Rev. Robert H. Tucker
Sermons on the Web

Is There a Duty to Die?


The Artist's Son Paolo. By Pablo Picasso, 1922.

Part of the continuing conversation on the faith journey
with the members and friends of
First Congregational Church of Houston

by

the Reverend Robert H. Tucker
April 19, 1998

The Father loves me, because I give up my life, so that I may receive it back again. No one takes my life from me. I give it up willingly! I have the power to give it up and the power to receive it back again, just as my Father commanded me to do.

 

Two relatively recent cartoons in The New Yorker demonstrate how much assisted­suicide, or "dying with dignity," has become an accepted part of the public forum.

A physician, seated at his desk, advises a patient, "Before we try assisted suicide, Mrs. Rose, let's give the aspirin a chance."

Four telephone operators are answering incoming calls. Above is a sign that reads, "Crisis Hot Line." One operator answers, "How may I direct your call? Doctor­assisted or regular?"

Should people-should we-have the legal right to choose to die? Should we allow physicians to assist people in dying? Should we allow society to tell people-to tell us-that it is now time to die? These questions in one form or another, and with varying degrees of intensity, are now part of the debate about death and dying in this country.

I have long supported the concept of "Death with Dignity," and at one time was a member of the Hemlock Society, the group that has been the main proponent of making legal people's ability to control their own deaths. Hemlock is the drink that Socrates used to end his life. Over time, I still maintain that position, but less enthusiastically and far more soberly. I came to this position through the experience of being at the bedside of the sick and dying. I have heard people thinking about, and asking for, their life to end:

sometimes the thoughts were sparked by the financial drain that hovered heavily over patient and family alike;

sometimes there was the hopelessness of the situation, the patient knowing that he or she would never leave the hospital did wanting to prolong the inevitable;

sometimes it was the unfocused eyes and clenched jaw of never­ceasing pain; and

sometimes depression set in, stemming from personal uselessness.

Then there was the case of The Rev. Henry Van Dusen and his wife, Elizabeth, both of whom were in pain and with no prospect of recovery, but not facing immediate death. They joined in a suicide pact. The deaths were front page news and struck ministers with special force since Van Dusen was President of Union Theological Seminary in New York City and one of the more respected theologians in the world. In her suicide note, Elizabeth wrote: "There are too many helpless old people who, without modern medicine, would have died, and we feel God would have allowed them to die when their time had come."

Of course, many physicians have allowed people to die or have assisted in their death. Not many are willing to be publicly confessional about this when by doing so a physdician might be charged with a felony and perhaps lose one's medical license.

Over the years, a broad base support for assisted suicide has expanded into the general population.

The quite rapid public acceptance of assisted­suicide is due to factors other than medical.

I believe that the primary cause is not medical or situational. There is a is a central and dominant value for us Americans that fuels this acceptance of assisted­death: autonomy. Of core importance to our cultural is the attitude: "It's my body; it's my life; it's my freedom; it's my death. What I do with my life and my body is my business. Not you or anybody else can tell me what to do." Autonomy also underlies other feelings and fears:

Next, I think that many of us, thinking of our own death, are comforted by the knowledge that, if we so choose, a physician will be ready, willing, and able to help us escape agony and pain, financial destitution, and humiliation of helplessness by offering a death with dignity. It's not that we are planning to ask someone to help us die, but, if the situation calls for it, we want the option open to us, or for others.

The sheer number of people who are getting closer to their own death pushed us into serious consideration of the issue. In 1950 there were 585,000 Americans 85 years of age and older. In 1990 that number had grown to 3.1 million. By the year 2005 the number will have reached 5.3 million

Although I think there is far more fear of death in us that most of us recognize or are ready to admit, the greater fear, in my mind, is the dying, not death. The possibility of assisted­suicide alleviates some of that worry.

Paralleling that value of autonomy is our fear of pain, There is a feeling that we ought not to hurt. The huge amount of drugs-prescription and over­the­counter, legal and illegal-that we ingest each year demonstrates that.

The issue of dying took on a quite a different dimension when Richard Lamm, while Governor or Colorado, wrote an editorial for The Denver Post in which stated that, for a variety of reasons, including the large population and the limited resources of the earth, old people have a duty to die. He referred to the Eskimo practice of sending the elderly out to die as an example.

As you can imagine, this was highly provocative. But, it was an idea not dismissed out of hand. Although it stands untenable today, I predict that it will enter center stage at some future point. This is assisted-suicide for the general good of society.

In reality, there are times when we honor the choice of people to die on behalf of others. For example, consider Captain Oates, a member of Admiral Scott's expedition to the South Pole. Too ill to travel, he realized that if the team stayed with him, they would all die. So, one night he left his tent, walked out into a raging blizzard, and was never seen again. Is he to be condemned for his choice? Another example of the choice to die on behalf of others is Jesus.

An indication of the kind of debates that are now going on, consider the distinction being made between killing and being allowed to die, between passively allowing the normal process of dying to proceed as against actively removing a life support system.

Although many find the distinction between allowing a person to die and killing questionable, Robert M. Veatch, professor of medical ethics, Kennedy Institute of Ethics at Georgetown University, lists five different arguments for holding to the difference between killing and allowing to die.

1. They differ psychologically: we feel easier about allowing a person to die then withholding or withdrawing treatment (pulling the plug).

2. They differ by intention: one accepts our human limitations in reversing the dying process and the other aims at a person's death.

3. They differ in their long­range consequences: active killing may lead to active killing for other reasons.

4. They differ in the cause of death: death from the disease itself vs. death brought on by a human agent.

5. They differ on the role of the physician: a healer vs. a killer.

Before we embrace this brave new world of assisted suicide too easily, there are some serious questions that need to be faced. I believe that John F. Cavanaugh is right when he places "Selecting Suicide" as number four in a listing in what he calls the "Ethical Top 10." His list is drawn up from the viewpoint as what these issues mean for the kind of people we are becoming. For example, he writes, are we increasingly becoming "a culture of death?" We have accepted abortion (and now the killing of babies as they are in the process of being born). We kill each other with increasing frequency in post offices and schools [as witness Jonesboro, Arkansas and deaths at other schools]. Now we are quite rapidly and casually entering into physician­assisted and self­assisted suicide, have we begun to slide quite rapidly down the slippery slope? He looks at the issues of assisted­suicide in light of the question: what kind of people we are becoming?

Another ethicist says that we are a bit delusional about assisted­suicide because we base our ideas of assisted­suicide on two massive illusions.

The first illusion is that with laws and technology in place, we will be able at just the right moment to say, "That's it. No more. It's the end of the line for me."

The second illusion is that we know ourselves well enough to know exactly when to give up the struggle to stay alive.

Isn't it a fact that, if we reflect on the lives of others, the ones who are able to manage the course of life most effectively are the one who savor the benefits of the different stages of life and accept their accompanying burdens with good cheer?

They have an optimal self, but it is not one dependent for its sustenance upon their external circumstances, whether age or physical or mental condition. It is instead a self of their own inner making, fashioned from the ingredients of their enduring values and ideals.

So, it could be said that the ability to choose one's death is a sign of mental and spiritual health. Or, it could be said that choosing one's death is a sign of immaturity in that it is a refusal to live one's live in each "stage" as it comes along.

A question I ask is: "Are we being fair to physicians?" It is easy to glibly talk about physician­assisted suicide. But, what we are doing is asking another person to be an active agent in the death. Perhaps a member of the family is the one who takes action. Can most people, could you, live with that guilt?

Physicians in their training are taught "First do no harm." Do we want to break that principle which contradicts this life­respecting affirmation? And, since every medicine, even aspirin, and every technology has harmful potential, do we want to exercise the awful power to end life when even with the best of intentions can do harm?

It one thing for physicians to alleviate suffering by administering large dose of narcotics and sedatives which can hasten death. I would imagine that most physicians have hastened death and have felt self­justified because of the greater good. But to actively be involved in helping kill patients is a precarious moral position.

There was a cartoon in the papers in which the words at the top read: "Some Michigan Doctors Endorse Assisted Suicide and Form Group Called 'Physicians for Mercy.'" In the picture there is a physician behind a desk, but standing and reaching over and shaking hands with a very elderly man. The physician is saying, "Hello, I'm Doctor Smith but, please, just call me God!"

The slippery slope argument is not easily dismissed. We say now that assisted suicide is legal only for terminally ill patients (explicitly those having less than ix months to live). But, what about the teenager who from birth suffers from a chronic, painful disease that is not imminently life­threatening? What about the aged or chronically ill person convinced by others that her or his life is no longer worth living? What about the aged parent who will die and whose children who need an infusion of cash?

I think the best solution is to give more attention to the state of terminal care in our country. Hospices are one important element in that. Physicians need to be trained in managing death as well as to curing.

We Americans like the "quick fix" to our problems. "Bomb the hell out of them" is the way this gets expressed in our international relations. Is physician­assisted, or individually­administered, suicide just another excuse to not provide the attention and care to the dying?

What are the religious resources we bring to this cultural, and perhaps at some day, individual, decision?

Surprisingly, the Bible is not of direct help in this matter. There are six suicides in the Bible. In each one, the events leading up to the suicide is condemned, but the Bible's comments on each act of suicide are neutral.

The Gospel of John contains an interesting perspective, when Jesus says:

The Father loves me, because I give up my life, so that I may receive it back again. No one takes my life from me. I give it up willingly! I have the power to give it up and the power to receive it back again, just as my Father commanded me to do.

- John 10:17­18 (CEV)

 

Let me list some of the objections to this idea that we have a right or a duty to die.

We have a duty to God, the giver of life, to not destroy that which is not ours in the first place.
Assisted­suicide is incompatible with human dignity and the intrinsic value of personhood.
Are any burdens of illness great enough to justify an obligation to end one's life? What is lost is the notes of goodness which may spring into people's lives at such times as this: reconciliation with others, peace for one's soul, and a deeper awareness of the Divine Spirit operating in a person's life and dying.

 

REFERENCES CONSULTED

 

Adkins, Ron. "Don't Subsidize Assisted Suicide," The Wall Street Journal, 13 April 1998, p. A22.

"Confronting Death: Who Chooses, Who Controls? A Dialogue between Dax Cowart and Robert Burt. Hastings Center Report 28, no. 1 (1998), pp. 14­24.

Death & Dying: Opposing Viewpoints. Greenhaven Press, San Diego, California, 1998. [Cor 174.24; ISBN 1­56510­670­9]

1. The Constitution Protects the Right to Die. Part I: Ronald Dworkin, Part II: Leonard John Deftos, pp. 56­63.

2. The Constitution Does Not Protect the Right to Die. Jeffrey Rosen, pp. 64­72.

3. Physician­Assisted Death Should Be Legalized. William H. A. Carr, pp. 73­79.

4. Physician­Assisted Death Should Not Be Legalized. Louis Vernacchio, pp. 80­86.

5. Advance Directives Protect the Right to Die. Laura Taxel, 87­90.

6. Advance Directives May Not Protect the Right to Live. Burke Blach, pp. 91­95

Father Coleman, SS. Origins, pp. 663­668

Hardwig, John, "Is There a Duty to Die?" Hastings Center Report, March­April 1997, pp. 34­42.

McDaniels, Andrea. "Brazil Mandates Organ 'Donation' for Transplants," The Christian Science Monitor, 16 January 1998, p. 1f.

Page, Patricia N., "Christians Have An Answer to Death," Sewanee Theological Review, 40:3 (1997), pp. 294­298.





© Robert H. Tucker
19 April 1998

 

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