A recent court decision has vindicated the suicide-rights movement and thus put in jeopardy the lives of the sick, the elderly, the disabled, and the poor. On March 6 of this year the Ninth Circuit Court of Appeals struck down the state of Washington's ban on physician-assisted suicide. Judge Stephen Reinhardt, writing for the majority, declared there is a constitutional right for the "competent, terminally ill" to take their lives with a physician's help.
This momentous court decision makes expansive use of the Supreme Court's abortion rulings to establish a constitutional right for some citizens to have themselves killed. It effectively reduced the terminally ill to the same legal status that Roe imposed on the unborn. Thus the poison of legalized abortion continues to seep through the body politic as inexorably as Dr. Jack Kevorkian's carbon monoxide.
The majority opinion for this case abounds with cavalier and arrogant assertions. Notably, it dismisses the importance of the crucial ethical distinction between direct killing and actions that allow people to die, such as withdrawal of treatment. It reversed a previous appeals-court decision that wisely declared that the state has a valid interest "in not having physicians in the role of killers of their patients."
The Ninth Circuit Court of Appeals was not perturbed by the Dutch practice of assisted suicide and euthanasia that has widened to include a large number of nonconsenting clients. This is not really surprising. Though the decision claimed to vindicate the "liberty interest" of "terminally ill, competent adults who wish to hasten their own deaths," it explicitly envisions making "assisted suicide [sic]" available to noncompetent persons.
In his dissenting opinion, Judge Robert Beezer hit the nail on the head: "If physician-assisted suicide for mentally competent, terminally ill adults is made a constitutional right, voluntary euthanasia for weaker patients, unable to self-terminate, will soon follow. After voluntary euthanasia, it is but a short step to a 'substituted judgment' or 'best interests' analysis for terminally ill patients who have not yet expressed their constitutionally sanctioned desire to be dispatched from this world. This is the sure and inevitable path, as the Dutch experience has amply demonstrated. It is not a path I would start down." Tragically, the Reinhardt majority concluded otherwise. And in a similar case a month later, the Second Court of Appeals struck down a New York State law that proscribed physician-assisted suicide.
Two tacit assumptions drive the suicide-rights movement: (1) that the individual's autonomy is paramount, to the exclusion of other important values; and (2) that suffering is a purely negative experience to be avoided by any means.
RIGHT TO CHOOSE, RIGHT TO DIE
The first hidden engine that drives the assisted-suicide cause is embedded in the ambiguous expressions "right to choose" and "right to die." This latter slogan first won currency in the legal debate over the patient's right to refuse unwanted treatment. But now the assisted-suicide movement uses "right to die" language to include active measures to terminate life. Underlying these catch phrases is the assumption that the individual's self-determination is sovereign, severed from the realities of truth and responsibility.
Valuing the worth of the individual is a supreme achievement of Western culture influenced by the Greek philosophical and Judeo-Christian traditions. The human person, created in God's image, has an incomparable dignity that gives rise to rights and responsibilities. Safeguarding these rights and promoting corresponding responsibilities are the hallmarks of a just society.
However, as Mary Ann Glendon, professor of law at Harvard, has pointed out in "Rights Talk," a hyper-rights rhetoric has taken hold in our society, leading to a radical individualism crowding out other fundamental values: that humans are essentially social, and that as individuals we have responsibilities to others. American rights rhetoric renders "extraordinary homage to independence and self-sufficiency, based on an image of the rights-bearer as a self-determining, unencumbered individual, a being connected to others only by choice" (p. 48). Our rights-talk recognizes the immediate and "personal dimensions of a problem, while it regularly neglects the moral, the long-term, and the social implications" (p. 171).
The ideal of total self-sufficiency, a radical version of individual autonomy, has become normative. Dependency is implicitly viewed as something to be avoided in oneself and disdained in others. Professor Glendon remarks: "By exalting autonomy to the degree we do, we systematically slight the very young, the severely ill or disabled, the frail elderly, as well as those who care for them" (p. 74).
The modern tradition of natural rights has repudiated the idea of the human person as "naturally" situated within and constituted through relationships of care and dependency. John Stuart Mill extended the domain of individual sovereignty, and he did so by virtue of a right: "the independence of the individual is, of right, absolute." Mill considered that interference with individual freedom was justified only to prevent harm to others. This principle has had a major impact on American jurisprudence, evolving into the right to privacy that served as the basis for Roe v. Wade. It also powers the suicide-rights movement.
This notion of the isolated, self-sufficient individual endowed with the right to privacy is a fiction. The radical rights rhetoric promotes an ethical relativism that destroys the common bonds necessary for maintaining human dignity and social order. Human beings are not isolated monads. We urgently need to retrieve in our rights discourse a sense of the person situated within, and partially constituted by, relationship with others. The movement to legalize assisted suicide plays on the pernicious separation between private and public morality that corrodes our society. Physician-assisted suicide is presented as a private affair between two consenting adults. Proponents thus artificially isolate assisted suicide from the social context in which physician and patient operate. But the taking of life is never simply a private affair.
Radical autonomy is a deadly deception. Proponents of mercy killing argue for the right of mentally competent, terminally ill adults to receive a physician's assistance to commit suicide. The reality is that such autonomous requests will be subtly or not so subtly influenced by others.
A telling example of how easily the right to die can change into the duty to die appeared in a letter published in the Santa Rosa (Calif.) "Press Democrat" (Sept. 14, 1993) from an 84-year-old woman who had been living with her daughter for 20 years. "Everything went fine for many years," the woman wrote, "but when I started to lose my hearing about three years ago, it irritated my daughter....She began to question me about my financial matters and apparently feels I won't leave much of an estate for her....She became very rude to me....Then suddenly, one evening, my daughter said very cautiously she thought it was o.k. for older people to commit suicide if they cannot take care of themselves." After recounting the ways her daughter reinforced this message, the woman commented: "So here I sit, day after day, knowing what I am expected to do when I need a little help."
IT'S A SIN TO SUFFER
The second hidden engine that drives the suicide-rights movement is embedded in the catch phrase "the right not to have to suffer." Implicit is the unexamined estimation that suffering is an unmitigated evil to be avoided at all costs.
Elizabeth Kubler-Ross drew attention to the denial of death in her book about the stages of death and dying. But there has been at work in our society a more pervasive and portentous avoidance of the distinctly human experience of suffering. Amid cultural uncertainty about good and evil, suffering has come to be viewed as a secular equivalent of sin, from which we need to be saved.
There is an important distinction to be made in the use of the terms suffering and pain. Pain typically refers to a bodily sensation. Pain results from physical symptoms that usually have an objective basis, and it serves as a useful signal system.
The undertreatment of pain is a widespread failure of current medical practice, and there is clearly a need to enhance relief for the chronically and terminally ill. Sheer physical pain, however, seems not to be the primary reason people seek mercy killing. There is a high correlation between depression and the wish to commit suicide. Contrary to what many believe, the vast majority of individuals who are terminally ill or facing severe pain or disability are not suicidal. When the terminally ill receive appropriate treatment for depression, they usually abandon the wish to commit suicide. Perhaps the real issue is not pain, but our attitude toward suffering.
In contrast to pain, suffering refers to a more deeply personal experience that may or may not be concomitant with physical pain. French Catholic philosopher Gabriel Marcel's observation is useful here: suffering is a mystery and not merely a problem. It has physical, psychological, social, and spiritual aspects. Ultimately, the suffering in each of our lives is intensely personal, the depths of which we have trouble articulating or fully understanding. Eric Cassell expresses it succinctly: "Suffering is a consequence of personhood--bodies do not suffer, persons do."
Our society has found any sort of suffering increasingly difficult to bear, since it imperils our ideal of self-mastery and control, our pretense of self-sufficiency. However, the flights from suffering only intensify the private anguish. Suffering individuals feel isolated and stigmatized. The message in our society is that if you aren't "up," if you don't feel good, then you are an embarrassment and should have the decency to remove yourself.
In the last century, utilitarian philosopher and economist Jeremy Bentham formulated what has now become an operational understanding of human beings in consumer society. He held that people are basically motivated to maximize pleasure and minimize pain. Media images of human life that emanate from Hollywood studios and Madison Avenue typically perform a spiritual lobotomy on their human representations. This materialist and hedonist view of life views the experience of suffering in purely negative terms. In this climate, assisted suicide is seen as a quick fix to eliminate suffering.
Christian faith responds to the universal human experience of pain and suffering in a twofold manner. First, there is a humanitarian, and Christian, imperative to relieve pain and console the suffering. Second, there is the conviction that suffering assumes redemptive and intercessory value in the light of the saving mystery of Christ's cross and resurrection. In the Cross Christ has won salvation for sinful humanity through his atoning death. In following Christ's injunction to "take up [your] cross daily and follow me," our own personal and corporate sufferings are transformed.
Christians echo the prayer of Paul: "That I may know him and the power of his resurrection, and may share his sufferings, becoming like him in his death, that if possible I may attain the resurrection from the dead" (Phil. 3:10, RSV). The Letter to the Hebrews teaches us that Christ was made "perfect through sufferings," and that "because [Jesus] himself was tested by what he suffered, he is able to help those who are being tested" (Heb. 2:10, 18, NRSV). Christian faith gives meaning to our sufferings and strength to endure them and turn them into a source of spiritual good. The conviction that suffering can assume redemptive value needs to be preached and taught and, above all, witnessed to.
The suicide-rights movement poses a challenge to Christian faith and witness. Christians are called to practice a renewed art of dying. This art will find a middle way between the extremes of a technologically driven dying process and the preemptory termination of life by assisted suicide. In retrieving a communal, palliative, and spiritual approach, we will humanize death and witness to "the hope that is within us."
Peter J. Bernardi is a doctoral candidate in systematic theology at the Catholic University of America, Washington, D.C. This article was adapted from an earlier version published in "America" (May 6, 1995).
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