Special obligations

Dear Tony:

It is not that clear why the doctor could not do both, or the circumstances of this hypothetical case. There are a number of ethical and moral principles that could be used to decide cases like this, but a more detailed description of the factors involved is needed.

As a general consideration, doctors, and others who work in emergency services, have defined professional duties. Therefore, a police officer can’t simply avoid situations that might be dangerous, likewise a firefighter, etc. These people, and doctors, have professional and ethical principles that govern their work.

In the current example of the Ebola infections there have been a number of the health care staff, doctors and nurses, who have put their lives at risk, and some have died, because they were not prepared to abandon those in need.

From a Catholic perspective the answer is very clear in the many times that Jesus insisted on love of neighbour. Think of the parable of the Good Samaritan. He put himself in a certain amount of danger, in that the person lying on the road might have been a trap, but he helped the man.

Over the centuries there have been many people in Catholic hospitals who out of this love of neighbour have put their lives at risk in times of plague and epidemics.

Replied at 12:45 am on October 07th 2014

Hi Anthony,

I have just recently learnt about this issue in my university studies of philosophical ethics. The famous analogy you refer to is called “Jim and the Indians” (see this website for the full analogy: http://www.unc.edu/courses/2009spring/plcy/240/001/Jim_and_Indians.pdf). The consequentialist/utilitarian would argue that it is morally right to kill the one person in order to save the thirty (i.e. greatest happiness for the greatest good).

Fr John may be able to help me with this, but I would say that the Church would advocate against killing the one – even if this results in the killing of the thirty by Pedro. I’m not sure how I feel about this, perhaps I’m wrong?

Fr John’s response to your concrete example of “why can’t the doctor do both?” is correct. However, by way of the “Jim and the Indians” analogy, and it’s example, the doctor-epidemic crisis, the doctor is given an either/or choice. The reponse to simply change the hypothetical situation to a new hypothetical situation where you can achieve both outcomes is not really answering the dilemma. In the hypothetical case, it must be assumed that there are no other options other than the two that are presented.

That being said, I am interested to hear Fr John’s opinion on the hypethetical situation if there are only the two options available.

In any case, the point of the analogy is to show that utilitarianism, by focusing solely on outcomes and the weighing up of measures of pleasures, is inadaquate because it misses a central aspect of the dilemma: that whichever choice is made, the person making the decision to either kill one person or let thirty people be killed must live with his decision and the effects of this decision for the rest of his life. This important aspect of self-respect and one’s own morality is not taken into account by the utilitarian/consequentialist position – that’s one of it’s weaknesses.

Anthony 🙂

Replied at 08:54 am on October 07th 2014

Dear Anthony:

I think that the case of Jim and the Indians is really very uncomplicated – the end does not justify the means. In other words it is always wrong to choose an objectively evil act as a means to achieve what is supposedly a greater good.

On this subject one moral theologian who is very good is Germain Grisez. His textbooks on moral theology are online and if you look at volume one and go to chapter six there is a refutation of the proportionalist method of judgment – utilitarianism, consequentialism, and proportionalism are variously used as terms to describe this method of reasoning.

In terms of background it would be helpful to read chapter 5 regarding human goods which is at the centre of understanding how utilitarianism is flawed.

Grisez has a very detailed criticism of consequentialism in this article, which will require some time to go through. He mentions cases that are more complicated than the one you refer to, for example, if you go to page 51 – according to the numbering on the original journal article – he refers to an out of control trolley and someone has to choose which group of people to direct the trolley towards.

At the end of the article Grisez has this conclusion about consequentialism.

“Thus, consequentialism means that what one must be willing to do and to be to produce today’s greatest net good can require one to be and to do something totally different tomorrow. No commitment can be permanent, no covenant indissoluble. A person or community which accepts consequentialism ought in all consistency to avoid any firm self-definition. The consequentialist ideal is that the person be a utensil, an all-purpose tool, available to be and to do whatever is necessary to bring about the “greater good.” One is at the mercy of evil men, for one must always be ready to do what is necessary to bring about the least evil in situations they create.49 Consequentialists will be what their enemies make them be: obstructers of justice, droppers of napalm, targeters of hydrogen bombs. A sound ethics should help one to establish one’s self-identity. It should encourage one to make commitments and to form indissoluble covenants.

In this way it should provide the foundation for faithful ness and open up a possibility of magnificent creativity. A sound ethics leaves room for persons and communities to unfold themselves with continuity, to act with authenticity, to defend their own integrity.”

Replied at 01:02 am on October 08th 2014

A doctor is free to choose his patient, work place and work mode unlike a soldier who is obliged to work under order.

Whether a doctor should freely choose an Ebola patient to treat? It depends on the doctors responsibility and exercise of love towards others and the need of the patient. Like, does the doctor has any other commitments? if the patient has spiritual needs to attain salvation? Or if the patient just wanted to save his life or just some extrinsic needs? For judiciously exercising this charity towards others and self there is, as in all the moral virtues, a well-defined order. The ordo caritatis , as theologians a term it, takes into account these different factors:

1. the persons who claim our love,
2. the advantages which we desire to procure for them, and
3. the necessity in which they are placed.

Regarding the persons alone, the order is somewhat as follows: self, wife, children, parents, brothers and sisters, friends, domestics, neighbours, fellow-countrymen, and all others.

Considering the goods by themselves, there is a triple order:
1. the most important spiritual goods appertaining to the salvation of the soul should first appeal to our solicitude; then
2. the intrinsic and natural goods of the soul and body, like life, health, knowledge , liberty, etc.;
3. finally, the extrinsic goods of reputation, wealth, etc.

Viewing apart the various kinds of necessity, the following order would obtain:
1. first, extreme necessity, wherein a man is in danger of damnation, or of death, or of the loss of other goods of nearly equal importance and can do nothing to help himself;
2. second, grave necessity, when one placed in similar danger can extricate himself only by heroic efforts;
3. third, common necessity, such as affects ordinary sinners or beggars who can help themselves without great difficulty.

When the three factors are combined, they give rise to complicated rules, the principal of which are these:
1. The love of complacency and the love of benefaction do not follow the same standard, the former being guided by the worthiness, the latter by the nearness and need, of the neighbour.
2. Our personal salvation is to be preferred to all else. We are never justified in committing the slightest sin for the love of any one or anything whatsoever, nor should we expose ourselves to spiritual danger except in such cases and with such precautions as would give us a moral right to, and guarantee of, God’s protection.
3. We are bound to succor our neighbor in extreme spiritual necessity even at the cost of our own life, an obligation which, however supposes the certainty of the neighbor’s need and of the effectiveness of our service to him.
4. Except in the very rare cases described above, we are not bound to risk life or limb for our neighbour, but only to undergo that amount of inconvenience which is justified by the neighbour’s need and nearness.

By analyzing his circumstances a doctor may or may not choose to treat an Ebola patient.

Thus,

*A doctor who has no wife or children or who he has no other commitment or who he can take additional commitments without compromising the one he has already taken is more likely to choose an Ebola patient to treat.

*An Ebola patient who has more spiritual needs compared to others is more likely to be chosen by a doctor.

*A doctor is more likely to choose an Ebola patient who is his relative than someone else from a distant country.

* A Catholic doctor is not obliged to risk his life when he is not in sanctifying grace and when there is no extreme spiritual necessity for the patient. Simply dying to save other person’s life will not merit you heaven unless you are otherwise made fit for it.

Replied at 07:27 pm on October 13th 2014