Albert Camus, The Myth of Sisyphus & Other Essays, trans. Justin O'Brien (New York: Vintage Books,1 1955), p. 89. Richard Taylor, «The Meaning of Life,» Good and Evil, rev. ed. (Amherst, N.Y.: Prometheus Books,2 2000), p. 329. «Ecclesiastes,» The Anchor Bible, trans. Choon-Leong Seow (New York: Doubleday, 1997), p. 118.3 The author of Ecclesiastes remains unknown. Ecclesiastes has traditionally been attributed to Solomon. However, many bible scholars including Seow believe that this is implausible. SORITES (     ), ISSN 1135-1349 Issue #14 - October 2002. Pp. 70-84 Futility and the Meaning of Life Debate Copyright © by SORITES and Brooke Alan Trisel FUTILITY AND THE MEANING OF LIFE DEBATE Brooke Alan Trisel <triselba@cs.com> The concept of futility has figured prominently in the debate about whether there is a «meaning of life.» Futility is exemplified by the ancient myth of Sisyphus. Sisyphus, it will be recalled, was condemned by the gods to push a large stone up to the top of a mountain, whereupon the stone would immediately roll down the mountain, at which time Sisyphus would again push the stone back up the mountain, only to have it roll down again. This struggle by Sisyphus to get the stone to the peak of the mountain goes on forever. In recounting the myth, Albert Camus writes: «His scorn of the gods, his hatred of death, and his passion for life won him that unspeakable penalty in which the whole being is exerted toward accomplishing nothing.»1 Some have argued that the condition we find ourselves in is no different from the one faced by Sisyphus and that this becomes evident when we set aside our life affirming internal perspective and view life from a detached, external perspective. For example, Richard Taylor asserts: «The two pictures - of Sisyphus and of our own lives, if we look at them from a distance - are in outline the same and convey to the mind the same image.» However,2 Taylor concludes his analysis by arguing that it is best to view life from an internal perspective and that life's meaning is not bestowed from «without,» but comes from «within.» The notion of futility is also reflected in the provocative writing Ecclesiastes from the Old Testament, as evidenced by the following example: «So I turned to all my works that my hands had done, and my toil that I toiled to accomplish, and, lo, all is vanity and a pursuit of wind, and there is no advantage under the sun» (Ecclesiastes 2.11). The noted pessimist3 Schopenhauer expresses a similar belief when he writes: That the most perfect manifestation of the will to live represented by the human organism, with its incomparably ingenious and complicated machinery, must crumble to dust and its whole essence and all SORITES Issue #14 - October 2002. ISSN 1135-1349 68 Arthur Schopenhauer, «On the Vanity of Existence,» Essays and Aphorisms, trans. R.J. Hollingdale4 (London: Penguin Books, 1970), p. 54. See, e.g., Richard Taylor, «The Meaning of Life,» op. cit.5 Lawrence J. Schneiderman, Nancy S. Jecker, and Albert R. Jonsen, «Medical Futility: Its Meaning and6 Ethical Implications,» Annals of Internal Medicine, 112 (1990), p. 950. Ibid., p. 950.7 Ibid., p. 951.8 Ibid., p. 951.9 its striving be palpably given over at last to annihilation - this is nature's unambiguous declaration that all the striving of this will is essentially vain.4 One who believes that human endeavor is futile will hereinafter be referred to as a «futilitarian,» following the standard usage of this word. The following two questions will be explored in this article. First, what does it mean when someone claims that «life is futile» and is this claim valid? Second, if human striving is futile, as futilitarians contend, can life still be worth living? Although «meaninglessness» has been explored in great detail, the concept of futility, as expressed in the context of the5 meaning of life debate, has received very little scrutiny. However, an extensive literature has developed in the field of bioethics regarding «medical futility.» It will be useful to take note of these discussions before addressing the question of whether life is futile. I. Medical Futility Physicians have sought an «objective» way of determining when treatment should be withheld or withdrawn from a patient. The concept of medical futility has been proposed as one such method. The physician Lawrence Schneiderman, a proponent for using evaluations of medical futility to guide medical decision making, asserts that «a futile action is one that cannot achieve the goals of the action, no matter how often repeated.» In giving an example6 of a futile treatment, Schneiderman argues that it is futile to provide nutritional support to a patient who is in a persistent vegetative state and that this is futile «for the simple reason that the ultimate goal of any treatment should be improvement of the patient's prognosis, comfort, well-being, or general state of health.»7 Schneiderman indicates: The futility of a particular treatment may be evident in either quantitative or qualitative terms. That is, futility may refer to an improbability or unlikelihood of an event happening, an expression that is quasinumeric, or to the quality of the event that treatment would produce.8 Schneiderman proposes two standards for determining when treatment is futile. Under the quantitative standard, which is expressed in probabilistic terms, a treatment is futile «when physicians conclude ... that in the last 100 cases, a medical treatment has been useless, they should regard that treatment as futile.» Under the qualitative standard, «any treatment that9 merely preserves permanent unconsciousness or that fails to end total dependence on intensive «Futility and the Meaning of Life Debate» by Brooke Alan Trisel 69 Ibid., p. 952.10 Ibid., p. 951.11 See, e.g., Baruch A. Brody and Amir Halevy, «Is Futility a Futile Concept,» The Journal of Medicine12 and Philosophy, 20 (1995), pp. 123-144. Robert D. Truog, Allan S. Brett and Joel Frader, «The Problem With Futility,» The New England13 Journal of Medicine, 326 (1992), pp. 1560-1564. medical care should be regarded as nonbeneficial and, therefore, futile.» He argues that10 quantitative and qualitative determinations of futility relate to the same underlying notion that the result is not commensurate to the effort. In his words, «The effort is, on the part of the agent, a repeated expenditure of energy that is consistently nonproductive or, if productive, its outcome is far inferior to that intended [emphasis added].»11 Schneiderman's descriptions of futility, and his proposed standards for judging medical futility, clearly demonstrate that the concept of futility is a combination of and reflects three other more basic concepts: (1) ordinary causation; (2) failure; and (3) the temporal related notion of repetition. Futility is conceived of as a repeated failure of the means to «bring about» or «produce» an «intended» effect; the means are persistently insufficient at producing the intended effect. Many have argued that the notion of medical futility is value-laden and problematic and,12 therefore, that it should not be utilized as the basis for physicians to make decisions, especially unilateral decisions, about the provision of treatment. Robert Truog writes: «The fact that this concept has appeared in law and policy may seem to indicate that it is clearly understood and widely accepted. In reality, however, the notion of futility hides many deep and serious ambiguities that threaten its legitimacy as a rationale for limiting treatment.»13 Since futility is thought of as a failure to bring about the «goal» of treatment, whether or not treatment will be judged futile depends, in large part, on how one conceives of and defines the goal. For example, suppose that a patient has been in a vegetative state for nine months as a result of a serious head injury. The patient's physician has concluded that treatment is futile, and therefore that life-support should be withdrawn, since it is unlikely that the patient will ever regain consciousness, recover a significant amount of physical or intellectual functioning, and be free of intensive medical support. After sharing this conclusion with the family of the patient, the family inquires whether there is any possibility that the patient will ever regain consciousness. The physician indicates that this is a remote possibility, but that the patient would likely continue to be extremely debilitated and dependent on intensive medical care. The family concludes that treatment is not futile since there is a possibility, however small, that the patient will regain consciousness if treatment is continued. Standards, including those used to evaluate futility, are derived from our goals. The «goal» of the family, in the above example, is for the patient to regain consciousness, whereas the goal of the physician is for the patient to regain consciousness and some physical functioning, and to be independent, at some point, of intensive medical care. Since the goal of the physician is loftier (appropriately so, the physician would argue) than the goal accepted by the family, the physician adopts a higher standard than the family for judging whether treatment is effective and should be continued. Consequently, the physician and the family SORITES Issue #14 - October 2002. ISSN 1135-1349 70 William Lane Craig, «The Absurdity of Life Without God,» The Meaning of Life,14 ed. E.D. Klemke (Oxford: Oxford University Press, 2000), pp. 53-54. For an in-depth analysis of the external perspective, see Thomas Nagel, The View From Nowhere15 (Oxford: Oxford University Press, 1986), esp. pp. 208-231. Craig, op. cit., p. 40.16 reach different conclusions about whether treatment is futile. What can be learned about futility, in general, from the deliberations regarding medical futility? I believe there are three things of importance. First, futility is a combination of the concepts of ordinary causation, failure, and repetition, as argued above. Second, the concept of futility is value-laden, as argued by critics of medical futility. Why is this so? It is value-laden because it reflects the notion of failure, which is value-laden. Furthermore, futility is conceived of not just as repeated, failed causation, but as the failure to cause a desired or «intended» effect or to realize a goal. If an effect is intended or desired, or a goal is established and pursued, this suggests that it is valued. Evaluative standards are derived from goals which, in turn, are based on values. Through its association with goals, which can vary among individuals in terms of how a goal is defined and understood, futility ends up being a value-laden concept. The third, and perhaps most important, thing that can be learned about futility from the discussions about medical futility is that judgements about whether an activity is or is not futile will vary according to the level of a person's expectations; the higher one's expectations are, the greater the likelihood that an action or activity will be considered futile. II. Is Life Futile? According to William Lane Craig: «If God does not exist, then life is futile.» How do14 futilitarians reach the bleak conclusion that life is futile? There are some distinctive characteristics of the perspective adopted by futilitarians that predispose them to conclude that «life is futile.» They view life from an external perspective, as if they were looking at it from a distant vantage point. Our internal perspective is naturally limited since we are earthbound15 and unable to personally experience what happened before we were born or what will happen after we die. The external perspective is not subject to these limits since it involves imaginative thought. As a result, this perspective tends to be very broad in scope (temporally and spatially), extending beyond our lifetimes and this planet to encompass remote times and places. For example, Craig writes: «Compared to the infinite stretch of time, the span of man's life is but an infinitesimal moment; and yet this is all the life he will ever know.»16 From this distant viewpoint, a futilitarian sees not just himself or herself, but all of humanity. Consequently, they ask questions about life in general, as opposed to questions about individuals. For example, they ask «Is there a meaning of life?» and «Is life futile?» instead of personal questions such as «Is my life meaningful?» and «Is my striving futile?» Because the questions that arise from this external perspective are about life in general, the answers that are given to these questions tend to be generalized to all of life. Thus, a futilitarian concludes that life is futile, not just for a few individuals, but for everyone. Many of our goals can be achieved as, for instance, when treatment does eradicate a disease, thereby extending a person's life. However, by temporally expanding the scope of our perspective, it raises the threat of futility. For example, if we broaden our perspective far enough to encompass times before and after the existence of human life, we see, as did the «Futility and the Meaning of Life Debate» by Brooke Alan Trisel 71 Craig, op. cit., p. 44.17 author of Ecclesiastes, that «All came from dust and all will return to dust» (Ecclesiastes 3.20). By reflecting on the thought that we will eventually all return to dust, a picture upheld by modern science, it prompts us to wonder about the following question: Will all of our toil, effort, and striving lead to anything of «significance» and, if not, then why do we continue to expend such effort? Continuing with the types of questions raised by viewing life from a broad, external perspective, Craig asks: «If death stands with open arms at the end of life's trail, then what is the goal of life? To what end has life been lived? Is it all for nothing? Is there no reason for life? And what of the universe? Is it utterly pointless?»17 Before the question of whether life is futile can be properly addressed, it is necessary to have a clear understanding of the concept of futility, which can be obtained by reflecting on the following example. Suppose that there is a race, that a runner crosses the finish line, and that the other runners who are still making their way around the track witness this. Is continuing the race «futile» for these runners? This depends on their expectations in running the race. If a runner's goal was to finish first, and if this runner would not be satisfied with anything less than a first place finish, then continuing the race is futile for this runner. It is futile because there is nothing that this runner could do to achieve the desired result. Even if this runner sprinted the rest of the way around the track, the goal of winning the race is unachievable and therefore continuing the race is a futile activity for this runner. However, if a runner's goal in entering the race was to improve upon a personal record, to finish in the top three, or simply to enjoy the experience of participating in the race, then completing the race is not futile for this individual. Although someone else has won the race, it remains possible for this runner to realize his or her goal. «Medical futility» has been criticized because of its ambiguity yet, when compared with the notion of existential futility, it no longer seems that unclear. In the field of medicine, there may be disagreement regarding the likelihood with which a particular treatment will bring about the intended result. However, the treatment is generally well defined and most people understand that the treatment is the means for achieving the «end.» Regarding the goal of treatment for a patient who has a life-threatening condition, at times there may be conflict between physicians and the families of patients about the exact nature of the goal. However, it is understood by the various stakeholders that the goal has something to do with extending and improving the quality of human life. Thus, in evaluating medical futility, there is at least some clarity about what the means and the ends are. However, this is not true regarding claims about the futility of life. Is life a means to an end, as religious oriented futilitarians assume, or is living one's life the end? Effectiveness is the opposite of futility. If, for example, a treatment is effective at curing cancer, then the treatment is not futile. The question «Is life futile?» is extremely obscure. This becomes evident by reversing the question and asking «Is life effective?» The first response will likely be «effective at what?» A treatment is considered effective if it brings about the «intended» result (e.g., alleviates suffering). The question «Is life effective?» and the reverse question «Is life futile?» both presuppose, and misleadingly suggest, that «life» is a means to an end, in the same way that a medical treatment is, and that there is an intended result or purpose of life. SORITES Issue #14 - October 2002. ISSN 1135-1349 72 Lawrence J. Schneiderman, Nancy S. Jecker, and Albert R. Jonsen, «Medical Futility: Response to18 Critiques,» Annals of Internal Medicine, 125 (1996), p. 671. Craig, op. cit., pp. 53-54.19 Even the vague question «Is philosophy futile?» is clearer than the question «Is life futile?» Philosophy is often thought of as a means for obtaining «ultimate» knowledge. If it is understood as such, then the question becomes whether philosophy can in fact lead to this intended result. However, before this question can be addressed, the goal must be clarified and defined. If one presumes that the aim of philosophy is to attain a complete understanding of the relations between subjective reality and the rest of the world or to solve all of the problems in the world, then this person will surely end up believing that philosophy is futile. However, if an individual has more realistic expectations about what philosophy can achieve, then it will likely be concluded that philosophy is not futile. Schneiderman suggests various reasons why he believes that people sometimes insist on receiving futile medical treatment. One explanation for this, he argues, is that «means are confused with ends,» meaning that people conceive of receiving treatment from sophisticated18 medical technology as the goal, instead of recognizing that technology is merely the means for achieving the true goals of medicine. If it is believed that the «goal» is to receive treatment, then this can lead one, inappropriately, to pursue this goal with great fervor even though such treatment may not improve the patient's condition and therefore may be considered futile by the physician. In reflecting on life, including the question of whether human striving is futile, an opposite type of misconception often occurs: ends are confused with means. Living one's life is thought of, not as an end, but as the means for achieving some «higher» or «larger» cosmic or divine purpose. If a person works in an organization, is unclear about the purpose or mission of that organization, and does not see the relation between work activities and the organization's purpose, perhaps because the organization is large or undergoing rapid change, then this individual may become frustrated and feel that his or her efforts are futile. Similarly, if it is assumed that life was created for a reason and is a means to an end, but that it is unclear exactly what that goal is, then this may lead one to conclude that striving is futile. Alternatively, if living one's life to the fullest that one can is thought of as the «end,» then, because this goal is intelligible and achievable, one is unlikely to conclude that «life is futile.» Thus, one's underlying belief about whether living is a means to an end, or an end that is worthy itself, will affect one's conclusion about whether striving is or is not futile. The words «meaningless,» «purposeless,» and «futile» recur throughout the writings of pessimists. «Meaning» and «purpose» are often used interchangeability as, for example, when someone asks: «Is there a meaning or purpose of life?» Although this question can seem bewildering, using «meaning» and «purpose» interchangeably in this question does not generally result in confusion since these words, in this context, have a similar meaning. The words «futile» and «meaningless» are also frequently used interchangeably. For example, when Craig uses «futile» in the statement: «If God does not exist, then life is futile. If the God of the Bible does exist, then life is meaningful,» he seems to mean that life would19 be «meaningless» without God. Regarding the writings of pessimists, Paul Edwards indicates: «Futility and the Meaning of Life Debate» by Brooke Alan Trisel 73 Paul Edwards, «Meaning and Value of Life,» The Encyclopedia of Philosophy, ed. Paul Edwards (New20 York: Macmillan, 1967), vol. 4, p. 467. Kurt Baier, «The Meaning of Life,» The Meaning of Life, ed. E.D. Klemke (Oxford: Oxford21 University Press, 2000), pp. 101-132. «They usually speak of the 'futility' or the 'vanity' of life, and presumably they mean by this both that life is not worth living and that it has no meaning.»20 Although «meaningless» and «purposeless» have a similar meaning in the context of discussions about whether there is a meaning of life, there is a significant difference in the meaning of «futile» and «purposeless.» Futile means that there is a repeated failure to realize a purpose that one envisions whereas purposeless signifies the absence of a purpose. A failure to recognize the difference and to distinguish between futile and purposeless can lead one to conclude, quite mistakenly, that life is futile if it has no purpose. If there is no «objective» purpose of life and life was not created for a reason by a superior being or an «intelligent» universe, as I believe, then there is no way that we could be failing to achieve such a purpose. Therefore, life is not futile in any objective sense independent of human subjective evaluation. Life could be objectively futile only if there was an objective purpose of life and we were unsuccessful, for whatever reason, at realizing this purpose. For example, if human life was created by a god for the singular purpose of rescuing a dying alien civilization and, despite repeated attempts to do so, we were ineffective at accomplishing this goal, then this god might conclude that human life is futile. But since we were not created for such a purpose, it does not make sense to claim that «life is futile» any more than it would make sense to claim that «life is effective.» «Life» is not futile, but it is «purposeless» in the sense that it was not created as the means for achieving a cosmic or divine purpose. This does not mean, however, that each of our lives is devoid of meaning or purpose since, as Kurt Baier and others have convincingly21 argued, one can pursue worthwhile purposes and create meaning in life, even if there is no «purpose of life.» Although «life» is not futile, striving to achieve a particular goal can be futile for an individual. Because the question «Is life futile?» misleadingly suggests that life is a means to an end, it would be better to rephrase the question to ask: «Is striving futile?» It then becomes clear that this depends on what one is striving to achieve. III. Futilitarian Expectations Since there is no preordained purpose of life, or at least there is no evidence of such a purpose, the only purposes that we could be failing to achieve are ones that we have conceived. What are the purposes that futilitarians believe that we are failing to achieve? To evaluate whether there is any merit to the subjective determinations of futilitarians that human striving is futile, we must first have a clear understanding of what their expectations are regarding life. For example, until it was clarified what the runners' expectations were regarding the race in the earlier discussed example, it was not possible to answer the ambiguous question: «Is continuing the race futile?» Analogously, when futilitarians claim that human striving is futile, there is no way of knowing what they really mean by this statement, or of evaluating the validity of this claim, unless they also reveal what their expectations are. SORITES Issue #14 - October 2002. ISSN 1135-1349 74 Craig, op. cit., p. 40. 22 Ibid., p. 42. 23 Taylor, op. cit., p. 325.24 Without this essential information, the claim that «life is futile» is an empty statement. It conveys no information other than suggesting that the futilitarian is not meeting his or her expectations, whatever they are. Unfortunately, those who claim that life is futile do not state their goals clearly, but only indirectly through the standards they adopt to judge life. Rather than explicitly stating that   and  are their desires or goals, they claim that life is doomed or meaningless and/or futile without   and  . For example, Craig writes: «If God does not exist, then both man and the universe are inevitably doomed to death. Man, like all biological organisms, must die. With no hope of immortality, man's life leads only to the grave.»22 Death is thought of as preventing us from realizing a goal, but what goal? Craig suggests that achieving personal immortality is the goal. Thus, death is preventing us from realizing never-ending life. Since we are «biological organisms,» this goal of living forever is clearly unrealistic. Furthermore, even if personal immortality could be achieved, this would not automatically make a person's life meaningful. Indeed, part of what makes the life of Sisyphus seem meaningless to an outside observer is the fact that it persists forever. Craig recognizes this point, as indicated by the following remarks: But it is important to see that it is not just immortality that man needs if life is to be meaningful. Mere duration of existence does not make that existence meaningful. If man and the universe could exist forever, but if there were no God, their existence would still have no ultimate significance.23 Taylor indicates: «Activity, and even long, drawn out and repetitive activity, has a meaning if it has some significant culmination, some more or less lasting end that can be considered to have been the direction and purpose of the activity.» In addition to personal24 immortality, this «significant culmination» is what futilitarians seem to be seeking. They want to be able to look back at life, from the distant vantage point they are viewing life from, and to say that it amounted to something. Life did not simply perpetuate itself for a while and then crumble to dust leaving no traces that it had ever existed. Even if there was a significant culmination, then what? Would life suddenly be rendered purposeless since the «purpose of life» had been achieved? Thus, from the external perspective adopted by futilitarians, even a significant accomplishment might be unable to eliminate doubts about the significance of life. Furthermore, it is unclear what, if anything, would qualify as a «significant» achievement. We could construct a space station extending from one end of the galaxy to the other and yet, from an external perspective, this would not be considered «significant» since the space station, like life itself, will eventually be annihilated. Even if we had the grandiose powers sometimes given to us by science fiction writers, and were able to alter the course of the universe - perhaps extending its longevity - it is still doubtful that this would be considered a significant culmination for the following reason. If all of life will end at some point, as it surely will, it is inconsequential how long a cold, dark, and impersonal universe will persist after this point. «Futility and the Meaning of Life Debate» by Brooke Alan Trisel 75 Camus, op. cit., p. 3. 25 Indeed, as long as the universe is indifferent to our values and accomplishments, it is hard to imagine any achievement that would be considered «significant» from this external perspective. Consequently, one might be tempted to conclude that doubts about the significance of life would be erased, and that life could be considered significant, if there was a personal god who created life for a reason and who considers life important. Of course, this longing to be recognized by a superior being is reflected in Christian theology where it is written: «So it was; and God saw all that he had made, and it was very good» (Genesis 1.3031). To the best that can be determined, the principal goal of futilitarians is to achieve personal immortality. In addition, some religious minded futilitarians seek reassurance from an independent source that life matters and is significant. If these are their expectations, then it is not surprising that they would find human striving to be futile, in the absence of a personal god who has the power to resurrect us from death, since there is no way we can overcome death on our own to realize the goal of living forever. Furthermore, since nature is impersonal, it is unable to declare or affirm that life is of any significance. What if we received some reassurance from a superior being that life is significant? Would futilitarians then conclude that life is not futile after all? On the contrary, due to lingering doubts about the significance of life, and because of doubts that will surely surface regarding the superior being, such as whether this entity is in fact self-sufficient and unlimited and therefore deserving of respect, I suspect that they would then further increase their already unrealistic expectations. Thus, it would then be claimed that human striving is futile unless there is personal immortality and we receive some additional evidence - perhaps a second opinion - that life is significant. If one's expectations are a moving target, as described, and set such that they are always out of one's reach, then all striving will seem futile. Camus, in a well-known passage, indicates: There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest - whether or not the world has three dimensions, whether the mind has nine or twelve categories - comes afterwards.25 Suicide is not the only serious philosophical problem, but it certainly ranks among the highest in terms of questions that need to be confronted. One possible reaction to futility is to give up. For example, a runner when faced with futility - perhaps after falling during a race - may decide to quit the race since there is no longer any possibility of achieving the desired result of winning the race. With medical futility, «giving up» on the goal of improving the condition of the patient involves withholding treatment or withdrawing treatment if treatment had already been initiated. C. Stephen Evans, a philosopher and proponent of Christianity, characterizes, inaccurately I believe, existentialism as «the philosophy of despair.» In describing existentialism, he writes: The paradigm of despair is the moment when death is certain and final and there is no recourse. Despair as a way of life is living death. It is the knowledge that every action or decision I take is utterly futile. To live in despair is to be alive, but aware that my life is of no more consequence than a corpse. No experience, decision, or accomplishment is of any significance; whether a deed is done or undone is SORITES Issue #14 - October 2002. ISSN 1135-1349 76 C. Stephen Evans, The Philosophy of Despair: Existentialism and the Quest for Hope (London: Probe26 Books, 1984), p. 65. Kurt Baier, «Threats of Futility: Is Life Worth Living,» Free Inquiry, 8 (Summer 1988), p. 51.27 Ibid., p. 52. 28 infinitely trivial. Consistent despair leads to suicide, which is a serious problem for Camus and Sartre, one to which neither gives any ultimately satisfactory answer.26 Evans goes on to suggest that the only way to overcome the futility and despair written about by some existentialists is to have faith that God exists. Disputing the reasoning of futilitarians that all efforts are futile because death prevents us from realizing the goal of eternal life, Baier argues: Surely, there are many things we do that are not futile, that are effective and successful. All is futile only if all our actions aim at eternally perpetuating our lives. But surely this is not so and would be wholly irrational if it were so, given that we know very well that we cannot attain this goal.27 If it is believed that all striving is futile because life will end some day, one might consider giving up on life. However, suicide would be an irrational act for a person with such a belief. The fact that futilitarians want life to go on forever - at least those who are religious oriented - demonstrates that they value life and find it worthwhile. Baier makes a similar point when he argues: «The sadness that lies in the thought that life ends in death shows, not that nothing in life is worth having but, on the contrary, that death may bring to an end something that would be well worth continuing; that it must end does not show that it is not worth having while it lasts.»28 If life were truly miserable and not worthwhile, then futilitarians would not bemoan death as they do, and certainly would not yearn for eternal life. Since life is valued, taking one's life would be to destroy that which is valued simply because the meaning and benefits (e.g., happiness) that are derived from living will not continue forever. It would be as if one were to assert: «If I cannot have the benefits associated with living go on forever, then I no longer want any benefits.» Instead of contemplating suicide based on the belief that all striving is futile since life will end, a more rational course of action, and one that should be pursued before judging life, would be to examine one's expectations since, in large part, they determine whether striving will be considered futile. In this self-examination, it will be useful for each of us to ask ourselves the following questions: Have I chosen realistic goals, taking into consideration that we are finite «biological organisms» in a natural world? Why do I value the goals I have chosen? Are these goals really as important as they seem? Have I unwittingly turned a personal desire into a standard for judging all of life? Do I have control over the means necessary for achieving this standard? We have no control over whether it is physically possible to live forever, nor do we have any control over whether there is a god who believes that life is significant. Therefore, it would be imprudent to adopt these two conditions as a standard for judging whether human striving is futile. IV. Can Pursuits Be Futile, Yet Worthwhile? Nihilists and futilitarians seem to assume that life cannot be worthwhile if there is no «purpose of life» or «life is futile.» The first premise has been subjected to penetrating criticism, as noted earlier. Having been created for a purpose is unnecessary for one's life to «Futility and the Meaning of Life Debate» by Brooke Alan Trisel 77 be worthwhile. What about the second premise? Is it a valid assumption or can living be worthwhile even if one's goals cannot be achieved? Questions that have been discussed as part of the meaning of life debate include: «Does life have a meaning or purpose?,» «Is life futile?,» and «Is life worth living or worthwhile?» The first two questions are narrowly focused, in comparison to the third question, since they are concerned solely with purposes - whether there is a worthy purpose of life and whether one's envisioned purposes are achievable. The question about the worthwhileness of life is not limited to goal related experiences. Determining whether an activity is «worthwhile» involves weighing the tangible and intangible benefits associated with performing the activity against the costs. If the benefits outweigh the costs, then it is generally concluded that the activity is worthwhile. For example, if it is believed that the benefits derived from attending a concert will exceed the costs, then this pursuit is considered worthwhile. This type of evaluation is often crude, implicit, and guided by emotions as well as rational thought. The same is true about an evaluation of whether life is or is not worthwhile. Thus, this form of evaluation differs from a formal, economic cost-benefit analysis, where the costs and benefits associated with an activity are made explicit and expressed in monetary amounts. An evaluation of worthwhileness is a much broader type of evaluation than is an evaluation of futility. To see the difference between these types of evaluations, let us return to the race example. One runner is observed crossing the finish line as the slower runners make their way around the track. Since a runner has won the race, completing the race is futile for other runners whose goal was to finish first. Nevertheless, the runners typically complete the race. Why do they continue? If we asked them, I think they would give a variety of reasons. Some would continue for pride, because determination - even when defeat is a certainty - is a trait valued by many people, or simply because of the pleasure and exhilaration derived from running in the race. Others may continue to avoid certain costs such as the feeling of shamefulness that is often associated with quitting. In effect, the runners have made two different types of evaluations, one regarding futility and another about worthwhileness. Runners' generally conclude that completing the race is worthwhile even though it may be considered futile. Thus, a runner can arrive at inconsistent judgements about whether to continue the race. This inconsistency is a reflection of the fact that there is a significant difference in the scope of the two types of evaluations. Realizing the goal of winning the race is only one of the potential benefits of participating in the race. Even if this goal cannot be achieved, there may be other benefits associated with completing the race. These other benefits are taken into account in an evaluation of worthwhileness, but not in an evaluation of futility. A futility evaluation focuses primarily on the question of effectiveness: whether the means will be effective at producing the intended result. To a much lesser extent (it may be ignored altogether in some analyses), the costs (e.g., «toil») involved in achieving the intended result may also be considered in the evaluation. The broader evaluation of worthwhileness considers, not only the costs involved in pursuing the activity and whether the means will or will not be «effective» at bringing about the desired result, but other costs and benefits (e.g., joy of running in the race) of the activity that are unrelated to effectiveness. Because an evaluation of worthwhileness takes into account benefits not considered in an evaluation of futility, continuing the activity may be considered futile (i.e., ineffective), yet worthwhile. SORITES Issue #14 - October 2002. ISSN 1135-1349 78 For a detailed discussion of the various methods used to assist in health care decision making,29 including cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis, see Henry M. Levin and Patrick J. McEwan, Cost-Effectiveness Analysis: Methods and Applications (London: Sage Publications, 2001) and Cost-Effectiveness in Health and Medicine, ed. Marthe R. Gold et al. (Oxford: Oxford University Press, 1996). These sources do not discuss medical futility. However, there are some similarities between a futility evaluation and a cost-effectiveness evaluation. One similarity is that both methods employ the concept of «effectiveness» instead of the broader concept of «benefits» used in a cost-benefit analysis. To return to the question of suicide, how should one go about deciding whether to continue living? It is of utmost importance to choose the best approach in deciding this question since a particular method can unduly influence one's decision and because suicide is irreversible. Should one decide whether to go on living based on the results of a futility evaluation, a worthwhileness evaluation, or perhaps with another method? A futility evaluation involves answering the question «Is striving to achieve the envisioned goal(s) futile?,» whereas a worthwhileness evaluation addresses the question of «Do the benefits associated with living exceed the costs?» Which question should guide the decision? Before addressing the above question, it will be useful to consider why medical futility has been proposed as a way to assist medical decision making and the advantages and disadvantages of this method of evaluation. A perceived advantage of a futility evaluation is that it avoids some of the problems associated with an economic cost-benefit analysis, including controversial ethical issues associated with placing a dollar value on the length or quality of human life and the difficulty of identifying and quantifying costs and benefits.29 Since a futility evaluation is concerned solely with the narrow issue of whether or not a particular treatment will be effective for a given patient, the preceding problems are circumvented, to some extent, and this type of evaluation may be considered more «objective» than other types of evaluations. A futility evaluation may seem more objective at first glance. However, it can in fact be as subject to personal bias as an evaluation of worthwhileness since it involves an assessment of whether the envisioned «goal» (which individuals may conceive of differently) will be achieved. Furthermore, the limited scope of a futility evaluation is a disadvantage as well as an advantage. Narrowing the scope of the evaluation may reduce intersubjective variability among those involved in the evaluation, but as a result it may exclude important values that would be taken into consideration in a broader evaluation and thus there is a tradeoff involved. When a decision will be made on behalf of other people (e.g., provision of medical care to a patient), to help assure that the decision will be as fair and unbiased as possible, limiting the scope of an evaluation can be preferable in certain situations. However, the question about whether one should continue living is a different kind of question, one that we, as individuals, decide for ourselves. This personal question should be addressed using the broadest form of evaluation possible, which is an evaluation of worthwhileness. A person can be «effective» and «successful,» by conventional standards, and yet miserable and find living not worthwhile. Conversely, one can be happy and find living worthwhile despite being ineffective or only modestly effective at achieving goals. Since an evaluation of worthwhileness takes into account experiences ignored by a futility evaluation, inconsistent judgements regarding whether or not one should continue living that are obtained from these two types of evaluation are likely to be, and should be, resolved based on the results of the worthwhileness evaluation. Furthermore, because an evaluation of the worthwhileness of life is extremely broad, it subsumes an evaluation of futility. Any costs and «Futility and the Meaning of Life Debate» by Brooke Alan Trisel 79 benefits associated with achieving or failing to achieve one's goals are already factored into an evaluation of worthwhileness, which makes a futility evaluation superfluous. Having and achieving purposes is undeniably an important part of life and is something that can enrich and give direction to our lives. However, there are other praiseworthy aspects of life which have nothing or very little to do with goal-directed activity. In deciding whether one should continue living, these experiences should not be overlooked or discounted. V. Preventing Futility To sum up, «life» is not futile in any sense apart from human subjective evaluation. Furthermore, just because the goal of living forever is unachievable does not mean that every action we take is futile or, in other words, that every goal is unachievable. Striving can be futile from a personal perspective, but whether or not it is futile can vary among individuals, over time, and from one goal to another, and largely depends on how high an individual has set his or her expectations and, to a lesser extent, on the capabilities of the individual. Since no purpose has been imposed on humankind from without, we are free, to a large extent, to choose our own purposes in life, as many existentialists have emphasized. Not only are we free to choose which purposes we will and will not pursue, but we are free to choose how high to set our expectations. Futility is not an inescapable part of the human condition, as futilitarians suggest, nor is a deity necessary for one to overcome a life of futility. The likelihood of experiencing futility is correlated with how high we have set our expectations. Therefore, we have a significant amount of control over whether or not our efforts will be futile. A person who lived life without having any goals would never experience frustration or failure. However, since this person would also never experience a sense of accomplishment, choosing to live an aimless existence is a high price to pay to avoid futility. A better way to avoid futility is to set realistic goals. There is a delicate balance involved in setting expectations. Goals should be challenging, but achievable. A goal that is easily met provides little, if any, sense of accomplishment since it does not test one's capabilities. An unachievable goal also does not provide a sense of accomplishment, but for the opposite reason: because it exceeds human capabilities. The goal cannot in fact be achieved no matter how much effort is put forth. By setting realistic goals and assuring that we have control over the means for achieving these goals, we can help to prevent our pursuits from becoming futile. However, if a person's overriding goal in life is to achieve personal immortality, and this goal is turned into a standard for judging futility, then all of one's efforts will surely seem futile. As a result, much energy will be spent reacting to and trying to cope with futility. In choosing unrealistic goals, one also indirectly chooses a life of futility, which can lead to frustration and despair. When futilitarians wonder why striving is futile, they need not look much further than to their own towering expectations. Even by embracing realistic goals, achieving these goals might not be possible due to circumstances beyond a person's control. One way of reacting to futility, as discussed, is to give up. This could mean giving up on the few goals that one was unable to achieve or giving up on life altogether. Instead of choosing the latter option just because one's expectations cannot be achieved, it would make more sense to consider pursuing other goals. Not only may these goals turn out SORITES Issue #14 - October 2002. ISSN 1135-1349 80 For other statements supporting that the author concluded that living is worthwhile, see Ecclesiastes30 3.12-13 and 11.7. to be achievable, but, more importantly, pursuing these goals can foster the creation of meaning in life. It is also important to explore and understand how the decision to «give up» was reached in the first place. The questions «Is there a purpose of life?» and «Is striving futile?» are too narrowly focused to provide a solid foundation for making a decision about whether one should continue living. This decision should be made taking into consideration everything associated with life, not just goal related experiences, and should be guided by the question «Is living worthwhile?» If futilitarians would pause to consider this broader question, they will likely conclude, as I believe the author of Ecclesiastes ultimately did, that living can be worthwhile even if striving is futile (i.e., one's goals cannot be achieved). The author indicates: «So I have commended joy because there is nothing better for people under the sun, but to eat, drink, and enjoy» (Ecclesiastes 8.15).30 An evaluation of futility leaves out those experiences that many of us cherish the most: being with family and friends, appreciating the beauty and grandeur of the rising and the setting of the sun, and marveling at the fact that life exists, just to name a few. There is more to life than just having and achieving purposes. Brooke Alan Trisel <triselba@cs.com>