Monday, October 19, 2015

Do you have a moral obligation to die?

Legislation, most recently in California, legalizing the assisted suicide of a terminally ill person has prompted some musings about whether a person ever has a moral obligation to die.

Most persons can envision a situation in which they believe that a person has a moral obligation to put self heroically in harm's way for the sake of others. We celebrate the passengers of United Flight 93 who, following the hijacking of their plane by the 9/11 terrorists, refused to allow the terrorists to use the plane as a weapon of mass destruction. The passengers who decided to attempt to regain control of Flight 93 almost certainly recognized that their effort might result in one or more of their deaths. Similarly, some persons – for example, those in the military and police – have sworn to their willingness to risk going into harm's way for the public good. This post does not address these issues.

The indigenous cultures of some Native American peoples, especially in the Arctic, anticipated that an elderly person would decide when s/he had become a burden to the community, that is, when the person no longer was a net contributor to communal well-being. Once s/he reached that conclusion, the culture expected the person to make their farewells and then one night to slip away, to die quietly in the dark and cold. This ethic seemed especially understandable for people whose life in the harsh Arctic allowed only a slim margin of safety and few extras.

Life in the twenty-first century is more complex. In retirement, our culture no longer expects that people will contribute to the communal good. Instead, we hope that retirees will have the opportunity to enjoy life more freely and fully than they could during their working years. Many retirees, I hasten to add, substantively and generously contribute to the common weal through gifts of time, talent, and treasure.

The fortunate few live long, prosper, do good things, enjoy their golden years, and then die peacefully in their sleep sometime after marking their centenary.

Unfortunately, increasing numbers of people – some of whom have lived long, prospered, done good things, and enjoyed extended golden years – die after a lengthy decline and protracted, costly medical treatment. Approximately 28% of Medicare, for example, is spent on patients during their last six months of life. Spending those funds on younger patients would unquestionably achieve, on average, greater results in terms of improved quality and length of life. In other words, many elderly persons, because of their medical condition, place disproportionately large demands on the community. Do these persons have a moral obligation to commit suicide?

My answer has four parts.

First, the idea that God determines when each person will die is incredible (i.e., unbelievable and untenable) in the twenty-first century. If a merciful God actually held each life in God's hands, then literally millions of people, young and old alike, would not have died from excruciatingly painful and often easily preventable causes. Furthermore, arguing that God determines when everyone dies implicitly denies that one human ever has any responsibility in the death of another human. Although the biology of life is very poorly understood, death results from natural and not supernatural causes.

Second, killing another human is morally wrong. Even morally justifiable killing (a police officer shooting a mass murderer as the only way to prevent more deaths, for example) is an evil, albeit morally justifiable. Under no imaginable circumstances in the twenty-first century is killing an elderly person because s/he represents too large a drain on community resources morally justifiable.

Third, death is the natural end of life. Cherishing life is understandable and right. But no life, regardless of medical or other scientific progress, will endure forever. Accepting the reality of death can bring a person to the final stage of growth. Living in denial of death prevents one from appreciating life's transitory nature and rightly valuing each moment.

Fourth, individuals have an inherent but not absolute right to decide when to die. No person is an island. Our relationships with family and friends are integral to our human identity. The young adult who does not have a terminal disease yet who commits suicide acts as if s/he has an absolute right to decide when to die, abrogating the rights of others to be in relationship with that person. Such suicides point to undiagnosed or untreated mental illness and broken relationships.

States are slowly recognizing this inherent but not absolute right to decide when to die by legalizing assisted suicide for the terminally ill. These laws both respect the sanctity of life (nobody has the right to kill another) and recognize that death is the natural end of life. These laws also value the quality of life as much as its duration. Only the individual can determine when the quality of his/her life has diminished to the point where that life is no longer worth sustaining.

Individuals already have the option, in most jurisdictions, of refusing medical treatment if it appears that the treatment is likely to result in a significantly diminished quality of life. Describing this refusal as a moral obligation to die may paint an extreme picture. However, the phrasing dramatically and insistently underscores that healthcare is not an unlimited social good. Resources expended on one person thus become unavailable to help others.

In other words, many of the healthcare choices commonly viewed either as exercising one's right to care or as governed by the principle that every effort should always be made to preserve life are actually utilitarian decisions. In these utilitarian decisions, an individual should weigh not only what is good for the person but also what is good for loved ones and the larger community.

Illustratively, presume that you are 95 and your doctor recommends you receive a heart transplant. Important factors in whether to accept or to reject that recommendation include not only the projected effect of the transplant on your quality and length of life but also how you having a transplant would alter the options available to other, younger and perhaps healthier, patients who need a heart transplant or other costly healthcare.

My choices may be mine to make but that does not mean those choices do not have any consequences for others. Living abundantly occurs only in community; living abundantly is possible only when I value the lives of others as highly as I value my own life.

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