'African vital force and the permissibility of euthanasia' by Kirk Lougheed in (2024) Journal of Medical Ethics comments
One prominent idea in African metaphysics says that everything that exists, including both animate and inanimate objects, is imbued with an imperceptible energy known as vital force or vitalism. On this view, the goal of morality is to preserve and strengthen the force in oneself and in others. It is life itself that is the object of the greatest moral concern since once a person dies their force is completely snuffed out, which is considered to be the worst possible outcome. Inasmuch as Africans across the sub-Saharan affirm vital force, the sociological data suggesting that there is little support for euthanasia or physician-assisted suicide on the African continent is unsurprising. Instead, what is surprising is that in the few places where euthanasia is discussed by African ethicists, it often receives a very sympathetic hearing. Perhaps even more surprising is that the permissibility of euthanasia has recently been defended by appealing to an ethic based on African vital force as located in the work of Molefe and Maraganedzha. They suggest that when vital force cannot be participated in or otherwise fostered, then euthanasia is permissible. This is particularly so when such a person cannot meaningfully participate in the life of the community, which is regarded as a particularly powerful way of enacting vital force. Even for those who do not believe in the existence of vital force, there is still likely a certain amount of intuitive plausibility to the claim that relating well with family and friends is one of the most important activities for conferring meaning to one’s life.
Before proceeding, it is important to clarify the scope of my discussion, since euthanasia is a broad term that captures many different ideas. First, there is a distinction between passive and active euthanasia, where the former involves withholding life-saving treatment and the latter occurs when a patient’s life is actively terminated. Passive euthanasia occurs frequently and is not what I have in view here. For example, a patient with an advanced form of cancer may decline doing another round of treatment even if doing so would almost certainly extend their life, if only briefly. Active euthanasia is usually the target of the current philosophical debate. This can involve cases where a physician directly injects a patient with a lethal dose of medication or where a lethal dose is prescribed, but the patient must administer it themselves. This is sometimes referred to as Medical Assistance in Dying (or ‘MAiD’).i I am primarily concerned with whether it is permissible for a patient to use euthanasia and so what I say is meant to be consistent with both forms. In other words, my claims are intended to apply to a patient requesting that a doctor inject them with a lethal dose of medication or prescribe them a lethal dose that they can take themselves.ii Finally, there is a distinction among the voluntary, non-voluntary and involuntary active euthanasia. Voluntary active euthanasia occurs when a patient is competent, and requests MAiD.iii Non-voluntary active euthanasia occurs when the patient is incapacitated, and the request comes from a legitimate proxy or advanced directive and is fulfilling the patient’s wishes.iv Finally, involuntary active euthanasia occurs when euthanasia is conducted against the patient’s wishes.v I am primarily concerned with evaluating how well Molefe and Maraganedzha’s argument can defend voluntary active euthanasia, where the patient is competent and makes a request for MAiD. In what follows, when I write of ‘euthanasia’, I mean active voluntary euthanasia unless stated otherwise.
In view of my focus, notice that I am primarily concerned with the moral question of whether it is permissible for an agent who is considering euthanasia to be euthanised. In other words, is it permissible for the patient themselves to request and receive MAiD? Nothing that I write is intended to suggest that this is the only angle worthy of moral reflection when it comes to euthanasia. Family, close friends and medical practitioners of someone who is seriously ill may be forced to confront questions about euthanising someone else. The set of relevant moral considerations may not be identical to those of the agent who is considering it for themselves. It is not that I think Molefe and Maraganedzha’s argument suggests nothing worthy of discussion from these other perspectives; but this paper would quickly become far too long without delineating the scope in this way. Though I will suggest (see The nature of other-regarding duties in African thought) that the agent considering euthanasia needs to examine their decision from within the context of their community, I am still asking what is permissible for the agent.
In what follows, after reconstructing the argument (see Reconstructing the argument for euthanasia from vital force), I point to a number of areas of potential concern (see Evaluating the argument for euthanasia based on vital force). While these objections do not show that euthanasia is impermissible, they do suggest that it is doubtful its permissibility can be defended on the basis of African vital force. I conclude (see Conclusion) by observing that the time is ripe for cross-cultural dialogue between the Anglo-American and African bioethical traditions.
