Eye of the Heart: Knowing the Human Good in the Euthanasia Debate (review)

As a medical doctor who also holds a doctorate in philosophy, William Sullivan is especially well trained and appropriately situated to write on the euthanasia debate. He is particularly concerned to indicate the cognitive role of feelings in value judgments; he adopts and articulates Bernard Lonergan's position on this question and spells out the ramifications of this position for the euthanasia debate. Contrary to the dominant contemporary bioethical theories, Sullivan articulates a foundationalist position in which feelings are understood to play a crucial role in making epistemically objective value judgments, and which overcomes the generalist/ particularist divide by showing that these approaches are both indispensable and complementary. While Sullivan carefully expounds his own positions and criticizes a number of other positions in a penetrating and detailed way, this is not a polemical work, but one that invites readers to deepen their understanding of the issues being debated, and to arrive at a philosophical stance that is most defensible because least truncated.

Sullivan begins chapter 2 by reconstructing the life-stories of two individuals who suffered from amyotrophic lateral sclerosis (als), one of whom did, and one of whom did not, request assisted suicide. His approach, accordingly, can be described as a 'bottom-up' one, for it does not begin by articulating general principles and applying them to particular cases, but with the cases themselves; in this way, Sullivan illustrates the role of affectivity in persons facing end-of-life decisions, something that is often lost on bioethicists who fail to attend to and reflect on these lived experiences. Sullivan concludes this chapter by outlining some important positions on euthanasia in philosophical and legal debates in the North American context. Chapter 3 sketches some of the more important and influential philosophical accounts of feelings as to their cognitive role in knowing and grasping values. This allows the reader to situate the views on emotions in the contemporary euthanasia debate in a historical context, and to view Lonergan's position as one that develops the Aristotelian-Thomist tradition.

In the work's central chapters (4–7), Sullivan articulates Lonergan's cognitional theory. For Lonergan, acts of knowing have empirical and pre-empirical features, the latter being the philosophical presuppositions one brings to any concrete inquiry. Lonergan claims we discover these pre-empirical features of ourselves as knowers by answering three basic questions: the phenomenological question ('What am I doing when knowing [values]?'), the epistemological question ('How is doing that knowing valid?'), and the metaphysical question ('What is the structure of the real?'). This allows Lonergan to maintain that knowing is a series of distinct but dynamically related conscious and intentional acts, which arise as the result of the wonder that is proper to human beings. On Lonergan's account, human knowing can be thought of as a pair of double-bladed scissors, with an upper blade of transcendental intending (questions proper to corresponding cognitive acts), and a lower blade of empirical contents and determinations (concrete data one investigates). Sullivan helpfully deploys a medical example to illustrate this material, proceeds to indicate how values can be related and compared and to outline Lonergan's account of the structure of the human good, and concludes by affirming Lonergan's account as correct.

The advantage of accounting for the objectivity of fact and value judgments in this manner is that it provides ethics with a stable foundation that cannot be undermined. Moreover, such a foundation provides one with the requisite analytical tools to assess the various alternative and rival positions on the morality of euthanasia. Hence, in the work's final part, Sullivan returns, now via a 'top-down' approach, to the two life-stories and to the positions articulated in the philosophical and public policy debates discussed in chapter 2, evaluating them from the standpoint of their underlying philosophical commitments and of their treatment of the empirical questions surrounding the issue of euthanasia. Sullivan does not make any definitive pronouncements...