ksagnostic

Since brain dead can be argued to be a form of functional death, no particular argument here.

This is, as I read it, essentially a coma with no possibility of recovery. Families have the option of removing life support now in most (if not all) states, particularly if the person in question has left a living will. This is not the same as active euthanasia, but if the life of such a person has to be actively maintained, it is not that far different.

As you say, slippery slope time. My response to this is absolutely not. You are now talking about other people evaluating the worthiness of lives of other people who are conscious and, from their perspective, don't know any different kind of life, but can still derive enjoyment, comfort, and make choices about their lives. That is the very definition of a slippery slope. Also, as one who works both with people in this population and chimpanzees, I can say that the comparision is not appropriate. Chimpanzees are not imperfect humans, they are chimpanzees, and any cognitive ability that chimps and humans share can by definition be learned as well by a chimp as a human. A person with a developmental disability, even a severe or profound one, on one hand may not be able to learn concepts that both a human and a chimp without a disability can learn, but on the other hand the human with a profound disability is a human being, and as such can learn to function in a human society much better than a chimp can. I'd rather take to the grocery store even some of the big guys I work with who have autism and severe mental retardation than even a very calm and personable chimpanzee.

Edited to add: A person with severe or profound disabilities will still behave like a human, and will learn species specific human behaviors that a chimpanzee, except if s/he is REALLY human enculturated, will not. Furthermore, even a human with severe developmental disabilities is more likely to learn and maintain standards of behavior for functioning in human cultures than even enculturated chimps.


Families, and for that matter the state, assume the burden for human beings who need extensive supports all the time, they are called children. Again, you are getting into slippery slope territory where people other than the individuals under consideration are deciding how worthwhile their existence is. The Philip Becker horror story eighteen years ago demonstrates how a slipper slope like this can work with the wrong family. Fortunately, by far most families do not take such a callous attitude (and before you get into how big a burden people with profound developmental disabilities can be, I warn you, I have worked in this field, with this population, for eighteen years, nine with adults with profound developmental disabilities, and for the last six years for a private residential school that works with students so tough to serve, or so tough on their families, that they end up with us--so I good idea how tough these situations can be on families).

Plus, when you are talking about people with developmental disabilities you are talking about people who have no other experience. For that matter, people who are congenitally blind, deaf, or who have cerebral palsy have no other reference point. I saw a documentary not too long ago on conjoined twins, who pointed out that their situation didn't frustrate them, even though they were often asked how they could stand their situation. As they pointed out, they never knew any differently. Even my late wife, who had severe idiopathic arthritis since infancy, probably lived with pain on her good days, when she was really enjoying herself, that would have left most of us crying in bed. I may have a different opinion about people who acquire disabilities, but even then, they should make their own decisions, and advance directives should not be taken as carte blanche (where a person at the height of their ability says at the time that they wouldn't like to live diminished, and later on when they are diminished but still able to express an opinion, and that opinion is "I want to live", that person's previous decision should not carry the day, because that person does not have the person's current perspective).

Different issue, as long a euthanasia is the person's choice. However, the state does have a compelling interest in protecting people's lives from "Oh, Grandpa wouldn't want to live deaf and aphasic, never mind him shaking his head."

I find your statement (which I italicized) absolutely chilling. "I'm sorry, you take too much resources, so your family can euthanise you if they want to."?? Even Gattica didn't imagine a future quite that extreme. More like Logan's Run.

I don't consider the people I have worked with, and had the privilege of knowing, wastes of resources whose condition merits a sentence of death.

Regards,

ksagnostic

(tidied up the multiple "message edited" lines - Michael)

[ June 26, 2002: Message edited by: The Other Michael ]</p>

Jamie_L

Brain dead: yes

Severely retarded: no

Jamie

The Other Michael

Hi ksagnositc,

Thanks for taking the time to make your detailed reply.

Chimps came to mind because I've just read Sagan's "The Dragons of Eden" and he discussed the chimps who learned ASL. Chimps were therefore mentioned since I had recently gotten some information about their cognitive abilities.

Since you work with both chimps and the severely-mentally disabled I'll concede that you have greater first-hand experience (and probably overall knowledge) in those fields.

<strong>You are now talking about other people evaluating the worthiness of lives of other people who are conscious and, from their perspective, don't know any different kind of life, but can still derive enjoyment, comfort, and make choices about their lives. That is the very definition of a slippery slope.</strong>

People make judgements on the worthiness of the lives of other people everyday.

This can range from politicians shifting resources from a program that benefits one group of people to a different program that targets a different population, to my deciding if a particular panhandler is more deserving of a handout than the panhandler down the block. Emergency response teams may make the decision to save one person and not the other, or that the rescue operation to save one person doesn't justify the risk to a number of rescue personnel. Hospital staff will triage patients and focus health care on those more likely to respond favorably to it. Heads of state decide whether genocide in other countries justifies sending in troops or other aid, and if the decision is made to send in personnel they then decide on how much aid is justified.

Not all of those decisions are of the "Fred's a worthless bum, while Sally is a pillar of the community, so we'll save Sally" class, but some do constitute decisions of relative worthiness.

<strong>Families, and for that matter the state, assume the burden for human beings who need extensive supports all the time, they are called children. Again, you are getting into slippery slope territory where people other than the individuals under consideration are deciding how worthwhile their existence is. The Philip Becker horror story eighteen years ago demonstrates how a slippery slope like this can work with the wrong family. Fortunately, by far most families do not take such a callous attitude (and before you get into how big a burden people with profound developmental disabilities can be, I warn you, I have worked in this field, with this population, for eighteen years, nine with adults with profound developmental disabilities, and for the last six years for a private residential school that works with students so tough to serve, or so tough on their families, that they end up with us--so I good idea how tough these situations can be on families). </strong>

The only thing I turned up on Becker was a George Will column or essay, but I don't know how accurately that portrayed the case (Will is not high on my list of reliable sources).

Families and states also at times do not assume the burden of caring for children. That seems obvious to me from the large number of children in dire conditions throughout the world.

<strong>I may have a different opinion about people who acquire disabilities, but even then, they should make their own decisions, and advance directives should not be taken as carte blanche (where a person at the height of their ability says at the time that they wouldn't like to live diminished, and later on when they are diminished but still able to express an opinion, and that opinion is "I want to live", that person's previous decision should not carry they day, because that person does not have the person's current perspective).</strong>

People can and do change their opinions. It is often difficult to state at time X how you will be feeling at time X+20 years, so advance directives should certainly be updated to reflect the current state of the individuals thoughts. My example of being conscious but unable to communicate was given to show my personal concern over being "stuck" in a condition that I might or might not wish to terminate without being able to convey my wishes.

<strong>I find your statement (which I italicized) absolutely chilling. "I'm sorry, you take too much resources, so your family can euthanise you if they want to."?? Even Gattica didn't imagine a future quite that extreme. More like Logan's Run.

I don't consider the people I have worked with, and had the privilege of knowing, wastes of resources whose condition merits a sentence of death.</strong>

I've not seen either of those movies (which is what I have the impression they are) so I can't comment on them.

As to what is found "chilling", that is something I think is pretty obviously going to vary from person to person.

Resources are allocated all the time in societies, and different societies and individuals are going to value different things at different times and places.

We can drag out the example of the band of hunter/gatherers where the aged/infirm are expected to take themselves off into the bushes if their demands on the group are being more than the benefit they provide to the group (and I'd bet that some of them were probably driven out, instead of nobly "doing the right thing"). What is considered a norm in these types of cases will vary with both the culture and the amount of available resources.

Personally, I'd be thrilled if more people would seriously consider the consequences of having children as my impression is that many parents probably aren't qualified to care for a pet, much less a child. I don't see procreation as being an inalienable right when the procreators are not going to take responsibility for their actions.

I've spent some time dealing with the public in a social welfare program, and can recall some 3 generation extended families receiving benefits, with the majority of the family qualifying on a mental disability basis.

Before anyone starts to flame me, the vast majority of the people I dealt with were NOT "Reagan Welfare Queens" and I did my best to see they got the benefits they were entitled to receive. I am "pro-safety net". I'm not making a blanket condemnation of the welfare system.

I have a lot of difficulty with the concept of multi-generational families made up of the mentally retarded. I have a lot of difficulty with people having children they are not able to support (financially, physically and emotionally) until their majority (which is a different situation from someone who is originally able to support the child and later falls on hard times).

I don't have a problem with pre-birth euthanasia (abortion) if the fetus is identified as having Down's syndrome or other severe disability. I also don't see a huge phase change taking place in a fetus as it crosses the vaginal dividing line into the external world. If the fetus could have been legitimately aborted due to severe disability 30 minutes earlier, then 3 minutes after birth seems to me to not be a quantitatively different scenario. But the slippery slope comes back when we start looking at 3 years, 3 decades, etc.

If a society has sufficient resources and the collective will to care for those individuals being discussed, I see no reason why they shouldn't do so.

If a family has sufficient resources and the collective will to care for those individuals being discussed, I also see no reason why they shouldn't do so.

In re the OP, I think what I'm trying to get at (possibly a bit circuitously, but I've spent a moderate amount of time trying to edit this for clarity), is the question of how much of a claim the individual can reasonably make upon others (family/society) for their long term care/support. If they are making that claim on the resources of others, might there not be in exchange some surrendering by the individual of the right to make these decisions to those providing the support?

cheers,
Michael
(who appreciates the chance to think about this a bit)

Jamie_L

This relates to some old abortion threads in this way: How should we define "person" in the legal sense? Law proscribes certain rights to people that are legally "persons". The most fundamental of those rights is the right to live.

The question then becomes, is a brain dead human being legally a "person"? Is a severely mentally retarded human being legally a "person"? These questions are best solved by trying first to define what constitutes a "person" for the purposes of law. What is it that we, as a society, find valuable in human beings that makes them worthy of legal protection?

This is related to morality, because the legal definition will be based on our values, which is basically what morality is all about.

In my opinion, the heart of what constitutes a "legal" person, as far as human beings go, is mental activity (in general - a more specific definition is obviously required, but that's not important for this post, I don't think). Therefore, brain dead = non-person. Retarded = person.

The issue of obligations place on other people is important, but not relevant, I believe. The burden a human being places on other people should not enter into the legal definition of "person". If it does, this easily leads to infants not being "persons", and then infanticide becomes perfectly legal and acceptable.

Jamie

ksagnostic

Before I reply:

1) I cut my original comments that you replied to, to manage length and to make this easy to follow. Sometimes, deleting comments also means deleting context, but I hope I have not done so.

2) A point I suspect I will make again and again is that the original topic of discussion here is euthanasia, which is the active killing of someone for the purpose of ending pain or preventing unavoidable worsening pain. While I will try to discuss the allocation of resources points you make, I wish to make the distinction that proposing euthanasia is an extreme proposal

There is a considerable difference between resource allocation and euthanasia. I am quite aware of the triage approach that societies are forced to take when allocating resources. I realize that third world societies often have to make difficult decisions, although even there I would find the practice of deliberately putting people to death because of disabilities abhorrent. In developed countries like ours, I see no excuse for claiming that a person who has severe/profound disabilities is unworthy of life. Working in this field, particularly when I was an adult dd administrator, I am well aware of the politics and resource allocation arguments that go on. However, the discussions tend to go on the basis of how much to serve these people verses how much to serve those people, and how much can we afford to serve both. Not, "let's not bother to keep these people alive at all, or interfere with decisions to euthanise them, because of the resources we might save." Euthanasia is an active process, where a creature is intentionally killed, painlessly or not.

Me either. Will recently wrote an incredibly bullshit editorial on Title IX, and Will seems to have been drifting even further rightward recently (my Mom thinks this trend started with his divorce, not that Will was ever liberal or moderate). However, his editorial on Becker (probably his most famous), was pretty much on the money IMO. I was in graduate school when the Becker case was occuring. Becker's family, who had almost no involvement in his day to day life, wanted to withold life saving (but pretty straight forward, as I recall) heart surgery. From the information I could glean at the time, Becker, like most people with Down Syndrome, had the potential to function quite well. Although there is an extremely wide range of functioning among people with Down Syndrome, many of them hold down jobs, pay at least some taxes, and even vote. Becker's family, who had almost no day to day contact with him, unilaterally made the decision not to go forward with the heart surgery because of a judgement THEY made about the quality of his life. Someone else eventually paid for the surgery. Phillip Becker would NOT have even qualified as severely or profoundly mentally retarded.

True, but unless they make arrangements to have their children cared for, these families get charged with neglect and abuse. And I certainly don't think the incredibly dire situations children are put in around the world should be ignored. But that is a seperate issue. Here in the USA, at least officially, abandoning and not taking responsiblity for one's children is a crime. That includes children with developmental disabilities.

And if the person has been rendered aphasic, but is still otherwise competent, advanced directives should not be used to trump what the person might wish now, and efforts should be made to determine the person's wishes at the time. Right now, we are still a ways from going this route, even Kervorkian didn't do euthanasia, he did assisted suicide.


Correct. Logan's Run actually was both a book and a movie (the book was much better). I don't know about Gattica.


I agree, and decisions about how many can we save/help, are inevitably wrapped up in resource availability (as well as other issues). Heck, during relatively lean times my charitable contributions decrease, because my family comes first. But again, the topic here is euthanasia rather than a willingness to share resources. Euthanasia is an extreme solution, and certainly not one that is justified here in the USA.

It will also vary according to what a given culture/society values. For example, several hunter-gatherer societies, both past and (increasingly rarely) present, saw age as a resource. Actually, some of the more extreme cases of abandonment took place among primitive agrarian societies. I agree that cultures vary. Again, however, am referring primarily to our relatively affluent culture here in the USA.

A lot of people would agree with you in principle, but the problem comes with what to do about it. Draconian measures to limit childbirth would not be accepted, and would in fact open up a disturbing can of worms (could you imagine an asshole like Tom Delay being involved in assessing who could have children?). Then what, do you abandon the children who are born to sucky, immature parents? I too would be thrilled if parents thought about the implications of having children. This is, however, I think another topic (or set of topics).

I disagree, I think the slippery slope can start at any point, and the way to avoid it is to have clear guidelines. I personally would not condone an extremely late term abortion for someone simply because the fetus she is carrying has Down Syndrome. At that extremely late point of the pregnancy, I think the criteria of brain dead/anencephalic (and there are very different degrees of anencephaly) is one thing, but an additional 21st chromosome, or spina bifida, is quite another.

For my part, if a society has sufficent resources to care for those individuals being discussed, it is inexcusable not to do so. Families should also do so to the best of their ability. Most people in our society, and most families,do appear to strongly agree with this opinion, with some differences as to extent.

There is always some give and take in families and societies. But except in the most absolutely extreme of circumstances, that give and take stops well short of euthanasia.

Regards,

ksagnostic

Jesus Tap-Dancin' Christ

We're overpopulated as is. Yes to the brain dead who continue to consume resources that could be used on people who actually can appreciate them, as for the severely retarded...can't we just get along with the Christians instead of wiping them out?

But seriously, the severely retarded, well, no. They still can think to some degree, and unless they fulfill another condition for euthanasia, then they should not be killed. Retardedness in and of itself is not justification to be removed from the world. Incurable, debilitating, painful disease is. Brain death is. Simply riding the short bus to school? Come on.

The Other Michael

Hi ksagnostic,

Sorry for the delay - I've been caught up in the PoA brouhaha.

I can see that I (or we) should have more clearly defined the OP scenario (I'd blame it all on philechat, but I guess as moderator I'm supposed to help facilitate these discussions, but keep in mind I'm only a moderator 3rd class and still in training) as you seem to largely be discussing it taking place in a first-world society, while I think I've been looking at a broader-base.

I don't have much difficulty with your arguments when they take place in a society with ample resources to care for all.

I think though that in a society that was suffering from a severe lack of resources a case could be made for euthanasia.

For example, would it be better to let the person being considered starve to death when the society lacks the resources to care for him/her, or would it be more humane to euthanize?

If you ratchet the scenario up a level to where the care that takes place is something in the Bedlam level (least-common denominator warehousing of the nasty, short and brutish category) things are more difficult. Would a n,s,b life filled with terror and pain be more humane than euthanasia?

Would the family be justified in euthanasia in that case?

cheers,
Michael

Zippy

For what it's worth, I think the idea of killing retarded people is absolutely hideous. Adolf Hitler comitted just such an atrocity against the mentally handicapped, and you may be assured that a law granting rights of involuntary euthanasia to parents of retarded children would only come into effect under my dead body.

I am certainly in favour of abortion in cases where a fetus has shown signs of serious handicap, but to kill an innocent human being is despicable. The family or the government should shoulder the burden.

Paul

The Other Michael

Hi Paul,

What I'm interested in discussing is where the dividing line comes in the allocation of scarce resources.

Face it, in some situations, there just aren't going to be sufficient resources in a society to go around, and someone/something is going to get the short end of the stick.

If a society has an adequate amount of resources I don't think you'll see many people (not even me!) voting to off the severely handicappped.

But what if resources are terribly short, and you have to decide between life prolongation for the elderly, care for very premature newborns, or the severely retarded, and there is only enough for one of the three groups to get an adequate amount of resources to sustain their needs?

What then?

What group will yield the most value to the society?

cheers,
Michael

[ July 02, 2002: Message edited by: The Other Michael ]</p>

ohwilleke

I share the consensus that brain life, rather than hearth or lung function, is the proper measure of whether someone is dead.

Ability to live independently is certainly a poor gauge of whether a retarded person should live or die. Most people over the age of 70 or under the age of 16 can't live independently. Many of us have down periods due to physical or mental illness when we can't live independently. No this is an immoral standard. Life does not have to be independent to be worth living, we can say from experience.

I also don't think that this is a burden that the state should shy away from assisting in. A severely retarded child poses a heavy, heavy burden on a family. The family can do little to prevent it, and cannot insure against the possibility (and generally wouldn't in any case). More or less random, incredible burdens are just the sort of thing that the state should insure against to prevent people from taking cruel measures out of self-preservation. I think we as a society have a moral obligation not to create financial incentives to do things that are problematic morally. [I feel the same way about abortion by the way, while I feel that it should be a woman's choice, I also feel that the society has an obligation to eliminate the financial incentives imposed by our society that encourage abortion, so that the choice can be made solely on personal grounds, so the women don't feel compelled to have abortions by a strong likelihood of abject poverty if they do not choose abortion].

Euthenasia is generally a decision made on the basis of enduring untreatable pain negating the general good of living life, and not about the value of the general good of living life being great or small. If your severely retarded person is at a very low level of cognition, AND what cognition there is basically involves pure, constant, untreatable pain, this is one thing. If on the other hand, the low level of cognition is basically picking up beneign input, that is another. There is no mercy in mercy killing, if there is no pain to remove.