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Dying, without Reasons, in Massachusetts Print E-mail
By Hadley Arkes   
Tuesday, 19 June 2012

Early June, and I’m back in our adopted state of Massachusetts to do a talk on Obamacare and the courts for our friends at Massachusetts Citizens for Life. Our friends there, as elsewhere, await the decision coming from the Supreme Court any day now.

But in the meantime, the pro-lifers in Massachusetts have a pressing, immediate problem: a referendum on a legislative proposal known as the Death with Dignity Act, on the ballot for the fall.

The Massachusetts Medical Society has voted 3 to 1 against a bill that has doctors prescribing drugs, not to restore, but to end the lives of their patients. And yet the early polls shows a public inclined to accept this new policy at a level of 2 to 1.  

Some of this can be chalked up to the poll-tested title: Death with Dignity turns out to draw more votes than Doctor-Assisted Suicide. McCarthy Demers, a physician and lawyer in Memphis, used to give the paradigm for death-with-dignity: Fred Astaire, in white tie and tails, being shot in the middle of a pirouette. 

With the change in fashions this proposal comes dressed in a different garb, but at base it is the same old thing, fueled by the same passions that keep pressing on us abortion on demand and the kind of research that requires the destruction of human embryos.  

The proposal comes at a time when the souls of the people have been amply prepared to receive it. The Kennedys led the way in corroding the moral sense of a vast constituency by teaching, in the most visible, public way, that one could be at odds with the moral teaching of the Church and still be a good Catholic. Massachusetts is also thickly supplied with colleges – and, therefore, with academic enclaves and the kind of moral credulity that is now fostered in those enclaves.

The Death with Dignity Act offers a benign release from life from those patients “suffering from a terminal disease that will cause death within six months.” But of course we have had ample evidence over the years on how unreliable those estimates have been.  

There was the famous case of Carrie Coons in upstate New York in 1989. Everyone agreed that she was in a “vegetative state” with no possibility of recovering. As Nat Hentoff tells the story, Coons’s roommate went over to her bed, told Carrie that her relatives were about to do her in – at which point Carrie sat up, awake and a bit hungry.   

What keeps coming back is Henny Youngman’s line: “A doctor gave a guy six months to live. He couldn’t pay his bill – the doctor gave him another six months.”

          Don’t shoot!

And yet beyond the familiar points of weakness, it must be said that the bill in Massachusetts shows a remarkable cleverness. For in its details it seems designed to meet some of the most serious objections arising in the past.  

There has long been a concern that patients seek to end their lives because they are depressed. But the bill stipulates that, as part of the medical counseling, it must be determined that the patient is “not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” 

The accent is on the voluntary judgment of the patient, and the judgment is not voluntary if the patient is in ignorance of the drugs prescribed or distracted with depression. The doctor is not authorized to administer lethal injections; he is to be confined to prescribing drugs for the client to take.  

In what looks to be an effort to avoid the Terry Schiavo problem, the bill requires witnesses to the decision of the patient, and apart from one relative, a second witness may not be someone who profits from the death of the patient. Nor may it be the operator of a “health care facility” where the patient is being treated. At the same time, the patient should be apprised of the “feasible alternatives including, but not limited to, comfort care, hospice care, and pain control.”

And yet behind the rich detail of these provisions there is a logic that may call into question the very rationale of the bill. The marketing people tell us that the public shies away from arguments identified with the Church and “right to life.” But the provisions of the bill make no sense without the assumption, grounded in natural law, that life is a good – a good that should not be ended for casual or unserious reasons. 

As a moral good, there should be a moral justification for destroying that life. The bill tells us that life should not be ended out of ignorance or because people are deeply unhappy and depressed. Nor does it need to be ended because of pain, for pain can be managed, and comforting care provided. 

But then what finally are the reasons that would justify this decision to destroy a human life? The bill proclaims the object of a “humane” death, but it leaves out the ingredient that most defines a human and “humane” life: the capacity to give reasons over matters of right and wrong. 

The bill offers us a human being, animated by will, claiming a portentous license, but apparently not a being who can give us a moral account of the ways he has spent his life or the reasons that would justify anyone in ending it.

Hadley Arkes 
is the Ney Professor of Jurisprudence at Amherst College and the Director of the Claremont Center for the Jurisprudence of Natural Law in Washington. D.C. His most recent book is 
Constitutional Illusions & Anchoring Truths: The Touchstone of the Natural Law.
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Comments (13)Add Comment
written by Michael Paterso-Seymour, June 19, 2012
I believe our opposition to assisted suicide should always be accompanied by a salutary reminder that we are not obliged to preserve or prolong life by the use of extraordinary means. Too often, all that some aggressive and burdensome interventions achieve is to prolong the process of dying.
written by Manfred, June 19, 2012
Thank you for the erudition we have come to expect of you, Dr. Arkes. Frankly, the title of your article could just as well have been: Living, without reasons, in Massachusetts. Cong. Barney Frank, whose partner ran a male brothel out of their home, being re-elected for years? Ted Kennedy being buried by two Cdls.-O'Malley in MA. and McCarrick performing the burial in Arlington? Parishioners occupying their parishes for months?, years? while the Archdiocese attempted to close them? Pro-abortion Fr. Drinan serving as a congressman for years until the Vatican shook off the cobwebs and had him removed? I could certainly understand why even Catholics in MA would want to end their lives. How can they look at themselves in a mirror?
written by Dave, June 19, 2012
I am reminded of Benson's Lord of the World and specifically the Prime Minister's wife who went off to a center where for two weeks she reflected, so that it was clear the suicide was voluntary. Benson's descriptions of her last earthly and first eternal moments are indelible.

One chills at the notion of the social justice lobbies arguing in favor of the bill for reasons of social justice: application of funds to other, life-sustaining and community-building endeavors rather than their application to those who are dying. One chills as well knowing of all the abuse of process such legislation opens the door to. Is there any chance the bill may be stopped?
written by Grump, June 19, 2012
I've mixed feelings, professor, about euthanasia. As a lifelong owner of dogs, I've had to "put down" several and, while difficult, I always felt it was justifiable rather than seeing them suffer in pain during their final days.

I realize dogs aren't humans -- Scripture is silent on whether they have souls but God, it is said, made them before humans and I, for one, love them as much or more than my fellow species. As Will Rogers once said, 'If there are no dogs in heaven, then I want to go where the dogs went.'

Why, then, is voluntarily euthanasia wrong? Francis Bacon in the 17th century distinguished between the "outward" kind -- nothing it was the "physician's responsibility to alleviate the 'physical sufferings' of the body." This, as opposed to distinguish from the spiritual concept — the euthanasia "which regards the preparation of the soul."

Others such as Suetonius regarded it as the "painless inducement of a quick death" Have we not all suffered in this life -- some much more than others -- that it is necessary to suffer but a little more just to satisfy some noble notion that "life is precious." Put another way, on a battlefield when defeat is all but certain, does not one wave the white flag of surrender rather than endure more needless suffering and bloodshed? Did not Christ suffer so that we might not? (a question that has plagued me my entire 70 years of life so far).

There comes a point for many in their last days that life has no meaning or purpose, admitting that it had one before the throes of death. For the healthy and the living it is easy to advocate for life. But visiting a hospice or nursing home, as I have many times, where patients stare vacantly and are barely recognizable as human beings. My mother had stomach cancer and suffered tremendously in her last weeks before death finally took her at 87. Besides grief, the only other emotion we felt was relief.

Despite all this rationalization, it is hard for us to let go even as we must.

Emily Dickinson aptly put it this way:

Because I could not stop for Death,
He kindly stopped for me;
The carriage held but just ourselves
And Immortality.
written by Tony Esolen, June 19, 2012
Dear Grump: My own father refused extraordinary and pointless medical treatment to prolong his life. He died at home, in his chair, with all of us around him. He emphatically did not want to die in a hospital. I think that the Church needs to make clear the distinction between someone who is dying and someone who, like Terry Schiavo, is not dying but needs assistance in performing basic functions proper to life (as, for instance, someone who needs a colostomy bag, but is not terminally ill). Having made that distinction, the Church then can affirm that people retain the right to refuse treatment. In my father's case, that was to refuse intravenous liquid. He was dying, after all.

I'm persuaded that most people do not favor suicide in any of its forms, but that they are terrified of the hospital and its machines...
written by Chris in Maryland, June 19, 2012
Dear Grump:

I think that Christ suffered, not that we would not have to suffer, but to show us, by His suffering, that He fully identifies with us, and to sanctify suffering, and thereby teach His Church that we, as The Body of Christ, must imitate Him, even in suffering pain and death, and offer our own suffering as our gift in the mystery of salvation.

Let us all recall what Jesus taught St. Paul: "I make up in my own sufferings what is lacking in the sufferings of Christ."
written by Louise, June 19, 2012
This issue could gain no traction if Catholics and others understood that the end of life is not necessarily the end of suffering; sometimes it is just the beginning of suffering worse than this life has ever known. The Church in MA would do a great service to your State at this time if they would teach about the reality of Purgatory and Hell. There are some good quotes from St. Thomas and the Fathers about the difference between the suffering in Purgatory vs on Earth (worse in Purgatory).

I don't know about MA but in most places there has been only talk of Heaven and the idea is floating around that of course everyone will end up there right after death. If that is the case why not get there sooner? Of course we know that is not the case and it is a mercy to educate others on this fact.
written by Tony Esolen, June 19, 2012
When my mother-in-law lay dying, we asked that she be given glucose and water, and, since she was in no pain, that she not be given morphine to push her over the brink. My sister tells me that when she began practicing medicine it was unheard of to prescribe morphine with the express purpose of bringing on death, but that now it happens all the time. It is not clear that its use is primarily for the alleviation of pain in these cases -- and in some cases it is not used for alleviation of pain at all.

The most beautiful Catholic death scene in all of literature, for my money: that of Lavrans, in Kristin Lavransdatter. He died with his friend the priest nearby, praying with him; showing him the Cross of Christ; and having said goodbye to all his kin and his neighbors. The Church should perhaps change tack, and begin to show us again how to die.
written by Grump, June 19, 2012
Louise, you mean to tell me that after death things could possibly be worse than what we have to suffer in this world?! Oy vey!
written by DS, June 19, 2012
Manfred, you could also add to your list the child abuse scandal, which first erupted in Massachusetts, and the complete and utter failure of the church's leadership there to deal with it.
written by Grump, June 19, 2012
Tony, my optimistic friend...Unluckily, we neither have a choice about being born or how and when to die. For the less fortunate among us, I recollect Freud's lament: "What good to us is a long life if it is difficult and barren of joys, and if it is so full of misery that we can only welcome death as a deliverer?"
written by Louise, June 19, 2012
Grump, yes, at least that’s what I've always understood. Doesn't that put "euthanasia" in a whole new light? Not a good idea! It makes sense though.
It's easy to see why the suffering of Hell is worse but Purgatory?
Yet imagine what it’s like to be in Purgatory: so close and yet so far away. It must be excruciating. At least in Purgatory you won’t have the worry about going to Hell though…
Here’s an example from the old Catholic encyclopedia:
“Gregory the Great speaks of those who after this life ‘will expiate their faults by purgatorial flames,’ and he adds ‘that the pain be more intolerable than anyone can suffer in this life’”
“St. Bonaventure…adds that this punishment by fire is more severe than any punishment which comes to men in this life”
Take heart though, God gives us everything we need in this life to go straight to Heaven when we die. We just need to cooperate. And remember that we can help others get to Heaven as well. The suffering that God permits is part of the whole picture. Not that we can’t try to alleviate it; but when we can’t, we have to accept it, not end it by killing ourselves or someone else who is suffering.
written by Hadley Arkes, June 19, 2012
I’d like to thank so many of the “regulars” for writing in today, especially Tony Esolen, Grump, and Manfred. Manfred must know my mind by now for the original title we had down for this piece was, in fact, “Living and Dying, Without Reasons, in Massachusetts.” There is of course so much more to be said, and I’ll return to this question in another column. But my friends are right that there is no need, in Catholicism, to accept extraordinary, heroic, invasive measures to evade the death that is surely coming. And yet that is different from ending one’s life for reasons that could not be tenable in principle as the ground for ending any other person’s life. Suicide used to be understood as “self-murder,” and the fact that it’s done to ourselves does not remove it from the class of acts that stand in need of a moral justification.

Tony Esolen touches something no doubt critical when he mentions the aversion to hospitals. I certainly understand the people gripped by the terrors of dying, and the devastation that may be wrought by sudden deaths, wholly unexpected, unsettling and wrecking the lives of others. I understand the appeal of having a certain control over when that end will come. But we also learn that there are limits to what we may rightly control, or aspire to control. I fear, though, that Tony anticipates rightly a far graver situation ahead: there will be even more to fear in hospitals as doctors come to absorb the culture that swirls about the campuses, and show a breezy willingness to bring to an end lives that don’t strike the doctors as lives of consequence.

But Louise reminds us of an understanding that has curiously fled, and it surely figures to make the most notable difference. It must be a measure of something that the notion of hell does not seem to be taken overly seriously these days. Or perhaps people are reluctant to think long on it precisely because it is taken seriously. But for Grump and the hell he finds around us, we may recall Woody Allen’s line: that “there are certain things worse than death, like spending a whole evening with an insurance salesman.”

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