Epistemologists have a distinction between what they call methodism and what they call particularism. Particularism in epistemology is the idea that we start out with certain propositions that we just take as a given that we know--typically a fairly wide array of them--and then we figure out from there what knowledge is. These propositions will typically include not only, "I exist" but also things like "There is a book in front of me" and the like. Methodism, on the other hand, takes the more austere approach and begins with an analysis of the concepts of knowledge and justification. This analysis leaves open possibilities such as the existence of a Cartesian deceiver. If there were such a deceiver, he would cause us to be widely mistaken and hence not to know many common sense propositions. For example, there might not really be a book in front of me, in which case, appearances to the contrary notwithstanding, I don't actually know that there is a book in front of me.
In epistemology, I have always been a methodist and have defended that approach on the scholarly level. I think that for philosophers it takes more to answer the Cartesian skeptic (or for that matter the Berkeleyan idealist) than kicking a stone.
However, ethics is a whole different ballgame. I see no reason whatsoever why the natural light should not operate in such a way as to give us a priori knowledge of ethical particulars. In fact, that's how it seems to work. One can use extreme or odd examples to illustrate such self-evident particular ethical truths, such as, "It is always wrong to burn babies in gasoline for fun," but I think that, "It is always wrong deliberately to kill babies" will do as well or even better, without either the gasoline or the frivolous motives.
From there, we can try to figure out what it is about babies that makes this true, which helps us to develop our more general principles. (Hint: They are innocent human beings who are not actively harming anyone.)
The practical difficulty with either a principles-first approach or a specifics-first approach in ethics is that if you get either one drastically wrong to begin with, you end up somewhere drastically wrong. We see what happens when you start out with absolutely the wrong particulars in this story, highlighted by Wesley J. Smith.
Erik Parens, a senior researcher with the Hastings Center, is bothered about the fact that technically late-stage Alzheimer's patients can't be killed under Holland's euthanasia law. As it happens, late-stage Alzheimer's patients are killed in Holland with little or no consequence for the doctors. Parens admits this himself:
This situation may be changing, as suggested by the 2011 Dutch case of a woman in the late stage of Alzheimer's whose request for aid in dying was respected.
But he's still exercised by the fact that Dutch law has no clear provision for killing the mentally incompetent. You see, Holland's official euthanasia law was written up on what he calls a "cancer model." On a cancer model, the patient requesting suicide must be both mentally competent when making the request and also suffering unbearably.
Well, as Parens sees it, this poses a couple of problems for killing off late-stage Alzheimer's patients. One problem arises if the patient doesn't (darn it) happen to ask to be killed while still compos mentis. Perhaps the patient just doesn't get around to it, or perhaps early in the disease, he doesn't really feel that his suffering is unbearable. Then, later on, even if those around him think that his situation is terrible and his life not worth living, he's no longer mentally capable of asking to die. Another possibility would be that a mentally competent person would not feel that his suffering was at that time unbearable but would believe that later on, after he lacked mental capacity, his suffering would be unbearable. But, doggone it, the official law doesn't provide for such a person's saying, "Kill me later" while he is presently mentally competent. Hence, the only Alzheimer's patients who can be (fully legally) bumped off under Holland's current suicide law are those who are still mentally competent, early in the disease, and who at that time consider their existential suffering unbearable and request death.
And that just isn't enough for Parens. He is even concerned about cases where the person isn't suffering later on, when no longer mentally competent, but wanted earlier to set up a "death order" for that later stage:
The predisease person may have thought she would have wanted assistance in dying if she were to develop the disease, but that person may be replaced by a person who actually has Alzheimer's but is perfectly happy to live in a new, different way.
It bothers Parens that under these circumstances you can't be killed. Evidently the postdisease person is just too degraded to realize how degraded he is, which is why he's happy.
If one holds what we might call “the disease view” of the person, however, the current situation in the Netherlands can seem odd. On this conception (which in a nuanced form is associated with Ronald Dworkin), there is one person, who, when she is healthy, conceives of her whole life and makes a decision we should respect: that she wants help in dying when she is so far into the disease that she can no longer engage in meaningful communication with those she loves. On this “disease view,” the current Dutch practice is odd insofar as it fails to respect the healthy person's capacitated wish, and in so doing, subjects that person to what she said was, by her lights, unbearable suffering.
Parens wraps up his "field notes" with a candor that may be shocking to some members of hoi polloi, but probably won't shock his fellow bioethicists:
My guess is that it won't work terribly well to use the cancer criteria in the context of Alzheimer's disease. My further guess is that, to make headway, we will have to draw on both the “difference” and the “disease” views. How to do that is hardly clear, but that we need to try is.
Got that? We need to try. Because it must be possible to kill late-stage Alzheimer's patients, we, by which he means "we bioethicists," need to find a way that "we bioethicists" find philosophically satisfactory to justify such killings. In other words, Parens' ethical particulars, which are driving his search for ethical principles, include, "It must be possible to kill late-stage Alzheimer's patients legally."
Now, it isn't actually wrong across the board to allow ethical particulars to drive the search for ethical principles. The man on the street may have a far clearer understanding that it is wrong to kill babies than he has of more abstract principles under which that particular ethical truth falls.
But when one starts out with insane ethical particulars, one's principles will simply be warped because one's particulars were warped.
What ought to strike the ear about Parens' stunningly candid admission that he's going to find some way to justify bumping off late-stage Alzheimer's patients is its sheer, brutal recklessness. His conscience is so seared that he never says to himself, "Wait a minute. What did I just say?"
Very much to the contrary. Parens heaps fulsome praise and gratitude on his Dutch bioethics colleagues who are wrestling with this tough problem of finding a "model" under which to kill Alzheimer's patients:
I recently visited terrific colleagues in the Netherlands, primarily to explore the nexus of the bioethical debates about disability and enhancement. But since I've been contemplating the question concerning assisted suicide in the context of Alzheimer's disease, the visit was also a chance to learn a bit about how the Dutch are broaching that fearsome and bewildering question.
As in the United States, the Dutch conversation about assisted suicide emerged primarily in the context of cancer. At least in that context, before acceding to a request for assistance in dying, caregivers must be sure that the person has made a voluntary and carefully considered request, and that her suffering is unbearable and without prospect of improvement. The Dutch have recently been trying to use those criteria in the context of Alzheimer's disease. Given the wave of Alzheimer's cases poised to crash onto wealthy countries, along with emerging technology to detect the disease process before symptoms appear, we should be grateful to the Dutch for that attempt.
I have to admit that I'm much inclined to throw up my hands in despair over any philosopher, even a young philosopher, or any student messed-up enough not to be able to see what is wrong with what Parens is doing.
But let me try instead to find some cautionary further principle which might apply to all of us. It would doubtless not work to put the brakes on Parens, but it might help some other people. Let's call this the Monster-Avoidance Principle, or MAP, something roughly like this:
MAP: To avoid becoming a moral monster, any time I find myself trying to find a way to justify my or others' deliberate intention to kill specific fellow human beings, I should stop and think very hard and proceed cautiously. This should apply with special force if those human beings are helpless.
Now, notice: I did not include in the MAP any words like "guilty" or "innocent." That is because I didn't want to trivialize it and/or make it merely sarcastic. If I had said "my innocent fellow human beings," then, on my view, the MAP would just be a way of saying, "If I'm considering making ethical space for atrocities, I should stop and think first."
But the MAP as stated can also apply to advocates of the death penalty, like me. It requires an advocate of the death penalty to attempt not to be draconian, not to (for example) justify the death penalty for trivial offenses or even less-than-heinous offenses, merely in order to keep public order. It also raises questions about carrying out the death penalty upon people whose past actions have warranted it but who have since then been (say) severely injured so that they are presently dying or physically helpless.
Naturally, though, one especially hopes that the MAP would act as something of a brake on those whose consciences are somewhat messed up but not yet wholly messed up and who are considering what should be such evidently heinous particular ethical proposals as killing late-stage Alzheimer's patients. Killing a "wave" of them, no less, lest that "wave" crash into the wealthy nations and o'erwhelm them.
This is probably all hopeless, though maybe I'm just feeling a bit down today. Those who need something like the MAP are probably those who won't use it, or won't change their minds because of it. And those who have good instincts about defending themselves and their loved ones against psychopathic aggressors will probably try to follow the MAP and hence develop pacifist scrupulosity about self-defense. There really is no substitute for having your head screwed on straight about these kinds of things, and once your head gets partially unscrewed, I don't know if it can be fixed. But one occasionally likes to try something other than just saying, "What??"
Hence, I suggest that we all try to avoid becoming moral monsters. It might help; you never know.