Natural Death Black Boxes

Natural Death Black Boxes September 26, 2011

I warned commenters against turning the Soup Nazi Approach to Sex post into an abortion debate. Any free-ranging discussion of abortion tends to fail; I’ve only had productive conversations when I spend a lot of time narrowing the focus of a conversation and screening off anything else. I’m not surprised to see the discussion that broke out entering a tailspin, but I think there’s something to be gleaned from the wreckage.

I’m certainly not recapping the whole thread, so I picked the quote below because it gives me a good opening for my riff, not because I have any intention on weighing in on who started it. So, at some point in the discussion, a commenter said:

And if we’re going to pick out inconsistencies in people’s opinions about abortion… how about all the people who claim to believe that a fertilized egg is a person, and yet who don’t give a toss about the natural abortion rate of fertilized eggs? Its about 30%. If a fertilized egg is a human being, that makes implantation failure the single greatest cause of human death on the planet. And yet the amount of research money going into preventing these deaths is approximately zero dollars and zero cents, American. I wonder why that is.

This is meant to be a proof that Christian views on fetal death are inconsistent and can’t be the basis for legal or ethical restrictions. The conversation didn’t go well, and the word ‘sociopath’ got broken out downstream. Let me try and fill in the gaps of this discussion, since I am interested in talking about how we evaluate different kinds of death. I am still not interested in having a broad discussion of abortion in the comments of this post.

Christians tend to differentiate between ‘natural death’ and all other types (one commenter in the last thread labeled abortion and murder as examples of ‘induced death’). This categorization happens by some black box method (I definitely don’t understand it well enough to categorize it). So, although all deaths are sad, depending on what this black box outputs, there are different levels of duty to prevent death, and, in some cases, there is a duty to not act to prevent death, since such an act would be an implicit rebuke to the natural order.

Thus, Christians frequently oppose abortion but put spontaneous miscarriage in the same category of death by old age. Depending on how their black box of ‘natural death’ works, they could fall on either side of the extraordinary measures/Terri Schiavo-type debate. Almost all of the black boxes are opposed to cryonics, uploading, and other transhumanist attempts to achieve immortality.

Without nailing down how a particular Christian’s natural death black box works, you can’t spring the rhetorical trap the commenter set. The real argument was not about the intellectual integrity of abortion advocates, it was about whether their black boxes were calibrated correctly. So although it looks like you’re having a simple argument about a contradiction, you’re actually having a dispute that goes to the heart of their morality and metaethics. You’ve signed on to something at least as hard as persuading them that gay relationships are on the same moral footing as heterosexual ones.

So, just as a reminder, it’s ok to walk away from an argument that got a whole lot bigger than you’ve got the time to handle. If either of the disputants won’t recognize that the argument just got foundational, cut your losses and go. But now that we all know the scale of what we’re dealing with, I would like to have a conversation about those black boxes. Let’s have the Muppets take us through the transition from tactics to content:

I’d love to hear people (Christian or not) discuss how their black boxes label natural death. It’s also possible to reject this entire categorization schema and wish to prevent all deaths, with effort being allocated proportional to impact, probability of success, disability-adjusted life years, etc. Do you think that your black box is common to most people? What would you need to persuade someone of to get them to start using your black box?

I want to take a crack at the extraordinary measures/Terri Schiavo problem. I’m frightened by the way that some natural death black boxes seem to make us the slaves of scientific progress. Once you establish that failure to act to preserve life counts as inducing death, it becomes morally impossible to opt-out of any new heroic measures (sometimes even if the chance of success is small).

This problem is partially the fault of trying to stick with duty, instead of asking about what that duty is meant to serve. Once you catch yourself wishing that the machines or protocols keeping your loved one alive hadn’t been invented, you’ve judged that you and your charge would be better served by pulling the plug. You hesitate because your rule-based morality has declared that choice anathema. That’s when it’s time to go back and ask what that rule was meant to guard and decide whether scientific progress has created possibilities the old rule can’t cover.  Are you in a position to pick the values over the rule generalized to guard them?

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  • My black box – if it's human you can't directly and willingly cause it's death. Aborting a fetus and starving a stroke victim both fall under the "you're killing" category. If it's human and can continue to live with basic care (the same care you would give an infant – food, diapers, etc) then you should not be a party to killing it.The problem with Euthanasia isn't a "pulling the plug on extraordinary means", but the "withholding of food and water until the human in question dies a brutal death." This is wrong. Unless feeding a person causes problems (as in someone suffering from multiple system failure) it should not be withheld.As soon as you allow for the deciding of which humans deserve food and water you make the line an arbitrary one. Why should we stop at birth? Why should we stop at "vegetative state"? Why not remove those who are not useful or are a nuisance on the rest of the population?And before you scoff "eh slippery slope is a dumb argument" remember that we've had people calling for a legalizing of infanticide. We have people being starved to death who have begged for food and water who were tied down to prevent them from stealing others. These things are wrong. The death of any human at any time is a tragedy, yet the choosing to kill another human because they are inconvenient to you is a crime.

  • anon atheist

    I can't follow you with your black box. It is common that the punishment for killing somebody on purpose is higher than the punishment for killing somebody accidentally and that punishment is higher than the punishment for killing somebody by not helping the person. It is an interesting philosophical question as to why this should be that way. People will probably argue that this has to do with the level of culpability or responsibility or with how immediate the action caused the consequences.But to argue that there is a difference between an abortion and not funding research against “natural abortion” you don't need a cut-off. It is obvious that one thing is on one side of the scale while the other thing is on the other side.

  • @anon atheist: I think you're right that there's a surface level difference between those two actions, but that dispute seemed to be driving a lot of the rancor in the last thread, so I wanted to address it a different way.@Christina: I think it's inaccurate to claim the only way to carry out euthanasia is starvation. Pain medication tends to hasten death, period. People pursuing euthanasia often up the dose to speed up the process.Re the slippery slope: I think the consent of the patient through a living will is a pretty good guardrail. Yes, there are reasons to watch out for the elderly feeling obligated to give way, but that is already something to we watch for when people decide whether to pursue expensive, chancy treatment. It's a balancing act, but it's a long sight from "choosing to kill another human because they are inconvenient to you."I'm interested in the limits of the duty to resist death. To what extent is the patient expected to be a partner in the struggle? When their will goes, is everyone else required to fight on?

  • Yes I know it's not the only way, my grandmother was medicated to death, despite her wishes to be lucid with the pain. In this case, while it was legit to give her medication to ease the pain as she deemed necessary, it was not ethical to give her so much that she was dead 24 hr later from the overdose.Note, I didn't say you need to pursue every available means of treatment. If the chemo probably won't help then that is a decision you make. HOWEVER, you cannot kill yourself nor can you participate in the murder of another. It is NOT murder to allow someone to die a death that would happen despite interventions. It is not murder to give pain meds to ease the pain, even if it might cause harm. It is murder to hasten death along by pumping the patient into oblivion.In general, if someone wants to die we consider that they probably need help and compassion. Suicidal thoughts are not best met with "sounds like a good idea – let me help." (except maybe in the case of attention seekers).You make it sound as if these safeguards prevent the very bad things from happening, yet will they? If it's OK to kill this dying human with their permission, why is it not OK to kill that one without permission? Is it OK to kill that one who is not dying but who just doesn't want to live? Why does the opinion of the patient (which may change from day to day) matter at all?

  • Anonymous

    If it's OK to kill this dying human with their permission, why is it not OK to kill that one without permission? Regardless of your beliefs about assisted suicide, I have trouble believing you actually believe this is a convincing argument. Consider:"If it's OK to have intercourse with your spouse with their permission, why is it not OK to rape them without permission?"Surely consent has some relevance to the morality of actions?

  • Christina, like Anonymous, I think the space between 'things patients can consent to do with their body' and 'things other people cannot do to your body against your will' is a slope with a fairly high coefficient of friction. Anonymous's hypothetical above is well put, and, by this criteria, pretty much any medical treatment would be verboten.I suspect you think euthanasia is an act so abhorrent that no one can validly consent to it, but this is an entirely separate contention and needs to be supported with a different kind of argument.

  • I'll have an explanation of my black box later, but that can't be done in a two-liner.However, as a purely empirical matter that slope has low friction as can be seen from the Netherlands and Belgium already having ridden it all the way down.

  • Really? what point do the patient's wishes to continue taking meds get overridden for the good of the people? Perhaps 10 years ago people could argue there is no slippery slope…however can anyone honestly look at the cases of people being killed against their will, or merely because they were depressed, and seriously say that? All evidence points to the fact that once you say you can kill that human life if it meets condition X, then X shifts as the desire to justify arises.It's not about freedom to do whatever I want, but freedom for excellence. This silly notion of "I consent to doing X with my body therefore it is OK" is insane. There are things that will harm a person and should NOT be encouraged. A person may consent to drinking to death, but that doesn't mean we don't try to intervene. If we care about that soul at all we try to give them the freedom to be the best version of themselves they can be.

  • Christina, who's judging what the "best version of themselves" is and what criteria are they using. And how did they decide on those criteria?If I think the best version of you is a learned one and a fundamentalist Muslim or Christian thinks the best version of a woman is not a learned one then how are we to judge whose view is best? Surely you have to have some say in what the best version of you is?

  • Patrick

    "This is meant to be a proof that Christian views on fetal death are inconsistent and can’t be the basis for legal or ethical restrictions. "Only the first part.I keep disclaiming the second but no one believes me.

  • I don't think the black box model of the Christian mind is a good model of reality. It makes it sound like we first distinguish between natural and non-natural deaths (the black box) and then employ one of two different moral systems depending on how the black box has ruled.In truth it is almost the other way around: We talk of a natural death as a shorthand way of saying nobody was morally culpable for that death. This is not the full definition of a natural death because e.g. being struck by lighting or dying in a car crash are also non-natural deaths. But the distinction relevant here is between natural death and being killed and in this context the natural talk refers to denying the other side of that distinction. So while investigating potential moral culpabilities may involve appeals to human nature the main decision flow does not go from naturalness to the moral judgment. Rather, if no culpability is found at the moral stage that is one necessary condition for finding the death natural at the factual stage.Since naturalness doesn't help us here, I will just explain some of the moral principles relevant to evaluating such things.First, as Christina correctly observes, there is a difference between causing something and letting it happen. Two actions need not be on an equal footing because they share the same results. For example even if you can unplug the respirator you cannot shoot the patient dependent on that respirator. End of life care is so politicized that probably nobody has undamaged intuitions left, but in general I think this distinction is intuitively obvious to almost everyone. Trolley problem surveys seem to confirm this, though that is only week evidence because they all stink methodologically. Also I have anecdotal evidence from almost everyone to whom I talked about that distinction. But in all honesty my metaintuition about other peoples intuition is a lot stronger than any empirical data on that question. If I met someone who didn't get that distinction I would either look for signs of eupocrisy or distrust that person. This pretty much rules out a fully rule-free morality. Looking what the rule is meant to guard is basically just a way of looking at the consequences and that doesn't suffice to judge actions.Second, there are positive obligations to do things and failure to meet that obligations can result in culpability for bad results fulfilling them would have averted. For example few people would deny the culpability of Johnny's parent for not keeping the acid locked up. There are large differences in how far people would take this, but the basic principle doesn't seem very controversial.Third, suffering does not justify killing, even yourself. This one actually is controversial but it shouldn't be. Basically I believe in an inalienable right to life and the point of inalienable rights is that they can't be alienated. I can ground that in natural law arguments, but that tends to widen the discussion to include almost everything. So I would first try to ask the denier why if the right to life is alienable any other right shouldn't be. Most people are pretty sure I can't sell myself into slavery so the believe in some inalienable rights. More drastically most people who believe I should be able to have myself killed are liberals who don't even believe I should be able to sell my work for less than a preset minimum wage. (On some days I even agree. But then I don't believe the other half of the contradiction so it's OK). So most people do believe in inalienable rights and then it is hard to see how life could not be among them.

  • Fourth, there is no ability test for being a human and that includes intelligence, sentience, &c.; This is of course the central moral question on life issues and therefore extremely controversial. In practice very few people are ever convinced to switch sides on this. Still one can try for a consistency argument: There is variance in abilities and any such rule will elevate some apes over some born infants or cognitively disabled humans and humans loose the abilities every night. One can try to get around this with some additional rules but they get a lot less intuitive and could be tweaked to exclude even more people if that where convenient. This is the matter slippery slopes are made of.There are a lot more principles we could talk about, but these suffice for the questions we are talking about.On the early miscarriage research questions I would like to know which viable research avenues are actually ignored. All those I can think about would involve inherently evil actions. Since nothing can be both illicit and obligatory ignoring those is simply not candidate for a violation of the second rule.On the extraordinary measures question it's more complicated. There are situations where we don't want the patient to to die, we just want to stop fighting the inevitable. For example if one more round of chemotherapy will buy a few months but make them miserable it's reasonable to just dope up and enjoy whatever time is left. On the other hand if there is a reasonable chance of healing but the patient just has lost the will to fight, that is understandable and often even excusable but not right.The PVS question is different though. One difference is that a PVS does not automatically lead to death. With proper medical care people can survive it for decades. If in such situations we withhold care we would give to awake people that is an ability test and not OK. The other problem is what dehydration actually means. If the patient was awake we would count it as brutal torture. And unconsciousness can't change that fundamentally. We wouldn't see it as legitimate if someone with a torture fetish sedated the victim and then fastened the thumb screws. Basically human bodies have dignity and there are some things you just don't get to do to them. Dehydration is among them. Changing the rules for PVS patients is, again, an unacceptable ability test.