Front Page Titles (by Subject) CHAPTER 4.: Aiding the Sick and the Injured - The Principles of Ethics, vol. 2
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CHAPTER 4.: Aiding the Sick and the Injured - Herbert Spencer, The Principles of Ethics, vol. 2 
The Principles of Ethics, introduction by Tibor R. Machan (Indianapolis: LibertyClassics, 1978). Vol. 2.
Part of: The Principles of Ethics, 2 vols.
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Aiding the Sick and the Injured
441. Part of the subject matter of the preceding three chapters is included under the title of this chapter; for marital beneficence, parental beneficence, and filial beneficence, severally dictate solicitous care of any member of the family who is suffering from illness or from accident. In the natural order of things the house becomes at need a hospital and its inmates nurses.
Whether or not in respect of those outside the family group, beneficence requires that the sick and the hurt shall be succored, even at the risk of self-injury, it certainly requires that this shall be done inside the family group. If, as we see, the protecting of wife by husband is demanded as ancillary to continuance of species (since if the mother is unprotected the species must suffer), then, for the same reason, the care of wife when she is in any way prostrated is demanded. In like manner a reciprocal care of the breadwinner is called for as a condition to maintenance of the family. Still more obviously requisite is a diligent attendance on children who are ill: the obligation to nurse them being included in the general obligation to use all means of rearing them to maturity. Only in the case of afflicted parents having grown-up children, are we debarred from saying that the welfare of the species dictates the succoring of them. Here the fact that direct increase of happiness results from rendering the needful assistance, gives rise to the obligation.
As happens in the case of infectious diseases, obligations of this class have to be discharged, even at the risk of suffering and sometimes of death. Nature at large teaches us this lesson. Beyond the fact that among innumerable kinds of lower creatures, parental life is wholly sacrificed for the benefit of offspring, we see that among higher creatures the instincts are such as prompt, especially on the part of a mother, the facing of any danger for protection of the young: survival of the fittest has established this recklessness of evil. Hence it must be held that the risking of infection is ethically enjoined on a human mother: the only important check being the consideration that loss of life involves loss of ability to discharge obligations to the surviving members of the family. And there seems no reason why an equal obligation to meet the risk should not devolve on the father; unless it be that he has to provide the necessaries of life alike for the household at large and for its suffering member, and that his incapacity may bring starvation on all.
Are there any other checks to the self-sacrifices entailed on some of the family by the illness of another or others belonging to it? There are such other checks. A wise and duly proportioned beneficence does not countenance loss of the relatively worthy for preservation of the relatively worthless. Everyone can name persons wrecked in body and mind by cherishing invalid relatives–relatives who often thanklessly receive the sacrifices made for them. Here is a wife whose sole occupation for a decennium has been that of nursing a gouty husband; and who, as a result, dies of a worn-out physique before he does. Here is a daughter who, after many years' attendance on an invalid mother, is shortly after required to give similar attendance to an invalid aunt; and who, now that she has lived through these long periods of daily abnegations and wearisome duties, is becoming mentally unhinged. And here is a husband whose latter days are made miserable by the task of safeguarding, in his own house, an insane wife. Though in such cases (all of them occurring within my own small circle) beneficence demands great self-sacrifice, yet its dictates should be so far qualified as not to require that the lives of the healthy shall be lost in making the lives of the diseased more tolerable. Some compromise has to be made by which there may be achieved partial relief from the heavy burdens.
Especially is it proper that domestic invalids who make undue demands should receive a not unlimited attention. Often a whole household is subordinated to the exactions of a sickly member; and instead of gratitude there comes grumbling. This tyranny of the weak ought to be resisted. For the checking of their own egoism, as well as for the welfare of those around, the unreasonable sacrifices they continually ask should be refused. Such invalids are not only physically sick, but are morally sick also; and their moral sickness requires treatment as well as their physical sickness. Husbands in the decline of life who have married young wives, and presently make them little else than nurses–objecting even to have other nurses to share the labors with them–require awakening to a due sense not of others' duties to them but of their own duties to others. A man is not absolved from the obligations of beneficence because he is ill; and if he rightly feels these obligations he will insist that others shall not injure themselves for his benefit.
442. Concerning that wider beneficence which expends itself in care for sick persons not belonging to the family, it is difficult to say anything definite. Each case is rendered more or less special by the character of the patient and the circumstances; so that general propositions can scarcely find place. We may set down, however, the considerations by which judgment should be guided.
If, as all will admit, the care of one who is sick devolves primarily on members of the family group, and devolves secondarily on kindred, it devolves only in smaller measure on unrelated persons. These may rightly limit themselves to indirect aid, where this is needed and deserved. Only in cases where there are no relatives, or none capable of undertaking relatives' duties, does it seem that beneficence demands from unrelated persons the requisite attentions.
How far such attentions shall be carried must, again, be determined in part by thought of the claims arising from character and conduct. If, with Friendly Societies around him throughout life, the man who is at length taken ill, refused to make any provision against sickness, it cannot be held fit that his necessities as an invalid shall be ministered to as well as they might have been had he made such provision. If sympathy prompts an equal attention to the improvident as to the provident, the sentiment of justice puts a veto. Then, again, there is the question of character. If as much sacrifice is made for the sick good-for-nothing as is made for the sick good-for-something, there is abolished one of those distinctions between the results of good and bad conduct which all should strive to maintain. Further, there is the allied question of value. Much more may rightly be done for one whose abilities or energies promise public benefit, than for one who is useless to his fellow men, or is a burden on them.
Besides the beneficiaries, their characters and circumstances, there have to be considered the constitutions and circumstances of the benefactors. On those who have but little vitality and but small recuperative power after illness, a rational beneficence does not impose as heavy duties as it does on those in high vigor, who can bear disturbances of health without permanent mischief. Differences of claims hence arising, are seen to be greater on remembering that those with low blood pressure, are more liable to contract infectious diseases than those in whom the tide of life rises higher: especially when, as commonly happens, there is fear in the one case and not in the other. To the check which, for these reasons, a reasonable egoism puts upon altruism, must be joined a check of an altruistic kind; namely consideration for those on whom evils will be entailed by contracting an infectious disease, or an illness caused by exhaustion. These evils are of several kinds. One who, engaged in nursing a stranger, comes home to the family group with a fever, risks their health and life as well as her own. Moreover, she entails on them the troubles and anxieties attendant upon nursing her, as well as the moral pains which her sufferings and perhaps her death, produce. Even when a fatal issue is escaped, there is necessarily for some time an inability to discharge such obligations as she has ordinarily to discharge; and, occasionally, a permanent inability to discharge them. Evidently, then, while beneficence prompts such aid to sick persons who have no claims of relationship, as may be given without considerable risk, it does not dictate the giving of such aid by those who have family ties and important duties.
Nevertheless we must not ignore the fact that such aid may be, and often is, given without injury by those who, if the above reason is valid, ought to hesitate in giving it. In a way somewhat remarkable, medical men (taking, however, in most cases some precautions) daily visit patients suffering from fevers or kindred diseases, and but rarely take them. We must suppose that use, and perhaps an acquired mental indifference, unite to give them immunity; and yet, even if so, it is not easy to see how, during the earlier stages of their professional lives, they escape. Hospital nurses, too, apparently become impervious. So that the risks of evil run by those whose sympathies prompt them to adopt nursing as an occupation, are not so great as at first appears; and where the nursing is of those suffering from other than infectious diseases, it may be consistent with fairly good health.
That strange emotion, so difficult to analyze, the luxury of pity is an incentive to the sacrifices which nursing implies; and when with this there coexists a large share of the maternal instinct, which is in essence a love of the helpless, the care of the helpless sick becomes a source of subdued pleasure, which in large measure neutralizes the pain, and even makes the occupation a gratifying one. Without enjoining the beneficence which issues in these results, one may fitly look on and admire.
443. Though due regard for all circumstances puts some restraint on ministration to the sick who have no family claims, it puts no restraint on ministration to sufferers of another class–those who have met with accidents. Everyone is from time to time witness to injuries caused by falls, or by runaway horses, or by carriage collisions; and everyone is, in such cases, bound to render all possible assistance. None save those in whom the brutality of the barbarian still predominates, fail to feel contempt for the Pharisee in the parable and approval of the Samaritan.
But while the duty of caring for the injured is commonly recognized, as demanded even by the most ordinary beneficence, there is an ancillary duty which has only of late gained partial recognition–the duty of acquiring such knowledge and skill as shall make efficient the efforts to aid. Up to our own days, and even still in ninety-nine people out of a hundred, the wish to help the wounded or maimed is unaccompanied by instructed ability–nay, worse, is accompanied by an ignorance which leads to mischievous interferences. The anxiety to do something ends in doing harm; for there is commonly no adequate consciousness of the truth that there are many ways of going wrong to one way of going right.
Hence a provident beneficence suggests the acquirement of such surgical and medical knowledge as may be of avail to sufferers before professional aid can be obtained. Unqualified applause, then, must be given to those Ambulance Societies and kindred bodies, which seek to diffuse the requisite information and give by discipline the requisite skill. Unfortunately when there come the demands for the acquired knowledge and aptitude, the hoped for benefits are not always forthcoming: nervousness or indecision, or perhaps perplexity amid the various lessons which have been learned, leads to failure. Still, the inference to be drawn is not that such preparations for aiding the injured should be abandoned, but rather that they should be more thorough, and should in fact form a part of the education given to all.