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Can a Person Choose “Death with Dignity?”

State legislatures across the United States are considering “Death with Dignity” laws allowing “Physician-Assisted Suicide” (PAS) or “Physician-Aid in Dying” (PAD) for patients with terminal illness and a life expectancy of six months or less. Oregon, Washington, and Vermont have already legalized such procedures, and in California a similar “End of Life Option Act” has been proposed. Similar laws are already operational in countries like Belgium and the Netherlands, and have been proposed for deliberation across the Western world in places like Germany and the United Kingdom.

The argument for PAD is it allows people suffering through debilitating terminal illnesses to control how they die, offering relief from suffering and letting them maintain their dignity.

Supporters of PAD think dignity requires personal choice. Rational choice is a distinguishing element of human life; unlike other animals that act purely on instinct, humans exercise free will. Is not autonomy part of human dignity?

In the words of Jena Johnson, an “end-of-life counselor” for Compassion and Choices in Portland, a “good death” is “a death in which a person’s wishes for the end of his or her life are respected and carried out. No matter what those wishes are.” The editors of The Economist argue in the lead editorial (June 27 edition) for the “right to die with a doctor’s help at the time and in the manner of your own choosing.” They argue against “moral absolutists” who say, “deliberately ending a human life is wrong, because life is sacred and the endurance of suffering confers its own dignity.” The magazine counters: “Liberty and autonomy are sources of human dignity, too. Both add to the value of a life.”

In contrast, the Judeo-Christian view grounds human dignity in the teaching that humans are created in the image of God and therefore intrinsically valuable. This is a more inclusive, arguably firmer foundation, but let us accept humans’ intelligence or “autonomy” as our distinctive feature and source of dignity, since “Death with Dignity” defenders prefer this formulation. As the Enlightenment philosopher Immanuel Kant helps us understand, PAD is inconsistent even with this conception of human dignity.

In The Metaphysics of Ethics, Kant grounds human dignity in autonomy, as do the editors of The Economist. The human person is worthy of treatment as an end or good, not merely a means to another end, by virtue of possessing a rational will:

Now I say that man and every reasonable agent exists as an end in himself, and not as a mere mean or instrumental to be employed by any will whatsoever, not even by his own, but must in every action regard his existence, and that of every other Intelligent, as an end in itself.

On this basis, Kant concludes that human dignity rules out behaviors that demean or fail to respect human persons, and imparts a “duty owed” to self and others. Ethical and legal provisions against murder and theft are obvious examples of justified restrictions on behavior toward persons.

The principle of human dignity rules out suicide, as Kant explains: “He who proposes to commit suicide, has to ask himself if his action be consistent with the idea of humanity as an end in itself.” He writes:

The man who destroys his organic system to escape from sorrow and distress, makes use of his person as a mean toward the supporting himself in a state of comfort and ease until the end of life. But humanity is not a thing, i.e., is not that which can be dealt with as a mean singly, but is that which must at all times be regarded as an end in itself. I am therefore not at liberty to dispose of that humanity which constitutes my person, either by killing, maiming, or mutilating it.

To purposefully end one’s life is a failure to render a duty owed to a human person, even when natural death is imminent. Even if personal choice is central to human dignity, as “right to die” defenders argue, choosing death violates that dignity.

Ripple Effects

PAD will set a dangerous precedent, eroding the acceptance of duties owed that the principle of human dignity demands. Indeed, while The Economist scoffs at the “slippery slope” arguments of PAD’s opponents, James Mumford notes that the magazine “manages to slide down that slope in the course of its own 1,200 word leader.” The editors argue that PAD should also apply to patients suffering from chronic disabling conditions, or “mental pain”:

The hardest question is whether doctor-assisted dying should be available for those in mental anguish. No one wants to make suicide easier for the depressed: many will recover and enjoy life again. But mental pain is as real as physical pain, even though it is harder for onlookers to gauge. And even among the terminally ill, the suffering that causes some to seek a quicker death may not be physical. Doctor-assisted death on grounds of mental suffering should therefore be allowed.

The inexorable moral logic of choice threatens to expand its domain. It is a seductive logic, especially combined with “compassion.” Without the corollaries of duties owed and curtailment of behaviors that fail to respect human dignity, the logic of choice leads almost inevitably to acceptance of any choice – including suicide or murder.

This is a difficult and sensitive issue, and the intense suffering of patients with terminal illnesses and their families is devastating. Palliative care should be applied, and there is a clear distinction between declining treatment or life-support and PAD. But equating human dignity with unfettered choice, justifying doctor-administered death, is contrary to the principle of human dignity, even in the limited Kantian sense that underlies the “Death with Dignity” movement.

Though well intentioned, “Physician-Aid in Dying” is inconsistent with the very appeal to human dignity its supporters make. There may be a case for PAD, but it is not grounded in respect for human dignity. “Death with Dignity” laws in fact deny human dignity properly understood: regard for human life as intrinsically worthy of respect. Those who wish to preserve human dignity must oppose the trend toward acceptance of so-called “Death with Dignity.”

 

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  • Neal

    Dignity is something intrinsic to being human. To say that when we die while suffering is undignified is to misunderstand what it means to be human.

  • adams12

    No, just no, there is no dignity in screaming out in agony to your loved ones to “please let me die!” There is no dignity in letting a terminal disease progress to the point that you are left unable to control your bodily functions and must suffer the humiliation every hour of someone having to invade your personal privacy to keep you clean. Dignity comes when you are allowed to make your own decisions as to your life and end of life decisions not from a pat on the head from a theologian insisting that he knows God’s mind and path for you.

    • slainte

      Human dignity flows from being created in the image and likeness of God.

      • adams12

        Please explain that to someone who is terminally ill, while patting them on the head, I’m sure it will be of great comfort to them.

        • slainte

          I was the primary caregiver for my mother in the last year of her life during the terminal phase of an illness. I was privileged to care for her and attend to the full range of her physical needs.

          She never once lost her dignity, and together with my family, we made sure that her pain was alleviated with palliative care. She knew that she was profoundly loved and wanted.

          When the Lord called her, she went to her eternal rest gently having spent the evening with her family.

          Your responses are flippant and profoundly self centered.

          • adams12

            You and your mother made the choices that were best for her, what is flippant and self centered is your belief that you can make those for other families and that your belief system trumps theirs.

          • slainte

            We did not make a “choice”….we merely did what families have done for thousands of years by helping a beloved family member navigate the last stages of her natural life and we brought to bear the best that medicine offered in term of palliative care to ensure her comfort.

            Dying is a natural stage of life.

            The alleviation of pain in connection with a terminal illness is a reasonable and proportionate response to illness.

            Intentionally killing a person is neither reasonable or proportionate. How many people have lived years after receiving a fatal diagnoses? Killing a person extinguishes the fullness and accomplishments those years may have provided.

            Neither is it a reasonable or proportionate response to engage, or seek to compel a physician, who is a member of a healing profession, and has sworn an oath to Do No Harm, to intentionally kill his/her patient.

            Should physicians become executioners, patients should rightly question whether they should place their trust in those who would so willingly violate their hypocratic oath.

            People in pain do desperate things; thus alleviate the pain using the full range of medical alternatives and allow that person to live comfortably.

            Relatives and others who want inheritances sooner rather than later have been known to exercise duress over the ill and dying to ensure that bequests aren’t dissipated by the costs of end of life medical care.

            Perhaps the ill and dying need protection from relatives and others who, in the name of compassion, would prey upon and kill sick people to enhance personal benefit.

            I am grateful that I do not live in a state that allows for the intentional killing of the sick, the elderly, or the disabled. I am also grateful that I can trust my physician who honors her oath to heal and declines to be an executioner.

            But most of all I am grateful that I was privileged to be with my mom through the last stages of her life….I and my family have no regrets.

          • adams12

            Again you only see this issue through the lens of your life experience, giving no credence at all to someone else’s. You are not the only one who has seen a loved one through end of life care. Neither you, or a church or anyone else should be able to force someone to extend their life when ‘palliative’ care no longer works. Drugs can not always alleviate the pain, leaving a person writhing constantly in pain, if this was not your experience you do not get to judge. I am not advocating for anyone to act as an executioner, only to allow competent adults the choice to end their lives on their terms, not yours and not your churches.

          • slainte

            You are mistaken, I don’t advocate using extraordinary means to perpetuate life beyond its normal course. When healing is no longer possible, then, at the sole election of the patient, nature may take its course.

            Palliative Care doesn’t extend life; it alleviates the discomfort which may accompany the progression of terminal illness. I include within the definition of Palliative Care administering food (if tolerable) and water as a matter of justice and humane treatment for the dying person.

            Mahatma Gandhi said, “The measure of a civilization is how it treats its weakest members.”
            I submit to you that among the weakest of society’s members are the dying, the unborn, the disabled, and the elderly. All deserve respect; all deserve a just response to their fundamental needs. None deserve to be murdered at their own hand or that of a facilitator.

            Life is valuable from the moment of conception to natural death; a very rational proposition.

            Seeking to expedite death is irrational. So too is requiring a medical profession to transform its traditional mission of healing patients to killing them.

            No physician who has sworn an oath to protect life should be required to expunge a life; such an act betrays a duty of care to that patient and is fundamentally unjust, inhumane, and irrational.

            We are better, smarter, and more compassionate than to engage a myopic and destructive course of conduct that is defined solely by its permanence. Suicide is never a rational response to an illness.