If you are shipwrecked on a desert island with no hope of being rescued, you may not be morally obligated to stay alive
I am a 78-year-old woman with a loving husband, three sons, seven grandchildren and three great grandchildren. However, I was recently diagnosed with cancer. The initial surgery was successful, but I was left wondering whether I should opt for further treatment, and all the suffering it might cause, or take my chances without it. I have, after all, lived a long and happy life. While I have now thankfully been cured, I am still left wondering: do we have a moral obligation to live for as long as possible? — Ann, Tarbert, Scotland
There are many answers to this question – especially during a pandemic – and probably no clear solution. But that doesn’t mean we shouldn’t think about it. Indeed, by considering such questions we can discover some of the most enlightening perspectives on life.
Everybody has the right to a decent life. Photographee.eu/Shutterstock
So let me approach this issue as a philosopher – and define first exactly what we mean by a “moral obligation”. A moral obligation or a moral duty is a morally required form of conduct. Obligations can be perfect, leaving us no wriggle room – for instance, the duty not to kill unjustly. Obligations can also be imperfect, giving us some flexibility in when and how we honour them, such as the duty to be beneficent. Obligations can be context-specific, such as the duty to meet someone at 3pm as promised. And, they can be general, including the duty not to steal without necessity or the duty to try to save someone’s life when we can do so at little cost to ourselves.
In my view, we cannot have a blanket moral obligation to live for as long as possible regardless of our circumstances. Each life is unique and, for some people, continuing to live is a horrific experience. But, we can have an obligation to prolong our lives when certain conditions are met.
To add some clarity, here are some thoughts on two different sets of circumstances: living in isolation and living with others. These cases rely on some imagination, but then imagination is the tool that allows us to see dilemmas from alternative perspectives.
Imagine I am a solitary person, stranded on a distant and deserted island surrounded by a vast expanse of ocean. I have no one to love, no one who misses me, and my only hope of escaping the island and meeting another person again lies wrecked in the waves: the ship that brought me here. Now, I will likely want to survive, but that is a different thing. What we need to consider is whether, given my plight, I have an obligation to live for as long as possible.
I might, if my duties to respect myself include me prolonging my life. The German philosopher Immanuel Kant’s categorical imperative states that we have a duty to treat all people including ourselves as ends to be respected and not merely as means. But respecting myself need not entail striving to live an impressively long life. I have a duty to care for my mind and my body and, as a result, I may live healthily for a long time. But that doesn’t mean that living for as long as possible must be my aim or responsibility.
Even so, I might still have an obligation to prolong my life for a different reason. The people who raised me and were sufficiently invested in my fortunes to ensure I survived into adulthood might have a claim on me. This would suggest that this Robinson Crusoe version of me should care for myself now, to honour their investment.
In his book ‘Happiness’, the Buddhist monk Matthieu Ricard quotes the words spoken by a mother to her son shortly before her death:
Don’t think you’re paying me some kind of great tribute if you let my death become the great event of your life. The best tribute you can pay to me as a mother is to go on and have a good and fulfilling life.
But living a “good and fulfilling life” is not the same as living for as long as possible. Indeed, living a good life, not a long life, may be the best way to honour our guardians’ investment in us.
And what if those who raised me have passed away – do they still have a claim? Similarly, what if they are living, but will never know how I fared? Will their lives be worse if I don’t prolong my life indefinitely? Probably not. They likely think I am already lost forever.
When we have dependants, particularly young children in our care, we arguably do have a duty to try to keep ourselves safe and healthy for as long as they need us. But that doesn’t mean we have an obligation to live for as long as possible when they no longer depend on us. S Matthew Liao, a bioethicist at New York University, has argued that children have a human right during childhood to be loved, and that we all have a duty to ensure that children are loved because this is crucial to their lives and development. Once they have grown, our love-giving duties subside, but do not entirely disappear.
There’s a flip side to this, too. When we become dependent on our loved ones as we age, do we have an obligation to prolong our life or, alternatively, to end it – so that we’re not a financial or emotional anchor or an additional burden on our overcrowded, exhausted planet?
This question is an easy one to answer. People should never think of themselves as a “burden” or a “problem to be solved”. Every human being has a right to life and to lead a life that is at least minimally decent, free from degradation, cruelty, undue harm and unfairness. No one person has any more entitlement than any other to live in this world. We are all worthy of a place here, and older people should be treasured by their families, friends and societies.
Yet not everyone accepts this. The pandemic has held up a moral mirror to our treatment of older people and found it to be abysmal. Even though many countries have taken an age-attentive approach to vaccinations, older people have nonetheless borne much of the brunt of Covid-19.
Doing versus allowing
One final thorny question concerns doing versus allowing. Sometimes it’s unclear whether I am actively doing something, such as prolonging my life or seeking to end it, or simply allowing things to happen to me, such as letting doctors pursue a course of treatment (or not) with the result that my life extends or comes to a close.
The availability of various medical options can make the people who love me feel that they have failed me: “I should have convinced her to have surgery. I shouldn’t have let the medical staff opt for comfort-care only. I should have been her advocate. I should have pushed for her to stay in the hospital longer.” But, there is a natural arc to a life well lived, and well-being is not the same thing as biological self interest or longevity.
I have written all of this in the language of obligation since that was the language in which you posed your question. But the language of obligation is a strong one.
We might do better to ask whether we have good reasons to prolong our lives or whether we act virtuously if we seek to prolong our lives. Courage is a virtue that figures centrally at the end of life. To quote the poet Dylan Thomas, it takes courage to “rage against the dying of the light”. But it also takes courage to bear our mild yoke and, contradicting Thomas, opt to “go gentle into that good night”.
Professor of Philosophy,
University of British Columbia
* Published in print edition on 4 May 2021
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