We should not be surprised that the current controversy
over euthanasia and physician-assisted
suicide is being waged in a culture of abortion.

Matters of life and death

By Eduardo J. Echeverria

    What is euthanasia? “By euthanasia is understood an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated” (Declaration on Euthanasia, Vatican Congregation for the Doctrine of the Faith, June 26, 1980). This statement rightly considers euthanasia, whether active or passive, as intending or aiming at the death of the person. It may also be voluntary or involuntary: the former when a competent person explicitly consents to die by another’s action, and the latter when no such consent is given.

    We should not be surprised that the current controversy over euthanasia and physician-assisted suicide is being waged in a culture of abortion. If we are, then we have failed to grasp that the basic rationale behind these practices is similar—the noxious offshoots of absolutizing an already prodigious freedom allegedly possessed by us to define “one’s own concept of existence, of meaning, of the universe, and of the mystery of human life” (Planned Parenthood v. Casey, 1992). Absolutizing this freedom, making it the primary value, means that its intrinsic value is the power of freedom itself to make choices, regardless of what is chosen. This leads to the disastrous and mistaken idea that we are free to make whatever we choose right—even the choice to kill oneself, whether this is done by a patient himself with a doctor’s aid or by a doctor at a patient’s request.

    The May 1994 ruling in Seattle by U.S. District Court Judge Barbara Rothstein did not fail to recognize the common root of these practices. Says Rothstein, “Like the abortion decision, the decision of a terminally ill person to end his or her life ‘involves the most intimate and personal choices a person can make in a lifetime’, and constitutes a ‘choice central to personal dignity and autonomy’.” The appeal to autonomy, freedom, self-determination, and the right to control one’s living and dying is trumps, as it were, in decisions about matters of life and death. Indeed, at issue here (so it is said) is the “right to choose” to die.

    Of course, defenders of euthanasia and assisted suicide will insist that at stake here is the desire to relieve the suffering of persons who are terminally ill, and if only killing the patient will accomplish this, then killing is justified. But the standard arguments for these practices offer no principled reasons why the class of candidates should be limited to this category—it is inherently unstable, as Judge John Noonan rightly said. We can argue this point by showing that the proponents of these arguments have no answer to the following question. Why should the autonomous freedom to determine when, in what way, and by whose hand we will die be limited in principle to the competent adult person who is suffering greatly and is terminally ill?

    Expanding the logic of this position, Gilbert Meilaender critically asks, “If self-determination is truly so significant that we have a right to help in ending our life, then how can we insist that such help can rightly be offered only to those who are suffering greatly? Others who are not suffering may still find life meaningless, the game not worth the candle. They, too, are autonomous, and, if autonomy is as important as the argument claims it is, then their autonomous requests for euthanasia should also be honored, even if they are not suffering greatly.”

    By the same token, on what grounds should we restrict relieving the suffering of others only to those who are self-determining and autonomous, who are competent (not demented or mentally retarded) to request it? If relieving the suffering of others is an obligation we owe to one another, as proponents of euthanasia and assisted suicide urge, then surely we have a responsibility to kill them to bring their suffering to an end whether or not they are competent—which would include infants, the retarded and mentally ill, people with Alzheimer’s. In Daniel Callahan’s own words, “The standard argument would deny euthanasia to that person. But why? It would seem grossly unfair to deny such a person relief simply because he lacked competence. Are the incompetent less entitled to relief from suffering than the competent? Do they suffer less for being incompetent?”

    This position self-destructs because the supposed “right to die” cannot stop with the class of candidates for euthanasia described above. We are not dealing here with a fictional slippery slope. In fact, this has already happened with Jack Kevorkian, the crusading Michigan suicide doctor, and in the Netherlands (cf. R. Fenigsen, “The Report of the Dutch Governmental Committee on Euthanasia,” Issues in Law & Medicine, Vol. 7; “Euthanasia’s Home,” in US News & World Report, January 13, 1997). There is no principled reason offerable by euthanasia proponents to reject the logical outgrowth of this class, and this conclusion is, as Noonan puts it, a reductio ad absurdum.

    This does not exhaust the problems with the standard arguments for euthanasia and assisted suicide. These practices are not an expression of compassion but in truth acts of isolation and abandonment; they are signs of failure of moral community and contribute to its further erosion. At the root of exalting autonomy and self-determination in the practices of euthanasia and assisted suicide is the individualistic goal of self-sufficiency or independence. Proponents of these practices imply that there is a real loss of self and hence human dignity in recognizing ones dependency on others. Daniel Callahan exposes the error behind this idea remarkably well. “It is a profound error to think we are somehow lessened as persons because dependency will happen to us, as if that condition itself necessarily robbed us of some crucial part of the self. It does not. There is a valuable and necessary grace in the capacity to be dependent upon others, to be open to their solicitude, to be willing to lean upon their strength and compassion.”

    But recognizing our dependency on others as death nears requires trusting them fully precisely because they are unconditionally caring persons. In short, it requires moral solidarity with others. The point I now want to make is that the practices of euthanasia and assisted suicide are not consistent with the fostering of such care and trust, indeed, they encourage us to be moral strangers to each other. These practices actually reflect our society’s approval of abandoning the individual who chooses to kill himself to his own isolation and mentality of desperation all in the name of personal autonomy and dignity.

    This is particularly clear in the “epidemic of premature death,” as Paul R. McHugh has recently called “The Kevorkian Epidemic” (American Scholar, Fall 1996). In this epidemic, both suicidal depression and demoralization, which involves a sense of hopelessness and despair, are overlooked as acts expressive of mental disorders which are “eminently treatable mental conditions.” McHugh persuasively argues that “actions to hasten death are the ultimate neglect of patients with symptomatic depression [and demoralization]; they are, really, a form of collusion with insanity [and despair].” He says, “What had begun as an effort [by psychiatry] at explanation and understanding of the tragic act of suicide has developed into complicity in the seduction of vulnerable people into that very behavior—by isolating them, sustaining their despair, revoking alternatives, stressing examples of others choosing to die, and sweetening the deadly poison by speaking of death with dignity.”

    It is puzzling to me why no one has been able to stop Dr. Jack Kevorkian, the crusading Michigan doctor who is helping sick people kill themselves. Is a deliberately sought and caused death, whether this is done by a patient himself with a doctor’s aid or by a doctor at a patient’s request, no longer morally and legally wrong? Perhaps no one stops him because the debate about euthanasia and physician-assisted suicide has been distorted into being seen as a “pulling-the-plug” issue.

    In this context, many people have confused the acceptable practice of refusing useless or disproportionately and excessively burdensome treatment with the unacceptable practices of euthanasia or assisted suicide. But the debate is not about foregoing such treatment. It is really about the morality (and legality) of choosing to kill oneself by any action or omission intended to cause death when the motive for doing so is to eliminate suffering. I fear that this is a point lost on many people for several reasons.

    First, many people have come to judge the morality of an act in terms of its so-called motive, which is simply the reason why I do this or that act. This is a mistaken move to make, but I suspect that this is partly to blame for the unstoppable Dr. Kevorkian. For example, the British Medical Journal thought it fitting to describe him as a “hero,” echoing his own milder self-description as “humanitarian.” As one of Dr. Kevorkian’s fiercest critics puts it, “His champions see no discernible motive for Dr. Kevorkian other than that he believes his work is fitting. The BMJ notes that greed for money or fame or some sadistic urge does not motivate Dr. Kevorkian” (Paul R. McHugh, “The Kevorkian Epidemic,” American Scholar, Fall 1996).

    Let’s grant for the sake of argument that Dr. Kevorkian is a well-motivated person. It is nevertheless possible that well-motivated people do something morally wrong, just as it is possible for someone to do something right for the wrong reason. This point is quite clear when we recognize that the term “intention” has a two-fold meaning. It can mean, firstly, what one is doing here and now when one is doing this act on purpose. But it can also mean, secondly, the further intention, or ulterior intention as it were, with which one does this intentional deed. This second sense is usually called our motives for acting. Both intentions—what one is doing, whatever ones ulterior motives—can be either good or bad.

    Let me illustrate this point with Dr. Kevorkian’s claim that he is simply expressing his well-motivated compassion for a dying person who is suffering when he assists him in killing himself. If this is so, then Dr. Kevorkian’s act is well motivated (that is, his further or ulterior intention is good). But what he has chosen to do is undeniably an act of killing, regardless of his laudable motive. It is this act that he here and now intends on purpose, given that he has chosen to kill you, and in choosing to do this specific act he is choosing to make himself a killer. This action is what it is: the deliberate killing of an innocent person. It is not possible for any good ulterior intention to change this, and hence this action is morally wrong. As St. Paul says in Romans 3:8, “Evil may not be done for the sake of good.”     

    Of course there is a morally different way to express our compassion for this dying person. As William E. May puts it, “we may choose to accompany him in dying, to care for him in his dying. We may even choose to stop using procedures that are no longer obligatory and in this way ‘permit’ or ‘allow’ our friend to die his own death, but we do not choose to kill him or to make ourselves to be killers.” The significant difference here is between what one does to this dying person and what merely happens to him as a result, as a side-effect, accepted but not directly willed, of what one does. The upshot of this analysis is that “in both instances our motives may be the same, but the acts we freely choose to do are quite different sorts of acts.”

    There is a second reason why our view of the debate about euthanasia and assisted suicide has been skewed: the moral difference between directly intended killing and allowing to die, between inflicting death on purpose and letting die, has been explicitly rejected by some, most recently by the second and ninth circuits of the U.S. Court of Appeals. Both these courts see no moral difference between physician-assisted suicide and foregoing extraordinary treatment, because death results in both cases.

    Medical ethics professor James F. Bresnahan, S.J., describes the courts’ reasoning as follows, “These courts are asserting that whatever differences one may notice in the causal relationship of the act to the death, as long as doctors act ‘medically’ no moral stigma and no legal penalty should attach. For them, a physician’s aid in self-inflicted death is merely an ‘emerging’ development of an already socially and legally accepted treatment of the dying by hastening death” (“Killing vs. Letting Die: A Moral Distinction Before the Courts,” America, February 1, 1997). Still, we must ask whether these are the same acts, and hence morally equivalent? For if there is no moral difference between them, then every decision to refuse useless or excessively burdensome treatment can be viewed as direct killing.

    To see why the courts are wrong in this matter we must distinguish between the aim or intention of an action and its result. On the one hand, I can give myself a lethal injection, or refuse treatment, with the intention or aim of causing my death, of choosing to die, which is simply killing oneself on purpose. In this case, I am responsible for my death. Yet, on the other hand, I can also refuse cure-oriented treatments which are useless or excessively burdensome—that is, rather than prolonging an irreversible dying process, I put myself in the hands of those who will provide the best palliative medicine and hospice care possible for the dying. In this last example, I foresee that death will be, sooner or later, the likely result or side-effect of my action, but I do not choose to die because I do not intend my death on purpose or aim at it. I simply allow myself to die. In this case, the disease, not my action, is the cause of my death.

    Third and in conclusion, let me make it very plain that a clear moral difference exists between passive euthanasia (which is an omission which of itself or by intention causes death) and allowing to die. In particular, we should not confuse the acceptable refusal of extraordinary treatment with the failure to provide lifesaving treatment beneficial to the patient’s life. As Gilbert Meilaender wisely counsels, “We need to make certain that we ask of possible treatments: Will they benefit the life this patient has? That is quite different from asking, Is this patient’s life a beneficial one, a life worth living?” The following two examples will make this difference clear.

    Remember Baby Doe who had Down’s Syndrome and an abnormal esophagus (which is the tube through which food passes from the mouth to the stomach). This latter abnormality could have been repaired easily to make feeding possible. The baby died because treatment was withheld. A more recent case is the one of a man who took his premature infant son off a respirator that was preserving the baby’s life. If he survived, he might face complications (he was told) including poor lung development and brain damage. The man was tried for manslaughter but was acquitted on grounds that parents have the right to determine treatment for their children. Both these cases were instances of euthanasia by omission and should not be called allowing to die. Treatment was refused so that the child would die—this is the only way to describe both cases. We are not honest with ourselves if we fail to recognize that these cases involve the rejection of life, not just treatment, because life itself was seen as a burden not worth continuing, a life not worth living. Both cases were acts of killing on purpose and hence morally wrong.

    We must return to the moral sense and sanity of the truth that, “whatever its motives and means, direct euthanasia is morally unacceptable. Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator” (Catechism of the Catholic Church, #2276-77).

Professor Eduardo J. Echeverria teaches philosophy at Conception Seminary College in Conception, Mo. He is also a weekly columnist for the Maryville Daily Forum and the author of a forthcoming book, The Friendship of Charity: Civility, Truth and Christian Witness. This is his first article in HPR.

Back to January HPR Table of Contents