Euthanasia As Public Policy: Rights And Risks
Donald W. McKinney, First Unitarian Church, Brooklyn, New York
The Berry Street Essay, 1989
Delivered at the Unitarian Universalist Association General Assembly
New Haven, Connecticut
June 22, 1989
The intent of this essay is to explore our role as Unitarian Universalist ministers in the issue of death control. What responsibility is ours in the growing national, and international, debate over euthanasia? What—if anything—should we have to say about the efforts to legalize assisted suicide and merry killing being sponsored and encouraged by many Unitarian Universalists and now a resolution of our denomination? Is there significant moral conflict here between championship of individual rights of self-determination, and concern for the common good, the fashioning and functioning of society as a caring community?
I Framing the Issue
Four hundred years ago the French essayist and skeptic Montaigne wrote: "If you do not know how to die, don’t worry; nature herself will teach you in the proper time; she will discharge that work for you; don’t trouble yourself.”
At last year’s General Assembly in Palm Springs, UU delegates troubled themselves very much on this issue and proceeded to adopt a general resolution on "The Human Right To Die,” reading in part: "Unitarian Universalists advocate the right to self-determination in dying and the release from civil or criminal penalties of those who, under proper safeguards, act to honor the right of terminally ill patients to select the time of their own death...”1
Without question Montaigne’s advice "not to worry” was sage and sensible at a time when people died of contagious diseases, famine or other natural catastrophes over which human beings had little or no control. Today of course it is a very different scene. Many of the same advances in medicine and technology that have made it possible to all but eliminate plagues and contagious disease, ironically have made it possible to prolong indefinitely the process of dying from the degenerative diseases that eventually will fell most of us today. There is now almost literally no such thing as a truly "natural death”. In nearly every stage of medical care of the terminally ill, choices are made, and must be made, that either postpone death or allow death to take place. The availability and--in too many instances--the interminable and unwanted use of life support systems have made choices of how and when to die obviously something very much to worry about.
In nearly every sector of society, among health care providers and health care consumers, in legislatures and courtrooms, in churches, in the theater, on the air waves, even in TV soap operas, "whose life is it anyway?” or the so-called right to die issue, has been discussed and often still is an agonizing struggle for many people in and out of the medical profession to conceive of withholding or withdrawing treatment, when they know a patient’s heart can be kept beating or a kidney can be kept functioning--and however painful it still is for some doctors to surrender final authority on treatment decisions, patient autonomy is now the norm, not the exception, as it was only a few short years ago.
Indeed, the right of a competent adult to make her/his treatment decisions, including the withholding/withdrawing of life support systems, has been confirmed by the highest court in every state in the union where it has been challenged, as has the continuation of that right even after a patient becomes unable to make a decision if his/her wishes have been made known in advance through a living will or some other clear indication of intent.
In other words, the so-called right to die, which in all existing statutes and judicial decisions means purely and solely the right to refuse treatment, is essentially the law of the land. What happens in practice is another story, but in law the battle to assure recognition of the right to refuse treatment by and large has been won. Many UU’s—clergy and laity alike—have been strongly supportive of efforts needed to gain understanding and acceptance of this basic right of self-determination in decision making. In fact the very first large scale mailing on behalf of what was then the very new "living will” concept was made to all Unitarian Universalist ministers in the United States and Canada almost exactly twenty-five years ago. It has been most reassuring to me to realize that most consistent support has come from Unitarian Universalists. Now many UU’s are seeking an extension of this right to refuse treatment, to include the right to have the life of a dying person deliberately and immediately terminated upon request.
It was nearly thirty years ago that Joseph Fletcher, the distinguished ethicist and moral theologian, wrote in an article in Harper’s Magazine on "The Patient’s right to Die:” "Death control, like birth control is a matter of human dignity. Without it persons become puppets.” In this same article, which was one of the first popular efforts to address what was then only the beginning of a growing public concern, Dr. Fletcher explored the different ways in which euthanasia (from the Greek, meaning a merciful or good death) could be effected. Inasmuch as it is only voluntary euthanasia that is being argued as an ethical right today, I shall simply quote from Dr. Fletcher’s comments on the distinction between passive and active euthanasia, or withdrawing/withholding treatment and so called mercy killing or assisted suicide. He wrote, "[Some] claim to see a moral difference between deciding to end a life by deliberately doing something and deciding to end a life by deliberately not doing something… What, morally, is the difference between doing nothing to keep [a] patient alive and giving a fatal dose of a painkilling or other lethal drug? The intention is the same either way. A decision not to keep a patient alive is as morally deliberate as a decision to [actively] end a life.”
I cite these words of Fletcher as somewhat of a text for my remarks today, and do so for two reasons. First, he was the pioneer and remains today probably the most articulate and determined ethicist speaking out in strong support of active voluntary euthanasia, repeating essentially the same message again and again over the decades. His moral reasoning has probably influenced more Unitarian Universalists’ thinking than the arguments of any other person in this field. And, second, it was Joseph Fletcher’s moral suasion, more than anything else, that persuaded me to first become involved in this arena of public concern, and to assume the Presidency of the old Euthanasia Society of America way back in 1964.I cannot begin to remember the number of times in those critical earlier years that I quoted these very lines of Fletcher in talks and debates on the subject around the country-wherever anyone would listen--too often on late night radio talk shows! I wish, then, to pay special tribute to Dr. Fletcher on this occasion, in appreciation of all he has done to focus public attention on these moral issues. However, I must also state that over the years I have come, respectfully but ever more strongly, to question the efficacy of this position that insists that assisted suicide and mercy killing are morally indistinguishable from the withdrawing or withholding of treatment, and therefore should become public policy.
Furthermore, I shall proceed to argue, and hope to persuade, that we as UU ministers have a responsibility to place the matter of death control within a larger moral and spiritual perspective than simply that of advocacy of self determination.
II The Argument For Active Euthanasia
Within the strict parameters of concern for personal autonomy, I continue to recognize as valid the argument that there is no moral difference between active and passive euthanasia. The intent and effect in both are the same; a competent patient’s directive is being honored. A strong, logical, and morally consistent argument can be made to extend a terminally ill patient’s decision-making right to include the right to request assistance in committing suicide, or to request that there be administration of a lethal injection with the intent of effecting immediate death. By deliberately acting to mercifully kill a person who requests such help in dying, immediate release can be counted on. Withdrawing or withholding of treatment is not that certain in its timing. Here the disease takes over and does the killing, and the time of death, even with increased doses of pain-killing drugs, cannot be that carefully calibrated, no matter how certain the eventual outcome. In assisted suicide or mercy killing, therefore, full human control is operative.
The belief that it is imperative to have such individual control over how and when one dies is, I believe, the primary moral argument of the Hemlock Society and Americans Against Human Suffering in their efforts to change public opinion and public policy to permit assisted suicide and physician administered dying. And, indeed, I assume from the wording of the General Resolution adopted by our denomination last June, it is our strong belief in the right of self-determination and the importance of people having control over their own lives, including their dying, that compelled us to adopt that resolution to decriminalize assisted suicide and mercy killing.
Clearly the principal of self-determination is at the very core of our free religious faith. We deeply cherish individual freedom. Quality of life issues are an important part of our belief in human dignity. Therefore, it would seem to make a great deal of sense that one’s request for help in dying be honored. Where there is not direct control in dying, there is bound to be more uncertainty and, indeed, there can be a more prolonged dying process. This can be and often is unwanted by the patient and places a more extended burden, emotionally and financially, on loved ones and health providers, which can be harsh.
Who of us wants to suffer the indignity of prolonged, helpless and dehumanizing dying, or be a burden on loved ones in our dying? Who of us would will such a fate on anyone? Who of us would not like to know that when we can no longer function in ways which we determined to be our kind of living we could have our dying expedited, be able to have our lives ended on our terms, at our direction, according to our timing?
I know this is what 1, speaking here today, might have as something of the script for my dying. Why, then, should not compassion and concern, coupled with belief in the moral right of self-determination, be translated into public policy that sanctions active voluntary euthanasia?
III Risks in Active Euthanasia
There are a number of rather specific reasons why I believe this would be a grave mistake. Some of my doubts or concerns are more pragmatic than theological. All, however, speak of different moral values than have been addressed here so far. Such a categorization of concerns, however, does not mean that I necessarily believe the practical problems to be in any way less significant than those that address broader spiritual concerns. Anything that involves public policy and dying is pretty fundamental.
1. Semantic Confusion
My first concern is the widespread confusion that still exists over words and their meaning, the lack of clarity in public discussion of what specifically are the issues involved in advocacy of active euthanasia. Our UU Resolution on the Human Right To Die is a fine example. When this resolution was first introduced two years ago, there was rather widespread confusion over what it said and what it meant. Persons rather deeply involved in the resolution process told me they understood what this was essentially a reaffirmation ofUU support of living wills. The Study Guide prepared by the UUA to help our congregations wrestle with this issue did rather little to clarify matters. In fact, in no place in that material or in anything published by the UUA since, is it even suggested that this resolution calls for a most radical change in public policy; to wit, legalization of assisted suicide and merry killing. Indeed, at no place in the resolution itself are these words or euthanasia even used. I shall assume and trust this vagueness reflects a common semantic confusion, and is not deliberate. However, as this is the first statement to be adopted, I believe, by any religious body in the world in support of active euthanasia, it is unfortunate, to say the least, that its intent is so obtuse. But, then, perhaps what we said is not what we really meant to say!?
2. Slippery Slope in Reverse
One of the most common objections to active voluntary euthanasia, of course, is the "slippery slope” argument. I must confess that I do not share the concern that legalizing physician assisted dying would almost inevitably lead to involuntary euthanasia in its final horror of Nazi-like genocide. Here in the U.S.A. we have a good set of legal checks and balances, and a deep enough tradition of freedom of expression to stem such a movement before it became too slippery.
In this issue, however, it is not the slippery slope of possible abuse of expanded right to die laws that I fear, but just the opposite! There is a very real danger that the progress that has been effected over the last two decades in assuring the right to withhold or withdraw treatment would be seriously threatened and curtailed. What is rarely mentioned in discussion or debate on legalizing assisted suicide or mercy killing is that it has been the fact, the terribly, terribly important fact, that all Living Will, Natural Death or Right To Die laws in the 539 states and the District of Columbia, and all the court decisions in the many states upholding the right to withhold or withdraw treatment--all are predicated on the existing legal prohibition to active euthanasia. It is precisely because active euthanasia is legally prohibited in all 50 states that passive euthanasia has been able to become an accepted principle in medicine and law alike.
Susan Wolf, an associate for law at the renowned Hastings Center, and acknowledged by most persons familiar with the field as one of the country’s leading authorities on the whole right to refuse treatment issue, has written of the danger in the current enthusiasm for legalizing active euthanasia in these words:
That prohibition (on active euthanasia) has served as a dam. We have staked out territory on the very edge of life and worked to humanize it. But this a land we have claimed and tilled by restraining the waters. Remove that dam and a flood will surely overwhelm us. The courtyards and the prosecutors mill rush in. Our own ambivalence towards the dying will surge forward. Informality in decision making, our commitment to care at the end of fife, and the safety of the bedside mill be swamped It is not a matter of keeping the current landscape intact and simply taking another step, as some would have it, in furtherance of established principles of liberty and self-determination. That landscape cannot remain untouched by such a change.2
Unfortunately there already are signs that some courts are beginning to question and even retreat from a more liberal stance on the right to withdraw and withhold treatment; and indeed the debate over whether artificial nutrition and hydration may be terminated upon request has probably just begun in earnest Any legislative action supporting active euthanasia would accelerate the trend of the courts to be more cautionary, restrictive and more repressive. Indeed, here is where the slippery slope in reverse could well herald a return to more and more "horror stories” of people being kept "alive” against their wishes, and an ever increasing number of court battles. If physician administered dying were made legal, judges who have come to understand the need for courts to stay out of health care decisions involving a patient’s right to refuse treatment, would be running back in. No longer would these patient rights issues be subject to civil law, but would be within the purview of criminal courts, which would open a whole new spectrum of investigations and prosecutions. Whatever label is used to describe the act, killing would be the legal issue at stake. And it would be the worst form of naïveté to assume that there would not be a geometric increase in the number of suits brought to contest all manner of treatment decisions with dying patients. The only gain would be in lawyers’ fees!
However morally compelling and consistent an individual’s right may seem to be to request help in dying, is it morally acceptable to advocate such a public policy at the cost of the highly probable devastating effect it would have on the right of dying patients in general to refuse treatment? Is it morally acceptable to advocate action that threatens the very real and important advances that have been made in the struggle to establish a more humane and dignified climate in hospitals for dying patients, where it is now more generally recognized that treatment which simply prolongs the dying process is futile, and that it is immoral and illegal if it is done against the stated wishes of the patient? Again in Susan Wolfs words: "The legal prohibition of active euthanasia has been the necessary backdrop for what progress we have made. That prohibition has served as a dam.” Is it morally appropriate to act in ways which would seriously threaten that dam?
3. Confusing The Physician’s Role
A clearly different moral problem in assisted suicide and mercy killing concerns the responsibility of the physician. Doctors have come a long way from the prevailing approach of only a few years ago that proclaimed it to be a physician’s duty to do all that could be done to assure continuation of "life” in any form. Ceasing treatment, allowing death to come, more and more now is seen not as a denial of duty, but as an act done in fresh recognition of human limits in the physician’s ability to heal the sick. The administration of a lethal injection to a dying patient who has requested it clearly would have the same intent to be sure as letting the disease do the killing. But in terms of the general role and purpose of medicine, and not just as a patient’s right issue, proclaiming physician administered killing--merciful as it may be -public policy, significantly clouds if not transfigures the public image of the doctor as one who seeks to cure and heal. Furthermore, it affords doctors what can readily become an easy out from wrestling with the often difficult and demanding treatment decisions in care of the very sick. There is already a rather extensive suspicion and distrust of doctors in our land. Some of this is deserved to be sure, but suing doctors has become almost a national sport. Empowering them, in effect, to be beneficent executioners is hardly apt to generate a deeper sense of trust from the body public.
Some, and perhaps a good many, doctors certainly do endorse the legalizing of physician administered dying. I am sure they do so for a variety of reasons that are caring and compassionate, but not necessarily correct. They see how distressful the dying process can be to family and loved ones. They surely are the ones who are most knowledgeable of ways to effect dying quickly, surely, and painlessly. Therefore, some physicians today, as has been the case throughout the ages, take it upon themselves, without public knowledge or legal sanction, to mercifully help dying patients end their lives more quickly and easily. Naturally there are no valid statistics available as to how many doctors have practiced assisted suicide or merry killing, but it cannot be a small number. It is probable, however, that there are fewer cases today than a few years back when withholding or withdrawing treatment had not become accepted public policy and there was less medical expertise in pain management, and, of course when hospice care was unknown.
Today in a more permissive social climate and with a willingness -even eagerness- to talk about such things, more and more doctors are acknowledging that physician-aided dying does happen, as was reported in the highly publicized March 30th article of this year in the New England journal of Medicine: ‘The Physician’s Responsibility Towards Hopelessly Ill Patients.” This report appropriately distinguishes between the doctor’s role in assisted suicide and mercy killing. Assisted suicide, of course, is aid given to persons so that they can kill themselves, usually through provision of sufficient doses of sleeping pills or some other medication. For the first time in a highly respected medical journal, a panel of doctors has publicly stated that assisted suicide, noting only the important fact that "no physician has ever been prosecuted in the United States for prescribing pills in order to help a patient commit suicide.” They do add that the potential illegality of this act does serve as a deterrent, forcing the physician to think long and hard about what is being done.
This seems to me to be a good and appropriately ambiguous place to leave assisted suicide, recognizing that it can be a morally appropriate response in certain cases, but not seeking to make it public policy. The fact that suicide itself is not illegal in any state in the Union, clearly makes that awesome option one that is open to any competent adult. Assisted suicide, while legal in the sovereign state of Texas, is against the law everywhere else in the land--and, I submit, should remain so. A deliberate act to assist someone in taking her/his life--however merciful the intent--should not be sanctioned by law. Rather it should be left a private act, with society able to be called in to judgmen t when and if the motive be impugned. This is not a neat and precise system of justice to be sure, but one that continues to afford the least possibility of abuse.
It is even more important that this moral and legal ambiguity be left in tact when it comes to merry killing. If love or compassion and intense frustration or despair over the pain and suffering or lack of any meaningful existence being experienced by a patient or loved one, compels anyone to take another’s life, so be it. I speak here not only of physician administered killing, but in more general terms, because our denominational resolution on the subject does not limit its endorsement of mercy killing to doctors but speaks most vaguely of "those,” whoever they might be, who will so act. Intended or not, this is a very different and far more comprehensive in its coverage than even the legislation being proposed by Americans Against Human Suffering. I cannot begin to imagine how physician administered aid in dying- or this broad endorsement of all manner of mercy killing by any or all "concerned” persons--could be better protected from abuse than under present laws. Here again the overwhelming majority of merry killing cases are not challenged, and those that do come to trial rarely end with a conviction.
The suffering and tragedy AIDS is inflicting on so many, mostly young people, has been cited as a most compelling reason for advocacy of administered aid in dying. Over the past several years I have become rather deeply involved in counseling and support work with a number of gay and bisexual men with AIDS who have privately sought my help in their dying. All have seriously considered suicide, wanted to know from me how this could be effected and where they could get the needed drugs and assistance either in committing suicide or, if needed, some kind of administered aid in dying. In all but one instance, I have accepted their most rational and understandable desire to control their dying. I have told each of them precisely how to get the necessary help if they really wanted it. To my rather certain knowledge, of the sixteen of these men who have died to date, only one finally did choose suicide,
and one other was actively helped to die. All the rest finally chose to live out their dying, assured of support systems, knowing that they would not be forced to accept unwanted treatment, and would receive adequate pain control when and if needed. Granted this is limited and anecdotal evidence. To this date, however, I have met no one working in the AIDS care community in New York City who feels advocacy of active euthanasia the needed public response to this tragic epidemic. Instead, fear often has been expressed of how such advocacy would play into the hand of homophobes, and be an excuse for spending less money, care and time on AIDS treatment and research. In wrestling with AIDS, the will to fight, the right to live, and hope are the paramount needs which we in the religious community can and must foster whenever and wherever we can.
5. The Dutch Example
Lately, much attention has been given to the Netherlands and the general acceptance there of active voluntary euthanasia. The Dutch people, as I know from being married to a Hollander now for nearly 33 years, are extremely independent minded, and most tolerant of all manner of actions that do not threaten their own individual integrity and independence. However, Holland also is an extremely small country with a largely homogeneous population, totally unlike the United States of America. Yet even in Holland, active euthanasia has not been given legislative sanction, but is practiced under careful guidelines regulated and supervised by the courts, in ways that would be most difficult, if not impossible, to replicate in our judicial system that is quite different from that of the Netherlands.
Beyond the very real demographic, cultural and legal differences between Holland and the U.S.A., the most significant difference is one that I feel is perhaps the most compelling moral concern of all against legalizing active euthanasia in our country, certainly at this juncture in our history. Holland has universal access to health care service. The United States does not. We have the distinction of being the only industrialized nation in the world besides the Union of South Africa that does not have some form of national health insurance available to serve all its people. In our land, as we are only too aware, the delivery of health care services is in marked disarray: severely threatened by the spiraling cost of medical care, shortage of hospital beds and nurses where needed most, senseless competition among health care institutions, massive medical malpractice suits, prompting a growing fear among doctors and hospital administrators of initiating any kind of treatment change, a Medicare system providing less and costing more, and an alarming increase in the numbers of Americans completely uninsured and uninsurable. According to the latest polls I have seen, 89% of Americans are dissatisfied with our health care system.
Is it surprising, then, that so many Americans fear the thought of ending their days at the merry of a system that in so many ways is or is seen to be dehumanized and dehumanizing? That dread is real, and I would submit is a major consideration in the choice increasing numbers of us seem to be making in favor of various forms of active euthanasia. We fear being kept endlessly "alive” on machines by uncaring health care providers. We fear the burden the cost of our care can impose on loved ones. We fear the kind of treatment we could expect to receive if we do not have insurance or other resources to cover enormous expenses. And we fear the pain, the suffering and the indignity of it all. These are all understandable fears. That Americans, at the close of the twentieth century should live in such fear and dread of what their health care system could do to their dying is appalling.
In the Netherlands, when a person requests active euthanasia he/ she does so in the full knowledge that acceptable and humane options of treatment care really do exist for everyone, and there is little or no economic pressure in the decision-making process as to what kind of treatment a person really wants and gets. There is no question whatsoever in law or in practice that useless and/or unwanted treatment will be omitted or discontinued as requested. This is all standard medical practice. If none of the other differences between Holland and the U.S.A, existed, the glaring difference between our two countries in availability of health care services is, I believe, more than enough to negate the Dutch experience as a model for us. Fear, anxiety, uncertainty and suspicion never nurture an atmosphere where truly free and reasonable decision making can take place.
This is not an essay on the mounting dilemma in our society of access to and the allocation of health care services, but I would submit that advocating legal sanction of active euthanasia at a time and in a social system where access to care is so limited and its cost so critical, the "right” to die all too easily becomes a "duty” to die.
6. Pain Control
A final moral and most existential of concerns: pain. Periodically all the literature in support of active euthanasia and every argument for its necessity that I have heard asks why anyone should have to experience agonizing and prolonged pain in dying. Why, indeed? There is no moral argument possible in praise of the dignity of enduring pain, except one rooted in some sadomasochistic philosophy, or hopelessly fatalistic and cruel-God focused theology. And there is no medical reason today why anyone should have to suffer prolonged pain in dying. It still happens, but it is almost totally unnecessary and indeed inexcusable.
Pain management, to be sure, is a relatively new medical specialty and requires additional training and understanding by health care providers in the appropriate use of varied therapies. But, of greater significance, it requires changes in attitude and approach of many physicians. There is no question that steadily increased dosages of pain medication can hasten the dying process, and can cause drug addiction. It is to be hoped that with a minimum of reasoned dialogue most health care providers can be helped to overcome absurd guilt feelings they might have about making drug addicts out of their dying patients!
However, it is a fact that the increased medication needed so that a person is truly pain free can, and often does, result in a patient’s earlier death than if more conventional dosages were administered. This does raise a significant moral concern. It can be argued that a physician is committing active euthanasia by so hastening the dying process. It is a fine line that is being drawn here in judging intent. However, when the physician’s role and responsibility is seen as one that is and must be clearly focused on treatment of the disease and its effect on the patient, then adequate pain control is most appropriate -and essential therapy. The disease is causing the pain and the disease is doing the killing. The physician is doing her/his best to make the patient comfortable and pain free, having determined there is no way that a cure can be effected. The physician is not attempting to fulfill a duty beyond that of medical expertise in treatment. The physician is not being asked by society to be an executioner.
Even if you consider the fine line being drawn here a prime example of moral obfuscation, please ponder the difference it can and will make in our health care system generally when more and more doctors come to recognize that it is their responsibility and right under existing law, and it is sound medical practice, to provide adequate pain control. Such concerned, sensible palliative care in dying must be extended, not extinguished by insisting that the administration of pain killing drugs be made into an act of merciful murder. The disease must be seen and accepted as the killer, no the doctor!
The hospice movement has wonderfully demonstrated how significantly pain-free the dying process can be when sufficient medication is provided as needed in a caring and loving atmosphere. Here there is no talk or suspicion of physician-administered dying or merciful murder.
In this issue of pain control, as in the other specific moral concerns that I have detailed, obviously I have sought to demonstrate that advocacy of voluntary euthanasia, however appealing as an individual right of self-determination, can seriously threaten, indeed destroy, the hard fought gains in patients’ rights to forgo or refuse treatment. Its advocacy can well negate all manner of advances in public understanding and medical practice that have begun, at least, to re-establish dying as a natural, acceptable and inevitable event.
Of what particular relevance, however, are such concerns to us as UU clergy? Many are matters that involve the medical and legal professions more directly than the ministerial, to be sure. And bioethicists-in that newest of professions--are addressing these matters with great care and concern, and with an expertise that few of us can hope to match. Yet dying remains a rather basic experience, that belongs at the very heart of religious concern. As UU pastors and preachers we have a responsibility to help rehumanize the dying process. In our high tech age and highly fractured and atomized society, health care decision making often prompts the most complex and intense feelings among people about their living and dying, and they need to be faced within a spiritual perspective. Dying has been medicalized far too much, abstracted from the home and from care of loved ones and concern of friends. It has been institutionalized, legalized, and now politicized far too much.
More and more I am convinced that the legislative arena is the least productive and profitable place to address these concerns. As Americans and as Unitarian Universalists we have a special fondness for passing resolutions and laws to resolve ethical issues that bother us. Sometimes this works and is most appropriate. As a long tune social activist, I would in no way denigrate the importance of general resolutions or of political activism. It is a terrible irony, however, that often individual rights are eroded rather than enhanced by legislative efforts to insure and/or expand these most personal and private rights--as, alas, we are seeing in the issues of abortion and gay rights, for instance.
The right of a dying person to forgo treatment is the kind of basic right of privacy and personal liberty that must not be allowed to be a political football. Living wills, as expressions of such a personal right, do not so much require legislative endorsement as they call for education and understanding among health care providers and the public.3
The circumstances surrounding decision making in terminal illness rarely fit pat legalistic or moralistic frameworks and so often require most sensitive and soul searching analysis to determine what really reflects a patient’s wishes, even with living wills. It is quite remarkable how changeable so many of us, if not most of us, can be in our attitudes and convictions about our dying. We clergy are in an especially privileged position to see and to recognize how complex and variable the circumstances can be in times of terminal illness, and how critical it is that there be as caring, trusting and supportive an atmosphere as possible. Confrontation, posturing of competing moralistic convictions, suspicions, suits and counter suits, court hearings, do not create circumstances conducive to dignity and respect in anyone’s dying.
Few, if any, of us do not harbor considerable ambivalence about our own mortality, no matter how rational and resolute we think ourselves to be. Our congregants are no different For instance, I would assume at least 98% of UU’s affirm the concept of living wills, believe in their importance, and would have such detailed requests present to guide any treatment decisions that were to be made on their behalf. Yet I would hazard the guess that at most 20% of us in this room this afternoon have signed our own living wills. What does that say about our approach to dying? Our professed desire to control the circumstances of our own dying? How much responsibility do we really want and are we prepared to assume? Are we perhaps, unconsciously, recognizing that we can’t and don’t want to control it all? Or, are we denying our ownmortality? I don’t know. Do you?
As UU’s we cherish personal liberty. We hold individual freedom sacred. We would be free to hold whatever beliefs and convictions approve themselves to our hearts and minds. We would be free to act on our convictions. This means we would direct, control our lives in every way that is possible. What, however, guides us in exercising direction and control over our lives? It is our faith, the values we cherish, the life view we hold. Traditionally our challenge as UU clergy has been to expand the sense of ownership people feel over their own lives, the control they -we--should and must exercise if we would fulfill our potential as truly free and responsible human beings and help shape the world of our ideals.
More and more, however, we are coming to realize there are limits to how much we can and should hope to control things. Our presumptions of ownership and dominion and control over the natural order are coming up to haunt us at almost every turn. We are learning that human dignity is not only a matter of achieving one’s own potential, being liberated from arbitrary, oppressive controls, and directing our own footsteps. It is recognizing the very limits that do exist in humanness-and surely the most fundamental, universal of these limits is our mortality. We all die. We have no final control over this most basic fact of nature. Of course we cannot return to the world of Montaigne, but there is wisdom yet in work of dying for us.
Medical science is an awesome interference in the ways of nature, giving us humans amazing control over our living. In untempered zeal we have used this control heedlessly to prolong the dying process, to keep people alive who should have been allowed to die. Let us not now i seek to extend this zeal for control of the natural order by proclaiming it to be moral truth and public policy that there is no difference between the deliberate killing of a dying person, and letting nature, through whatever disease is at work, be the acknowledged power and force behind the event.
In our skepticism of dogmatic truths, and wise rejection of creedal professions of faith, it is difficult to bring these cautions and concerns about our presumptions of control under any clear imperative in our free faith. However, if I understand at all what is meant in our UUA Statement of Purposes in which we affirm: "Respect for the interdependent web of all existence of which we are a part;” it must mean that we acknowledge being part of one complex and finely interwoven life process which of necessity places limits on our wants and wishes.
To be sure, an awesome right and burden of freedom is that each of us always is free to defy moral convention and the law if we feel compelled to do so. Each of us is therefore free to assist in the dying of another if we are personally convinced that it is morally imperative to do so. But can we demand, should we advocate that our personal act of conscience be given the moral sanction of public policy?
In the last analysis, I would submit that however morally justified one may consider the call for legalization of assisted suicide and mercy killing or physician administered dying or whatever euphemism for active euthanasia we would use, it is more an elitist, consumer rights demand for personal power and special privilege than it is a moral imperative of our free faith. If achieved, it would be won at too great a cost to the rights of others not so privileged as most UU’s are. This must not be allowed to happen. Granted, our congregations generally are not made up of the threatened urban and rural poor and the homeless. UU’s are not among the ever growing number of N drug users who may or may not yet have AIDS and who are so extensively denied any access to treatment and care. Most of us are not the frail aged who are being made more and more to realize what a burden they have become to society. Yet we are one body. We have the one gospel to preach that would affirm and promote the inherent worth and dignity of every person. And, all of us need to face our dying and the dying of others not just in terms of rights and responsibilities, but in recognition of the holy event that it is--the most sacred and still the most awesome and mysterious aspect of living.
How a society approaches the needs and concerns of all its sick and dying surely is one of the most critical tests of its health and integrity. Let us not allow ourselves to be fooled into thinking that the many and complex concerns of death and dying can be resolved through parliamentary debates and legislative dictates. Dying remains a far more majestic matter than any and all our efforts to direct and control its ways. Let us focus afresh on things we can and must do to strengthen the bond of community and caring within our churches and society. For it is finally in relationship, respect, a sense of responsibility for others and with a hefty dose of humility, chat the strength and wit and faith are found to wrestle with all issues of living.
‘1. For full text of the Resolution see the Appendix.
2. S. M. Wolf, Holding the Line on Euthanasia,Hastings Center Report, A Special Supplement, January/February, 1989, p. 13.
3. This same conclusion, I am glad to say, was reached by the U.S. President’s Commission For The Study of Ethical Problems In Medicine and Biomedical And Behavioral Research, in its landmark report: Deciding To ForegoLife Sustaining Treatment.
Text of the Resolution adopted 6y the General Assembly of the Unitarian Universalist Association, Palm Springs, California, June, 1988.
THE RIGHT TO DIE WITH DIGNITY
Guided by our belief as Unitarian Universalists that human life has inherent dignity, which may be compromised when life is extended beyond the will or ability of a person to sustain that dignity; and believing that it is every person’s inviolable right to determine in advance the course of action to be taken in the event that there is no reasonable expectation of recovery from extreme physical or mental disability; and
WHEREAS, medical knowledge and technology make possible the mechanical prolongation of life; and
WHEREAS, such prolongation may cause unnecessary suffering and/ or loss of dignity while providing little or nothing of benefit to the individual; arid
WHEREAS, such procedures have an impact upon a health-care system in which services are limited and are inequitably distributed; and
WHEREAS, differences exist among people over religious, moral, and legal implications of administering aid in dying when an individual of sound mind has voluntarily asked for such aid: and
WHEREAS, many counselors, clergy and health-care personnel value prolongation of life regardless of the quality of life or will to live;
THEREFORE BE IT RESOLVED: That the Unitarian Universalist Association calls upon its congregations and individual Unitarian Universalists to examine attitudes and practices in our society relative to the ending of life, as well as those in other countries and cultures; and
BE IT FURTHER RESOLVED: That Unitarian Universalists reaffirm their support for the Living Will, as declared in a 1978 resolution of the General Assembly, declare support for the Durable Power of Attorney for Health Care, and seek assurance that both instruments will be honored; and
BE IT FURTHER RESOLVED: That Unitarian Universalists advocate the Right to self-determination in dying, and there lease from civil or criminal penalties of those who, under proper safeguards, act to honor the right of terminally ill patients to select the time of their own deaths; and
BE IT FURTHER RESOLVED: That Unitarian Universalists advocate safeguards against abuses by those who would hasten death contrary to an individual’s desires; and
$E IT FINALLY RESOLVED: That Unitarian Universalists, acting through their congregations, memorial societies, and appropriate organizations, inform and petition legislators to support legislation that will create legal protection for the right to die with dignity, in accordance with one’s own choice.