Killing off the dying?

Public Interest, Spring, 1998 by Adam Wolfson

"Death with dignity"

The present push to legalize physician-directed killing is based primarily upon an appeal to tenderness or compassion. The political implications of giving doctors this lethal power are generally slighted, lost in debates over constitutional interpretation and the effectiveness of palliative care. But, as O'Connor knew, a pure ethics of compassion has had political consequences in our own century, of the most calamitous sort. Obviously we need not worry about gas chambers here, but there are other dreary possibilities; some of them are already in view.

It is, strangely enough, the principle of dignity that could provide a bridge from our natural fellow feelings of compassion for those who suffer to a politics that ceases to care for those who suffer. The word dignity itself is on the lips of every supporter of physician-assisted suicide, second only to compassion. In the popular defenses of the practice, as well as in the legal arguments of the courts, it is invoked like a talisman. One of Quill's books is titled Death and Dignity; Oregon named its assisted-suicide measure, "Death With Dignity Act"; the word comes up over a dozen times in Judge Stephen Reinhardt's Ninth Circuit ruling in favor of assisted suicide; it graces the names of many a pro-euthanasia organization.

But what does it mean to "die with dignity"? and why does that mean dying with the assistance of a physician? On the face of it, dying at the hands of another, by lethal injection no less, would hardly seem dignified in the dictionary sense of the word - noble, honorable, excellent. In truth, the sick and dying possess a dignity that transcends the doctor and his technique.

To die with dignity means something else to its promoters. Here's how Dworkin defines "dignity": "The most important feature of that culture [Western political culture] is a belief in individual human dignity: that people have the moral right - and the moral responsibility - to confront the most fundamental questions about the meaning and value of their own lives for themselves, answering to their own consciences and convictions." The Supreme Court in its Casey decision, defending the right to abortion, also equated dignity with autonomy. Thus, at least in its present meaning, to believe in human dignity is to believe that humans have a right to make choices for themselves, whether that choice is for assisted suicide or abortion or whatever. To be for dignity is, as a popular slogan of the day would have it, to be "pro-choice."

But dignity as it is used by supporters of assisted death has a second meaning, one that is decidedly illiberal and far more judgmental than the rhetoric of choice would suggest. When advocates appeal to human dignity they not only defend a person's right to choose assisted suicide; they also implicitly suggest who in particular might want or need to exercise this option. It is those who supposedly lack dignity.

In the literature, for instance, one finds references to those who, consumed by their diseases, are "undignified" and "humiliated," to those for whom life has become nothing but "meaningless existence with no escape." Consider along these lines a remark by Quill and his co-authors Christine K. Cassel and Diane E. Meier in the New England Journal of Medicine: