This section contains a discussion on individual and collective loss both from the perspective of the persons directed affected by the loss and from the perspective of public policy. Euthanasia as a way of bringing an end to pain and suffering is controversial from both perspectives. The use of public resources to care for the elderly and those with severe physical and mental disabilities is a question that contains several controversial policy issues. Suicide is a controversial moral question although this is not a policy question since public policy seemingly can do very little to discourage or prevent it. How individuals should deal with personal loss and how groups should deal with collective loss are subjects about which opinion is very much divided but which are not matters of public policy. All of these topics will be touched upon. The kinds of personal loss that will be considered will include aging, crippling illnesses and injuries, bereavement, and loss of esteem. Analogous losses that can be suffered by groups, organizations, communities, and states will be included in the “collective losses” considered.
One basic tenet of the ethical theory that is being presented in this book is that doing good consists of promoting the sustainable expansion of human abilities. A second basic tenet is that any flourishing of human abilities can only be brought about within a flourishing of life on our planet. A good life for humankind requires a good life for myriads of other species. The lives of many individuals may be brief, but each life span must admit an exercise of abilities serving to nourish and nurture a globally conscious ecological system.
One consequence of this theory is that the consumption of meat needs to be discouraged. This certainly entails more humane treatment of livestock while they are being fed in anticipation of slaughter. Far more than that, the level of consumption of meat needs to be drastically reduced to allow more grain to be used directly for human consumption.
In line with the basic tenet that The Good is the expansion of abilities, harm or loss is equated with a loss of abilities. Dealing with loss, then, involves finding a way to rebuild, moving in a different direction (and redirecting the capacities that remain after the loss), or a combination of the two.
It will be helpful to our investigation of individual and collective loss to recall some of our discussion of “Emotion and Values” (pages 82 ff). As was said there, enjoyment and satisfaction come from the exercise of abilities. Accordingly, any loss or impairment of abilities diminishes at least temporarily our means of gaining enjoyment. Our achievements can be an enduring source of satisfaction even after the abilities that produced them are lost, but they can also sadden us by bringing to mind how valuable those abilities have been to us.
In our earlier discussion it was said that our enjoyment and satisfaction are relatively greater when we exercise abilities:
1. In which we are proficient
2. That are comprehensive or require more subtle discrimination, or both
3. Where there is a greater element of purpose and rationality, especially where done as part of an intelligently conceived plan for reaching a clearly desirable goal
4. Where there is social approval of the purpose and the standards of excellence and where the relevant aspects of the action can be discussed with others
5. Where the consequences of the action can be reliably predicted
6. Where the ability contributes to a larger ability
7. Where done as part of a planned course of acquiring and exercising abilities
All of these factors can contribute to our sadness when abilities are lost. Likewise from our discussion in the section on “Basic Well-being (pages 56 ff), it can be seen that our sense of well-being can be diminished by a fear that we now may be less able to cope with our environment or a fear that we now may no longer be able to function as fully as before.
In the telling of stories of loss it is not usual to portray each loss as a loss of abilities, but it is possible to see each loss in that light. If a person is injured in an accident, the telling of the story is likely to emphasize the details of the causal events, the actions taken in response, and the pain and other subjective experiences of the injured person. It is not always recognized that physical pain is related to a physiological reaction of the body to impairment of function, however great or small. Nor is it always recognized that the mental anguish, fear and apprehension one feels in serious accidents are due to an awareness of being somewhat disabled and not knowing how long it will take to recover or how fully one will recover.
There are many kinds of personal loss that can be suffered. First, there are crippling illnesses and injuries. Some types of illness bring about a gradual decline of physical capacity, while others cause a sudden loss. Likewise a single injury may do only slight damage at first, but the person’s condition may continue to worsen. Other injuries may be devastating at first but may then begin to heal. Whether the loss is sudden or gradual and whether the person thereafter recovers to some extent or gets progressively worse, there are difficult decisions to be made. Should the same type of work be pursued? Are the goals that one had previously hoped to achieve still attainable or should lesser goals be substituted? What about friends and family members? Will these relationships change? What relationships are now most treasured? What can one now contribute to those relationships?
Another type of personal loss occurs when a close friend, family member or colleague dies. One feels sorrow on his or her behalf. One thinks about what the person has been cut off from. One also feels a personal loss because one has had a friendship taken away from him. One can no longer interact with the person, no longer see the person’s changes of facial expression or hear his or her voice answering him.
To some extent, differing in different cases, people interact on a personal level in order to provide each other with companionship and to enjoy each other’s company. Personal relationships usually serve other purposes as well. The participants derive other advantages. An exchange of benefits occurs. Two friends usually have a range of topics that they like to discuss. If nothing else, they can exchange viewpoints and reactions to events pertaining to those topics. Often they are able to help each other in tangible ways, such as providing information to each other or doing favors for one another. And the benefits can be far more substantial than mere “favors.”
In the course of time, the interactions and interchanges between two people serve to define a relationship between them. From another perspective, what happens is that the two people create certain collective abilities. They are able to do certain things jointly that neither of them could do individually. They jointly respond to jointly perceived situations. They begin by acting individually. As they learn to share observations and thoughts about events, they begin to coordinate some of their actions and to compare their perceptions about the outcomes of those actions. As they come to recognize what effects they can have by coordinating their actions they cement certain collective abilities.
Many things can happen to two people’s collective abilities. As a mutual trust develops and grows these collective abilities can expand in all the ways discussed previously. If disagreements arise, the collective abilities may contract. They may contract because one of the two people sustains a loss, or a series of losses, of abilities. The partnership can be affected by all the kinds and all the possible histories of personal loss discussed above. The possible histories certainly include the cases where one partner dies, although the association between the two people may dissolve and their collective abilities may vanish long before death comes to either of them.
It is important here to bring the personal or individual perspective back into focus. When a dear friend, a close family member or a colleague dies or suffers a lesser loss of abilities, one may be affected in that some collective abilities have been lost. If collective abilities have been lost, one is no longer able to participate in the activities that created those collective abilities. One may feel that something he or she was a part of no longer exists. The other person’s loss becomes one’s own loss in this respect as well as in the respects already mentioned (i.e., comradeship and interaction).
Other types of personal loss include financial losses and losses of other resources. These too are losses of abilities in that one is now not able to do the things that that wealth or those other resources had made possible before. The loss of a job or a position or a significant loss of esteem can work the same way. One finds oneself cut off from certain sources of information, excluded from certain activities.
Analogous to all of these personal losses are losses that can be suffered by groups. A group can be weakened internally. A group can suffer financial losses or losses of other resources. A group can be seriously hurt by any of these losses experienced by a second group with which the first group has a close, mutually beneficial relationship.
As discussed in the section on “The Quality of Life,” there is an enduring quality to the satisfaction one gets from the exercise of abilities. Our actions manifest our abilities. Although individual actions have a beginning and an end, the abilities that have been demonstrated by those actions remain with us. If we have done something well once, we can do it well again, perhaps even better the next time. The more often we do something well, the more our confidence grows. We feel confident that our abilities will endure and will be expanded. Thus our satisfaction endures and grows as our abilities endure and grow.
We tend to focus our attention on the activities that we find challenging. We can call to mind turning points in the development of our abilities in these challenging areas. It is because we can remember the trials and hardships we have endured in reaching our present state of development as well as our past satisfactions from exercising the abilities lost that damaging injuries or disabling illnesses cause us such distress. A temporary setback, seen as such, may not alarm us; a long-term or permanent injury can seem quite tragic. In our memories is an accounting of the time and effort that went into building up our capacities and the joys they gave us. Hence a loss in our capacities can be appraised as a very great loss.
One feels desolation like the desolation of seeing a beloved city destroyed in wartime or of seeing one’s own home destroyed by natural causes. What had seemed permanent is seen as transient, passing quickly away. Knowing the greatness of the effort of mind and will and the magnitude of the toil invested in building a proud city or in creating a cherished home, one feels pain of corresponding intensity.
When we come to ask how we can deal with loss, several answers may emerge. The ensuing discussion will draw out these answers.
First, someone else’s loss may not be a loss for us. We may have learned enough from that other person that we are able to carry on without his or her assistance.
Likewise, a loss of abilities of some member of a group may not mean a loss of the group’s collective abilities. The group may have learned enough from the member to be able to carry on without his or her participation.
Second, it is possible to become indifferent to pain. This type of fortitude enables one to carry on in spite of losses. It may be helpful toward building this fortitude to bring to mind what was said earlier in the section on “The Quality of Life” (pages 57 ff). Our emotions can be strongly influenced by our thought. By focusing our attention on setting and pursuing attainable goals for the future, measuring our progress, devising new strategies and tactics, we can make our emotions enliven our efforts and spur us on rather than discourage us.
It is also possible to build up a love for challenges and to learn to regard every setback, every loss, as a new challenge. So armed, one can persevere. Again, reflecting about the factors that determine the quality of life can help a person to develop perseverance.
It is clearly part and parcel of developing the fortitude and perseverance just described to form a habit of always looking forward, planning future actions and carrying them out, rather than looking backward and cursing. A particular way to look forward and to take up the challenge of the future is to continually set before oneself the goal of doing the most good with whatever strength one has and with whatever time one has for doing it. Doing good consists of expanding abilities and making them sustainable. Abilities are made sustainable by ensuring that others have learned what they need to have learned to take over from those now performing each function. They are also made sustainable by being documented well enough to allow others to follow in the same path. A “cookbook” can be prepared for each job.
Whether a person or a group will serve as a model for others and transmit to them the key elements of the person or group’s abilities will depend largely on the closeness of contact with the potential recipients. Emulation is only possible when the abilities to be emulated and the value of those abilities are known. A willingness to learn is also fostered by an atmosphere of sharing and good will rather than competitiveness. Creating this kind of atmosphere and developing friendly relationships is a way of preparing for eventual losses.
The whole of humanity can be seen as a vast array of overlapping groups continually in need of repair and healing. The life history of any person or group can be viewed to be a history of acquiring and exercising abilities within a history of changing affiliations and functions. It is then an elementary part of wisdom to accept the changing nature of things, to accept a cycle of life in which apprenticeship and mastery are followed by being a mentor, a friendly companion, and a reflective observer. It seems good for society and good for the individual that a person in his declining years still remains active in devising strategies for doing the most good in whatever time is left to him. Society as a whole and the individuals within it need to make an effort to enable the elderly to remain in contact with society, give older adults opportunities for contributing to the general well-being, give them attention and learn from them. An essential part of this picture is a sharing of life stories, a learning from one another’s experiences. All need to work for a society in which persons and groups share knowledge of each other’s histories, share concern for each other’s healthy development, and share an understanding of the meaning and purpose of their lives.
When a person or group has reached a point where they have almost nothing more to give, where they have become more of a burden than a contributor, they may decide to end their existence. No one should choose suicide quickly. Yet society needs to allow suicide and allow receiving help in ending one’s life. Society should also allow for the following of previously prepared instructions for withholding treatment, possibly including intravenous feedings, when a person is no longer able to give those instruction himself.
A decision to end one’s life should not be and should not be regarded as an unwillingness to suffer pain or depression. It should instead be and be regarded as a strategy, rightly or wrongly chosen, to contribute positively to the good of society.
When making such a decision, after all other considerations have been given due deliberation, one should ponder society’s need to learn care-giving. All human beings deserve to be cared for. Perfection in care-giving is an achievement to be honored above all others. Allowing oneself to be cared for, kindly and gratefully, may be one’s last opportunity to be useful.
With regard to the use of public resources to care for the elderly and persons with severe mental or physical disabilities, it seems appropriate for each nation to establish a comprehensive public health care system covering all forms of health care: all varieties of long-term care, drug and alcohol abuse, smoking clinics, psychiatric services, and all the usual forms of hospital and medical care. Each nation should define three classes of health care, all upholding a high standard in the level of respect and concern shown to the recipients. Each class should have a list of medical procedures and devices (hearing aids, eyeglasses, etc.) and maximum durations for each kind of special care (intensive care units, nursing home care, convalescent hospital care, etc.) The top class of care would be available to anyone who could afford it. The second class care would operate like medicare and would have formulas for the portion paid by the patient and the portion paid by the government. The lowest class care would be available only to persons who could not pay for their proportion of the costs defined by the second class of care. The number of procedures and devices and the durations of care available in the third class would be less than in the second. Each medical facility would have a small amount of discretionary funds allowing them to extend to relatively few patients more care than their money, or lack of it, entitled them to. In spending these additional funds each facility would be guided by a facility-defined policy which would aim to achieve the most benefit to society per dollar spent.