Abstract
The presence of a human being/organism—a living human ‘whole’, with the defining tendency to promote its own welfare—has value in itself, as do the functions which compose it. Life is inseparable from health, since without some degree of healthy functionality (if not in all cases active functioning) the living whole would not exist. The value of life differs both within a single life (in different periods or possible situations) and between lives (lives that vary in length, health or even physical maturity are not all equally fulfilled). As with any other form of human flourishing, the value of life-and-health must be distinguished from the moral importance of human beings: less fulfilled means not less important morally, but more in need of being fulfilled. That said, to say that life and health has value is not to say exactly what—if anything—that value requires by way of active promotion at a given time. Many factors must be taken into account in making health care decisions, even if the worth of all lives, and the dignity of all human beings, must in every case be acknowledged.
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Notes
For example, it is possible to believe that all lives have inherent value of a kind that should in principle be promoted—but by nursing care rather than medicine if the aims seen as proper to medicine can no longer be achieved. See Linacre Centre (1993, pp. 138–9).
There are those who believe that life lacks all value in certain conditions, such as a state of permanent unconsciousness, but still do not believe it is the task of health professionals to ‘take it upon themselves’ to end such lives as having no worth or a negative worth.
An organism, as I am using the term, is a self-organising whole (as opposed to a living part), which dies when the capacity to organize itself, even momentarily, is irrevocably lost. This capacity in more developed human beings is widely linked to the presence of a working brain, although this is increasingly disputed (see e.g., Shewmon 2009). Whether or not brains are indeed necessary to integrate older human beings, they are clearly not necessary to integrate very immature human beings. The embryo who constructs its own brain is clearly alive before the brain it systematically constructs.
On the tendencies required to be a living human embryo, see Watt (2007), Condic (2011). Note that a human being/organism of any age can be imminently dying—or at least, imminently dying without some major intervention. A patient in the middle of a heart transplant is still alive, even if the transplant is doomed to fail, and even if the patient does not have the inner resources for more than momentary survival. Such a patient retains specifically human life (life is always specific to the kind of organism in question), composed of, among other things, a directedness to rationality seen in the person’s structure and potential, including potential blocked due to missing or damaged features (see below).
This is not to deny that when we think of human life, we also think of ‘vital functions’ such as heartbeat, breathing and so on.
Note, however, that someone who believes that life is not just instrumentally but inherently valuable may also believe that this value is contextual: it ‘inheres’, they may say, in the conscious activity that life involves or enables (or will enable in the future). Such a view may be held by someone who accepts that human ‘persons’ or (full) human moral subjects are bodily beings who exist as long as life remains, while denying that basic bodily functioning or functionality is an aspect of human existence with value in itself.
For practical purposes, the view that only life-with-knowledge is valuable may well be indistinguishable from the view that knowledge rather than ‘life itself’ is valuable. For example, someone who holds either view may see no reason to prolong life in an unconscious state, whether or not he/she believes that life in such a state may be purposely ended (see below for a discussion of euthanasia and support for unconscious lives).
As it may not be in the case of frozen embryos, for example (see below). Every actual expression will of course build on a tendency: it is impossible to imagine running without the tendency to run at every point, which forms part of the ongoing action itself.
This seems implausible: it would seem to exclude, for example, deliberately giving the common cold to volunteer research subjects, or deliberately withholding confidential information with the aim that this information not be acquired. That said, some deliberate attacks on innocent human beings are indeed morally excluded: we can think of deliberate killing, deliberate mutilation and so on.
This is certainly the case with proponents of the ‘new natural law’ approach to ethics. See, for example, the following evocative passage from Finnis (1980), p. 86:
A first basic value, corresponding to the drive for self-preservation, is the value of life. The term ‘life’ here signifies every aspect of the vitality (vita, life) which puts a human being in good shape for self-determination. Hence, life here includes bodily (including cerebral) health, and freedom from the pain that betokens organic malfunctioning or injury. And the recognition, pursuit, and realization of this basic human purpose (or internally related group of purposes) are as various as the crafty struggle and prayer of a man overboard seeking to stay afloat until his ship turns back for him; the teamwork of surgeons and the whole network of supporting staff, ancillary services, medical schools, etc.; road safety laws and programmes; famine relief expeditions; farming and rearing and fishing; food marketing; the resuscitation of suicides; watching out as one steps off the curb…
This potential or capacity is in fact an aspect of health in those of the relevant age.
This is not to deny that an exercise of function can impact immediately, for good or ill, on health—just as an exercise of kindness or courage on some occasion can help make a person more courageous or kind.
See note 12.
Sometimes it is better morally overall and/or in terms of overall health to decline to use a function: a person who goes on a much-needed diet is declining to use a function, or to use it as much as he or she normally does, precisely for the ‘health good’ and/or some ‘social good’ of the whole.
Can health be good and not the life that healthy functions help to compose? Yes, someone might say—or at least, if there is some good in these healthy functions, that good might be outweighed by some overwhelmingly bad attribute. Is that not what we say about euthanasia for animals? A pet owner might refer to his badly-injured pet still having bright eyes and many functioning organs, and recognise good in the entire functioning animal, while seeing this good as outweighed by the pet’s suffering, such that it not only may but must be ‘put down’.
One response to this challenge is simply to deny that animal ‘euthanasia’ or putting animals down is in the interests of the animal overall, despite the real disvalue of the animal’s suffering and the moral permissibility of ending the suffering in this way. A separate consideration is that in feeding and caring for an animal, we take on responsibility for its well-being. Putting animals down, even if not beneficial to the animal (we might think of drowning newborn kittens) removes that responsibility, which we may reasonably want to avoid. It is good to identify with the suffering of animals (say, to think that if one is thirsty, one’s dog may also be thirsty), but euthanasia as opposed to ‘putting down’ for other reasons is not necessarily a beneficial response to the suffering of animals, any more than that of human beings. On the question of animal euthanasia see J.L.A. Garcia (2007).
Functionality above a certain level—say, exceptional athletic potential—may be an expression of the good of health in some sense but is less clearly the province of health care, even if its promotion may involve medical expertise. I will not here address the question of ‘enhancement’ of this kind.
Even conceding that desires can be linked with genuine interests which can then be thwarted, it is not clear why we should think that the presence of desires or projects is always necessary for us to have interests to be thwarted or fulfilled. Certainly, desires are not necessarily sufficient for us to have interests in the satisfaction of precisely those desires. For one thing, not all desires are morally good: some not only may but should be thwarted as objectively harmful to our interests and perhaps those of others. The desire to end one’s own life would be one widely accepted example.
In contrast to organisms, machines have functions which relate entirely to the intentions of their makers. Similarly, if a genetic engineer produced a heart defect in a human or non-human animal in order to study that defect, this instrumental, externally-imposed ‘function’ would not be a true function of the animal but would be a malfunction, physiologically speaking.
Note that this applies even to cases where a function, while geared like any function to overall health, harms overall health in a particular individual, say, by increasing cancer risk, even if it retains a value worth preserving if we could.
As Brock (2005) points out, irreplaceability is not the same as uniqueness: “We do not have to suppose that every person makes a unique or outstanding ‘contribution’ to the world—as though, if no category were overlooked, every person would find his or her way into the book of world records. Even if this were true, it would not establish the person’s value as one who exists just for his or her own sake. It would only establish the value of something that the person has—some quality or work. What we are seeking is something else: the value pertaining to the very subject, the person himself or herself, in his or her sheer ‘selfhood.’” Brock further observes that it is not easy to square the thesis of the essential equality of human persons with the idea that personal dignity rests on uniqueness.
Admittedly, people who love their pets may not see them as exactly replaceable even as they prepare to ‘get another’ (often in a rather different spirit, though, from bereaved parents who may decide to ‘have another child’).
As Alexander Pruss (2010) has noted:
“Who loses a good can be morally relevant, over and beyond the question of what the lost good is. The mouse's breathing does not have as its telos the support of distinctively human activity, while the human's breathing does have as its telos the support of distinctively human activity. This value in the human's breathing is present even when, in fact, the human is unable to engage in any distinctively human activity. For there is a value in a striving for an end even when the end is not expected to be achieved, and that value derives from the value…of the end (this is related to issues in sexual ethics), and the human's breathing strives for the end of distinctively human activity.”
The value of human existence cannot be demoted by disease to that of lower animals with a very different welfare. Human beings have interests in a far richer range of goods than non-rational animals. When things go badly for us, there is more of which we are deprived: more value missing, for the very reason that there is also more value present in the orientation to rationality which we always possess.
See Pruss (2013). Pruss reflects further in a blogpost (2010) on valuing the beloved: “Consider the attitude one might have towards someone that one loves who has fallen dreamlessly asleep—say, one's child or one's spouse. One may fondly kiss the beloved's head, recognizing the beloved's present value—fondness always involves an element of taking the beloved to have value. If the value of humans essentially requires consciousness, there is either a mistake here or else the value is entirely constituted by the expected future consciousness. It is implausible to say that a mistake is being made, so let us consider the future-consciousness hypothesis. Suppose that the beloved is going to be executed by a tyrant as soon as she is about to regain consciousness. Then there is no future consciousness (except in the afterlife, and I do not think the attitude depends on beliefs about the afterlife). But the tragic absence of a future consciousness does not make one less fond—it does not make one value the person less—but the very opposite. Nor is one's attitude as it is towards a corpse. In the case of the sleeping person who will be executed, one dreads and mourns a future loss; in the case of the corpse, one mourns an already present loss.”
As Brock (2005) observes: “it would be a mistake to think that in ‘wanting good for some being’ what is wanted must always be other than the being that it is wanted for. This would make little sense. In loving a friend, one does not just want other goods to exist, for him; one surely also wants him to exist, for him. One wants his wellbeing. A necessary element of this is his simply being… the object of love of friendship, as such, is not only a being for which good is wanted, but also a good that is wanted—for itself.”
There are various possible permutations here: the value of segment A in terms of life-and-health i.e., functionality may be equivalent to the value of segment B; however, segment B may include more valuable functioning whether from the physiological perspective (over this period, you successfully had a child) or from the moral and social (you functioned well as a human being, bonded with your child, celebrated with your spouse and friends, did other worthwhile things for yourself and others, and so on).
That said, the relative simplicity of a child has a charm and value of its own, just as a sketch may have a charm and value lacking in the greater, finished work of art.
We differ in many ways; however, we are all the same kind of being, who could (in theory) be fulfilled in the same basic ways, and whose fulfillment is always morally important, as the same fulfillment in the life of one and the same living being.
This also applies to those, such as dissidents living under murderous regimes, who give up their lives such that these lives, though cut significantly and unjustly short, now include an admirable choice of self-sacrifice as risks of death are freely accepted. Death remains bad in itself, but there is a (social, non-medical) sense in which such shortened lives have achieved more than our own.
References
Ber, R. (2000). Ethical issues in gestational surrogacy. Theoretical Medicine, 21, 153–169.
Brock, S. L. (2005). Is uniqueness at the root of personal dignity? John Crosby and Thomas Aquinas. Thomist, 69, 173–201.
Condic, M. (2011). A biological definition of the human embryo. In S. Napier (Ed.), Persons, moral worth, and embryos (pp. 211–235). Dordrecht: Springer.
Eberl, J. T. (2012). Metaphysical and moral status of cryopreserved embryos. Linacre Quarterly, 79(3), 304–315.
Finnis, J. (1980). Natural law and natural rights. Oxford: Clarendon.
Garcia, J. L. A. (1990). The primacy of the virtuous. Philosophia, 20, 69–91.
Garcia, J. L. A. (1997). Intentions in medical ethics. In D. Oderberg & J. Laing (Eds.), Human lives: Critical essays on consequentialist bioethics (pp. 161–181). London: Macmillan.
Garcia, J. L. A. (2007). The doubling undone? Double effect in recent medical ethics. Philosophical Papers, 36(2), 245–270.
Garcia, J. L. A. (2010). The virtues of the natural moral law. In H. Zaborowski (Ed.), Natural law in contemporary society (pp. 99–140). Washington: Catholic University of America Press.
Grisez, G., Boyle, J., & Finnis, J. (1987). Practical principles, moral truth, and ultimate ends. American Journal of Jurisprudence, 32, 99–151.
Howsepian, A. A. (2009). Very quiet people: Ethical, medical, and theological perspectives on those in ‘vegetative’ or other hypokinetic states. In H. Watt (Ed.), Incapacity and care: Controversies in healthcare and research (pp. 122–135). Oxford: Linacre Centre.
Linacre Centre. (1993). Submission to the select committee of the House of Lords on medical ethics. In L. Gormally (Ed.), Euthanasia, clinical practice and the law (pp. 113–165). London: Linacre Centre.
McCarthy, A. (2009). Human dignity and the intellectually disabled person: Can prevention of harm justify sterilisation? In H. Watt (Ed.), Incapacity and care: Controversies in healthcare and research (pp. 37–57). Oxford: Linacre Centre.
Nozick, R. (1981). Philosophical explanations. Cambridge: Harvard University Press.
Pruss, A. (2010). What is the essential harm in murder? At http://alexanderpruss.blogspot.co.uk/2010/09/what-is-essential-harm-in-murder.html.
Pruss, A. (2011). I was once a fetus: That is why abortion is wrong. In S. Napier (Ed.), Persons, moral worth, and embryos (pp. 19–42). Dordrecht: Springer.
Pruss, A. (2013). One body. Notre Dame: University of Notre Dame Press.
Ravelingien, A., Mortier, F., et al. (2004). Proceeding with clinical trials of animal to human organ transplantation: A way out of the dilemma. Journal of Medical Ethics, 30, 92–98.
Ravelingien, A., Mortier, F., et al. (2006). Authors’ reply: A body at will. Journal of Medical Ethics, 32, 609–611.
Shewmon, D. A. (2009). Brain death: Can it be resuscitated? Hastings Center Report, 39(2), 18–24.
Sparrow, R. (2006). Right of the living dead? Consent to experimental surgery in the event of cortical death. Journal of Medical Ethics, 32, 601–605.
Tollefsen, C. (Ed.). (2008). Artificial nutrition and hydration. Dordrecht: Springer.
Valiquette, J. (2009). PEG tubes in end-stage dementia: Benefits and burdens. In H. Watt (Ed.), Incapacity and care: Controversies in healthcare and research (pp. 106–121). Oxford: Linacre Centre.
Watt, H. (2000). Life and death in healthcare ethics: A short introduction. London: Routledge.
Watt, H. (2004). Beyond double effect: Side-effects and bodily harm. In D. Oderberg & T. Chappell (Eds.), Human values: New essays on ethics and natural law (pp. 236–251). London: Palgrave MacMillan.
Watt, H. (2007). Embryos and pseudoembryos: Parthenotes, reprogrammed oocytes and headless clones. Journal of Medical Ethics, 33(9), 554–556.
Watt, H. (2009). Justifying research without consent. In H. Watt (Ed.), Incapacity and care: Controversies in healthcare and research (pp. 58–74). Oxford: Linacre Centre.
Watt, H. (in press). Childbearing: The ethics of pregnancy, abortion, and childbirth. New York: Routledge.
White, A. (2014). Body integrity identity disorder beyond amputation: Consent and liberty. HEC Forum, 26, 225–236.
Acknowledgments
I am grateful to Anthony McCarthy, Joseph Boyle, Tim Wilkinson, David Jones, Stephen Barrie, Colin Harte, Ted Watt and two anonymous reviewers of HEC Forum for their comments on this paper.
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Watt, H. Life and Health: A Value in Itself for Human Beings?. HEC Forum 27, 207–228 (2015). https://doi.org/10.1007/s10730-015-9288-2
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DOI: https://doi.org/10.1007/s10730-015-9288-2