Barry, Robert

The Linacre Quarterly

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epublications@Marquette

The Linacre QuarterlyVolume 54 | Number 3 Article 8August 1987Aid in Dying: Problems and ParadoxesRobert BarryFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationBarry, Robert (1987) "Aid in Dying: Problems and Paradoxes," The Linacre Quarterly: Vol. 54 : No. 3 , Article 8.Available at: http://epublications.marquette.edu/lnq/vol54/iss3/8Aid in Dying: Problems and Paradoxes Rev. Robert Barry, O.P ., Ph.D. Father Barrr is Linacre Quarterly's hook re\'ie ll ' edilOr and is a \'isiting assistalll proj'essor oj'religiou,\' studies at the Uni\'ersitr oj'lIIinois, Champaign- Urhana, At its international conference in September. 1986. the Hemlock Society announced that it would introduce a referendum into California in January, 1988 which would allow a physician to give "aid-in-dying", letha l injections to termina lly ill persons on request. In recent rponths, the Dutch Supreme Court gave wide-ranging approval to thi s sort of action, and it appears that physician-administered letha l injections have become rather common in Holland at the present time, The grave practical problems which would result from legal endorsement of a proposal such as that put forth by the Hemlock Society will be discussed here . Then. the se rious logical dilemmas and paradoxes of lega lized "aid-in-d ying" or voluntary euthanasia will be analyzed . Euthanasia: The Educational Problem The most se rious problem with the Hemlock referendum would be the message it would communica te to the unsta ble and immature. On the ABC television program, "Nightline", Dr. Pieter Admiraal. M.D. , indicated that the ideal way to give "aid-in-dying" would be to gather the person's famil y 22 Linacre Quarterly about the individual as he or she is receiving it. This would show the person receiving "aid-in-dying" that he or she was not being abandoned and that the action was one of compassion, love and support. This scenario points out the serious educational problem which legalized euthanasia would present. I n either very blunt and crude ways or in much more subtle ways, legalized and socially endorsed "aid-in-dying" would communicate a message to the immature and emotionally unstable that the rational and intelligent way of coping with grave suffering or loss of dignity would be to deliberately end one's life. Dr. Admiraal wishes to limit "aid-in-dying" to those who are rational, emotionally stable, competent and in control of their lives. But limiting self-killing to them alone would communicate to the immature and emotionally unstable that suicide is the way for those who are emotionally mature to cope with suffering, a message we do not wish to communicate to our young today. We should also recall that the immature and the emotionally unstable do not perceive reality in the same way that the mature , rational and competent do. The immature and unstable are often not able to see the fine distinctions and subtle reasons that the mature , competent and rat ional see. They tend to act impulsively and without due consideration , and when they perceive their elders electing to end their lives when they experience suffering, they will see this as a warrant to end their own lives, but on their own terms. At this time in America, we need to communicate that they are not to harm themselves deliberately to cope with suffering. We wish to teach them that they are not to take drugs, smoke, engage in frivolous sexual encounters or kill themselves to resolve problems of alienation, loneliness, suffering and anxiety. But if they see their elders, who are supposedly wise, mature and intelligent, killing themselves to escape their sufferings, it will be difficult, if not impossible, to persuade them not to imitate them in their own way. 2 Overturning the Common Law Tradition Another serious problem with legalizing "aid-in-dying" is that it would overturn the common law tradition on homicide. This tradition has consistently prohibited acts such as giving "aid-in-dying" because these acts are deliberate and willful killings of innocent sick, despairing, disabled, and dying private citizens by other private citizens. The common law tradition has also objected to legalized voluntary mercy killing because the motive of a homicidal act not done in self-defense has never been permitted as an excuse for the act. The common la w tradition has seen that if altruistic motives were allowed to excuse homicidal acts, then one would be logically committed to permitting such motives for killing the innocent as protecting the welfare of the community to justify other forms of killing of innocent private citizens. August, 1987 23 The common law traditi o n has also refused to a llow mo ti ves to justify killing because it is not possi ble in a great number o f instances to determine what the m oti ves of a n individ ua l ac tu a ll y are. The ex perience of German physicians between 1920 and 1945 should rem ind us of how difficult this is, for many of th e m, during the Weimar and Nati o nal Socialist eras, killed ene rgeticall y, be liev ing that they were acting o ut of la udable motives. They thought their actions were who ll y upri g ht. and w hen the law pe rmitted them to follow th eir own judgme nt s, frightful co nsequ e nces fo llowed . Medicine needs clear guidelines to direct itself to keep from being the m ost da ngerous o f all professions . Any killing which has bee n permitted by thi s traditi o n, with the exception of killing in se lf-defe nse, has been governed a nd controlled by the state, so that it could bring the rigorous scru tin y of the judicial system to prevent unjust killings. Lega li za tion of "aid- in-d ying" wou ld den y the state its class ica l ro le of protectin g private citizens from other private citizens, and thi s would be an unprecedented change in the common law tradition . The common law trad iti o n has been adama ntl y op posed to permitting priva te citizens to kill other private citizens, beca use such actions cannot be rectified if a wrong is d o ne. Unlik e ot her act io ns such as ex to rtion o r emben lement where there is the poss ibilit y of the damage being rectified , if an unjust act of killing occurs, there is no possible way of rectify ing the damage. Lega li zed me rcy killing would ha ve to be subject ed to the same rigorous standards tha t reg ulate ca pital punis hme nt to minimi ze the danger of un wa rra nted a nd unjust ifi ed acts of mercy killing. S hould lega lized mercy killing be per mitted, it would be a revo lution in our common law tradition of the most profound nature. Probably the most important reason "aid-in-d ying" has been rejected by th e common law tradition has bee n that the practice of mercy killing is fundamentally unc o ntro llab le . Th is is seen by the fact that th ose soc ieties which ha ve perm itted vo luntary mercy ki lling have fou9d tha t they could no t keep it under effecti ve control. ABC television rep o rted o n Feb. 3, 1987 that nurses in Holland were bei ng convicted of ho micide fo r having give n euthanasia to patients without the a uthorization of a phys ician , which was contrary to contemporary Dutch law. The euthanasia programs of Germany under the Weimar RepUblic and a tiona l Socia lists were no torious for be ing out of control. I n our own cou ntry, in December, 1986, Dr. Joseph H ussma n was convicted of mercy killing because he put a dose of Demerol in hi s m other' s feeding tube. There was never a ny pretension of th e act being vo lunta ry suicide as hi s mother neve r requested this, and Dr. H uss man killed he r sim ply to accede to the wis hes of his family. However, he was not se nt enced to jail because the judge claimed that no good purpose would be se rved by such a sentence . These incidents a ll show that non-voluntary mercy killing simply cannot be co ntro lled without ex pa nding it to such an ex ten t th a t it poses g rave dangers to the sick, handicapped , disabled, d y ing and despairing. 24 Linacre Quarterly Advocates of "aid-in-dying" claim that they seek to limit it to the rational and those who are emotionally stab le. But there is no agreement among its advocates as to what constitutes rationality. Nor is there agreement as to what classes of patients or persons should be given or denied mercy killing. Forexample. some wish to administer"aid-in-dying" only to those who are experiencing severe physical pain. wh il e others would give it to those who believe their lives are hopeless. whatever that might mean. If either of these classes of persons is permitted to kill themselves, the other will press its claims even more vigorously. Approving it for some classes of patients will on ly increase pressure for it to be given to other classes of patients. Even allowing only those who are in incurable and untreatable suffer ing to kill themselves eventually becomes uncontrollable. This is so because there is nothing in their principle that those who are suffering can end their lives which could restrict this to one class of patients. I f se lf-killing were not to be allowed to a class of patients it would not be because some principle prohibited it , but merely because an arbitrary decision was made to exclude that class. There is no way of determining whose suffering or loss of dignity is worse than someone else's. Is the suffering of a terminally ill cancer patient worse than that of a lovelorn adolescent? H ow can the law determine which of these two should have the right to commit suicide? 3 "Aid-in-Dying": Health Care Providers Turned Killers Legalizing "aid-in-dying" would necessarily make killers out of healers which wou ld undermine and compromise the objectives of the healing professions. Legalized euthanasia would necessarily involve health care providers in killing because it would be necessary to use their expert ise and judgment to assure that mercy killing was restricted only to those categories of patients for whom it was intended. But to use them for these purposes would make them formal cooperators in the kilt.ng of the sick, terminal , dying, depressed and despairing. Legalizing "aid-in-dying" which turns healers into killers is objectionable because, in the words of an Auschwitz survivor quoted by Dr. Robert J. Lifton, M. D. in his recent book The Nazi Doctors: "The doctor ... if not living in a moral situation ... where limits are very clear . . . is very dangerous." Dr. Lifton attempted to understand from a psychiatric viewpoint how it happened that many German doctors were turned from their traditional professional goals of healing into killers for the Nazis . Lifton suggested that they engaged in a psychological process called "doubling", in which the physician created an alternate "self' who was responsible for the killings. Legalizing mercy killing would create a severe identity crisis for medical professionals, a crisis they do not need at this time. Turning physicians into killers would create not only grave personal August, 1987 25 .Jroblems for health care providers but also grave social consequences as well, as the trustworthiness of the medical profession would be undermined. The ABC television program, "Nightline", reported that there were signs that some of the elderly in Holland were reluctant to enter hospitals because they mistrusted the physicians. For the well-being of all in our anonymous society, it is absolutely necessary to keep our healers from becoming random killers. Health care providers would find their roles unduly complicated by legalization of mercy killing. Giving them "the killing option" would confront them with the awful question of when they would have to abandon healing and start killing. Without legalized mercy killing, they would not have to confront this option which could be preferable to most health care professionals today. This is the sort of decision that many physicians would consider to be wholly foreign to their professional objectives. 4 The Paradoxes of" Aid-in-Dying" Besides the practical problems, there are also logical problems in legalized mercy killing. One of the serious problems with "aid-in-dying" is that most of its proponents want the la w to permit it to be given quickly, so that a person will not have to suffer pain or loss of "dignity" for a long period of time. But the more expeditiously mercy killing is given, the fewer will be the legal safeguards to prevent it from being given without warrant to those who do not wish it. Proponents of "aid-in-dying" want to have it both ways: they want to have it administered in a way that protects individuals from unwanted mercy killing, but they also want it administered so swiftly that "deliverance" from suffering or "indignity" would not be delayed even momentarily. In practice , it is not possible to give mercy killing swiftly to relieve intolerable pain while also giving it only to the rational and in such a way that only those who truly want it are given mercy killing. A further paradox with legalized "aid-in-dying" is that there is no consensus among suicidologists, psychiatrists, ethicists, philosophers and physicians that choices to end one's life are free and rational. If a patient is truly in a condition of intolerable and untreatable pain, then the freedom of such a person is probably very limited. A choice of such a person would be questionably free because ofthe limited options available to the person, and also because of the c\oudedjudgment that the person would probably experience from the pain. And if the person did not suffer from intolerable and untreatable pain, there is a serious question as to whether a choice for death would be in the best interests of the person. The same can be said of persons who atempt to justify chposing suicide because of a purported loss of dignity. If they have truly lost so much of their dignity that they judge their lives to no longer be worth living, one would 26 Linacre Quarterly have to wonder if they have sufficient rational power or freedom left to make such a monumental decision. And if they have not lost this dignity, one wonders what good purpose would be served by their choice of death . Mercy killing should not be legalized because it is immoral, and it should certainly not be legalized until the profound difficulties and paradoxes concerning its rationality and freedom have been resolved to the satisfaction of society. Finally, mercy killing is intolerable because it cannot be done either openly or in secret. If it is done secretly, the possibilities of abuse are so great that it cannot be permitted. There must be public scrutiny in orderto prevent unwarranted mercy killings. But if it is done in public, it would influence the immature and unstable to take their own lives. Thus there is no possible circumstance in which mercy killing can be practiced in which others could not be positively harmed by it. Some appear confident that "aid-in-dying" could be legalized in this country with no harmful side effects or consequences. It is my judgment, however, that very harmful consequences would accompany legalization of any form of mercy killing. In all likelihood , these harmful consequences will be seen shortly in Holland, and that nation's experiment with mercy killing should be stud ied very closely. But even if very dangerous practical consequences are not found in the Dutch experiments, we should be very cautious about taking any measures to endorse it in this country because our legal systems are so different and what might not appear in Holland might very well plague us in America. There is one thing we should not forget about "aid-in-dying". No matter what the motives of the mercy killer are, the action remains the deliberate killing of innocent , sick, disabled, dying a nd suffering persons. Our culture has espoused the principle that killing innocent persons does not resolve problems, and legalization of "aid-in-dying" might very well be a wholesale abridgement of that principle. It is by no means certain that legalized mercy killing will truly resolve any of the serious social problems which will confront our society as it enters the next century, and it might very well destroy some of the traditions which could help us in solving those problems. August, 1987 27 

Aid in Dying: Problems and Paradoxes

Robert Barry

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Aid in Dying: Problems and Paradoxes

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