Michael Cholbi

By emphasising the intentions underlying suicidal behaviour, suicidal death is distinguished from accidental death in standard philosophical accounts on the nature of suicide. A crucial third class of self-produced deaths, deaths in which agents act neither intentionally nor accidentally to produce their own deaths, is left out by such accounts. Based on findings from psychiatry, many life-threatening behaviours, if and when they lead to the agent’s death, are suggested to be neither intentional nor accidental, with many apparently suicidal behaviours being of this sort, especially the so-called “cries for help”. This category may be usefully analogised to the existing legal category of manslaughter.

Conservatives commonly claim that systems of formal education are biased against conservative ideology. I argue that this claim is incorrect, but not because there is no bias against conservatives in formal education. A wide swath of psychological evidence linking personality and ideology indicates that conservatives and liberals differ in their learning orientations, that is, in the values, motivations, and beliefs they bring to learning tasks. These differences in operative epistemologies explain many demographic phenomena relating educational achievement and political ideology. Systems of formal education thus disadvantage conservatives, especially in the later stages of formal education. Conservatives are therefore ‘selected against’ in the process of formal education, not due to their values or ideology but because their learning orientations are not especially conducive to academic success beyond a certain point. However, because the bias against conservatives in not ideological in origin, a case cannot be made that conservatives are victims of institutional injustice. This bias against conservatives in formal education could be mitigated were the purposes of formal education radically modified (the education of the military class in Plato’s Republic serves as a model). But such a model of formal education would ill serve the needs of modern, industrialized, information-driven societies.

Numerous studies indicate that racial minorities are both more likely to be executed for murder and that those who murder them are less likely to be executed than if they murder whites. Death penalty opponents have long attempted to use these studies to argue for a moratorium on capital punishment. Whatever the merits of such arguments, they overlook the fact that such discrimination alters the costs of murder; racial discrimination imposes higher costs on minorities for murdering through tougher sentences, and it imposes lower costs on whites for murdering minorities by dispensing weaker sentences. These cost differentials constitute an injustice not simply to actual minority defendants in capital cases, nor simply to the actual minority victims of murder, but to all members of minority communities. I here offer two arguments for a moratorium on capital punishment: The first draws upon evidence of racial discrimination against minority defendants in capital cases, and claims that such discrimination modifies the costs of murder in such a way that minority individuals do not enjoy equal status under the law. The second draws upon the evidence regarding racial discrimination in relation to the race of victims, and claims that such discrimination modifies the costs of murder in such a way that minority individuals do not enjoy the equal protection of the law. Thus, by not assigning equal costs to murder, the American criminal justice system fails to provide racial minorities the equality under the law and discounts the value of their lives and liberties. A moratorium is the least unjust response to such a social injustice. I also reply to the criticism that a moratorium prevents us from executing deserving murderers.

Thanks to recent scholarship, Kant is no longer seen as the dogmatic opponent of suicide he appears at first glance. However, some interpreters have recently argued for a Kantian view of the morality of suicide with surprising, even radical, implications. More specifically, they have argued that Kantianism requires that those with dementia or other rationality-eroding conditions end their lives before their condition results in their loss of identity as moral agents, and requires subjecting the fully demented or those confronting future dementia to non-voluntary euthanasia. Properly understood, Kant’s ethics has neither of these implications. wrongly assumes that rational agents’ duty of self-preservation entails a duty of self-destruction when they become non-rational. further neglects Kant’s distinction between duties to self and duties to others and wrongly assumes that duties can be owed to rational agents only during the time of their existence.

Introduction Cholbi, Michael (et al.) Pages 1-10 Assisted Dying and the Proper Role of Patient Autonomy Bullock, Emma C. Pages 11-25 Preventing Assistance to Die: Assessing Indirect Paternalism Regarding Voluntary Active Euthanasia and Assisted Suicide Schramme, Thomas Pages 27-40 Autonomy, Interests, Justice and Active Medical Euthanasia Savulescu, Julian Pages 41-58 Mental Illness, Lack of Autonomy, and Physician-Assisted Death Varelius, Jukka Pages 59-77 Euthanasia for Mental Suffering Raus, Kasper (et al.) Pages 79-96 Assisted Dying for Individuals with Dementia: Challenges for Translating Ethical Positions into Law Downie, Jocelyn (et al.) Pages 97-123 Clinical Ethics Consultation and Physician Assisted Suicide Adams, David M. Pages 125-147 License to Kill: A New Model for Excusing Medically Assisted Dying? Huxtable, Richard (et al.) Pages 149-168 Medically Enabled Suicides Cholbi, Michael Pages 169-184 Saving Lives with Assisted Suicide and Euthanasia: Organ Donation After Assisted Dying Shaw, David M. Pages 185-192 Implanted Medical Devices and End-of-Life Decisions Gill, Michael B. Pages 193-215 Everyday Attitudes About Euthanasia and the Slippery Slope Argument Feltz, Adam Pages 217-237 “You Got Me Into This…”: Procreative Responsibility and Its Implications for Suicide and Euthanasia Weinberg, Rivka Pages 239-252 .

This article addresses the question of whether the arguments for a duty to die given by John Hardwig, the most prominent philosophical advocate of such a duty, are sound. Hardwig believes that the duty to die is relatively widespread among those with burdensome illnesses, dependencies, or medical conditions. I argue that although there are rare circumstances in which individuals have a duty to die, the situations Hardwig describes are not among these.After reconstructing Hardwig's argument for such a duty, highlighting his central premise that ill, dependent, or aged individuals can impose unfair burdens upon others by continuing to live, I clarify precisely what Hardwig intends by his thesis that many of us have a duty to die. I then show that an important disanalogy exists between an uncontroversial example in which an individual has a duty to die and the situations in which Hardwig proposes individuals have a duty to die. More specifically, in situations where a duty to die exists, an individual's having a duty to die logically implies that those she burdens have a right to kill that individual in self-defense. I then suggest that the burdens that ill, dependent, or aged individuals impose on their families, loved ones, or caregivers do not constitute the kind of threat that warrants the latter killing the former in self-defense. Hence, the duty to die is much rarer than Hardwig supposes

Kant's claim that the rational will has absolute value or dignity appears to render any prudential suicide morally impermissible. Although the previous appeals of Kantians (e. g., David Velleman) to the notion that pain or mental anguish can compromise dignity and justify prudential suicide are unsuccessful, these appeals suggest three constraints that an adequate Kantian defense of prudential suicide must meet. Here I off er an account that meets these constraints. Central to this account is the contention that some suicidal agents, because they are unable to fashion a rational conception of their own happiness, are diminished with respect to their dignity of humanity, and as a result, lack the pricelessness that makes prudential suicide wrong on a Kantian view

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. Popular and academic discourse about assisted suicide paradigmatically focuses on individuals with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions.

Many participants in debates about the morality of assisted dying maintain that individuals may only turn to assisted dying as a ‘last resort’, i.e., that a patient ought to be eligible for assisted dying only after she has exhausted certain treatment or care options. Here I argue that this last resort condition is unjustified, that it is in fact wrong to require patients to exhaust a prescribed slate of treatment or care options before being eligible for assisted dying. The last resort condition effectively pits one right of patients, their right to refuse medical treatment or interventions, against another patient right acknowledged by advocates of assisted dying, the right to die. Drawing on an analogy with the legal notion of an unconstitutional condition, I argue that the last resort condition unjustly demands that an arguably more fundamental right—the right to refuse medical treatment or intervention—be foregone in order to acquire a less fundamental right—the right to die. I then address three rationales for the last resort condition and find that they subject individuals to arbitrarily stringent standards for exercising the right to die, standards to which those who seek to end their lives by voluntarily ending life-sustaining treatments are not subject. Subjecting those who seek assisted dying to the last resort condition therefore wrongfully infringes on their right to refuse medical treatment or interventions

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible.

abstract Ryan Tonkens proposes that my Kantian approach to suicide intervention with respect to the mentally ill (2002) wrongly assumes that the suicidally mentally ill are rational and are therefore rational agents to whom Kantian moral constraints ought to apply. Here I indicate how the empirical evidence concerning the suicidally mentally ill does not support Tonkens' criticism that the suicidally mentally ill are irrational. In particular, that evidence does not support the conclusion that such individuals are systemically practically irrational so as to undermine the attribution of at least minimal rational autonomy to them. A Kantian moral framework, albeit one developed in a non-ideal direction, remains applicable to such individuals.

Motivational internalism (MI) holds that, necessarily, if an agent judges that she is morally obligated to ø, then, that agent is, to at least some minimal extent, motivated to ø. Opponents of MI sometimes invoke depression as a counterexample on the grounds that depressed individuals appear to sincerely affirm moral judgments but are ‘listless’ and unmotivated by such judgments. Such listlessness is a credible counterexample to MI, I argue, only if the actual clinical disorder of depression, rather than a merely hypothetical example of such listlessness, is the source of this listlessness. However, empirical evidence concerning depression shows that, to the extent that the depressed are motivationally listless at all, they are abnormally listless only with respect to an important class of non-moral judgments, namely, their prudential normative judgments (i.e., those concerning their own happiness and well-being), not their moral judgments. Hence, depressed individuals do not constitute a counterexample to MI. This conclusion has important methodological implications concerning how supporters and opponents of MI can best defend their respective theses

Philosophical discussions of the morality of suicide have tended to focus on its justifiability from an agent’s point of view rather than on the justifiability of attempts by others to intervene so as to prevent it. This paper addresses questions of suicide intervention within a broadly Kantian perspective. In such a perspective, a chief task is to determine the motives underlying most suicidal behaviour. Kant wrongly characterizes this motive as one of self-love or the pursuit of happiness. Psychiatric and scientific evidence suggests that suicide is instead motivated by a nihilistic disenchantment with the possibility of happiness which, at its apex, results in the loss of the individual’s conception of her practical identity. Because of this, methods of intervention that appeal to agents’ happiness, while morally benign, will prove ineffective in forestalling suicide. At the same time, more aggressive methods violate the Kantian concern for autonomy. This apparent dilemma can be resolved by seeing suicide intervention as an action undertaken in non-ideal circumstances, where otherwise unjustified manipulation, coercion, or paternalism are morally permitted.

T.M. Scanlon (1998) proposes that promise breaking is wrong because it shows manipulative disregard for the expectations for future behavior created by promising. I argue that this account of promissory obligation is mistaken in it own right, as well as being at odds with Scanlon's contractualism. I begin by placing Scanlon's account of promising within a tradition that treats the creation of expectations in promise recipients as central to promissory obligation. However, a counterexample to Scanlon's account, his case of the "Profligate Pal," will show that this view of promissory obligation, which I call the Expectations View, is incorrect. In its place, I propose an account of promissory obligation I call Promising as Accountability, according to which promising is a way of making oneself accountable to others for a future act. Not only is Promising as Accountability a more defensible approach to promissory obligation, it also better fits with certain general features of Scanlon's contractualism.

T.M. Scanlon has recently proposed what I term a ‘double attitude’ account of blame, wherein blame is the revision of one’s attitudes in light of another person’s conduct, conduct that we believe reveals that the individual lacks the normative attitudes we judge essential to our relationship with her. Scanlon proposes that this account justifies differences in blame that in turn reflect differences in outcome luck. Here I argue that although the double attitude account can justify blame’s being sensitive to outcome luck, it cannot justify allocating blame differently when agents with the same attitudes differ only with respect to the luck-based outcomes of their actions. However, Scanlon’s own contractualist theory of morality can be invoked to show that the double attitude account is compatible with blame-based sanctions (e.g., compensation mandated when negligence or reckless result in harm) being sensitive to outcome luck. The resultant view of blame and luck remains desert-based while making sense of the common intuition that differences in outcome luck can matter to how lucky and unlucky individuals are justifiably treated

Much of the literature on the desirability of immortality (inspired by B. Williams) has considered whether the goods of mortal life would be exhausted in an immortal life (whether, i.e., immortality would necessarily end in tedium). However, there has been very little discussion of whether the bads of mortal life would also be exhausted in an immortal life, and more generally, how good immortal life would be on balance, particularly in comparison to a mortal life. Here I argue that there are compelling reasons to favor a mortal over an immortal life because a mortal life offers a higher ceiling for well-being and assigns our agency a greater role in how our lives turn out.

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the explanation of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis.

Consequentialism is often criticized for rendering morality too pervasive. One somewhat neglected manifestation of this pervasiveness is the obligatory self-benefit objection. According to this objection, act-consequentialism has the counterintuitive result that certain self-benefitting actions turn out, ceteris paribus, to be morally obligatory rather than morally optional. The purposes of this paper are twofold. First, I consider and reject four strategies with which consequentialists might answer the obligatory self-benefit objection. Despite the apparent consequentialist credentials of these answers, none of these strategies is adequate because each fails to justify agents failing to benefit themselves when benefiting themselves would be otherwise required by the imperative that overall good meet a certain threshold. Second, I argue that no plausible consequentialist response to this objection is forthcoming because consequentialism denies the central axiological fact propelling this objection, namely, that the self possesses a normative architecture relating the self as agent and self as patient. This architecture, I propose, justifies the option not to benefit oneself

The metatethical position known as motive internalism (MI) holds that moral beliefs are necessarily motivating. Adina Roskies (in Philosophical Psychology, 16) has recently argued against MI by citing patients with injuries to the ventromedial (VM) cortex as counterexamples to MI. Roskies claims that not only do these patients not act in accordance with their professed moral beliefs, they exhibit no physiological or affective evidence of being motivated by these beliefs. I argue that Roskies' attempt to falsify MI is unpersuasive because the evidence used to attribute the relevant moral beliefs to VM patients is insufficient: Contra Roskies, that VM patients are proficient moral reasoners does not establish the presence of these moral beliefs. In addition, the linguistic evidence Roskies cites (a) is vulnerable to methodological worries about its reliability or authenticity, (b) does not override counterevidence derived from the patients' nonlinguistic behavior, and (c) is undermined by VM patients' inability to correctly attribute moral beliefs to others. I conclude with a proposal about how MI should be interpreted, given that it is not falsified by empirical evidence of the sort put forth by Roskies.

Suicide is a controversial ethical issue in large part because the reasonings of and above appear plausible but support contradictory conclusions. in effect asks: Why should we be granted an exemption to the prohibition on human killing when the person we kill is ourselves? What makes killing oneself so special? on the other hand starts from the intuition that there is something special or distinctive about the moral relationship we stand in to ourselves, a relationship that can at least sometimes morally justify suicide. The reasoning of and thus establishes the contours of the ethical debate concerning the permissibility of suicide and explains why suicide is one of the most hotly debated issues in bioethics

Samuel Scheffler has recently defended what he calls the ‘afterlife conjecture’, the claim that many of our evaluative attitudes and practices rest on the assumption that human beings will continue to exist after we die. Scheffler contends that our endorsement of this claim reveals that our evaluative orientation has four features: non-experientialism, non-consequentialism, ‘conservatism,’ and future orientation. Here I argue that the connection between the afterlife conjecture and these four features is not as tight as Scheffler seems to suppose. In fact, those with an evaluative orientation that rejects these four features have equally strong moral reasons to endorse the existence of the collective afterlife