Summary and Relevant Facts
In Pulling the Plug, we are presented with the story of Hope’s mother, Anna. Anna was diagnosed with an incurable autoimmune disease called polymyositis – a sickness with a low remission rate which causes the body’s system to shut down on itself. Despite the pain, Anna promises Hope that she won’t go down without a fight, even if she ends up in a vegetative state. As the disease relentlessly spread throughout her body, Anna’s organs began to fail one after the other. She was put on life support through a machine which causes her extreme pain. Anna was given the choice to undergo stem cell therapy. However, she refuses to go through the treatment because it is a costly procedure. Anna’s family thinks otherwise and wants to exhaust all possible means to save her. Sadly, Anna eventually goes into cardiac arrest. The doctors have been trying to resuscitate her with the use of powerful drugs to no avail but they were no longer getting a positive response. Ultimately, Hope’s family decides to let Anna go because they felt her immense pain and suffering should come to an end.
This case aims to judge whether the family’s decision to pull the plug and let Anna go was right or wrong. Hope herself remains unsure of the decision her family made and whether they had the right to deliberate on the continuation of a life which was not theirs to begin with. The moral dilemma posed in the situation was whether it would be right to keep a sick and dying person alive or commit mercy killing on the premise of alleviating pain and suffering – a decision Hope’s family ultimately made for her.
The two competing actions presented in the case are:
To keep Anna alive despite her suffering from an incurable disease and going through cardiac arrest. This option explores the possibility of Anna being resuscitated by her doctors and potentially surviving the episode. Anna’s survival of her cardiac arrest implies she would still be enrolled in several treatments and hooked up to several life-sustaining machines.
Committing euthanasia would mean Anna’s pain and suffering will end. It was evident in the case that Anna was already in an immeasurable amount of pain. It was emotionally draining and traumatic for family members, who merely served as helpless bystanders, resigned to watch their kin in this state. Furthermore, the issue of money should also be considered – as hospital fees and medical bills tend to be very costly.
Utilitarianism and Deontological Ethics for Analysis
At first glance, Mill’s Utilitarianism might suggest that killing Anna is the better choice. Utilitarianism is often called “The Greatest Happiness” principle. It holds that “actions are right in proportion as they tend to promote happiness and wrong as they tend to produce the reverse of happiness”. The definition of happiness in utilitarianism is the “intended pleasure and the absence of pain”. Unhappiness, on the other hand, is defined as “pain and the privation of pleasure”. (SOURCE: Mill’s article, page 7) Utilitarianism focuses more on the consequences and effects of an action rather than the moral intentions of the person. Given these principles, it may seem that killing Anna benefits more people than saving her because her disease has been very painful not only to her but also to her doctors and family. Killing her produces pleasure to more people by alleviating the financial as well as psychological nightmares the family experiences for Anna who is suffering. It saves the family from spending more drugs and fees on doctors who could be spending time on other patients with more hopeful conditions.
However, such conviction is a product of act utilitarianism alone and thus disregards another class of utilitarianism known as rule utilitarianism. Act utilitarianism focuses more on the consequences of individual acts in relation to the total amount of happiness that they produce. They look more closely on the situation at hand. On the other hand, rule utilitarianism looks at the long-term consequences of people following that rule. Rule utilitarianism argues that the maximum pleasure obtained immediately by act utilitarianism can be forgone for the sake of a bigger pleasure that involves more people in the long run. This is especially true in the case of justice, which rule utilitarianism protects. In the case of Anna, to illustrate, the decision to kill patients with a similar case as Anna’s comes into question. If anyone can do so just because the patient is no longer able to think at the moment, then all the rights of patients like Anna and furthermore even simply under cardiac arrest will also be gone. Even if the family is the one asked to make the decision, the family is not to know what Anna’s wishes are and if there may or may not be hope for Anna to live with new treatments possibly arising in the future. What they must look at, according to utilitarianism in general, is not the quantity of the effects of their decision but rather their quality. From a rule utilitarian perspective, we look at the impact of the act of saving Anna bears consequences to not just Anna and those who are close to her but everybody else who might end up in her state.
Deontological Ethics (Kant)
Anna’s case is one which involved nonvoluntary euthanasia. This means that Anna was no longer capable of making the decision to live or not given her incapacitated state due to cardiac arrest. Anna would have most likely already been in a comma when the doctors were trying to resuscitate her, thus rendering her incapable of being part of the decision making process of determining whether she should live or not. Her family then chose for Anna, by pulling the plug on her life.
Now, Kant asserts that the moral worth of any action should be judged on the basis of the motive of the action and the action itself, no matter how positive the consequences may be. As such, we have to disregard any and all outcomes that could possibly have happened whether Anna lived, or was cured, or ultimately. Instead, we must delve deeper into the motives of the family for letting Anna go. Based on the case, we can see that the family decided on their choice of action not because of any monetary benefit or control. They decided to because they wanted to alleviate Anna’s suffering from her sickness.
According to Kant’s teaching, all actions must follow the fundamental principle of morality which states that we must act on maxims which we can, at the same time, will it as a universal law. The family’s action of willingly taking Anna’s life is wrong because it goes against this principle. By taking Anna’s life to ease her suffering, her family are basically saying that they approve of the maxim of granting death to anyone who is suffering. Here, all weak and impotent people (such as the elderly, infants, or the handicap) could be sent to death by virtue of their weakness. They can no longer be deemed worthy of life or capable of making the choice for it themselves, particularly when they are in a disabled state as Anna was. This could even be extrapolated further, since it can be argued that anyone who living is technically going through the hardships of life, and is suffering as well. Through this logic, any person could grant death to anyone else. By universalizing killing another person (who is suffering), we would encounter a contradiction (where it must be noted that Kant specifically mentions that moral actions cannot and should not encounter any contradictions for it to remain moral). The contradiction here is if everyone were to be allowed to kill anyone else, then, eventually, there would no one left in this world and murder would lose any meaning. Therefore, the action of granting death to anyone who is suffering isn’t universalizable.
Furthermore, Kant states that as human beings, we all have a duty to uphold the common good, which in this case is life. Thus, killing (whether it may be merciful or vindictive) is totally wrong, because it goes against the moral imperative of sustaining life. Our morality, employed with reason, is what makes up the categorical imperative or the universal rule.
By ending a person’s life, we are denying that person justice. Justice implies the respect for human rights, decisions, and choices.
KANT: The intention to outrightly end a person’s life is morally unacceptable but if the intention were to alleviate pain, then death as an end would be acceptable.
**maxims are intentions/ subjective principle of action
Our actions are based on maxims
Our maxims are based on reason
Our practican reason is based on our ability to will
Our will encapsulates our desire and rational capacity (meaning it is filtered to intend what can inherently bring about the most good/ good will)
While both present two unique perpsectives in approaching this case, Utilitarianism and Kantianism have come to the same conclusion, basically stating that taking away anyone’s life is a serious, immoral act.
However, in the end, these two philosophical understandings have serious flaws in their application. For Utilitarianism, it would be impossible to predict what positive or negative consequences could have happened from their decision. For Kantianism, it makes a immovable, irrefutable statement that does not accept any exceptions to the rule and fails in considering the context of the entire story.
This group believes that the family’s decision in pulling the plug may not necessarily be the most “moral” action, but it is definitely the most humane.
Kozlova, Anna. 2015. Kant and Mill on Physician-Assisted Suicide. Inquiries Journal/Student Pulse 7 (09), http://www.inquiriesjournal.com/a?id=1183
Mill’s article (don’t forget!!)
utilitarianism = avoid pain (sickness), go for the pleasure
Consider alternative solution
If Anna lived, will she be able to live a “normal” life again? Given her condition, will the treatment cure her disease completely?
Conclusion: judgement if the action is right or wrong
Right to pull the plug ? extraordinary means of sustaining life is not right, she was already suffering, if not for the life support her body wouldve already given up (natural course of action)