In Defense of Active Voluntary Euthanasia: A Religious Framework
by Robert M. Baird
Many die too late, and a few die too early. The doctrine still sounds strange: "Die at the right time."
He who is "able to say a holy No when the time for Yes has passed…knows how to die and to live."
Friedrich Nietzsche[i]
We need, in love, to practice only this:
letting each other go. For holding on
comes easily; we do not need to learn it.
Rainer Maria Rilke[ii]
Pontiac, Mich. [Wednesday, May 15, 1996]-A jury here Tuesday acquitted Jack Kevorkian of criminal charges that he helped two women kill themselves in 1991, a verdict that Kevorkian immediately declared should legitimize the practice of physician-assisted suicide in Michigan and elsewhere in the country. "I now consider this a legitimate medical service," Kevorkian said shortly after a jury, for the third time, refused to find him guilty of a crime. The 67-year-old retired pathologist added that "the time has come for the medical profession to come forward and set down the guidelines on how this is going to be done."[iii]
Despite the fact that the law in Michigan and, until recently, in every other state[iv] makes physician-assisted suicide illegal, it increasingly appears that no jury is going to find Kevorkian guilty of a crime. Why? One plausible answer is that most people support active euthanasia under certain circumstances and do not believe that physician-assisted suicide should be viewed as criminal. Regardless of the explanation of the juries` absolving of Kevorkian, few events underline more graphically the emotional, moral, and legal complexity of the euthanasia controversy.
Now the issue is before the United States Supreme Court. In March 1996, the United States Court of Appeals for the 9th Circuit ruled 8 to 3 that the Washington state law prohibiting physician-assisted violated the United States Constitution. A federal appellate court has also found a New York law banning assisted suicide unconstitutional. The issue has been appealed to the Supreme Court, arguments have been heard, and a decision is expected by summer.
Legally permitting physician-assisted suicide, a form of active euthanasia, would, of course, constitute a dramatic change in public policy. Ideally, such changes should be preceded by careful and protracted public discussion and debate, and the purpose of this essay is to enter that debate by exploring active euthanasia from a religious point of view. Since the essay is not rigorously argumentative, it might be taken as a "mere rhetorical expression of my own feelings."[v] I would dispute the "mere," however, for while the essay certainly expresses deep sentiments about euthanasia, I am attempting to provide a religious framework that supports those sentiments.
On the morning of March 29, 1986, the day before Easter [writes Presbyterian minister Harry Cole], my wife, Jacqueline, suffered a sudden and massive stroke. Within minutes she lapsed into a coma and was rushed to the nearest hospital, where I was told that she would almost certainly die within a few hours. Although Jackie did survive the day, and several days thereafter, I was informed by her physician that she would never regain consciousness and, if she were to survive, it would be in a persistent vegetative state.
On the forty-first day of her coma, May 9, convinced that Jackie could not recover from her stroke, I petitioned the court for permission to disconnect her life-support system. The permission was denied.
On May 15, six days after my appearance in court, I came to Jackie`s room for a last visit before transferring her to a long-term nursing care facility. I looked at her lying in the bed and saw Jacqueline open her eyes and look at me. It was the forty-seventh day of her coma. Today, almost two years later, after many long hours of therapy, she is well on her way toward a full recovery….[vi]
I introduce the Coles` story because their experience enables me to acknowledge the awesomeness of the subject, to make clear that defending euthanasia can only be done in fear and trembling. I recount their story with mixed feelings, however, because it would defeat my purpose if the reader were to conclude immediately from such a case that euthanasia is always wrong. For precisely what I want to argue is that euthanasia is sometimes morally, indeed, religiously permissible, but, nonetheless, only fearsomely so.
When I read someone`s assertion that he has "yet to hear a plausible argument why it should be permissible for us to put this kind of power [euthanasia] in the hands of another, whether a doctor or anyone else,"[vii] I am puzzled. I can certainly understand someone`s claim that the weight of argumentation is against active euthanasia or that no public policy could be devised that would prohibit abuse, but I find it difficult to understand how anyone could deny that the depth of suffering experienced by some individuals provides at least a plausible argument in support of active euthanasia. A study showing greater support for voluntary euthanasia by nurses than physicians "may reflect the closer relationships…[nurses] form with incurably ill patients and the resultant understanding of… [patients`] plight."[viii]
In fear and trembling, then, but motivated by human suffering and motivated by the desirability that the process of one`s dying reflect the values that have characterized one`s life, I support voluntary active euthanasia under certain circumstances, and I will advance a religious framework for its defense.
A brief comment on the common distinction between passive and active euthanasia: Passive euthanasia is the termination of therapy or the withholding of treatment when to do so will probably result in death. Turning off, or never starting the respirator, ceasing the chemotherapy, and withholding the penicillin are, under certain circumstances, examples. I want to make two observations about passive euthanasia, and then turn to active euthanasia.
Passive euthanasia is not a particularly controversial topic. Most individuals and all religious traditions that I am aware of agree-at times heroic medical procedures are inappropriate. At times it is legitimate to cease medical intervention and let death have its way. The American Medical Association, in a 1973 policy statement, sanctioned passive euthanasia: "The cessation of the employment of extraordinary means to prolong the life of the body where there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family."[ix] The morality of passive euthanasia is not the debatable issue.
While its morality is not, its accessibility is. This leads to a second observation. Some physicians and medical ethicists believe that it is people`s fear that the medical and legal establishments will not cease treatment, will not let them die when the time comes, that motivates the move to legalize active euthanasia. One ethicist argues that people are so afraid that their lives will be pointlessly sustained by technology that they want "authorization for a preemptive response to the dangers of cure-fanaticism…."[x] That preemptive response is active euthanasia which I will define as the overt taking of someone`s life who is suffering intensely, or who judges that her life is pointless, or who no longer has the possibility of conscious life, at the request of and for the benefit of the one who dies.
Is it morally right to grant a person`s wish to die, to die sooner rather than later, as a way of relieving physical pain or psychological anguish or pointless existence? Is active voluntary euthanasia ever morally permissible?
Some who oppose active euthanasia assert, as does former United States Surgeon General C. Everett Koop, that "the deliberate killing of one human being by another, no matter what the motivation…is murder."[xi] This begs the question, for murder is by typical usage always morally and legally wrong, whereas the issue here is precisely whether it is always wrong for one human being to kill another intentionally.
A serious claim that it is always wrong is the religious argument. At this point in history, religious tradition overwhelmingly opposes mercy killing. Jews, Catholics, Christian Scientists, Episcopalians, Jehovah`s Witnesses, Mormons, Lutherans, Mennonites, Greek Orthodox, Moslems, Hindus, Buddhists, and Baptists all have formal statements condemning active euthanasia.[xii] Consider a sampling: a Jewish document: "only He who gives life may take it away;"[xiii] a Baptist document: "We believe life and death belong in the hands of God;"[xiv] an Episcopal document: the "Church believes that as God gives life so only through the operation of the laws of nature can life rightly be taken from human beings;"[xv] a Lutheran document: "Life as a gift from God is an endowment whose disposition lies in the hands of God Himself;"[xvi] and Pope John Paul`s recent statement: "God alone has the power over life and death."[xvii]
The argument of these traditions is the same. God is the giver of life; therefore, only God has the right to take it. When we intervene in matters of life and death, the argument goes, we usurp divine prerogative. This has been and continues to be the fundamental religious argument against euthanasia.
I want to respond to this pervasive religious objection to euthanasia by suggesting a religious framework for thinking about human responsibility that might provide a justification for active euthanasia, that might reorient our perspective on who has responsibility for death.
The framework I will propose takes its key from the weakness in the traditional religious objection to euthanasia: God is the giver of life; therefore, only God has the right to take it. There is a sense in which the premise of this argument is true and a sense in which it is not. As the foundation of natural processes, God is the source of life. But God has designed those processes to include human beings as necessary to the production of life. One does not have to be a secularistic naturalist to believe with Annette Baier that "a person is, as Montaigne put it, `marvelously corporeal," and to see persons as having person-progenitors…."[xviii] Both God, then, as the author of natural processes, and human beings, as a result of our assigned role in the reproductive process and as a result of our scientific advances in medicine that make human life possible in circumstances where previously not possible, are necessary conditions for the creation of and/or the sustaining of human life. Humans have been assigned responsibility for continuation of the species-a responsibility sometimes maturely assumed by persons, sometimes not.
To be created in the image of God means, among other things, that we are endowed with the ability and freedom to create. We have accepted this power regarding the creation of and sustaining of life. Is it not time to assume it with regard to death? "Only he who gives life may take it" is the traditional religious argument against euthanasia, but does not the fact that God has assigned us a role in the creation of and sustaining of life suggest the possibility that God may, at times, be assigning us a role in the taking of life?
A fundamental religious model, particularly within the Judeo/Christian tradition, is the image of God as father or parent. Consider our relationship with our own children as an analogy. As parents, we raise them to assume increasing responsibility for their own decisions. We help them become mature by increasing their accountability. Evidence that they have become adults is their ability to assume responsibility for the profound choices that affect their lives. Is it not helpful to think of God as using time and history to increase the responsibility of his children? Does that not seem to be God`s plan for human development-increasing our responsibility even for (especially for) matters of life and death. Jonas Salk, in the laboratory, assumed responsibility for life. The pediatrician in the hospital nursery assumes responsibility for life when she places the prematurely born in the incubator. When a cardiologist resuscitates a heart attack victim, he assumes responsibility for life. Every time a surgeon removes a perforated appendix, she has assumed responsibility for life. We have long since passed the "watershed of medical innocence."[xix] Someone once argued that if it is God`s role to decide when we shall live and when we shall die, then we `play` God just as much when we cure people as when we kill them. Tris Engelhardt is surely correct when he asserts that "the expansion of human capabilities [entails]…an expansion of human responsibilities."[xx] As the axiom states: "To whom much is given, much is expected." Increasingly we are given much-especially in the area of medical breakthroughs and technology. Increasingly much will be expected of us. We do now assume responsibility for life. Is it less human, less religious, less Christian, to assume, at times, responsibility for death?
Moreover, since dying is an aspect of living, is not this responsibility for death one manifestation of our concern for responsible living? Concern for how we live inevitably involves concern for how we die. Furthermore, if, within reason and when possible, we should assume responsibility for how we live, is it not the case that, within reason and when possible, we should assume responsibility for how we die?
Christianity and most religious traditions emphasize a high level of responsibility for the course of our lives, for how we spend our time, our energy, our money, for how we relate to other individuals, to institutions, to the community-at-large. In deciding how to spend resources and in developing relationships, we are, as it were, creating ourselves, constructing our character, determining who we will be. From another perspective, we are projecting an image of how we want to be perceived and remembered.
Since dying is an aspect of living, should we not feel an obligation, to whatever extent possible, to assume some responsibility for that too? Concern with how we die is a further manifestation of concern with our character, with who we want to be, with how we want to be remembered. It is as if we were painting the picture of, or writing the story of, our lives, and concern with our manner of dying is concern for the final details of the portrait or the final chapter of the book. This matter becomes critical if we are faced with becoming a person incompatible with the values we hold dear and incompatible with how we want those whom we love to remember us. Does not our right as an autonomous agent involve the right to preclude this from happening? Do we not as moral agents have the right to paint the final stroke or to write the last line?
While I am not suggesting that philosopher Alasdair MacIntyre would agree with the position I am developing, he advances a narrative perspective on the moral life which I find helpful in articulating my own position on euthanasia. "In our moral lives," says MacIntyre, " we are engaged in enacting our own narrative."[xxi] Thus, "my life has the unity of a story with a beginning, a middle, and an end."[xxii] Moreover, he argues that "to ask `What is the good for me?` is to ask how best I might live out that unity and bring it to completion."[xxiii] I would add that it is precisely the bringing of one`s life to a unified completion that may under certain circumstances justify euthanasia. MacIntyre also affirms the Aristotelian position that "a completed and fulfilled life is an achievement and death is the point at which someone can be judged happy or unhappy."[xxiv] Again, I would add: since the manner of dying is a fundamental aspect of one`s life, should not control, where possible, of one`s manner of dying be legitimately considered a part of the achievement of a completed and fulfilled life?
Moreover, the Christian tradition strongly suggests that biological idolatry should be avoided, and this certainly has relevance for the Christian view of a successfully completed life. Consider the Apostle Paul`s admonition: "We know that so long as we are at home in the body we are exiles from the Lord…. We…would rather be exiled from the body and make our home with the Lord."[xxv] The religious vision Paul expresses here can certainly affect our attitude toward euthanasia. We must be careful, however, in interpreting Paul`s statement.
To interpret this vision as justification for despising life or belittling death would be contrary to human experience and the spirit of the Christian and other religious perspectives. A common and profound human experience is loving life with others and grieving over their death. The pain is deep because death is separation, and the separation sometimes overwhelms all other realities. No matter what one`s theological views, the loss of a loved one is painful, and the experience of suffering such separations binds together the human community.
Nevertheless, Paul expresses a religious vision that cautions against biological idolatry. To be at home in the body is, in some sense, says Paul, to be exiled from God, and to be exiled from the body is, finally, to make one`s home with God.
Paul`s vision certainly suggests that the body can be too much with us, that the body is not the ultimate value. Life alone, simple biological existence, is not the highest value. Altering slightly the observation of another: if "life is not an absolute good to be preserved" under any circumstances, neither is death "an absolute evil to be avoided at all costs."[xxvi]
In his recent Encyclical Letter, The Gospel of Life, Pope John Paul II accuses contemporary culture of adopting a Promethean attitude "which leads people to think that they can control life and death by taking the decisions about them into their own hands."[xxvii] But clearly God does require of us decisions about the production of life. Moreover, almost everyone approves of using the capacities we have developed to control death by sustaining life in many circumstances. Our desire to control cannot in and of itself count as a moral argument against euthanasia. And just as the human decision to produce life may be morally wise or unwise, so may the decision to cause death be morally wise or unwise. In both cases it depends on the circumstances.
Throughout John Paul`s letter he seems to argue that freedom is normally a value, but not in the case of choosing euthanasia. Eliminating suffering is typically justified, but not if it involves choosing euthanasia. Control is often good, but not in the case of controlling death by choosing euthanasia. The justification of these "exceptions" seems to lie in absolutizing the value of biological existence, but this John Paul cannot consistently do (and certainly would not intentionally do) given his other theological commitments. Indeed, no one has articulated more clearly than John Paul the claim that "the life which the Son of God came to give to human beings cannot be reduced to mere existence in time."[xxviii] Moreover, in some passages he explicitly argues that "the life of the body in its earthly state is not an absolute good."[xxix] This Christian rejection of the absolute value of biological existence, in conjunction with the God-given freedom and responsibility to live productive lives and to provide comfort to the suffering, provides prima facie justification for active voluntary euthanasia in certain cases of intense suffering, in circumstances when conscious life is no longer a possibility, and in other situations of pointless existence.
A confessional note: when I had my fifty-fourth birthday, I remembered that Janet Adkins was fifty-four when she was diagnosed with Alzheimer`s disease. Contemplating the mental deterioration, the physical wasting away, she chose death. It is a superficial judgment, of course, because I did not know Janet Adkins, but I like to think of her choice as a Pauline refusal to permit the body to be too much with her, as a mature and moral assumption of responsibility for the end of her life. When illness, accident, the ravages of time take away irrevocably that which makes one a person, is not the absolute determination to keep the body functioning a form of biological idolatry at odds with the religious spirit? Can the assumption of responsibility for deciding that it is time to die not be considered an appropriate assumption of a role divinely given?
Let me conclude with three caveats. First, by emphasizing autonomy and personal accountability, I am not failing to recognize the communal framework within which individual responsibility arises and must be exercised. We are who we are and we will be who we will be not simply as a result of our choices; to a significant degree, we are children of community. As Annette Baier expresses it: "persons are born to earlier persons, and learn the arts of personhood from other persons."[xxx] Can anyone nurtured within a caring family or within the Christian or some other religious tradition deny that much of who one is has been given as a gift? Moreover, our individual choices often have significant social consequences (indeed, that is what makes them moral choices) and moral reflection must consider these consequences. Further still, our community provides us with our moral language and is often the most significant contributor to our moral discernment. Any decision for euthanasia, then, must be a communal one.
Second, I am not absolutizing or making a fetish of autonomy. That would be a mistake comparable to absolutizing biological existence. Life is complicated and moral choices require wisely negotiating among a plurality of values.
A third caveat: I do appreciate the unavoidability of undergoing suffering in the course of a human life. John Wilcox, in his perceptive book, The Bitterness of Job: A Philosophical Reading, notes that living is more than acting. To live is to act; but it is also to undergo, to experience, to suffer, to be a patient… My life is, in part, a matter of whether I rob my neighbor…[or] help him in time of need…of things I do; but…[life] is also a matter of becoming sick, of growing old, of being injured…of dying-not things I do…but things I undergo….[xxxi While Wilcox is not discussing euthanasia, his observation reminds us that at times being a responsible patient requires that one live with sickness, that one accept the debilitation of old age, that one accept injury, or that one passively undergo death. Nevertheless, I believe that, under certain circumstances, people have the moral right to act, to choose death.
There is, of course, a litany of problems with which I have not dealt: possible abuses, the development of cavalier attitudes toward death, the impact on the medical profession of adopting such a social policy. These issues require serious discussion, and clearly any change in public policy would require the creation of a structure to minimize abuses and unwise decisions. Indeed, I suspect that many individuals might morally support assisted suicide under certain circumstances and might see it as compatible with their religious commitments, but nevertheless have serious reservations about a change in social policy for fear of certain consequences. I repeat, these are matters for serious reflection.
Life is complex, and death makes it more so. Moreover, we fallible creatures see through a glass darkly. But for every thing there is a season, and a time for every purpose under heaven: a time to be born, and a time to die. At times, death is a good. At times, bringing it about may also be a good.
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Endnotes
[i]Friedrich Nietzsche, Thus Spoke Zarathustra from The Portable Nietzsche, edited by Walter Kaufmann (New York: The Viking Press, 1954), pp. 183 and 185.
[ii]Rainer Maria Rilke, "Requiem for a Friend," The Selected Poetry of Rainer Maria Rilke, edited and translated by Stephen Mitchell (New York: Vintage Books, 1984), p. 85.
[iii]Edward Walsh, a Washington Post news release, Waco Tribune Herald, Waco, Texas, May 15, 1996.
[iv]In 1994 , Oregon voters approved Measure 16, The Oregon Death With Dignity Act, that would permit physician-assisted suicide under certain circumstances. A federal judge declared the law to be in violation of the 14th amendment, and an injunction against its implementation has been in force
[v]Annette Baier makes this comment about some of her essays. See Moral Prejudice: Essays on Ethics (Cambridge: Harvard University Press, 1994), p. vii.
[vi]Harry Cole, "Deciding on a Time to Die," Second Opinion: Health, Faith, and Ethics, vol. 7, March 1988, p. 11.
[vii]Daniel Callahan, "When Self-Determination Runs Amok," Hastings Center Report, vol. 22, no. 2, March-April 1992, p. 52.
[viii]"Euthanasia Down Under," Hastings Center Report, vol. 22, no. 6, November-December 1992, p. 3.
[ix]See James Rachels, "Active and Passive Euthanasia", The New England Journal of Medicine, vol. 292, no. 2, January 9, 1975, p. 78.
[x]James F. Bresnahan, "Is Active Euthanasia Justifiable?: A Reflection," Active Euthanasia, Religion, and the Public Debate (Chicago: The Park Ridge Center, 1991), p.84.
[xi]C. Everett Koop, "Euthanasia," The Right to Live; The Right to Die (Wheaton, Ill: Tyndale House Publishers, Inc., 1976), p. 88.
[xii]See Ron Hamel and Edwin DuBose, "Views of the Major Faith Traditions," Active Euthanasia, Religion, and the Public Debate (Chicago: The Park Ridge Center, 1991), pp. 45-77.
[xiii]Ibid., p. 49.
[xiv]Ibid., p. 54.
[xv]Ibid., p. 57.
[xvi]Ibid., p. 62.
[xvii]Pope John Paul II, The Gospel of Life (New York: Random House, 1995), p. 121.
[xviii]Annette Baier, "A Naturalist View of Persons," Moral Prejudice: Essays on Ethics (Cambridge: Harvard University Press, 1994), p. 316.
[xix]Joseph Edelheit, "Is Active Euthanasia Justifiable? A Reflection," Active Euthanasia, Religion, and the Public Debate (Chicago: The Park Ridge Center, 1991), p. 94.
[xx]H. Tristram Engelhardt, Jr. "Ethical Issues in Aiding the Death of Young Children," Baird and Rosenbaum (eds.), Euthanasia: The Moral Issues (Buffalo, New York: Prometheus Books, 1989), p. 148.
[xxi]Alasdair MacIntyre, Three Rival Versions of Moral Enquiry (Notre Dame, Indiana, University of Notre Dame Press, 1990), p.80.
[xxii]Ibid., p. 197.
[xxiii]Alasdair MacIntyre, After Virtue, Second Edition (Notre Dame, Indiana, University of Notre Dame Press, 1984), p.218.
[xxiv]Ibid., p. 34.
[xxv]II Corinthians 5: 6-8. The Revised English Bible.
[xxvi]Margaret Murphy, "Should We Have A Public Policy: Reflection," Active Euthanasia, Religion, and the Public Debate (Chicago: The Park Ridge Center, 1991), p. 94.
[xxvii]Pope John Paul II, The Gospel of Life, p. 27.
[xxviii]Ibid. p. 66.
[xxix]Ibid., p. 83
[xxx]Baier, "A Naturalist View of Persons," p. 313.
[xxxi]John T. Wilcox, The Bitterness of Job: A Philosophical Reading (Ann Arbor: The University of Michigan Press, 1989), p. 50.
