The Panacea Problem: Indifference, Servility, and Kantian Beneficence

Benjamin Eneman
Georgetown University

April 30, 2021

Kant’s account of the duty of beneficence as a wide, imperfect duty initially seems at odds with our intuitive belief that helping others is, at least in some cases, morally obligatory. Various Kantian philosophical accounts have constructed different ways to address this problem. In this paper, I adopt and expand on Karen Stohr’s account of the duty of beneficence as a two-part duty composed by a wide duty to help others and a narrow duty to avoid indifference. After observing that merely adopting this view seems to result in over-stringency, I then argue that perfect and imperfect duties to others and the self act as counterarguments to claims of indifference.

We have obligations to help others. That fact seems almost universally intuitive; it appears quite clear that, at least in some instances, we are somehow morally deficient if we fail to help other people. What is often less clear is the source of such strong obligations, and what sorts of concerns have the capacity to limit them. In this paper, I aim to construct a system of Kantian obligations that define and adequately bound our duty to help others, then consider the implications that system of obligations has on everyday life. I will argue that we should adopt Karen Stohr’s model of beneficence as a two-part duty where the duty to avoid indifference towards others in their role as end-setters is bounded and framed within duties to oneself, particularly duties to avoid servility and to respect one’s own status as a setter of ends.
I will briefly summarize Kant’s view before proceeding. Kant divides duties into perfect and imperfect, as well as wide and narrow, categories. Taking Kant’s universal law formulation, if the maxim of a particular action’s very conception cannot be universalized without inherent contradiction, it violates a perfect duty; if the maxim results not in contradiction in conception but rather in contradiction of the will, it violates an imperfect duty. For example, making a false promise to a friend to repay a loan violates a perfect duty, because the concept of lying is only coherent when truth is assumed, and universalizing the maxim that “one ought to lie to a friend in order to get money” would result in a world where that assumption would deteriorate, making the concept of lying incoherent. Alternatively, under Kant’s humanity formulation, perfect duties are violated when someone treats another person as a mere means (fails to show respect for humanity as a negative end), while imperfect duties involve obligations to value and show respect for humanity as setters of ends.
Perfect duties are always narrow—they are stringent, and we have an obligation to follow them at all times. Imperfect duties, however, can be broader or narrower, depending on the degree and kinds of latitude afforded to them. Generally speaking, broader duties allow for more variation than narrower duties in how they are achieved and the degree to which they are pursued at any given time. Wide duties leave “playroom (latitudo) for free choice in following the law” and “cannot specify precisely in what way one is to act and how much one is to do by the action,” Kant says, but cautions that they don’t grant carte blanche to “make exceptions to the maxim of actions but only as permission to limit one’s maxim of duty by another.” Consequently, “Fulfillment of [imperfect duties] is merit = +a, but failure to fulfill them is not in itself culpability = -a, but rather mere deficiency in moral worth = 0, unless the subject should make it his principle not to comply with such duties.” In other words, people are standardly praiseworthy for taking actions that fulfill imperfect duties, but are not standardly blameworthy for failing to do so on any particular occasion.
At first glance, then, it might seem as if Kantian moral theory does not adequately address the scope of duties of beneficence—obligations to help others. The duty of beneficence is imperfect, since violating it stems from a contradiction in the will. We can conceive of a world in which nobody helps anyone else or adopts others’ ends as their own, but such a world would ultimately result in the frustration of our own ends, and therefore cannot be rationally willed, since one cannot rationally will the frustration or denial of one’s own ends (as doing so would mean willing against what one wills). Because the duty of beneficence is a wide, imperfect duty—one that affords real latitude in the manner and extent to which it is met—it seems difficult to square with intuitive judgements about situations in which one is truly obligated to help another person. For example, in cases of easy rescue (say, a child drowning in a bathtub a foot away from someone able to help) it seems like anyone who does not perform the rescue is displaying immoral behavior rather than simply not displaying moral behavior. It seems like not only do they have a particularly strong sort of obligation to others to help, but also that they are standardly blameworthy for failing to do so even if they do not make it a principle to fail to help in those sorts of instances. If, by some bizarre set of circumstances, I encounter five different children drowning in shallow water in one day, I could not justify not saving the fifth by pointing to the other four I had saved that day to show that it was clearly not my principle to avoid helping drowning children (or people in general). Such an attempted justification would seem absurd for instances similar to this. This is a real problem for proponents of Kantian ethics—it seems as if Kantian moral philosophy is not demanding enough in cases like these. Cases of easy rescue pose a strong (though, I contend, not insurmountable) challenge to latitudinarian accounts of the duty of beneficence (accounts that argue that the duty of beneficence inherently grants latitude in terms of the means by and extent to which it is pursued).
Broadly, there seem to be three different approaches one could take when confronted with this problem, and while I only aim to pursue one, it seems worthwhile to at least sketch out the others and briefly address the reasons they fall short. First, one could accept the problem itself as reason enough to reject Kantianism in general. Because I contend that the problem, while significant, is not insurmountable, this approach seems to me to fall short. Second, one could bite the bullet and simply say our intuition is wrong in those cases of easy rescue, but it seems quite implausible that our intuitions surrounding these cases are wrong, so a solution that is able to account for them without abandoning the ethical framework we want to preserve would be better. Third, one could abandon, alter, or expand upon the latitudinarian account of beneficence specifically. This is the approach I will utilize.
There have been a few different proposed Kantian solutions surrounding the latitudinarian account of beneficence: by finding a more rigorist interpretation of duties of beneficence (while still being constrained by perfect duties) as David Cummiskey does, by appealing to “true needs'' as opposed to “wants” as Barbara Herman does, and by arguing that the wide duty of beneficence is framed in part by a narrow duty to avoid indifference to others as Karen Stohr does. I will argue for Stohr’s approach, then modulate it in the face of a serious concern.
For Stohr, what we ordinarily construe as a single duty of beneficence is really comprised of two parts: “a wide duty to perform helping actions on occasion and a narrow duty to avoid an attitude of indifference towards others as end-setters.” On many occasions, we can be non-indifferent without actively helping another person. To illustrate, Stohr gives the example of wishing someone luck before they go out in the rain to get a ticket to a concert they really want to see or congratulating them when they return with a ticket. However, this is not always the case—in the cases of easy rescue I have been discussing, the only way to avoid indifference is to rescue the person, since anything short of helping them constitutes a wanton display of indifference.
The duty to avoid indifference as constructed by Stohr is imperfect (since it stems from a requirement to adopt a maxim rather than perform or abstain from a particular action, and violations result in a contradiction of the will rather than a contradiction in conception inherent to universalizations of indifference), but the sort of latitude it allows is only in the manner in which it is achieved and not the extent to which it is achieved, because displaying indifference towards a person involves not adopting “the attitude that her ends carry moral significance insofar as they are her ends,” and displaying indifference therefore shows a lack of acknowledgement for her “status as a setter of ends.” Therefore, because the duty of non-indifference is narrow in this particular sort of way, we owe non-indifference to others at all times, so actions that show indifference are never permissible—unless avoiding indifference would necessarily result in the violation of a perfect duty—and cases of easy rescue, for example, always necessitate action, since helping is the only way to avoid violating the stringent imperfect duty of non-indifference as constructed by Stohr.
I will illustrate this distinction with an example from the superhero web serial Worm, in which a character named Panacea has the power to quickly heal any disease or injury. This power has also given her a sense of obligation that has dominated her life—she gained the power when she was a young teenager, and ever since then, she has felt that every moment she takes to herself is horrendously selfish since she could be, for example, visiting a hospital to cure every cancer patient there instead.
Suppose Panacea walks past a large hospital on her way to see a movie with her sister Victoria. Of course, she knows there are almost certainly dozens if not hundreds of people who stand a very real chance of dying if she doesn’t help them immediately. Since all it costs her to save dozens of lives is that she postpone or cancel movie night with her sister, it might seem as if choosing to see the movie over saving lives is necessarily a display of indifference, no matter how many people she saved earlier that day—much as walking past a drowning child one could easily save at effectively zero cost to oneself results in a display of indifference no matter how many drowning children one has helped so far that day. Panacea also cannot just wish the patients well or pursue some other non-helping action to satisfy the constraint of non-indifference, since any well-wishes or non-helping action would seem horrendously insincere—she could have actually cured their illnesses and injuries but chose not to due to a more or less insignificant cost to herself.
So, under a plain reading of Stohr’s model, Panacea would seem to be expressing indifference whenever she decided to go see a movie with her sister instead of saving hundreds of lives, and since non-indifference is owed to others at all times, she can never permissibly see a movie with her sister, since she will never reach a point where nobody is in need of her help. But it seems difficult to square that result with our own intuition.
While there are obviously no Panaceas in the real world, some trained medical professionals might feel the same sort of burden. Take one of the permutations of Stohr’s example about a doctor “performing life-saving surgery on impoverished people in developing countries.” Suppose that the doctor plans on taking a flight home in an hour (not to attend to any particularly urgent crisis at home, simply because they want to go back), but someone appears in their waiting room in urgent need of such a surgery, which will take two hours. It seems to be a display of indifference to ever prioritize not delaying one’s flight over another person’s life. However, it seems intuitive that a moral theory ought not require them to stay indefinitely if they are helping in such a region. Resultantly, it seems like something is missing from the account that simply argues that we have a narrow imperfect duty to avoid indifference—it seems to be, in some cases, too stringent.
It now seems that a Kantian approach has to be able to thread the needle between never requiring a particular act of aid and being over-demanding (e.g., requiring the surgeon to stay indefinitely). I contend that, in some cases, the only way to effectively do this from a Kantian lens is to appeal to certain duties to oneself—a perfect duty to refrain from servility, and imperfect duties that stem from the duty to respect one’s own autonomy—and use them to bound or frame duties to help others.
First, let’s consider possible duties to others that might allow the surgeon to leave, both intuitively and within a Kantian framework. It is simply the case that any sort of perfect duty one has to another “trumps” the narrow, imperfect duty of non-indifference if the two are ever reasonably in conflict—that’s a fundamental quality of perfect duties. But certain sorts of urgent, narrow, imperfect duties can act to allow the surgeon to leave as well. Suppose the surgeon has a son at home who was just critically injured in a car crash, and needs to leave as soon as they can to be there for him. At this point, the sort of familial obligations the surgeon has can serve as a justification for leaving even if a patient has just come to the waiting room in need of assistance, because we can imagine the surgeon justifying their decision to the patient with something along the lines of “of course, I don’t want to leave you in the lurch, and it hurts me deeply that I can’t help you, but I have to go see my son.” The patient almost certainly won’t like this, but they cannot reasonably see the surgeon as displaying indifference through that action. So it is possible that some obligations to others can act as a sort of counter to any claim another might make that they are displaying indifference—exactly what sorts of obligations can function that way depends largely on the circumstances.
Since certain important obligations the surgeon has to others can allow them to leave, it seems as if they aren’t trapped after all. But something important is missing in this solution. It is always possible to include in the construction of our scenario that there is no other obligation to others that is sufficient to act as a counter to claims of indifference. For example, if the obligation for a family member is sufficient to counter claims of indifference, we can simply stipulate that the surgeon has no family, and we can continue doing this for any given condition. Ideally, our solution would include a broad account of the sorts of duties that are sufficient to counter claims of indifference.
In sum, appealing to certain obligations to others to counter the overly-stringent demand of non-indifference seems to fall short of an adequate solution. We are in need of a different kind of solution. In addition to obligations we owe to others, Kant also argues that we have duties to ourselves that are no less deliberatively impactful than our duties to others. I will argue that the surgeon can justify flying home by appealing to such duties to the self rather than duties to another person, duties which are (as before) divided into perfect and imperfect duties.
One such duty to oneself is the perfect duty to avoid servility. Thomas Hill, a modern Kantian moral philosopher, defines servility as a “kind of deferential attitude towards others resulting from ignorance or misunderstanding of one’s moral rights” or, when aware and educated on those rights, “a willingness to disavow one’s moral status, publicly and systematically, in the absence of any strong reason to do so.”
On face value, it seems strange that avoiding servility would be a perfect duty. It has been established that adopting the ends of others as your own is an imperfect duty, after all. But upon reflection, avoiding servility is a perfect duty since abnegation of one’s own ends to satisfy the ends of others creates a contradiction if universalized: completely subsuming one’s own ends to the ends of others results in an individual whose only actual ends are the ends of others, and if universalized, nobody has any ends for anyone else to achieve. Here is why. If I adopt a servile attitude, I am taking up an attitude that I matter less than others from a moral standpoint, and that therefore my ends have no real deliberative weight or moral value compared to the ends of (at least some) others. Consequently, I cannot really be said to put any significant moral stock in my own ends, instead subsuming them to the ends of others, and therefore do not really hold my own ends, since holding an end means believing it carries some real normative weight. If this attitude of servility is thus universalized, nobody really values or holds their own ends in any meaningful way, so servility, which relies on others holding ends, is an incoherent concept. Servility results in a contradiction in conception rather than a contradiction in the will. Alternatively, this can be framed in terms of the humanity formulation, which contends that since to be servile is to treat yourself as a means to the ends of others, someone who is servile fails to show respect for their own humanity as a negative end and therefore violates a perfect duty.
In our example, a doctor choosing to stay indefinitely would necessarily be abandoning large swathes, if not the entirety, of the ends that they genuinely hold—they would be treating the ends of their patients, at least those ends that represent true needs, as lexicographically (i.e., weighted categorically) more important than other ends the doctor might have—to watch terrible science fiction movies, or enjoy the Washington, D.C. cherry blossoms, or any other number of possible personal ends—since staying indefinitely seems to mean taking up the attitude that those ends don’t deliberatively matter at all and ought to be completely abnegated in the presence of the ends of the patients. It’s clear that this sort of systematic disavowal of their own ends constitutes the sort of deferential attitude that indicates servility and results in the doctor not showing respect for their own humanity as a negative end and viewing themselves as a mere means to the ends of others.
As stated earlier, perfect duties trump imperfect ones, so if the doctor remaining (or continuing to perform any beneficent act) constitutes servility which would entail violating a perfect duty, then the doctor ought not remain, and it seems that the doctor remaining does constitute servility.
One possible objection is that the doctor remaining is not necessarily servile, since the doctor could be seeing to the ends of others as an extension of their genuine autonomous decision to do so.
This objection does not seem to work. The doctor pictured in the objection would be holding attitudes with certain limited parallels to Hill’s “Deferential Wife,” a hypothetical person holding particular attitudes towards herself. The Deferential Wife believes that, while women are fundamentally mentally and physically equal to men, “the proper role for a woman is to serve her family” and who resultantly chooses to act deferentially to her husband in every instance. As Hill argues, this is sufficient to bar the concept of legitimate consent, because “if she believes that she has a duty to defer to her husband, then, whatever she may say, she cannot fully understand that she has a right not to defer to him.” If someone thinks exercising a right would be an offense, they cannot “really understand what it is to have and freely give up” that right. Just like the Deferential Wife, it seems here that the doctor does not believe in any sort of inferiority for themselves but rather simply believes that, for doctors in their position, it is their proper role to stay and see to the needs of those in need. Moreover, the potentially horrific consequences of leaving (viz., the death of patients who could be saved) seem very likely to create an incredible amount of social pressure and fear of later guilt that have the potential to crowd out the capacity for a genuinely autonomous decision to stay. This does get complicated by the fact that staying is in accordance with the wide duty of helping on occasion and the narrow duty to avoid indifference to others. Taking into account all these moral psychological factors, the doctor’s understanding of what it means for them to have a right to leave is likely occluded at best. The doctor doesn’t really know what it means for them to have a right to leave, and so does not value themselves as a moral agent with the right to choose to leave, falling into the same sort of servility as Hill’s Deferential Wife, or the defendant who believes they have an obligation to not exercise their right to a trial by jury of their peers with a competent defense attorney since they believe doing so would be rude. One who does not understand their rights does not understand their moral worth, and one who does not comprehend one’s moral worth and as a result subsumes one’s ends under the ends of others is servile. Here, the doctor does not understand their rights and, by extension, their moral worth, since feelings of obligation and social/psychological pressure crowd out their capacity to understand that they have a choice. As a result, the doctor has an obligation to themselves to leave, since remaining violates a perfect duty to avoid servility.
Admittedly, one might argue that if the doctor becomes legitimately aware of their own moral rights, they are not being servile even if they continue to display the same sorts of “marks of deference” by staying indefinitely. Here, the doctor is neither ignorant of their rights nor acting as if they were insignificant; rather, they are pursuing a task with a cost to themselves after weighing and considering their options. Here, staying would no longer necessitate violating a perfect duty to themselves, and leaving would therefore not be strictly obligatory.
Still, even in this case, I would argue that the doctor has certain imperfect duties to themselves that act (much as imperfect duties to others do) as a counterargument against claims of indifference.
Kant’s standard imperfect duties to the self as laid out in The Metaphysics of Morals are to cultivate one’s own talents (“Natural Perfection” for a “pragmatic purpose”) and to cultivate one’s own moral capacity (“for a moral purpose only”). The duty to develop one’s own talents is a wide imperfect duty in both quality (the means and methods one uses to pursue a duty) and degree (the extent to which one pursues that duty), since it stems from a duty to take up a general maxim, and violation of the duty results only in a contradiction of the will and not a contradiction in conception. The duty to cultivate one’s own moral capacity is “narrow and perfect in terms of quality” but “wide and imperfect in terms of degree,” since it is a perfect duty to strive for moral perfection, but our own human limitations prevent us from actually achieving it.
Both of these duties, I contend, stem from, and are crucial to achieving, a duty to promote and cultivate one’s own autonomy. Here I mean autonomy in the Kantian sense as truly free capacity to choose to act in accordance with moral law and not just nominally free choice. Both the applicability of talents and moral capacity depend crucially on our capacity for autonomy, since autonomy is necessary for moral agency. In addition, fulfilling self-duties framed by the Humanity Formulation (i.e., respecting one’s own status as a setter of ends) necessarily entails cultivating the capacity to set those ends, which is an act of cultivating autonomy.
We all have the capacity for autonomy as human beings, but such capacities are often limited by factors both outside and within our control. For example, I have panic disorder, and frequently have panic attacks that both prevent me from making autonomous decisions while having them, and result in other conditions—physical, mental, and emotional exhaustion, anxieties, etc.—that all act to limit my autonomy. In order to cultivate my talents, my moral capacity, and autonomy, I have a wide duty to take actions that mitigate these effects—a class of things like seeing a psychiatrist, taking medication, finding and pursuing outlets for dealing with stress or emotional catharsis, and so on. In sum, I have a wide duty to myself to pursue self-care. Likewise, even neurotypical folks have a bevy of social pressures, stressful conditions, feelings of obligation to others, and levels of mental, physical, and emotional harms that are autonomy-limiting, and resultantly also have duties of self-care.
Another important duty that stems from that cluster of duties to oneself to cultivate, promote, and respect one’s own autonomy is a duty to the self to live one’s life in a genuine, authentic manner—that is, to live life in accordance with one’s own permissible ends and the moral law, free as much as is psychologically possible from pressures that limit one from doing so. This has a justification similar to our duty to promote our own autonomy and cultivate our talents, which parallels obligations to one’s own ends that are also duties as laid out in Kant’s Doctrine of Virtue.
In staying indefinitely despite wanting to leave, the doctor cannot fulfill duties of self-care and duties to pursue and promote their own autonomy. To be clear, so long as the doctor avoids servility (i.e., genuinely understands that they have a right to leave and stays despite so understanding), staying is probably permissible since those unfulfilled duties are imperfect duties that do not have the trumping feature of the perfect duty to avoid servility discussed earlier. But nonetheless, these sorts of imperfect duties can serve as a counterargument against claims of indifference. We can imagine the doctor speaking to a hypothetical patient and saying something like: “Look, it legitimately pains me to go before I can fully help you, but I have to live my own, genuinely autonomous life pursuing my own ends, so I have to pursue the sorts of things that allow me to live in such a way, and that means I have to leave.” This certainly seems weaker than the argument made before (about leaving to be with a critically-injured son) since the duties used as a counterargument are broader and seem less urgent, at least for any given occasion, since most single actions do not in and of themselves prevent someone from living their own life. But, I would contend, they are sufficient grounds for rendering the act of leaving permissible, since they act as counterarguments against claims of indifference, meaning that the doctor can leave without violating that duty. And, of course, if the doctor genuinely regards their commitment to helping their patients as what their life is about, and reaches that conclusion autonomously with full understanding that they are free to choose other permissible ends and is therefore not displaying servility in doing so, staying is also permissible.
Neither of these two cases (a perfect duty to leave that stems from the perfect duty to avoid servility and a set of imperfect duties to respect, cultivate, and promote one’s own autonomy) erase one’s obligations to avoid indifference to others. Rather, the first case acts as a trump when the two are in conflict, and both act as arguments against claims that the doctor is violating a duty of non-indifference in leaving—the first case because it is a stringent duty that would leave no room for permissibly staying, the second because a doctor who has to leave to respect, cultivate, and promote their own autonomy could plausibly argue that they really do value the people they’re leaving behind but cannot stay indefinitely without indefinitely violating an important if imperfect duty to themselves. In this manner, imperfect duties to the self act in a similar way to imperfect duties to others (e.g., an imperfect duty to be there for one’s children if they become critically injured) in terms of their function as a counterargument to claims of indifference.
These sorts of arguments, and the case for the permissibility of leaving, are strengthened the more the doctor does to show non-indifference. The doctor has an obligation to set a departure date ahead of time and stick to it as best as possible—otherwise, the time they do leave risks being or seeming arbitrary. If possible, the doctor ought to attempt to find a replacement so that nobody dies or suffers greatly because of their departure; failing that, they ought to help with passing on basic, vital skills to those in the country while there. Further, they continue to have obligations once they get home to continue to show that they do care—to financially and socially support institutions that bring physicians to impoverished nations to do medical work, to work to erase the conditions that cause poverty in general, and so on. This list is not exhaustive, obviously, but rather a broad sketch of the sorts of things they probably ought to do to further solidify the permissibility of leaving, where the permissibility of leaving is dependent on avoiding showing indifference to others.
Most of us are not highly-trained doctors in far-flung nations helping solve life-or-death crises. But, given how interconnected the world is, it can seem like others are constantly in need of the sort of help we can provide—whether financially, through social and political advocacy, or some other means. And, I would argue, we do have a duty to help them, stemming from concerns about indifference as well as duties to help others. It is still incumbent on us to avoid feeling indifferent (numb, jaded, or otherwise) towards people. But we cannot devalue ourselves entirely. Beyond utilitarian sorts of concerns for psychological well-being, we have to see ourselves as autonomous members of a moral community with incalculable value. Panacea cannot be indifferent to the suffering of the sick, but she is not morally bankrupt for spending time with her family or alone enjoying nature. We have obligations to others, obligations to avoid indifference that we all too often shirk—we turn away refugees, paint homeless people as junkies to justify not helping them, become jaded and callous in the face of anti-Semitic, Islamophobic, and other forms of bigoted violence, and fall victim to countless other pitfalls of indifference. But we must also take care not to erase ourselves from the picture, abdicating our place in the great project of humanity.
To close with a story from the Jewish tradition, Rabbi Simcha Bunim took to the habit of carrying two slips of paper, one in each pocket. One read “V’anochi afar v’efer”—I am but dust and ashes. The other read “Bishvili nivra ha-olam”—the world was created for my sake. He used to look at one or the other when he needed to throughout the day. We must remember that we are but dust and ashes, and live a life dedicated to important causes and projects, not turning away from the suffering of others, but we also need to remember our place as moral agents and as ends in ourselves. And as such, we have to take care of and be gentle with not only others but also ourselves.




REFERENCES

Buber, Martin. Tales of the Hasidim, Vol. 2: The Later Masters. Translated by Olga Marx. Schocken Books.
Hill, Thomas E. Jr. “Servility and Self Respect.” The Monist, Oxford University Press, Vol. 57, No. 1, January 1973, pp. 87-104.
Kant, Immanuel. The Metaphysics of Morals. Translated by Mary Gregor. Cambridge University Press.
McCrae, John C. Worm. Wordpress, 2011-2013.
Stohr, Karen. “Kantian Beneficence and the Problem of Obligatory Aid.” Journal of Moral Philosophy vol. 8 (2011), pp. 45-67.
Williams, Bernard. “A Critique of Utilitarianism.” Ethics, 6th ed., edited by Steven M Cahn and Peter Markie, Oxford University Press, 2016, pp. 544-560.

Thanks also to Dr. Karen Stohr for advising and helping guide me through this paper, my peers for questions and comments which helped me clarify and strengthen my case, and family members for listening to me work through the early stages of thinking about this topic.