Does "Quality of Life" Make a Difference?

Last year President Ronald Reagan died after a long battle with Alzheimer’s Disease. For weeks afterward we heard tales of his slow descent from a sharp, out-going man to the mentally and physically frail kind of person that Alzheimer’s always leaves in its wake. It was a sad time for Americans and the world, and it reminded many of us how much we want to avoid that sort of fate. It is not unusual for people to want to take matters into their own hands, or at least ask family members to do so. In other words, many would rather be euthanized than let nature take its course. But is euthanasia a morally viable option? Should it be legal?

The key question is this: can we rightly call euthanasia murder? Murder, as we all know, is the unjustified taking of a human life, but proponents of euthanasia often appeal to a person’s quality of life as a justification for the practice. So is euthanasia a justified killing or not? We must acknowledge that the concept of “quality of life” has a certain gut-level appeal in our culture. Even Christian people will nod in agreement when it is mentioned. If your quality of life is low, then you should be allowed to exit gracefully, or so the reasoning goes (notice how terms like “exit gracefully” can be used to deflect the arguments that euthanasia is murder).

It seems to me, however, that “quality of life” is a bit of a slippery concept. It has an inherent appeal to enjoyment or pleasure that seems to be problematic. According to some, if a person, say an Alzheimer’s patient, is not able to enjoy her life, then she should be euthanized, or at least have the option of euthanizing herself. This gives rise to a question: If quality of life the deciding factor, why should we not allow suicide for those with severe depression? Especially for those for whom therapy and/or medicine has had negligible effect? They are not enjoying life. Surely their quality of life is as low as the Alzheimer’s patient. Most people, however, will reject this idea. Why? It is because they think the life of the depressed individual still holds more promise than the life of the Alzheimer’s patient, and they may be right about that last point. However, I reject this as a reason for differentiating between the Alzheimer’s patient and the severely depressed. If we make life and death decisions based on potential for future actions we run into yet another problem. Once again, where is the line to be drawn? There are degrees of potential, are there not? Where should we draw the line as to who lives and who dies? Are people with higher potential, like a young Albert Einstein, more valuable than a more average person like myself? And if so, why stop with the terminally ill? Why not move forward to the mentally disabled?

Right about now I expect some are crying “slippery slope argument!” Though there may be a “slope” there is no fallacy here. I am not claiming that the execution of the mentally disabled will occur. Instead, I am saying that the same logic can be used to justify the euthanasia of the terminally ill and the mentally disabled. This indicates the flawed nature of this argument in favor of euthanasia. It leads to undesirable consequences.

Another argument for euthanasia relies on a system of morality that allows for the killing of those who are no longer useful for themselves or society. This kind of argument certainly does not follow the moral intuitions of most people, though that in itself does not mean the idea is false. It does, however, mean that we can feel free to treat it with skepticism. If the person who holds to this morality cannot give us a strong reason to abandon what we intuitively believe, it can be rejected. I must point out, however, that even if we do allow for this form of morality the person to be euthanized can still serve a useful purpose for society, if not for themselves.
For instance, caring for such individuals can positively shape the character of those who perform the care. When we care for those who cannot care for themselves we may develop empathy for those who are less fortunate in society. The benefits are obvious. Increased personal generosity could alleviate problems with poverty. We might also develop an appreciation for our own lives through the care for those in such need. Don’t misunderstand; I am not saying these things absolutely would happen. I am not that naïve. I am saying that with proper direction those involved in care for invalids can develop these positive character traits.

Noticeably absent from this essay so far has been any reference to physical suffering. We’ve covered issues stemming from psychological suffering, but we haven’t mentioned anything about pain. For instance, cancer can be an agonizing way to die. Why not let someone die to avoid the pain? I must point out that with modern medicine the pain is avoidable. “But,” someone may object, “often pain medicine leaves you in a stupor. You are not yourself for the rest of your life!” My response is to say that the section above applies to this sort of psychological suffering. Besides, it is clear that the person in the stupor is not suffering because they are not aware enough to suffer.

A better objection is this: “We certainly have this pain medication now, but what about in the past or somewhere where no anesthesia is available? Was allowing someone to suffer wrong then?” As a preliminary response I would say that people didn’t live as long with their illnesses in the past either, so suffering often wasn’t prolonged as it can be today.
Ultimately it comes down to your view of what it means to be human. Are we valuable in ourselves, or are we only valuable as long as we are useful? If we are valuable in ourselves no amount of pain can justify one of us taking another’s life (what can justify taking a life is another question entirely). If we are valuable as long as we are useful, then by all means eliminate the “useless.” Beware, however, because this logic will justify a long and gruesome future.