Medical Perspectives on Death and Dying
Several states have begun to consider legislation that would
legalize active voluntary euthanasia. To address some of the
ethical issues raised by such legislation, the Center for Applied
Ethics sponsored a symposium entitled Legalizing Euthanasia:
Ethical Perspectives on Medicine and Dying. Principal speakers
were Derek Humphry, founder and president of the Hemlock Society,
and author of the current best-seller, Final Exit, a
suicide manual for the terminally ill; and Richard Gula, S.S.,
Ph.D., a professor of moral theology at St. Patrick's Seminary
in Menlo Park, California. The symposium was funded in part
by the California Council for the Humanities, a state program
of the National Endowment for the Humanities. The following
excerpts highlight the remarks of Mr. Humphry and Father Gula.
Let me explain how I became involved with the subject of euthanasia.
In 1974 my first wife, Jean, was dying of bone cancer. Thrombosis
had set in, her bones were cracking and she was losing control
of her bowels. One day, after a very close brush with death,
she sat up in her hospital bed and said to me, "Will you help
me die?" That is when I first encountered the issue of euthanasia;
from across my late wife's hospital bed.
After she made her request, I asked myself, "What if I were
sitting in that hospital bed? What if I had had two years of
pain and agony? What if I faced an imminent death? What if I
was losing control of my bowels and my bones were cracking and
so-forth?" I realized then that I would be asking her to help
me to die. That, ladies and gentlemen, is my simple reason for
what I did. It was an act of love.
Jean had been a good wife to me for 22 years. She stood by
me in good times and bad. And when she was experiencing a bad
time, I felt it was my duty to support her in her decision.
I am not a Christian. I am an atheist. So, for me there was
no question of consulting any god. It was a matter of situational
In 1980, five years after Jean's death, I helped to establish
the Hemlock Society. This organization seeks to change certain
laws regarding suicide. We want the government to decriminalize
the actions taken by physicians in the assisted suicides of
terminally ill patients.
We believe that a mentally competent adult who is dying should
be able to submit a written request to their doctor that would
state, "I've had all I can take. The pain and suffering are
too much. I wish to die. Help me."
The physician, according to the Hemlock movement's prepared
law, would have to obtain the opinion of a second doctor. They
would both have to agree that the person is dying. The first
doctor could then end the life of the patient with an oral or
intravenous drug overdose, without the threat of prosecution
or lawsuit. Our laws also state that the doctor could elect
not to assist the patient with such an action.
There are those who agree with what the Hemlock movement is
saying at the present time, but are fearful that such an ideology
would result in a system of euthanasia similar to that used
by Nazi forces. It is true that the Nazis introduced a program
which they called euthanasia. They murdered about 100,000 people
who were physically or mentally handicapped. No senior citizens
or terminally ill people were allowed to voluntarily end their
But how can you say to a person who is dying of throat cancer
today that they cannot have voluntary euthanasia because of
what the Germans did in 1940 and 1942? I think that the person
would respond, "It's not relevant. It's me. It's my body. It's
my liberty. It's my life. And it's my death. Let me have control."
I would claim that this is the ultimate civil liberty. If
we cannot go to our deaths in the manner of our own choosing,
what liberty do we have?
Most of the focus on euthanasia so far has been dominated by
what I'm going to call the paradigm of individual case analysis.
My position is that euthanasia is not primarily an individual
issue; it's a societal one. So discussion about euthanasia should
not be governed primarily by individual case ethics, but by
The sanctity of life principle is probably the common ground
principle. There are two extreme positions that can give sanctity
of life as a principle a bad name. One extreme is what I call
vitalism, and that is the extreme that tries to absolutize physical
life making an idol out of biological existence. This principle
says no cost is too great to keep this biological life going.
The other extreme interpretation leads to what I'm calling a
utilitarian perspective, which values life for its usefulness.
This is the interpretation that says only the strongest and
the fittest ought to survive. The danger here is the abuse of
I want to think about the sanctity of life from the middle
position. This is the interpretation of the principle that recognizes
we have limited dominion over life. It's the interpretation
that says we are stewards of life, that we ought to care for
life and promote it and enhance it in order to allow our lives
to flourish and to achieve our potential. This is the interpretation
that wants to respect life in all its forms and in all its stages.
Interpreting sanctity of life in this way entails two obligations:
a positive one--to nurture and support life„and a negative obligation
not to harm life. Therefore, to appeal to sanctity of life in
a discussion of euthanasia is to create a presumption in favor
The second principle is the principle against the prohibition
of killing. I want to look at three ways of interpreting this
principle. The first says there is no moral difference between
killing and allowing to die -- that once you decide that life
no longer needs to be sustained, because the use of treatment
would be futile, then it makes no difference whether you actively
intervene or simply withhold or withdraw treatment.
The second interpretation is that there is a qualified moral
difference. That qualified moral difference is that the distinction
holds but gives way at a certain point. Some will say when the
person has gone beyond the reach of human care, when there is
no longer the capacity to receive love, or to receive comfort,
then the distinction dissolves. Others will say when the person
is in intractable pain and there's nothing more that can be
done to relieve the pain, then the distinction between killing
and allowing to die dissolves. Others would say when the patient
is overtaken by the dying process -- that is to say, once you
have decided that nothing more needs to be done, that life has
reached its limits, then it makes no difference whether you
withhold treatment or intervene, because in that condition,
you are not usurping the dominion that is not yours. Then there's
the third position that says the distinction holds all the way
The next principle is the principle of autonomy, which is
probably going to be at the core of this discussion of whether
euthanasia ought to be legalized. In our culture, we interpret
autonomy as the right to self determination. The prevailing
interpretation of autonomy in our culture is that autonomy is
there to maximize self-interest. That means that we are able
to pursue our own goals and life plans without external constraints.
When we interpret autonomy this way, we answer the question
"whose life is it anyway?" in favor of the one whose life is
in question. This is solid ground for supporting euthanasia.
Can the principle of autonomy be used to challenge euthanasia?
Some argue that the very interpretation of autonomy that says
that you have the freedom to have another person intervene to
take your life is a contradiction of what autonomy means --
that actually what you're doing is giving away your freedom.
The other way of looking at it is to say that euthanasia is
not primarily a private affair. It's a public or societal action
that involves others, and therefore it is something that ought
to be treated as a form of public action.
The third principle is the principle of the common good. To
show that euthanasia ought to be sanctioned as a public practice,
we need to be able to show that we can justify it in more than
the individual case. This is the principle that says that when
we establish a policy, we are sanctioning actions as a common
practice. When we apply that principle to euthanasia, we need
to ask, "how does the goal of my own private killing contribute
towards making society the context in which human life can flourish?"
Now let's turn to the perspective of virtue. Virtue asks whether
or not a policy on euthanasia creates the right kind of relationship
between the physician and the patient, and would a policy on
euthanasia create the right kind of community in which health
care is delivered. The perspective of virtue asks that the physician
deliver compassionate care within the limits of the physician's
role. The trust that we extend to the medical profession to
heal and protect life is something that we would want to sustain
and the perspective of virtue asks whether that kind of trusting
relationship would be enhanced or hindered if euthanasia became
part of the options that are available to the physician. The
perspective of virtue looks on ourselves as a community of interdependents
in which we are partners to one another. It sustains the community
of trust and care by promising not to abandon anyone, and it
tries to be realistic about accepting the limits about what
it means to be human. We recognize that life will not be free
of suffering, that life will be burdensome, and there will be
tragedy. The perspective of virtue tries to be realistic about
accepting that. It encourages us to construct structures of
support which will enable us to raise those who suffer into
the network of the supportive, caring community.
Ultimately we cannot convert individual cases into public
policy without having something remaining. The common good resists
the temptation. How do the burdens to one individual compare
to the burdens and the benefit on society as a whole? I think
all of this ultimately is going to turn not on the basis of
principles we argue with, but on the kind of people we are.
Are we a virtuous people that creates a community of caring
or are we going to compromise that in the way we allow euthanasia
to become a practice in our healing society?
Videotapes of the symposium are available for $16.50 by writing
to the Center for Applied Ethics, Santa Clara University, Santa
Clara, CA 95053.