But the human body is not simply a body; it is a living body, which (a) is not dominated by its quantity, and (b) controls itself, as we saw in Chapter 1 of Section 1 of the third part 3.1.1. We also saw in Chapter 3 of Section 4 of that part 3.4.3that life of itself that, as equilibrium, its tendency is to continue indefinitely, and in human beings survives death. Let us discuss the implications of this point first.
The metaphysical implication is that, though we can die, we cannot go out of existence, and also that the existence we have as disembodied spirits after death is not natural to us. It follows from this that
Conclusion 4: It is immoral for any person ever to choose his own death.
Death is, as I said in Chapter 7 of Section 4 of the first part 1.4.7, contrary to the nature of an embodied spirit, because the spirit and its energy-"dimension" are one and the same act, and for the spirit to go on existing without its own energy-"dimension" is for it to exist without an essential aspect of itself; it is possible, but unnatural--and of course this is why our instinct resists death.
Hence, our control over our lives does not extend to ending them. Obviously, if we commit suicide with the idea that we are going to stop existing, we don't know what the facts are, and we are in for a surprise. Also, if we commit suicide with the idea that this embodied life is intolerable and without bodies we will be in a better or more fulfilled state, we are also in error, because death is a loss of ability to act, not a gain--not to mention that the frustration connected with choosing loss to gain by it will be with us forever. Suicide could be a rational option if this life were all there is; but in the real world, it never works.
But since this is so, if we add Conclusion 29 of the preceding section to this, we can say the following:
Conclusion 4a: It is immoral in general to choose an act which reason says might result in your death.
When you choose an act which might bring about a given effect, then in general you choose the effect along with it. Note here, however, that you have to have some evidence that it might in fact happen to you, not simply the knowledge that it can happen, or the fear that it might happen.
What is the difference between evidence that it might happen and evidence that it can happen? People who play the lottery have evidence (because they have the ticket) that they can win; but the chances are millions to one against the fact that they will win; and so if anything, the evidence is that they won't.
But if you're going to do something that can cause your death, it isn't enough that the odds are better than fifty-fifty that you won't die. I gave the example in the last section of the fact that it would be immoral to play Russian roulette, even though there are five chances out of six that you will survive; because a one-in-six chance makes it reasonable to say that it might happen as well as that it can happen. It probably won't happen, but it might actually happen.
It is, of course, the person's own conscience which determines when the odds against death's occurring are so great that the fact that death can happen becomes only a theoretical possibility, not something which might in practice occur. Nevertheless, since there are people who can't make reasonable distinctions here because they worry too much (just as those who play the lottery and shell out their hard-earned cash for a ticket can't be said to be reasonable in their belief that they just might win), we can say that, just as I said in Chapter 3 of Section 7 of the fourth part 4.7.3, there are "community standards" for damage, so we can adopt here a kind of "community standard" for danger.
Conclusion 4b: If the community at large, or unbiased experts in the field, regard a certain act as dangerous to your life, then absent evidence that your case is special, this is evidence that doing the act might in fact result in your death.
For instance, not everyone who goes over Niagara Falls in a barrel has died from it; but "everyone" regards this sort of thing as risky to the point of foolhardiness. But more important are these: (1) Experts in the health-care field have determined that smoking more than a pack of cigarettes a day poses a significant risk of dying from one of various diseases; and therefore, it is immoral to choose to smoke if you know this. (2) Experts have also determined that the equivalent of two drinks impairs your ability to drive, and that half of the traffic fatalities last year involved someone who had been drinking; and therefore driving after drinking this quantity is a significant risk of killing yourself and others; and from this it follows that it is immoral to choose to drink knowing that you will be driving afterwards. (3) Using other types of drugs poses risks similar to those of smoking and alcohol; and therefore it is immoral to choose to use these dangerous drugs.
Yes, these are moral issues, not just "health care" or "social" ones. There is reason to believe that if you do these things (to the degree indicated by the official warnings) it is not simply the case that death can happen to you, but it might in fact happen; and so it is immoral to choose them.
This, of course, supposes that you are not already addicted to them in such a way that you can't stop; in cases like that, the Double Effect applies. And so let us now add this to what has been said so far.
Conclusion 4c: A person can choose an act which reason says might or even will cause his death when the Double Effect applies.
Once again all five rules have to be fulfilled: the act itself must not have anything wrong with it except the danger of the death as its effect; there has to be a good effect that you also foresee; the actual harm or death cannot be what brings about the good effect; you must not want to die; and the damage avoided by choosing the act must be at least as great as the damage incurred.
Obviously, in the case where reason says that, barring some miracle, you will die, the fifth rule is fulfilled only if, (a) in your own case, what you avoid by dying is something you consider at least as bad as death, but (b) in the case where the good effect is avoidance of harm to someone else, only if one or more lives are saved because of it. We saw this in the discussion of this rule in the preceding section, where we gave the example of a person's falling on a hand grenade to block the blast from his companions.
But a person in the kind of prison camp Alexsandr Solzhenitsyn talks about in The Gulag Archipelago would not be being immoral if, as Solzhenitsyn says somewhere, he tried to run away knowing that he would be shot and would die. It would be reasonable to say that a given person could regard the kind of life in those camps as something worse than death, and therefore could choose to get out of it, even if the act of getting out involved the certainty of his death. The act of running in itself is all right; there is a good effect: the life in prison is escaped; the death is not really the means to the escape from life in prison (because if the guards missed, the good effect would be achieved); you don't want to die, but to escape this kind of life, and, as I said, the alternative of staying is worse than death. You can't shoot yourself to escape the life worse than death; you can only run the risk if the death is independent of the effect you want to achieve.
In cases where you might die, since there are chances that you might in fact survive, then the damage of the risk is to be balanced against the damage incurred in not taking the risk. For instance, it would in general not be immoral to choose to treat sick people even if the disease were infectious and could be fatal; the greater the hope of cure of the sick person, the greater the risk that can be run. Even if there is no cure, running a significant risk to avoid having the patient spend his last days in isolated agony can, depending on a person's conscience, be moral.
However, the risk cannot be undertaken if the death that might result is the means toward the alleviation of suffering or even death. I am thinking of examples like that of those who discovered the cause of malaria by injecting various components of the secretion of mosquitoes into them, on the grounds that the one who caught the disease would indicate which component caused it, and then a cure could be developed. But in this case it is the actual catching of the disease with its risk of death that brought about the good effect. For instance, if none of them had caught it, then they would be no wiser and the cure could not have been found; hence the good effect depended on the wrong one. Sorry, but that sort of thing is morally wrong.
This is not to say that a person can't test drugs so that the community can find out their effects, even if the testing is risky. In that case, the damage is not what brings about the knowledge; if the drug turns out not to be damaging at all, the good effect has been achieved: you know what it does. Hence, even though there is a danger of damage, the damage itself is not a means to the good effect, as it was in the case just above.
Conclusion 4d: It is immoral for a person, except when Conclusion 4c applies, to refuse what sustains life.
This should be obvious. To refuse to do what everyone needs to do in order to stay live (breathe, eat, drink, etc.) is in effect to choose your death.
How much must you do these things? Enough so that you don't run a significant risk of death.
But there is a variation of this which needs discussion:
Conclusion 4e: If a person is dying, he may refuse to take steps to postpone the death, though he cannot in general refuse what sustains life.
Obviously, there's a distinction here that must be made clear between what "postpones death" and what "sustains life."
What sustains life is what everyone always needs in order to stay alive, such as air, food, and water.
What postpones death is what is needed to keep a person alive only if he is in the process of dying.
This whole issue has been confused by moralists up to the present, when they talk of "ordinary means" and "extraordinary means" of keeping a person alive, because it sounds as if technological complexity is the issue, when this is not the case at all. Death-postponement may be as simple as taking a pill, while life-sustenance may be technologically complicated, as in feeding a person directly into his stomach if he can't swallow.
First of all, since, as I said, to refuse life-sustaining means is to choose your death, then even if you are dying, you cannot refuse life-sustaining measures like food and water to accelerate the process unless what was said in Conclusion 4c above applies.
Secondly, what does it mean to say that you "are dying"? Aren't we always dying by degrees? No. As I said in Chapter 2 of Section 1 of the third part 3.1.2, the living body tends toward and then tends to maintain its biological equilibrium, and the tendency downwards toward ground-state equilibrium that happens all through life is due to the physico-chemical nature of the body which is counteracted by the unifying energy. A person is dying when something happens to the body that the unifying energy can't cope with, and the maintenance of the super-high biological equilibrium can't be sustained any longer, and there is an actual process toward death. The losing of energy which is replaced (which happens even in one's prime) is not a process.
In this case, the application of the Double Effect is a little different from what was said in Conclusion 4c. The reason is that the death-postponing measures give no reasonable hope for a cure, but simply put off--even indefinitely--the moment when death will occur. Hence, the death is inevitable, no matter what you do; so your action does not have the effect of avoiding death, but merely postponing it.
Therefore, the good effect is what kind of life you will be living between now and the time you will die. It is foregoing this that you are now comparing with not foregoing it. Note that it is only in this case that the "quality of life" can be taken into consideration. In the case, for instance, of refusing food, you would be in effect killing yourself, and therefore, in that case, it is the death that has to be kept out of the choice according to what was said in Conclusion 4c. But in the case of simply postponing inevitable death, the actual death is not the issue; it is going to occur in any case, and is not "brought about" by not using the death-postponing means, but merely brought closer. There is a subtle distinction here, but it is very significant.
Hence, let us look at the rules. First, the act of not using the machine (or taking the pill, or whatever) is all right in itself; if you were healthy, there would be no problem. Second, there is a good effect: the pain and the trouble and expense of others is lessened by not lengthening the time until you die. Third, the damage involved in not living longer is not the means toward the good effect; if you suddenly got cured, the good effect of not taking the death-postponing means would have been achieved without any bad effect at all. Fourth, you don't want to shorten your life, you want to avoid the agony connected with living longer in this way. And finally, giving up the kind of life you would be living in the interim can be, depending on what that life is, much less than what is given up by dying later. If all you've got to look forward to is three more weeks of pain, why bother, if you save yourself pain and your loved ones from pain and expense? The point is that this is legitimate in this case, because you're not killing yourself to avoid the extra three weeks.
A variation of this occurs with the elderly who, if not dying, are near the time when they could be expected to die. An elderly person may continue doing things like smoking which put his life at risk, balancing off the discomfort of trying to kick the habit against the fewer number of years he might have if he continued smoking and actually got lung cancer from it. The closer he is to the time when he would normally be expected to die, the fewer steps he has to take to avoid risks of death. This is not, of course, to say that he shouldn't try to preserve his life as long as possible; obviously, this would be consistent with the nature of life. It merely says that he doesn't have to, and since he is near death anyway, he is not really in effect choosing death if he continues to smoke heavily, for the same reason that a dying person is not choosing death if he foregoes death-postponing treatment.
Note here that this only deals with what you can do with your own life. If you are making the decision for someone else who is, say, unconscious, then the question of rights comes into play, and we will discuss that in the first section of the next part.
But not only does a living body tend to stay alive, it tends to maintain its biological equilibrium, which amounts to saying that it tends to preserve itself at a level where it can do all that is in its genetic potential to do. I discussed the human genetic potential when I dealt with essential acts and necessities in Chapter 3 of Section 7 of the fourth part 4.7.3. Let me here make another definition:
A living being is healthy if it can do all that is in its genetic potential to do.
A living being is unhealthy if something within it prevents it from doing what it is genetically capable of doing.
Because of the activity of maintaining biological equilibrium on the part of the unifying energy, the natural condition of a living being is that of being healthy. "Being healthy" is not, as I said also dealing with kinds of values in Chapter 4 of Section 7 of the fourth part 4.7.4, the same as "being fit," where you can do these acts with ease. Health as opposed to being unhealthy simply means that there is no significant difficulty in doing the acts.
It follows from this that
Conclusion 5: It is immoral to choose to harm your health.
Hence, putting your health in danger is analogous to putting your life in danger, except that it is less serious, and, depending on what acts are made difficult and the degree of difficulty, the harm you are avoiding by doing what puts your health at risk need not be as serious as the harm you have to avoid in order to run the risk of dying.
Conclusion 5a: A person can do what has or might have the effect of harming his health if the Double Effect applies.
For instance, a person with respiratory problems could probably alleviate them if he lived in Arizona, and is certainly doing harm to his health by living in Cincinnati. But moving from Cincinnati to Arizona means giving up his home, his friends, and his job; and this disadvantage can outweigh the disadvantage to his breathing if he doesn't move.
There are practices like certain types of sexual activity that also have serious health hazards associated with them. By practicing what is called "safe sex" you can reduce the hazards, just as you can reduce the danger to your health from smoking by smoking filtered cigarettes. But I hear plenty of people saying that smoking filtered cigarettes is a delusion; what you have to do is quit if you care about your life or health. I do not hear voices saying that same thing about these sexual acts, which, by the way, are morally wrong on other grounds as well, as we will see shortly.
It is also obvious that, analogously to starving yourself to death by not eating, refraining from certain acts can also harm your health; hence, there are certain things you must positively do to avoid harming your health.
Conclusion 5b: A person must morally do what is necessary to maintain his health.
Again, by "maintaining your health" here, I do not mean "being in the best shape you can be in," but merely that you must do enough exercise, eat enough of a balanced diet, and so on that you don't impair your body's ability to do what it is genetically capable of doing. If you happen to be overweight, for instance, but not so overweight that it is a great effort to do what you need or want to do, then you can use the Double Effect and balance off the inconvenience of dieting against the inconvenience of not being able to do your acts as easily as you could if you were at your ideal weight.(1) The same goes for exercise. If you're not going to be doing any running or pitching of bales of hay, then there isn't any moral obligation to do aerobics or weight lifting; but if you get to be so much of a couch potato that your heart is in danger, you have to have a good reason for not starting some kind of exercise program.Next
1. One should beware of delusions about this. Many is the seriously obese person who thinks he is "just a little overweight" and does nothing about a lifestyle that is dangerously damaging to him.