Ethics at the End of Life: New Issues and Arguments is a collection of 14 newly published essays tackling some of the more scarcely discussed topics in contemporary ethics concerning life and death. Editor John Davis claims the collection has “a focus on cutting-edge work and new issues.” This is somewhat misleading, as most of the topics discussed in this collection are covered more thoroughly and persuasively elsewhere, and the discussion of any particular topic in this collection is incomplete, usually assuming the author is familiar with the touchstones issues in the debate, tackling a small area of contention on the issue, and at best moderately progressing the debate.
This collection is not a suitable introduction to questions concerning life and death, does not propose persuasive responses to either classic or contemporary issues regarding death or the relatively new challenges posed by contemporary life-extension medical treatments, and provides neither an in-depth analysis of a single issue or a sampler of tantalizing, philosophically interesting issues found in the field.
This text is not essential reading for scholars or students; however, it is acceptable supplementary reading for students and can be a helpful midway point for scholars. The essays found in this collection are clear, well-written, and accessible to any scholar that has had a sensible introduction to the field. One of the virtues of this collection is that it would serve as a fair companion text to a 200-400 level course in biomedical ethics, applied ethics, or philosophy of death. The majority of the essays in the text are written in an open-ended manner that it suitable for philosophical analysis, discussion, and exploration; each would provide an adequate foundation for a variety of short-answer assignments or more rigorous research assignments.
The essays in this collection are organized into four subsections, which Davis contends roughly reflect the order in which someone deliberating the end of life might consider the topics. Part one is the longest, with five essays, and includes the more protracted discussion in the text concerning whether death is, or can be, a harm to the person dying, with four chapters tackling or evading the Epicurean analysis that death cannot be a harm to the dead because the dead do not exist to experience anything.
Although this discussion takes up approximately a third of the collection’s length, it seems to be at odds with the rest of the collection which deals with intimate and practical questions that one would expect of such a text. In chapter 1, Geoffrey Scarre asks the question if it is possible to be better off dead, setting aside the metaphysical Epicurean existence criterion, then discussing three theories of what gives life value – hedonistic theories, desire-satisfaction accounts, and objective-list theories. However, this discussion feels needlessly stifled; rather than ask whether one can be better off dead, it would evade metaphysical and coherence concerns to ask whether it ever rational to want to die.
Furthermore, rather than tackle specific theories of the value of human life, Scarre would have been better off discussing Don Marquis’s future of value view. Marquis’ view shares similarities with Kantian ethics, as he contends that what makes life valuable is that an agent can come to value his or her life, but differs insofar as Marquis contends that the future of possible value is morally relevant even if she cannot at present value it. On Marquis’ view, the death of a (temporarily) suicidal teenager is bad if, at some point in the future, she could have come to value her life, while for the terminal, suffering patient who lacks any future in which she values her life, death is not bad. The future of value theory faces significant challenges comparable to the three theories Scarre discusses, but is somewhat more open-ended, as the theory doesn’t care what the individual might come to value, concluding that it is wrong to kill someone if there is any future that person would come to value. Scarre concludes that the question of whether one is “better off dead” is personal and subjective, such that analysis defies answer. Yet, in comparison, the question of whether it is rational to want to die (say to avoid impending suffering) is neither metaphysically shaky nor all that subjective.
Part two tackles four excellent essays tackling questions concerning who should decide when to end a life, living up to the promise of the book by discussing varied, relevant issues in an accessible manner. James Stacy Taylor discusses matters of autonomy and competency, Eric Vogelstein looks at issues regarding deciding for the incompetent. Paul T. Menzel looks at the rather deep, often undiscussed topic of advance directives, and the section ends with a solid chapter by Nancy S. Jecker on medical futility.
Part three is the shortest section, containing only two essays dealing with how to end a life, and feels the most incomplete. The first, by Paul T. Menzel, discusses the rather unappetizing prospect of ending a life by refusing treatment, food, and water. In light of the rather specific, and morally tenacious aspect of this discussion, the absence of any serious discussion of preferred active and passive euthanasia options is a noticeable deficit.
The second essay in this part is written by Thomas S. Huddle, and includes a suitably researched discussion of questions regarding the doing-allowing distinction and doctrine of double effect. This essay breaks form with the rest from this collection, and serves as a fair introduction to the issues, but I wish these issues were further explored in independent essays.
The final part of this collection contains three essays concerning how the end of life affects those other than the dying. These essays are novel and a somewhat refreshing way to end the collection, as the topics discussed therein – grief, solidarity, and justice – are a welcome distraction from the previous two parts, which tackle difficult, first-person concerns.
This collection features quality work by influential philosophers on matters of great importance, and scholars interested in life and death issues will benefit having this collection at hand. However, as a collection, this feels incomplete.
© 2018 William Simkulet
William Simkulet, Ph.D., University of Wisonsin, Marshfield/Wood County