I want to address this argument
from Rivka at Respectful of Otters, in which she makes a moral
distinction between allowing yourself to die and killing yourself (or, more exactly, between allowing someone else to die according to their
wishes and killing them, also according to their wishes).
She starts by making the case for personal autonomy as the basis for
the right to decline life-saving treatment: "No one has the
responsibility to submit to everything that medical
science could potentially do to prolong life. As individuals who own
and have sovereignty over our bodies, we have a fundamental right to
bodily integrity." She then gives a list of examples of situations in
which someone might choose to decline medical treatment and writes, "
We have the right to say 'enough,'
and let the natural dying process take its course. We have the right to
have the integrity of our bodies unviolated by unwanted medical
treatment - just as we have the right to insist on aggressive efforts
for life extension. We have the right to choice. And when we are no
longer able to exercise that right ourselves, we have the right to
designate our closest others to do so on our behalf."
"To
define
the exercise of that right as 'killing' is to pervert the end of life
unimaginably." She then relates the story of her grandfather choosing
to die at home, although heroic measures in the hospital might have
extended his existence a few days. She says that her grandfather's
decision was entirely rational. " But who would have benefited
had my grandfather been forced to squeeze out a few extra days in an
intensive care unit, on a respirator, confused and disoriented? In what
way would that have furthered a culture of life?"
The nut of her argument then follows:
The natural
course of life ends with death. To allow that natural process to take
its course is profoundly different than hastening it along. Asking
others to refrain from interfering with nature is profoundly different
from asking them to make, or be complicit in, the decision that nature
is not progressing quickly enough - as in euthanasia or
physician-assisted suicide. Euthanasia asks the physician to play God,
to decide whether another person's life is sufficiently without value
that it should be actively terminated. The cessation of life support
asks the physician to stop playing God, to refrain from intervening
further in a disease process which has its natural terminus in death.
She
concludes by saying that the evidence of Terri Schiavo's intent has
been weighed and re-weighed, that the evidence shows that her "wish
would have been to remain unviolated by
a feeding tube if she had no hope of recovering", and so her will
should be carried out.
My difference with Rivka's argument is that I doubt, morally and
practically, that "allow[ing] that natural process [of dying] to take
its course is profoundly different than hastening it along." I think
that making the distinction between withdrawing care and active
euthanasia is important to people who believe that the dangerous
principle of personal autonomy has to be cabined. It's also a helpful
way to sell the principle of personal autonomy to those who would never
accept its logical conclusion - namely, that people should have the
right to end their lives whenever they choose.
The moral distinction Rivka makes rests on two smaller distinctions:
action versus inaction, and natural versus artificial. Both of those,
I think, are smaller than meet the eye, especially in the medical
context.
One always has the right to not seek medical care, Rivka says, even
knowing that doing so will cause you to die sooner than otherwise. I
agree. I can go my whole life never visiting a doctor and expire,
clutching my chest during a fit of apoplectic rage, in front of my
computer. (In fact, I just might, someday, although I aspire to be
shot by a jealous man.) In the context of terminal illness, how is the
action/inaction distinction relevant? When a patient's condition
reaches a certain point, agreed upon in advance, the doctor withdraws
hydration and nutrition. Everyone knows - indeed, the whole point is -
that in a few days the kidneys will start to shut down, followed by
other internal organs, ultimately resulting in death. This is not
"doing nothing", this is taking an active step to end life. It makes
more sense to me that the doctor would simply give the patient an
injection to stop the heart. In both cases action is taken that is
known, expected, desired, to end the life of the patient. To call one
"respecting the right of personal autonomy" and the other homicide is
somewhat silly.
In withdrawing care, one can take comfort in the belief that the
patient died of natural causes instead of by unnatural means. It is
true that renal failure is a natural cause of death when the patient is
not getting any water. But it is the doctor's hand that prevents the
administration of water. If you can't get any air, you will
suffocate. That's natural. If you can't get any air because my hand
is over your nose and mouth, ordinarily we would not say you died of a
natural cause. The fact that there is a delay between the doctor's
action and the consequence does not reduce the doctor's moral agency.
When you know the effect of what you will do, then whether your means
are a quick lethal injection or the slow effect of turning off a tap is
really irrelevant.
I think I understand why Rivka and others like the distinction she
makes. Most people, especially most Christians, are uncomfortable with
suicide. But the Enlightenment concepts which have led to the
exaltation of patient autonomy seem irrefutable. In order to prevent -
or at least forestall - the arrival of the day when a patient can
successfully request that their life be terminated, the arbitrary line
between withdrawing care and administering lethal medication is
preserved as a fig leaf.
Also, of course, many people worry that the doctor (or the patient's
family, as in the Schiavo case) will order death when the patient would
not have wanted it. But the withdrawing care/euthanasia distinction is
inapposite to that concern. The crux is a worry that there is
insufficient proof of what the patient would have wanted, and that
worry exists whether you are withdrawing a tube or inserting a needle.
If sufficient proof of intent is desired, mandate a standard of proof
you would accept rather than proscribing certain means for carrying out
that intent. Perhaps, again, the length of time required for
withdrawing care to do its job gives a false reassurance. It seems
"natural", so we demand a lower standard of proof. Maybe the longer
period of time gives the sense that anyone who objects will be able to
raise their opposition before it's too late, giving the whole thing a
gloss of due process by which we believe good decisions will be made.
Or maybe the emotionally charged, drawn-out process of dying drains the
guilt and sense of responsibility from the person who has ordered that
the patient's wish be carried out, simply by exhaustion. Call it
pre-grieving, but whatever it is, it works.
I don't want to come off like I am criticizing Rivka or anyone else
who likes the withdrawal of care distinction too much. I think half a
loaf is better than none, and I would much rather have this much
patient autonomy than none at all. Also, I am not an ethicist or a
doctor, and so this is not my field. But I do think it is worth
considering whether we are perpetuating an incoherent standard, and
whether we can continue to live with the incoherence or whether it is
time to resolve it.
***
In actual Schiavo-related news, there is no joy in Red America
today. To the surprise and dismay of every idiot in the country, a
federal
judge has turned down the opportunity to grant an order re-inserting
Terri Schiavo's feeding tube. Even with Bush's new super-special
federal question law, the judge thinks that since 9 judges over 7 years
have considered - and rejected - the parents' claims, there is little likelihood that
their assertion of denial of due process will succeed. Huh. Go figure.
How the hell all that will turn out I have no idea.
I don't want to see Ron Jeremy under the best of circumstances. I certainly don't want to see him on my cell phone. But he's bringing 
Oh well, if they didn't want to get shot, they shouldn't have attacked us on 9/11. Anyway, no one could ever have predicted that invading and occupying a country like Iraq would result in untold thousands of unintended civilian deaths, or teenagers who long to drink American blood. We all thought it would be a cakewalk, and we'd be greeted as liberators.
In fact, I think Volokh is being unnecessarily restrained. Why limit torture to mass murderers? Is the desire for revenge less in the family of a single murdered child? Indeed, this principle should not be limited to murder or even crimes of violence. If I were to be raped, I am sure I would want to cut off the rapist's nose with a jagged piece of broken glass, and I should be given leave to by the state. Only blue-state wimps would disagree. And if some white-collar criminal steals the life savings of thousands of elderly pensioners, why should they be denied the chance to take it out on him corporally? I certainly would enjoy watching Bernie Ebbers flayed, as would every right-thinking person. America will not be truly civilized until torture is a part of the price of every failure or transgression in our society. Late for work? Electroshock. Missed a field goal? Caning. Each of these applications of societally-approved violence will strengthen us as a people.
I hope his honesty doesn't come back to bite him. One hopes that events over the next few years will vindicate his position (I can easily imagine that after another 9/11-style attack people will be much more on his side), but if not, it would be a shame if his desire for more torture prevented him from getting a seat on the federal bench, even a top job. U.S. Supreme Court Justice Volokh would be a refreshing antidote to all this liberal claptrap.
Recent Comments