Term Paper for course on Death

M. D.
Phil 676
Term Paper
November 29, 2001



A Duty of Death



When the governor of Colorado, Richard Lamm (served from 1975-1987), remarked to reporters that “Old people have a duty to die and get out of the way,” he did not know what a firestorm his offhand comment would have on his political career. Lamm spent the rest of his political career as governor trying to defend or re-interpret his original statements, often highly unsuccessfully.
Many people discount the concept of the existence of a moral ‘duty to die’ in any circumstances outright. Richard Lamm’s pronouncements are dismissed as being the ravings of a lunatic and the issue is immediately forgotten. In this essay we will return to the public policy decisions and moral issues brought to media attention by Lamm. Are there instances wherein a person has a moral obligation to end his or her life? If so, what are those conditions? If not, on what grounds do we base the rejection of the ‘duty to die?’
In this essay we will concentrate on whether we are morally obligated to die, without considering the specific public policy options available. We make the assumption here that law is codified and legislated moral imperative, based in philosophically ascertained principles, and applicable to the society as a whole. This view is supported by Roscoe Pound, a noted political and legal theorist, who stated that, “…law may be conceived as a philosophically discovered system of principles which express the nature of things, to which, therefore, man ought to conform his conduct.1” Pound continues on claiming that, “…In the hands of philosophers the foregoing conception [above] often takes another form so that law is looked upon as a body of ascertainments and declarations of an eternal and immutable moral code.1” In viewing law as codified morality (of whatever persuasion), we will assume that moral imperatives should be (or are) legislated duties.
To begin an analysis of the topic of a duty to kill one’s self (or to allow one’s self to die), an examination of the dominant paradigms of contemporary medical ethics is necessary. We will start with the examination of patient-centered care, paying particular attention to how ‘Sanctity of Human Life’ frameworks, and ‘Interest’ frameworks view the concept of a duty to die.
We will then turn to another approach to medical ethics, namely that of Utilitarian analysis (the ‘Social’ framework). As an offshoot of Utilitarian consideration, we will consider a feminist argument against having a duty to commit suicide.

PATIENT-CENTERED CARE ETHIC

SANCTITY OF HUMAN LIFE FRAMEWORKS

Let us first begin by considering a ‘Sanctity of Human Life’ framework’s views on the concept of a duty to die. According to those that utilize this framework for resolving ethical dilemmas, all human life is sacred and precious. No human life may be sacrificed for a greater good, no matter how humane, no matter how great the benefit from ending the life. Often relying upon religious messages of life as a gift from a deity, it is seen as impious to destroy that gift of life.
In some ways this framework is a rejection of utilitarian ethical analysis. Proponents of this framework often create examples where utilitarian analysis might be weak, such as murdering a young man for organs that will save the lives of a dozen more people, and use these examples to show that an analysis that does not strictly prohibit killing human life allows all manner of atrocities. Correctly, advocates of this framework show that the needs of others should not always outweigh the need of the individual.
Because of this, followers of this framework will ultimately reject the concept of a duty to die for fairly intimate philosophical reasons. It is not obligatory for a person to end their life when they become a burden to others because it is immoral for a person to end their life before their ‘natural death.’ Any attempt to legalize physician-assisted suicide or active euthanasia is met with strong defiance from proponents of this framework, for fear that it decreases the inherent dignity and value of a human life.
Although Sanctity of Human Life advocates reject utilitarian analysis of duties, they do not explicitly advocate the standard patient-centered view either. The standard medical ethical literature focuses exclusively upon the needs of the patient and the desires of the patient. The desires of the family, friends, or society do not weigh into the equation. However, in a religious context, “…we belong not to each other, or to ourselves, but to God, both by creation and by redemption. We are bought with a price, to use St. Paul’s words. Life is thus a matter of stewardship, rather than ownership. And the lives entrusted to us are to be loved and nurtured until the Master takes them from us.6”
Whereas the typical patient-centered care ethic revolves around the patient’s needs and wishes, the Sanctity of Human Life framework usually (though not always) revolves around God’s needs and wishes. Luckily for patients, God’s needs and wishes overlap with patient-centered care.
Of course, in utilizing a sanctity of human life framework to analyze whether a human being has the duty to kill himself, one falls prey to the numerous objections to this framework. Why are the interests of one human being more important than the interests of many human beings? What is the answer to the dilemma when one individual’s right to exist infringes upon another individual’s right to exist (for example, in the case of an elderly parent whose care destroys the life of their caretaker)? These are questions that the advocate of this viewpoint is ill-equipped to handle. As one writer stated in Canada’s National Post, “…Somerville tells us euthanasia does violence to ‘the human spirit’ and our ‘sense of the sacred.’ At their root, both arguments represent variations on the idea that it is somehow degrading and morally wrong if the time and manner of a human death is not left to a higher power. Only by invoking God… can opponents of euthanasia overcome the utilitarian presumption that it is correct and good to answer a person’s plea for death.6”

INTEREST FRAMEWORKS

Some philosophers have also discussed the issue of a duty to die in terms of interests. This approach follows a line of reasoning that it is morally correct to accede to the wishes of the patient, in an attempt to meet the demands of the ‘best-interests’ test of medical care. All physicians desire to do what is in their patient’s best interests, and Interest framework theorists claim that an individual takes interests in various treatment options, and that following these interests quickly points the treating physician in the direction of the patient’s best interests.
In terms of a duty to die, interest frameworks do not provide much concrete support. Consider the following case. An elderly man fears his growing dementia and knows that he soon will become incompetent. The man has always valued his independence and ability to care for himself in the twilight of his life. However, he foresees a time in the near future where his independence will be highly reduced by the care he will require from his family, and he does not desire to die in that manner. The problem is that the man is intensely afraid of death, and is interested in staying alive, but also recognizes that he is afraid of the life will create for his family, and is interested in a painless, dignified death. How should we resolve what ought to happen with the elderly man? Which interest is truly his ‘best interest?’ Do we have any way of accurately determining this?
Interest frameworks give no true answer to problems, and serve only as a rationalization when the wishes of the patient match those of treating physician. Indeed, the Interest framework can give no real answers to ethical dilemmas, because it is flawed in such a way as to render the conclusions useless. Why should we equate having an interest in something with taking an interest in something? It seems quite obvious that this is not always the case for many people, especially young children (who take an active disinterest in attending school) and college students (who take an active disinterest in attending school).

UTILITARIAN CARE ETHIC

SOCIAL FRAMEWORKS

Utilitarian considerations in medical ethics are few and far between. The ‘greater good for the greater number’ has been discarded as being too brutal and callous for civilized medical personnel. However, if one holds that morality is concerned primarily with how one’s actions affect others, then you are forced to ask why was this rejection of utilitarian principles uncontested for so long?
Matt Ridley, a sociobiologist who writes extensively about virtue, had this to say on the topic of morality and other-centered thought: “Selfishness is almost the definition of vice. Murder, theft, rape, and fraud are considered crimes of great importance because they are selfish or spiteful acts that are committed for the benefit of the actor and the detriment of the victim. In contrast, virtue is, almost by definition the greater good of the group. Those virtues (such as thrift and abstinence) that are not directly altruistic in their motivation are few and obscure. The conspicuously virtuous things we all praise – cooperation, altruism, generosity, sympathy, kindness, selflessness – are all unambiguously concerned with the welfare of others.2”
In his piece, entitled “Is There a Duty to Die?”, John Hardwig makes a bold claim from a utilitarian point of view that, indeed, there is a duty to end one’s life in circumstances where you become an excessive burden to your family. Hardwig speaks in terms of responsibility, citing “a responsibility to try to protect the lives of loved ones from serious threats or greatly impoverished quality, certainly an obligation not to make choices that will jeopardize or seriously compromise their futures.10” Hardwig asserts that in cases of excessive burden, it would violate this responsibility to “do just what we want or just what is best for us; we should choose in light of what is best for all concerned.10”
Those in need of excessive social and medical care are those most likely to be large burdens to their families and friends who support them. Therefore it is among this class of people where one might look to discover those who could be said to hold this duty. Indeed, some philosophers have extended the duty to die concept over all net social resource consumers, though arguably less convincingly.
There are many drawbacks to using a social framework, especially one of the nature proposed by John Hardwig. Only those whose care is an excessive burden have the duty to die, according to this framework, but whether care is an excessive burden to the family is a direct result of the financial, temporal, and emotional resources of all involved. A family with much wealth to pay for high medical premiums, quite a lot of time to spend with an aged dying relative in the hospital, and with plenty of emotional vigor to sustain themselves through the grueling times ahead appear to have a social advantage in these situations than does a family below the poverty line, who have neither the money, nor the time, nor the emotional resources to deal with a problem of this magnitude. In other words, the rich do not have a duty to ‘get out of the way’ for younger generations, but the poor still do have this duty.
Also, Hardwig’s analysis does not need to be stretched far to make arguments for the euthanasia of other undesirable people. A new baby boy may pose an excessive burden to a young single mother, forcing her to drop out of college to take care of the child. The child’s care necessitates loss of time, emotional resources, the woman’s career (quite possibly if she does not continue on to graduate), and a reduction in the quality of her life from the moment of the son’s birth until the end of her life. Could we not claim in this case that the woman is suffering an excessive burden? Should not the infant have an undischarged duty to die? If so, then the mother ought simply to become a surrogate decision-maker for her child (something we grant her anyway) and decide that the child should be euthanized.

FEMINIST ARGUMENTS AGAINST A DUTY TO DIE

Also coming from a utilitarian viewpoint are some groups of feminists who examine the social framework and find the holes in it to be too glaring to be accepted. Viewing humankind not as a collection of individuals, but rather as an interconnected web of relationships, these feminist philosophers conclude that a duty to kill one’s self would increase the burdens on society.
These feminists recognize the need to look outside the individual when determining the solution to these ethical dilemmas. “Feminists have rightly attempted to make explicit what has too often been ignored – i.e., the social and dynamic developmental realities of actual human lives. Human beings must be born, nurtured, reared, domestically maintained and cared for when they are ill, old, or dying. A unique individual self can only be formed within social matrixes of interpersonal relationships; the self is partly created by ongoing self-other dialogues. Each adult person continues to live within embodied, embedded and interpersonal relationships. Inevitably, the private and the personal interact with public and political actions because no one an live or work without receiving domestic and emotional support.5”
In this, both the social framework and the feminists believe that the interests of others are crucial in deciding the issue. However, the feminists adhering to this particular philosophy argue that the interests of others demand that euthanasia not be allowed. “Implicit in the claim is the assumption that an individual owns his or her personal body-self so completely that he or she can kill or extinguish life at will. This concept of absolute human ownership or property right appears morally misguided… Whence would such an individualistic moral right or assumption of absolutely dominant power come from? After all, each individual self-consciousness, like each individual’s body-self, has been created and received from one’s parents and forebears and nourished by the community and culture in which an individual’s life is originally embedded. A human life is a gift from evolutionary biology, natural ecological conditions, parental procreative child-rearing and collective cultural socialization, all transcending the individual power of a self-determining will claiming unilateral life-or-death powers.10”
The problem with this violation of the rights of the ‘others’ in whom we are embedded becomes more clear when you realize that the act of killing one’s self is an act of ending relationships. It is a permanent cessation of all human interdependence with regard to the person who chooses to die. In this way, the loss is felt throughout the entirety of the web of interpersonal relationships. After all, “…such acts are not without interpersonal consequences because we do not exist alone.10”

CONCLUSION

Whether or not we have a duty to die in some cases seems clear. On a utilitarian basis, cases of excessive burden are not difficult to find. These cases are the meat of Hardwig’s analysis of a duty to die. There is certainly merit to his argument that is seems wrong to force (or even allow) your family to carry excessive burdens to care for you in your final months.
However, the feminist claim at interpersonal relationships also strikes a chord of truth. The decision to end one’s life out of a sense of obligation is a decision that we cannot make on our own, and indeed, should not make on our own. The web of relationships in which we are all embedded is affected by the severing of a single strand.
The solution seems to be a synthesis of the two ideas. While Hardwig’s case for a duty to die is solid, the addition of the feminist’s objection is well worth the time. The dying patient ought not simply consider the needs of his family, but also discuss the situation with them openly and honestly, in an effort to soothe the parting blow.
Although the viewpoints presented here provide different accounts of the nature and meaning of a duty to die and disagree about whether there is such a obligation, there is an important point of agreement. It is appropriate, and indeed, imperative, for people who are dying or seriously ill to consider the needs and interests of close family and friends.