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Life's
Worth:
The
Case Against Assisted Suicide
by
Arthur J. Dyke
Eerdmans
Publishing Commpany, 2002. x + 110 pages.
Reviewed
by David R. Larson
Comments by James W.
Walters and John B. Wong
Are
there any important ethical differences between allowing a terminally ill
patient comfortably to die, on the one hand, and either killing him or
her, or enabling him or her to commit suicide, on the other? Written
by a specialist in ethics who teaches in the School of Public Health and
in the Divinity School at Harvard University, this book argues that there
are and that the second and third alternatives should remain illegal.
In harmony with customary usage, Arthur Dyck defines "passive
euthanasia" as allowing a terminally ill patient comfortably to die.
By "active euthanasia," or often simply "euthanasia,"
he means intentionally killing him or her, and by "assisted
suicide" he means enabling such patients to end their own lives.
He prefers the expression "comfort-only care" to "passive
euthanasia," however.
Dyck challenges three frequent claims on behalf of assisted suicide.
Against the assertion that it honors the wishes of patients, he argues
that such desires usually vanish once patients receive adequate comfort
care and that the attitudes of those who favor assisted suicide often
shape these wishes unduly. Against the idea that suicide can be
rational, he contends that this is so only if one accepts a doubtful view
of human nature, one that overlooks the degree to which we are social
beings who cannot make this choice without adversely affecting others.
Against the notion that in some cases the goal should be not merely to
alleviate discomfort, but wholly to preempt its possibility by ending the
patient's life, or by enabling him or her to do so, he asserts that the
intention should be to relieve actual pain and suffering. In harmony
with the so-called "rule of double effect," he argues that
relieving the discomfort of terminally patients is ethically imperative
even if doing so unintentionally and unavoidably shortens their lives
somewhat.
If this is so, how can active euthanasia and physician assisted suicide be
ethically wrong? Dyck's answer is that they are unacceptable because
in them the patient does not die from his or her disease, trauma or old
age but from some lethal agent others introduce. Furthermore,
"comfort-only care allows one to sustain the quest to live a virtuous
life and even to gain in virtue in one's very last days." [42].
The most important consideration, however, is that active euthanasia and
assisted suicide intend the patient's death as such and not merely the
relief of pain and suffering.
Isn't this morally acceptable if this is what the terminally ill patient
truly prefers? Dyck claims that if we base our moral approval of
active euthanasia and assisted suicide upon an individual's preferences,
there is no logically necessary reason why he or she must be terminally
ill. Appealing to preferences therefore proves too much.
Dyck's exposition of what he calls "the moral structure of life's
worth" rests upon three considerations. The first of these is
that killing innocent humans, or helping them to commit suicide, violates
both their right and their responsibility to live, both of
which are natural and inalienable. The second is that the love of
life is so much a part of normal human functioning that when people lose
it the proper response is not to honor their desires to be killed or to
kill themselves but to correct the problem. Once this is done, their
preferences almost always change, even if they are terminally ill.
The third is that human life is of incalculable worth and that this
conviction rightly has been embedded in the Anglo-American legal tradition
for more than seven centuries.
That one's own life is so valuable that no one else possesses a moral
right intentionally to end it unless one has committed a capital offense
is generally acknowledged and Dyck agrees. He also contends that one
does not have a moral right to end one's own life, or to request someone
else to help one do so, however. Because human lives are neither
solitary nor isolated but interwoven, each time someone's life ends by way
of active euthanasia or physician assisted suicide, the value of every
other human life is lessened and the necessary societal protections for
human existence are weakened, he argues. "People ought
to be grateful for life," he writes, "and ought to act in
ways that help support the proclivities and inhibitions that sustain
individual and communal life." [67. Emphasis supplied.]
Dyck holds that this conclusion represents a "Natural Rights
Synthesis" that is compatible with Christianity but only partly
derived from it. He holds that it also flows from the more secular
philosophical points of view of people like Thomas Hobbes and John Locke
who held that human beings naturally regard their lives as having great
worth. It therefore applies to all citizens, not only Christians.
I began this book agreeing that from a Christian point of view it is
morally wrong to intend the death of an innocent human person but that it
is morally right to accept this as an unintended and unavoidable side
effect of relieving intense pain and suffering. Dyck's case pushes
me to pay more attention to the possibility that this may be morally wrong
for all people and that therefore our laws should continue to prohibit
both active euthanasia and physician assisted suicide.
Much depends upon the nature of Dyck's case about what our laws should
allow, however. If his point is that in fact active
euthanasia and physician assisted suicide harm the "natural
proclivities and inhibitions" that make human life possible, his case
could be falsified by contrary empirical evidence that is available to
all. But if his point is that in principle this is so because
we are social animals, as both Scripture and the secular sources I regard
most highly claim, then has case cannot be falsified by empirical evidence
as easily, but neither can it claim to be religiously and philosophically
neutral. Because he apparently believes that both considerations support
his case, Dyck probably does not worry about this dilemma. This
gives us a chance to do so!
James W. Walters
First, I suggest that Dyck, like most of us, probably had a visceral sense
of the answer to the social dilemma that PAS poses, and then he used his
considerable skills to marshal arguments to support that view. Fine,
we all do this; let's just not fool ourselves into thinking that neutral
principles and empirical evidence bolster only our favored position.
Second, I question the implicit sanctity he ascribes to human life.
That human life is sacred I have no doubt, but that biological--as opposed
to spiritual--human life possesses such sanctity I dispute. From the
review, I don't see that Dyck recognizes or at least accepts this
distinction. From what I read of Dyck's position, it would seem a
logical conclusion of his argument for him to contend for reinstatement of
the laws of yore that made attempted suicide illegal, and of regulations
in the Roman Catholic communion that determined all suicide as
unpardonably sinful. If, however, one sees spiritual life (including
intellectual, aesthetic and moral dimensions) as distinguishable from
biological existence, this understanding is a possible foundation upon
which one can make a case for there being circumstances in which the
spiritual trumps the biological.
Third, for
Dyck to accept the morality of passive euthanasia and reject all cases of
active euthanasia has tradition going for it, but not logic--at least not
the logic of the jurists of the 2nd and 9th circuits of our US appellate
courts. If the intention is that the patient not live, whether the
patient dies from withholding of life support or from administering of a
life-taking agent is not of legal importance. And I, for one, think
that the justices are more clear-headed on this one than are we ethicists.
However, regardless of this particular issue, the larger point is that
passive euthanasia does allow precious life to be lost before its
inevitable end, and so if vitalism holds, as it seems to with Dyck, why
doesn't he also oppose passive euthanasia in the name of life's sanctity? John B. Wong: Regarding
physician assisted suicide: after reading and reflection, I as a physician
have come down to the bottom line toward which, I suppose, all personal
ethics often gravitate, Would I do this to my mother, my wife, my brother?
No! Then neither would I do that to or for my patient. However, neither
would I condemn another physician who, after the most thoughtful
deliberation, sincerely believes that the assistance constitutes the most
humane and kind act to relieve the suffering of another person. Only God
in His wisdom, love, and justice can know and weigh the motives behind
both the patient's request and the physician's acquiescence. Despite the
advanced pain control available in a doctor's armamentarium, there must
be, in my view, some exceptional cases where humanly speaking, the pain
and agony have reached the threshold beyond human endurance. |