To Treat or Not To Treat

To treat or not to treat, that is the question? What would you do? How does the subject of cancer treatment apply to the moral theories of Egoism and Utilitarianism? Which theory best addresses this problem? I would assert Egoism best handles the dilemmas undressed by this ethical scenario.
Egoism is a normative ethical theory that contends we act morally when in any given situation the right thing to do will be whatever maximally promotes long term self-interest. It does not describe how people behave; rather, it describes how people "ought" to behave. (Class notes February 23) This is a key element of all normative theories. Another key element of egoism lies in “long term”. Simply stated, an ethical egoist would typically not endorse running up credit card debt. While it might fulfill one's interests in the moment, it would undermine one's long term self-interest. James Rachels says it best; "Ethical egoism endorses selfishness, but it doesn't endorse foolishness.” Rachels also suggests each of us possess the ability to know what is in our own best interest, therefore to attempt to provide charity to another would directly disregard that ability. In essences, to give a man a fish would suggest they do not have the same ability you possess to acquire their own fish. Based on principles outlined by James Rachels and others, Thomas Hobbes may be viewed to be an ethical egoist, although he argued that if everyone follows their own long term self-interest completely, a logical inconsistency would result. Thus part of following one's own long term self-interest in a larger society involves allowing others to follow their own self-interest, thus perhaps giving up some of one's own long term interests. (Class notes February 28)
Utilitarianism is another normative ethical theory that proposes we act morally when in any given circumstance; the right act is the one that produces the most “happiness” for all creatures capable of facing well or poorly, from now onward into the indefinite future. English philosophers John Stuart Mill (1806-1873) and Jeremy Bentham (1748-1832) were the leading proponents of what is now called Utilitarianism. Jeremy Bentham was a British reformer who believed the human experience can be summed up through either pleasure or pain. He defines the “Principle of Utility” as such; we ought to act only in ways that promote the long term happiness of everyone affected (or minimize the long term suffering). John Stuart Mill holds happiness to be not just quantitative; it’s also a matter of quality. (Class notes March 15) One of his most famous quotes states, “Pleasure and freedom from pain, are the only things desirable as ends.” Utilitarians are social reformers that support suffrage for women and those without property, and the abolition of slavery. They also argue that criminals ought to be reformed and not merely punished (although Mill did support capital punishment as a deterrent). Bentham spoke out against cruelty to animals. Mill was a strong supporter of meritocracy. Essentially, they believed that everyone’s happiness counts equally. Imagine that you or a loved one were in the hospital suffering from a terminal illness, let’s say breast cancer, and the pain is so unbearable that the subject of continued treatment comes up. You want what is best for your loved one but the family is on the other end fighting as well, they want to discontinue treatment in which the patient's disease is allowed to run its natural course. And you seeing how much your love one wants to fight until the bitter end, no matter the cost. I again ask what you would do. Treat or not treat?
Both you and the family wants what is best for the sick loved one but only one decision can be made and allowed. Simply stated, an ethical egoist would say the loved one “ought” to determine what is in their “own” long term self-interest. Therefore, if it is their desire to continue treatment then so be it. To suffer unbearable pain is not enough of a deterrent when considering “long term” as a possibility. The loved one determines the definition of “quality” life and according to them the ability to live in pain outweighs the desire to end life to avoid prolonged suffering. To deny their wishes would deny their rights as an individual, and philosopher Ayn Rand contends, to deny the value of individualism is destructive.
Utilitarianism on the other hand, equates happiness with pleasure and unhappiness with pain. Therefore, they would unequivocally side with the family who would say end treatment immediately. Ending treatment maximizes happiness for all involved. The loved one is allowed to decrease the number of days of pain, thus allowing them to experience the maximum amount of days without pain. The amount of days the family has to watch their loved one suffer is also decreased, in turn maximizing their pleasure. According to Utilitarianism, our one moral duty is to maximize pleasure and minimize pain.
One would argue that the Ethical Egoist theory seems to be the most plausible when evaluated. It defines definitively what the “right” thing is. In contrast, a major reason why Utilitarianism comes under attack is because of its components related to consequentialism and welfarism. Consequentialism fails to address the issues of justice, individual rights, and it employs backward reasoning. Considering the component of welfarism, the main premise of happiness is far too limiting. Therefore, when considering common sense morality the Egoist present the best argument by defining succinctly the “rightness” of the act of continued treatment.
In my opinion, both arguments, even though one seems to be sounder than the other when evaluated through common sense morality, are flawed. They tend to over simplify the rightness and wrongness of the decision to continue treatment. Evaluation does not consider the sacrifices being made by the family and the loved one effectively. Should they be considered equally as Utilitarianism suggest? Or, should the rights of an individual override the rights of the overall community as Egoist would suggest? Again, the scenario is fair too complex to answer those questions. Is the sick loved one able to make a sound decision about their desires given their possible state of mind? No one can determine why the loved one would choose to continue treatment. It cannot be determined if they are making decisions based purely on their long term self-interest or if they are operating altruistically. In the end all things need to be considered, and the matter of equality and justice become mood issues.
The desires of the family and the loved one are important when making life or death decisions. These decisions cannot be plugged into a quantitative formula to decipher a plausible solution, nor can the decision be left to one individual. The burden is too great!!