Dignity & the End of Life

Physician-assisted suicide (PAS) and euthanasia have long been the redheaded stepchildren of the prolife movement. They are dutifully included in the litany of life-related issues, yet they have not attracted the sustained attention—or passion—that has characterized the struggle against abortion. That may be about to change.

In May 2011, Gallup named PAS the most divisive moral issue in American life. According to their “Values and Beliefs” poll, 45 percent of the population now think it is morally acceptable, while 48 percent believe it to be morally wrong. In June, the United States Conference of Catholic Bishops issued its first full statement on PAS, “To Live Each Day with Dignity” [pdf].

Catholic culture warriors also seem to be girding themselves for battle on end-of-life issues. In a recent column in Crisis, Catholic media commentator Barbara Nicolosi writes, “We need an emotionally winning language for this fight. The other side should not get away with christening themselves ‘mercy killers’; they are ‘death dealers,’ ‘elder abortionists,’ ‘needlers.’” She urges prolifers to invoke the Nazis, who started a secret euthanasia program.

While well-intentioned, Nicolosi’s strategy is mistaken. The best way to promote human dignity at the end of life isn’t to clone the culture war over abortion. PAS raises very different questions of law and public policy. It also plays on very different human emotions, which shape our response to the legal frameworks of the two issues.

Abortion is now a constitutionally protected choice. Assisted suicide is not. In 1997, the Supreme Court held that the Constitution leaves the matter of assisted suicide to the states to decide. In the past fourteen years, only three states have legalized the procedure (Washington, Oregon, and Montana). On abortion, prolifers are fighting a judicially imposed status quo. In contrast, in most states, the status quo favors those opposed to PAS and euthanasia. In fact, a review of older Gallup polls shows that opposition to assisted dying has actually grown over the past decade. In this context, a scorched-earth culture-war approach may prove to be overkill, so to speak.

Abortion kills the unborn without their consent, depriving them of their entire future. It evokes in its opponents the desire to protest injustice and to protect the innocent against unwarranted harm. In contrast, to stave off suffering among the terminally ill in the last weeks or month of their lives, PAS allows them to kill themselves with medicine provided by a physician. Since the person to be killed both instigates and carries out the killing, most people do not think it is primarily a matter of justice, although it may be wrong on other grounds, such as a violation of God’s law.

Prolifers have a response. Drawing on data from the Netherlands (where euthanasia has long been legal), they have argued that PAS would be just the first step down a slippery slope. PAS (in which the patient administers the legal dose) may evolve into voluntary euthanasia (in which the physician kills the patient), which in turn could evolve into nonvoluntary or even involuntary euthanasia (in which patients are killed without or against their will). Involuntary euthanasia is clearly a matter of justice.

This response is important, and in my view, insightful. But it’s not sufficient. Some will question whether the Netherlands can be analogized to the United States. Others will say that the data on PAS in Oregon do not support the worries. I think these responses can be successfully addressed.

But there is a deeper problem. The prolife slippery-slope argument plays to people’s generalized fears about living in a brutally unjust society. Many people of a certain age have a countervailing set of fears. The anxiety created by the prospect of one’s own very bad death is far more immediate and visceral than any concern that the United States might become a Nazi dystopia. People do not want to die abandoned, alone, and in pain. They do not want to bankrupt themselves arranging for around-the-clock nursing care, or to become a physical and financial burden to their already overstretched children. In the context of these fears, the legal availability of PAS can become a security blanket, an emergency exit “just in case” their worst fears are realized.

To combat these fears, it is not enough to excoriate a culture of death. We must actively build a culture of life. Universal health care, including the latest techniques for pain control, must be widely available. In-home elder care and respite care need to be easily accessible. And churches, synagogues, and mosques ought to ramp up their ministries to the sick and the homebound. As Pope John Paul II recognizes in Evangelium vitae, protecting human dignity at the end of life is a matter of both justice and the works of mercy.

Related:'Peaceful & Private,' by Cathleen Kaveny
Doctors without Borders, by Daniel Callahan
Bishops & Pols and License to Kill, by the Editors