Nothing to lose? Killing is disabling

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnott-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them.

Usually penalties for killing are more severe than those for actions that disable. Imagine, for example, that a man, John, goes into his brother Jack’s house intending to kill him so that John will inherit his father’s fortune. John shoots his brother in the head, but Jack does not die. Instead he is left in a state of permanent unconsciousness. Jack has (let us assume) no awareness of pain or pleasure. He is completely unable to act or move. He lives for a further 10 years in this state. Would it really be worse if John had killed Jack? It is hard to see how it could be worse for Jack if he had died. (Many, myself included, might think that it is actually worse that Jack lives in this state for 10 years after his shooting).

But the second, and more controversial implication of the Sinnot-Armstrong and Miller argument is that if killing is wrong because it dis-ables someone, then in some very special circumstances it would not be wrong to kill. If there are cases when killing does not strip someone of any of their abilities (because they already have none), then killing would not harm the individual, and it would not be morally wrong. The example that Sinnott-Armstrong and Miller give is of a patient with such severe brain injury that they have lost all brain function, and are dependent on artificial life support for support of their breathing and circulation. This patient has already, and irreversibly, lost all of their abilities. Sinnott-Armstrong and Miller argue that it would not be morally wrong to kill such a patient and remove their organs, as long as the patient had not previously expressed a wish not to donate. In fact, at present, this patient would be eligible for organ donation. They would be diagnosed as being ‘brain-dead’, and therefore, the surgical procedure that removes their organs isn’t classified as an act of killing. However, Sinnott-Armstrong and Miller add one more voice to a recent and growing chorus of dissent with the concept of brain-death. It is not that these philosophers believe that it is wrong for patients with total brain failure to donate their organs. On the contrary, as Julian Savulescu, and I have argued, it is totally appropriate for organ donation to proceed in situations where death is inevitable because intensive care is being withdrawn, and where this is consistent with the previous wishes of the patient. Killing in these very unusual circumstances is not disabling, and it is not morally wrong.