The End of Life by James Rachels (review)

714 BOOK REVIEWS The End of Life. By JAMES RACHELS. Oxford: Oxford University Press, 1986. Pp. 204. The rise of advanced medical technologies, especially life-sustaining ones, has brought to center stage the hioethical issues which arise in acute and long-term care contexts. Especially pressing have been problems about the nature and permissibility of euthanasia. Roughly speaking, there are two major views about euthanasia. The traditional view holds that it is wrong intentionally to kill an innocent human being, hut that, given certain circumstances, it is permissible to withhold or withdraw treatment and allow a patient to die. A more radical view, embraced by groups like the Hemlock Society and the Society for the Right to Die, denies that there is a morally significant distinction between passive and active euthanasia. Further, mercy killing , assisted suicide, and the like are permissible. James Rachels's hook is the most articulate expression of the radical view. The work contains 'ten chapters which can he broken down into l:wo main sections. In chapters one through four, Rachels draws a distinction between what he calls biographical and biological life, and he maintains that, whereas ithe traditional view places emphasis on the latter, the former is what should he considered in euthanasia cases. In chapters five through ten, the distinction between active and passive euthanasia is analyzed. Rachels argues that ithere is no distinction between the two and that euthanasia is permissible in certain circumstances . Chapter one traces the rise of the traditional view in the west from 1the Greeks and Romans to the development of Christanity. According to Rachels, the Greeks and Romans allowed aotive euthanasia-infanticide , suicide-in some cases, because they believed that life held little value apart from the chance of a meaningful or happy existence. But the coming of Christianity caused the traditional doctrine to arise. Until Augustine, the Church taught ·that all killing was wrong. But Christendom during Augustine's time made a politically expedient decision to change its views in 1the face of pressure from the state. The Church adopted the position that all taking of innocent human life was wrong. Two observations should be made here. First, Rachels would have a difficult time proving that the Church changed its views for reasons of political expediency. He makes no attempt to analyze the theological aspects of the situation during Augustine's time, e.g. the shift from a premillenial to an amillenial eschatology with a concomitant change in how the two kingdoms should he related, Second, and more importantly , Rachels discussion of 1the Greeks and Romans contains a serious BOOK REVIEWS 715 omission which is quite revealing in light of later chapters. He does not distinguish happiness and the good life in its formal and material aspects. For many Greek and Roman thinkers, e.g. Aristotle, happiness was more than a mere formal principle. It contained substantive content , viz. the progressive embodiment of intellectual and moral virtues. For Rachels, the good life is whatever an individual finds to be in his own best interests. Chapter .two focuses on the sanctity of life. After surveying eastern views (all life is equally sacred, including that of insects) , Rachels criticizes the sanctity-of-life view. As it is expressed in Christianity, this view, as understood by Rachels, holds that all human life is sacred merely because it is biological human life. Being homo sapiens is what gives value to human life. According to Rachels, this is a mistaken understanding of why life is valuable. The sanctity of life should he construed as protecting biographical life, not mere biological life. One's life has value from tlie individual's point of view because he has a biographical life; that is, he can pursue interests and goals that are important to him. The importance of being alive is derivative from the importance of having a life. The traditional view, says Rachels, has lost sight of the point of the rule against killing. H we fail to ask for the purpose of a moral rule, we may sometimes fulfill its letter by going against its spirit. For example , we are taught to drive on ,the right side of the road. But if we...