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Published online by Cambridge University Press: 26 January 2009
Near the beginning of the last chapter of Life's Dominion, Ronald Dworkin expounds the following problem. Margo has Alzheimer's disease. She suffers from ‘serious and permanent dementia’ (p. 220). It transpires that some years ago, at a time when she was mentally fully competent, Margo executed an advance directive. In this formal document she expressed her wishes concerning what should happen to her if she were to develop Alzheimer's. Should those wishes now be acceded to? For instance, suppose that in her document Margo directed that she should not receive treatment for any life-threatening illness she might contract. Should a doctor therefore now refrain from such treatment? What if, more than this, Margo indicated in her will that after the definitive onset of Alzheimer's ‘she should be killed as soon and as painlessly as possible’ (p. 226)? Could it possibly be right to grant that request?
1 Dworkin, Ronald, Life's Dominion, London, 1993.Google Scholar
2 It might be found surprising that Dworkin takes this line of approach. What, one might ask, licenses the presupposition that there is any single decision that is the right one ‘no matter who makes it’ (p. 182)? Might it not be that a decision in favour of complying with such a request for death would be morally justifiable if made by close relatives of the person affected (who have known the person well for much of her life, and who perhaps owe her a characteristic kind of allegiance) but would not be so if made by a doctor who was not previously acquainted with her? But this kind of challenge need not be addressed here. We can take it from Dworkin, 's description (pp. 220–1)Google Scholar that no such relatives are on hand in Margo's case. If Dworkin's argument regarding Margo were successful, it would then need to be considered to what classes of case his result could be extrapolated.
3 For example, why has the matter come up for decision only now? How gradually has Margo lost her mental powers? A proper examination of the general problem in its own right would need to reckon with the fact that mental competence is not an ‘all-or-nothing’ possession, that the capacity for autonomy in Dworkin's sense can have degrees. Another variation I shall not directly discuss relates to ‘mental state’: how great a difference would it make if Margo were not calm and contented but instead frequently confused and distressed?
4 Dworkin, Ronald, ‘Foundations of Liberal Equality’, Tanner Lectures on Human Values, xi (1990), 1–80.Google Scholar
5 In confirmation of this reading, we might juxtapose Dworkin's affirmation, in connection with sanctity, of the intrinsic value that belongs to every human life thanks to natural and human creative investment (pp. 81£; and see further in my Section IV below) with a claim made in the context of a discussion of critical interests: ‘Value cannot be poured into a life from the outside; it must be generated by the person whose life it is’ (p. 230). There is, therefore, on the one hand, a value that may be due in large part to investment from outside, by God or nature, parents, Mends; and, on the other, a value that cannot be so ‘generated’.
6 Perhaps one should say, more cautiously, that these effects are not relevant in themselves; it remains possible that Margo's interests could suffer at the hands of other people who mind greatly about the critical value of her life.
7 ‘Foundations’, 45.Google Scholar
8 As presented by Dworkin, Margo's is a one-person case, as it were, of those predicaments in which it is judged that only an abortion can avert a major impairment of other people's lives: the suggestion is that Margo's own life is least damaged if she herself is now allowed to die.
9 What kinds of response are appropriate to the conviction that one's own life is sacred? One familiar reaction, referred to by Dworkin at p. 215, is to feel a specific kind of responsibility, to acknowledge an obligation not to waste one's life. It seems to me, however, that the question acquires a special complexity if one accepts Dworkin's view that a person's ‘self-defining commitments’ (p. 205)Google Scholar may have a part in determining what constraints on conduct follow from the sanctity of that person's life. What attitude should one have to one's own past commitments? Dworkin allows, as one would expect, that a pregnant Woman can reasonably see the impact of motherhood on her existing plans of life as relevant to the question what, in her situation, respect for the sanctity of human lives demands (pp. 60, 99–100). But he would presumably also agree that in general for a person to revoke a long-standing ambition, or abandon a long-pursued enterprise need not be any sort of offence to the sacred. If so, then there will be a kind of discretion peculiar to first-person invocations of sanctity – unless for some reason the two options, of invoking and revoking, can never arise together.
10 Parfit, Derek, Reasons and Persons, Oxford, 1984, ch. 16.Google Scholar
11 There is the germ here of an intriguing line of thought, which it would be agreeable to explore, but which I shall only glance at here. Many philosophers find appealing each of the two following propositions: (i) the great majority of persons have lives such that they are better off living as they do than not having been born at all; (ii) for any person, the great majority of possible courses of history are such that in them that person would not have been born. Against the background of those two assumptions, Dworkin's suggestion that events before my birth can sensibly be said to be in or against my interests would appear to support the view that for nearly every (actual) person nearly every way the world could have been would have been worse than the way it actually has been. But if that view is correct, then the way the world has actually been must come close to being the best, at least in terms of the welfare of the persons who have existed, of all possible ways the world could have been. A new-style Panglossianism?
12 I have benefited greatly from the kind comments and suggestions of Adam Zeman, Melissa Lane, Sally Laird, Ross Harrison, Gwen Griffith Dickson, Roger Crisp, and Stephen Byrne. I am also grateful to Ronald Dworkin for generously supplying me with a copy of his 1988 Tanner Lectures.