Suicide, Assistante Suicide And Euthanasia

SUICIDE, ASSISTED SUICIDE, AND VOLUNTARY EUTHANASIA: UNSETTLING QUESTIONS, UNSETTLED RESPONSES

Conventionally understood as the intentional and active killing of oneself, suicide has been overwhelmingly condemned by the church. Granted, Scripture and early church teaching are somewhat equivocal on the question of suicide.[1] New Testament authors and early church fathers struggled to distinguish legitimate martyrdom from suicide, to understand the meaning of Christian suffering in the face of state persecution, and to integrate the discipline of asceticism into broader church teaching.[2] Early church fathers also debated whether Christian women could be permitted to commit suicide to preserve their chastity in times of war. Still, suicide is generally condemned in the early church and any equivocation is gone by the time of Augustine, who in the City of God condemned all suicides without exception, even those committed by Christian women seeking to preserve their chastity.[3] Later, Augustine's arguments were repeated, amplified, and sharpened by Catholic theologians, most notably Thomas Aquinas,[4] and largely accepted by Protestant and Anglican Reformers.[5]

In view of this tradition, it is perhaps all the more remarkable that delegates at the 1997 General Convention of the Episcopal Church will be asked to reconsider the moral permissibility of suicide. More to the point, delegates will be asked to reconsider suicide in the context of the current societal debate about medically assisted suicide and a form of medically assisted killing[6] now commonly called voluntary euthanasia or voluntary active euthanasia. This reconsideration is being urged by at least two dioceses of the Episcopal Church, the Diocese of Newark and the Diocese of Washington.

Self-consciously breaking with centuries of church tradition, the Diocese of Newark will present a report that asks convention delegates to affirm the moral permissibility of suicide and assisted suicide when the decision is informed and voluntary, the underlying medical condition or injury is terminal or incurable, the pain or suffering is persistent or progressive, and all other reasonable means of amelioration of pain and suffering have been exhausted.[7] The second report, produced by the Committee on Medical Ethics for the Diocese of Washington,[8] treats both assisted suicide and voluntary euthanasia; indeed, the two are said to be morally equivalent since the person requesting assistance with suicide or voluntary euthanasia retains primary moral responsibility for the act.[9] The Washington Report is officially neutral on these controversial issues. It is intended as a study document, and it presents arguments both for and against assisted suicide and voluntary euthanasia. However, this neutrality can also be viewed as a break with church tradition, for these are issues on which the church has hardly been neutral.

In view of these reports, then, and their possible implications for church teaching, I want here to raise a number of questions related to suicide, assisted suicide, and euthanasia. My aim is not so much to offer a detailed critique or close reading of the Newark and Washington Reports (though I will do some of this) as it is to use them as an occasion to reflect on some of the issues at stake for delegates in considering these reports. First, then, I want to consider why these questions are being raised now, and particularly why they are being raised now by Christians. For while I could not agree with the Bishop of Newark that "these issues are peculiarly modem ones,"[10] I do agree that there are reasons why suicide, assisted suicide, and euthanasia now seem particularly urgent to contemporary (western) Christians. Second, I want to explore some conceptual and ethical problems that make it difficult to construct coherent arguments for or against these practices. For on examination, and as a result of certain medical and technological developments, it may be that conventional understandings of suicide and the moral arguments made on the basis of these understandings are not as straightforward or as compelling as they once seemed. Perhaps somewhat more controversially, it may also be the case that Scripture and theology will be of little use in helping us sort out these ambiguities. And last, I want to examine the purposes of these reports. This examination may suggest why delegates sitting in deliberation at the 1997 General Convention will, on the basis of these reports, be particularly well-equipped to raise these questions, but perhaps at the same time particularly ill-equipped to address them.

Why Now?

One may not, in fact, need to search far to discover why members of our society are beginning to question traditional prohibitions on suicide, assisted suicide, and euthanasia. In the rapidly expanding literature on these subjects, there is a broad consensus on why these issues are being raised at this time.[11] At base, most commentators believe that recent efforts to have these prohibited acts accepted morally and legally represent ways for individuals to regain control of their dying process. This need to regain control of our dying is, in turn, thought to be related to a number of conditions that are distinctive to dying in contemporary western societies.

First, advances in medical technology have transformed dying from a relatively quick process, primarily caused by infectious diseases, to a prolonged and often unnecessarily painful process, primarily caused or at least accompanied by degenerative diseases. Moreover, for the very sick and the very old, medical technology can too often extend the length of a patient's life only at the expense of its quality. Thus, as these patients approach the end of their lives, they must often make hard choices between maximizing the length and the quality of their lives. A choice to maximize quality, for instance, by taking large doses of pain medication, may mean hastening one's own death, whereas a choice to maximize the length of life may mean condemning oneself to a painful and costly dying process.[12]

Second, the institutionalization of this prolonged dying process in large and impersonal bureaucratic settings forces too many to die accompanied not by their loved ones but by loneliness, helplessness, despair, and, as they lie tethered to machines, a profound alienation from their own bodies. Moreover, this same institutionalization of dying, together with our dependence on the technologies of scientific medicine, have considerably increased the costs of dying. Much of the money spent on health care in the U.S. is spent in the last few weeks of life, and this problem will only worsen as the number of older citizens increases. Thus, some see a quick death as a way to spare themselves the agony--and their loved ones