Life and Death: Grappling With the Moral Dilemmas of Our Time

AND

;i;tb

CHAPTER

11

What Is Death? The Crisis of Critefia

Awoman in NewYork is beaten by a man until she is unconscious. She is put on a ventilator until physicians decide that she is irreversibly comatose. The ventilator is then detached, and she dies. Later in court the lawyer for the maD accused of beating her to death argues that the doctors, not the accused, killed the woman. For had the doctors not removed tJ:e respirator, the woman would still be alive. In Kansas a man on a ventilator was declared brain dead, but when he was transported across the border to be buried in his home state, Oklahoma, hewas declared alive again, since the definitions of death in the two states differ. In a famous case in Kentucky, CrE o. Swayn (1952), a court had to decide which of two individuals, a man and a woman, would inherit a large sum of money. The will stated that the person who survived the other would inherit the money. In an automobile accident both parties were killed, but while the man soon lost his pulse, the woman, who had been decapitated, continued to spurt blood for a short time after the accident. Physicians testified that "a body is not dead so long as there is a heartbeat and that may be evidenced by the gushing of blood in spurts."l The courtruled on the basis of this cardiovascular definition of death that the woman survived the man-
158

ChaPter

\{hat Is Death? The Crisis of Criteria

ll

"mechanically alive . .

. [his]

prognosis for recovery is

nil and death

imminent." At ttre same time a patient namedJoseph Klett was in a ward waiting for a donor heart. When the electroencephatogram attached toTucker They showed a flat line, the doctors concluded that he was 'brain dead." also were Lp.ot a -d transplanted his heart to Klett. Tucker's kidneys for transPlantation. removed -atthorgt, Tuc1er's wallet contained his brother's business card, including a"phone number and address only 15 ltg:ts away from the hospital. no attempt was made to contact him. william Tucker, the Uio'it .r, Ur"ught suit against the doctors who performedthe oPeration, U"i ,ft.'a""to"* *,.r. Exonerated in court, even though Virginia law functions. william Tucker, defined death as total cessation of all bodily *There'snothing they can say exclaimed, disappointed with the verdict, me believe they didn't kill [my brother]'a t" "irt when is someone dead? until the mid-nilentieth century this was seldom a serious question. If someone failed to have a pulse and stgPned Lr..,fri"g, this cllar$ determined that he or she was dead' But in the centurybiomedical technologydevelopedwap to keep the *iaaf" "F,ftis indefinitely, causing us to reflect anew on the meaning U.Jy af* "fmost this same technblogy can transplant organs.from Moreover, of death. orr. p"ti..tt to another, so thatwe need a definition of death to guide us when to remove the organs from the Person declared dead' Several phpicians,-philosophers,-and medical ethicists, including Henry Beech.i, Rob.tt ivt. Veatctr, tristram Engtll'Tdtrlt:, lnd Roland po..Jtti, have called for a redefinition of. death in terms of brain i"".ti""i"g, 'brain death." Others, like Paul Ramsey and HansJonas' have opposed this move.

Ruqchis the same word used for breath, and tJ:e Greek word pnzumahas the same double meaning. There are problems with this view. First, it is difiicult to know what

the soul is, let alone whether we are endowed with one (or more).

Second, neurologic science can explain much of human behavior by an appeal to brain functioning, so that the notion of a separate spiritual

entityseems irrelevant. Third, ifasoulisin usand if itonlyleavesus after we hive breathed our last, medical technology can keep the soul in the bodyfor scores ofyears after the brain has ceased to function and, as far aswe can tell, all consciousnesshas long disappeared. Unlesswe are really convinced that God has revealed this doctrine to us, we should dismiss it as unsupported by the best evidence available.

&dioputmonaryVieut. When the heart and lungs stop functioning, the person is dead. This has been the traditional medical definition. Blach's Law Dictionary Puts it this way: 'The cessation of life: the ceasing to exist; defrned by physicians as a total stoppage of the circulation of the blood, and a cessation of the animal and vital functions consequent thereupon, such as respiration, pulsation, etc." [n Thomas a. Andersona California District Court in 1950 quoted Blac*'s and added, "Death occurs preciselywhen life ceases and does not occur until the heart stops beating and respiration ends. fieath is not a continuous event and is an event that takeJphce at a precise time."4 This standard definition is problematic in that it goes against the intuitions of'many of us that irreversibly comatose patients like Karen Ann Quinlan or Nancy Cruzon are not alive at all. Bodily functioning alone does not constitute human life. We need to be sentient and self. The

conscious.

FourdefinitionsofdeathaPPearintheliterature:(l)thedepartureof flowofvital fluids r1.e soul from the body; (2) tire irreversible loss of the (3) or the irreversible ..*otiot of cardiovascular pulmonary function; death' brain (4) neocortical whole brain death; and

occurred The Los of sout. The first major philosopher to hold that death in the found is view the but Plito, the .e of h.patt the

with

*rt *o

Ortfr"ao*3l*ish and Christian traditions and in the writings of Ren6 pineal D;;;;"r (tfgetOfO), who believed that the soul resided in thewas the departure the of sign gl;J ,"Jr.rt the body at de1th.-Th-e only is dead person 'ihe that-a OrthodoxJewslay Eessation of breathing. spirit, when the last breattiis drawn.s Note-that the Hebrew word for

hak

Yieut. AsRoland Puccetti puts it, Where the brain goes, there the person goes.5 In the same year that Bruce Tucker had his heart and kidniys removed, the Ad Hoc Committee of the Harvard Medical School under the chairmanship of Dr. Henry K Beecher met to decide on criteria for declaring a person dead. The studywas a resPonse to the growing confusion over the uses of biomedical technologyin be_ing able io keep physical life going for an indefinite period of time after consciousneis has been irretrievably lost. It also was a resPonse to the desire to obtain organs from 'donors" who were Permanently comatose but whose organs were undamaged-because of the ability of technology to keep the vital fluids flowing. The Whotc

urHAIIg pEAmrl

f 59

The Committee came up with four criteria ttrat together would enable the examiner to Pronounce a person dead: (l ) unreceptivity and unresponsivig (i.e., no awarenes{i of externally applied stimuli); (2) no movement or breathingwithout the use of artificial mechanisms; (3) no

f60

Chapter ll

reflexes; the pupil is fixed and dilated and will not respond to bright lights; (4) a flat electroencephalogram, which indicates that there is no cerebral activity. The test must be repeated at least 24 hours later to rule out rare f;alse-positives (such as those caused by drugs or hypothermiathe body's having a temperature of less than 90o F). The Harvard Committee's criteria have been widely accepted as a safe set, allowing medical practitioners to detach patients from artilicial respirators and to transfer organs to needy recipients. Of thousands of patients tested no one has regained consciousness who has met the

criteria. But critics have objected that the Harvard criteria are too conservative. By its norms patientswho are permanently comatose or in persistent vegetative states, like Ihren Ann Quinlan and Nancy Cruzon, would be

considered alive, since their lower brainstems continued to function. Indeed, people have been recorded as living as long as 37 years in this

unconscious state. Since they are alive and can be fed intravenously, or via gastric feeding tubes, we have an obligation to continue to maintain them. The worry is that hospitals and nursing homes could turn into mausoleums for the comatose. So a fourth view of death has arisen.

Neoortiul Bmin Death, What is vital to human existence? Henry Beecher, head of the Harv-ard Ad Hoc Committee, says 'consciousness." Henry Veatch, a prominent medical ethicist, sap it is our capacity for social interaction, involving the porver of thought, speech, and consciousness. These higher functions are located in the neocortex of the

cerebrum orupperbrain, so thatwhen asufficientpartof thissection of our brain is destroyed, the patient is dead. As Tristram EngelhardtJr. says, "If the cerebrum is dead, the person is dead.6 An electroencephalogram can determinewhen the cerebrum hasceased to function. Beecher, Veatch, and Engelhardt see human death as the Ioss ofwhat is significantfor human life. Veatch defi nes death thisway: "Death means a complete change in the status of a living entity characterized by thg irreveisible loss of those characters that are essentidly significant to it."7

Where does the truth lie? To understand what is going on in this debate we should note the relevant phpiologic and neurophysiologic aspects. The brain has three basic anatomic parts (Fig. ll-l): (l) the cerebrum, with its outer layer, the cortex; (2) the cerebellum; and (3) the brainstem, including the midbrain, pons, and medulla oblongata. While the cerebrum is the locus of thought, memory and feelings, consciouv ness itself remains a mystery. Many believe it to result from complex interrelations between the brainstem and cortex. The brain is kept alive by blood carrying oxygen. If it is deprived of orygen for more than a few minutes, it sustains permanent damage. After 4 or 5 minutes of deprivation, it usually dies.

What Is Death? The Crisis of Criteria

r6r

Muscle Movements and Muscle Sense

Skin Sensations Parietal Lobe

Frontal Lobe

Vision Occipital Lobe Hearing Cerebellum UGURE f l-l

Temporal Lobe

riChlcacbral lvnisplurc of man, santfron ttu sid,, showing the fuur ard tlu bcalizd, anas conemA with spcialBnctions. Alsociition otatn ac unshadd^ 'Shin scnsati.ons" lic in tlu pariztal lobe; "rnuscb mwatucnts,' in tlvlrontol lob,

Ty bb

Respiration, on the other hand, is controlled in the med.ulla of the brainstem (Fig. f f -2) . When the medulla is destroyed, the body is unable to breath and normally dies, unless placed on an artificial respirator. When the respiratory system is destroyed, the heart is deprivedof vital or
Parietal Lobe

Frontal Lobe

Occipital Lobe

Thalamus Hypothalamus

Pinml Body

Hypophysis Temporal Lobe

Midbrain

Cerebellum

Medulla FIGURE I l-2

Tlv brain as san in

a

urticat mid,tiru scction.

162

Chapter I I

What Is Death? The Crisis of

the heart rate. When the heart is destroyed, it cannot pump orygen to the

brain, so the brain dies. We see the possible combinations:

f 63

'those characteristics that are essentially significant to it" and death

as

the irreversible loss of those characteristics. The key phrase is "essentially significant," that is, aafua.bb. This redefinition muddies the waters. A comatose human whose lower brainstem is still functioning, whose heart is beating, and whose

-

l.

Respiratory q6tem destroyed but artificial respirator keeping heart and brain orygenated. 2. Heart destroyed but artificial heart pumping blood to brain and lungs. 3. Cerebrum destroyed but heart and lungs still functioning (the persistent vegetative state). Neocortical death. 4. The brainstem and cerebrum destroyed but the heart still beating and the lungs still maintained by an artificial respirator. Whole brain death. 5. The brainstem, cerebrum, and heart all destroyed.

Biomedical technology has allowed these possibilities to arise. We are looking at the issue as a problem, but, in a sense, the problem is simply

the downside of an enorrnors blessing. We should be grateful for such life-saving mechanisms. Without the ventilator many living people would be dead. Because of the ventilatorwe can keep organs fresh to transplant them to needy recipients. Still the new wonders have brought with them new responsibilities and conceptual confusion about the meaning and nature of death. The move to alter our definition of death iswell motivated. First, we desire to alleviate the agony and financial burdens of relatives waiting for their comatose loved ones to die. How long must the relatives maintain irreversibly unconscious patients? Karen Ann Quinlan was kept alive in a nursing home for l0 years, and others have been maintained even longer. Ifwe can agree to a view of death that includes the cessation of consciousness or neocortical functioning, we can mitigate the emotional suffering and financial hardship of loved ones. Second, a redefinition of death would enable us to transPlant organs from biologicallyviable humans to needyrecipients. Bykeeping the body alive but pronouncing the penon dead, we canjustifiably transfer fresh organs to waiting patients. There is a growing tendency to accePt this logic. How absurd to care for bodies without mindst Keeping Ihren Ann Quinlan in a nursing home for l0 years seems irrational. When the cerebral cortex dies, so does the human being. All that is valuable comes to an end with the end of conscious life. To be permanently comatose is to be dead.

However, this argument has a problem that must be addressed before its conclusion is accepted. The questionable move involves substituting a nalue for a fact or deriving a fuctual definition from our moral v:alues. Veatch is guilty of this when he defines life

Criteria

as

containing

respiratory qntem is intact is still a living organism. Thus, something like the second view of death is correct. Death is an event, not a Process, in which the biologic organism ce:rses to function. Thc vital fluids cease to flow and the heart and lungs cease forever. David Mayo and Daniei 14likler make this pointwith regard to the dying process by distinguishing four possible states of the human organism.8 Beginningwith death proper the stages are:

All principal life qntems of the organism (cardiovascular, Jentral nLrvous, and pulmonary) irreversibly cease functioning'

stage 4.

The organism death proper.

as

awhble permanentlyceases to function. This is

3.The patientis irreversiblycomatose because the entire brain ieas.r functioning, but cardiovascular and pulmonary functions continue because they are maintained by artifical life support

Sta.ge

systems.

The patient is irreversibly comatose because the cerebral iort * hasleased functioning but the brainstem is still active, so ttrat the cardiorrascular and pulmonary functions continue' stage l.The dying patient is conscious and in pain and desires to be in Stage 4.

Stage 2.

Here Mayo and wikler separate the biologic from the valuational or moral dimension. That persons in Stages I to 3 are alive is a biologic fact. Butitis avalue questionwhetherwe should keep them alive. OnlyStage 4 constitutes dlath, properly understood, but our r€sPecl for the patient's autonomy siouta place the burden of proof on-those who i,ould paternalistically intervene in preventilg the patient from going from Siage I to Stage 4. In Stage 2, the case of irreversible coma, we are absolvedlfanydutyto preservi life since it has lostwhatisvaluable about humanity. Thi sanie gbes for Stage 3. The patient should be detached from the artificial maintenance and left to die. so what should we do about the tragic blessing of biomedical technologywith its abilityto keep the organism, but not the mind, alive indefinitiiy? If Mayo andWikler-are right, we should girre up our notion of the sanciity of biologic life, and recognize that some lives are not worth living, including life as an organism !n a p91si-stelt y-tgtPti': state' Alth6ugh the iieversibly comitose being is biologically alive, it is no

164

Chapter ll

longer a life possessing any quality. If we see that personhood involves being selFconscious, we may say in these cases that although the body is alive, the Pmm is dead. Not only should the body be detached from expensive life-saving machines, but its organs should be removed for use on the living. Organs are a precious medical resource that can be used to enable people to live longer and bettbr. Indeed, you might conclude that this reasoning entails a PresumP tion oforgan removal in irreversiblycomatose patients, to be overridden

only by the expressed wishes of the person when he or she was alive. That is, given suitable public education, we should realize that the organs of the irretrievably comatose or dead should be used to helP the living. Just as the United States Supreme Court has ruled that a dying person can give advance notice that should he or she become irreversibly comatose, all life suPPort systems should be removed, so likewise our living wills should have provisions in them directing that our organs be removed for transplantation while we are in such a state. In this case the immediate cause of death should be recorded as the donation of vital organs rather than removal of life suPPort. This should be the next steP in the attempt to make moral use of our technologic wonders. Eventually, a presumption in favor of transplanting organs from brain dead and neocortical dead patients would be recognized. The response of the definitional reformers to all this is that the term death zlreadyhas value connotations with the public, so that in including the permanent loss of consciousness in the definition of death, we are preserving what is practicallyvaluable about the concept. This response needs careful consideration. It may, in the end, be the rightway to go. Nonetheless, clarity of thought inclines us to seParate the biologic fact of death from the rraluational and admit that a bodywith a dead cerebrum but a living brainstem is still biologicallyalive. Perhapswe need two locutions, 'biologic death" and "person death," to preserve the integrityof meaning. So longaswe see the issue clearly, the names don't

\{hat Is Death? The Crisis of Criteria

In Bruce Tuckir's case, due process was violated. His family should have been notified, and the electroencephalogram reapplied several hours later. Even though the doctors were correct in wanting to trane plant Tucker's heart and kidnep, the laws in place would have given his brother William the right to veto that desire. Doubtless the hospital was unwise in permitting the procedure. Whether people like William Tucker, who believe that a breathing body is still a person, should be allowed to veto what society's experts decide to be rational procedure, is a difficult issue. Given our commit-

ment to democratic processes, it is hard to see how we could justly override these vetoes, at least until a consensus is formed in society for such an override. That is one of the challenges of our time-to educate the public to ttre importance of quality concerns without destroying a basic commitment to the preservation of life. On one hand, we need to reject the absolutism of the Sanctityof Life Principle. On the other hand, we need to respect a basic presumption in favor of life as the basis of all other rralues. This is not an easy set of distinctions, but that'sjust why the process of coming to a clearer understanding is a challenge.

Study Questions

l.

Discuss the four definitions of death. Which seems nearest to the

truth? why?

2.

Discuss Mayo and Wikler's four stages of the human organism and

their implications for our view of death. How cogent is their argument? 3. Since body organs are a scarce natural resource, should our policy be changed to allow the removai of the organs from the patient as soon as he or she dies (or while the dying person is unconscious or brain dead)? What.re the arguments for and against this policy?

matter.

Finally, let's look back on the problem c.rses mentioned at the beginning of this chapter. In the case of the NewYorkwoman who was beaten until she was irreversibly comatose, the assailant robbed her of all that was valuable to her as a person. This is just as evil as if he had killed her. We need a new concePt for rendering a Person permanently comatose, but the punishment should be'equal to that given to a murderer. Likewise, in C,rq a. Swayerthe law must recognize irreversible loss of consciousness as tantamountto death. Ifithad to decide between the two parties, it should have made the opposite award, for a body without a head cannot be conscious.

165

Endnotes

l. Cited in H. Tristram Engelhardt lr., Tlu Faundations of Bi.oethia (Oxford: Oxford University Press, 1986), pp. 209f. 2. Cit€d in Robert M. Veatch, Death, Dying antt tlu Biohgi.cal Reaolution (New Haven: YaIe, 1976), pp.

2l-24.

3. Immanuel Jakobovitz, Jauish Md.ical Ethia (Philadelphia: Block, 1959), p,.277.

4. Quoted in Thomas Beauchamp and Seymour Perlin, eds., Ethical Isinieath dAing (Englewood Cliffs, NJ. : Prentice Hall, 1978) ' p. 14. 5. Roland Puccetti, "Brain Transplantation and Personal Identity," Analysis 29 (1969), p. 65. Engelhardt restates Puccetti's motto, "If the cerebrum is dead, the person is dead.' (Engelhardt, op. cit., P. 2f l). sues

166

Chapter ll

6. Engelhardt, op cit, p. 2f f . 7. Engelhardt, op cil, p.53. 8. DavidJ. Mayo and Daniel Wikler, 'Euthanasia and the Transition from Life to Death,'in Thomas Mappes andJane Zembaly, eds., Biomedical Eiluas (NewYork McGraw Hill, 1986), pp. 400-408.

SELECTED BIBLIOGRAPHY

Code:D = Deontologlcal;

U = Utilitarian; C = Contractualist or Egoist;

O = Objectivisti R = Relativist.

I. Ef,HIC.ALTHEORY Kurt Tlu Moral Point of tfieut.Ithaca, N.Y.: Cornell University Press, 1958. This influential work sees morality primarily in terms of social

Baier,

control. (C) (O) Dawkins, Richard,. Tlu &lfuh C,eru. 2nd. ed,. Oxford: Oxford University Press, 1989. One of the most fascinating studies on the subject, defending limited altruism from the perspective of self-intercst (a type of C) Frankena, Witliam K Ethics. 2nd ed. Englewood Cliffs, NJ.: Prentice-Hall, 1973. A succinct, reliable guide. (D) (G-Intuitionism) Gert, Bcrnard . Moralily: A NcwJustifimtion of the Moral kil*t. 2nd ed. Oxford: Oxford University Press, 1988. A clear and comprehensive discussion of

thc nature of morality. (C) Hobbes, Tho mas. Leviathaz ( I 65 I ) . Indianapolis: Bobbs Merrill, I 958, Parts

I and II. Classic work in Contractarian ethics. Kant, Immanuel. Foundati.ons of tlw Metoprysics of Mmals. Lewis White Beck, trans. Indianapolis: Bobbs.Merrill, 1959. A classic work in D. Maclntyre, AlasdLir. A Shott Hittory of Ethia. London: Macmillan, 1966' A lucid, if uneven, suryey of the history of Western ethics. Mackie,J. L. Ethics: Inaenting Right and Wrong. London: Penguin, 1976' A modern classic defense of relativism. (R) Mill,John Stuart" Utilinrianism. Indianapolis: BobbrMerrill, 1957. Aclassic

workin

U.

I

Nielsen, I(ai. Ethicsuithout C,od. Bufialo: Prometheus, 1973. Avery accessible defensc of secular morality. (U) Pojman, Louib. EthielTheory: Ctassicnl and C*ntmtporary Read,ings. Belmont,

Calif.: Wadsnorth,lg8g. An anthology containing readings on all the major positions. Ethics: Discouering Right and Wrong. Belmont, Calif., Wadsworth, f989. An objectivist perspective. (O) Quinton, Anthony. UtilitarianEthics. London: Macmillan, 1973. A clear exposition of classic Utilitarianism. Rachels,Jam es. Tlu Elcttogttts of Moral Philosophy. New York Random House, 1986. One of the clearest introductions to moral philosophy. Singer, Petcr. Tlu Exfanding Circle: Ethics and bdobiolog. Oxford: Oxford University Press, 1983. A fascinating attempt to relate ethics to sociobi-

ology. (U) Taylor, Richard.

C,ood

iead work that

andEuil. Buffalo: Prometheus, 1970. A lively, gasy tq

sees

the main role of mordity to be the resolution of

conflicts of interesl (C) (R) 167

168

Selected Bibliography

Van Wyk, Roberl Introd.uction toEthics.New York St. Martin's Press, 1990. A clearlywritten recentintroduction to the subject. (O) (attacksversions of

C-minimal morality)

Selected

Aiken, I{illiam and Hugh LaFollette. WorA Hg,ngr and Moral Responsibikg. Englewood Cliffs, NJ.: Prenlice-Hall,1977. The best collection of essays on the philosophical implications of world hunger. Battin, Margaret Pabst and David Mayo, eds. Suicidt: Tlu Philosophical Issues. New York St. Martin's Press, I 980. A set of contemporary essays, especially those by Brandt, Mayo, Martin, and Battin. Beauchamp, Tom L. and Seymour Perlin, eds. Ethical Issues in Death and Dying,Englewood Cliffs, NJ.: Prentice-Hall, 1978. The best collection of gssays

on the subjecl

Beauchamp, Tom L. andJames F. Childress. hinci.ples of Biomed,ical Ethics. 2nd ed. Oxford: Oxford University Press, 1983. An accessible work showing how ethical theory applies to issues in medical ethics. Bedau, Hugo Adam, ed. The Death Penalty in Amsica.3rd ed. New York: Oxford, f 982. A helpful set of readings, reflecting all aspects of the contemporary debatc. Berns, Walter. For Capital Pttnishment: Tlu ltuoitabihE of Caprice and Mistahe. New York Norton, 1974. A retributivist defense of capital punishment. Devine, PhilipE. ThzEthiaofHomicidt.Ithaca, N.Y.: Comell UniversityPress, 1978. The best treatrnent from a conserv'ative perspective of the issues discussed in this book. Feinberg,Joel, ed. Tlu hoblctn ofAbortion Belmont, Calif.: Wadsworth, 1973. A valuable antholory, containing classic articles. Frey, R G. Rights, Killing and Sulfering. Oxford: Basil Blackwell, 1983. The Ge

bestwork opposing animal rights. rber, Rudolph and Patrick McAnany, eds. Contem.poraty hrnishmentr. Notre Dame: University of Notre Dame Press. A helpful anthology with important articles by Hart, Wasserstrom, Flew, Mabbott, Packer, Menninger, Lewis, and others,

Glover,Jonatha* CausingDeath

and. Saving Liaes. [.ondon: Penguin, 1977 . A U examination of several moral problems. Hardin, Garrett. "Lifeboat Ethics: The CasC Against Helping the Poor." Psycholog Today (1974), reprinted in Aiken and LaFollette, op. cit. A modern classic of the Neo-Malthusian perspective. Harris,John. The Valuc of Li.fe. [,ondon: Routledge & Kegan Paul, 1985. A succinct but penetrating work in medical ethics, covering many of the topics discussed in this book. Kleinig. VafuingLife Princeton: Princeton UniversityPress, 1991. The most thorough study of the value of life.

169

Kohl, Marvin , ed. Bencficertt Euthanosia. Buffalo: Prometheus, 1975. An excellent colleclions of articles. Lackey, Dou glas. The Ethics of War and Peace. Englewooac]if1, NJ.: Prentice

A clear-headed discussion of pacifism and thejustwar theory. Moral hinciptcs and Nuclzar Weapons. Totowa, NJ.: Rowman and Allenheld, f 984. A comprehensive study of the moral asPects of nucleag arms policy. Ladd, John, ed. Ethical Issua Rclating to Life and. Death. Oxford: Oxford University Press, 1979. Contains nine important articles. Mappes, Thomas and Jane Zernbaty, eds. Social Ethics. 3rd ed. New York: tvtccraw Hill, 1986. An excellent anthology with succinct selections on most of the issues discussed in this book. eds. Biomcdical Ethict.2nd ed. New York.: McGraw-Hill, 1986. An excellent set of readings on abortion, euthanasia, and the concept of death. Menninger, l\arl. The C'ri.mc of htnishmmt,New York Viking-Press, 1968' A defenle of rehabilitation as a way of dealing with criminals. Munson, Ronald, ed. Interumtian and RcJbction. Belmont, Calif.: Wadsworth,

Hail,

II. APPLIED ETHICS

Bibliography

1989-.

1987. One

. abortion

of the best anthologies in medical ethics,

especially on

and euttranasia. Murphy,Jeffrie, ed. htnishntcrtt and Rehabititati,on.2nd ed' Belmont, Calif': Wad's;iorth, 1985. An excellent collection of articles on the subject of punishment and its alternatives. O'ileill, Onora. Faes of Hunga. Allen & Unwin, f986. A careful Kantian discussion of the principles and problems surrounding world hunger' Perlin, Seymour, ed. A Handbooh for the 5tu4 oI Suicidt. Oxford: Oxford University Press, 1975. A helpful series of articles. Pojman, Louis, ed. Life an^d Death: An Antholog. Boston: Jones & Bartlett, iSgZ. e companion to this book, containing readings on every topic discussed here. Rachels,James. CreaudFrom Animals: Thz Moral Imqkcations of-Darui'nism' oxforl: oxford University Press, 1990. A provocative studywith relevance to the issue of the sanctity of life and animal righs. The Enn of L?fe. New York Oxford University Press, 1986' A clear defense of voluntary active euthanasia. Regan, Torn,' Tlu case'for Animal Rights. Berkeley: University of california, Igag. T.t. most comprehensive philosophicd treatise in favor of animal

rights. excellent set of eisays on euthanasia, suicide, war, capital punishment, animal righs, and environmental ethics. Regan, Toni and Peter Singer, eds. Animal R],ghx and Human Obkgatioru' Englewood Cliffs,NJ.: Prentice Hall, 1976. The bestanthologyon animal rights. RobSins,Joh n. Diet for a Nao Ameri.u: Huo YourFood Choias Affect Your Heokh, Happi,izss and tlte Future of Life onEarth.Walpole, N.H.: Stillpoint, 1987' A strong case for vegetarianism.

170

Selected Bibliography

Rohr,Janelle ,ed,. AnimalRiglttt: OpposingvicttpoinB. San Diego: Greenhaven Press, 1989. Elementary essir,ts on the subject. Schell,Jonathat Fate of tlufurth.NewYork Knopi 1982. An excellent book on the dangers ofnuclearwar. Simon, Arthur. Br"ad for tha WorA. Mahway, NJ.: paulist press, 19i5. A poignant discussion ofthe problem ofworld hunger and some thoughtfi.rl suggestions for improving the situation. Singen Percr. haaicalEthics. Cambridge: Cambridge University press, 19i9. A hclpfrrl U approach. Animal l;ibqation, 2nd ed. New York New york Review of Books, 1990. The classic work on the subject The second edition contains recent _ d4a_on animal experimentatiori an factory farming. sorell, Tom. Momlrheory and c.apitolhtnishttocit.oxfor* Blackwel, 1987. A _ clearly written, thoughtfrrl work for the bcginning student. Sterba,James, ed. The Ethia of Wm and Nuclear Detatwtce. Belmont, Calif.: Wadsworth, 1985. The best anthology on the subject. Stoessingcr,John G. Wry Natilmt Cn to Wan 4th ed. New york: St. Martin's Press, 1985. A fiascinating essay on the causes of war in the tnentieth-

century.

Szums.ki, B_onnie, Lynn Hall, and Susan Bursell, eds. The Death penally: Of posi,ng l4at*oints. St" PauL Greenhaven Press, 1986. Contains shoit but

important articles. Basic. T"91% Michael. AMion and Infanticide. Oxford: Oxford Universiry press, 1983. A susained case for a liberal position on abortion.

VandeVeer, Donald and Christine PiCrce, eds. People, paryuins and, plastic -of

Tras. Belmont, Calif.: Wads,vorth, fgg0. A good set readings on environmental issues, including animal rights. veatch, Robert M. Daa th Wng and tlu Biologiamclnlzrroz. New Haven: yale universityPress, 1976. Athoughtfrrl discussion of issues relating to death and dying. Walzer, Michael.../zsr andUnjust War. [.ondon: penguin, 1977. Apenetrating, and very readable study of morality and war. Waslgrstrom, Richard, ed.. Wo and Morality. Belmont, Calif.: Wadsworth, 1970. Contains excellent articles.

-Index abortion arnd,7*

Abolitionist theory, of

75

capital

punishment,9293

Active cuthanasia,

definition of,55

Adkins,Janct, xi-xiv, 49

ofwar, 127

Allocide,6l

Abortion,69{2

Absolutc Right to Priracy argumcnt

a.,159

Tlwmas

abortion and, 6974

Alsop, Stcwart,5T

Ailinon"

Augustine, Bishop of Hippo,44, 126127,732 Aurelius, Marcus, 35 Autonomy, expression of,

arrd,,7*75 birth and, 72

Animal expcriments, animal rights and,

Baltimore, David, 106 Beecher, Henry K, 159-

consenratism

Animal rights, l0}f l9 animal cxperimens and, l16-l17 Eoual Consideration

Benign Demographic Transition theory, world hunger and,

and,7l,

7v74,76 conserrratism vcrsus

liberalism and,7&

8l

cutoffpoints of,7l-73 experience in, 72 expression

of

autonomy and,

69*'4 Fairness argument and, l5

genocide and,6$-74 Invited Guest argument and, 73 Iiberalism and,, 7 l, 7 478

moderate position and,

8rJ2

moral issue, TG-71 Personhood argument as

and,76 76

quickening in, 7l radical relativism and, 74

selfdefense arBument

and,73 argumentand,

'

theoryof,

llff

lS

Equal Stanrs view of,

108-rl0 hunting and, 117-l 18 Indirect Obligation theory of 106-f08 justified and unjustified activities in, l19 No Status theory ot r05-106 Personhood and,7678

arSument and, b5, 67

an(I, I I Sptit Level theory of,

bf

67

subjectivism and,74 viability in, 72 Absolute Right to PrivacY arSument,

rl3-r14

theories of, 105-114 vegetarianism and, r

l.{-l

zoos and,

16

f17-ff8

Aquinas, Thomas, 44,

107,132 Arguments, moral, Slippery Slope

and,6F{8 Arthur,John, 147-749 Aspin, trs, 104 Asiisted death, 61. Euthanasia

rll

160

145

Beniamin, Martin, 113 Ben"tham, Jere my , 17, 24,

46,89-90

Bentham,Joseph, f f0111

Best Bet argument,

of

capital

punishment,9495

Bettleheim, Bruno, 80-81 Birth, abortion and,72 Brain, cerebral hemisphere of,

l6l

Slippery Slope sDecresrsm

Quality of Life argument and, 75-

Slippery Slope

llFu7

Saa also

vertical midline section of, 161 whole, as view of death, 159-160

Brain death, neocortical, as view of death, 160-162

Brandt, Richard, 49 Buchanan, Patrick, 58-59 Bush, George, 70 Caesar,Julius, 34 Camus, Albert, 35, 39,

45-46 Cantor, Norman, 15 Capital punishment. Srr also Death PenaltY; Punishment

172

Index

Index

abolitionist theory of 92-

fear of, 37-39

93 Best Bet argument of, 94 death penalty and, 9f-99

Hebrewview of, 30-31 Loss ofSoul view of, r58-159 meaninglessness and absurdity of, 35-36 neocortical brain view of, 160-162 OId Testament and,

objections t6,,$!BB retributivist theory of,

92-93,96-99 utilitarian theory of,

9L

94

Cardiopulmonary view,

ofdeath, 159 Carrying c4pacity,

platonic{hristian view

of

environment in population growth, world hunger and, 141-

142,74+t45 Carton, Sidney, 4243, 45 Christ, 32. &a alroJesus Christian doctrine, death

I

and,32-33 Cicero,33 Clark, Barnen 50 Commons, tragedy of.

Sae

'Tragedy ofthe Commons" Concetti, Gino,54 Conscience, as theory of

ethics, &9 Conservatism, abortion

and,71,73-74,76 versus liberalism,

abortion and, 78-

8l

world hunger and, 140, 149-154 Constantine, 127 Contractualism, 1 1-12, 24-25 war and, l3l-132 world hungerand, 150 Coulson, Charles,32 Creative Resignation,

3G-3r

3L

of,3l-33

stages of, 163 survirral after,37

in Western Society, 3G 39

whole brain view of, 159-160 Death penalty, 85-99.

Sr

alsoCapital punishmenq Punishment capital punishment

and,91-99 punishment and,87-

9l

Deontology, 10,12,2224 Just War theory and, 132-133

daVinci, konardo, S3 Death, assisted, 61. See alro Euthanasia cardiopulmonary view of, 159 Christian view of, 3233

criteria for, 157-165 definitions of, 158-165 dlng and, 29-39 Epicurean view of, 33 existential view of, 3536

Equal Stanrs view,

146-148 Depression, suicide

and,49 Descartes, Ren6, 106, 158

l0$-

Diaz, Angel,85 Dickens, Charles,43

'Doomsdayers," 152-

t53 Dukakis, Michael, T0 Dying, death and,2$-

of

animal rights,

l0&

110 Erasmus, 127

Ethics, definition of, 4-5 morality and, 4-8

teleologic, lG-ll theories of, Ll3 world hunger and. &a World hunger Etiquette, morality and,

vl Euthanasia, 53-68 active, definition of, 55 arguments against, 5761

arguments suPPorting,

6t-62 definition of,55 involuntary, definition of,55 passive, definition of, 55

prevention of cruelty and freedom and, 62

Righr to Die and,

world hunger and,

6l-

62

Right to Life

and,6l-

62

Slippery Slope argument and, 5&59,67 voluntary, definition

of,55 Existential view, of death, 35-36 Experience, in abortion, 72

39

35

Cruzan, Nancy,56, 160

Equality-Absolute Principle, of, world hunger, 145-149

Edward (King of

England),6 Ehrlich, Anne, 152 Ehrlich, Paul, 152 Eleazar,44 Energy, pyramid of, 115 Englehardt, Tristam Jr., r60 Epictetus,33,48, 50 Epicurean view, of death, 33

Epicurus,39 Equel Consideration theory, of anima! rights, ll0-ll3

Fairness argument,

abortion and,73 Falls, Margaret,9T-99

Farben, l. G.,25, 26 Fernandez, Daniel, 42-

43,45 Fletcher,Joseph, 139,

t53 Florian,Johanna, 56 Fox, George, 127

Franklin, Benjamin, 32 Freedom, prevention of cruelty and, euthanasia and, 62 Furs, animal rights and, I

l7-l

18

Gallup, G., 106 Gandhi, Mohatma, 127 Geiger,Jack, 135 Genocide, abortion and, 69-74 Genovese, Kitty, L4,6, r50 Ceorgia,

Gregv.,85

Gibbon, Edward,44 Golden Rule argument, euthanasia and, 62 as theory of ethics, 9 Greek civilization, war in,

Involuntary euthanasia, definition of, 55

Maris, Ronald,42 Marshall, Thurgood, 97, 99

Jacobs, F. S., 106 James, William, 736-137 Jesus, 22, 4344,128-

Martin, Ian, 42

129.

See also

Christ

Judas Iscariot, 44

JustWar theory, deontology and, 132-133 nuclear war violating, 136

Gregg,Alan,140 Gregu. Gemgia,85 Gq u. Suayn,l57,164

Kahane, Howard, 149 Xamisar, Yale, 65

Kant, Immanuel, 1G-11,

22-24,45,88-49, 92,98, 107-109,

Hardin, Garrett, 1-3, 14u145,151-153 Hare, R M., 10,56-57 Harman, Gilbert, 149 Heath, Edward,96 Hebrewview, of death, 30-31

Hegel, George Wilhelm

Friedrich, 126 Heidegger, Martin, 34 Hobbes, Thomas,3, ll,

24-25,130,149 Holland, Roy,43 Holmes, Robert, 127

Homer,3l Hospers,John, 149 Humanism, sacred, Sanctity of Life

principle and, 18-

2t Human rights, Personhood argument and, 7&78

Hume, David, 11,45 Hunger, world. &eWorld hunger Hunting, animal rights and, 117.'118 Hutcheson, Frances, 1l Huxley, Aldous, 38 Ideology,

l0

Ignatius,44 Immortality, 3l-33 Indirect Obligation theory, of animal rights, l0Ll08 Invited Guest argument,

abortion ztd,73

127

Ibrpman, Benjamin,9G91

Kevorkian, Jack,

Mayo, David, 163 Meaning of life, suicide and, 45-50 Menninger, Ibrl, 90-91

Mill,John Stuart, ll, 24, 46, 89-90,94 Moody,James,3T Morality, of abortion, 70-

definition of, 4-5 ethics and, 4-8 Qualiry of Life principle and, 2126 Sanctity of Life

l5-

principle and, 21

xi-xiii

Kiley,John, xii King, Martin LutherJr.,

t27

Iblft, Willem,50 Koran, 123, 127 Law, ethics and,6-6 moraliry and, 6

Arthur,94 Lewis, C. S.,88Jg Lewis,

Liberalism, abortion and,

71,74-78 versus conservatism,

abortion and, 78-

8l

world hunger and, 140, r46-149 Life, meaning of, suicide and, 45-50 quality of, 21-26 sanctity of, 15-21 Lifeboat theory, NeoMalthusianism and,,143-144 world hunger and, 140-141

Lloyd, L., I Loss of Soul view, of death, 15&-159 Love, as theory of ethics,

I

Lynn,Joanna, xii Machiavelli, 130 Malthus, Thomas Robert, 140

Maxton,John,9T

7t

t25-126 Greenhouse Effect, 153

173

secular, 33

'Tragedy of the Commons" and, 113

war and, 130-133 Moral reasoning, Slippery Slope

argument and, 6768

Moral theory, moderate, world hunger and, 150-151 Nazi, 25, 54, 103, 108, 127

Neal,James,5-6 Nelson, William, 149

Neocortical brain death, as view of death, r60-162 NeoMalthusianism, world hunger and, 140-145 New Testament, war in, 126

Niebuhr, Reinhold,3S Nietzsche, Friedrich

Wilhelm,35, 126 Noonan, John, 66'

8l-82

7

l,

7

6,

No Status theory, of animal rights, 105r06 Nozick, Robert, 149 Nuclear war, 134-137 violatingJust War theory, 136

174

Index

Index

Oates, Captain,43

Old Testament, death in, 30-31 war in, 125

Rachels,James, 59-60, 105

Rachet efiect, world

hungerand,

Origin,4F44

142,t4L145

Pacifism, war and, 127-

r29

Paddoc\ Paul, 153 Paddock, William, 155 Passive euthanasia, delinition of,55 Personhood argument, abortion and, 76 Philosophy, definition of,

lx-x

Greek, death and,3132 moral, ethics and,5

Plato,3l,

158

Platonic€hristian view, death and, 31-33, 36

l4l-

Ramsey, Paul, 1L20,60 Rand, Ayn, 149 Rawls,John,9l, 109 Realism, war and, 130

R alpohtih 126,131 Reasoning, moral, Slippery Slope argument and, 6568 Regan, Tom, 108-110,

tlllt4, rl7-r18

Rehabilitative theory, of

punishment,9G9l

Relativism, radical,

abortion aid,74 Religion, cthics and,5 Resignation, crearjve, 3335

Resurrection, 3l-33 Retributivist theory, of capital

Porzio, Ralph,54

of punishment, 38-89 Revcrse Slippery Slope

Prevendon of cruelty, freedom and, euthanasia and, 62

Punishment. Saa a&o Capital punishmenq Death penalty capital, death penalry

and,9l-99 death as, 30-3f

9l

87-

delinition of,87-88 rehabilitative theory of, 90-91 retributivist theory of,

8L89

theories of, 8&-91 ucilicarian rheory of, 89-90 Pythagoras,3l Qualiry of Life principle,

abortion and,7576

morality and, 2l-26 Quickening, in abortion,

7t

Quinlan, Karen Ann, xii,

5L56,160,

punishment,92

162

103

Singer, Peter, 24, 77, I to-l I 4, 117 , 146_

t49, t54 Sisyphus, 35,39,45 Skinner, B.

F.,9L9I

Slippery Slope argument, aborrion and, 6667 67 euthanasia and,5&59, 67 moral arguments and,

6H8

moral reasoning and, 67-68 reverse, 68

Smith,Adam,

ll

Smith, Cheryl K, xii Socrates, ix,'21 Soul, Ioss of, as view of death, 15&159 Speciesism, animal right

and,

3E

Strong Principle, of world hunger, 146-148, 154

Romanticism, war and, 126-127 Rowan, Andrew, 116 Royko, Mike,98-99

Styron, William, 130 Suarez, Francisco, 132 Suarez, S. D., 106

Russell, Bertrand, 127

Ryder, Richard, 116

Suicide,4l-50 definition of,42 intentional, 42-43

Sackin, Henry 117 Sanchez, Victor, 85 Sanctity of Ufe principle morality and, 15-21

vitalism and, 16-18 Sartre, Jean-Paul, 35-36

meaning of life and, 45-50

rational,48-50 Sullivan,Joseph V.,65 Sulliyan, Thomas, 60

Schopenhauer, Arthur,

Suayr, Gq u,157,164 Thomas, 69, 7l

35

Schur, H., 74 SchweiEer, Albert,

117-rr8

Sr Augustine, 9, 29 Stoic view, of death, 3$-

ll7-ll8

Szasz,

l5*l

8

Selfdefense argumenq abortion and,73 Seneca,34 Shakespeare, William, 34

capital punishment

and,9L94 punishment and,8990 war and, 132-133

world hunger and, 146 Values, ethics and, 5 van den Haag,94,96 Van Dusen, Dr. and Mrs. Henry 49 Veatch, Henry, 158, 160, 162-163

114

Spors, animal righa and,

and,6l-62

Utilitarianism, ll-L2, 24

rightsand, 11.{-116 Viability, in abortion, 72 Violence, crimes of,

and,61-62 Rodeos, animal rights

Commons," 1l morality and, 1-13 world hunger and, l4l Triage approach, world hunger and, 153 Truman, Harry S., f 3l Tucker, Bruce, 157-159, r65

Vegetarianism, animal

Split I*vel theory, of animal righs, l13-

Right to Life, euthanasia

Thomson, Judith Jarvis, 59 Tolstoy, l*o,127 "Tragedy ofthe

and,,77

argument 68 Rickary,Joseph S. J., f 03 Right to Die, euthanasia

Rna. Wadq54,72

death penalry and,

Anthony, 19, 24

Sherwin, Rabbi Byron, 18 Shils, Edward, 16 Singer, Isaac Bashevis,

animal rights and,65,

Population gtowth, carrying capaciry of environment in, world hunger and,

147-t42,74Lt45

Shaw,

Teleology, lO-ll Tendler, Rabbi Mosha,

t9-20 Tertullian, 43-44 Thonas a. Andenon, 159

causes

of,86

Vitalism, sanctity of life and, lL18 Voluntary euthanasia, definition of, 55 von Moltke, Helmet, 126 Von Treitschke,126-12T Walker, Lois Hope, 69-70

War, l2S-137 abolitionist theory and,

t27 contractualism and,

r3l-132 in Greek civilization, 125-126 Just, deontology and, 132-133 morality and, 130-133

in NewTestament, 126 nuclear, 13+-137 violatingJust War theory, 136 in Old Testament, 125 pacifism atd,127-129 realism and, 130 romanticism and, 126127

utilitarianism and, 131-r33 in Western history, 124-130 Warren, MaryAnn, 116 Wasserstrom, Robert, 129 Watson, Richard, 146148, r54 Weak Principle, of world hunger, 747-149 Western history, death in, 30-39 war in, 124-130 Whewell, William, 106 Whole brain view, of death, 159-160

Wikler, Daniel, 164 Wittgenstein, Ludwig, 44 Wolf, Susan M., xii World hunger, 139-154 Benign Demographic

175

Transition theory and, 145 carrying capacity of envrronment rn population growth

and,147-742, 144-145 consenatism and, 149154

contractualism and, r50 deontology and, 146,148

Equality-Absolute

Principle

of,l47-

148

ethics and, f40-154

liberalism and, 140, 146-149 lifeboat theory and, r40-14t, 143-744 moderate moral theory and, 150-151 Neo-Malthusianism and, I40-145 rachet effect and, 141-

r42,144-145 Strong Principle of, 14U748, 154 *Tragedy of the

Commons" and,

l4l

Triage approach and, 153

utilitarianism and, 146 Weak Principle of,

147-148 Wright, Robert,65 Zeno,33

w

Grappling utitb tbe

t\loral Dilemmas

)iith

oJ

Our

Time

..ouis P. Pojman "l'r'e long

{"11 u

rr""J {or a te*ttooL tlrut o#".s. plriloroplri".i treatment o{

tL," .r-r"iul issues connecteJ with our teing ulir" u.,J kaving to {ace tLe re.liry o{ J"utlr, orre centered in tLe current JeLate t"tw"e. tke sanctity li{" .rJ "[ th""ght&J people to t1r" quality o{ 1i{" p.irr"iples, a griJ" tLat will chull.'rg"

-o.L th.orgh th"r" p.oLl"-, {o. th"-s"l r"r."

"11

Louis P. Poiman iJFEAND DEATH, Grappling witb the Morallssues oJ OurTime, Louis P. Pojman offers such a ide. Chapters on current issues (abortion, euthanasia, capital punishment, the signifi,ce of death, and others) are centered around the quality of life/sanctity of life debate rh background and philosophical arguments for each side of the debate. Some highlights,

., An introduction to moral theory which

relates morality to the

tragedy of the commons

., An extended discussion of world hunger and war

.

A comprehensive discussion of animal rights and the problem of cosmetic and scientific experimentation o. Study Questions to reflect on at the end of each chapter and a glossary of terms. '

rccompany tbis text and Death, A Reader in Moral Problems, Poiman

About the author Louis P. Pojman, who earned his Ph.D. at Oxford University, is a Professor of Philosophy and Chair of the Philosophy Department at the University of Mississippi. He is the author of Pbilosopby, The Quest Jor Trutb, Philosophy oJ Religion, An Antbology, andEthical Tbeory, Classical and Contemporary Readings.

( over Illrrstration,

rsBN 0-8h740-

33r-t-X

't

ht Voyage ol Life, Marlool, Thomas Cole National Callery of Art, Vashington, Allsa Mellon Brrrcc Frrnd

Jones and Bartlett Publishers

,llil 80867

illl

2033