Respecting Uncle Jack: On Death With Dignity

 
 

A new effort to legalize doctor-prescribed suicide in Massachusetts reminds us that we are not our own to dispose of at will.

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“Burley Coulter was saying the other day that Uncle Jack’s turning into a statue. That’s going to be his metamorphosis. One day he’ll just stop the way he does and never start again. The birds’ll roost on him.” Thus jokes Mat Feltner at breakfast on a cool September morning in 1952 in Wendell Berry’s The Memory of Old Jack. At the end of that day, Uncle Jack does in fact die in his chair looking out the window at the town that has been his home all his life. Berry’s short novel, part of a series based in the fictional Port William, Kentucky, tells the story of Jack Beechum’s life as he remembers it in flashbacks on his final day. Mat jokes, but he “feels a heavy portent in the imminent breaking of that strand of memory, reaching back into the Civil War, on the end of which Old Jack now keeps so tenuous a hold.”

I have been thinking a lot about death lately, which may have led me to pick up one of Berry’s novels, many of which are, to a large extent, about death. But perhaps it is more accurate to say that they are about life—its finality, and its intimate connection with a broader fabric of a way of life and of the lives of other persons.

Perhaps death is on my mind because my living set of grandparents have reached the age at which no one will be surprised upon hearing that they have passed on. Perhaps it is because my parents, too, have reached an age at which health scares come more often. Or perhaps the extraordinary energy of my two children under three has made me think more deeply about my own role as a link between my parents and grandparents and the lives of my kids.

I know with certainty, though, that death has been on my mind because of an effort under way in Massachusetts to make it legal for doctors to prescribe lethal doses of drugs for the purpose of ending their patients’ lives.

The patient, of course, will have to voluntarily ingest the fistful of pills it will take to kill him. A patient can do that now, if he can get his hands on any of the myriad substances which, in sufficient quantity, will kill a human being. But what this ballot initiative proposes is that doctors—and we as a society—should affirm that course of action.

Tens of thousands of Americans commit suicide every year. Nowhere in the U.S. is it a crime to do so. It is an unfortunate fact that some people determine that their lives are no longer worth living. But we see it as a tragedy; this is why high bridges often have signs encouraging troubled individuals to seek help rather than jump. Suicide hotlines are open 24 hours a day because we hope to prevent as many suicides as possible.

This consistent cultural message is contradicted when we give doctors the right to prescribe lethal drugs as a medical treatment. It is like replacing the suicide intervention signs on bridges and railroad tracks with signs that say, “Ask your physician if jumping is right for you.” Of course, one of the arguments in favor of legalizing doctor-prescribed suicide is that ingestion of a very large quantity of pills is much cleaner and easier to manage than throwing oneself in front of a speeding train (although we might ask Derek Humphry how clean it was when, as he was “assisting” his first wife’s suicide, he eventually had to smother her with a pillow to achieve the desired result). But from the perspective of what we value as a society, the two are equivalent.

If the Massachusetts ballot initiative passes, only individuals who have been diagnosed with a terminal illness that will result in death within 6 months will be eligible for a lethal prescription. Yet everyone knows that a 6-month prognosis is a guess. Anyone who is seriously ill or seriously old will be able to obtain a suicide prescription. Some insurance companies will refuse to cover treatment while offering to cover “death with dignity,” as has been documented in Oregon. And with no protections for those who are no longer fully cognizant of what is happening around them, there is ample room for abuse of the elderly.

But put these difficulties aside. What of the individual who, with a clear mind and a truly terminal illness, says, “I prefer to die”? Do we want to validate that choice?

Many arguments have been mustered in recent years against doctor-prescribed suicide by many able thinkers. Leon Kass has argued that suicide as a medical treatment will dangerously pervert the medical profession by making the doctor a mere technician of bodily function. Christopher Tollefsen has expertly articulated the argument that doctor-prescribed suicide is wrong because it is simply always wrong to intend the death of an innocent human being. Rita Marker has argued that legalization could lead to its use for cost containment, and Wesley Smith has lain to rest the illusion that doctor-prescribed suicide is necessary to control pain. The list goes on.

But Old Jack brings to mind another reason we should reject suicide as a medical treatment: the profound integration of human individuality and freedom into human community and the interdependency of persons.

Perhaps the most famous statement of Barack Obama’s presidency thus far has been his quip, “You didn’t build that.” It has been the subject of political cartoons, newspaper columns, and t-shirts. As clumsily as the president made his point, only the most partisan ideologue can deny the kernel of truth in his assertion: no individual exists in a vacuum. No person can take full credit for all that he or she has accomplished. We have all benefitted from the help of others. There is plenty of room for disagreement about whether the federal government or any particular state or local government was more of a help or a hindrance in any particular case, but it is clear that even the most successful are heavily indebted to others, and thus have plenty to be grateful for. We are, as President Obama says, in this together. We all have a debt to pay to each other. We all have something to pay back, and something to pay forward.

In this context of community, of interconnectedness and interdependence, what do we make of an individual’s decision to take his own life? It seems there are two questions we should ask as we form opinions about whether our society should affirm that decision. First, have we, as a society, failed to embrace that individual and to share what there is to spare of our bounty? And second, has that individual been faithful to us, as a society, and especially to his own, his family, his friends, in gratitude for all he has received? In other words, do we have the right to say, yes, that seems like a good decision given the circumstances, and does he have the right to make that decision?

An ideology of absolute individual autonomy exists at the extremes of both sides of the political spectrum: on the right we find a defense of extreme individual economic autonomy, and on the left we find a defense of extreme individual lifestyle autonomy. Both extremes commit a common fallacy by forgetting that rights are never separable from duties. With every right comes a concomitant responsibility. The corollary of President Obama’s “you didn’t build that” is “you can’t tear that down.” Can we ever so fully and autonomously own anything of value that we have the right to destroy it? We are stewards of what we own. All that we have we hold in trust. And most of all we hold ourselves and our relations to others in trust. We are not our own to dispose of at will.

Toward the twilight of Old Jack’s last day, he is visited by his grandnephew Andy Catlett who is about to leave for college. He has come to say goodbye. They chat for a while, and then Andy leaves. Old Jack is familiar with the experience: “He knows that as one of the inescapable themes of his life: the departure from him, from the beginning, of men and women he has loved, of days and years, of lightness and swiftness and strength.” But there is another theme. Jack continues: “The other theme is faithfulness to what had remained. . . . Too little respect is paid to that now, he thinks, but he has respected it. He has thought of it without ceasing.”

Berry’s novel paints a stirring portrait, not merely of an individual man, but of the community to which he belonged, and of his role as a connector between those who came before him and those who have followed him. We each have Old Jacks in our lives, and someday we will be Old Jack to the communities in which we have spent our lives. We depend on each other. While we each have our rights, and while each of us has a legitimate sphere of freedom, we also have duties to one another, debts we owe to the communities of persons that have nurtured us along our way. We didn’t build our lives alone, so we can’t tear them down at will.

For us as a society to define suicide as a medical treatment is to bring into question the idea that we have fundamental responsibilities to each other as beings in community. It is to strike at the root of what unites us as a community in the first place.

Greg Pfundstein is the Executive Director of the Chiaroscuro Foundation. He also serves on the board of the Patients Rights Council.

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