Causing Death and Saving Lives (1977)

This book has three central thrusts. The first is an attempt to provide a new model for thinking about the moral wrongness of killing. It sets out to challenge the orthodox account based on the sanctity of life. If life is sacred, can this approach allow for the greater importance we give to life or death decisions about people than to such decisions about chickens or trees? On the proposed new model, the wrongness of killing people is partly based on respecting their autonomy. It is also based on the value to the person of being alive. “Life is only of value as a vehicle of consciousness”, and consciousness is only of value as a condition of a kind of life experienced as worthwhile.

The second thrust challenges another aspect of conventional morality: the huge moral difference assumed to exist between killing someone and either deliberately or intentionally allowing them to die. Sometimes it is judged that it would be a mercy to allow a hospital patient in a desperate condition to die (perhaps by giving no protection against flu). The intention is for the patient to die, and this is the consequence. Is this really so different to administering a lethal injection with the same intention and the same consequence? And should we really be so comfortable with the way we allow so many preventable deaths by doing so little about hunger and disease in the devastatingly poor majority of the world’s people?

The third thrust is to try to provide a way of thinking about life and death decisions more humane than the legalistic rules often associated with the traditional sanctity of life approach. The aim is to move the debate on abortion, capital punishment and war away from abstract rules about the sanctity of embryonic life, retribution or national defence: to shift the focus of the ethics of decisions about war towards the consequences of those decisions for the people affected. The chapter on war started: "It is widely held that killing in war is quite different. It is not, and we need to think about the implications of this." Years later, an article I wrote against the invasion of Iraq, both drew on the book and at the same time was a distillation of its essence.

Can we justify killing the children of Iraq?

The key to the spirit of Causing Death and Saving Lives is a remark it quotes by Bertrand Russell, a year before a pamphlet he wrote against the First World War resulted in him being sent to prison.

The question of the rights and wrongs of a particular war is generally considered from a juridical or quasi-juridical standpoint: so and so broke such and such a treaty, crossed such and such a frontier, committed such and such unfriendly acts, and therefore by the rules it is permissible to kill as many of his nation as modern armaments render possible. There is a certain unreality, a certain lack of imaginative grasp about this way of viewing matters. It has the advantage, always dearly prized by lazy men, of substituting a formula, at once ambiguous and easily applied, for the vital realization of the consequences of acts. Bertrand Russell: The Ethics of War, International Journal of Ethics, 1915.

Causing Death and Saving Lives was developed as my contribution to an Oxford class given with Derek Parfit and James Griffin in the years from 1967. Its influence can be seen in the writings a number of those graduates who attended the class and who became leading philosophers, including Peter Singer and John Harris.

In the legal case about Tony Bland, who was in persistent vegetative state after a brain injury, the House of Lords made the landmark ruling allowing the removal of life support when consciousness was lost irrecoverably. Tony Bland’s doctor told me that he and the family had used the book in their thinking. One of the legal judgments echoed the book: “life is of value only as a vehicle of consciousness”.

"My original motives for writing this book were the interest of the questions involved and my own lack of any clear and defensible answers... One of its aims is to persuade people to change opinions which they already hold. This is because some of the views criticized here cause much unnecessary misery, while others lead to loss of life that could and should be avoided. The conventional view that philosophical discussions are quite remote from having any practical upshot, such as prevention of suffering or loss of life, has very little to be said for it."