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A Time to Live, A Time To Die: But is it or us to decide which is which?

Sidney Callahan

Since the demise of slavery, society has agreed that no body can be treated as disposable private property. To treat a body, even one's own, as an object that can be destroyed at will violates the intrinsic value and dignity of each member of the human family. We don't own ourselves but receive our individual lives in trust as a gift from our parents, our forebears, our sociocultural communities, and eons of natural evolutionary processes.

So why do certain persons assume that they have a right to suicide, much less the further right to a physician’s help in killing themselves? Accepting physician-assisted suicide as a liberty right for individuals is morally unacceptable.

An autonomous act of will that kills the self or another plays out the "logic of domination" or abuse of power from which humankind suffers. Granted, acts of destruction can be causally effective, but at what price? Joseph Stalin once stated, "Death solves all man, no problem." True enough, but those who are dedicated to "nurturing," "enabling," or "actualizing" forms of power must insist on a different way to meet the challenges of the process of dying.

When persons are ill and most vulnerable at the end of life, they need sustained personal attention, support, and complex kinds of care. Those exercising responsible nurturing power, for instance, will insist that the dying receive pain relief and all the blessed medical techniques developed in the new specialty of palliative medicine. Persons need never die in extreme physical agony.

Nor should dying persons fear that they will be subjected to futile medical interventions that can only prolong their dying. Patients have a long-recognized right to refuse burdensome treatments. Withdrawing futile treatments at the end of life is very different from acts that are intended to kill a person. As a disease takes its course, the disease is the cause of death, not the giving up of fruitless efforts to keep a body breathing.

We all have to accept that we will die, but we do not have to accept conditions where human beings die without supportive care and comfort. Hospice care, for instance, concentrates upon pain relief and efforts to encourage the whole person’s well being. The dying, too, wish to live as fully as they can.

True human dignity in dying demands an assured trust that one has an inviolable right to life and a right to expect care from others until the end. Those who claim an individualistic right to suicide along with a physician’s assistance have it all wrong; they hold a dangerously mistaken view of mercy. By insisting on a self-determined death, one unilaterally cuts off further human bonding and possible relationships with others—ending all giving and receiving.

ALL INDIVIDUALS WILL suffer if the law approves physician-assisted suicide as an acceptable option. Inevitably the bonds between persons at the end of life will change for the worse. If suicide were culturally validated, an ill person would have to justify his or her decision to keep on living, rather than assume that the family and the community have an absolute duty to sustain his or her right to life and care, no matter how burdensome. Others around a dying and ill person would also have to contemplate the option of hastening death. Once the taboo against taking life is breached, individuals and their families would be subject to disturbing pressures and wrenching negotiations.

Physicians given permission to assist in suicides would also find their role as healers changed in negative ways. They would face the danger of becoming inured and habituated to abuses of their new powers. And why should we trust that physicians will know whether requests for suicide are not the result of depression or of subtle pressures from family members? Already in the Netherlands, requests for suicide need no longer come from terminally ill cases—if there is a right to suicide, how could you limit it to the terminally ill?

In Holland also, more and more persons now suffer involuntary euthanasia at the request of families or on the judgment of the physician alone. Those who worry about the growth of these abuses rightly point out that, unlike the case in Holland, health care expenses would be a factor in the United States. We have a large population of uninsured and marginalized poor people who possess few economic and social resources. Would they not be persuaded that they have a duty to die?

The fight against physician-assisted suicide is a struggle for foundational principles that enable human beings to flourish. No, we do not have the liberty to kill ourselves or others at will. No, we cannot be allowed to treat ourselves or others as disposable private property. As human beings who are members of the human family, we have certain moral obligations and duties toward our lives that we do not contract for or consent to—and these obligations cannot be revoked by autonomous decisions. We live with inherent responsibilities that forbid killing. We owe ourselves and other members of our human community an inalienable duty to care for one another until the end of our natural lives.

SIDNEY CALLAHAN, the author of In Good Conscience: Reason and Emotion in Moral Decision Making and several other books, is a psychologist and Catholic ethicist living in Ardsley-on-Hudson, New York.



Copyright 2004 Victor Claveau. All Rights Reserved