What is a “Life Not Worth Living”?
by G. Steven Suits, MD
Last week, a subcommittee of the SC Senate Committee on Medical Affairs held a hearing on the Pain Capable Infant Protection Act (H.3114), a bill that passed the SC House by a vote of 80-27 on February 11. The law, if passed, would limit abortions in South Carolina to fewer than 20 weeks gestation, the point at which many researchers have determined the unborn child can feel the pain of being aborted. When the subcommittee meets again, a key question will be whether to amend the bill to allow abortions 20 weeks or after in cases of “fetal abnormalities.” In light of that looming hearing, Palmetto Family asked our former Chairman and President, Dr. Steve Suits to tell his family’s story. As a medical doctor, an ethicist, and the father of Kres, Dr. Suits is in a unique position to advise the subcommittee. –OPS
“Doctor, there’s a reporter on the phone from the Herald – Journal,” my receptionist said, continuing “and I know you don’t like talking with reporters, but she’s doing a story on the crisis pregnancy center.” I took the call, knowing that the AP Stylebook didn’t allow for neutral reporting on abortion. But the center was a cherished ministry and I couldn’t refuse the chance to promote its work.
“Doctor, I’m doing a report on the crisis pregnancy center and when I was over there yesterday one of the staff said something that struck me as incredible,” the reporter began. “And I wanted to talk with you about it because she said that you were the source of the statement.”
“She said that there was no such thing as a life not worth living.”
“Well, I have said that, but it is not original to me,” was my reply.
“I’m not sure that I agree with that,” she opined, uncharacteristically for a news reporter.
“What do you mean?” I probed.
“You know. Some people are so bad off that their lives are nothing more than a burden – on themselves and on others.”
I asked her to explain to me such a person (careful to put a mild, but unmistakable, emphasis on person). She responded with commonly used terms such as “brain dead,” “on a ventilator,” and “in a coma.” It was when she used the expression “vegetable” that I responded.
“I don’t normally refer to those with whom I work as vegetables, but let me describe a typical patient that I as a pediatric surgeon would encounter. Then you can tell me if that is the kind of life you would consider not worth living.”
“Okay,” she said with a hesitancy revealing her concern that she was not directing this dialogue in a manner comfortable to her.
“An eight-year-old boy born with hydranencephaly – that means he didn’t have any higher brain function – requires constant care, and always will. He is in diapers, spends his time between his waterbed and a custom-molded chair. His only response is to cry. When his diaper is wet, he cries. When he his mother moves him to change it, he cries. Because his limbs are held in constant flexion and pulled inwardly, his legs are hard to spread. This necessitated surgery just a year ago to release his hips.
“When he has been in his chair too long, his wailing adds to the noise of his siblings at play. But unstrap him and lay him down and he shrieks as if being tortured. When he’s hungry, he gives the same notification as always. And you can imagine how he reacts as the feeding tube is inserted through his nose into his stomach in order to pour the liquid nutrition into him. On top of all of this, he cannot even recognize those who care for him. Is it mother, father, sister, brother, or baby-sitter? He has no clue. Never will.”
I hesitated, trying to sense if she needed more detail to the picture I was painting upon the canvas of her mind. But this was enough. She rejoined, “That’s exactly what I’m talking about.”
“I just described to you my eight-year-old son,” I answered, I’m sure with obvious pain from her insinuation that he was worthless. During the silence that followed I felt that pain, but also an almost nefarious pleasure at having led her into such an abrupt confrontation with her own value system. I waited, hoping she would see the implications of her position and satisfied that they were now obvious.
“I don’t think I’d want to live that way,” she finally retorted.
That was it? “I don’t think I’d want to live that way”?
“Come on, lady, none of us would want to live that way!” I thought, almost out loud. Should I speak to her of Bentham and Mill and utilitarianism? Did I dare mention human life as the image of God? How could I bring her back to a discussion of worth from her focus on desire? I settled my thoughts on continuing an existential approach.
“To my wife and me, Kres (yes, he even has a name I was saying to her) is son. To our seven other children he is brother: ‘Kressy-poo’ usually. His life is worthy not because of what he can do but because he is. You see,” I concluded, “we live daily – hourly – knowing that as life cannot get ‘worse’ than Kres’s, there is really no such thing as a life not worth living.”
“I can see why you might see that, Doctor. But I don’t think most people I know would agree with you.” With this she thanked me for talking with her, admitting that it had not been the interview she had expected.
The following Sunday, the article appeared in the paper. In it were descriptions of the work at the crisis pregnancy center with the insinuation that somehow free pregnancy tests lured unsuspecting women in to be propagandized with videos, pamphlets and “anti-abortion counseling.” But there was not one word about life not worth living, Kres, or the doctor on the board of directors of the center who had some “incredible” things to say.
Also recommended: A Broken Heart, A Child’s Life
Different Approaches to Ethical Thinking
How could there be such polarity to the conclusions reached about the same circumstances? This encounter illustrates the importance of understanding the system or world view in which one is thinking. Rather than seeing someone’s arguments as merely invalid, it is necessary to consider the foundational principles upon which the arguments build. For the reporter, the fundamental principles were utilitarian as opposed to my absolutist position derived from biblical principles. What are the components of utilitarianism and what are its strengths and weaknesses?
Utilitarianism is a teleological or goal-oriented theory of ethics. Its single supposedly simple principle was described by John Stuart Mill as the “principle of utility” which he explained: “Actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.”[i] To the utilitarianist, right and wrong are determined on the basis of the results, outcomes or consequences. This theory is also referred to as “consequentialism,” and is a classic example of “the ends justify the means.”
To Mill, the principle is stated in terms of happiness. More commonly, it is given in terms of pleasure and pain. This is the classic formulation of Jeremy Bentham. He identifies happiness with pleasure – any pleasure. Mill agreed that happiness could be identified with pleasure, but insisted that there was a hierarchy of pleasures, some being “higher” than others.[ii] “It is better to be an unhappy human being than a happy pig.” “It is better to be Socrates dissatisfied than a fool satisfied.” For this reason, Mill’s utilitarianism is sometimes called “qualitative.”[iii]
In another model statement of utilitarianism, its telos is the “greatest good (or pleasure) for the greatest number of people.” In a well-known rendition, the “hedonistic calculus”[iv] is applied: computing the pleasure pain ratio. The utilitarian strives for the greatest amount of pleasure while trying to minimize suffering.
A final differentiation within utilitarian theory is between act utilitarianism and rule utilitarianism. Bentham was the father of the former and proposed that utility was determined for each act which was “morally right and obligatory if it would produce the most utility (the best consequences) under the prevailing conditions.”[v] Rule utilitarianism determines that “an act is right if it would be more beneficial to have a code of moral rules permitting that act than one which excluded it.” It “looks for rules that as a whole produce the greatest utility, and it prescribes them.”[vi]
Utilitarianism applies one simple, objective goal for ethical action: pleasure. Ethics consists in finding that goal. As such, utilitarianism is result-oriented and seeks practical means of achieving its goals.
But utilitarianism suffers from unclarity.[vii] What is the greatest good? Would one not have to be omniscient to be sure that a certain act is greater than all other possible acts? Is the most important utility individual or social utility? What is the basis for seeking the good of society, and for which “society” does one seek the good? Is intensity of pleasure or quality of pleasure more important, more utilitarian?
Utilitarianism also is criticized for being prescriptive (and arbitrarily so) in establishing pleasure as the highest good. Do all humans seek pleasure above all else? For Nietszche, it was power. For Frankl, it was meaning.
Finally, application of the hedonistic calculus could result in justifying acts of harm against minorities as long as the pleasure of the majority was so augmented that a net utility resulted from the prejudiced action.
From the reporter’s utilitarian perspective, Kres did not have the requisite amount of pleasure to offset his suffering and thus deem his life worth living. For her, only a positive hedonistic calculation could provide his life with value. Had she really thought through the consequences of living in a culture where everyone assigned value to the lives of others by such calculations?
[i] Mill, John Stuart. Utilitarianism: With Critical Essays. Edited by Samuel Gorovitz. Indianapolis: Bobbs-Merril, 1971. As quoted in Munson, Ronald. Intervention and Reflection: Basic Issues in Medical Ethics. Fifth edition. Belmont, CA: Wadsworth Publishing Company, 1996, p 3.
[ii] Munson, Ronald. Intervention and Reflection: Basic Issues in Medical Ethics. Fifth edition. Belmont, CA: Wadsworth Publishing Company, 1996, p 4.
[iii] Brown, Harold O. J. Lecture notes for Theology 603, Reformed Theological Seminary, Charlotte. Fall, 1998.
[v] Feinberg, John S. and Feinberg, Paul D. Ethics for a Brave New World. Wheaton, IL: Crossway Books, 1993, p. 28.