Phil-osophically Speaking: June 17, 2011


The Death of ‘Dr. Death’

The old priest was good-hearted but hard of hearing. “So Father,” said the earnest parishioner, “What do you think of euthanasia?” The priest shifted his bulky body in his high-backed chair and said, “Well, my son, I think the youth in Asia are as good as the youth anywhere else.”

I begin with a humorous story as an introduction to a very serious and complex subject. The passing of Dr. Kevorkian, a Minnesota pathologist, who not only advocated but performed many “assisted physician suicides” brought this issue home like a forced march over a bloody battlefield. Dubbed ‘Dr. Death’ by the media, an oxymoronic appellation that underscores the macabre caricature he had become during his ill-conceived career. The death of Dr. Death does not mean, of course, that there will be less death in this vale of tears. But it might compel us to become more sensitized to these “end of life issues” without the irresponsible grandstanding of a libertarian run amuck. Kevorkian’s contemptuous flouting of existing laws prohibiting euthanasia, his intemperate language and his positively euphoric zest for his work made him the poster child for a culture of death. He was a willing accomplice in the demise of at least 140 people; Kevorkian was happy to oblige even those who were just depressed and didn’t want to live anymore.

As modern medicine’s capacity to keep patients alive through extraordinary means grows ever greater, euthanasia becomes ever more relevant. The word comes from the Greek “eu thantos” meaning “good death.” Dying with dignity is life’s final blessing, a fate that most of us would choose if the choice were ours. But frequently it is not. The issue first made national headlines in 1975 when young Karen Ann Quinlan, after allegedly mixing tranquilizers with alcohol, descended into a persistent vegetative state. Debates raged on how far one should go in sustaining a life whose prospect of recovery was virtually hopeless. In such cases, ethicists were at pains to make important and discriminating distinctions between active and passive euthanasia. The Hippocratic School of Medicine centered its entire creed on unwarranted intervention by having its communicants swear an oath that, I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. It was a pledge consonant with the scruples of the great world religions that hold life to be a unique gift that was vouchsafed to the recipient and which cannot be arbitrarily and capriciously dispensed by someone else or the person themselves. Since the expositors of this ethical system were initially pagans, it is reasonable to conclude that in Western societies the sacredness of life was universally held.  

Within the strict parameters of the Hippocratic Oath, the idea of passive euthanasia was countenanced as a viable option in that allowing a patient so ill and disabled to die by non-intervention is morally different than administering a lethal injection. To put it simply: If a doctor gives an injection hastening the demise of a patient with terminal cancer then he is the proximate cause of their death, if he doesn’t, the cancer is. Active euthanasia, the lethal injection scenario, cannot be justified on any philosophical and moral grounds no matter how unsettling and disturbing the suffering of a patient might be. If you don’t feel queasy about “physician assisted suicide” it is because talking about things in the abstract is much easier than being the prime protagonist in a life and death drama. If you were the one administering the deadly injection instead of some nameless executioner, whatever the condition of the patient, it is likely you will be deeply disturbed about stopping the beating heart of a fellow human being.

 Having eliminated active euthanasia as a viable moral option, this still leaves us with the vexing problem of its more passive cousin. Since this subject and its multifarious nuances is too vast a subject to explore in a newspaper column, let us introduce once again the hypothetical patient terminally ill with cancer. Moreover, let’s further muddy the waters by making this patient incognizant with no living will stating their wishes on medical or palliative intervention. Pursuant to a consultation with the family, it is decided to simply let the patient die.  

Initially, this might appear to be a morally permissible distinction from the lethal injection scenario and yet, a rigorous analysis of the circumstances ineluctably leads to the opposite conclusion, since both result in the intentional termination of life. If one argues that the cessation of treatment is not the intentional termination of a life, then exactly what is it? Under the American Constitution all who belong to the human species, whether in its earliest or most advanced stages of life, are persons by virtue of their very nature, endowed with inalienable rights, and neither the individual, nor even the State can take away or diminish these rights without due process of law. I would argue that the 14th Amendment made what was already implicit in the Constitution, explicit: No State shall make or enforce any law which shall abridge the privileges or immunities of the citizens of the United States, nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. This remained the case up to the legalization of abortion when personhood of the fetus was adjudicated, for the most part, to be privately determined without the interference of government and its laws. Regardless of the controversy surrounding the equal value of nascent life, the 14th Amendment still clearly applies to the aged, the infirm and the insensate. We must be scrupulously conscious about restricting these broad rights by conveniently adopting shades and degrees of truth because it’s in society’s interest, as history abundantly attests, not to subscribe to anything that will weaken the reverence human beings have for life.

How we make distinctions in the midst of complexities that go right to the very core of civil society, defines us as a people. They must be made reasonably but humanely, never losing sight that some things are beyond rational analysis and can only in light of tradition and revelation be intuitively grasped. Whatever the prevailing circumstances of the moment, there must always be a powerful presumption in favor of life but one must, albeit grudgingly, acquiesce to the biological imperative when that life’s denouement appears unalterable or irreversible. To sustain life then, beyond all proportionate means, is not an affirmation of life but a cruel and distorted parody of it. Championing even the dullest spark of vitality at the expense of every other human consideration is to prolong dying not living. We cannot, after all, avoid death, only postpone it. To technologize life for no other reason but to perpetuate biological existence blasphemes it by denying that death is as natural an occurrence as birth. The Roman statesman Seneca once said that, the wise man will live as long as he ought, not as long as he can. It seems to me the only sensible way to live and to die.

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