Suicide: When a Right Becomes an Obligation

October 17, 2014

[After two days of jury duty, during which I was not selected for a three-week trial, I am finally coming back to the topic of physician-assisted suicide. Thanks for your thoughts and prayers while I was otherwise occupied.]

One of my deepest concerns, from a sociological and ethical point of view, about physician-assisted suicide (PAS) is the “slippery slope” argument. In a BreakPoint broadcast this week, Eric Metaxas addressed the broader issues with historical illustrations. The sociological equivalent of “give them an inch, and they take a mile” is a reality, as evidenced by the gradual acceptance and practice of all sorts of behaviors that in the 19th century would have been deemed unconscionable. These days, when the claim is made that “this [practice] will be regulated and controlled,” as a Calvinist who believes in “total depravity,” I simply cannot buy it. I don’t buy the idea that legalized marijuana (starting out as “medical marijuana”) is harmless, that gambling is a destination recreation rather than an economic cash-cow, or that abortion is rare but necessary. As these doors have opened, so have the floodgates of crime, addiction, and/or exploitation.

But where does the slippery slope take us in the realm of physician-assisted suicide? When a right (promoted for rare, but difficult cases) becomes a social or ethical obligation (i.e. under certain conditions, it becomes mandatory that a person die), a slide downward has begun. Let’s say that the most likely candidate for PAS is terminally ill, undergoing great suffering, and pleads for relief through death. A parishioner once appealed to me, several times, to give her moral permission to end her cancer misery by taking an overdose. We had long talks about it, and she was angry with me for not siding with her wish. She did die a natural death, with her pain and anxiety under control until the end. What if PAS had been a legal option, and her family agreed to let her go that route to end her life on her own terms?

The supposed safeguards to prevent a slippery slope put many conditions on the practice. PAS, where it is legal, requires evidence that the patient is indeed “terminal,” is making a free choice, is not mentally ill, and can in fact administer the means of death without assistance. All control is completely in the hands of the ailing patient.

But wait . . . what if a person has Amyotrophic Lateral Sclerosis (ALS) and loses the ability to pull a lever or take a pill independently? Someone is “needed” to do what the patient cannot. Then the situation slips from physician-assisted suicide to mercy killing (euthanasia). The patient is still in control of the decision whether or not to proceed, but cannot implement the decision because the ailment has gone too far.

But wait . . . what if a person is comatose, unresponsive and unable to render an opinion about his or her care. If wise and forward looking, that person had a Durable Power of Attorney for Health Care to guide decisions about such things and place them in the hands of a trusted ally. But so far, in California at least, the decision in the hands of a loved one does not include proactive measures to end life but only the withholding of artificial support for biological functioning that cannot be sustained without it. [I know I am oversimplifying this a little bit, but hang with me…]

But wait . . . what if our town has a whole lot of elderly, comatose individuals who have no hope of recovery? Their care is exhausting limited supplies and human resources that could be spent on younger patients with whole lives ahead of them? Isn’t it okay to hasten the process of dying for the older ones, in good stewardship of those resources, and for the good of the town’s future? Aha, now all of a sudden we are in morally reprehensible territory, are we not?

P. D. James, known for her splendid Adam Dalgliesh murder mysteries, wrote a novel of a different sort called The Children of Men. The “what if” she explores in chilling detail is the discovery that all men on the planet had become infertile, and no children had been born anywhere in the world for over twenty years. As governments, schools, health care systems, and even businesses realize the reality unfolding, a deep-seated depression sets a fatal logic in motion. The elderly and infirm, the weak of society are deemed an undue burden upon the healthy who want to enjoy what little “life” is left to them. The picture of mass suicides, masked in a shroud of dignified ceremony, is haunting.

The worry is the misplacement of power to the young and healthy and the demands of a society short on resources. If ever we come to the point where it is deemed a shame to care for folks who are “going to die anyway,” we have crashed to the bottom of the slippery slope. This is why, for instance, the ministry of Mother Teresa was so very important. I think many criticized her for not setting up hospitals and actually treating the diseases of the destitute in Calcutta; but her specific calling was to spend time and effort ministering to the basic human needs of individuals who, yes, were “dying anyway,” so that they would know the love of God and the dignity of being cared for as a human being.

I know you are thinking that P. D. James’ dystopian view cannot possibly take hold, and I pray that you are right. But the trend is for a right, such as euthanasia in the Netherlands, to get out of control and reduce human beings to the active culling of the weak from the human herd. And then we all lose, because the goal then is not “life, liberty, and the pursuit of happiness” for all people, but death to the weak so the strong may have power.

 

My next post will process state-sanctioned physician-assisted suicide from a theological/biblical perspective.

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4 Responses to “Suicide: When a Right Becomes an Obligation”

  1. Jodie Says:

    Mary,

    I am confused by your starting point “the gradual acceptance and practice of all sorts of behaviors that in the 19th century would have been deemed unconscionable.”

    Seriously, would you uphold the morality of the 19th Century as a role model? That was the Century of Manifest Destiny! In America it led to the virtual genocide of the Native Americans, and the wholesale land grab of half a continent. America was plagued by rampant alcohol addiction, business practices that caused the birth of Socialism and Labor movements, and government failures that led to the births of both Communism and Fascism. Racism and bigotry and lynch mobs were at an all time high. The morality of the 19th Century put in motion 2 World Wars that devastated the lives of 100s of millions of people. It’s a wonder we are all still here. And the Church was right there in the middle of all of it.

    I think the reality is that the practice of all sorts of behaviors in the 19th Century are today deemed unconscionable. But there are some behaviors that are coming back. PAS, or mercy killing may not be worse of them.

    • emd5542 Says:

      “The B I B L E: That’s the book for me. I stand alone (but with Mary and I pray many silent ones) on the Word of God. The B I B L E.” Amen!! The Bible does not lead us to behave atrociously but rather away from horrendous actions. Amen!

    • revmary Says:

      Jodie, you mistook my comment and its context. I was referencing specific issues that have “evolved” or slid down the slope since then. It was not a claim that the U. S. was morally pure on all fronts in that century.

      • Jodie Says:

        Mary, maybe I did mistake the context of your comment, but I don’t think I did. What I am saying is that in the greater context, I don’t think your claim makes sense.

        While the Church may challenge the morality of medically assisted suicide today, it didn’t much challenge the Genocide of the Native Americans then (for example). And if not, I doubt it could have mounted any meaningful moral argument against PAS either.

        There has to be a global context under which to address specific issues. And I think the global context of the 19th Century was vastly inferior to the one we have today. Yet I do think the global context has been slipping of late. Our sliding standards for “just war” for example indicate an erosion of the wider sense. I am not a social activist by any measure, but I just wonder if it is effective to address ad hoc moral questions without establishing first a global context by which all (or many) moral questions can be consistently addressed. The slippery slope Domino Theory method just plays on people’s wild imagination. It’s effective as a scare tactic, but it doesn’t leave one in a higher moral state than before (often quite the opposite), and it doesn’t help you address the next question that comes down the road either. The global context does.

        I think I would even claim that the slippery slope method itself is immoral, because it is fundamentally manipulative, and as such it corrupts the morality of the conclusion.

        Do I make more sense?

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