1 Rule-Utilitarianism and Euthanasia Brad Hooker 1 Introduction Different moral theories will of course ap- proach questions about the moral status of eu- As scientific and technological advances enable thanasia in different ways, though some of these the medical profession to keep people alive theories will end up with the same conclusions. longer, the question arises whether this is This essay considers euthanasia from the per- always a good thing. Should those who could spective of just one moral theory. The theory is prolong life step back under certain conditions rule-utilitarianism. Rule-utilitarianism assesses and allow a very ill person to die? And if possible rules in terms of their expected utility. allowing to die is sometimes right, then what It then tells us to follow the rules with the about actively killing patients when this would greatest expected utility. (Expected utility is be better for the patients than allowing them to calculated by multiplying the utility of each die more slowly and painfully? possible outcome by the probability that it will Such questions are debated under the occur.) heading of euthanasia. The term ``euthanasia'' In the next section, I explain what the term derives from the Greek term for an easy, pain- ``utility'' means. Then I outline another utilitar- less death. However, we often now hear the ian theory ± act-utilitarianism. I do this in order term ``passive euthanasia,'' which refers to pass- to contrast rule-utilitarianism with this perhaps ing up opportunities to save an individual from more familiar theory. I then outline the distinc- death, out of concern for that individual. If tions between different kinds of euthanasia. The passive euthanasia is indeed one kind of eutha- final sections of the paper consider the various nasia, then ``euthanasia'' cannot mean ``killing factors that would go into a rule-utilitarian de- painlessly''; for to pass up an opportunity to cision about euthanasia. save someone, i.e., passive euthanasia, is argu- ably not killing. Furthermore, the death in- volved in passive euthanasia is often painful. 2 Utility So let us take the term ``euthanasia'' to mean ``either killing or passing up opportunities to A moral theory is utilitarian if and only if it save someone, out of concern for that person.'' assesses acts and/or rules in terms of nothing (Note that, on this definition, what the Nazis but their utility. Classical utilitarianism took called ``euthanasia'' was not euthanasia, because ``utility'' to refer to the well-being of sentient it was not done out of concern for the pa- creatures. And classical utilitarianism took the tients.) well-being of sentient creatures to consist in 22 Rule-Utilitarianism and Euthanasia pleasure and the absence of pain (Bentham, I shall also follow conventional philosophical 1823; Mill, 1863; Sidgwick, 1874). On this view, opinion in supposing that it is possible to be in people's level of well-being is determined solely such a bad condition that death would be a by how much pleasure and pain they experience. welcome release. Severe pain can be unremit- If anything is desirable for its own sake, ting, and indeed so overpowering that the pleasure is. But most utilitarians now think person experiencing it can think of nothing that pleasure, even if construed as widely as else. If the rest of my life would consist of possible, is not the only thing desirable in itself, nothing but excruciating physical pain, then I and pain not the only thing undesirable in itself might be better off dead. Indeed, if the rest of (Moore, 1903, ch. 6; Hare, 1981, 101ff; Parfit, my life would consist wholly of intense psycho- 1984, appendix I; Griffin, 1986, Part One; logical suffering, I'd be better off dead. Of Goodin, 1991, p. 244; Harsanyi, 1993). Utilitar- course, we may argue about where to draw the ians can think that things that are desirable for line between being better off dead and being their own sake include not only pleasure but better off alive (Mitchell, 1995). But it seems also important knowledge, friendship, auton- deeply unreasonable to insist that there are omy, achievement, and so on. Indeed, many never any instances of patients who would be utilitarians now construe utility just as the ful- better off dead. fillment of desire or the satisfaction of prefer- Now, what about divinely bestowed benefits ences, with relatively few restrictions on what and harms? Most utilitarians, and all utilitarian the desires or preferences are for. writers of our era, have written as if there were One reason most utilitarians have moved no rewards or punishments granted by a god or away from a version of utilitarianism that gods. This is not to say that all utilitarians have focuses exclusively on pleasure has to do with been atheists. In fact, many have been religious knowledge. Many of us care about certain believers (perhaps most notably, Bishop Berke- things over and above the pleasure they typic- ley, 1712). Nor would any utilitarians ± theistic ally bring, and one of these things is knowing or agnostic or atheistic ± hold that a person's the important truths (e.g., about the nature of religious beliefs are completely irrelevant to the the universe and about oneself), even if not morality of how he or she is treated. For any knowing the truth would be more pleasant for utilitarian would recognize that people's reli- us. Bliss isn't everything ± for example, if pur- gious beliefs can have an effect on what brings chased at the cost of ignorance. To be sure, them pleasure and on what preferences they knowledge does not always constitute a more form. So utilitarianism will favor, for example, significant addition to well-being than does freedom of religion and even the neutrality of pleasure. But sometimes it does. the state with respect to religion.1 But while People also care about autonomy, by which I utilitarians can think that people's religious mean control over one's own life. Many of us beliefs are often relevant to moral argument would be willing to trade away some pleasure about how these people should be treated, for the sake of an increase in autonomy. Again, modern utilitarians eschew basing any moral this is not to say that even a tiny increase in argument on the truth of any religious belief. autonomy is more important than a great deal of And this prohibition on assuming the truth of pleasure; rather, the point is that pleasure is not any religious belief applies to the belief that always more important to our well-being than there are divinely bestowed benefits and harms. autonomy. Neither value is always more im- That said, we must also note that utilitarian- portant than the other. ism is also often said to assume a god's-eye I agree with such convictions. Knowledge, point of view. The main respect in which this autonomy, and other things can be beneficial is true is that the utilitarian approach prescribes to us, can increase our well-being, over and a totally impartial calculation of well-being. To beyond whatever pleasure they directly or in- be more specific, in the calculation of utility, directly bring us. I shall presuppose this in what benefits or harms to any one person are to count follows. for just as much as the same amount of benefit 23 Euthanasia or harm to anyone else ± that is, count the same way to prevent something much worse. But we without regard to race, religion, gender, social don't think such acts are permissible when the class, or the like. expected and actual utility of such an act would It is a mistake to think that utilitarians hold be only slightly greater than that of complying that what benefits more people is necessarily with the prohibition. better than what benefits fewer. Utilitarians Another problem with act-utilitarianism is focus on the greatest aggregate good. What that it seems unreasonably demanding, requir- results in the greatest aggregate good is some- ing acts of self-sacrifice that seem beyond the times not what benefits the majority. This is call of duty. Think how much a middle-class because the benefits to each of the smaller individual in a relatively affluent country would number may be large and the benefits to each have to give to CARE or Oxfam before further of the greater number small. And large benefits sacrifices on her part would constitute a larger to each of a minority can add up to more than loss to her than the benefit to the starving that small benefits to each of a majority. Thus, utili- CARE or Oxfam would produce with that con- tarians will favor what benefits the minority if tribution. Making sacrifices for strangers up to (but only if ) what benefits the minority results the point that act-utilitarianism requires would in the greatest good overall. be saintly. But morality, most of us think, does On the other hand, many philosophers have not require sainthood. pointed out that utilitarianism gives no intrinsic weight to how equally or fairly benefits are distributed. I myself accept that this is an im- 4 Rule-utilitarianism portant potential problem with utilitarianism. But because I don't think these worries about Rule-utilitarianism differs from act-utilitarian- distribution are relevant to euthanasia, I shall ism in that rule-utilitarianism does not assess ignore them in this paper. each act solely by its utility. Rather, rule-utili- tarianism assesses acts in terms of rules, and rules in terms of their utility. Rule-utilitarian- 3 Act-utilitarianism ism holds that an act is morally permissible if and only if the rules with the greatest expected The most direct and most discussed form of utility would allow it.