the destruction of that life unlawful. That argument has solid truth, but if it held absolutely it would prevent us from desiring death in any case, and no one denies that there are conditions in which a desire for death is fully legitimate. No desire for death, however, can give the slightest justification for the destruction of life.

Again, the argument that suicide is cowardice is not broad enough. Fortitude is a mean between fear and rashness, and this argument maintains that the suicide sins against fortitude by rashness. If we have good reason it is not rash to expose ourselves to death; the soldier may do so, the person struggling to save a neighbor's life, and so on; it may be the highest form of fortitude thus to expose oneself to death. If the suicide can persuade himself that by his act he is seeking greater good than the life he possesses he would have reason for his act, and at least be above cowardice. This argument is one that can be turned at times so as to cut the fingers of the man that uses it. The fundamental reason that suicide is not lawful is that man cannot be master of his own life, and therefore he may not dispose of it as he pleases.

Suicide is the direct killing of oneself on one's own authority. A killing is direct when death is intended as an end, or chosen as a means to an end. Direct killing is positive by commission, or negative by omission. In such cases the will directly rests in the death as a voluntary and free act. A killing is indirect when the act of which death is the effect by its nature and the intent of the agent is directed toward another end, but concomitantly, or as a consequence, results in death. In such case death is an accidental effect, and comes indirectly from the activity of the will—it is not necessarily voluntary. If one has a right to do that other deed, or if it is his duty to do it, and there is a proportion between it and his life, he may do the deed and permit the consequent death.