I am a 78-year-old woman with a loving husband, three sons, seven grandchildren and three great grandchildren. However, I was recently diagnosed with cancer. The initial surgery was successful, but I was left wondering whether I should opt for further treatment, and all the suffering it might cause, or take my chances without it. I have, after all, lived a long and happy life. While I have now thankfully been cured, I am still left wondering: do we have a moral obligation to live for as long as possible?
— Ann, Tarbert, Scotland
There are many answers to this question — especially during a pandemic — and probably no clear solution. But that doesn’t mean we shouldn’t think about it. Indeed, by considering such questions we can discover some of the most enlightening perspectives on life.
So let me approach this issue as a philosopher — and define first exactly what we mean by a “moral obligation.” A moral obligation or a moral duty is a morally required form of conduct. Obligations can be perfect, leaving us no wriggle room — for instance, the duty not to kill unjustly. Obligations can also be imperfect, giving us some flexibility in when and how we honor them, such as the duty to be beneficent. Obligations can be context-specific, such as the duty to meet someone at 3 p.m. as promised. And, they can be general, including the duty not to steal without necessity or the duty to try to save someone’s life when we can do so at little cost to ourselves.
In my view, we cannot have a blanket moral obligation to live for as long as possible regardless of our circumstances. Each life is unique and, for some people, continuing to live is a horrific experience. But, we can have an obligation to prolong our lives when certain conditions are met.
To add some clarity, here are some thoughts on two different sets of circumstances: living in isolation and living with others. These cases rely on some imagination, but then imagination is the tool that allows us to see dilemmas from alternative perspectives.
Imagine I am a solitary person, stranded on a distant and deserted island surrounded by a vast expanse of ocean. I have no one to love, no one who misses me, and my only hope of escaping the island and meeting another person again lies wrecked in the waves: the ship that brought me here. Now, I will likely want to survive, but that is a different thing. What we need to consider is whether, given my plight, I have an obligation to live for as long as possible.
I might, if my duties to respect myself include me prolonging my life. The German philosopher Immanuel Kant’s categorical imperative states that we have a duty to treat all people including ourselves as ends to be respected and not merely as means. But respecting myself need not entail striving to live an impressively long life. I have a duty to care for my mind and my body and, as a result, I may live healthily for a long time. But that doesn’t mean that living for as long as possible must be my aim or responsibility.
Even so, I might still have an obligation to prolong my life for a different reason. The people who raised me and were sufficiently invested in my fortunes to ensure I survived into adulthood might have a claim on me. This would suggest that this Robinson Crusoe version of me should care for myself now, to honor their investment.
In his book Happiness, the Buddhist monk Matthieu Ricard quotes the words spoken by a mother to her son shortly before her death:
Don’t think you’re paying me some kind of great tribute if you let my death become the great event of your life. The best tribute you can pay to me as a mother is to go on and have a good and fulfilling life.
But living a “good and fulfilling life” is not the same as living for as long as possible. Indeed, living a good life, not a long life, may be the best way to honor our guardians’ investment in us.
And what if those who raised me have passed away — do they still have a claim? Similarly, what if they are living, but will never know how I fared? Will their lives be worse if I don’t prolong my life indefinitely? Probably not. They likely think I am already lost forever.
But perhaps I am a remarkable person — Mozart, say — and I have been abandoned on this island. I have a musical genius that arguably I shouldn’t squander, even though the music I compose in my head here will never be heard. My potential to craft masterpieces might give me an obligation to prolong my life but, of course, only for as long as I can create divine music.
Indeed, even if my talents aren’t “divine,” I might have an obligation to “use up” the talents or blessings I have been given. The American humorist Erma Bombeck, for example, wrote that:
When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, ‘I used everything you gave me.’
It’s an inspiring approach to life — but, as the 17th century British poet John Milton argued: “God doth not need Either man’s work or his own gifts; who best Bear his mild yoke, they serve him best … They also serve who only stand and wait.”
Ultimately, as Milton suggests, no one of us has any greater claim to life than another — even if we have no talents, choose to ignore the talents we do have, or simply “stand and wait,” we still fulfil our purpose.
Of course, most of us do not live alone on deserted islands. We don’t exist in isolation, but with and among others, at least until the pandemic forced us behind our front doors. Consequently, perhaps we have an obligation to prolong our lives for the sake of the people we love and who love us.
When we have dependants, particularly young children in our care, we arguably do have a duty to try to keep ourselves safe and healthy for as long as they need us. But that doesn’t mean we have an obligation to live for as long as possible when they no longer depend on us. S Matthew Liao, a bioethicist at New York University, has argued that children have a human right during childhood to be loved, and that we all have a duty to ensure that children are loved because this is crucial to their lives and development. Once they have grown, our love-giving duties subside, but do not entirely disappear.
There’s a flip side to this, too. When we become dependent on our loved ones as we age, do we have an obligation to prolong our life or, alternatively, to end it — so that we’re not a financial or emotional anchor or an additional burden on our overcrowded, exhausted planet?
This question is an easy one to answer. People should never think of themselves as a “burden” or a “problem to be solved.” Every human being has a right to life and to lead a life that is at least minimally decent, free from degradation, cruelty, undue harm, and unfairness. No one person has any more entitlement than any other to live in this world. We are all worthy of a place here, and older people should be treasured by their families, friends and societies.
Yet not everyone accepts this. The pandemic has held up a moral mirror to our treatment of older people and found it to be abysmal. Even though many countries have taken an age-attentive approach to vaccinations, older people have nonetheless borne much of the brunt of COVID-19.
One final thorny question concerns doing versus allowing. Sometimes it’s unclear whether I am actively doing something, such as prolonging my life or seeking to end it, or simply allowing things to happen to me, such as letting doctors pursue a course of treatment (or not) with the result that my life extends or comes to a close.
The availability of various medical options can make the people who love me feel that they have failed me: “I should have convinced her to have surgery. I shouldn’t have let the medical staff opt for comfort-care only. I should have been her advocate. I should have pushed for her to stay in the hospital longer.” But, there is a natural arc to a life well lived, and well-being is not the same thing as biological self interest or longevity.
I have written all of this in the language of obligation since that was the language in which you posed your question. But the language of obligation is a strong one.
We might do better to ask whether we have good reasons to prolong our lives or whether we act virtuously if we seek to prolong our lives. Courage is a virtue that figures centrally at the end of life. To quote the poet Dylan Thomas, it takes courage to “rage against the dying of the light.” But it also takes courage to bear our mild yoke and, contradicting Thomas, opt to “go gentle into that good night.”
Whatever your choices are going forward, I wish you and your family courage, grace, and happiness. And remember: life is yours to live and “death shall have no dominion.”
Kimberley Brownlee is a Professor of Philosophy at the University of British Columbia.