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As we wrap up Crash Course Philosophy, we’re using the things we’ve learned to explore big issues like the value of life. Today, we’re discussing abortions in cases of fetal abnormality, assisted suicide, and euthanasia. We will consider the standard of substituted judgment and the values people hold on both sides of these issues—values about the sacredness of life, and the importance of a life of quality, as well as the values of personal liberty and avoiding pain.

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In November 2014, Britney Maynard, a 29-year-old woman with terminal brain cancer, took her own life, surrounded by her loved ones, by swallowing a lethal dose of legally prescribed pills. In April 2003, after finding out that their fetus had severe spina bifida and would be born paralyzed, severely brain damaged, and with an exposed spine, Gretchen Voss and her husband terminated their much-wanted pregnancy in its second trimester.

Yeah. It’s going to be another one of those episodes.

If you’re like me, thinking about cases like these makes your heart hurt, and your head spin. But we have to think about them. So, in this penultimate episode of Crash Course Philosophy, we’re going talk about some of the ways in which humans orchestrate death including abortion, assisted suicide, and euthanasia. Basically, three things people never want to talk about.

And, if we do talk about them, it usually leads to arguments that are highly emotional and seldom rational, as you may be seeing in the comments of this video. But we do think it’s worth it because, by talking about these difficult topics, we’re going to gain some insights into what it is that we actually value about life.

As we wrap up Crash Course Philosophy, I want to take a moment to reflect on how far you’ve come. You have many philosophical concepts under your belt now, and you are fully equipped to step into the wilderness we call everyday life and analyze what you find.

For example, take these two data points: In March 2016, Indiana governor Mike Pence signed a bill into law that made abortion for reason of fetal abnormality illegal in his state. Then, just five months later, the first cases of pregnancies affected by the Zika virus were confirmed in the US. Zika is transmitted by mosquitoes and can be passed between people through sexual contact. The illness caused by the Zika virus itself is generally mild, and rarely fatal. But if the virus is present in a pregnant woman, it can cause a condition in the fetus known as microcephaly.

Microcephaly inhibits development of the brain, resulting in an abnormally small head, severe cognitive and motor deficiencies, seizures, rigid limbs, and vision and hearing problems. Microcephaly is a fetal abnormality, which means in states like Indiana, aborting a pregnancy for that reason is illegal. It’s also not detectable until the third trimester of pregnancy, and abortion that late in pregnancy is also illegal in many states. So, some people see these types of abortions – ones that are performed after the fetus has been found to have a disability – to be morally abhorrent. And others see the prospect of being unable to obtain such an abortion, if it’s needed, to be just as abhorrent.

So let’s look at the arguments from each side.

Back when we talked about personhood, we learned that much of the abortion debate hinges on whether or not you think a fetus is a person. For now, let’s assume, for the sake of argument, that fetuses are persons. Making that assumption doesn’t actually solve anything.

Some people will argue that fetuses are persons, so fetuses with abnormalities are simply disabled persons. Therefore, choosing to have an abortion on that basis would be a form of disability discrimination.

But more broadly, the argument against abortion in these cases is often based on the premise that life is sacred, and it’s not in our moral job description to pass judgment regarding the quality of life that fetus might go on to live.

Yet, those on the other side of the issue, such as Gretchen Voss and others who terminated pregnancies that they wanted, also cite a deep respect for life as their justification. So, can they both be right?

Contemporary American philosopher, Margaret Olivia Little, argues that the decision to abort is often about a deep respect for creation, rather than a disregard for it. Bringing another human being into the world, of course, is an enormous responsibility. If you know that a fetus will grow into a child who suffers, and you allow that to happen, aren’t you responsible, in some sense, for its suffering? Do you do something more noble, more selfless, in sparing your potential child a painful existence? Obviously, there’s a lot of disagreement about this.

For one thing, every life involves pain. Every parent sentences their child to some amount of disappointment, heartache, failure, and grief – it’s the human condition. And there are certainly people with disabilities, even severe ones, who are happy to be alive. So perhaps the moral thing to do is to simply help every life to flourish as best it can.

But on the other hand, there are some people whose disabilities, or illnesses, cause them to desire their own deaths. Like Britney Maynard, who stared death-by-cancer in the face and decided not to wait around, but instead to do it on her own terms.

Those who take Little’s view might say that people like Maynard loved life. They loved it so much and valued themselves and their own worth so highly, that to them, it only made sense to choose their own ending.

Proponents of the death-with-dignity movement find value in concepts like personal liberty. They think everyone should be free to make decisions about their own lives and their own deaths. But, it’s important to note that you can’t use personal liberty arguments to defend a decision to abort a fetus, if the rationale for that decision is to spare the potential child pain.

When you invoke personal liberty regarding abortion, you’re talking about a woman’s right to choose what happens to her body. And those arguments are not without merit, don’t get me wrong. But what I want you to see here is that the arguments need to be separated.

You might think that a woman has the right to choose to terminate a pregnancy that’s occurring inside her body. But that’s a different argument than the one that says parents have a right to choose to abort for the sake of the fetus. Do you see the difference? The distinction here is in whose interests are primary.

Voss and Little and others who support abortions in cases of fetal abnormality are making an argument from the interest of the fetus, not the mother. So if you want to defend these types of abortions, arguments about personal liberty aren’t going to hold. You’ll need to look elsewhere.
And it turns out, you don’t have to look very far. Suppose Gretchen Voss had allowed her pregnancy to continue to term. Had that child been born, he or she would have immediately required sophisticated medical care. And that infant – like every other infant – would not have been able to make decisions about its own care. So, the parents would have been the baby’s proxy decision-makers, using what’s known as the standard of substituted judgment.

This standard allows all parents to make medical decisions on behalf of their kids. It also lets us make healthcare decisions for our loved ones when they’re unconscious, suffering from dementia, or otherwise unable to make decisions for themselves.

When you use the standard of substituted judgment, you’re asked to do not what you want to do, but what you believe the patient herself would want. It might be that what Gretchen Voss most wanted was to have her baby in her life for as long as possible, even if it was extremely sick. But, using the standard of substituted judgment, she might have come to the conclusion that, while what she wanted was her baby to be alive for as long as possible, what the baby would want is to spared the pain and suffering that it faced.

The biggest problem with using the standard of substituted judgment with fetuses and infants, is that they don’t yet have opinions that can be known. Britney Maynard’s loved ones were well aware of her wishes, and would have been in a good position to carry them out if she had been unable to do so on her own. But when you’re dealing with a fetus, all you can do is fall back on the basic assumption that sentient beings have an interest in avoiding pain. And so you conclude that this fetus has an interest in avoiding pain.

Now, notice here that we keep coming back to the issue of pain. Sparing pain is probably the most compelling reason that people support decisions to orchestrate death in various ways. So, it’s worth pointing out that, just as personal liberty arguments don’t hold water when thinking about fetuses, arguments for pain avoidance are useless when thinking about some cases of euthanasia.

This is especially true with what’s known as non-voluntary euthanasia. These cases often involve a decision about removing life support from a patient in a persistent vegetative state. We tend to see these cases as the least morally questionable, because if a patient isn’t conscious, it can be hard to see how that life has any quality at all. But the thing is, a patient in such a state isn’t feeling anything. So, arguments based on mercy and pain-avoidance aren’t actually going to work here. And neither will liberty arguments, unless the patient’s desires were made known before they lost consciousness.

Of course, you can make arguments based on concern for the family, or financial considerations. But actual patient-centered arguments can be tough to come by in these cases. Which might actually shed some light on why we find them less objectionable.

By the time a patient is in a state of irreversible unconsciousness, most of the arguments we might have about protecting her – from unwanted pain, from a life she doesn’t want – all sort of seem misplaced. Because at this point, to many people, there really isn’t any personhood left. And if you reach that conclusion, you might fall back on the argument that the best way to honor the dignity of the person who once existed is to stop keeping her body alive with machines.

Now, those who take a hard stance on the sanctity of life will – or should, for consistency’s sake – say that yes, even the life of an individual in a persistent vegetative state is still a life and therefore valuable, and should be promoted.

But there are other cases of euthanasia to consider as well – those known as voluntary euthanasia. In these cases, a patient has willfully made a decision to die, but she might simply be unable to carry out the act herself, so she asks someone else to do it for her. Likewise, in assisted suicide, the decision still rests with the patient, but here, the “assistance” comes in the form of something like a prescription from a doctor, but the patient is the one who ultimately ends her own life.

Unlike with non-voluntary euthanasia, these cases might be defended using liberty arguments because they center on the patient’s freedom to choose whether to live or die. So, all of this leaves us with one question. And it’s a bit of a big one: What makes life worth living?

Next time, we’ll say goodbye to Crash Course Philosophy by taking some time to think about what a “life well lived” looks like.

Today we talked about abortions in cases of fetal abnormality, assisted suicide, and euthanasia. We discussed the standard of substituted judgment, and also talked about the values people hold on both sides of these issues: values about the sacredness of life, and the importance of a life of quality, as well as the values of personal liberty and avoiding pain.

Crash Course Philosophy is produced in association with PBS Digital Studios. You can head over to their channel and check out a playlist of the latest episodes from shows like PBS Space Time, BBQ with Franklin, and PBS OffBook.

This episode of Crash Course was filmed in the Doctor Cheryl C. Kinney Crash Course Studio with the help of these awesome people and our equally fantastic graphics team is Thought Cafe.