MORAL
DECISIONS INVOLVING EUTHANASIA AND SUICIDE
David
Lester
Summary – Recent neuroscientific research on how people respond to
personal and impersonal moral dilemmas is applied to explain why individuals
are more comfortable with passive euthanasia than active euthanasia and why
suicidal individuals use tactics to reduce the role of emotions in the decision
to commit suicide.
Greene, et al. (2001)
compared the brain responses of people to personal and impersonal moral
dilemmas. They presented subjects with two types of moral dilemmas. In the
impersonal moral dilemma, a train is approaching a junction, and it cannot be
stopped. On one of the two possible tracks, five people are working and will be
killed by the train. On the other possible track, one person is working and
will be killed by the train. Will you divert the train to the track with one
worker? Almost all respondents say “Yes,” and they make the decision quickly.
In the personal
dilemma, there is only one track with five people working on it who will be
killed by the train. The only way to stop the train is to push an individual
who is sitting on a bridge off onto the track so that his body stops the train.
Will you do it? The majority of respondents say “No,” and those who say “Yes”
take much longer to make the decision than those who say “No.” (It should be
noted that from a simple utilitarian point of view, the answer should be “Yes”
in both cases. Five people would be saved for the cost of one life.)
Greene et al. found
that the brain regions that were more active in the “personal” dilemma than in
the “impersonal” dilemma (e.g., the posterior cingulate gyrus) were those
associated with emotional arousal, while areas associated with cognitive
processing (e.g., the right middle frontal gyrus) were less active in the
“personal” dilemma than in the “impersonal” dilemma.
Greene et al. concluded that emotion can play
an important role in moral judgments. Pulling a switch is an impersonal act,
and the decision is made quickly. It involves cognitive reasoning, and there is
less emotional involvement. Pushing a person off a bridge to be killed entails
a very “personal” involvement. Emotion plays a large role, and the decision to
over-ride the emotional reaction by cognitive reasoning takes time.
Application to Passive and Active Euthanasia
It has been found that
medical personnel are more comfortable with passive euthanasia (for example,
letting the batteries on life-sustaining equipment run down, so that the
equipment stops functioning and the patient dies) than with active euthanasia
(for example, turning off the electrical supply to life-sustaining equipment).
Why is this so?
The parallel with impersonal and personal
moral dilemmas is clear. Passive euthanasia (such as letting the batteries
energizing medical equipment run down) requires less personal involvement. Calm
reasoning can operate, and the decision is made more easily. Actually turning
off the life-sustaining equipment is a more “personal” action and produces an
emotional reaction that cognitive reasoning has to overcome.
Application to Suicide
Suicide is, in most
religions, an immoral act. Jacobs (1967) called suicide a violation of the
sacred trust of life. In his examination of suicide notes, Jacobs documented
how would-be suicides try to persuade themselves, others and God that their
suicide is morally justifiable. They may assert that God will understand, and
they ask others to pray for them. They also frequently change their religious
beliefs so that they come to believe that suicide will be forgiven.
Committing suicide is
a very “personal” act. There will typically be an emotional reaction and a
cognitive appraisal involved in the decision to commit suicide. The research of
Greene, et al. reviewed above suggests that it takes time for the cognitive
appraisal to overcome the emotional reaction.
There may be many cognitive maneuvers
employed to reduce the role of emotions in the decision. For example, Spiegel
and Neuringer (1963) found that completed suicides tend to avoid the use of the
word suicide and suicide synonyms in their suicide notes, and they suggested
that this was to reduce the dread (an emotional reaction) of committing
suicide. These maneuvers may be facilitated by ingesting alcohol or other drugs
(such as marijuana) prior to the suicidal act, a phenomenon observed by Chiles,
et al. (1986). By reducing the role of emotions, the decision to commit suicide
may be made more quickly and using primarily cognitive processes.[1]
REFERENCES
Barnes, D. H.,
Lawal-Solarin, F. W., & Lester, D. (2007) Letters from a suicide. Death
Studies, 31, 671-678.
Chiles, J., Strosahl, K.,
Cowden, L., Graham, R., & Linehan, M. (1986) The 24 hours before
hospitalisation. Suicide & Life-Threatening Behavior, 16, 335-342.
Clements, C., Bonacci, D.,
Yerevanian, B., Privitera, M., & Kiehne, L. (1985) Assessment of suicide
risk in patients with personality disorder and major affective disorder. Quality
Review Bulletin, 11(5), 150-154.
Greene, J. D., Sommerville,
R. B., Nystrom, L. E., Darley, J. M., & Cohen, J. D. (2001) An fMRI
investigation of emotional engagement in moral judgment. Science, 293,
2105-2108.
Jacobs, J. (1967) A
phenomenological study of suicide notes. Social Problems, 15, 60-72.
Keith-Spiegel, P., &
Spiegel, D. E. (1967) Affective states of patients immediately preceding
suicide. Journal of Psychiatric Research, 5, 89-93.
Pennebaker, J. W., &
Stone, L. D. (2004) What was she trying to say? In D. Lester (Ed. ) Katie’s
diary (pp. 55-79). New York: Brunner-Routledge.
Spiegel, D., &
Neuringer, C. (1963) Role of dread in suicidal behavior. Journal of Abnormal
& Social Psychology, 66, 507-511.
[1] Related to this is the common observation that the mood of suicides
tends to improve, and they seem calmer prior to the suicidal act, both in the
short-term (e.g., Clements, et al., 1985; Keith-Spiegel &Spiegel, 1967) and
in the months leading up to the act (e.g., Pennbaker & Stone, 2004: Barnes,
Lawal-Solarin & Lester, 2007). The role of emotions in the decision to
commit has been reduced.
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