Source: The Elements of Moral Philosophy (2012) by James Rachels and Stuart Rachels (McGraw Hill, 2012)
Lesson 1: What Is Morality? The Problem of Definition
“We are discussing no small matter, but how we ought to live.”
Socrates, in Plato’s REPUBLIC (ca. 390 b.c.)
Part 1
Moral philosophy is the study of what morality is and what it requires of
us. As Socrates said, it’s about “how we ought to live” —and why. It would be
helpful if we could begin with a simple, uncontroversial definition of what
morality is, but that turns out to be impossible. There are many rival theories,
each expounding a different conception of what it means to live morally, and
any definition that goes beyond Socrates’s simple formulation is bound to
offend at least one of them.
The Case of Baby Theresa
Theresa Ann Campo Pearson, an infant known to the public as “Baby
Theresa,” was born in Florida, United States in 1992. Baby Theresa had
anencephaly, one of the worst genetic disorders. Anencephalic infants are
sometimes referred to as “babies without brains,” but that is not quite accurate.
Important parts of the brain—the cerebrum and cerebellum—are missing, as is
the top of the skull. The brain stem, however, is still there, and so the baby can
still breathe and possess a heartbeat. In the United States, most cases of
anencephaly are detected during pregnancy, and the fetuses are usually
aborted. Of those not aborted, half are stillborn. About 350 are born alive each
year, and they usually die within days.
Baby Theresa’s story is remarkable only because her parents made an
unusual request. Knowing that their baby would die soon and could never be
conscious, Theresa’s parents volunteered her organs for immediate transplant.
They thought her kidneys, liver, heart, lungs, and eyes should go to other
children who could benefit from them. Her physicians agreed. Thousands of
infants need transplants each year, and there are never enough organs available.
But Theresa’s organs were not taken, because Florida law forbids the removal
of organs until the donor is dead. By the time Baby Theresa died, nine days later,
it was too late—her organs had deteriorated too much to be harvested and
transplanted.
Baby Theresa’s case was widely debated. Should she have been killed so
that her organs could have been used to save other children? A number of
professional “ethicists”—people employed by universities, hospitals, and law
schools, who get paid to think about such things—were asked by the press to
comment. Most of them disagreed with the parents and physicians. Instead,
they appealed to time-honored philosophical principles to oppose taking the
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Source: The Elements of Moral Philosophy (2012) by James Rachels and Stuart Rachels (McGraw Hill, 2012)
organs. “It just seems too horrifying to use people as means to other people’s
ends,” said one such expert. Another explained: “It’s unethical to kill person A
to save person B.” And a third added: “What the parents are really asking for is,
Kill this dying baby so that its organs may be used for someone else. Well, that’s
really a horrendous proposition.”
Is it horrendous? Opinions were divided. These ethicists thought so, while
the parents and doctors did not. But we are interested in more than what people
happen to think. We want to know what’s true. Were the parents right or wrong
to volunteer their baby’s organs for transplant? To answer this question, we
have to ask what reasons, or arguments, can be given on each side. What can be
said to justify the parents’ request or to justify opposing their request?
The Benefits Argument
The parents believed that Theresa’s organs were doing her no good,
because she was not conscious and would die soon anyway. The other children,
however, could benefit from them. Thus, the parents seem to have reasoned: If
we can benefit someone without harming anyone else, we ought to do so.
Transplanting the organs would benefit the other children without harming Baby
Theresa. Therefore, we ought to transplant the organs.
Is this correct? Not every argument is sound. In addition to knowing what
arguments can be given for a view, we also want to know whether those
arguments are any good. Generally speaking, an argument is sound if its
assumptions are true and the conclusion follows logically from them. In this
case, we might wonder about the assertion that Theresa wouldn’t be harmed.
After all, she would die, and isn’t being alive better than being dead? But on
reflection, it seems clear that, in these tragic circumstances, the parents were
right. Being alive is a benefit only if it enables you to carry on activities and have
thoughts, feelings, and relations with other people—in other words, if it enables
you to have a life. Without such things, biological existence has no value.
Therefore, even though Theresa might remain alive for a few more days, it would
do her no good.
The Benefits Argument, therefore, provides a powerful reason for
transplanting the organs. What arguments exist on the other side?
The Argument That We Should Not Use People as Means
The ethicists who opposed the transplants offered two arguments. The
first was based on the idea that it is wrong to use people as means to other
people’s ends. Taking Theresa’s organs would be using her to benefit the other
children; therefore, it should not be done.
2
Source: The Elements of Moral Philosophy (2012) by James Rachels and Stuart Rachels (McGraw Hill, 2012)
The idea that we should not “use” people is obviously appealing. “Using
people” typically involves violating their autonomy—their ability to decide for
themselves how to live their own lives, according to their own desires and
values. A person’s autonomy may be violated through manipulation, trickery, or
deceit. For example, I may pretend to be your friend, when I am only interested
in going out with your sister; or I may lie to you so you’ll give me money; or I may
try to convince you that you will enjoy going to the movies, when I only want
you to give me a ride. Autonomy is also violated when people are forced to do
things against their will. This explains why “using people” is wrong; it is wrong
because it thwarts people’s autonomy.
Taking Baby Theresa’s organs, however, could not thwart her autonomy,
because she has no autonomy—she cannot make decisions, she has no desires,
and she cannot value anything. Would taking her organs be “using her” in any
other morally significant sense? We would, of course, be using her organs for
someone else’s benefit. But we do that every time we perform a transplant. We
would also be using her organs without her permission. Would that make it
wrong? If we were using them against her wishes, then that would be a reason
for objecting—it would violate her autonomy. But Baby Theresa has no wishes.
When people are unable to make decisions for themselves, and others
must do it for them, there are two reasonable guidelines that might be adopted.
First, we might ask, What would be in their own best interests? If we apply this
standard to Baby Theresa, there would be no objection to taking her organs, for,
as we have already noted, her interests will not be affected. She is not conscious,
and she will die soon no matter what.
The second guideline appeals to the person’s own preferences: We might
ask, If she could tell us what she wants, what would she say? This sort of thought
is useful when we are dealing with people who have preferences (or once had
them) but cannot express them—for example, a comatose patient who signed
a living will before slipping into the coma. But, sadly, Baby Theresa has no
preferences about anything, nor has she ever had any. So we can get no
guidance from her, even in our imaginations. The upshot is that we are left to do
what we think is best.
The Argument from the Wrongness of Killing
The ethicists also appealed to the principle that it is wrong to kill one
person to save another. Taking Theresa’s organs would be killing her to save
others, they said; so, taking the organs would be wrong.
The prohibition against killing is certainly among the most important
moral rules. Nevertheless, few people believe it is always wrong to kill—most
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Source: The Elements of Moral Philosophy (2012) by James Rachels and Stuart Rachels (McGraw Hill, 2012)
people think there are exceptions, such as killing in self-defense. The question,
then, is whether taking Baby Theresa’s organs should be regarded as an
exception to the rule. There are many reasons to think so: Baby Theresa is not
conscious; she will never have a life; she is going to die soon; and taking her
organs would help the other babies. Anyone who accepts this will regard the
argument as flawed. Usually, it is wrong to kill one person to save another, but
not always.
There is another possibility. Perhaps we should regard Baby Theresa as
already dead. If this sounds crazy, bear in mind that our conception of death has
changed over the years. We now understand death as occurring, not when the
heart stops beating, but when the brain stops functioning: “brain death” is our
new end-of-life standard. This solved the problem about transplants, because a
brain-dead patient can still have a healthy heart, suitable for transplant.
Anencephalics do not meet the technical requirements for brain death as
it is currently defined; but perhaps the definition should be revised to include
them. After all, they lack any hope for conscious life, because they have no
cerebrum or cerebellum. If the definition of brain death were reformulated to
include anencephalics, we would become accustomed to the idea that these
unfortunate infants are born dead, and so taking their organs would not involve
killing them. The Argument from the Wrongness of Killing would then be moot.
