Review of Mary L. Hopcroft, ed. The Oxford Handbook of Evolution, Biology, and Society (Oxford: 2018)

Mary L. Hopcroft, ed. The Oxford Handbook of Evolution, Biology, and Society (Oxford: 2018)

 

Reviewed for Choice Magazine by Ronald F. White 

In recent years there has been growing interest among scholars in the evolutionary foundations of collective human behavior. Although the institutional orthodoxy in the social sciences remains resistant to interdisciplinary analysis, there are many heterodox scholars now engaged in biosocial research. This most recent addition to Oxford University Press’s “handbook,” series is a 681 page tome, which includes 29 scholarly articles by 38 authors, from around the world, mostly from the U.S.  These essays are organized under six headings or “parts.” Part 1: Introduction (4 essays), Part 2: Social Psychological Approaches (6 essays), Part 3: Biosociological Approaches (9 essays), Part 4: Evolutionary Approaches (7 essays), Part 5: Sociocultural Evolution (2 essays), and, Part 6: Conclusion (1 essay). Each essay includes a useful bibliography. Many of the essays could be listed under more than one heading. Although the four essays that comprise the Introduction provide important context, the four-page conclusion is pretty thin, predictable, and perhaps a bit disappointing. Anyone interested in this fine collection, should also look into Edward Elgar’s Handbook of Biology and Politics (2017), edited by Somit and Peterson; and check out the Association for Politics and the life Sciences, and its journal Politics and the Life Sciences.      

Suicide

Like, the concept of "euthanasia," the concept of "suicide" carries with it a lot of ambiguity and social baggage. The word "suicide" is used (both legally and morally) to signify the "act of killing oneself," as distinct from being "euthanized by others." On the surface, suicide appears to be a purely self-regarding act, protected by the liberty principle. However, historically, other moral principles such as utility, beneficence, non-maleficence, and justice have been invoked. Libertarians such as J.S. Mill have argued, that rational competent adults "own their bodies" and therefore have the right to end their lives without interference from others. However, there is often disagreement over whether any given person is rational/competent and/or whether any given decision by a seemingly rational/competent person is, in fact, rational/competent. Some philosophers have sought to identify the various context whereby a rational/competent adult might justifiably kill themselves for either self-regarding and/or other-regarding reasons. 

Most egoistic utilitarians agree that the "good life" is marked by a positive ratio of pleasure over pain. Therefore, a rational/competent adult whose life consists of an intractable imbalance of excruciating pain over pleasure, has a right to kill himself. Two self-regarding problems emerge: At what point does extreme pain become objectively excruciating?" And, in light of modern medicine, at what point does temporarily intractable become permanently intractable? Pain and suffering is, obviously, subject to greater and lesser degrees of magnitude; and some individuals adapt to pain and suffering better than others. For better or worse, we also distinguish between "physical" and "psychological" pain. Both are invoked in the context of the justification of self-regarding suicide and/or suicide prevention.

Philosophers disagree over the justification of suicide. Kantians, argue that suicide is an abuse of freedom, and that we have a negative duty to refrain from killing ourselves, regardless of the presence of overwhelmingly negative pain-pleasure ratios.
Most libertarians, in the J.S. Mill tradition  agree that young children are neither rational nor competent, however they also acknowledge that cultures disagree as to when children become rational and competent varies... anywhere from 14 to 21 years. In the US, legal adulthood is contextual (and occasionally comicalL), with laws dictating at what point should children be allowed to drink, smoke, drive automobiles, vote, refuse medical treatment, or commit suicide? Unfortunately, many children commit suicide every year over minor, temporary psychological harms such as breaking up with boyfriends/girlfriends or bullying in school. Many young gays, lesbians, and transsexuals are also vulnerable.  While we all agree that we have individual and collective duties to prevent teenage suicides, disagree over exactly who is responsible for intervening and how to intervene.  Do teenage suicides signal parental and/or institutional neglect of that duty to prevent suicides? How much time, energy, and resources must beneficent parents expend paying for psychologists, psychiatrists, anti-psychotic drugs, and/or institutionalization of suicidal children? Should local, state, and/or federal governments contribute? If so, how much?

Age alone is does not, necessarily, signify rationality or competence; as many adults lack rationality due to the presence of short-term and long-term diseases that affect the human brain. Thus, many adults are over 21, but irrational and/or incompetent to perform various acts. In general I am a rational competent adult, but I am an incompetent airplane pilot.

The intractability of excruciating pain is relative to time and place. Since the early 20th century, opiates (and other drugs) have been successfully used to minimize pain and suffering. In China, Japan, and India other techniques have been developed to help those suffering from chronic pain learn to adapt to a  life of pain. Today, many people commit suicide without trying a variety of pain relieving drugs, or ancient techniques such as yoga, transcendental meditation, or the various marshal arts. Thus, the question emerges: What do we do as beneficent individuals and/or as societies to prevent irrational/incompetent adults from needlessly killing themselves?

Not all rational/competent suicides are for self-regarding reasons. Other-regarding reasons for suicide include the desire to spare family, friends, and or society the emotional and/or financial harms that result from remaining alive. From both self-regarding and other-regarding perspectives, there are better and worse ways to kill oneself. Shooting oneself in the head, is very efficient and painless self-regarding way to kill oneself, but it leaves behind a mess that others have to see and/or clean up. Some of us attempt to kill ourselves via automobile wrecks, but inadvertently kill or injure others in the process. Others attempt suicide via drug overdoses, without knowing how many to take, and end up surviving the overdose, and having to live with drug induced disabilities, including persistent vegetative state. Sometimes surviving a suicide attempt ultimately subjects individuals, families, friends and society to even greater costs.

To the extent that at least some suicides are rational and competent, the ultimate  question is whether the rest of us have either a positive right or a positive duty to assist or prevent others in committing suicide? If so, how much assistance is justifiable? At what point does suicide-assistance become euthanasia? Based on beneficence, do we have a paternalistic duty prevent all or some self-regarding and/or other-regarding suicides? At what point does paternalistic suicide prevention by family, friends, and or government undermine personal liberty?                          

Euthanasia

Since the 1970s, health care policymakers in the U.S. have debated the morality and legality of  Euthanasia. Much of that debate stems from a conceptual framework that has been a critically adapted from ancient/medieval thought, especially Roman Catholicism.

The term "euthanasia" has it's origin in the Greek terms "eu" and "thanos," which means literally "good death." For most of us steeped in Western culture, "good death" seems self-contradictory. Most of us regard death as the supreme "objective harm" that all of us seek to avoid, unless we have a good reason to not avoid it. Other objective harms include pain, disability, and loss of pleasure. For a utilitarian, a "good death," is contextual, referring to the "least worst" alternative among those objective harmful consequences. Hence, one might argue that in at least some contexts, a quick painless death is preferable to a long life of intractable, excruciating pain; or a life of extreme disability. This raises an empirical question. Are there levels of pain and/or disability that are worse than death, and therefore, if given the choice, would most rational/competent adults choose death over suffering? If so, do other have a right or a duty to kill those persons?

For better or worse, the euthanasia debate in the US involves two issues: First, is the person requesting death a rational competent adult? Second, if it is morally acceptable (or morally required) to assist others in bringing about a painless is it better to actively kill that person or passively allow that person die, naturally? 

According to J.S. Mill (and other libertarians) rational competent adults "own their bodies" and therefore have a right to do whatever they want to do with those bodies, as long as they don't harm others.  However, the debate over euthanasia can also be framed in Kantian terms in the form of a "right to live," "right to die," and/or the "duty to live" and/or the "duty to die?" If all humans have a "right to life," then the rest of us have a perfect duty to "keep them alive" by providing provide food, clothing, shelter, and/or heath care. On the other hand, Roman Catholics argue that the "right to life" includes a self-regarding "duty to live," which suggests that, at least to a certain degree, we are morally responsible for staying alive and keeping others alive.

Theologically speaking, Catholicism argues that "life is a gift from God." Because, God is (by definition) "omnipresent, omniscient, omnipotent, and good," the gift of life is of infinite value. Therefore, choosing to die is tantamount to refusing that gift. Hence, the decision when and how to die, must be left to nature, which was created by God. Therefore, in all contexts, actively killing other persons is a priori wrong, including the active euthanasia, death penalty, and killing in war. However, Roman Catholicism also posits a right and a duty to defend yourself, therefore killing others in self defense is at least sometimes justified. At least some wars are just, and therefore killing others in a just war, is morally acceptable. In short, the "right to life" is contextual, and therefore, must include all forms of killing.

If euthanasia is justified, then the next question is: How to do it?" Active euthanasia says that "A kills B for beneficent reasons." Passive euthanasia says that "A allows B to die, for beneficent reasons." Today, passive euthanasia involves withholding life-saving treatment. Since, the 1970s a series of Supreme Court cases established that it is legally acceptable to withhold all forms of medical treatment, including respiratory technologies, food and hydration. Several states have legalized active euthanasia via various combinations of drugs...often the same drugs that are used in capital punishment.

There is also a third Roman Catholic alternative, called "double-effect euthanasia." It is based on the Catholic notion that it's always wrong to kill someone, however we also have a duty to minimize pain and suffering. Therefore, double-effect euthanasia occurs when you can foresee two effects of your actions, one is "good" (easing pain and suffering) and the other is "bad" (causal involvement in death). Roman Catholicism, therefore, argues that it is morally acceptable to give high doses of morphine to dying patients, knowing that that does will hasten their death... but only if your intention is to remove pain and not kill. Today, most people who die take pain-relieving drugs, even though everyone knows they will die earlier, as a consequence. 

In sum, over the years, the arguments for and against active euthanasia have remained, essentially, the same. Arguments in favor focus on liberty (informed consent), beneficence (remove harms), and utility (wasting health care resources). Arguments against focus on non-maleficence (Hippocratic Oath, "Do no Harm."), justice (killing poor sick people), and utility (slippery slope arguments, "Allow passive euthanasia and eventually we'll be killing people who can't afford treatment).

Finally, it is important to note that the drugs that are typically used to ease pain and suffering are highly addictive, and that the ongoing drug war now focuses on physicians that unnecessarily prescribe those drugs. Thus, one unanticipated consequence of the war on drugs, might be an increase in pain and suffering of patients.