Is physician-assisted suicide morally justifiable?

Sam asked:

Is physician-assisted suicide morally justifiable?

Answer by Craig Skinner

I think it is.

Let’s take the question bit by bit.

1. Is suicide morally justifiable?
2. If it is, is assisted suicide morally justifiable?
3. If it is, is physician-assistance morally justifiable?

1. Suicide

Suicide was once widely condemned, at least in Christendom, as sinful, and I can recall the days when it was still a crime in the UK. A human life was considered a gift of God, and it was for God, not the person living the life, to decide when to end it.

Kant, in Groundwork for the Metaphysics of Ethics gives avoidance of suicide as an example of a perfect duty to oneself because the maxim ‘from self-love I will shorten my life when the future seems more troublesome than agreeable’ fails his conception test: to self-destruct through self-love would be self-contradictory as a law of nature. However, elsewhere in his writings, he says that martyrdom may be justifiable.

These days, most people feel that a life belongs to the person living it, and many, including myself, think that suicide is morally justified as an alternative to unavoidable, persistent, severe pain or suffering.

2. Assistance

Although suicide is legal in the UK, assistance is still a crime. Although, typically, charges are often not brought these days, or serious punishment meted out, especially if the assistant is a long-standing and clearly loving spouse.

Given that suicide is morally justified, it seems to me that assistance is a service or a kindness to somebody unable to proceed because of, say, paralysis, or ignorance about a suitable fatal drug/dose.

Naturally safeguards are needed. For example, encouragement to go ahead by a greedy relative who stands to inherit a packet does not constitute ‘assistance’.

So I am in favour of a change in the law allowing assistance when this is necessary due to disability or ignorance.

3. Physician-assistance

Given that assistance is morally justified, a physician might be as good an assistant as anybody else.

However, as regards suicide, physicians have two important roles quite separate from assistance.

First, making an accurate diagnosis, sound prognosis, and assessment of treatment options, so that the would-be-suicide knows what he is up against should life go on. Misdiagnosing a treatable disabling condition for one that will progress relentlessly would be unfortunate and often negligent.

Secondly, establishing that the patient is of sound mind and able to make an informed decision. This can be a real problem for dementia sufferers: in the early stages, when still of sound mind, they want to live; by the time the disease has advanced to the point they no longer want to live, no doctor will pronounce them capable of making a judgment as to suicide.

Aside from these standard duties to patients, doctors, in my view, should steer clear of assisting suicide. They are not needed for this. And trust in doctors might be weakened if patients, especially if already feeling themselves a ‘burden’, think doctors are in the suicide business and might even hint to the relatives that they might like to encourage the old dear to consider it. The Dignitas system works well. Doctor only certifies patient as of sound mind and able to freely choose suicide. Suicide assisted (usually in the person’s own home, although foreigners e.g. Brits have to attend a Centre) by escorts/ receptionists who get the client to complete the paperwork, drink the preliminary anti-emetic ensuring that the fatal drink (pentobarbitone) taken half an hour later stays down, and await death after some minutes. The package typically includes cremation and despatch of death certificate to address of choice should the client be unaccompanied.

In summary, I think suicide, assistance with safeguards, and physician-assistance are all morally justifiable, but that the last is best avoided since doctors are not needed for the task, and their participation might weaken doctor-patient trust.

Declaration of interest: I am old, and am a physician.

So the big bang theory is only a theory?

Tommy Evans asked:

So the Big Bang theory is only a theory, and when another theory comes along, that will become another ‘theory’. In other words, no one knows or prove exactly how how the universe came into being.

Answer by Shaun Williamson

You are being deceived by the different senses of the word theory. In ordinary life we often describe something as just a theory meaning it is a proposed explanation for things which has not yet been supported by the evidence.

However in science the word theory is used to mean an explanation for the facts which is supported by all the evidence. In science a hypothesis is a proposed explanation. When we get good solid evidence for a hypothesis it becomes a scientific theory.

So the Big Bang is a scientific theory. It is misleading to describe it as ‘only’ a theory. It will only ever be replaced if someone comes up with a stronger theory that is also supported by all the evidence.

Evolution is a scientific theory. Relativity is a scientific theory. Quantum mechanics is a scientific theory. No one who understands science doubts that these theories are true because there is just so much evidence in favour of them that it makes no sense to doubt them. We may modify these theories in the light of further evidence but we will never completely discard any of them.

The Big Bang Theory is not as strong a theory as the previous three but it is still strongly supported by all the available evidence. It isn’t just a wild idea that will be easily replaced.

To summarise ‘just a theory’ and ‘a scientific theory’ mean two completely different things. Don’t confuse one with the other. It is unfortunate that we use the word theory in these two completely different senses.

Answer by Craig Skinner

You don’t exactly ask a question. But you do express an important truth about science. Science does not prove things. It probes them. Proof is the business of logic and maths, consisting of deductions from axioms, but tells us nothing about the world. To learn that we need to investigate the world. Science does this systematically by the method of conjecture and testing. We start with an intelligent guess (hypothesis or theory) about how the world works, then test it by seeing whether things predicted by the theory are found (corroborating the theory so that we hold on to it for now) or not (refuting the theory so that we think up a new or amended one and test that). We aim to arrive at true theories, and probably do sometimes, but we can never be sure we have done so. A theory is just the current best-supported conjecture — a future observation or experiment may require us to change it.

Of course in practice we accept many theories as true. For example, aerodynamics — we fly off on holiday in machines designed as per this theory, and never doubt that they will fly; I compose this email, confident of electronic theory that says you will receive it; I am careful not to drop my beer glass although it’s ‘only’ a theory (Einstein’s theory of gravitation) that says it will fall to the floor.

There are good theories and bad ones. A good one needn’t be true. For example Newton’s theory of gravity served us well for 250 years, it’s calculations good enough to get men to the moon and back (but not good enough for accurate urban car sat navs). But it was superseded by Einstein;s theory when different predictions flowed from the two theories and observations supported Einstein.

For a theory to be scientific at all, it must be testable. In particular there must be some observation or experiment which would refute it. As in the example described above where Einstein’s theory would have been refuted had no bending of starlight been found.

So what are the features of a good theory? Here they are:

1. Consistency — the theory must account for what is already known

2. Scope — the theory explains more, often by uniting theories dealing with seemingly different things eg Newton’s laws of motion accounted for movements of stars, planets, Earth, moon, comets, cannon balls, falling rocks

3. Novel predictions — Einstein’s theory predicted bending of starlight in the vicinity of the sun: observations at the time of the 1919 solar eclipse found this.

4. Fertility — the theory stimulates research leading to new understanding.

5. Elegance or simplicity — prized by some scientists, difficult to measure.

So, although theories are ‘only’ theories, they are not all on a par, and good ones are rarely dreamed up by punters in their armchairs (such as me) by by scientists familiar with existing theory and practice of science, and with good intuition and judgment.

So what of the Big Bang theory? Until the 20th Century, the universe was considered static: after all, the patterns in the stars do not change over a human lifetime or over historical periods. Einstein’s theory predicted an expanding universe, but this was too much for the great man (or anybody else) to accept. So he added a fudge factor (cosmological constant) to his equations so that they implied a static universe. But then observations found clear evidence of expansion of the universe (‘red shift’ of light from distant galaxies). Some held on to the static universe idea despite expansion by suggesting that matter was constantly created from nothing in small amounts everywhere, thus counteracting the expansion’s effect of making the universe ever less dense, even if expansion went on for ever. Hoyle was a main proponent of this ‘steady state’ theory. The alternative view extrapolated backward, reasoning that, if expanding, the universe was smaller, denser and hotter in the past, and would have started in a very tiny very hot state about 13 billion years ago. In a radio programme Hoyle ridiculed this theory as the ‘Big Bang’, and the name stuck.

The Big Bang theory is a good theory. It accounts nicely for the expansion of the universe. It makes a novel prediction, different from what the steady state theory predicts. Thus, if the universe started off very very hot and tiny 13 billion years ago, it has since expanded cooled down gradually to leave a background very low temperature radiation (3 degrees absolute) everywhere in the sky. Sure enough, this Cosmic Background Radiation was discovered in the 1960s. The Big Bang theory has also stimulated much other theory and experiment.

But, of course, it’s not the last word. As you say another theory comes along (importantly, though, this often adds to rather than replacing the old theory, and this is the case here). Thus the Big Bang didn’t account for the homogeneity or the flatness of the universe (I wont go into the technicalities), and the Inflationary Big Bang theory replaced it. But plenty of uncertainties remain. Such as what happened before the BB ( was there a ‘before’), why did it happen, was it unique or just one of many BBs (serially or in parallel).

Must we obey our parents?

Jisan asked:

We must obey our parents for giving us birth because we can’t repay them in any other way. But why must we repay them?

Answer by Shaun Williamson

You repay your parents by loving them, respecting them and perhaps by helping them when they are old. When you are an adult you do not have to obey your parents. You are responsible for your own decisions. You are not a child any more.

If your parents tell you that you must obey them even though you are an adult then they are wrong. They are treating you like a slave and good loving parents would not do that.

Parents have children because they want to have children. You don’t owe them anything for giving birth to you. You cannot be expected to repay a debt that you didn’t agree to in advance. Children don’t ask to be born.

Rationalist, empiricist and Kantian views of Plato’s forms

Nicky asked:

How does Plato’s Theory of Forms relate to rationalism, how does it relate to empiricism, how does it relate to Kant’s theory?

Answer by Helier Robinson

Plato’s theory of forms postulates a second world, beyond the empirical world, such that the empirical world is a poor copy of the world of forms. This is often called the two-world hypothesis, and is invoked to explain illusions in the empirical world: illusions are poor copies of reality and we know them to be such because they are either empirical contradictions (e.g. the half immersed stick is bent to the sight and straight to the touch) or else they contradict well-established belief (e.g. the railway lines do not really meet in the distance). Contradictions are impossible (except in language) and hence illusions are unreal. Plato was mostly concerned with the conflict between Heraclitus and Parmenides, which arose from the fact that if you apply logic strictly to common sense you find that one thing cannot change with time and remain one. So for Heraclitus only change is real, and for Parmenides only the One is. Plato’s world of forms is Parmenidean: the forms are unchanging and perfect. And the empirical world is largely illusory, including the illusion of change.

Rationalism goes along with Plato. Rationalist philosophy begins with the fact of illusion and the need to both explain it and correct it. This is done with the representational theory of perception, in which real objects cause images (representations) of themselves in the brains of perceivers; in so far as the images are untrue to their originals, so are they illusions, or misrepresentations. This theory is bolstered by the fact that every empirical object, if you think carefully about it, is a structure of sensations; but all sensations are manufactured in the brain, so that the empirical world is inside your head, and this seems absurd since it is obvious that all empirical objects are outside our heads.

Herein lies the basic disagreement between rationalists and empiricists.

Empiricists side with common sense and say that the empirical world is real, in the sense of existing whether perceived or not; but they cannot satisfactorily explain illusions or the sensational character of empirical objects. Rationalists can explain these, but seemingly at great cost to common sense. This was resolved by Leibniz, who realised that if every empirical thing that we perceive is an image of reality, rather than reality itself, then our own empirical bodies are images and so we have two bodies (as well as two worlds): they are the noumenal body and the empirical body. (I use the word noumenal here because the word real is so ambiguous; it means known by the mind, as opposed to the empirical, which means known by the senses.) Consequently your entire empirical world (which is always limited by horizons of the moment, such as the blue sky) is contained in your noumenal head. So beyond the blue sky is your noumenal skull. Rationalists are very rare these days in philosophy departments but common in physics departments, where they are called theorists. Theoretical science describes the underlying causes of empirical things, and these underlying causes are noumenal. (But I do not know of any theorists who take this to its logical conclusion and put their noumenal skulls beyond all horizons of the moment.)

Kant had two theories. In his youth he was a Leibnizian and wrote of two worlds, noumenal and phenomenal (i.e. empirical), but later, after he read David Hume, who ‘awoke him from his dogmatic slumbers,’ he tried to reconcile empiricism and rationalism. He failed. Like Hume, he finished up on the slippery slope to solipsism, with nothing but dogmatic common sense preventing him from sliding all the way down. And like Leibniz he retained two worlds but insisted that the noumenal world was radically unknowable, and he failed to recognise Leibniz’ distinction between our noumenal and phenomenal bodies.

Logic puzzle about knights and knaves

Joe asked:

The philosopher chose the correct door and safely entered the Inner Sanctum. Seated on two diamond thrones were the two greatest priests in the entire universe. It is possible that at least one of them knew the answer to the Great Question: ‘Why is there something instead of nothing?’.

Of course, each of the two great priests was either a knight or a knave. (Whether they were human or monkey is not relevant.) So we do not know of either whether he is a knight or a knave, or whether he knows the answer to the Great Question. The two priests made the following statements:

First Priest: I am a knave, and I don’t know why there is something instead of nothing.

Second Priest: I am a knight, and I don’t know why there is something instead of nothing.

Did either of the priests really know why there is something rather than nothing?

Answer by Craig Skinner

Yes. The first priest really knows; we can’t say as regards the second priest.

In this kind of logic puzzle, the two rules are: 1. Knaves always lie, knights always tell the truth. 2. A statement is a lie if part (or all) of it is a lie (so part of a lying statement may be true)

First priest can’t be a knight (a knight can’t say ‘I am a knave’). So he is a knave. So his statement must be a lie. But the first part is true (he is a knave), so the second part must be false. So he really does know why there is something instead of nothing.

The second priest could be:

(a) a knight who doesn’t know why there is something instead of nothing (the statement is true) (b) a knave who doesn’t know why there is something instead of nothing (first part of statement false) (c) a knave who does know why there is something instead of nothing (all of statement false).

This is one of many logical puzzles found in the Penguin book What is the Name of this Book? (1990) by the logician and magician Raymond Smullyan. They are all good fun, help you to think straight, but are of limited value for systematic learning of either symbolic logic or philosophical logic.

What is the essence of a question?

Greg asked:

What is the purpose or otherwise underlying ‘essence’ of a question?

This may seem obvious, ‘to know’, but why do I want to know? I’d really appreciate an honest and well meditated upon answer. I may not respond at all but the best of the mind answering this will be appreciated.

Answer by Helier Robinson

There are three kinds of question involved here. All three occur in everyday living, but more specifically a ‘what?’ question occurs in empirical science, a ‘how?’ question in technology and engineering, and a ‘why?’ question occurs in myth, theology, metaphysics, and theoretical science. We ask all three because their correct answers have survival value, and so evolution disposes of the incurious.

Answer by Shaun Williamson

There is no underlying essence or purpose of a question. Every question has its own individual purpose. It is a superstition about language to imagine that all questions must have a common essence just because they are all called questions.

Wittgenstein wrote, ‘Philosophy is a battle against the bewitchment of our intelligence by means of our own language.’

Answer by Geoffrey Klempner

I suspect that your question isn’t about questions as such, but rather about (what you take to be) ‘interesting’ questions, e.g. philosophical questions.

A logician can give a formal definition of a question, sufficient to distinguish the syntax and semantics of a question from those of a sentence. The key here is to distinguish questions requiring a yes/no answer, from questions for which the appropriate answer is a term designating an individual (who…? where…? when…? etc.), and also questions for which a piece of discourse (say, an explanation) is the appropriate response (why…? how…? etc.).

Syntactically, a question (in English) is identified by the use of a question mark, as well as by terms such as the ones mentioned above (who, where, why, how… etc.).

This would have to be tightened up to cover various hybrid or non-standard cases. It is actually quite difficult to give a watertight definition, which covers all possible cases.

— But I guess at this point you are getting pretty bored.

I would venture the theory that before we even consider the conventional form of a question, there is a sense in which all thinking, all perception, is a process of framing questions, more or less implicit or explicit, and seeking answers to those questions.

The British philosopher R.G. Collingwood, put forward the radical view that truth is always an ‘answer to a question’ (see Autobiography and Essay on Metaphysics). Every question has relative and absolute presuppositions. It follows that there is no such thing as truth ‘as such’, or for all time.