Touchstone: A Journal of Mere Christianity
“Terminal Logic” first appeared in the March 2006 issue of Touchstone.
Everyone Is a Person—No One Is “Mere Biological Life”
by Robert P. George
There is a spectrum of positions on end-of-life issues, and on life issues generally, but a crucial line divides those who affirm and those who deny that the life of each human being possesses inherent and equal worth and dignity, irrespective not only of race, ethnicity, age, and sex (as everyone agrees), but stage of development, mental or physical infirmity, and condition of dependency.
People who deny this frequently distinguish what they describe as “mere biological human life” from the life of a “person.” A person possesses self-consciousness and, perhaps, developed capacities for characteristically human mental activity, such as conceptual thinking, deliberation, and choice. It is personal life, they say, that has intrinsic value and dignity; “mere biological life” does not.
Persons, or Not
So some people argue that some human beings—those in the embryonic, fetal, and at least early infant stages of human development—are not yet persons, and others—the severely retarded, the seriously demented, those in permanent comas or persistent vegetative states—will never become, or are no longer, persons. These are, they insist, either pre-personal or post-personal human beings.
They insist that the question is not, When does the life of a human being begin or end?, but, When does a human being qualify or cease to qualify as a person, and therefore a creature with a serious right to life? Those they regard as non-persons do not possess such a right, though killing them may be wrong for some reason other than that killing them denies the inherent dignity of persons.
This view is often allied, though it need not be, with a sweeping belief in “autonomy” (or “privacy” or “moral independence”) as a core right. The right of autonomy immunizes individual choice in matters having to do with how one leads one’s own life against interference by others, including the state, especially when the choices do not directly damage the interests or violate the rights of others.
So, the thought goes, if a woman wishes to abort a fetus, or parents wish to terminate the life of a severely disabled newborn, or a person wishes to end his own life, respect for their autonomy demands that others, including public officials acting under color of law, refrain from interfering with these choices, and perhaps even take positive steps to facilitate them.
Now, those who oppose abortion, infanticide, assisted suicide, euthanasia, and so forth, as I do, oppose them both because we reject the idea that there are or can be pre-personal or post-personal human beings, or human non-persons of any description, and because we do not accept the sweeping view of the value of autonomy. We affirm a doctrine of inherent and equal dignity that affirms all living human beings as persons, excludes the direct killing of innocent human beings, and demands respect for every individual’s right to life. Most of us also believe that the law should honor the principle of the sanctity of human life and not privilege the belief in autonomy over it.
We view human life, even in those who are developing and those who are severely disabled, as inherently and unconditionally valuable. Though we regard individual autonomy as an important value, we understand it to be an instrumental and conditional one: one that is morally bounded by a range of ethical considerations, including but not limited to others’ autonomy.
Many of our opponents take precisely the opposite view: Autonomy has intrinsic worth, is inherently and unconditionally valuable; so-called biological life is of instrumental or conditional value.
I have elsewhere stated at length my reasons for believing that the life of every human being has inherent and equal worth, and for rejecting the proposition that some living human beings are not persons and therefore lack a right to life. (See, for example, my article “The Moral Status of the Embryo” in the Spring 2005 issue of the journal Perspectives in Biology and Medicine, published by Johns Hopkins University Press.)
The core of my argument is that to treat as the ground of dignity and basic rights only immediately exercisable capacities for characteristically human acts, as opposed to basic natural capacities, is inherently arbitrary. I have also stated, at book-length in Making Men Moral, my reasons for rejecting the doctrine of the priority of autonomy and the political principles following from it.
I propose to show that theories of morality that treat autonomy as intrinsically valuable, or that seek to derive a sweeping right to autonomy from the value of equality or some other putatively fundamental normative principle, enmesh themselves in contradictions and conundrums that cannot be resolved without adjusting the theories to limit in significant ways the scope of autonomy. I will not in the limited space available here rehearse these arguments. What I will do is try to give some indication of how I think someone on my side of the debate ought to think about issues of the sort that came to the fore in the Terri Schiavo case and continue to vex our public life.
The position was summed up a few years ago in a statement by the Ramsey Colloquium of the Institute on Religion and Public Life entitled “Always to Care, Never to Kill.” We are to maintain solidarity with those in disabled conditions, seeking to heal their afflictions when we can and making every effort to relieve their suffering and discomfort. At the same time, we should discourage anyone tempted to regard his life as valueless or merely burdensome to himself or others from thinking this and from committing suicide. We cannot encourage or assist suicidal choices and assisted suicide or euthanasia.
Does this imply “vitalism,” that is, the view that human life is not only inherently valuable but the supreme value that trumps all others? Does it mean that we must struggle to keep dying patients alive at all costs?
No. The key distinction, however, is not between “killing” and “letting die,” nor is it between killing by a positive act and killing by not acting. Nor, strictly speaking, I believe, is it between the use of “ordinary” as opposed to “extraordinary” means of life support, at least where “ordinary” and “extraordinary” are defined in terms of the complexity or novelty of the technologies employed.
Rather, the key is the distinction between what traditionally has been called “direct killing,” where death (one’s own or someone else’s) is sought either as an end in itself or as a means to some other end, and accepting death or the shortening of life as a foreseen side effect of an action or omission whose object is something other than death—either some good that cannot be achieved or some evil that cannot be avoided without resulting in death or the shortening of life.
Of course, the norm against the direct killing of innocent human beings is not the only norm that can be relevant to end-of-life decisions. Norms such as the obligations of fairness and equity also apply, even when one can accept death as a side effect. They may prevent one from accepting death even for the reasons just given. To show that an act that causes death or shortens life is not an act of direct killing is not necessarily to show that it is a morally legitimate act.
There are some classic examples of the distinction between direct killing and accepting death. A soldier jumps on a grenade that has been rolled into the camp in a life-sacrificing effort to save the lives of his comrades in arms. Because he did not intend his own death, though he foresaw and accepted it, no one regards this as a suicide. It was a side effect of his (heroic) attempt to save the lives of others.
More immediately relevant is the case of a patient suffering from a painful condition who takes palliative drugs of a type that he knows will result in his dying sooner than he would otherwise. Again, he does not intend his own death, though he foresees and accepts it, and no one regards this as suicide. (We may assume that his willingness to accept death is not incompatible with any obligation he may happen to have to others—such as an obligation to children or other family members—though if it is, the moral equation obviously changes.)
Now, there are lots of reasons why someone in extremis, or who anticipates being in extremis, may decline life support without willing his own death either as an end in itself or as a means to some other end.
Particular forms of life support may be painful, burdensome, and expensive. When they are, people can certainly choose to forgo them without willing their own deaths. So someone who thinks as I do may support, as I in fact support, giving people broad latitude to decide whether to accept life support and whether to maintain it. This is one of the places where respect for autonomy makes a valid claim.
Of course, some people will use this latitude for reasons that are not morally legitimate. This is itself an acceptable bad side effect of a policy that has as its aim something perfectly good and legitimate: respecting people’s autonomy to choose among morally acceptable—even if tragic—but incompatible options bearing on their lives and futures.
But this does not mean that we should accept a right to assisted suicide or conceive the right to decline life support, or life-saving medical care generally, as a right to commit suicide or to assistance in committing suicide. Nor should we accept policies or practices that are implicitly premised on belief in a right to suicide or assisted suicide or euthanasia.
Terri Schiavo died of dehydration. Her brain was damaged, yes, but she did not die of brain damage or any other affliction. Others chose her death by deciding to deny her fluids. She was not “allowed to die,” for she was not dying; she was not “brain dead”; she was not even terminally ill. The choice to deny her fluids was a choice to cause her death.
Those who supported that choice said it was right to do so either because she was not really a person anymore or because she would have wanted to die, as she allegedly made clear in comments later recalled and placed into evidence by her husband. In neither case can her killing be justified under the moral understanding I defend and that has traditionally governed medical ethics. Under that understanding, Terri was a person with a right to life, not a non-person (“mere biological life,” a “vegetable”), nor was she a person with a right to commit suicide or to order her own death should she become disabled. The obligation of others towards her was “always to care, never to kill.”
Never to Kill
Does this mean that it is never morally acceptable to withhold fluids or food from a patient? Is it never right for a patient, or those making medical decisions on the patient’s behalf, to decline food and fluids?
Some people on my side of the debate have argued that food and fluids must always be administered—that they are “hospitality” rather than life support, and are part of “ordinary” care rather than extraordinary means. I agree that food and fluids are in most cases (or, as Pope John Paul II put it in his allocution on the subject, “in principle”) part of ordinary care, but there can be cases, comparatively rare to be sure, in which they can be legitimately not administered.
There can be cases in which the reason for not administering food and water is some goal or purpose other than the desire to bring about death, when food and fluids themselves cannot be administered without causing harm to the patient. Sometimes the problem will be in the administration of the food and fluids, and sometimes it will be a consequence of the food and fluids themselves. In either case, when the administration of food and fluids will cause or contribute to morbidity or even hasten death, plainly a decision to withhold them is not a choice to kill.
This was not the case for Terri Schiavo. The point of withholding food and fluids from her was precisely to bring about her death. The problem was not that she could not tolerate the food and fluids or that the administration of them would further damage her health. On the contrary, food and water would sustain her in life—a life that some judged to be in itself burdensome, both to Terri herself and to others, and which she, they contend, would have wanted to end were she in a position to decide the question.
From the perspective of those who supported removing her feeding tube, doing so was a means of ending her life; it was not a side effect of a choice whose object was something else. It was a choice to kill, a choice the moral logic of which is indistinguishable from a choice to have ended her life more quickly by, for example, administering a lethal dose in an unambiguous act of euthanasia.
“Always to Care, Never to Kill” can be found at www.firstthings.com/ftissues/ft9202/articles/documentation.html.
Robert P. George , a Roman Catholic, is McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. His books include In Defense of Natural Law (Oxford University Press) and The Clash of Orthodoxies (ISI Books). He is a Senior Editor of Touchstone.
“Terminal Logic” first appeared in the March 2006 issue of Touchstone. If you enjoyed this article, you'll find more of the same in every issue.
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