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sanctity of life

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Aid in Dying in New Jersey

photograph of private hospital room with comfort items

On August 1st, New Jersey’s Aid in Dying for the Terminally Ill Act came into effect, and, after the included waiting period, August 16th marked the beginning of its effectiveness. This brings New Jersey into the group of states, including Washington, D.C., that allow terminally ill patients to determine the manner in which their lives will end. Maine has a bill that will go into effect in September, which will bring the group of states/DC that have aid-in-dying legislation to ten out of fifty-one. 

Legal principles in aid-in-dying cases rest on core values that the US Constitution is designed to protect. The major legal principles that have been relevant physician assistance cases include the Due Process Clause and the Equal Protection Clause. 

The Due Process Clause protects our liberty to make our own decisions about the most important parts of life – like marriage, children, etc. These kinds of life events are recognized by the government as particularly important for individuals and are thus left to individual discretion. The Supreme Court case of Washington v Glucksburg raised the question of whether this reasoning could be extended in order to protect individual choice in end-of-life care. The plaintiff argued that end-of-life is one of those important times in our lives. As such, terminally ill patients should be able to be allowed control and physician aid in dying should therefore be legal. But the Court unanimously held that physician aid in dying was not covered by the due process clause, blocking one avenue to federal protection. 

In the Supreme Court case of Vacco v Quill in 1997, the plaintiff argued that the 24th amendment and the Equal Protection Clause made it the case that physician aid in dying should be legal. The legal principle in the case was that like cases should be treated alike, and the plaintiff argued that “voluntary passive euthanasia” was sufficiently like physician aid in dying. “Voluntary passive euthanasia,” where a patient’s death is hastened by the removal of treatment, was legal. Terminal patients could opt to cease medical intervention and/or life supporting aid such as feeding tubes, respiratory aid, and hydration. Because ceasing intervention amounted to hastening death just as physician aid in dying amounts to hastening death for the terminally ill, we should not allow some patients but not others the opportunity to have control over their deaths. Thus, the plaintiff argued, because we should treat like cases alike, and physician aid in dying is basically the same as voluntary passive euthanasia, physician aid in dying should also be legal. The ruling, however, was that the state did not have an interest in protecting the process of hastening death, and the case is often cited as establishing that there is no state interest in protecting a citizen’s “right to die.” 

Because of these Supreme Court cases, there is no protection at the federal level for physicians to intervene and allow terminally ill patients to control their own deaths. This, however, has not stopped the nine states and D.C. from either legally outlining such a protection through legislation or through judicial precedent. Opposition, on the other hand, is often motivated by the moral evaluation of the intervention more than the legal standing. 

The main values that conflict in the moral debate over aid-in-dying are the inherent value of life on the one hand, and the rights of liberty or autonomy to determine how your life is shaped and will unfold on the other. For many, it is a grave moral wrong to end a person’s life, regardless of the circumstances (for discussion see Marko Mavrovic’s “What It Means to Legalize Euthanasia”). This may be the most central ethical prescription for creatures with the moral standing that comes with being a person. However, for most there are exceptions to this tenant. Perhaps ending someone’s life in self-defense isn’t completely morally forbidden, or perhaps there exists some moral calculus that points to a good (like the avoidance of harm) that could justify the sacrifice of one person’s life.

If we admit cases like these into our moral perspectives, we move away from absolute evaluations and allow for the weighing of morally relevant features; we could think it’s likely that there are other goods which compete with the value in not ending life. Non-interference with how a person wishes to live their life is a core moral value that can be at odds with the duty to preserve life. When a competent person makes up their mind to end their suffering, it is unclear to many that it is right to prevent this. And when there are experts that can ensure a safe and humane procedure, this leads to many advocates defending physician aid-in-dying legislation. Growing support appears to favor allowing terminal patients more autonomy in how they spend and end their final months.

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Moral Standing and Human/Non-human Hybrids

photograph of lab rat perched on human's arm

In a groundbreaking development towards the goal of growing human organs viable for transplant, Japanese scientists announced that they have government approval to create animal embryos containing human cells in them. The experiments could consist of mice and rat embryos, adjusted to grow with human cells that hopefully will grow into organs once the embryos are implanted into mouse surrogates. 

This is the first such experiment since the government adjusted its stance in March. Before this change, studies were banned that developed embryos that contained human cells beyond 14 days, and scientists were not permitted to implant such embryos into uteruses. One reason to be cautious of implanting an embryo and allowing it to develop to full term is the possibility that the human cells may extend past the initial point and function of their hybridization. So, the unpredictability of developing hybrids even with smaller organs composed of human cells has been met with restraint by the scientific community.

The “14 day rule” has widespread use either in strict policy or soft adherence (though in the past few years some experts have proposed doubling it). Embryos typically implant in the uterus around day seven so it is only recently that the technology to develop embryos past the 14 day rule without implanting them has even been a serious possibility. At around 14 days, the “primitive streak” appears: “a faint band of cells marking the beginning of an embryo’s head-to-tail axis.” Why does this matter?

“The formation of the primitive streak is significant because it represents the earliest point at which an embryo’s biological individuation is assured. Before this point, embryos can split in two or fuse together. So some people reason that at this stage a morally significant individual comes into being.” 

The 14-day rule arguably provides a helpful legal doctrine in its clarity and its non-arbitrary grounding. Most scientists and laypeople alike would prefer to have some such standard so that embryonic research is both possible but regulated. 

There are certainly other, more philosophically popular, standards for moral status – the status that grants a being the cluster of rights and responsibilities as a member of the moral community. Moral status is a difficult quality to codify: while it is pretty intuitive that I cannot be wronged by a table and don’t owe it anything, this is decidedly not the case with my partner of a decade. So what about a pet kitten who scratches me? Does she wrong me? What sorts of behavior and treatment might I owe a pet kitten? These questions get at the moral status of the table, my partner, and a kitten. 

Typically, theories of moral standing have a difficult time including humans at early stages and excluding non-humans (at mature stages of development). This makes the moral status of human/non-human hybrids potentially interesting. If it is, for example, our ability to experience complex pain and pleasure that makes us morally significant, there is great evidence that a number of non-human animals share these capacities (as well as our intellectual abilities). 

For bioethicists and layfolk alike, embryos may possess moral standing for a few reasons. It could be species membership itself that grants humans in early development their status. Or, it could be the potential for developing into a creature with advanced capacities of emotionality and rationality. 

If the experiments proceed as designed, the human cells will stay focused to organs such as the pancreas. Given this, hardline pro-lifers may say these aren’t human enough to have moral value, depending on what’s driving their intuitions: if the moral status is grounded in the religious view that god implants a soul into a zygote, they might simply reject this as human-made, without a human soul, and assign no moral value. If their intuitions are driven by the notion that human embryos have the potential to develop into a creature with special capacities such as intellectual, relational, or emotional capacities, then the moral status of the embryo would depend on what capacities these hybrids would have once developed. It is unlikely that the capacity to produce insulin and regulate blood sugar is the morally significant capacity that grants humans their status in our moral community. 

If it’s “sanctity of human life” that drives one’s intuition of moral status and the status of embryos, the presence of living human cells, and eventually organs, may lead to different positions. For such a position, it is not intellectual, emotional, or sentient abilities that ground the status, so the lack of overall capacities of the hybrid is no drawback. The presence of living human cells seems to be enough of a grounding, but in the hybrid’s case, it doesn’t qualify as “human” overall, only partly, hence “hybrid”. For such a circumstance, one could admit of a scalar model of moral standing, so the hybrid could have whatever percentage moral status that it is made up of human organs, or keep a binary understanding of moral status that the hybrid must cross a threshold of composition to meet.  

For most thinkers, having a human organ is insufficient for qualifying for full moral standing of a mature human. These mice and rats that are implanted with organs will have the standing that mice and rats normally have. The monkeys that scientists are using to perform similar hybridization for organ development will similarly have whatever status monkeys normally do. To contrast, consider the experiments begun earlier this year to make chimeras of brain cells. In such experiments, we aim to alter monkeys’ capacities and manner of experiencing the world by adding human brain cells. Here it becomes more difficult to determine the moral status of the resulting animal.