Editorial
203
Editorial
Dignity and Death
The sustained discussion in religious, medical, psychological, and legal circles over planned parenthood, population control, abortion, and other methods of limiting h u m a n reproduction revolves, as we know, around the definition of life: what it is distinctively for h u m a n beings, when in the reproductive process it comes into being, and whether it is ever ethical or legal to limit it in any way. The accusation that the practice of any form of birth control constitutes murder is as extreme as the rhetoric that declares that no unwanted life should ever be permitted to be born. While assuming the good intentions of those who make such extreme claims, one m a y question their good judgment. M a n y lives unwanted at the start have turned out to be wanted and needed by the h u m a n race; and on the other hand an ethical case can be made for the deliberate and selective limitation of the creation of life in the interests of individuals, the family, and the human race itself. W e are here concerned, however, with the other side of the same question. W h a t is the humane, ethical, and religious view of the end of life, the process of dying and death? Here, as in our thinking about birth, it is important to avoid extreme and dogmatic positions. Most of us would agree that there comes a time for many, perhaps most,, people when life as a self-conscious, experiential, sensitive, and developing reality ceases, even though the vital organs m a y still be functioning or can be made to function by mechanical devices. W e also know that this moment is often hard to determine and that it is probably better, as the medical profession has done from time immemo-
204
Journal of Religion and Health
rial, to err on the side of preserving life t h a n on the side of destroying it or letting it ebb away. But within these extremes there is r o o m for discussion, choice, a n d planning. W e were r e m i n d e d of this fact recently w h e n a n interesting d o c u m e n t c a m e to o u r attention. It is k n o w n as " A L i v i n g Will," published b y the E u t h a n a s i a E d u c a t i o n a l F u n d , 250 West 57th Street, N e w York City. T h e d o c u m e n t reads as follows: T O MY FAMILY, MY PHYSICIAN, MY CLERGYMAN, MY L A W Y E R - If the time comes when I can no longer take part in decisions for my own future, let this statement stand as the testament of my wishes: If there is no reasonable expectation of my recovery from physical or mental or spiritual disability, I, , request that I be allowed to die and not be kept alive by artificial means or heroic measures. Death is as much a reality as birth, growing maturity and old age--it is the one certainty. I do not fear death as much as I fear the indignity of deterioration, dependence and hopeless pain. I ask that drugs be mercifully administered to me for terminal suffering even if they hasten the moment of death. This request is made while I am in good health and spirits. Although this document is not legally binding, you who care for me will, I hope, feel morally bound to follow its mandates. I recognize that it places a heavy burden of responsibility upon you, and it is with the intention of sharing that responsibility and of mitigating any feelings of guilt that this statement is made. T h e above is m e a n t to be signed a n d witnessed like a will, a n d copies are to be filed with family, c l e r g y m a n , doctor, a n d lawyer. This simple s t a t e m e n t is based u p o n the recognition of a n u m b e r of profound affirmations a b o u t the n a t u r e a n d m e a n i n g of life. First is the r e g a r d for life as something m o r e t h a n the m e r e functioning of the vital organs. Life is consciousness, a c a p a c i t y to respond a n d interact with other life, the ability of h e a r t a n d b r a i n to feel a n d think. W h e n these activities are no longer possible, a n d w h e n it a p p e a r s all b u t certain that they c a n n o t be recreated by a n y t r e a t m e n t or stimulation, then d e a t h has indeed o c c u r r e d or is well on the way. Dr. H e r b e r t R h o a d s of Chicago, who has been c h a i r m a n of the A m e r i c a n Medical Association's commission on medicine a n d religion in recent years, has said t h a t " t h e r e is a reasonable a m o u n t of a g r e e m e n t a m o n g
Editorial
205
doctors that if certain signs are present, it is pretty sure that a patient won't survive without 'heroic measures.'" These measures include such things as a mechanical respirator or the electrical stimulation of the heart beat, not for a brief period to "prime the pump," as it were, but on a more or less permanent basis, even though signs, as Dr. Rhoads points out, indicate that it is time to turn off the machines. For example, when there is no response to painful stimuli, when the pupils are greatly dilated, when the electroencephalograph shows only a straight line for several minutes, it is likely that brain death has occurred, and the process cannot be reversed. According to Dr. Rhoads, only a minority of physicians would keep a patient alive artificially if all these signs were present. T h e y would avoid "heroic measures" and let death come as painlessly as possible. The living will provides not for the active bringing about of death, but for the passive acceptance of it as a natural and inevitable reality. Moreover, it touches another aspect of the h u m a n psyche that is familiar to many. We do not fear death itself. W e know that it is a part of life and nature. W h a t most of us fear is the process of dying, which is so often in later years prolonged, painful, debilitating, and undignified. Most of us cherish the hope that we m a y be able to die, as it were, in the midst of life, without the tragic sense of running down and losing our grip that is the real sadness of sickness and old age. In a world that is facing the necessity of some kind of control over the creation of life so that the communal life of man may continue, it is not surprising that there should be concern for the conscientious and compassionate control of the end of life. One of the problems here is that people are often no more conscious of w h a t is going on when life ends than they were when it began. There can be no planning of one's own creation and birth, but there can be a certain amount of reflection and planning about the way one would prefer to die. We cannot escape suffering, but we can perhaps escape some degree of prolonged suffering, weakness, and incompetence that destroys the mind and the spirit and makes us in the end less human than we would want to be and makes our lives a burden to ourselves and our loved ones. It is in this spirit that the living will has been proposed.
206
Journal of Religion and Health
It should be noted that the living will puts the responsibility upon others to decide when the heroic measures should be refused or suspended and when the individual's life should be permitted to end. The assumption is that in most cases, as long as we are conscious, capable of reflection, and aware of some kind of responsive and affectionate interchange with the world around us, we will choose to live. But if and when the time comes when consciousness is gone entirely or is permanently receding, we must ask those who know us best to decide for us what we would most like to do and to perform an act of love by letting us die in peace. It is hard to imagine a greater and more loving gift that a person could make to one he loves than that of a peaceful death. After all the other gifts of love and strains of life, this is perhaps the hardest to make and the most precious gift of all. Euthanasia is not, as extremists tend to insist, either suicide or "mercy killing." It is exactly what the Greek root of the word implies: good death, death with a sense of respect for the dignity of the dying individual. It is a trustfulness in the processes of nature that goes so far as to believe that there comes a moment when it is simply best to let them take their course. The living will asks each person involved in the choice to take the moral responsibility for a final act of love. In a world where death comes to so m a n y with carelessness, cruelty, neglect, and studied indifference, as in war, p~verty, individual and collective violence, n a t u r a l calamities, starvation, and political suppression, it is perhaps asking much to suggest that those who may be fortunate enough to die peacefully in bed give some thought to the act of dying. So precarious are our life and our so-called civilization that these choices may not, in the end, turn out to be available to any of us. But there may be some moral and spiritual value, some h u m a n utility, in each person's reflecting on his own death long enough to decide how he would like it to be. Such reflection is not depressing, but simply more realistic and more sane than the pretense that we are always young and that death is something that happens only to other people. It is well also that we should learn to talk about these matters with those we trust and love while we and they can still talk with some calmness and objectivity. T h e counsel and guidance of physicians, clergymen, and lawyers are of great
Editorial
207
importance, too. When death comes close to us, it is always a shock. We do not think well. We too easily become prey for those who exploit the emotions and needs of death and the grief that inevitably attends it. T h e n we find, when calmness returns, that we have clothed with sentimentality and conspicuous consumption the last highly personal and deeply important act of a loved one's life--his death. The hunger to live with responsibility, awareness, and love is surely akin to the hunger to die with dignity. Perhaps these two hungers, taken together, say more about the destiny of m a n both scientifically a n d spiritually than we can possibly imagine at this stage of h u m a n development. Harry C. Meserve
203
Editorial
Dignity and Death
The sustained discussion in religious, medical, psychological, and legal circles over planned parenthood, population control, abortion, and other methods of limiting h u m a n reproduction revolves, as we know, around the definition of life: what it is distinctively for h u m a n beings, when in the reproductive process it comes into being, and whether it is ever ethical or legal to limit it in any way. The accusation that the practice of any form of birth control constitutes murder is as extreme as the rhetoric that declares that no unwanted life should ever be permitted to be born. While assuming the good intentions of those who make such extreme claims, one m a y question their good judgment. M a n y lives unwanted at the start have turned out to be wanted and needed by the h u m a n race; and on the other hand an ethical case can be made for the deliberate and selective limitation of the creation of life in the interests of individuals, the family, and the human race itself. W e are here concerned, however, with the other side of the same question. W h a t is the humane, ethical, and religious view of the end of life, the process of dying and death? Here, as in our thinking about birth, it is important to avoid extreme and dogmatic positions. Most of us would agree that there comes a time for many, perhaps most,, people when life as a self-conscious, experiential, sensitive, and developing reality ceases, even though the vital organs m a y still be functioning or can be made to function by mechanical devices. W e also know that this moment is often hard to determine and that it is probably better, as the medical profession has done from time immemo-
204
Journal of Religion and Health
rial, to err on the side of preserving life t h a n on the side of destroying it or letting it ebb away. But within these extremes there is r o o m for discussion, choice, a n d planning. W e were r e m i n d e d of this fact recently w h e n a n interesting d o c u m e n t c a m e to o u r attention. It is k n o w n as " A L i v i n g Will," published b y the E u t h a n a s i a E d u c a t i o n a l F u n d , 250 West 57th Street, N e w York City. T h e d o c u m e n t reads as follows: T O MY FAMILY, MY PHYSICIAN, MY CLERGYMAN, MY L A W Y E R - If the time comes when I can no longer take part in decisions for my own future, let this statement stand as the testament of my wishes: If there is no reasonable expectation of my recovery from physical or mental or spiritual disability, I, , request that I be allowed to die and not be kept alive by artificial means or heroic measures. Death is as much a reality as birth, growing maturity and old age--it is the one certainty. I do not fear death as much as I fear the indignity of deterioration, dependence and hopeless pain. I ask that drugs be mercifully administered to me for terminal suffering even if they hasten the moment of death. This request is made while I am in good health and spirits. Although this document is not legally binding, you who care for me will, I hope, feel morally bound to follow its mandates. I recognize that it places a heavy burden of responsibility upon you, and it is with the intention of sharing that responsibility and of mitigating any feelings of guilt that this statement is made. T h e above is m e a n t to be signed a n d witnessed like a will, a n d copies are to be filed with family, c l e r g y m a n , doctor, a n d lawyer. This simple s t a t e m e n t is based u p o n the recognition of a n u m b e r of profound affirmations a b o u t the n a t u r e a n d m e a n i n g of life. First is the r e g a r d for life as something m o r e t h a n the m e r e functioning of the vital organs. Life is consciousness, a c a p a c i t y to respond a n d interact with other life, the ability of h e a r t a n d b r a i n to feel a n d think. W h e n these activities are no longer possible, a n d w h e n it a p p e a r s all b u t certain that they c a n n o t be recreated by a n y t r e a t m e n t or stimulation, then d e a t h has indeed o c c u r r e d or is well on the way. Dr. H e r b e r t R h o a d s of Chicago, who has been c h a i r m a n of the A m e r i c a n Medical Association's commission on medicine a n d religion in recent years, has said t h a t " t h e r e is a reasonable a m o u n t of a g r e e m e n t a m o n g
Editorial
205
doctors that if certain signs are present, it is pretty sure that a patient won't survive without 'heroic measures.'" These measures include such things as a mechanical respirator or the electrical stimulation of the heart beat, not for a brief period to "prime the pump," as it were, but on a more or less permanent basis, even though signs, as Dr. Rhoads points out, indicate that it is time to turn off the machines. For example, when there is no response to painful stimuli, when the pupils are greatly dilated, when the electroencephalograph shows only a straight line for several minutes, it is likely that brain death has occurred, and the process cannot be reversed. According to Dr. Rhoads, only a minority of physicians would keep a patient alive artificially if all these signs were present. T h e y would avoid "heroic measures" and let death come as painlessly as possible. The living will provides not for the active bringing about of death, but for the passive acceptance of it as a natural and inevitable reality. Moreover, it touches another aspect of the h u m a n psyche that is familiar to many. We do not fear death itself. W e know that it is a part of life and nature. W h a t most of us fear is the process of dying, which is so often in later years prolonged, painful, debilitating, and undignified. Most of us cherish the hope that we m a y be able to die, as it were, in the midst of life, without the tragic sense of running down and losing our grip that is the real sadness of sickness and old age. In a world that is facing the necessity of some kind of control over the creation of life so that the communal life of man may continue, it is not surprising that there should be concern for the conscientious and compassionate control of the end of life. One of the problems here is that people are often no more conscious of w h a t is going on when life ends than they were when it began. There can be no planning of one's own creation and birth, but there can be a certain amount of reflection and planning about the way one would prefer to die. We cannot escape suffering, but we can perhaps escape some degree of prolonged suffering, weakness, and incompetence that destroys the mind and the spirit and makes us in the end less human than we would want to be and makes our lives a burden to ourselves and our loved ones. It is in this spirit that the living will has been proposed.
206
Journal of Religion and Health
It should be noted that the living will puts the responsibility upon others to decide when the heroic measures should be refused or suspended and when the individual's life should be permitted to end. The assumption is that in most cases, as long as we are conscious, capable of reflection, and aware of some kind of responsive and affectionate interchange with the world around us, we will choose to live. But if and when the time comes when consciousness is gone entirely or is permanently receding, we must ask those who know us best to decide for us what we would most like to do and to perform an act of love by letting us die in peace. It is hard to imagine a greater and more loving gift that a person could make to one he loves than that of a peaceful death. After all the other gifts of love and strains of life, this is perhaps the hardest to make and the most precious gift of all. Euthanasia is not, as extremists tend to insist, either suicide or "mercy killing." It is exactly what the Greek root of the word implies: good death, death with a sense of respect for the dignity of the dying individual. It is a trustfulness in the processes of nature that goes so far as to believe that there comes a moment when it is simply best to let them take their course. The living will asks each person involved in the choice to take the moral responsibility for a final act of love. In a world where death comes to so m a n y with carelessness, cruelty, neglect, and studied indifference, as in war, p~verty, individual and collective violence, n a t u r a l calamities, starvation, and political suppression, it is perhaps asking much to suggest that those who may be fortunate enough to die peacefully in bed give some thought to the act of dying. So precarious are our life and our so-called civilization that these choices may not, in the end, turn out to be available to any of us. But there may be some moral and spiritual value, some h u m a n utility, in each person's reflecting on his own death long enough to decide how he would like it to be. Such reflection is not depressing, but simply more realistic and more sane than the pretense that we are always young and that death is something that happens only to other people. It is well also that we should learn to talk about these matters with those we trust and love while we and they can still talk with some calmness and objectivity. T h e counsel and guidance of physicians, clergymen, and lawyers are of great
Editorial
207
importance, too. When death comes close to us, it is always a shock. We do not think well. We too easily become prey for those who exploit the emotions and needs of death and the grief that inevitably attends it. T h e n we find, when calmness returns, that we have clothed with sentimentality and conspicuous consumption the last highly personal and deeply important act of a loved one's life--his death. The hunger to live with responsibility, awareness, and love is surely akin to the hunger to die with dignity. Perhaps these two hungers, taken together, say more about the destiny of m a n both scientifically a n d spiritually than we can possibly imagine at this stage of h u m a n development. Harry C. Meserve
