The Cause-of-Death Equivocation Fallacy

The Cause-of-Death Equivocation Fallacy March 18, 2023

Today we’re looking at a particularly abhorrent fallacy I ran across this morning, and no, I’m not going to give any attention to the offender. By the end of this tutorial you should have no difficulty spotting it when you see it in the wild.

(If you’ve never been quite sure what “equivocation” means, the Wiktionary definition may help.)

The fallacy runs like this:

Person A died of a cause described in the medical terminology as XYZ. Person B also died of a cause described in the medical terminology as XYZ. Therefore, both deaths are morally equivalent and equally acceptable.

I’m going to run through some real-life examples to show that cause of death alone is not sufficient to evaluate moral decisions.

Are all deaths by  “untreated cancer” morally the same?

Let me give you some scenarios, three from real life and one that is real but anonymized:

My grandmother died of untreated cancer.

That sounds terrible, right? But let’s add some circumstances:

  • She was in her nineties at the time of the diagnosis, having throughout her life received all appropriate screenings and medical care.
  • The available cancer therapies would have done more harm than good, given the unavoidable frailty of her advanced age.
  • She was in her sound mind and freely chose her treatment plan after considering all the options.
  • By choosing hospice care, she lived longer and more comfortably than if she had chosen to directly treat the cancer.

So while it is true that she “died of untreated cancer” in fact we can say that she received the best possible care, which thus provided her with the longest and best quality of life — a medical success.

My great-grandmother died of untreated cancer.

It was the 1950’s and she had ovarian cancer. It was just a fact that the treatments available today did not exist then. It was a terrible reality of an earlier age. We can lament her death, we can be deeply sorry that she and her family missed out on decades more of life together, but no one did anything wrong. It was just sad.

My friend’s best friend died of untreated cancer.

This was such a sad case. A mom in her forties was diagnosed with a terminal cancer. She could have pursued treatments that would have extended her life somewhat, but  with crushingly debilitating side effects; the prognosis was terminal no matter what. After evaluating the choices, she freely chose to pursue hospice care, even though it did likely shorten her life.

Again, this was a very painful situation. We can allow that her immediate family members have a right to question whether a little bit more time with Mom would have been worth the significant physical toll of the limited choices for marginally extending her life. But ultimately we can respect that in a no-win situation, Mom had a right to make her own decisions about risks and benefits of different treatment decisions.

______ died of untreated cancer.

In our final scenario, our patient is otherwise sufficiently healthy to endure any side effects, the treatment is well known to be quite effective, and there is no good other reason someone should be denied the treatment. The obvious choice is to receive the treatment, be cured, and go on to many more years of happy post-treatment life. (My grandmother in the first story example did just that with a previous cancer.) But in this case, the cancer goes untreated because a corrupt system refuses to offer the treatment to our patient.

That “corruption” might be political enemies being denied care in a despotic regime; care being denied due to ethnic prejudice or apartheid; care being denied due to inability to pay bribes or exorbitant (unjustified) fees in a corrupt healthcare system; doctors dismissing patient complaints due to medical gaslighting; care being denied through the impossibility of travel due to violence or war . . . insert your horrible situation here.

We would rightly be outraged. This is manslaughter. You have the ability to save a life, but instead you deny care and the person dies an agonizing and premature death.

In all these examples, the person died of untreated cancer, but clearly one of these is very different morally than the others. The first three are unfortunate and painful; in the fourth case, it is a type of murder.

Are all deaths by “drowning” morally the same?

Let’s look now at a common non-disease cause of death. Here are six different moral scenarios, all of which happen in real life:

A. Premeditated murder. John is a murderer. He stalked his victim, overpowered her, forced her to the lake near his house, and there he drowned her. Clearly this is murder, and we rightly punish it severely.

B. Psychiatric disease. Mary is a mother with a severe psychiatric condition, but which is well-controlled by the medication she takes without missing any doses.  Unfortunately one time her medication is held up due to a paperwork problem at the clinic, and her pleas for a few samples to tide her over are ignored. In her resulting psychosis she drowns her toddler.

This too, is a form of murder. However, we rightly recognize that Mary’s guilt is lessened by the fact that she didn’t know at the time what she was doing, and likewise the bureaucrats who created this problem likely did not intend to create it. We also rightly insist that if necessary Mary be required by law (even against her will, if necessary, though in this story she is more than willing) to receive treatment to prevent this from ever happening again.

C. Negligence. Ed is a loving grandfather who has the little ones over. On his watch, he unwittingly leaves the gate to the pool open and the toddler sneaks out and drowns. It’s too late by the time anyone realizes what happened.  This is a horrible and heart-breaking situation. Depending on the precise details, the amount of guilt Ed bears will vary — he might bear no guilt at all if the negligence was on the part of a manufacturer whose latch-locking mechanism failed.

Regardless, the whole situation will be absolutely crushing to him, and to all the family in a different way . . . but it wasn’t murder. He did not choose this death. Not at all. It’s just not murder.

E. Self-defense. Joan is out walking alone on the beach and a stranger starts following her. She tries to avoid him, but he closes in and attacks. She fights back, and finally manages to save her own life when, in their struggle, he dies of drowning in the surf. She is not guilty of murder. She was acting in self-defense.

F. Accident. Bob is horsing around at the river, and he hits his head on a submerged rock he didn’t realize was there, losing consciousness. By the time his friends are able to reach his body, he’s died of drowning. It’s a horrible situation. It’s an accident.

There could have been negligence on Bob’s part, or it may have been a freak mishap, depending on the details what happened. But nobody is guilty of murder.

G. Heroic rescue. Susan is one of several passengers on a boat that capsizes due to circumstances that were a known risk but ultimately just came down to bad luck. Due to the way it all happens, she ends up giving up her own life jacket so that someone else, who was certainly going to die without it, can use it instead. That person survives, but Susan drowns.

Despite the fraught circumstances, no one is guilty of murdering Susan. It was a no-win situation, and Susan heroically chose to risk her own life in order to save someone else.

So. Six different deaths, all due to drowning.  Medically, everyone in each of these cases died of the same cause. And yet morally each of these scenarios is quite different.

In each case, something very bad happened. In each case there is grief and trauma. In each case we rightly ask: How can we prevent this from ever happening again? And yet, despite each of them being drowning deaths, they are not the same.

Terminology Equivocation: Is all “Cardiac Arrest” the same?

Having established our main point, there is one more aspect to this fallacy that we need to explore: Sometimes medical terminology is not very specific when it comes to causes of death. Let’s consider “Cardiac Arrest.”

It means that your heart stopped, and it’s one of the last things that is ever going to happen to you, during your transition into the hereafter.

For some people, the heart stops and then you die. For others, some other vital bodily process fails, you die, and your heart stops somewhere in that sequence — but it isn’t the cause of death, it’s one of the consequences of death. So while “cardiac arrest” is a useful medical term, it isn’t sufficient to understand how someone died, let alone whether their death was morally acceptable or not.

We need to know:

  • What caused the cardiac arrest?
  • Was it avoidable?
  • Was it a treatable condition?
  • Was it inflicted by criminal action?
  • By negligence? By accident?
  • By the inevitable reality that sooner or later our bodies fail, and though medical technology works miracles at time, death eventually comes for us all?

It would be nonsense to say, “Everyone experiences ‘cardiac arrest,’ and thus it hardly matters what the cause is.” It matters greatly.

How to Avoid the Cause-of-Death Equivocation Fallacy

I think these examples make clear what was already abundantly obvious: We know that the mechanism of death, whether it be due to illness or injury, does not tell the whole story.

We know that the circumstances around that death are what guides us in a moral evaluation. We know that our legal system, though imperfect, should attempt to make distinctions between intentional, unintentional, and unavoidable causes of death.

And yet, just this morning I saw someone who is otherwise quite intelligent trying to say that two deaths that happened to share a common bit of terminology in the medical history were morally equivalent, even though one was a premeditated, intentional, direct taking of life and the other happened despite no one doing anything wrong and every effort being made to save the victim.

How could someone make this egregious error in analysis?

Because she wanted it to be true. She wanted to be able to justify the killing of an innocent person.

Don’t do that.

US sailors in a motorized life raft rescue a sick child at sea.

Photo: 2014 joint-services effort to save a sick child at sea, public domain. Click through for a more detailed description.


About Jennifer Fitz
Jennifer Fitz is counting on your ability to take what you've learned and apply it to other situations. Home base is On Twitter @JenFitz_Reads. You can read more about the author here.
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