Armpits and Intuitions
In which we talk about about moral intuitions and paper everyone should read.
bing AI image creator again.
What do armpits and intuitions have in common? Answer: Everybody has a couple and if not attended to carefully, they tend to stink.
In Practical Bioethics I take philosopher’s license to define a moral intuition as an untested moral opinion. It’s a flash of insight. It sits somewhere between a feeling and a theory. One of the greatest books I’ve ever read is Thinking Fast and Slow by Daniel Kahnemann.
Do yourself a favor and get this book. Kahneman explains that our brains operate on two different systems. One is fast and intuitive. The other is slow and deliberate. We need both, but both have their flaws. Kahnemann illustrates this with a puzzle.
A bat and ball cost $1.10.
The bat costs one dollar more than the ball.
How much does the ball cost?
Was your immediate intuition that the ball cost 10 cents? If so you would be in line with 50% of Harvard graduates and you would also be wrong. The ball costs 5 cents.
I’m suggesting that moral intuitions are often the same. We are sure we know the answer and we make a quick decision/gut reaction without thinking “Why do I feel this way”?
[As an aside, it doesn’t help that though we act on reasons, our certainty of the rightness of the reasons, is more affective than cognitive according to another excellent book How Minds Change by David McRaney. When confronted with the fact of our own intuitions, we are not likely to give them up because how certain we "feel” about the intuitions themselves]
One area where our moral intuitions count the most is at the end of life. Is removing a breathing tube of a dying patient allowing them to die or killing them? Is stopping CPR because a family member produces at Do Not Resuscitate (DNR) order allowing someone to die or killing them? Is passive (allowing to die) always moral?
A very, very important article in Practical Bioethics is one by philosopher Jeff McMahan called “Killing, Letting Die, and Withdrawing Aid.” McMahan says that our moral intuitions about a moral “letting die” and an “immoral” killing depend on a lot more than the distinction between acting and omitting or active and passive.
Through a series of ingenious little analogies, he tests our intuitions about withdrawing and withholding aid. Here’s a sample.
The Pipe Sealer.—An earthquake cracks a pipe at a factory, releasing poisonous chemicals into the water supply. Before a dangerous amount is released, a worker seals the pipe. But a year later he returns and removes the seal. As a result, numerous people die from drinking contaminated water.
The Dutch Boy.—A little Dutch boy, seeing that the dike is beginning to crack, valiantly sticks his finger in the crack to prevent the dike from breaking and flooding the town. He waits patiently but after many hours, no one has come along who can help. Eventually succumbing to boredom and hunger, the boy withdraws his finger and leaves. Within minutes the dike bursts and a flood engulfs the town, killing many.
Notice, in both instances a barrier to death is removed but McMahan thinks the Dutch boy allows the town to flood, but the pipe sealer clearly kills the town’s inhabitants. I hope you can see the analogies with withdrawing ventilators or stopping CPR etc. McMahan argues there are three distinctions that affect our moral intuitions about withdrawing life saving aid:
Whether the person withdrawing the aid is also the one who started it. If the person who starts the life saving aid is also the one who stops it, then it feels more like letting die. If however, the person who stops the aid is not the one who started it, then it feels a bit more like killing.
Whether the aid is seen as self-sustaining or one that requires on-going maintenance. If the aid is self-sustaining, and it is removed it feels more active than if the aid requires continuous contribution from the provider.
Whether the aid is fully operative or not yet operative. If the aid is seen as operative and then removed it feels more active than if it is not yet operative.
McMahan’s conclusion is, I think, very instructive:
[I]f aid or protection against a lethal threat is both operative and self-sustaining, withdrawing it appears to count as killing irrespective of whether the person who withdraws it is also the person who provided it. But, when aid that is as-yet-inoperative is withdrawn, it seems to make a difference to whether this counts as killing or letting die whether the person who withdraws it is also the person who provided it [emphasis mine]
To me, if McMahan is right, this explains why medical providers and family members don’t see eye to eye. After all, if the family member thinks a ventilator is self-sustaining and the physician thinks of it as on-going, or vice-versa, then we are going to have a real difference of opinion about whether something is more like killing than letting die.
All of this to say, those of us who have power of attorney for our family members and those who provide medical care, should both start thinking about what counts as killing and letting die, and why so that our intuitions don’t end up like armpits.