While in a hospital context, the decisions for maintaining or interrupting life seem to define a threshold between the lives which would be worth living and those which would not be worth living, the book by Marie Gaille La valeur de la vie wants to question the moral legitimacy of this notion of “value of life“. This philosophic investigation in medical field proposes a conceptual clarification of the new usages of the terms “value of life” and a critical assessment of these judgements and their moral consequences. It leads the author to assert that “the judgement on the value of life, whatever it is, does not constitute a moral argument for deciding to maintain or interrupt life (…) because the very idea of a “measure“ and of an establishment of a hierarchy between the status of human life does not have any objective foundation and cannot legitimate the act of the physician, even when it is made as the expression of a strictly personal value judgement of the patient about the life“.
A debated notion
The idea of “value of human life” is today debated. From one hand, it has the negative aspect caused by the Nazi eugenics which was founded on the idea that some lives were not worth living because they were an expensive weight or simply are not anymore useful for the society. From another hand, the political and moral option of democracies, which consists in legitimating any free and personal choice, “goes until the relatively consensual acceptation that an individual is the sole judge of the value of his life“. Finally, “the usage of new techniques seems to have aroused a doubt on the fact that the principle of the absolute respect of human life should guide the practice of the physician.” In situations such as adult resuscitation, neonatal resuscitation or medically assisted termination of pregnancy, the question “is now rather to know if the life of this patient, in his current and functional status of health, is (still) worth living.»
The challenge of the controversy is then to delimitate the contours of human dignity. Two conceptions oppose: the first one, inherited from Kant, lays down that the man has, according what he is, an inherent and inalterable dignity which involves a radical respect, including of the person towards itself. This particularly passes by the duty to not damage his body. The second one, developed by John Stuart Mill, links the dignity to the “feeling of dignity” that the individual feels. Then the ups and downs of life and subjectivity can cause different assessments, even the lost of the person dignity.
Value of life: usages
The notion of “value of life” is used in two situations in medical field: the one when a person is going to judge his own life within the framework of a demand to let him die or to help him to die; or the one when a third has to make a decision for other.
The question of the “right to die“, reintroduced in the public debate, has diverse and particular meanings and should be heard as it is. The development of palliative care showed that, more than a death request, it often covered a pain relieving request. But the negative judgement of a person on his life can also show an incapacity to re-appropriate his life after the irremediable loss of his capacities, or a willing to freely choose his destination in a situation where all is stress, what Freud calls “the inversion of will“.
Within the framework of a medical decision of interrupting or maintaining the life of a patient who cannot anymore give his opinion, the assessment consists in wondering about the quality of life of the person. But this refers again to the question of the foundation of criteria accepted to declare a lively life. The author delivers the anxiety of healthcare professionals who confess “to not always know if they care a human being“. Moreover, she notes that the moral markers are often absent from the decisions of maintaining or interrupting life: “Above all in some occasions when a member of the department intends to clarify a doubt or a disagreement on the rightfulness of the principles and current practices, the physicians who manage the team devote generally to ‘recode’ them in a technical or psychological register enabling to occult the moral challenges. “
Philosophical criterion
It is to remove any ethical ambiguity that Marie Gaille makes a philosophical critic of the notion of the value of life through two questions: may we pose an objective value judgement on human life? Does the subjective preference of a patient constitute for the physician a reason to act?
To show that we cannot assess objectively the life according to different status it has, the author gather rapidly the thoughts of three philosophers. With Kant, she lays down the affirmation of an intrinsic and absolute dignity of the man, attached to his nature of moral being. Thus the man is worth himself, for an end purpose. Schopenhauer recognises that there can be different appreciations of the life, but he distinguishes carefully the will to live, which is a matter of subjective appreciation, from an objective knowledge of the value of life. “If we follow Schopenhauer, consequently, the judgement on the value of life cannot be challenged as long as it refers to a ‘feeling’, a true experience of the subject, but there can be no pretention to objectivity“. Finally, Nietzsche’s philosophy gives him the reason of these subjective appreciations. For this latter, as long as the man is an integral part of life, any judgement on the value of life will only be considered as a personal, symptomatic preference of the vitality level of the person who expresses it.
Such a personal preference cannot be a valid reason of the physician’s decision. If the bioethics literature promotes a rational and autonomous subject, the author notes that the request to let die is not a personal decision: it puts the physician in a position in which he has to give an answer.
“The question does not come down, in other words, to the definition of a new ‘freedom’ of the citizen or to the extension of his ‘autonomy’ regarding the prerogatives of the State. It puts at stake the professional relation into which a physician wants to enter with his patient and the way the society envisages this relation.”
Ref: La valeur de la vie, Marie Gaille, Les belles lettres, Paris, 2010