Killing off the dying?

Public Interest, Spring, 1998 by Adam Wolfson

How the virtue of compassion could become an excuse for physician-directed killing has a long, complicated history, one that I can hardly do justice to. Clifford Orwin has argued that certain modern thinkers, Rousseau the most important of them, elevated compassion to prominence, even as a replacement for the traditional theological virtue of Christian charity.(2) The advantages of the former were thought to be many. Whereas charity is other-worldly and concerned with man's eternal soul, compassion is this-worldly and concerned with his physical estate; whereas charity is of God, compassion is of man and based on a primordial need, felt by all, for relief from suffering. We see someone suffer and, realizing that it could be us, feel compassion for him. We feel his pain, as it is said, because we instinctively sense that it could be our own pain; and sensing that it could be our own, we want to end it as soon as possible. In extremity, compassion could lead us to minister to those who suffer by doing away with them, as it sometimes does in fact.

This is the reason - the evocative power of compassion - that advocates of physician-assisted suicide emphasize it above all else, purposely avoiding formal arguments. Timothy Quill, who has done so much to advance the cause of assisted death, advises policy makers, "Don't argue over positions" (italics in original). Instead, tell stories "of the unrelieved suffering of dying patients." For with the acknowledgment of such suffering "comes the possibility of a change in public policy and legal restrictions." In other words, the American public is to be persuaded to accept assisted death not by arguments about right and wrong. "Our obligation in medicine is to understand and explore, not to judge or impose," admonishes Quill. They are to be led to it via an unthinking compassion for those who suffer.

The books that "argue" for physician-assisted suicide consist mainly of harrowing accounts of human misery that even the best palliative care cannot treat. In the pages of such books, for example, Lonny Shavelson's A Chosen Death, as well as many others, one meets patients with full blown AIDS, patients with severe forms of dementia, patients with physical disabilities that defy imagination, patients with aggressive cancers that eat them alive. In his book A Midwife Through the Dying Process: Stories of Healing and Hard Choices at the End of Life, Quill tells the story of Cynthia, a thirty-seven-year-old graduate-school student diagnosed with gastric cancer:

Each hour she had to choose between enduring severe pain and allowing her consciousness to be clouded. When she was alert she had relentless dry heaves, retching, and hiccoughs. In addition, the smell from her now gaping abdominal wound could not be ignored and was humiliating to Cynthia.... Life as she was now forced to live it had no quality.

In Cynthia and others like her, we are encouraged to see ourselves, and to wonder whether killing is not the most compassionate solution.