Euthanasia
Like other contemporary controversies considered in this course, the issue of euthanasia looks very different from different points of view. One of the classic dichotomies which arises in this debate is that between the good of the individual and the interests of society. In this paper, I will argue, firstly, that the first of these perspectives should indeed be considered primary, and secondly, that in so doing we would be aided in responding systematically to the moral issues which arise in this debate, in effect, accomplishing the good of the latter.
On behalf of the pros, allow me to lay out some background. When I was 13 years old, my father was diagnosed as having lung cancer. In his 55 years, he had worked nearly 20 in such hazardous conditions as foundries, tire plants, pesticide distribution, and auto body work. For the 17 years preceding his diagnosis, he had been the chief cook and bottle washer in our families main-street restaurant, breathing in carcinogenic fumes from his hot grilllO to 14 hours a day. In addition, my father was a big little man who considered himself too tough to observe cautions about smoking, and enjoyed 2 to 3 packs of unfiltered cigarettes every day of his adult life. Predictable as such health effects would seem today, we were shocked and saddened by this unexpected family tragedy.
My father was a very proud and strong man. He'd learned to fight to win as a light weight boxer in his youth, and that determination would sustain him through 7 major surgeries, including among other procedures the removal of one lung and half of his ribs. Through all the pain he endured and the suffering and economic ruin of his family, my father fought for his life for eight long years, as we stood beside him, watching, powerless against the premature decay that deteriorated this bull of a man into an emaciated shadow of the man he had once been.
Disheartened over time from more suffering than any one being should ever have to endure, my father came to realize that nothing could have "saved" his life, that is, make it like it was. All the doctor's efforts could only prolong his suffering. Does this mean he should have given up sooner? Said "no thank you" somewhere along the line to their proposals of new procedures designed to fix the damage from the last, or a new drug that would not have the same side effects as the last, but would likely have new and maybe worse ones? Should he have saved himself the pain and the indignity of his ordeal? Saved his family the emotional and economic ordeal of sharing his struggle? No, he said once when I asked. Each and every decision to proceed with treatment had been a thoughtful one, chosen on the basis of a steady and determined will to live. he would have gone through it all over again, he said, to prolong the rest of what he enjoyed--including the birth of three of his grand children--during the extra time that medical technology and therapy had allowed him.
However, as according to the law of diminishing returns, the time comes when the wise decision is not to fight death, but to let it have its way, finally. My father had reached that point where death seemed to him a blessing long before he ever gave into it. But even having accepted the inevitability, he realistically feared certain ways of dying, in his case most likely by prolonged choking. It was a possibility that brought uncharacteristic tears to the eyes of this once hearty man.
For my father it was never been a matter of ever getting well. It was now only a matter of
how much more he would suffer before an undignified death finally overcame him. His doctors understood, and when asked for help, did not hesitate to prescribe a sedative powerful enough that he would never have to return from his peaceful and painless sleep to the pain of life. In quiet collusion, my family, my father, and his doctors planned his sweet and merciful death. While the very idea of losing him was almost more than any of us could take, the truth that we realized was that we had already lost him, for all that was left to carry on was this twisted and tortured body, a body whose mind was too burdened by pain to even notice us, let alone be glad to still be here with us. And so I myself walked to the pharmacy to get the medication that would end his suffering, and I did it gladly. My father was happy that day, maybe for the first time in years, knowing finally that freedom from his pain was just beyond this quiet threshold, and now that there was nothing to fear of the threshold itself, he was relieved finally of the burden that life had become- heavier for some than most of us can ever imagine.
Those who fight the movement to legalize euthanasia are obviously not the ones who must live in such unbearable positions, at least not yet. This is one of those cases which shows that there is indeed such a thing as too much objectivity, especially where deep subjective suffering is concerned. We would do well to use a little more empathy than is our habit in deciding what position to take on such issues as these, which make so much difference in the real life of so many who have more pressing things to do than take part in this debate--i.e. struggle with their pain--and no time when they will be finished that they can tell us how they were feeling about this issue, which is the right to a self-directed and dignified death where suffering is intense and incurable. The very conditions in which these people live and die prevent us from hearing as much as we might if they could tell us with their full faculties how they feel about this right or its lack. We are left to imagine what we would feel if faced with such options, an exercise too few actually undertake, and yet not such a difficult thing to do as some suppose. Indeed, none of us can actually be sure that it won't in fact be us who will one day face this terrifying reality. It is arguably this very potential which makes the act of empathy in this case so difficult. And yet it is also this fact which makes it so important that we do take this step, and put ourselves in the place of one so distressed.
Now, from here, honestly, would it seem to you to make sense that "society" could not let
you choose when to die, no matter how much pain you're in, no matter how unbearable is your suffering, simply because no one could figure out a way to let you die in dignity without also letting the whole of society slide down that slippery slope toward the wholesale killing of those defectives whom we consider disposable? Would you understand this utilitarian argument against euthanasia as an explanation for why you must go on living--because no one can figure out how to treat individual cases as individuals? Would you think it makes perfect sense that you be forced to continue suffering because it's better for society that you do, or that the distinction between you and those who don't want to die poses an unresolvable difficulty? Or would you think something more like--What the f..., get over it!
It seems clear to me that if I were the one who was suffering for this failure to resolve a
simple conceptual difficulty, I'd know perfectly well that no one was really trying very hard. Just like I'd know that no one was really trying very hard to redistribute wealth if I were hungry and homeless. Time has different meaning from these different points of view. These are immediate issues to those who suffer with them, and this immediacy compels more concern than our slow and reluctant philosophical deliberation suggests. These conceptual snags are difficult, yes, but not so much so that we cannot work them out for the sake of those who need relief when life becomes agony.
Euthanasia has long been common practice in many European countries, where the right to die with dignity is considered fundamental, and the maintenance of suffering when disease is incurable is considered cruel and barbaric. It is said that 53% of the American public also favors legalized euthanasia, but the American medical community publicly rejects it on the grounds that it is "contrary to the norms of American medical practice," reasoning which sounds suspiciously circular to me.
The argument against euthanasia thus takes it's strength from belief in the so-called sanctity of life and the assumed duty of the medical community to prolong and "save" it at all costs, even the cost of personal autonomy in this matter which would arguably be the biggest decision a person could ever make. No one who argues for the right to choose the manner and time of one's own death when death is already inevitable would deny the sanctity of life. In fact, it is arguable that few understand such a concept as either "sanctity" or "life" better than those who have fought so hard to save their own. It is, in fact, this very respect for life which gives one the right to end it with dignity and without fear. Like the millions of Americans who undergo such an agonizing end, my father did not give up life without a fight. But there comes a time when the fight is honestly over, and no principles of sanctity or preservation can morally rationalize its further maintenance.
We can say many good things about medical technology, but since it can so readily prolong life artificially, we must admit that it sometimes only prevent nature from doing her rightful job, which in my father's case, was to ease his pain. Here, medicine had stood in nature's way long enough to be able to justify giving it a hand in the end. I was glad--out of love and respect--to go to the pharmacy for the lethal prescription, to be able to help in some way to give him the relief that he had craved and deserved for too long. And frankly, my family and I were almost more grateful to his doctors for their quiet aid in ending his torture than we were for their aid in prolonging it.
One gets the feeling from such quiet service as my father's doctors contributed to his gentle passing that, despite the public profile against euthanasia in our country, and all the controversy over certain widely publicized cases, this practice of easing the death experience is actually more wide-spread than any of us who have no need of it might realize. This much, at least, is as it should be. And perhaps one day those who believe and participate in this practice will actually stand up and take a position on behalf of those who deserve this justice. If for no other reason, it is simply fair for those with incurable and debilitating conditions to be allowed to choose when and how to die. At least in such cases where one has fought for life, for such a one has earned the right to give up that fight without having to fear a fight with death.
The arguments put forth in this paper are based on a concrete respect for individual life, rather than an abstract concept of "sanctified life," and they hope to show that it stands to moral reason that the very same respect which brings us to defend euthanasia for agents in need of relief from suffering, also brings us to draw the line clearly between these cases and those which lack this element of urgent need, which is to say, between what we might call self-willed and other willed euthanasia. I believe this distinction can ward off the slippery slope danger, for while it may seem easy to worry that the medical community may loose respect for the lives of those about whom they make life and death decisions objectively (maybe too much so), it is unlikely that such degradation of life would occur if the decision remains with the choosing agent. We are wrong to worry that some may discard their own lives too easily--such disregard only happens when we take the choice from the agent and put it in the hands of someone who is too "objective" to perceive the will sensitively.
This distinction will be easier to draw if we keep in mind the point of view from which we are viewing the subject at hand, inside-out vs. outside-in, for the issues involved in this debate are complex and worthy of deeper consideration than our traditional reductionist methods can reach. From the inside-looking-out, respect for life means more than forcing it to either continue or to end, and this raises a host of important related issues. Among these are certainly questions of competency. Who is qualified to choose for themselves whether to live or to die? And if the agent him or herself is not thus competent, who is? I think the question of method gets at this question better, at least, than methods of old. We go further toward understanding the will of patients, even unconscious ones, better with empathy than with objective outside-looking-in assessments.
Other issues involve the meaning and definition of death. For instance, following a line of reasoning that begins in this primacy of consciousness, and follows through on the importance of process, i.e. growth and decay, we come to a conclusion that, life being such a process, without as many clear lines and boundaries as we might like, we can see that any line we draw between !ife and death is at least somewhat arbitrary, and also part discovery. Having participated in my father's dying experience, I could see that there are not the clear and distinct thresholds that we conveniently assume to be between life and death. Throughout his slow and agonizing ordeal, my father died more times than any one human being should ever have to. The cessation of breathing and heartbeat are only the final manifestations of a death that can begin years earlier, and can go on ad nauseum for one so affected. None of those who loved him saw any moral reason why--least of all "the good of society" or "the sanctity of life"--he should be forced to go through it yet one more time.
On the other hand, this line draws a very interesting conceptual distinction worth examining, for we can come closer to understanding the interconnection between mind and body by asking the question, Where does life meet death? One might want to argue that consciousness, which is ubiquitous in natural systems, perhaps even more than we realize, is the locus of subject and object, mind and body--not merely mind as we often think, for as we well know by the attachment of our attention to our senses, body seems essential to consciousness. We need the physical body to house the awareness, the mind being one among all the interactive systems, although perhaps a critically important system since it seems clear that we need at least some part of the mind for survival of the body. Where decay of the body detaches this psychological/spiritual capacity from the physical/sensual organism, subject and object disintegrate, which is to say, attention no longer engages the world at the cutting edge of time. But the system is clearly interactive, and the centrality of the brain in the bodies system of life functions is not as intuitively clear as some seem to think.
It is thus tempting to consider consciousness to be the essential element of life that ought to be protected. On the positive side, this would bring us to value more forms of life than merely human life, a desirable state of affairs, since we have too long allowed ourselves the value judgment of our superiority. We have seen the effects of this arrogance in the breaking of many evolutionarily constructive chains of interdependence. And, in many ways, our environmental crisis seems to parallel our personal identity crisis', for on both scales, narrow self-interest brings us to disrespect our fellow creatures at our own expense, just as the sense of one's own superiority can bring an individual to disregard the interests of others, thwarting one's own interests in the process. We make most of the messes with which we live, just like we make the joys. While it seems high time we got over that narrow sense of our own self which allows us to see our own species as superior, and ourselves as separate and above those with whom we are in truth interdependent, meaning, I suppose, that we can do anything we want, it is also time that we recognize how much "what we want" matters. There is a sense of the word "superior" we might do well to reconsider, for having this power only makes us morally responsible, and then the question becomes, what should we do with all this power that our broadened consciousness gives us?
This view of consciousness would be consistent with an appeal to merciful death, seeming to justify the relief of consciousness from pain. Unfortunately, on the more negative side, it also seems to be consistent with an excessively broad definition of death, one which would classify many of those living in persistent vegetative states as already dead--a conclusion we would be wise to doubt if we truly respect "consciousness," in all it's awe and mystery.
Given this value of consciousness, the question regarding the medical power to give and take life then becomes, "Do we value life even if unconscious, or do we value life only as a vehicle for consciousness?" If we value this inside-looking-out point of view as primary, we cannot but admit that the point where consciousness leaves the decaying body, finally and irreparably, to be the moment when the body is rendered useless to its agent. Since "the continued capacity for a mental life is what makes our life valuable, without it, life would not be worth living," and at this point, where there is irreversable loss of brain function, "life would be no more valuable to the patient than death."
However, this is not to say that we are justified in actively quickening death for such a patient. As Green and Wikler point out, while "the existence of the brain-dead patient is without any value to itself or others...", and "care should be withdrawn from the brain dead... But it in no way shows that the brain dead are dead." Brain-death is not necessarily enough to qualify as death, for a body that persists in surviving has a right to the struggle it choose to maintain. From this view, a brain-dead body does not belong to us, to science, to the family, or to the public at large, to discard at will simply by virtue of the death of higher brain functions, regardless of the function of other systems. Rather, the body that keeps struggling spontaneously, even after brain death, still belongs to the agent for whom it has been home--even after all deliberate choice in the matter is gone, for who is to say that choice, of some sort, is not still occurring? A body which struggles to live is in some sense choosing to struggle.
My point is that respect for consciousness does not mean disrespect for what is left when it is gone, which we can never be certain about. Rather than sin against aspects of the mind we don't yet understand, we might actually broaden our conception of consciousness to recognize that, since it develops evolutionarily to keep the body alive, and can persists in that function, perhaps for reasons beyond our understanding in this world, sometimes long after deliberate thought about the matter has ended, it is not for us to call it dead--against the claims of its own spirit. If we see survival and well-being as the function of consciousness, then when a body keeps on living on its own, we can know that something is keeping that body alive--and that something exists, and thus, is not dead. This intangible spirit may not be detectable by eegs, but this does not render it unreal. The force is with a body that struggles to live on, and we ought not to be in a hurry to end that struggle, which almost certainly has more value than we know. Perhaps we should even be in awe of it.
Thus, the same respect which justifies euthanasia for those in conscious agony, can justify restraint from interference in dying with regard to those who do not choose it for themselves. On the strength of the same argument then, a person who has struggled or whose impending struggle is unbearable on the face of it, has the right of every free agent to choose to give up that struggle- just the same as a body which struggles to live on is choosing, on some level, to do so. Either way, a body which chooses to continue or to end that struggle is making a justified decision, its rightful autonomous choice.
Thus, I would recommend that we resolve the dilemma between the justified right to euthanasia and the more or less realistic fear of the slippery slope by recognizing the primary importance of the agents own will, so far as we can determine it, and I would argue that we can determine it much better with empathy that without. This would take us far enough to allow merciful death for those who crave it, without going so far as to impose that choice on those who do not, and most especially not on anyone whose spirit still struggles to keep their body alive. The need to escape pain is urgent and immediate, whereas the need to empty hospital beds is not.
In conclusion, none of the slippery slope or rule utilitarian arguments, which come down on the side of the interests of society over the good of the individual, holds up in the face of even one person who is faced with the otherwise horrifying options. This is a person with an honest need and a legitimate claim to a right to autonomous action in seeing to that need. If the only reasons we deny such individuals the satisfaction of this urgent need is because we can't figure out a way to distinguish this individual from others who have less need in order to morally justify this exception to the rule, then this is no reason at all, for we have a reason right before us in the very difference in their need. From the point of view of the suffering person in need of relief, it must seem clear that we just don't care enough about him or her, as an individual, to recognize them as an exception to the moral rule against taking life. Good God, a person in such circumstances might cry out, this is not the kind of "taking life" that such a moral rule rules out. It might even be argued that such an act is life-giving, in as much as we are giving this individual back what he or she would otherwise have to pay in order to live any longer. It's interesting that we don't have moral qualms about administering health care even when it seems to cause pain, and we don't seem to worry about slippery slopes here, i.e. that society will degenerate into causing pain left and right because we don't know where to draw the line once we start. But we are extremely hesitant to discontinue this health care, even when it has become torturous to the individual it was designed to aid. In the very same way that we don't slip like the baby out with the bathwater where causing pain for the sake of health, I would argue that we are perfectly capable of distinguishing death for the sake of life from death for the sake of other ends, like transplant farming and systematic genocide. We ought to give ourselves more credit, as human beings, than we do when we suggest that people don't know the difference between those for whom death is mercy and those who would not welcome it. It is a simple matter of listening. Certainly controversy will occur, as it should, but we tend to pretend that empathy tum up so much controversy in the form of an infinite number of points of view that we cannot reconcile, but honestly, anyone who can't see the deep and urgent reason inside this need is really not trying to understand it, and so why should such a view carry weight? We often see only what we want to see, and thus, one who cannot empathize fully enough to appreciate the profundity of such circumstances is the very least qualified to be
making decisions regarding this issue. We can easily rationalize away other's needs by too much objectivity, and here is indeed a slippery slope, for this easily becomes cool detachment--an entirely inappropriate approach to such moral issues of urgent need. It is not so easy to ignore when the need is our own. In principle, if one can imagine even and only one situation where they themselves would feel the need to make such a decision as to desire a merciful death, then they have the one reason they need for allowing at least this exception to the rule against deliberately taking life, because someone, somewhere, is living that possibility as real life. Do we care about individuals, or not? Ask it this way and the answer seems clearer--do we, when our time comes, want to be cared about as an individual, or not? If we do, then we must do onto others as we would have them do onto us. How could such a policy of empathic decision-making be anything but good for society as a whole?
Like other contemporary controversies considered in this course, the issue of euthanasia looks very different from different points of view. One of the classic dichotomies which arises in this debate is that between the good of the individual and the interests of society. In this paper, I will argue, firstly, that the first of these perspectives should indeed be considered primary, and secondly, that in so doing we would be aided in responding systematically to the moral issues which arise in this debate, in effect, accomplishing the good of the latter.
On behalf of the pros, allow me to lay out some background. When I was 13 years old, my father was diagnosed as having lung cancer. In his 55 years, he had worked nearly 20 in such hazardous conditions as foundries, tire plants, pesticide distribution, and auto body work. For the 17 years preceding his diagnosis, he had been the chief cook and bottle washer in our families main-street restaurant, breathing in carcinogenic fumes from his hot grilllO to 14 hours a day. In addition, my father was a big little man who considered himself too tough to observe cautions about smoking, and enjoyed 2 to 3 packs of unfiltered cigarettes every day of his adult life. Predictable as such health effects would seem today, we were shocked and saddened by this unexpected family tragedy.
My father was a very proud and strong man. He'd learned to fight to win as a light weight boxer in his youth, and that determination would sustain him through 7 major surgeries, including among other procedures the removal of one lung and half of his ribs. Through all the pain he endured and the suffering and economic ruin of his family, my father fought for his life for eight long years, as we stood beside him, watching, powerless against the premature decay that deteriorated this bull of a man into an emaciated shadow of the man he had once been.
Disheartened over time from more suffering than any one being should ever have to endure, my father came to realize that nothing could have "saved" his life, that is, make it like it was. All the doctor's efforts could only prolong his suffering. Does this mean he should have given up sooner? Said "no thank you" somewhere along the line to their proposals of new procedures designed to fix the damage from the last, or a new drug that would not have the same side effects as the last, but would likely have new and maybe worse ones? Should he have saved himself the pain and the indignity of his ordeal? Saved his family the emotional and economic ordeal of sharing his struggle? No, he said once when I asked. Each and every decision to proceed with treatment had been a thoughtful one, chosen on the basis of a steady and determined will to live. he would have gone through it all over again, he said, to prolong the rest of what he enjoyed--including the birth of three of his grand children--during the extra time that medical technology and therapy had allowed him.
However, as according to the law of diminishing returns, the time comes when the wise decision is not to fight death, but to let it have its way, finally. My father had reached that point where death seemed to him a blessing long before he ever gave into it. But even having accepted the inevitability, he realistically feared certain ways of dying, in his case most likely by prolonged choking. It was a possibility that brought uncharacteristic tears to the eyes of this once hearty man.
For my father it was never been a matter of ever getting well. It was now only a matter of
how much more he would suffer before an undignified death finally overcame him. His doctors understood, and when asked for help, did not hesitate to prescribe a sedative powerful enough that he would never have to return from his peaceful and painless sleep to the pain of life. In quiet collusion, my family, my father, and his doctors planned his sweet and merciful death. While the very idea of losing him was almost more than any of us could take, the truth that we realized was that we had already lost him, for all that was left to carry on was this twisted and tortured body, a body whose mind was too burdened by pain to even notice us, let alone be glad to still be here with us. And so I myself walked to the pharmacy to get the medication that would end his suffering, and I did it gladly. My father was happy that day, maybe for the first time in years, knowing finally that freedom from his pain was just beyond this quiet threshold, and now that there was nothing to fear of the threshold itself, he was relieved finally of the burden that life had become- heavier for some than most of us can ever imagine.
Those who fight the movement to legalize euthanasia are obviously not the ones who must live in such unbearable positions, at least not yet. This is one of those cases which shows that there is indeed such a thing as too much objectivity, especially where deep subjective suffering is concerned. We would do well to use a little more empathy than is our habit in deciding what position to take on such issues as these, which make so much difference in the real life of so many who have more pressing things to do than take part in this debate--i.e. struggle with their pain--and no time when they will be finished that they can tell us how they were feeling about this issue, which is the right to a self-directed and dignified death where suffering is intense and incurable. The very conditions in which these people live and die prevent us from hearing as much as we might if they could tell us with their full faculties how they feel about this right or its lack. We are left to imagine what we would feel if faced with such options, an exercise too few actually undertake, and yet not such a difficult thing to do as some suppose. Indeed, none of us can actually be sure that it won't in fact be us who will one day face this terrifying reality. It is arguably this very potential which makes the act of empathy in this case so difficult. And yet it is also this fact which makes it so important that we do take this step, and put ourselves in the place of one so distressed.
Now, from here, honestly, would it seem to you to make sense that "society" could not let
you choose when to die, no matter how much pain you're in, no matter how unbearable is your suffering, simply because no one could figure out a way to let you die in dignity without also letting the whole of society slide down that slippery slope toward the wholesale killing of those defectives whom we consider disposable? Would you understand this utilitarian argument against euthanasia as an explanation for why you must go on living--because no one can figure out how to treat individual cases as individuals? Would you think it makes perfect sense that you be forced to continue suffering because it's better for society that you do, or that the distinction between you and those who don't want to die poses an unresolvable difficulty? Or would you think something more like--What the f..., get over it!
It seems clear to me that if I were the one who was suffering for this failure to resolve a
simple conceptual difficulty, I'd know perfectly well that no one was really trying very hard. Just like I'd know that no one was really trying very hard to redistribute wealth if I were hungry and homeless. Time has different meaning from these different points of view. These are immediate issues to those who suffer with them, and this immediacy compels more concern than our slow and reluctant philosophical deliberation suggests. These conceptual snags are difficult, yes, but not so much so that we cannot work them out for the sake of those who need relief when life becomes agony.
Euthanasia has long been common practice in many European countries, where the right to die with dignity is considered fundamental, and the maintenance of suffering when disease is incurable is considered cruel and barbaric. It is said that 53% of the American public also favors legalized euthanasia, but the American medical community publicly rejects it on the grounds that it is "contrary to the norms of American medical practice," reasoning which sounds suspiciously circular to me.
The argument against euthanasia thus takes it's strength from belief in the so-called sanctity of life and the assumed duty of the medical community to prolong and "save" it at all costs, even the cost of personal autonomy in this matter which would arguably be the biggest decision a person could ever make. No one who argues for the right to choose the manner and time of one's own death when death is already inevitable would deny the sanctity of life. In fact, it is arguable that few understand such a concept as either "sanctity" or "life" better than those who have fought so hard to save their own. It is, in fact, this very respect for life which gives one the right to end it with dignity and without fear. Like the millions of Americans who undergo such an agonizing end, my father did not give up life without a fight. But there comes a time when the fight is honestly over, and no principles of sanctity or preservation can morally rationalize its further maintenance.
We can say many good things about medical technology, but since it can so readily prolong life artificially, we must admit that it sometimes only prevent nature from doing her rightful job, which in my father's case, was to ease his pain. Here, medicine had stood in nature's way long enough to be able to justify giving it a hand in the end. I was glad--out of love and respect--to go to the pharmacy for the lethal prescription, to be able to help in some way to give him the relief that he had craved and deserved for too long. And frankly, my family and I were almost more grateful to his doctors for their quiet aid in ending his torture than we were for their aid in prolonging it.
One gets the feeling from such quiet service as my father's doctors contributed to his gentle passing that, despite the public profile against euthanasia in our country, and all the controversy over certain widely publicized cases, this practice of easing the death experience is actually more wide-spread than any of us who have no need of it might realize. This much, at least, is as it should be. And perhaps one day those who believe and participate in this practice will actually stand up and take a position on behalf of those who deserve this justice. If for no other reason, it is simply fair for those with incurable and debilitating conditions to be allowed to choose when and how to die. At least in such cases where one has fought for life, for such a one has earned the right to give up that fight without having to fear a fight with death.
The arguments put forth in this paper are based on a concrete respect for individual life, rather than an abstract concept of "sanctified life," and they hope to show that it stands to moral reason that the very same respect which brings us to defend euthanasia for agents in need of relief from suffering, also brings us to draw the line clearly between these cases and those which lack this element of urgent need, which is to say, between what we might call self-willed and other willed euthanasia. I believe this distinction can ward off the slippery slope danger, for while it may seem easy to worry that the medical community may loose respect for the lives of those about whom they make life and death decisions objectively (maybe too much so), it is unlikely that such degradation of life would occur if the decision remains with the choosing agent. We are wrong to worry that some may discard their own lives too easily--such disregard only happens when we take the choice from the agent and put it in the hands of someone who is too "objective" to perceive the will sensitively.
This distinction will be easier to draw if we keep in mind the point of view from which we are viewing the subject at hand, inside-out vs. outside-in, for the issues involved in this debate are complex and worthy of deeper consideration than our traditional reductionist methods can reach. From the inside-looking-out, respect for life means more than forcing it to either continue or to end, and this raises a host of important related issues. Among these are certainly questions of competency. Who is qualified to choose for themselves whether to live or to die? And if the agent him or herself is not thus competent, who is? I think the question of method gets at this question better, at least, than methods of old. We go further toward understanding the will of patients, even unconscious ones, better with empathy than with objective outside-looking-in assessments.
Other issues involve the meaning and definition of death. For instance, following a line of reasoning that begins in this primacy of consciousness, and follows through on the importance of process, i.e. growth and decay, we come to a conclusion that, life being such a process, without as many clear lines and boundaries as we might like, we can see that any line we draw between !ife and death is at least somewhat arbitrary, and also part discovery. Having participated in my father's dying experience, I could see that there are not the clear and distinct thresholds that we conveniently assume to be between life and death. Throughout his slow and agonizing ordeal, my father died more times than any one human being should ever have to. The cessation of breathing and heartbeat are only the final manifestations of a death that can begin years earlier, and can go on ad nauseum for one so affected. None of those who loved him saw any moral reason why--least of all "the good of society" or "the sanctity of life"--he should be forced to go through it yet one more time.
On the other hand, this line draws a very interesting conceptual distinction worth examining, for we can come closer to understanding the interconnection between mind and body by asking the question, Where does life meet death? One might want to argue that consciousness, which is ubiquitous in natural systems, perhaps even more than we realize, is the locus of subject and object, mind and body--not merely mind as we often think, for as we well know by the attachment of our attention to our senses, body seems essential to consciousness. We need the physical body to house the awareness, the mind being one among all the interactive systems, although perhaps a critically important system since it seems clear that we need at least some part of the mind for survival of the body. Where decay of the body detaches this psychological/spiritual capacity from the physical/sensual organism, subject and object disintegrate, which is to say, attention no longer engages the world at the cutting edge of time. But the system is clearly interactive, and the centrality of the brain in the bodies system of life functions is not as intuitively clear as some seem to think.
It is thus tempting to consider consciousness to be the essential element of life that ought to be protected. On the positive side, this would bring us to value more forms of life than merely human life, a desirable state of affairs, since we have too long allowed ourselves the value judgment of our superiority. We have seen the effects of this arrogance in the breaking of many evolutionarily constructive chains of interdependence. And, in many ways, our environmental crisis seems to parallel our personal identity crisis', for on both scales, narrow self-interest brings us to disrespect our fellow creatures at our own expense, just as the sense of one's own superiority can bring an individual to disregard the interests of others, thwarting one's own interests in the process. We make most of the messes with which we live, just like we make the joys. While it seems high time we got over that narrow sense of our own self which allows us to see our own species as superior, and ourselves as separate and above those with whom we are in truth interdependent, meaning, I suppose, that we can do anything we want, it is also time that we recognize how much "what we want" matters. There is a sense of the word "superior" we might do well to reconsider, for having this power only makes us morally responsible, and then the question becomes, what should we do with all this power that our broadened consciousness gives us?
This view of consciousness would be consistent with an appeal to merciful death, seeming to justify the relief of consciousness from pain. Unfortunately, on the more negative side, it also seems to be consistent with an excessively broad definition of death, one which would classify many of those living in persistent vegetative states as already dead--a conclusion we would be wise to doubt if we truly respect "consciousness," in all it's awe and mystery.
Given this value of consciousness, the question regarding the medical power to give and take life then becomes, "Do we value life even if unconscious, or do we value life only as a vehicle for consciousness?" If we value this inside-looking-out point of view as primary, we cannot but admit that the point where consciousness leaves the decaying body, finally and irreparably, to be the moment when the body is rendered useless to its agent. Since "the continued capacity for a mental life is what makes our life valuable, without it, life would not be worth living," and at this point, where there is irreversable loss of brain function, "life would be no more valuable to the patient than death."
However, this is not to say that we are justified in actively quickening death for such a patient. As Green and Wikler point out, while "the existence of the brain-dead patient is without any value to itself or others...", and "care should be withdrawn from the brain dead... But it in no way shows that the brain dead are dead." Brain-death is not necessarily enough to qualify as death, for a body that persists in surviving has a right to the struggle it choose to maintain. From this view, a brain-dead body does not belong to us, to science, to the family, or to the public at large, to discard at will simply by virtue of the death of higher brain functions, regardless of the function of other systems. Rather, the body that keeps struggling spontaneously, even after brain death, still belongs to the agent for whom it has been home--even after all deliberate choice in the matter is gone, for who is to say that choice, of some sort, is not still occurring? A body which struggles to live is in some sense choosing to struggle.
My point is that respect for consciousness does not mean disrespect for what is left when it is gone, which we can never be certain about. Rather than sin against aspects of the mind we don't yet understand, we might actually broaden our conception of consciousness to recognize that, since it develops evolutionarily to keep the body alive, and can persists in that function, perhaps for reasons beyond our understanding in this world, sometimes long after deliberate thought about the matter has ended, it is not for us to call it dead--against the claims of its own spirit. If we see survival and well-being as the function of consciousness, then when a body keeps on living on its own, we can know that something is keeping that body alive--and that something exists, and thus, is not dead. This intangible spirit may not be detectable by eegs, but this does not render it unreal. The force is with a body that struggles to live on, and we ought not to be in a hurry to end that struggle, which almost certainly has more value than we know. Perhaps we should even be in awe of it.
Thus, the same respect which justifies euthanasia for those in conscious agony, can justify restraint from interference in dying with regard to those who do not choose it for themselves. On the strength of the same argument then, a person who has struggled or whose impending struggle is unbearable on the face of it, has the right of every free agent to choose to give up that struggle- just the same as a body which struggles to live on is choosing, on some level, to do so. Either way, a body which chooses to continue or to end that struggle is making a justified decision, its rightful autonomous choice.
Thus, I would recommend that we resolve the dilemma between the justified right to euthanasia and the more or less realistic fear of the slippery slope by recognizing the primary importance of the agents own will, so far as we can determine it, and I would argue that we can determine it much better with empathy that without. This would take us far enough to allow merciful death for those who crave it, without going so far as to impose that choice on those who do not, and most especially not on anyone whose spirit still struggles to keep their body alive. The need to escape pain is urgent and immediate, whereas the need to empty hospital beds is not.
In conclusion, none of the slippery slope or rule utilitarian arguments, which come down on the side of the interests of society over the good of the individual, holds up in the face of even one person who is faced with the otherwise horrifying options. This is a person with an honest need and a legitimate claim to a right to autonomous action in seeing to that need. If the only reasons we deny such individuals the satisfaction of this urgent need is because we can't figure out a way to distinguish this individual from others who have less need in order to morally justify this exception to the rule, then this is no reason at all, for we have a reason right before us in the very difference in their need. From the point of view of the suffering person in need of relief, it must seem clear that we just don't care enough about him or her, as an individual, to recognize them as an exception to the moral rule against taking life. Good God, a person in such circumstances might cry out, this is not the kind of "taking life" that such a moral rule rules out. It might even be argued that such an act is life-giving, in as much as we are giving this individual back what he or she would otherwise have to pay in order to live any longer. It's interesting that we don't have moral qualms about administering health care even when it seems to cause pain, and we don't seem to worry about slippery slopes here, i.e. that society will degenerate into causing pain left and right because we don't know where to draw the line once we start. But we are extremely hesitant to discontinue this health care, even when it has become torturous to the individual it was designed to aid. In the very same way that we don't slip like the baby out with the bathwater where causing pain for the sake of health, I would argue that we are perfectly capable of distinguishing death for the sake of life from death for the sake of other ends, like transplant farming and systematic genocide. We ought to give ourselves more credit, as human beings, than we do when we suggest that people don't know the difference between those for whom death is mercy and those who would not welcome it. It is a simple matter of listening. Certainly controversy will occur, as it should, but we tend to pretend that empathy tum up so much controversy in the form of an infinite number of points of view that we cannot reconcile, but honestly, anyone who can't see the deep and urgent reason inside this need is really not trying to understand it, and so why should such a view carry weight? We often see only what we want to see, and thus, one who cannot empathize fully enough to appreciate the profundity of such circumstances is the very least qualified to be
making decisions regarding this issue. We can easily rationalize away other's needs by too much objectivity, and here is indeed a slippery slope, for this easily becomes cool detachment--an entirely inappropriate approach to such moral issues of urgent need. It is not so easy to ignore when the need is our own. In principle, if one can imagine even and only one situation where they themselves would feel the need to make such a decision as to desire a merciful death, then they have the one reason they need for allowing at least this exception to the rule against deliberately taking life, because someone, somewhere, is living that possibility as real life. Do we care about individuals, or not? Ask it this way and the answer seems clearer--do we, when our time comes, want to be cared about as an individual, or not? If we do, then we must do onto others as we would have them do onto us. How could such a policy of empathic decision-making be anything but good for society as a whole?