For many parents, a Volkswagen
van is associated with putting children to sleep on a camping trip. Jack Kevorkian, a Detroit pathologist, has
now linked the van with the veterinarian's meaning of "putting to
sleep." Kevorkian conducted a dinner interview with Janet Adkins, a
54-year-old Alzheimer's patient, and her husband and then agreed to help her
commit suicide in his VW van. Kevorkian
pressed beyond the more generally accepted practice of passive euthanasia
(allowing a patient to die by withholding or withdrawing treatment) to active
euthanasia (killing for mercy).
Kevorkian, moreover, did not comply with
the strict regulations that govern active euthanasia in, for example, the
Netherlands. Holland requires that death be imminent (Adkins had beaten her son
in tennis just a few days earlier); it demands a more professional review of
the medical evidence and the patient's resolution than a dinner interview with
a physician (who is a stranger and who does not treat patients) permits; and it
calls for the final, endorsing signatures of two doctors.
So Kevorkian-bashing is easy. But the
question remains: Should we develop a judicious, regulated social policy
permitting voluntary euthanasia for the terminally ill? Some moralists argue
that the distinction between allowing to die and killing for mercy is petty
quibbling over technique. Since the patient in any event dies -- whether by
acts of omission or commission -- the route to death doesn't really matter. The
way modern procedures have made dying at the hands of experts and their
machines such a prolonged and painful business has further fueled the
euthanasia movement, which asserts not simply the right to die but the right to
be killed.
But other moralists believe that there is
an important moral distinction between allowing to die and mercy killing. The
euthanasia movement, these critics contend, wants to engineer death rather than
face dying. Euthanasia would bypass dying to make one dead as quickly as
possible. It aims to relieve suffering by knocking out the interval between
life and death. It solves the problem of suffering by eliminating the sufferer.
The impulse behind the euthanasia movement
is understandable in an age when dying has become such an inhumanly endless
business. But the movement may fail to
appreciate our human capacity to rise to the occasion of our death. The best death is not always the sudden
death. Those forewarned of death and
given time to prepare for it have time to engage in acts of
reconciliation. Also, advanced grieving
by those about to be bereaved may ease some of their pain. Psychiatrists have observed that those who
lose a loved one accidentally have a more difficult time recovering from the
loss than those who have suffered through an extended period of illness before
the death. Those who have lost a close
relative by accident are more likely to experience what Geoffrey Gorer has
called limitless grief. The community,
moreover, may need its aged and dependent, its sick and its dying, and the
virtues which they sometimes evince -- the virtues of justice and love manifest
in the agents of care.
On the whole, our social policy should
allow terminal patients to die but it should not regularize killing for mercy. Such
a policy would recognize and respect that moment in illness when it no longer
makes sense to bend every effort to cure or to prolong life and when one must
allow patients to do their own dying. This policy seems most consonant with the
obligations of the community to care and of the patient to finish his or her
course.
Advocates of active euthanasia appeal to
the principle of patient autonomy -- as the use of the phrase "voluntary
euthanasia" indicates. But emphasis on the patient's right to determine
his or her destiny often harbors an extremely naïve view of the uncoerced
nature of the decision. Patients who plead to be put to death hardly make
unforced decisions if the terms and conditions under which they receive care
already nudge them in the direction of the exit. If the elderly have stumbled
around in their apartments, alone and frightened for years warehoused in
geriatrics barracks, then the decision to be killed for mercy hardly reflects
an uncoerced decision. The alternative may be so wretched as to push patients
toward this escape. It is a huge irony and, in some cases, hypocrisy to talk
suddenly about a compassionate killing when the aging and dying may have been
starved for compassion for many years. To put it bluntly, a country has not
earned the moral right to kill for mercy unless it has already sustained and
supported life mercifully. Otherwise we kill for compassion only to reduce the
demands on our compassion. This statement does not charge a given doctor or
family member with impure motives. I am concerned here not with the individual
case but with the cumulative impact of a social policy.
I can, to be sure, imagine rare
circumstances in which I hope I would have the courage to kill for mercy --
when the patient is utterly beyond human care, terminal, and in excruciating
pain. A neurosurgeon once showed a group of physicians and an ethicist the
picture of a Vietnam casualty who had lost all four limbs in a landmine
explosion. The catastrophe had reduced the soldier to a trunk with his face
transfixed in horror. On the battlefield
I would hope that I would have the courage to kill the sufferer with mercy.
But hard cases do not always make good
laws or wise social policies. Regularized mercy killings would too quickly
relieve the community of its obligation to provide good care. Further, we
should not always expect the law to provide us with full protection and
coverage for what, in rare circumstances, we may morally need to do. Sometimes
the moral life calls us out into a no-man's-land where we cannot expect total
security and protection under the law. But no one said that the moral life is
easy.
(1990)
