Death Without Dignity

For several years now Americans have been hearing a somber new slogan: "Death with dignity." Meaning: the American way of death has become too technological, often condemning a patient to a lingering and painful end in which he is kept artificially alive by a maze of tubes and life-support machines. To prevent such dehumanizing procedures, the advocates of death with dignity recommend that doctors be allowed to cease extraordinary lifesaving efforts when it is clear that the patient is beyond further help. The living are counseled to ease the dying person's final agony by keeping him company during his last hours. This approach to terminal illness (TIME Essay, July 16, 1973) has won wide support, including the approval of Protestant, Roman Catholic and Jewish moralists.

Last week another call for death with dignity--one certain to provoke a sharp ethical debate--appeared in the new issue of the bimonthly journal The Humanist. Entitled "A Plea for Beneficent Euthanasia," it bears such diverse signatures as those of French Biologist Jacques Monod, Situation Ethicist Joseph Fletcher and CORE Founder James Farmer. The document recommends not only the "passive" euthanasia now widely advocated, but "active" euthanasia as well: direct action to speed the death of a dying patient--an act that is technically murder. (No country has yet legalized euthanasia, though in some nations a compassionate motive has been recognized in law as an extenuating circumstance in mercy killing.) Lethal Drugs. To be sure, only patients who freely request either form of euthanasia would be so treated (an exception: those already suffering brain death). The definition of active euthanasia in the plea is also narrowly specific: "The administration of drugs to relieve suffering until the dosage reaches the lethal stage."

One of the 40 signers is Catholic Theologian Daniel C. Maguire of Marquette University, author of the recent book Death by Choice. In an accompanying essay, Maguire points out that in spite of the widespread notion that Catholics are totally opposed to active euthanasia, or what he plainly calls mercy killing, he is not the only Catholic theologian who believes it may be justified in some cases.

Against such swift developments in the growing euthanasia campaign, there is also the beginning of a countermovement. In fact, one of the men who first spoke out against excessive medical care for the dying, Princeton Ethicist Paul Ramsey, is now worried because so many people have taken up the cause.

Writing in the current issue of the Hastings Center Studies, Ramsey argues that the idea of death with dignity is now being too readily promoted and death itself too easily accepted. To suggest, as many proponents of euthanasia are doing, that death is an occurrence as natural as birth smacks of "whistling before the darkness descends" and denotes a "very feeble philosophy." It is "soap-opera stuff' to say that "death can be beautiful." Indeed, says Ramsey, death is "the ultimate indignity."

Ramsey, a Methodist, cites St. Paul's Epistle to the Romans in supporting the traditional Christian view that death entered the world as "the wages of sin" --the punishment for Adam's fall.* Ever since, Ramsey insists, death has been "the enemy." Jesus' death on the cross redeemed man for immortality, but did nothing to prevent death from being a shattering separation of soul and body. Christians, argues Ramsey, thus properly dread death, and in their care for the sick wisely laid the foundations of Western medicine. Nowadays, Ramsey says, "true humanism" still depends on a "dread of death." Romantically investing death with a bogus dignity, he suggests, may in fact hinder care for the dying by establishing a new set of illusions.

Ramsey receives both support and strong criticism in the same issue of the Hastings Center Studies from Dr. Leon Kass, a physician and molecular biologist who works in biomedical ethics. Kass takes issue with Ramsey's view of death as an "indignity," insisting instead that "to live is to be mortal." Jewish, if not Christian teaching has generally held that view, Kass says; evolutionary biology confirms and strengthens it.

Yet Kass, like Ramsey, is worried about euthanasia sloganeering that might mask "our prejudices against the old and 'useless' and, in some cases, our simply crass and selfish interests." Like Ramsey, he questions the slogan's implication that "dignity will reign if only we can push back officious doctors, machinery and hospital administrators." Indeed, reflects Kass, "a death with dignity may turn out to be something rare and uncommon, like a life with dignity."

* Some modern Christian theologians and biblical scholars are less literal about the cause of death in the world. Any "immortality" of primordial man was a divine gift, explain some, not man's natural condition. Another suggestion is that pre-fall man would have somehow had to end his "biological and historical" existence, but would have done it voluntarily and without trauma.

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