Schwartz AT: V2L is Neg

When faced with a K making a "no value to life" claim, may affirmatives read this schwartz card (below) or some variant that basically says euthanasia/nazi doctors prove that allowing external actors determine the value of someones life is bad/promotes attrocity, only an individual can decide whether their life has value.

This evidence flows neg. Here is why:

The general assumption the aff is making is that the negative has made the argument "you do XYZ, therefore I have determined that your life has no value". I.E. they presuppose that the negs argument is doing X causally results in you having no value to your life, according to me the arbiter of value.

I do not believe this is the claim the neg is in fact making. Instead, the neg is saying that some kind of system (capitalism, biopolitics) does not see value in life, and the affirmative propogates that system. This external system is then the actor who decides life has no value, and is the external system deciding the patients life has no value, so Schwartz would indeed be criticizing that system- which is what the neg is doing, hence this evidence goes neg.

A more concrete example. Cap K. The idea that capitalism commodifies humanity and reduces us all to dollars and cents is not the neg saying "I, the 2NC, believe the affirmatives life has no value, because they endorse capitalism". It is saying the capitalist system that the aff props up is indifferent to life, and therefore it views lives as meaningless/mere commodity. So its like this

Neg- aff props up capital, capital views life as having no intrinsic meaning, that causes genocide
Aff- individuals should get to decide their own value of live
Neg- Agree- they should get to do that- capitalism prevents them from doing so- and you promote capitalism









Card in question (as an aside this is probably the weakest card to make this weak argument, its prevalence confuses me)
Those who choose to reason on this basis hope that if the quality of a life can be measured then the answer to whether that life has value to the individual can be determined easily. This raises special problems, however, because the idea of quality involves a value judgement, and value judgements are, by their essence, subject to indeterminate relative factors such as preferences and dislikes. Hence, quality of life is difficult to measure and will vary according to individual tastes, preferences and aspirations. As a result, no general rules or principles can be asserted that would simplify decisions about the value of a life based on its quality. Nevertheless, quality is still an essential criterion in making such decisions because it gives legitimacy to the possibility that rational, autonomous persons can decide for themselves that their own lives either are worth, or are no longer worth, living. To disregard this possibility would be to imply that no individuals can legitimately make such value judgements about their own lives and, if nothing else, that would be counterintuitive. 2 In our case, Katherine Lewis had spent 10 months considering her decision before concluding that her life was no longer of a tolerable quality. She put a great deal of effort into the decision and she was competent when she made it. Who would be better placed to make this judgement for her than Katherine herself? And yet, a doctor faced with her request would most likely be uncertain about whether Katherine’s choice is truly in her best interest, and feel trepidation about assisting her. We need to know which 110 Medical ethics: a case-based approach considerations can be used to protect the patient’s interests. The quality of life criterion asserts that there is a difference between the type of life and the fact of life. This is the primary difference between it and the sanctity criterion discussed on page 115. Among quality of life considerations rest three assertions: 1. there is relative value to life 2. the value of a life is determined subjectively 3. not all lives are of equal value. Relative value The first assertion, that life is of relative value, could be taken in two ways. In one sense, it could mean that the value of a given life can be placed on a scale and measured against other lives. The scale could be a social scale, for example, where the contributions or potential for contribution of individuals are measured against those of fellow citizens. Critics of quality of life criteria frequently name this as a potential slippery slope where lives would be deemed worthy of saving, or even not saving, based on the relative social value of the individual concerned. So, for example, a mother of four children who is a practising doctor could be regarded of greater value to the community than an unmarried accountant. The concern is that the potential for discrimination is too high. Because of the possibility of prejudice and injustice, supporters of the quality of life criterion reject this interpersonal construction in favour of a second, more personalized, option. According to this interpretation, the notion of relative value is relevant not between individuals but within the context of one person’s life and is measured against that person’s needs and aspirations. So Katherine would base her decision on a comparison between her life before and after her illness. The value placed on the quality of a life would be determined by the individual depending on whether he or she believes the current state to be relatively preferable to previous or future states and whether he or she can foresee controlling the circumstances that make it that way. Thus, the life of an athlete who aspires to participate in the Olympics can be changed in relative value by an accident that leaves that person a quadriplegic. The athlete might decide that the relative value of her life is diminished after the accident, because she perceives her desires and aspirations to be reduced or beyond her capacity to control. However, if she receives treatment and counselling her aspirations could change and, with the adjustment, she could learn to value her life as a quadriplegic as much or more than her previous life. This illustrates how it is possible for a person to adjust the values by which they appraise their lives. For Katherine Lewis, the decision went the opposite way and she decided that a life of incapacity and constant pain was of relatively low value to her. It is not surprising that the most vociferous protesters against permitting people in Katherine’s position to be assisted in terminating their lives are people who themselves are disabled. Organizations run by, and that represent, persons with disabilities make two assertions in this light. First, they claim that accepting that Katherine Lewis has a right to die based on her determination that her life is of relatively little value is demeaning to all disabled people, and implies that any life with a severe disability is not worth The value of life: who decides and how? 111 Write a list of three things that make your life worth living and ask someone else to do the same. Compare your lists. Are they identical? Why? Are they not identical? Why not? living. Their second assertion is that with proper help, over time Katherine would be able to transform her personal outlook and find satisfaction in her life that would increase its relative value for her. The first assertion can be addressed by clarifying that the case of Katherine Lewis must not be taken as a general rule. Deontologists, who are interested in knowing general principles and duties that can be applied across all cases would not be very satisfied with this; they would prefer to be able to look to duties that would apply in all cases. Here, a case-based, context-sensitive approach is better suited. Contextualizing would permit freedom to act within a particular context, without the implication that the decision must hold in general. So, in this case, Katherine might decide that her life is relatively valueless. In another case, for example that of actor Christopher Reeve, the decision to seek other ways of valuing this major life change led to him perceiving his life as highly valuable, even if different in value from before the accident that made him a paraplegic. This invokes the second assertion, that Katherine could change her view over time. Although we recognize this is possible in some cases, it is not clear how it applies to Katherine. Here we have a case in which a rational and competent person has had time to consider her options and has chosen to end her life of suffering beyond what she believes she can endure. Ten months is a long time and it will have given her plenty of opportunity to consult with family and professionals about the possibilities open to her in the future. Given all this, it is reasonable to assume that Katherine has made a well-reasoned decision. It might not be a decision that everyone can agree with but if her reasoning process can be called into question then at what point can we say that a decision is sound? She meets all the criteria for competence and she is aware of the consequences of her decision. It would be very difficult to determine what arguments could truly justify interfering with her choice. Subjective determination The second assertion made by supporters of the quality of life as a criterion for decisionmaking is closely related to the first, but with an added dimension. This assertion suggests that the determination of the value of the quality of a given life is a subjective determination to be made by the person experiencing that life. The important addition here is that the decision is a personal one that, ideally, ought not to be made externally by another person but internally by the individual involved. Katherine Lewis made this decision for herself based on a comparison between two stages of her life. So did James Brady. Without this element, decisions based on quality of life criteria lack salient information and the patients concerned cannot give informed consent. Patients must be given the opportunity to decide for themselves whether they think their lives are worth living or not. To ignore or overlook patients’ judgement in this matter is to violate their autonomy and their freedom to decide for themselves on the basis of relevant information about their future, and comparative consideration of their past. As the deontological position puts it so well, to do so is to violate the imperative that we must treat persons as rational and as ends in themselves. It is important to remember the subjectivity assertion in this context, so as to emphasize that the judgement made about the value of a life ought to be made only by the person concerned and not by others. Of course, this presumes that the person deciding is conscious and competent to make the decision at all, which is especially complicated in cases when the patient is unconscious, immature or suffering from a mental illness, such as depression, that could distort their decisionmaking abilities. Thus, seeking patient choice is not always a viable option. Not all patients are capable of choosing for themselves. In Janet Johnstone’s case, and in the similar case 112 Medical ethics: a case-based approach of Tony Bland, the decision was made externally, by people involved in their care. In such situations, family or practitioners have been known to make the decision on behalf of the incompetent patient, usually because they claim to know what the patient in question would have wanted. Relatives and doctors of Janet Johnstone argued that her condition lacked the dignity and control she valued, and that her situation would not improve. Under the circumstances, the judge decided the quality of her life was so diminished that her life was no longer worth living and that Ms Johnstone herself would have reached the same conclusion. The same sort of proxy decision making occurs when a woman, or couple, decide to terminate a pregnancy based on antenatal screening and testing. Here, parents make the decision on behalf of a fetus or a child. In such cases the parents must decide if, on balance, their child’s life is worth living given the possibility of pain and suffering or such inhibited interaction with the world that it would be of no value to the person living it. Needless to say, this is a difficult and trying dilemma for anyone to face. It also introduces a concern that underlies all prenatal screening programmes, in that these are supported by the social values implied by screening, which direct women towards termination of positive tested pregnancies.3 In the past, women were barred from screening and testing for similar conditions if they had previously decided that they would not terminate a pregnancy if the fetus carried the genetic condition. Hence screening was meant to be followed by testing, and positive results were meant to be followed by termination of pregnancy. The conclusion this yields, like it or not, is that our screening programmes carry with them an implication that the lives of those who are affected with certain conditions ought to be terminated because they are of comparatively less value than the lives of those who are not. This is supported in law by Wrongful Life suits in which parents of people born with screenable genetic conditions, such as spina bifida, have successfully sued doctors for the burden involved in caring for those born with such conditions.4 The problems associated with screening will be discussed elsewhere in Chapter 8 (p. 146–147). They are significant here because they elucidate the third assertion made by supporters of quality of life considerations in the medical context. Equal or unequal value? The third assertion is that, as a result of subjective and relative determinations about the quality of a life, lives can be seen to be of unequal value. At the extreme, it follows that it is possible to describe a life as valueless, especially when it is compared with the value of a life that has greater quality. In the case of the unborn fetus affected by a debilitating inherited condition, the welfare of the parents and their other children can be invested with greater value than the potential good of a potential child born with a severe disability. This allows us to make relative judgements among or between lives of individuals or groups. This is especially useful in healthcare economics, where decisions about distribution of resources rely on comparative information of the effectiveness of treatments. In this way it can be determined that resources will be made available for treatments that are more effective at improving quality of life in The value of life: who decides and how? 113 Case 24 Screening/testing for Down syndrome A 42-year-old woman presented at an antenatal clinic with her husband to discuss the results of her recent amniocentesis. In addition to Down syndrome, echocardiography of the fetus showed cardiac abnormalities, including atrioventricular septal defect. After extensive discussion between the parents and the obstetrician, the parents decided that the fetus had too many problems and that it would be unfair to the unborn child and to their other four children to continue with the pregnancy. particular conditions and not where the quality of life is not improved or so diminished that improvements are too small to justify. This point will be developed more fully in the section on quality-adjusted life-years (QALYs) and rationing in Chapter 9 (p. 163). Here, it is important to point to the possibility of making comparative judgements based on assessments of the quality of life and to emphasize that such judgements can be used to inform decisions about distributing and rationalizing scarce resources. As a result, there is a concern about quality of life decisions being made for others without their participation, and about decisions imposed without their consent. Both these concerns are tempered by the second assertion of the quality of life ethic. This states that value must be personally assessed by the individual concerned, and imposed externally only in extreme circumstances where patients are unable to decide on their own behalf and their wishes can be reasonably determined. An advance directive can be highly useful in the latter case. If a balance is made between both subjective determination and comparative decisions, we can avoid classifying a life as of comparatively low value where the person possessing it does not agree. Basing value of life decisions on quality of life has strong advantages. It: • Is subjective: takes seriously personal assessments made by individuals about the quality of their own lives • Is flexible: recognizes the possibility that the subjectively determined value of one’s life can change • Is comparative: recognizes that the way one life is valued need not impose the identical value on a similar life condition • Permits rational suicide: recognizes that one can legitimately assert the relatively low value of one’s own life. No one denies the importance of a good quality of life, or one that is acceptable to the person who has to live it. However, some argue that it is not the sole criterion upon which to base value of life decisions. These people include considerations of quantity and sanctity in their determination. Quantity The value of the quantity of a life should not be underestimated. In the past, so much emphasis was placed on the quality of life lived that quantity was virtually forgotten. More recently, attitudes have changed and consideration is given to the possibility that a long life of diminished quality could be as highly valued as a short life of high quality. In some senses the comparison seems absurd, unless we consider cases in which patients have refused complicated or agonising treatments that they perceived would exacerbate their suffering rather than extend their lives. Other patients prefer to extend their lives at any cost or risk to them because they value their existence so much that they will sacrifice quality in favour of quantity. This indicates that quantity ought not to be mistaken for quality and that prolonging a patient’s life might be nothing more than a burdensome and painful extension of suffering for them and their loved ones. However tempting it is for doctors to provide whatever care they are capable of providing, there is a responsibility to ensure that the treatments are actually useful to the patient and not unnecessarily burdensome. This means that a cost–benefit analysis can be usefully applied to a care management plan for an individual patient. The aim is to determine the extent to which treatment will be helpful and where the healing stops and the burden begins. Quantity might not be identical with quality but, often, increased quantity in medicine can be equal to cure or control of disease and hence does enhance quality of life. The Compression of Morbidity principle cited by Downie and Calman is useful for guiding these decisions: 114 Medical ethics: a case-based approach Compression of morbidity principle: the objective of increasing life-span should be associated at the same time with an increasing quality of life or reduction of disability.5 So, provided quality of life is maintained or enhanced, quantity is a positive factor in healthcare. There is a sense in which quality of life judgements are made in a wider context and not just as they pertain to particular patients. Health economists have long tried to determine the appropriateness of costly treatments on the basis of their burdensomeness and effectiveness. The most famous of these is a system known as QALYs. QALYs stand for quality-adjusted life-years, and are a means of making comparisons between health states. Equally concerned with quantity and quality, QALYs can be applied to a ‘relative health states’ scale. The problem is that these scales are themselves value-laden. Such issues will be covered in Chapter 9, where the idea of QALYs will be discussed as they relate to rationing and distribution of resources. They are introduced here because they show how a model for decision making can include the notions of quality and quantity discussed in this chapter. QALYs help decide which healthcare needs will be met by identifying which yield: • the greatest amount of good for • the greatest amount of time for • the greatest number of people.