What is the purpose of prolonging life in painful terminal diseases?

Let us examine the problem from the point of view of a rational ethics based on anthropological grounds. By rational, I mean a discourse whose statements are not contradictory among themselves, and by anthropological grounds I mean a non-transcendental valuation of life, a human axiology. Particularly, I will use two anthropological ethic principles:

P.1 Principle of life preservation: We have to preserve human life.

P.2 Principle of primacy of the public interest: the life of the group has preference over the life of the individual. Human individual life is conditioned by the life of the group and subsumed to its needs. Not only my actions are rightful when they do not imply any sort of harm to others, but they cannot be autonomous when there is an urgent need of society: we work and die for the group whenever is needed. And since the needs of society are always urgent, life preservation is limited by public interest, as has always been the case with wars.

In relation to our question, we can imagine, at least, the following scenarios for a dying patient in pain:

1     The patient is sustained by public funds.      

           a. Society denies further sustenance for it is an incurable disease and cannot benefit from the              situation. 
      b. Society agrees to sustain the patient despite the non-economic benefits of the situation.

1.   The community wants the person to live longer in pain.

2.  The community wants the person to live longer but not in pain.

3.  The community leaves the choice to the individual.

2       The patient is self-sustained.

a.   Still the society wants to exercise the control.

1.    Society wants the individual to suffer.

2.    Society wants the individual to live longer but not to suffer.

b.  Society declares the case to be a private choice.

In the case 1.a, when the patient is sustained by private funds and society denies further sustenance, we are dealing with a rational choice according to principles 1 and 2, for P1 cannot be enacted (is a terminal disease), and there is nothing positive for the patient (supposing that s/he is driven by the principle of avoiding pain) in the situation. The rational action is assisted death.

The second choice has, in turn, three scenarios. The first one, 1.b.1 is not as rare as it would seem. Such is the case with criminals or by religious motives in which the valuation of pain extends beyond this life to other worlds. There are religious ethical values which consider suffering as a way for purgation in a context of otherworld scenarios. Here, is not the principle of life preservation what is at work, but a principle of punishments and rewards on a transmundane scale, which is contrary both to any anthropological principles and to the structure of most of our legal systems. Since this punishment does not serve any practical purpose for the community, beyond sadistic morbid satisfactions, it obeys only non-rational valuations, therefore are not part of a rational ethics.

The second scenario of the second choice, 1.b.2, when the community wants the person to live his/her final days without pain, does not affect the principle of life preservation, for life cannot be preserved in this case, and also conforms to the public interest principle, which in this case is to alleviate the patient’s pain. The rational action is the alleviation of pain whether by the increase of medication for relieve, or by the shortening of the condition of pain. If pain cannot be alleviated, the rational outcome of the scenario is assisted death, for since P1 cannot be accomplished and the choice is not to suffer, it can only be obtained by shortening the duration of pain.

The third scenario, 1.b.3, is to leave the choice to the patient, which will decide therefore either to continue his/her suffering to the very end or to suicide. None of these decisions is contrary to the ethical principle of life preservation nor to the one of public interest, for life cannot be prolonged and the community has passes the choice to the patient, i.e., has given the ownership of life to the individual. This case is equivalent to 2.b, and both are rational actions.

The case 2.a. 1, when the patient is self-sustained and society still wants to control the life of the individual for it wants him to suffer (for whatever ethical or metaphysical reasons) is equivalent to the 1.b.1, and therefore, is not a choice of rational ethics. On the other hand, the case 2.a.2, is analogous to 1.b.2, and represents a choice of rational ethics which developed to its consequences leads to assisted death.

Therefore, pain can only be prolonged in terminal disease cases under non-rational ethical principles, whether those corresponding to the personal choice of the individual or the group.