On Disconnecting a Patient from Life Support: The Case of Alta Fixsler (Column 424)
We have almost forgotten that about a week and a half ago there was a jolting case in Britain, in which the infant Alta Fixsler was disconnected from life-support machines and deliberately left to die in the hospital against her parents’ wishes. In my impression, outside of Haredi media, this case hardly found a place in public discourse and news coverage, appearing on the margins of the news (to my surprise, I searched for a Wikipedia entry about her and found none). Beyond the minor reports, I did not hear any ethical discussion of the matter anywhere (I assume there were some, but they were not very present). Well, it is apparently not as important as what model X said to singer Y (by the way, her words were taken out of context), but still I would have expected far more serious reporting and debate regarding such a wrenching case.
Description of the Case
Alta was an infant with Israeli and British citizenship who lived with her (Haredi) parents in Britain. She was born about two and a half years ago with a rare defect that impairs brain function. The doctors at the Royal Hospital in Manchester decided she should be disconnected from life support to spare her continued futile suffering (there was no chance of saving her). The parents demanded to continue treatment and eventually petitioned the court to allow them to transfer her to Israel for further care. They expected involvement from official bodies in Israel, and hardly received any (apart from a few not-very-official appeals, such as that of former President Reuven Rivlin). The British court authorized the hospital not to transfer her to Israel and to disconnect her from the machines against her parents’ will, and the UK Supreme Court upheld the decision. On a Monday about a week and a half ago she was disconnected and passed away in the hospital.
You will surely not be surprised to learn that in Haredi discourse there were very harsh expressions against this decision (“cold-blooded murder,” and the like). Although Haredim do not really have another (more moderate) mode of expression, and therefore even if someone decided to donate to the community charity fund (for the poor orphans who, with their last breath, whisper “give us life”) only 5 shekels instead of 10, you would find screaming headlines in the Haredi press about the murder of the unfortunate, “whose heart of stone would not be moved,” “a stone from the wall cries out,” and so on and so forth.[1] But in Alta Fixsler’s case it is indeed hard not to feel that way, even if you are capable of seeing things in reasonable proportion. There is an incomprehensible stubbornness here to go against the parents’ will, against their religious faith, against the option of transferring her to a place willing to continue treating her (meaning there is no financial cost to the British treasury), and all this in order to take the active step of disconnecting life support (not just something entirely passive like not connecting). This in itself is an ethically fraught decision, and therefore all the other considerations I described certainly carry weight, if only as supporting considerations toward leniency (or stringency). In the end, a paternalistic decision was made to kill her now in a fairly active manner despite all the impediments, solely to prevent her continued suffering.
What the Discussion Is About
As stated, on its face this looks like an infuriating and blatantly immoral decision. Precisely for that reason, I thought it appropriate to devote a bit more thought to it, and to try to find logic and an ethical basis for the decision that was made—to examine whether it is indeed such an absurd decision. My conclusion is that it is not. I will preface by saying that the considerations I present here are merely arguments in favor of the court’s decision. My words should not be read as a clear ruling or as my fully formed position in such a case.
One more note. I am not here to discuss what ought or is permitted to be done in such a situation, halachically or morally. I am discussing who and how should make the decision—namely, whether the court acted properly in taking upon itself the authority to decide according to its own value scale. Whether such an act is permitted or forbidden, and whether a person may disconnect himself from life support in such a state, is a different question. I think that in cases of extreme and prolonged pain there is room to argue that yes. But, as noted, that is not my topic here.
A Preliminary Note on the Dire State of the Value of Life
In the reports I saw about this case, it was presented as an action against the religious beliefs of the infant’s parents. That was the only reference I saw to the problematic nature of this decision. Somehow it seems that the question of euthanasia and the value of life today is nothing but a “meshugas” of religious people. Clearly, there is the value of preventing suffering that stands against the value of life, as well as considerations about the worth of such a life altogether; but it seems that no one mentions those sides of the dilemma. Somehow it seems that enlightened secular people can no longer even see the complexity and the problematic nature of such a decision. All that troubles them is that the decision went against the parents’ beliefs (their “meshugas”).
My explanation for this phenomenon is that the value of life in our world is truly no longer what it once was. At most it is a person’s asset that must not be harmed, just as one must not steal. Life as an absolute value (some would say “the sanctity of life”) no longer really exists there (except for occasional pompous declarations when pacifism or the pursuit of peace are on the agenda). I pointed this out in Column 73, when I discussed abortions and the strange and bizarre—yet nonetheless very popular—argument about “a woman’s right over her body.” I think the survival of values such as tolerance, respect for autonomy, and freedom of religion is based on the fact that these are distinctly secular-democratic values. These are values that still speak to the typical secular person. The value of life, by contrast, is apparently no longer really with us.
Again, I do not intend to claim that this decision is absurd in the eyes of everyone for whom the value of life still exists. I already mentioned that there are different sides to this equation, and it is not a priori clear which of them prevails. Had this been the decision, but I had seen a discussion of the price in the currency of the value of life (and not only of the harm to the beliefs and autonomy of others), I would have remained silent. My words here about the cheapening of the value of life do not stem from the decision itself, but from the character of the discussion surrounding it (if any), and from which sides of the issue are raised and debated.
Leibowitz on the Value of Life
In the last essay in his collection, Faith, History and Values, Leibowitz discusses a similar case. An American girl named Karen was terminally ill and connected to machines. At that time the value of life was still a prevalent, almost self-evident value, and it is no wonder that in the United States there was a stormy public and legal debate about whether it was legitimate, permissible, desirable, or forbidden to disconnect her from the machines. I will note here that, in my estimation, as a result of such cases and the decisions made about them in recent decades, the status of the value of life has been severely damaged (at the expense of elevating the value of autonomy), to the point that we have reached the situation I described above. Here the slippery slope appears in all its glory.
If we return to Karen, Leibowitz argued emphatically that it is absolutely forbidden to disconnect her from life support. His claim was based on an analysis of the concept of “value.” He explained there that the claim in favor of disconnection is based on viewing life as a means to pleasures and meaning. Once those possibilities no longer exist, life has no value and there is a legitimacy to end it. Leibowitz argued that this reflects a misunderstanding of the concept of “value.” He defines a value as an unconditional principle that cannot be rationalized (that is, reduced to other principles), and therefore it cannot be made contingent on particular outcomes. Life is not a means to anything—neither to pleasures nor to meaning. Life has absolute value in and of itself, regardless of what one does with it.
We can add that any justification or argument rests on assumptions. Thus, at the beginning of any justificatory chain there must stand principles that themselves cannot be grounded in other, more basic principles (otherwise we fall into an infinite regress; moreover, as a matter of fact we do not have an infinite number of principles to insert into such a chain). What are the unconditional assumptions at the basis of any ethical justification? These are what we call “values.” A value is a binding principle not grounded in other principles and therefore not a means to achieving some outcome (for if it were, it would be grounded in that goal—and then the goal would be the value). One of the central values in our ethics, if not the central one, is the value of life. Therefore, arguments that view life as a means and attempt to rationalize the value of life, in effect say in subtext that life has no value in and of itself. Life is not a value but a means. Many still use the humanist pathos from the school of Kant—talk of the human being as an end, and of his life as a supreme, unconditional value—but in today’s normative world these are usually empty words, lip service.
A Critique of Leibowitz
My humble self fully accepts Leibowitz’s definition of values. One cannot rationalize them or ground them in more fundamental principles. By definition, a value is a fundamental principle under which nothing more fundamental stands. And yet we cannot ignore the fact that there are conflict situations. There are cases where one value clashes with another, and then we must decide in favor of one side. The picture Leibowitz presents—according to which there is never a justification to infringe a fundamental value because any infringement would express its rationalization, a view of it as a means—is not necessary. It may be that I understand that the value of life is unconditional and not subject to rationalization, but it is overridden by other values that stand against it (autonomy, prevention of suffering, some quantification of the value of life, and so on).
Consider, as an example, a situation where a person (an adult, not an infant) wants to end his life due to suffering or any other reason. There is a conflict here in which the value of life stands against the value of autonomy. If I decide to permit him to do so or even assist him, does that necessarily mean that the value of life is not absolute in my eyes? Not at all. Autonomy and the prevention of suffering are also values, and thus they too are not subject to rationalization and limitation. So what do we do when there is a conflict between two values, each of which is unconditional and not subject to rationalization? One can, of course, freeze in place and die like Buridan’s donkey, but people usually decide in favor of one side (for that purpose they build a value hierarchy that determines which value overrides which). Such a decision does not necessarily express doubt about the value of life any more than the opposite decision expresses doubt about the value of autonomy. There are cases in which we have no choice but to harm one value in order to uphold the other (when both cannot be upheld). The value of life is overridden not because life is a means but because the value of autonomy prevails over the value of life.
From here we understand that even in Alta Fixsler’s case, one can say that the decision to disconnect her from life support does not necessarily express an affront to the status of life as a value; rather, it may be—and is even likely—the result of a decision in a conflict between two values: preventing suffering (and, as I will explain below, perhaps autonomy) versus the value of life. Preferring the prevention of suffering does not testify to any deficiency in the attitude toward the value of life. Therefore, this decision, in and of itself, does not say that the value of life is no longer a value. As I explained above, my claim about the decline in the status of the value of life is based on the nature of the discussion and not on the decision as such.
One can, of course, argue that the value of life should stand at the top of our value hierarchy and override autonomy or the prevention of suffering. That is a legitimate ethical claim, but it is a different claim. Moreover, if Leibowitz intended that claim, what would he say in a conflict where the value of life stands on both sides (war, harming one in order to save others, fetal reduction, separating conjoined twins, the law of the “pursuer” [rodef], and so on)? In such cases, whatever we decide will harm the value of life. He too must concede that the picture he presented is overly simplistic. One cannot claim that since life is a value, there can never be any situation in which life is harmed.
Thus, Leibowitz’s assumptions about the meaning of values and about life being a value are indeed correct and acceptable to me. But the sweeping conclusion he drew from them—that there is no legitimacy under any circumstances to harm life—is certainly not correct.
So How Do We Decide, After All?
The question now arises: in a case like that of the infant Alta Fixsler, how is the decision made? We have seen that there is a clash between the value of life and the prevention of suffering (regarding autonomy in the case of an infant, we will see below). I will note that preventing suffering is a value from the perspective of another person. From the person’s own perspective, preventing suffering is an interest, not a value. But even in a clash between an interest and a value there are times when the interest prevails, and that is legitimate. For example, if my life is threatened, I may kill the one threatening me, even though what stands against the value of his life is my interest in living. The same goes for harm to a thief who threatens to steal my property.[2] Likewise, with charity, I am not obligated to give all my property to charity, nor even half of my property, even if the remainder is enough to live with dignity. This is so despite the fact that we are dealing with a conflict of interest versus value.
Therefore, even in Alta Fixsler’s case, it is legitimate to argue that it is permitted to kill her (or to disconnect her from life support; here I set aside the question of passivity versus activity) to prevent her suffering. From my perspective, this is certainly value versus value; but even if she herself were making the decision—where it would be interest versus value—it is sometimes legitimate to override a value due to an interest.
Yet of course, the counter-claim, which prefers the value of life over preventing suffering, is legitimate as well. So how is the decision made in such a case? In other words, how do we reach the conclusion about which of the two legitimate rulings is the correct/appropriate one? This brings us to constructing a value hierarchy.
I do not have much to say about constructing a value hierarchy. This is a matter entrusted to each of our ethical intuitions, or to our religious or other beliefs. But each person constructs for himself a value hierarchy and acts accordingly. I have often pointed out the inherent difficulty in constructing such a hierarchy (the problem of incommensurability),[3] and I will not enter into that here. For our purposes, I will suffice with the assertion that we have value hierarchies by which we make this decision.
The Decision Regarding Alta
The question that now arises is: whose value hierarchy determines our conduct toward an infant like Alta Fixsler? After all, she cannot express her own hierarchy. In fact, she does not yet have one, since she has not reached the age of reason. So it is true that the hierarchy of the British court prefers preventing suffering over the value of life (at least the value of life in Alta’s state—which is perhaps a diminished value). But her parents’ hierarchy is different; in this case it is a religious hierarchy, according to which the value of life overrides preventing suffering (let us assume this for the sake of discussion; there are cases in which this is far from clear). Why does the court regard it as legitimate to impose its value hierarchy on a family that clearly believes otherwise?
It is commonly thought that in the case of an infant, who has not yet formed her own value hierarchy, the relevant hierarchy is that of her parents. Moreover, had she continued to live, her parents would have educated her according to their hierarchy, and there is a fairly high chance she would have adopted it herself. Therefore, there is a common intuition that what determines is the parents’ hierarchy. This, of course, only deepens the troubling feelings regarding the decision of the British court, which acted against the parents’ value hierarchy. It is one thing if the judges’ value hierarchy differs from the halachic-Jewish one; that is entirely legitimate. But here we are dealing with a Jewish infant raised in a family committed to halacha. How can the court impose its hierarchy on that of the family?!
I will add another point. I am not a legal scholar and did not check, but it is quite clear to me that there is no explicit law in Britain that mandates disconnecting an infant in such a state from life support (though British law is generally based on precedents—Common Law). If so, this was an ethical decision made by the court and the doctors on behalf of the infant. That only worsens the problem, since in the realm of ethics there are disagreements among individuals and groups, and as long as there is no clear law on the matter, it is hard to see the justification for imposing the ethical hierarchy of these particular judges and doctors on a person or family who think otherwise. This is precisely the claim of a lack of respect for the autonomy and beliefs of the other that was raised against this decision.
And Yet…
So what, after all, can explain the difficult decision the British made here? The analysis above assumed that the infant has no value hierarchy of her own and therefore the relevant one is that of her parents. But at this point we must invest a bit more thought.
If indeed what matters is the person’s own hierarchy, then why do the parents have any standing in this matter at all? In fact, we ought to ascertain Alta’s own value hierarchy. True, she is an infant who has not formed such a hierarchy and certainly cannot express it, but still, in such cases the logical thing to do is to assess what she would want. And in the absence of clear information, we must assess what a reasonable person would want. Of course, the term “reasonable person” is exceedingly vague, and someone once quipped that the reasonable person, in his eyes, is the person he meets every morning in the mirror. And yet we have no choice: we must assess what a reasonable person would do in such a situation. We are essentially asking: assuming Alta were an adult and able to form and express a position, what would she herself say? That is, in fact, what matters for making this decision.
The conclusion is that if the court assessed that a reasonable person in such a situation would want to be disconnected, then a situation arises in which it is appropriate to act against the parents’ position. As noted, what determines is the person’s own position, not that of the parents. And even if the assumption is correct that had they raised her she would likely have adopted their hierarchy, we must remember that this is not necessarily what would have happened. Beyond that, they have no option of raising her, and therefore this is a hypothetical discussion. Alta is a concrete person, not a hypothetical one, and as such she is not supposed to end up holding a halachic position. Hence, it is doubtful how much standing the halachic position has regarding her.
This, of course, depends on the question of what a reasonable person is. The dispute between the parents and the doctors and court may revolve around that: in the parents’ view, a reasonable person would want to continue living; in the court’s view, a reasonable person would want to be disconnected. So the same dispute rages over the very determination of who is a reasonable person. But here I will again say that the parents have no special standing. The question of who is a reasonable person is, in principle, an objective one (for now the parents’ and the court’s views are not being considered as such, but only as measures for determining who is reasonable). True, opinions about this are divided, but there is no reason to assume that the parents are more correct than the judges and doctors on this question. Note well: here the question is who is right, not whose opinion is decisive. It is a question of right and wrong, not of who has the authority and right to make the decision.
It may also depend on whether “reasonable person” means the person who thinks correctly (ethically) or the commonly accepted person (the statistically average type). The first definition seems circular, since there is a dispute about what the correct thinking is in this issue. That returns us to the dispute between the parents and the court, and we have already seen that the parents do not necessarily have standing in that dispute. Moreover, in my view, this is not a question that a court has the authority to decide. By contrast, according to the second definition, we are dealing with a claim that can be examined empirically or by assessing reality—conducting a broad survey and seeing what people answer about their preferences in such a situation. Here this is no longer a value dispute but a factual one. It seems to me that most people do not think as halacha does in such a case, but this certainly deserves examination.
Breaking the Question into Its Components: Instincts and Values
Beyond all this, the question of what a person would want—whether Alta herself or the reasonable person—is itself divided into two parts: (1) What does he in fact want? (2) What does he think is right to do in such a situation? These are not at all the same question. I can well imagine people who would say that ethically (according to their value hierarchy) they prefer the value of life and it is forbidden to disconnect them even in such a situation, but in practice they cannot stand it, or do not want to suffer, and therefore in practice they would want to be disconnected. Which of these decisions should we take into account when deciding about disconnecting an infant from life support?
Note that the answer to this question is also composed of three elements: What does the (reasonable, or any) person basically want? Does he have a value system that directs him to do something else? And finally, do such a person’s values prevail in practice over his simple instincts and desires, or not?
We can now argue that any reasonable person would want in practice to be disconnected. A reasonable person, of course, does not want to suffer. The question then arises: from the standpoint of his value hierarchy, does he perhaps think that the value of life should nonetheless be preferred, and thus he ought to act against his instinct? And finally, we may ask whether in practice his values prevail over his instinct and natural desire. According to this analysis, we can suggest another rationalization for the court’s decision: first of all, a reasonable person would want to be disconnected. Now there is a dispute as to whether this is ethically proper or not; and even if it is proper, it is not certain that the person would in fact uphold it (though it is not clear that this consideration is relevant for us when the person himself is not standing at the decision point). One can say that doubt does not remove certainty. First of all, he wants to be disconnected, and that is clear. Now whoever claims that it is not proper to do so and that we must take account of the value of life and prevent him from getting his wish (and perhaps that is what he himself would want), the burden of proof is upon him. He must prove that Alta—or the reasonable person—thinks that the value of life prevails, and he must also prove that a reasonable person would act that way in practice. As long as there is no such proof (and of course there is not), the basic (certain) consideration remains—that a reasonable person would want to be disconnected—and doubt does not remove it.
A Final Note: Perhaps We Don’t Need to Seek Alta’s Own Value Scale at All?
In closing, I will raise another possibility. If we begin from the premise that Alta herself has no position of her own (and she will also not reach the stage where she will have one), it may be that, regardless of all the considerations I have raised so far, in such a case we, as a society—and not the parents—will make the decision for her, according to our value hierarchy. If there is no relevant value hierarchy of the person herself, then the hierarchy of those making the decision is the one that determines. This consideration is different from everything I have described above. Until now I assumed we are searching for a relevant value hierarchy—Alta’s own, or that of the reasonable person, or that of the parents. The search was for which value hierarchy is relevant to Alta, in the absence of a known hierarchy that she herself formed and expressed. Here I suggest that there is no need to search for such a hierarchy. In a situation where a person has no clear hierarchy of his own, the determining hierarchy is that of the court and the doctors. They are the ones acting in practice and entrusted with this decision, and therefore they must act according to their own conscience.
Thus far my thoughts. As noted, there is no fully formed position here, but rather considerations I have raised to judge the court and the doctors favorably. I tend to think this is the right decision, but I am not certain. I would be happy to hear what you think, and from me and from you the matter will be clarified.
[1] I have previously mentioned the wonderful opening of Amnon Levi’s book The Haredim. In the first chapter of the book (called “The Bold Course of Life”), he notes that in their world nothing is minor. Everything is either a Holocaust or a redemption. The genre of prose is not really familiar to them.
[2] In my view it is also permitted to kill such a thief. See my article in Techumin on killing a thief for the sake of defending property.
[3] See on this in the series of lectures on halacha and ethics, as well as at the beginning of the third book of the trilogy.
Discussion
I didn’t understand the question, and even less its connection to the post. I am entirely in favor of killing Eichmann.
What is the moral justification for that? It wasn’t to prevent murder, but as revenge.
Why do you say that one should deliberate according to her own values?
With regard to sending a child to school as well, do you think one should discuss the child’s own scale of values in deciding where to send him?
There is complete agreement that in value-laden matters concerning a minor, his guardian decides for him. Quite apart from the fact that he would absorb the values of wherever he grows up. Rather, simply because they decide for him.
You didn’t address the scientific question of what counts as a living human being..
Is a person whose heart is functioning by means of machines, but whose brain has no electrical activity whatsoever (brain waves), considered alive?
Does life truly have absolute value? We are accustomed to cite the argument, “What makes you think your blood is redder?”, but the Yad Ramah on Sanhedrin 74a gave a different explanation.
“It may be explained that the commandments were not given to be set aside in the case of saving life except so that he may live and keep many commandments, as we say there (Yoma 85b): ‘Desecrate one Sabbath for him so that he may keep many Sabbaths.’ But here, regarding murder, what makes you think that your blood is redder and that you are fit to live longer than your fellow, such that you would say that his life—which is shorter and insufficient to fulfill many commandments—should be set aside for my life, which is longer and fit to fulfill many commandments? Perhaps your fellow’s blood is redder.”
According to him, life has no absolute value at all, and the value of life is grounded in another value.
First, what is wrong with revenge? Where it is called for, I have no problem with it whatsoever. “So shall you clear away the evil from your midst.” Beyond that, it has consequences (deterrence of future evildoers).
And you still haven’t explained to me what this question is doing here.
I intentionally did not address that. It is not the topic under discussion here.
On this matter, see my correspondence with Dr. Vladimir Weinstein here on the site: https://mikyab.net/%D7%A9%D7%95%D7%AA/%D7%A1%D7%95%D7%92%D7%99%D7%99%D7%AA-%D7%94%D7%92%D7%93%D7%A8%D7%AA-%D7%B4%D7%90%D7%93%D7%9D%D7%B4-%D7%95%D7%B4%D7%9E%D7%95%D7%95%D7%AA%D7%B4-%D7%91%D7%99%D7%94%D7%93%D7%95%D7%AA
Indeed נכון, and I disagree. I explained here (posts 420–421) the Gemara in Yoma, and showed that he is wrong. R. Shimon ben Menasya does not argue that life is a means for fulfilling commandments.
Indeed. A distinction must be made between the manner of upbringing and the decision whether to put someone to death or let him live. Regarding upbringing, the child is entrusted to his parents (and even that not always—only when they are deemed competent by society’s standards). But regarding his life, no. They are not entitled to decide whether to kill him or let him live.
One can explain this by saying that those are decisions that are in principle reversible (the child will grow up and can decide whether his parents’ values seem right to him or not). In our case, the child will not grow up and will not be able to decide to reverse his parents’ decision.
But it seems more plausible to explain it as follows: decisions about the minor’s fate and way of life are made by his parents. But the decision to kill him is not a decision about the minor, for after they kill him he will no longer be in the world. It is like the discussion of wrongful birth (see post 270 and elsewhere).
I read the above-mentioned post.
There you speak about an extreme case that theoretically everyone agrees is a wrong. But as is well known, people’s value scales today differ greatly from one person to another, and many people think that having more than two children is a wrong to your child, for all kinds of reasons.
Likewise, being in a socioeconomic situation that doesn’t include a pool at home and vacations abroad, etc.
So how do we actually see this being treated? In the end, it is always the parents who make the value judgment.
Only in extreme cases, like a murderous father, is intervention relevant, because those are more absolute values.
But in the end, even in matters of life and death, it is the parents who determine the scale of values.
According to your approach in your (excellent!) books, one can distinguish between:
Postmodernists—people entirely lacking any scale of values whatsoever.
Modernists—people who believe that a scale of values exists.
Except that, according to what you say, one cannot really decide between different values. (In the same way, as I understand it, one also cannot prove that any value exists at all, beyond the imagination or feelings of the person who believes in that value.)
In the end, I do not see a great difference between the two views.
The aforesaid modernist is a postmodernist in disguise.
There is no way to clarify value questions, even between two such modernists, and each person just follows his gut feeling.
By contrast, there is a principled outlook among modernists who see the fact that we strive to reduce suffering and increase happiness as a basic datum, one that can be proven empirically. Once that value is recognized, it becomes possible to conduct meaningful discussions and reach intelligent decisions in various human dilemmas.
Chinese.
I wrote that with respect to murder, parents have no right, whereas in other matters they do. What does that have to do with whether the situation is extreme or not? Who said anything about that? Where do we see that parents make decisions of killing? I’m not sure you read what I wrote to you here.
I’ll just add that since the ethical/philosophical discussion here was based on the specific case of the late Alta, it is worth noting that there was a major dispute over whether she was suffering at all. One could not see any suffering on her face (that is of course not proof that she wasn’t suffering, only an absence of proof for the other side), and in addition there were prominent experts brought by the parents who claimed that she was not suffering at all.
All this, of course, does not obviate the principled discussion.
Your claim itself reflects postmodernism. I claim that one can discuss and argue about first principles and also about values (= ethical first principles), and can sometimes persuade or be persuaded. The way to do that is rhetoric, not logic. I have explained this in several places, especially in Truth and Stability.
There is no value that can be shown empirically. That we aspire is indeed a fact. Whether it is proper to aspire—that is a value question.
That really is an interesting question. It is not clear to me whether experts can determine at all whether she is suffering (even if they themselves think she is suffering and that they can know this). It depends on the question whether physiological indices necessarily reflect suffering, or whether they can appear without suffering or fail to appear despite suffering, when the infant is in this kind of condition. I do not know, but it requires an in-depth examination (asking the experts themselves will not help, because many of them are mistaken on questions like these).
Your response reflects postmodernism.
You insist on talking about values that “exist” in the world of imagination, but your rhetoric is far from convincing intelligent and thoughtful people.
There is no value that can be observed, agreed.
But examine yourself: is there any action you take whose purpose is not connected to reducing suffering and/or increasing happiness?
From scratching your head to caring for your children, everything is directed by this rule.
In fact, this is what underlies the Golden Rule; it is the only moral intuition that is universal.
All the rest is sterile babble that convinces the already convinced.
“For example, if my life is under threat, I am allowed to kill the one threatening me, even though what stands against the value of his life is my interest in living.”
Why are my life not a value but merely an interest?
It is hard to argue with forceful declarations (even when they are plainly mistaken). I do many actions that are not intended to increase happiness and prevent suffering, and in my opinion so do you. I addressed this point in posts 120–122.
So now is the time to part as friends. We’ll leave the question of who is a postmodernist for another time.
Because from the standpoint of value, my life is no more important than the life of the one threatening me (“What makes you think your blood is redder?”). All the more so since killing him is active murder, whereas leaving myself to die is passive non-action (from my standpoint). What tips the balance here is my interest in living.
Are you at peace after all that?
I read it. I was referring to the link you made to wrongful birth.
So you likened bringing life into the world to taking it out of the world.
So I moved to speaking about bringing life into the world, and said that there too the values of each parent determine things.
I didn’t understand. The connection I made was that there too one compares between two options, and if one of them is an option in which the person does not exist, then there is no room for comparison. I did not make a comparison regarding who is supposed to make the decision. That is a different question. I am indeed also opposed to abortions, and I have already written about that too (and linked to it here in the post).
Leibowitz once said, “Values are not argued about. Over values one fights,” in the context of the principle of rationalization mentioned above.
But your argument implicitly assumes that the authority figure should take into account the scale of values of the particular person—the patient (and in the absence of her own scale of values in this case, the question arose according to whose scale of values one should proceed: the parents’ or the court’s).
But assuming that the authority figure’s scale of values is, in his eyes, the correct one—what reason does he have to take into account values outside his own scale of values?
After all, morality is universal (a sentence I have heard the rabbi say many times). Therefore what obligates me should obligate every person. Is that not so?
For example, halakhah forbids a person to injure his own body. Even though he may very much want to do so (interest/value), the Torah forbids it and imposes its scale of values on the individual.
Indeed, the question arises who that legislator is according to whom we will decide the fate of future patients (the court? the state? perhaps the parents themselves?). But even in a situation where the patient is an adult and lucid, why should the authority take his choice into account?
A. Perhaps a reasonable person would not do that, so as not to cause suffering to his religious parents.
B. Perhaps the court and the doctors should take that into account as well.
And what is interesting in this whole story is that those same people who fought for the toddler’s life dismissed all the dangers of COVID.
How is it that you do not accept upon yourself the postulate that one must not take a human life? Deterrence? If you think that human beings are instruments by means of which you convey messages (objects), then good for you.
He said that many times, and was of course mistaken. See my article on Leibowitz’s mistake: https://mikyab.net/%D7%9B%D7%AA%D7%91%D7%99%D7%9D/%D7%9E%D7%90%D7%9E%D7%A8%D7%99%D7%9D/%D7%A9%D7%A8%D7%99%D7%A8%D7%95%D7%AA%D7%99%D7%95%D7%AA-%D7%94%D7%A8%D7%A6%D7%95%D7%9F-%D7%91%D7%9E%D7%A9%D7%A0%D7%AA%D7%95-%D7%A9%D7%9C-%D7%9C%D7%99%D7%91%D7%95%D7%91%D7%99%D7%A5-%D7%A4%D7%95%D7%96
A person’s autonomy is itself a moral principle. Therefore, even if he is mistaken, he should be allowed to act according to his own understanding. Coercion is a moral evil in itself, even if one is coercing toward something good and correct. See my article on autonomy in halakhic decision-making and whether halakhah is pluralistic.
I don’t know whether these are the same people. But if we want to be precise, Haredim generally do not speak about the value of life but about the prohibition of murder or suicide.
Human beings are not instruments for conveying messages. Those people deserve punishment, but there are those who would not kill them unless there is some future benefit in killing them. So there is a combination here: the need to kill them is for the sake of deterrence. The justification for why it is permitted to kill them in order to convey a message is that they deserve punishment. We also find this in halakhah with regard to the law of the pursuer, where there is a distinction between the purpose of the killing (saving the one being pursued) and its justification (the wickedness of the pursuer).
Leaving the girl like that is such a grave moral crime—almost the gravest there is—that this whole discussion is incomprehensible to me. It would be advisable to kill the crazy parents too (out of sheer exasperation).
At last, someone writes the obvious. One can only be appalled by the theoretical writing, without even a minimum acquaintance with the prevailing reality, without delving into the details of the present case, reading the court rulings on the matter, etc.
I think there is a complete mistake in the use of the concept “value” in this article. A value is not a decision or consensus that exists among the “reasonable person,” meaning most human beings, or any other way of deciding what a “reasonable decision” is; a value must be absolute. The issue of prolonging life versus preventing suffering, since it is subject to dispute among people, and some want their days to continue being prolonged, is not a “value.” And using “preventing suffering” as an all-inclusive value, and including this case within it, is an error, for there are people who want this suffering so long as they live. A value is only something universal, absolute, intuitive, found in every healthy person by virtue of his nature. Therefore “the sanctity of life” is a value, whereas “preventing suffering” is a very general label and does not include our case. Therefore, without entering the question of parental authority, which I think is certainly weighty given that they are the natural guardians in all areas—except, of course, in the case of non-normative people—here a court must refrain from acting, not because of the point that there is no guiding value to disconnect life-support and therefore the value of the sanctity of life does not permit it, certainly not where there is no clear expression of the patient’s wishes.
What does your response have to do with my comment? If you have something to add based on familiarity with the reality and deeper knowledge of the details, etc., by all means add it.
The question ought to be whether it is permitted at all to intervene in nature so drastically and connect an infant with an incurable severe illness to resuscitation machines.
“From here we learn that the physician has been given permission to heal” somehow became, for cowards, “from here we learn that one must do everything to prevent death.”
An approach arising from sheer cowardice that has taken over the cowardly thinker’s moral system.
Perhaps in the future, thanks to those same cowards, we will reach a situation in which healthy human beings will be obliged to amputate limbs from their bodies so that the gravely ill can continue living. When the supreme principle is to prevent death, this is a necessary consequence. The cowards are simply afraid to amputate limbs, so they do not think through the necessary conclusion.
What about the halakhic aspect of the matter?
Is there not a basic prohibition against euthanasia?
And if there is, then this is in effect religious coercion against the parents.
I did not enter into the question of whether this is permitted or forbidden. The discussion in the post was not about that. But the doctors did it, not the parents.
Recently I came across a ruling that concerns violation of a fetus’s autonomy—attached is a link:
https://docs.google.com/document/d/1lEFPc_pfcUXbi9daEUKZILOhk2U9v0Ma/edit?usp=sharing&ouid=103054435058019085063&rtpof=true&sd=true
In short, it concerns a case of a woman whom doctors recommended have an abortion, claiming that her fetus had syndrome X, when in fact it had a syndrome similar to X but not X. The doctors deliberately concealed this from her so that she would be more likely to abort. In the end the mother chose to undergo an abortion, but it failed, and the result was that a girl was born with defects caused in part by the failed abortion attempt. The mother could no longer sue because the statute of limitations had run, but with respect to the girl the limitations period had not yet expired. The judges ruled by majority that a fetus has no autonomy of its own, and therefore its autonomy cannot be violated. From what I understood from the ruling, the fetus’s autonomy automatically passes to its parents as its natural guardians. Therefore, seemingly with regard to the Pixler case, her parents were the ones who should have made the decision whether to keep her alive or not. Only in extreme cases where society sees the parents’ decisions as manifestly unreasonable (such as criminal neglect) is there justification to infringe the parents’ autonomy for the child’s benefit. The question is whether in the present case the British saw the parents’ choice as manifestly unreasonable, justifying infringement of their autonomy. Also, I am not sure the girl is even capable of feeling pain or suffering in her condition. Especially nowadays, when there are anesthetics and sedatives, so it is not clear why the British were so insistent.
That is already a legal question, and one for jurists. I would only note that there is a difference between a fetus and a child. A fetus is considered part of its mother, and therefore if there is a guardian at all (and as you know, like you I do not think that is the situation), it is reasonable that this would be the mother/the parents. But after the child is born, he is an independent person, and the considerations I described in the post can lead to the British court’s conclusion.
I did not understand in what way this case differs from any case in which parents are given autonomy over their small children—in the type of education, in the choice of medical treatment for them, etc.
Oh dear, how in the end you always get to the Haredim.
I’m beginning to think that your hatred of the Haredim certainly rivals Hitler’s hatred of the Jews
The ruling stems from an EU children’s rights law, under which the authorities can intervene and even impose their opinion on the child; this is also the problem with obscene studies that the government wants to force onto the country’s religious institutions by virtue of this law.
It is worth adding that according to the common view today, if we set aside halakhic considerations (which in Israel are also reflected in law), the life of a person who will not be able in the future to live on his own and is currently nonfunctioning in every respect is not considered life, and there is no point in ventilating him constantly; rather, one should let him die. According to this, there is no “value of the sanctity of life” here, since there is not really much life here. Therefore there is no need to arrive at a clash with another value (the suffering in this case, which is doubtful) in order to disconnect her from the machines.
What nonsense. There is no comparison. I am far worse.
They are not given such authority where their decision is especially deviant. In the British court’s understanding, the decision there was especially deviant (or sharply contradicted the child’s wishes in the senses defined in the post). Beyond that, I explained that a decision about life is different from a decision about education (as in wrongful birth).
I commented on that (when I added in parentheses regarding the value of life in such a situation).
In the post you deal with the moral problem of causing life to cease. But if a hurricane came and disconnected her, would you “be pleased” without any doubts? That point was not clear to me from the post (which, to judge it favorably, is an embellishment of studying four months before the festival). Likewise in the trolley problem about pushing from the bridge: suppose a wind comes and knocks him off—would you “be pleased”? (It may be that in the trolley case not, and in the girl’s case yes, because there are lives whose value is diminished.) This is not a normative question, but it does reveal something.
Psychologically I would certainly be pleased. Morally—I don’t know. But when my heart is merry with wine, perhaps I will be able to answer. Let’s wait another four months.
You discuss the matter morally and criticize the secular sociological group. It sounds as though you are raising a claim about a slide from a secular outlook toward a moral failure. If so, what could explain such a slide? [It is less likely that what helps religious people morally recognize the value of life properly is halakhah, since it seems that religious Christians as well share this appreciation of life.]
You wrote: “I note that preventing suffering is a value from the standpoint of another person. From the standpoint of the person himself, preventing suffering is an interest, not a value.” What does that mean? If a person decides to cause himself suffering, then apparently in his hierarchy of desires that suffering overall satisfies his will more. And therefore there is no moral problem in it. But when a person weighs moral obligation against his own suffering, clearly avoiding involuntary suffering to himself is an important and precious moral matter. Why should it not be? Is his blood less red? And if so, here, when the girl is not conscious and is not deciding, and those deliberating are deliberating from the outside about what prevails according to her own values, then certainly her suffering carries enormous evaluative weight. That is, even when deciding from her point of view, there is here a value against a value.
Possibly. I’m not sure. On the face of it, it seems to be rooted in the very belief that man was created by God and has a role and value. It is possible that Christianity was influenced here by Judaism, from which it came. In a world without God (and certainly if one is speaking of materialism), it is not likely that an attitude of “sanctity” toward anything, including life, would arise. Secular pathos when speaking about the sanctity of life is nothing but a religious remnant that has undergone secularization.
Also in the hierarchy of the other person’s desires, my suffering is justified because it satisfies his desire. In my view, you will not be able to escape the difference between me and another.
Therefore, in my opinion, even when I deliberate on her behalf, the discussion is interest versus value. I step into her shoes and act on her behalf. Of course, this is only with respect to that particular consideration I raised, beyond all the other considerations.
A. If a person decides to climb a tree to pick a fig even though he knows he will get scratched by the branches and become tired—it is clear there is no moral problem here. Why? Because overall, in his view, the expected satisfaction of his desire is positive, and therefore he does it. In such cases the suffering is justified because, on balance, it satisfies the sufferer’s will. The problem with suffering is that the person does not want it.
B. But when one is not dealing with a person’s desire but with his obligation, why does his suffering not enter the value-account like any other suffering? For example, when a person sees that the cost of obeying a moral value—for instance, gratitude to his parents—will come at the price of great suffering to himself. I understand that you see here a conflict of interest versus value; that is, morality as such demands every effort and suffering from a person in order to realize gratitude to his parents, except that his own interest then comes along and somehow prevails even from a value standpoint, and this is not value versus value. But when a person is considering, say, gratitude to his parents while the suffering of another is at stake (for example, while he is investing effort in showing gratitude to his parents, he could help someone else many times over who is in distress and captivity), then this is indeed a conflict of value versus value. Is that really what you mean? If so, then at the most basic level I do not understand why one should think this way.
[Therefore, even when the girl herself considers her own moral obligation, she sees here the value of her life and opposite it the value of reducing suffering (hers, or that of any other person). Except that if she herself considers the matter and decides that she wants, on her own account and not because of morality, to go on living, then indeed there would be no moral problem in causing suffering to herself, because overall her will has been better fulfilled. But when she considers matters morally, how can it be possible in the world that her suffering is not weighed and measured? Therefore, when others consider matters on her behalf, they weigh only the values and do not descend to the depths of her self-interested will, and therefore her suffering is a distinctly evaluative matter.]
I think that is very significant. It is not merely diminished value; I think the common view is that there is no difference between this state and brain death. And another thing: in your view, is there room in a “secular” outlook for the distinction between passivity and activity in this matter? If we remove halakhah from the picture, is there any essential difference between disconnecting someone from a machine and a case where, had you known he would reach this state, you would not have connected him to machines in the first place?
The question is not well-defined, because in my opinion within a secular framework there is no room for values at all. The distinction between passive and active has its basis in reasoning, not in a verse, and therefore I do not see any necessity that it appear specifically within a religious framework.
So I’ll try to define it:
The moral framework in which I understand most “secular” people to live is: belief in universal human values (life, equality, etc.) which God implanted in creation (even if they are not aware of this), but lack of belief in a framework of religious laws added on top of the above. The definition of those values and decisions between them are according to intuition about what is more “moral” (good?)—a kind of “supreme value” to which all are subordinate (as I understand, you also wrote somewhere).
Within this framework there are two possible ways of looking at Alta’s life:
1. It has value, therefore one should continue to keep her alive unless she is suffering, in which case that is less good.
2. It has no value, because the value of life exists only if life has some prospect, if something can be made of it and it is not merely a beating heart.
If we hold that such a life has no value at all, then there is no point at all in continuing to keep her alive. And in such a state there would also be no difference between disconnecting her and not reviving her in the first place. Although the distinction between the two is mainly rooted in reasoning, that reasoning mainly serves to analyze a halakhic commandment of “Do not murder”; but it cannot decide a moral ruling of “Do not murder,” because this is not an external command prohibiting the act itself, but a value-command to arrive at the desired result, and in terms of the end result there is no difference whether I arrived at the result actively or passively.
What the secular person thinks is less significant to me. I, as a religious person—if the halakhic problem is resolved for one reason or another—think that it is moral to disconnect her from the machines and there is no value problem here. (I think the ostensibly Haredi mistake stems from thinking that if there is a halakhic prohibition then there is also a moral problem in disconnecting—and therefore one may even project this onto a situation where she is suffering.)
It seems to me that I am the father of the approach that disconnects halakhah from morality, so I assume you are not arguing with me here.
Throughout the post, the question you presented in the final section kept nagging at me.
With regard to what she wants, and what she thinks ought to be done, one more point should be added.
You have a person whose instinct wants to stop suffering, but whose belief in the reward awaiting him (as against the punishment awaiting him if he gives up his life) overcomes the instinct. More precisely, a change in his point of view causes the instinct—which wants what is best—to change its conclusion. This is not necessarily a value-based decision as opposed to an instinctive action, but a faith-based picture of reality that causes a different decision.
From the standpoint of my discussion, a faith-based worldview is part of a person’s values. This is not a different discussion.
The halakhic and human assumption regarding a minor is that his law follows that of his parents.
This assumption is also correct in the case of a person lacking understanding, whether as an adult or as a minor.
This is the reason one desecrates the Sabbath for an insane Jew or a minor—which means that his life has value—but not for an insane gentile or a minor gentile who has committed no transgression binding on a Noahide, and even on a weekday one does not save his life. (That is according to the law of the Gemara; I am not entering now into the view of the Meiri and Michi that today “nature has changed” and the gentiles are moral and so we save them both on the Sabbath and on weekdays.)
This is also the reason one performs circumcision on an eight-day-old infant and causes him pain (even though, apparently, one cannot say that he thereby fulfills a commandment)—because that is the value of his parents, and therefore also his.
This applies even to an infant who will in all likelihood not reach adulthood and will never recognize the value of circumcision. We regard the value as already existing in the infant now, even if he will never recognize it.
Therefore the parents’ values are relevant in this case too, and the court cannot kill the girl contrary to her parents’ values—which we regard as the girl’s own values.
Michi,
According to your approach, was killing Eichmann immoral?
(It was revenge, not prevention of future harm.)
And I remain your inquirer and well-wisher, honoring him according to his lofty worth,
the insignificant one among the thousands of Israel,
Shmuel Rozovsky