Abstract
In the relevant circumstance of both relatively high burden or cost to others and low prospective gain for themselves, people have a prima facie duty to die sooner rather than later. This duty is a personal moral duty, not a “societal” duty, and thus, it in no way implies that others may demand that it be exercised. It is literally a duty to let death come, not a more general duty to die that encompasses active measures to ensure death. A person can owe this duty not only to close family and loved ones when they are heavily burdened, but in the right circumstances also to more distant persons, even to “society”; the fundamental reason is fairness to others in the society or insurance pool, given one’s own evaluative preferences about trade-offs involving expensive, low-chance-of-benefit care. This personal moral duty to die does not extend to incompetent patients, at least not in any literal sense. The duty to die also does not jeopardize the marital vow, “for better or worse, in sickness and in health”; the creative and mutual relationship envisioned in a marital promise does not bar people from ever coming to think that they may be obligated to accept death because of effects on a spouse. Finally, although this duty is rooted in sensitivity to considerations of quality of life, it need not threaten the “special” value of individual life and lifesaving.
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Notes and References
Hardwig, John (1997) Is there a duty to die? Hastings Center Report 27, 2 (March-April): 34–42.
These two attributes characterize the duty to die that I defend in pp. 190–203 in Strong Medicine: The Ethical Rationing of Health Care. New York: Oxford University Press, 1990. Part of the next section is a review of the discussion there.
Callahan, Daniel (1997) Letter in response to Hardwig (note 1). Hastings Center Report 27, 6 (November-December): 4.
For the difference between the “individual health state utility” that is measured by methods, such as the Time Trade-Off, and the “societal value” of health improvements that is measured by the Person Trade-Off, see Nord, Erik (1995) The person trade-off approach to valuing health care programs. Medical Decision Making 15; 201–208. On the different roles of these two kinds of value, see Nord, Erik, Pinto, Jose Luis, Richardson, Jeff, Menzel, Paul, and Ubel, Peter (1999) Incorporating concerns for fairness in numerical valuations of health programmes. Health Economics 8,1 (January), 25–39.
One study reporting this effect is Nord, Erik, Richardson, Jeff, and Macarounas-Kirchman, K. (1993) Social evaluation of health care versus personal evaluation of health states: evidence on the validity of four health state scaling instruments using Norwegian and Australian surveys. Int. J. Technol. Assess. Health Care 9: 463478. For normative analysis related to such empirical work, see Menzel, Paul, Gold, Marthe, Nord, Erik, Pinto Prades, Jose Luis, Richardson, Jeff, and Ubel, Peter (1999) Towards a broader view of values in cost-effectiveness analysis of health care. Hastings Center Report 29, 3 (May-June): section II - 2.
Ubel, Peter, and Loewenstein, George (1995) The efficacy and equity of retransplantation: an experimental survey of public attitudes. Health Policy 34: 145–151.
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Menzel, P.T. (2000). The Nature, Scope, and Implications of a Personal Moral Duty to Die. In: Humber, J.M., Almeder, R.F. (eds) Is There a Duty to die?. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-000-1_6
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