In the November issue of the Journal of Medical Ethics, there’s a great paper on the Ashley case by Naomi Tan of Center for Social Ethics and Policy, University of Manchester and I. Brassington. It is titled “Agency, duties and the ‘Ashley Treatment.’”
Reading its full text, I find it reassuring that the authors, unlike some others who have written papers on the case, have obviously read pertaining documents very rigorously and have steadfast understanding of the facts. After describing the case and pointing out some ethical problems in the justifying rationale by Ashley’s father and the doctors, that are not very different from those already pointed out, the authors proceed to a philosophical discussion.
If we call creatures with autonomy and personhood “agent” for the sake of ease, and think that Ashley is a “non-agent,” would it justify the invasive treatments done to her? The authors give two different arguments to conclude that it wouldn’t. In the first, they write, “although a family might consist of agents, it is not an agent in its own right. And if we are prepared to treat one non-agent – such as a family – as a “direct” object of moral concern, then it is hard to see why we mightn’t have the same attitude to another non-agent – such as Ashley.” But the beauty of the paper is in the next argument of physicians’ moral duty. Here they point out that the doctors’ rationale to justify the Ashley treatment is based on the assumption that moral agents (doctors here) act in a moral way because of the moral status of the recipient of their good act. And quoting from Kant, they claim that we owe our moral duty to ourselves, not to the moral status of the recipient of our act. It is the duty to maintain our humanity, our capacity to act as moral agents. We have to act in a moral way and it is the duty to ourselves because cruelty to non-agent like animals, for example, dulls our compassion and as Kant says “gradually uproots a natural predisposition that is very serviceable to morality in one’s relations with other men.” It is more about virtue than rights. We also have a duty to refrain from acting wantonly for the same reason. That makes causing Ashley to suffer surgically because of the suffering that may or may not be caused doubly immoral in light of the physicians’ moral duties to themselves.
They write, “Not acting for a reason generates a reason not to act” and conclude “we cannot do to them what we would be unwilling to do to their brothers.” They also say that the problematic and worrisome aspects of the Ashley case “seem to be worthy of further investigation; and the results of this investigation may well resonate beyond questions of what we may do to one disabled girl.”
Not acting for a reason generates a reason not to act…….. This seems to be true not just to “the Ashley treatment” but to many other ethical issues like futile care theory, genetic testing, surrogacy and such. Maybe human-beings have a moral duty to themselves to refrain from doing something just because it is technically doable and refrain from harming their corrective humanity, their ability to sympathize, understand, accommodate, love and care.
This paper also reminds me of this great post by Dr. Sobsey.