There are both legal and ethical questions in regard to euthanasia and suicide. I shall address here the moral question. The question I will focus on is: Is it always morally wrong intentionally to kill someone, whether oneself or another, in order to end his suffering? I will argue that the answer is yes, and so it also will follow that all of the various types of intentional mercy killing are wrong: suicide, assisted suicide, voluntary, nonvoluntary, or involuntary euthanasia. I argue that the intentional killing of an innocent human person1 unavoidably includes a profound disrespect for the good of human life.
After explaining why euthanasia and suicide are wrong, and distinguishing between intentional killing and causing death as a side effect, I will examine the main objections to this traditional position. The argument as a whole will be philosophical, though I will also point out, at least on one of the important points (the bodiliness of the human person) the theological warrant for the position I defend.
There are various arguments against suicide and euthanasia. For example, one might argue that such acts violate God's dominion. Here I will argue that the reason why suicide and euthanasia are wrong is that they are choices contrary to the intrinsic good of a human person. Such acts are contrary to the love of God, neighbor, and self that is the objective moral standard of our choices under the natural moral law that is evident to reason.2
When one chooses an action, one chooses it for a reason, that is, for the sake of some good one thinks this action will help realize. That good may itself be a way of realizing some further good, and that good a means to another, and so on. But the chain of goods cannot be infinite. So, there must be some ultimate reasons for one's choices, some goods which one recognizes as reasons for choosing which need no further support, which are not mere means to some further good.
These ultimate reasons for choice are intrinsic goods, that is, conditions understood to be good for their own sake, and not just as means to some further end. What these goods are is not determined by choice, since they make choice possible. Hence these goods have a natural appeal to us; they must be activities or conditions to which we are naturally inclined. Moreover, these goods are conditions that can be realized by our actions. Thus, these fundamental human goods are the actualizations of our basic potentialities, the conditions to which we are naturally oriented and which objectively fulfill us, the various aspects of our fulfillment as human persons. To choose in a way that respects all of these human perfections, both in ourselves and in others, is to respect human persons and to choose morally well. It is to act in a way that is consistent with love of God, neighbor, and self.3 To choose to act against a fundamental human good is to act against some intrinsic good of a human person. To make such a choice is to substitute one's own preference for the objective standard provided by what is objectively fulfilling.
Human life itself is a fundamental human good. Thus, we ought to respect this good.4 But the choice to destroy a human life is contrary to respecting human life. And so, we ought never to choose precisely to destroy a human life, whether of another person or our own. To do so is implicitly (and sometimes explicitly as well) is to adopt the attitude that this human life is not objectively good, but is good only if I desire it. To choose to destroy one basic good for the sake of others is to adopt the attitude that human goods, including human lives, are only conditionally good. It is to adopt the attitude that the goodness of this life, for example, can be outweighed by the good consequences (or avoidance of bad consequences) one would bring about by destroying it. It is to adopt the attitude that, in effect, a price can be placed upon this life. But the intrinsic goods of persons, including life itself, which is the very being of the person, are irreplaceably good; each is a good whose loss cannot be made up for by some other condition. Every human life is priceless.5
Thus, the choice to kill an innocent human life, whether one's own or another's, even for the sake of avoiding terrible suffering, is intrinsically immoral. Euthanasia and suicide are contrary to the intrinsic dignity of human persons.
This does not mean, however, that we must always take all measures possible to preserve someone's life, our own included. While it is always morally wrong intentionally to kill a human person, it is sometimes morally right to choose not to use certain means to preserve someone's life, because of the burden of those means.
For example, someone with cancer may choose not take a course of chemotherapy if doing so offers little or no chance of bringing complete recovery, it is quite expensive, and it would block spending time with one's family. Such a choice is not disrespectful of the basic good of life. Rather, it is a choice not to use certain means of extending life on the grounds that these means involve a diminishing of one or more basic goods, or on the grounds that adopting these means is incompatible with pursuing other goods (one's other responsibilities).
Such diminishing of basic goods as a side effect of what one does is not the same as choosing against a basic good, and it does not necessarily involve a lack of appreciation or commitment to those goods that are diminished (or destroyed) as a side effect. Indeed, such diminishing or destruction of basic goods as a side effect is strictly unavoidable. Every choice we make is a choice to pursue and enhance some goods and not others. Thus every choice we make involves a diminishing or at least a nonenhancing of some basic goods as a side effect of what we directly (intentionally) do.
On the other hand, a choice to kill a human life is incompatible with a love for that life: such a choice involves -- as proponents of euthanasia themselves often testify -- the judgment that some lives are not worth living, that some lives are mere means to some other condition, a denial of the intrinsic dignity of the person killed.
If one chooses to kill in order to end suffering, one sees (at least initially) that continuing to live does instantiate a human good, but that escaping pain also would instantiate a good.6 To act against the first reason, one must judge that the second reason (escaping pain) is preferable to it. But one can make such a judgment only on the supposition that the good offered by the second alternative (escaping from pain) is of a higher order than the good offered by the first alternative (human life). But it could be of a higher order only if human life were not a basic and intrinsic good. Thus, the choice to kill as a means toward escaping pain involves, at least implicitly, the attitude that human life is not a basic and intrinsic good.
One might object: it is a basic, intrinsic good, but it can be outweighed by the prospect of a greater good, such as relief from excruciating pain. However, how can one objectively measure the worth of a human life versus that of relief from pain? On what scale does one measure these two goods? In fact, these goods are quite heterogeneous and therefore cannot be objectively measured. In order for two things to be measured against one another they must have something in common so that one can have more of it than the other, or else one must simply have the sole valuable quality which the other lacks. But neither of these can be the case with two objects both of which are basic, intrinsic goods. So, the judgment that this human life can be suppressed for the sake of relief from pain is tacitly a judgment that this life does not have basic, intrinsic worth.
It has sometimes been objected that there is no morally significant difference between actively killing a dying person and letting him die.7 Therefore (the argument continues), since everyone admits that it is sometimes morally right to let someone die (that is, choose not to use a lifesaving treatment), then it also is morally right in some cases to choose to kill a dying person. However, this argument is surely mistaken. If killing were the same as withholding or withdrawing lifesaving treatment, then everything we did other than lifesaving attempts would be cases of killing. For in every choice we make to pursue some good other than the saving of someone's life we are doing something which has the side effect of not saving someone's life. If this objection were correct, then, as John Finnis points out, the choice to take one's children for a walk, thus passing up the opportunity to take a plane to Calcutta to save street children, would be as murderous as deliberately blanketing those same children with machine gun bullets.8 We cannot pursue all of the basic goods all of the time, but we are morally required to maintain an openness or appreciation for all basic human goods, including human lives. And that is incompatible with a choice to destroy one instance of a basic good for the sake of others.
It is important to see that the difference between intentionally killing and causing death as a side effect is not primarily a difference in physical behavior. The same physical behavior -- for example, injecting a patient with morphine -- might in one case be carrying out a choice to relieve pain with the side effect of hastening death, and in another case carry out a choice to kill in order to relieve pain. Although the external results are the same, there is a tremendous moral difference between the two cases.
So not doing something -- an omission -- can in some cases be a way of intentionally killing someone. Clearly, if someone withholds needed insulin from his wife in order to end her life, he intends her death just as much as if he had deliberately dropped arsenic in her orange juice. Similarly, if a relatively nonburdensome lifesaving treatment is withheld or withdrawn then the reason probably is that one wants the death -- in this case the omission is the means chosen for the sake of the death.9
Of course, really causing death as a side effect is not always morally right either. How does one decide when it is? Frances Kamm has argued that everyone already admits that we may let someone die, if doing so would be for the patient's overall benefit. In other words, we sometimes make the judgment (according to Kamm) that, "in this particular case, the greater good for the patient is relief of pain, and the lesser evil is loss of life ... "10 But if that is so, she argues, it should also be morally right to kill the patient in order to bring about this greater good. I believe Kamm is right that if that were the basis for not adopting those means, then it would be inconsistent to say that the letting die can be permissible but not the killing. However, contrary to what Kamm assumes, people often make such judgments (that they should withhold lifesaving treatment) on the basis of something other than the denial of the patient's intrinsic dignity (which is what the judgment that a patient would be better off dead amounts to).
Think of a concrete case. The patient who forgoes chemotherapy does not usually say to himself, "The total consequences of living two months without chemotherapy will be objectively better, overall, than all of the consequences of living six months with chemotherapy." No, there usually is no futile attempt to calculate what all of the consequences will be in the two different scenarios. Rather, people usually make such a judgment on the basis of the belief that their responsibilities to family and others could best be carried out in one way rather than the other. The criterion for whether one should do something that causes bad side effects is not whether doing so will produce the greatest net good, since that is a judgment that cannot be objectively assessed, but whether doing so is just and consistent with all of one's responsibilities.11
The case against suicide and euthanasia is based on the proposition that human life is a basic, intrinsic good, a good that ought at all times to be respected. But some have argued that human life is not always a good. One very important argument for this position is that those who are permanently unconscious or demented are no longer persons. The argument mirrors a similar argument regarding abortion, though it has a different kind of appeal in the context of euthanasia. Suppose Grandfather has a stroke, his son and daughter call the ambulance, and he is brought to the hospital. As a result of the stroke he loses significant memory and becomes demented. Suppose he no longer recognizes his family and can no longer carry on a conversation. His family come to visit him. They spontaneously react: "That's just not Grandfather anymore. Grandfather -- the lovable, affable person we have known for years -- is just not there any more!" This is an understandable reaction. But some proponents of euthanasia articulate this reaction into an argument. It is wrong to kill persons (they argue), but the person who was living at his family's home exists no longer. True, it would be wrong to kill Grandfather, but that (meaning the human organism now hooked up to various tubes in the hospital) is not Grandfather. So, a week later the doctors in charge propose that this isn't really Grandfather any more either and that therefore we should withdraw nutrition and hydration. Keeping this organism alive who, or which, is not Grandfather, and is not a person, is futile. Proponents of euthanasia add that the doctors should be allowed to hasten the demise of this organism by more active methods. In short: it is not a person, so it is not murder to kill it.
This argument indicates how fundamental the issues at stake in this debate are. If the entity that was Iying in his bed and talking to you two weeks ago (Grandfather) is not the same entity as the one these doctors propose to kill -- but plainly it's the same human organism -- this can only be because Grandfather is not a human organism. What then is Grandfather, that is, what is he when he is alive and conscious before his trip to the hospital? Proponents of euthanasia are usually not so clear about the answer to this question. But if Grandfather is not a human organism, then he must be either a spiritual subject somehow associated with a human organism, or a series of experiences -- a nonsubstantial consciousness sustained or embodied somehow in this organism during certain stages of its existence. In other words, this popular argument for euthanasia relies on an implicit denial that we are essentially bodily beings. The body and bodily life are treated as interesting fools or instruments good just insofar, and for as long as, they enable us to have and enjoy various experiences.
For example, speaking of human beings in the "persistent vegetative state," Peter Singer argues as follows:
In most respects, these human beings do not differ importantly from disabled infants. They are not self-conscious, rational, or autonomous, and so considerations of a right to life or of respecting autonomy do not apply. If they have no experiences at all, and can never have any again, their lives have no intrinsic value. Their life's journey has come to an end. They are biologically alive, but not biographically.12
This view of the human person is seriously mistaken. Human persons are not spiritual subjects who have bodies; they are not just series of experiences, mere consciousnesses, or conscious information related to their bodies as software to the hardware in a computer. Human persons are living, organic animals -- free and rational animals, but essentially animals nonetheless. What I am, the thing the word "I" refers to (or 'he', 'him', and so on) is a human, physical organism. So, the time that this human organism comes to be is the time that I come to be. And I do not cease to be until this physical organism ceases to be.13 The accidental characteristics or properties I have are distinct from the thing that I am. Such accidental properties as my height, my shape, my color, can come to be or cease to be at a different time than the time that I come to be or cease to be. However, since the human, physical organism is what I am, rather than a property I have, I cannot come to be or cease to be at a different time than the time that this human organism comes to be or ceases to be. It is the same with all human beings, of course. Thus, it makes no sense to say that, yes, the same physical organism that Grandfather was is Iying on the hospital bed, but Grandfather has ceased to be. Grandfather does not cease to be until the physical organism which he is ceases to be.
How do we know that we are essentially human organisms, rather than having or possessing organisms? For Catholics, one way of knowing is that the Church clearly teaches that a human being is a body-soul composite, that one's soul is per se and essentially the form of the body. This was defined by the Council of Vienne and the Fifth Lateran Council.14 Pope John Paul II reaffirmed this in the context of moral teaching in The Splendor of Truth.15 That is, the soul is by its nature a part of a larger whole. Hence I am not a soul, but a body-soul composite, that is, a rational and free animal.
But this point also can be shown philosophically. In fact it seems that there is in some way an immediate awareness of the truth that we are living bodies. When I take a shower I say that I am washing myself. If you strike my face I do not say, "You hit my body," but: "Why did you hit me?" If while walking past a vase on a coffee-table I accidentally knock it to the floor and it shatters, I do not say, "My body did that," but: "I am so sorry, I accidentally broke your vase."
Phenomenologists have argued that there is an immediate awareness of one's lived body, and that according to this immediate awareness I do not have a body, but I am a body. I am aware of myself as having spatial location. My lived body is the locus of my spatial interaction with others. I am immediately aware of myself as projecting toward other objects from this place, the here and now of this body. This awareness is an evidence -- perhaps not certain by itself, but suggestive -- of an identity. It seems that I am my body rather than have a body.16
The best argument for this point, however, seems to me to be one sketched by Thomas Aquinas. The dualist, that is, one who denies that I am essentially a bodily being, refers to the person he is by way of intellectual or volitional acts -- the thing he refers to as "I" is the thing that understands, thinks, wills, and so on. But one can show that this thing (the thing that understands) is identical with the thing that senses (which must be a bodily entity).
The basic argument is that it is the same thing, the same subject of action, which senses and which understands. We can see that this must be so, for the following reason. When one affirms, for example, that "That is a tree," it is by one's understanding, or an intellectual act, that one apprehends what is meant by "tree" and apprehends objects as unitary, living things. This affirmation or judgment has a subject-predicate structure. The predicate of this judgment (what is meant by the word "tree," which signifies a concept or a nature that can be found in many) is grasped by one's understanding. The subject of the judgment, however, what one refers to by the word "That," is apprehended by sensation or perception. What one means by "That" is precisely that which is perceptually present to one. But, clearly, it must be the same thing which apprehends the predicate and the subject of a unitary judgment; it cannot be one thing that knows "This" and a different thing that knows "tree" when it is one thing (I) who knows, "That is a tree."
But, sensation (or perception) is clearly a bodily act, that is, an act in which the subject of the action is a living organism. This is an act which is clearly performed by lower animals, such as lions, dogs, cats, and so on. Hence, the thing that senses (or perceives) is a living bodily being, that is, an animal organism. (For a thing acts as it is: we know what a thing is through its actions; its actions are the manifestation or unfolding of what it is.)
Since that which understands is what we refer to as "I," and that which senses, namely, an animal organism, is the same thing as that which understands, it follows that I am an animal organism, that is, a living, bodily being. Thus, animal organism expresses (indeterminately) what I am, rather than a property I have.17
So, Grandfather is essentially a human organism. That is, animal organism is not a property or instrument which he has, but it expresses the kind of thing he is. Therefore, it makes no sense to say, "Yes, that is the same human organism that the ambulance raced to the hospital a week ago, but that is not Grandfather." Rather, Grandfather continues to exist for as long as the human organism that he now is continues to exist. Moreover, what is intrinsically valuable is the concrete person himself or herself -- the thing that he or she is -- and that concrete thing, that human person, is identical to the human organism, and continues to exist until the death of the human organism. The person ceases to exist neither before nor after the death of the human organism.
It also is important to note that every human being is an animal with the basic natural capacity to reason and make free choices, even though something may prevent the actualization of that natural capacity. When thinking of "capacities" or potentialities one often thinks of such capacities as the ability to play a musical instrument, to work mathematical problems, or to speak a language. Such abilities, however, are quite different from the more basic potentialities such as the abilities to move, to grow, to see, to reason, and so on. In the Aristotelian tradition the former were called habitus and the latter were classified as natural powers.
The distinction is important. The ability to play the piano or to speak a language are refinements, or specifications, of more basic potentialities -- to move, and to think. These specific abilities are acquired by repeated acts, repeated acts that in some manner dispose the agent so that its potentiality becomes more specific or perfected. However, it is clear that not all abilities can be of this sort. Acquired dispositions presuppose capacities that are given with the nature of the thing. So each thing must have specific basic potentialities not acquired by repeated action, but as part of its nature. These basic potentialities may require time to be actualized. Even so, as basic, natural capacities, they will be there as part of the thing from the time of its coming to be. Moreover, it is possible for the basic capacity to be present and yet some other defect in the thing prevent its actualization. This is obviously the case with persons in a coma. They possess the basic capacity to reason and make free choices, but a defect in their brains -- perhaps quite temporary -- prevents the actualization of that capacity. This also is true of severely retarded children and persons in "persistent vegetative state."18
But perhaps one might grant that an unconscious or severely demented human being is the same individual who was intrinsically valuable a few weeks ago, but argue that this individual is no longer intrinsically valuable. Perhaps one might express this thought by saying, "This is no longer a person." Notice that this argument is distinct from the last argument, even though either of these might sometimes be expressed by claiming that the individual "is not (or no longer) a person." However, one might mean by that, either, that the individual which was a person has ceased to be (the argument replied to in the last section), or that the same individual has ceased to be intrinsically valuable, and in that sense has ceased to be a person. This second position will be examined in this section.
Speaking of an advanced Alzheimer's victim, Ronald Dworkin says that "... he is no longer capable of the acts or attachments that can give [life] value. Value cannot be poured into a life from the outside; it must be generated by the person whose life it is, and this is no longer possible for him.19 But could it be reasonable to say that you exist throughout a time, but that you have moral status and rights during only a certain portion of that time?
A first difficulty can be expressed as follows. If a thing itself could continue to be but cease to be valuable as a subject of rights, then there would be no reason why a being could not have the property which qualifies him for personhood or moral worth (e.g., self-consciousness, in the sense of immediately exercisable self-consciousness), then lack that property, then have it again, and so on. Suppose human beings hibernated for one-month periods every year. Would it not still be wrong to kill a human being during his hibernating periods? Clearly it would be. But severely demented human beings or human beings in a so-called persistent vegetative state are in situations not significantly morally different from such human beings. They still are identical to the beings that at some point clearly do have intrinsic value.
A hibernating human being would still be per se valuable as a subject of rights. (By "per se valuable" I mean: valuable for its own sake, rather than as a means to something else.) In the actual order, sleeping human beings and reversibly comatose human beings are universally recognized as subjects of rights. The best explanation for this point is that what makes a thing per se valuable as a subject of rights is not any accidental characteristic he or she has, but the thing himself or herself.
There are two distinctions between ways of being valuable that must be clarified. There is first of all a distinction between valuing something as a subject to whom one wills benefits (the person to whom one wills learning and health, and so on) versus valuing something as a benefit inhering in a subject (learning and health, for example). Clearly, we normally value ourselves as subjects, and not merely as benefits to others. We value at least most other human beings as subjects to whom we will (and ought to will) various benefits. The question regarding the extension of basic rights is, what entities ought we to value as subjects?
Secondly, we value something either per se or for the sake of something (or someone) else,for another. This is related to the first distinction, but it is not the same. We do value learning per se, rather than as a merely instrumental good, and yet it is valued not as a subject but as inhering in a person (whether oneself or another person). Now, the ultimate subjects of rights, those entities that we ought to take account of for their own sake in our deliberations, and whom we (at least almost always) ought not to kill or use for food -- such subjects of rights should be: a) valued as subjects rather than merely as benefits for someone, but also b) valued per se rather than (merely) for the sake of something or someone else.
The reason why is this. A thing (as opposed to a state or property) can be valuable in one of two ways (keeping in mind the above distinctions): First, it might be valuable as a vehicle or carrier of what is per se valuable. If human beings were valuable in that way, then they would not be per se valuable, but only the states or properties that they bore or carried would be of per se value. Or, secondly, a thing might be valuable because it is per se valuable, that is, it is valuable for its own sake, and not as a means toward what it enables to be instantiated. But, human beings must be valuable in the second way rather than in the first way. For if they were valuable only as mere vehicles for what is per se valuable, then it would always be morally right to kill one child, provided one agreed to replace him with two others. No human beings would have more than replaceable value. None would have the kind of value that almost all of us recognize that at least some human beings do have. So, human beings are intrinsically valuable, that is, valuable per se. This means that they themselves are valuable, not just as vehicles for what is valuable.
So, ultimate subjects of rights should be per se valued. But what is per se valued must have in itself what it takes to be valuable, rather than depend on an additional characteristic to be valuable. In other words, persons are: a) valuable as subjects to whom we will various benefits; and b) valuable per se, that is, not just as bringing about some other condition, but for their own sake.
The thing itself (a person) cannot be per se valuable as a subject of rights but at the same time require accidental attributes (such as, having conscious desires) in order to be valuable. A thing's having an accidental attribute cannot make it per se valuable.
Still, even apart from such untenable dualism and unacceptable ethical presuppositions, one might argue, can't one hold that biological life is not an intrinsic good at all? Perhaps one grants that we are bodily beings, rational animal-organisms, and perhaps one grants that we remain persons until biological death. Still, might one not argue that biological life, at least just by itself, is not an intrinsic good deserving of respect? In other words: biological life (one might argue) is good only as instrumental to other conditions and experiences which are intrinsically good. So, when biological life ceases to bring about these other conditions, then the biological life ceases to be valuable.
However, one cannot view biological life as merely instrumentally valuable without adopting (at least implicitly) a false dualistic view of the human person.
As I explained above, the basic reasons for action are the various forms of personal perfection or fulfillment. Now, the fulfillment of a thing cannot be viewed as valuable and yet the thing itself as merely instrumentally valuable. The thing itself cannot be viewed as instrumental to its good -- its good must include its being as well as its full-being. It is true that an intrinsic part of myself can be viewed as in some way instrumentally valuable -- my bodily parts are called "organs," which is from the Greek word for instrument. But it is impossible to view my whole self as merely instrumental to another good. So, when one views one's whole biological life as merely instrumentally valuable, then he is, perhaps implicitly, identifying himself with something other than that living bodily entity. He is, perhaps implicitly, identifying himself with a mere consciousness or nonbodily subject.
So, since what I am is a living bodily entity, and the thing which I am is intrinsically valuable, it follows that this bodily entity itself is intrinsically valuable. To deny that is to denigrate one's bodily life, to demean one's bodily person. Suicide and euthanasia necessarily involve a denigration of the very thing which you and I are, our bodily lives. The choice of suicide or euthanasia unavoidably involves a denial of the intrinsic dignity of the human person.
Still, one might further object: Perhaps my continuing to be is not good in every case, but is in some cases actually an evil. Suppose my continuing to live involves such suffering that I judge that this kind of life is not good. According to Gary Seay, for example, killing someone who is suffering immediately produces a good because: "... it is not difficult to imagine the case of a dying patient whose entire conscious experience is wholly consumed by physical suffering so excruciating that his life has nothing at all good about it (emphasis in original) (such cases are, in fact, all too common)."20 However, if the badness of the experience is the reason why one views one's life as bad, then one is not actually viewing one's life as bad in itself or per se bad. If life really were viewed as per se bad then it would be viewed as bad at all times. Rather, the thought expressed above is actually that the life is bad when it brings about bad experience. But this means that life is viewed as in itself neutral, and good or bad according to whether it brings about good experience or bad experience.
However, what is valuable cannot be mere experience, but must be the reality of which one may, or may not, have an experience. On this point our culture is, indeed -- and not just on the euthanasia issue -- profoundly confused. We are a hedonistic culture. But to make experience the criterion for the value or goodness of a thing is to put things backwards. Rather, we should judge the quality of our experience on the basis of the goodness or badness of that of which it is an experience. Thus, for example, I may take pleasure in the downfall of my enemy, but this is not a good. The character of my pleasure derives from the character of its object, not vice versa.
Moreover, although suffering is not in itself good, focusing only on experience rather than the realities involved in a situation can make us blind to the real value that our living with suffering can have. Christians know that suffering is not meaningless, that we are called to join our suffering to the sufferings of Christ. This does not mean we should actively seek suffering, or that we should not try to remove it or avoid it when possible. But it does mean that it is not the ultimate evil and that living with suffering is not in itself evil. One of the insidious effects of the euthanasia mentality is to suggest, and subtly to convince many people, that what is valuable is only the quality of one's experience and therefore if one's experience is negative one's existence itself is negative. Indeed this implicitly Manichean doctrine that some beings are in themselves evil (or become so in certain circumstances) has become subtly inserted into our culture's outlook. A person's being and real fulfillment is a genuine good, not just a mere means to pleasant experience.
Perhaps the most popular argument in behalf of euthanasia or suicide is that there are various conditions that make continuing to live a severe indignity, and therefore in choosing to kill one is not choosing to destroy what retains intrinsic value. "Granted," the argument could be made, "one ought not to kill any person whose life retains dignity or intrinsic worth. Still, to live as a vegetable, or as severely demented, or as completely dependent on others and burdensome to them -- to continue to have biological life but without meaningful life -- is a fate worse than death. To kill oneself in such a situation is not to choose to destroy something that preserves intrinsic value or dignity since one's dignity has already been lost." Indeed in certain cases, it is argued, life is the evil and death the good. Dworkin claims: "Just as Justice Rehnquist was wrong to assume that there is no harm in a patient's living on as a vegetable, so it would be wrong to assume that there is no harm in living on demented."21
To understand where this argument goes wrong we must uncover what is meant by "dignity. "As a beginning, we can agree on examples of dignity and indignities. We all would agree, for example, that being in a hospital with little privacy, almost completely dependent on others, without control over our bowels or feeding, is to suffer indignities, or in some way to lose dignity. On the other hand, we are apt to refer to an elderly person who maintains a healthy routine and calmly visits her relatives as "dignified," or as exhibiting "dignity."
Dignity, however, is not a distinct property, a quality one might know by intuition. Rather, it is the possession of other qualities different qualities perhaps in different circumstances -- that cause one to excel, and thus elicit or merit respect from others. There are different types of dignity. First, in aristocratic countries (and even to a certain extent in our own) those of a higher class have a certain dignity not possessed by persons in lower classes. Thus, the loss of a job or the loss of financial status can harm one's dignity in this sense.
Second, and of most interest to us here, there is the dignity of a person or personal dignity. The dignity of a person, whatever that consists in, is that whereby a person excels other beings, especially other animals, and merits respect or consideration from other persons. Now, what distinguishes us from other animals, what makes us persons rather than things, is our capacity to shape our own lives, our capacity for rationality and free choice. However, as I argued above, the capacities to reason and make free choices are basic, natural capacities, possessed by every human being, even those who cannot immediately exercise these capacities. If dignity derives from the kind of thing one is, a human being -- and surely this is dignity in the most important sense -- then one cannot lose this dignity as long as one remains a human being.
Third, there is a type of dignity which varies in degrees, which is the manifestation or actualization of those capacities that distinguish us from other animals. Thus, slipping on a banana peel (being reduced for a moment to a passive object), losing one's independence and privacy (especially as regards our baser functions), are events that detract from our dignity in this sense. However, note that while this dignity seems to be harmed by various situations, it never seems to be completely removed. Moreover, this dignity, which varies in degrees, is distinct from the more basic dignity that derives from the kind of thing one is.
In addition to the different types of real dignity, it is important also to distinguish one's sense of dignity. Something may harm one's sense of dignity without really removing one's real dignity. Everyone who becomes dependent on others feels a certain loss of dignity. Yet their dignity, in either of the first two of the three senses of dignity distinguished, may not have been harmed at all. Often one's sense of dignity can be at variance with one's real dignity (in both of the last two senses). Those who are sick and who bear their suffering in a courageous or holy manner, often inspire others even though they themselves may feel a loss of dignity. In other words, not only must basic personal dignity be distinguished from secondary or manifested dignity, but dignity in both of those senses must be distinguished from felt or sensed dignity.
So, replying to the argument based on the concept of dignity, we must distinguish between different types of dignity and even a sense or feeling of dignity distinct from these. In truth, every human being has a basic real dignity based simply on being a person, that whereby he excels other animals and has in him that which deserves respect and consideration from all other persons. It is precisely this truth that is at stake in the debate about suicide and euthanasia.
There are conditions that harm our dignity in the third sense discussed above -- such as being dependent on others, loss of privacy, preoccupation with pain. These conditions are certainly bad. None of us desire to be in these conditions, and we should work to remove or alleviate such conditions as much as possible. But that does not mean that it would be right to kill someone (or oneself) to prevent those indignities. First, the end does not justify the means. And, second, the very act of killing a person with the supposed justification that the one killed has lost his dignity, or is about to lose his dignity, denies the intrinsic personal dignity of the one killed.
No one wants to die without dignity, but we do not really want to die now with dignity either.22 Death itself is never a dignity -- it is, in a way, the supreme indignity. We may bear suffering and death well, and whether we do so depends, in part, on whether we continue to treat ourselves, as well as others, as persons with intrinsic dignity, that is, persons who have dignity simply because they are persons.
Finally, another way of construing death as sometimes a good in itself good and life an evil has been proposed. Ronald Dworkin has argued that one may view life as like a work of art or drama that one composes, and death as its boundary. The boundaries of a work of art help make it what it is, that is, contribute to its beauty and unique statement. Analogously, Dworkin argues that in some cases death is good because it is the way one chooses to end one's life:
We should distinguish between two different ways in which it [i.e., death] might matter: because death is the far boundary of life, and every part of our life, including the very last, is important; and because death is special, a peculiarly significant event in the narrative of our lives, like the final scene of a play, with everything about it intensified, under a special spotlight.23
If this argument worked, it would justify suicide and not, I think, any other kind of euthanasia. Notice, however, that it would also justify suicide for many reasons other than to escape suffering or pain.
To reply to this remarkable claim, several things must be noted. The analogy or metaphor of life as a work of art should not be left at the vague level. The analogy is helpful in many ways. It helps to emphasize how one should see one's life as in part constituted by one's choices, and it helps to emphasize the importance of trying to organize one's life and of viewing it in its unity. Still, the respects in which the analogy limps -- that is, the respects in which life is not like a work of art -- should also be noticed. Most importantly: in a work of art the entire composition is within the artist's control; every aspect of the work of art is there only because of the will of the artist. Not so in human life: there are aspects of human life that have their design and constitution prior to devising by human will. We do constitute our characters by our choices, but we do not constitute other aspects of our being by our choice. Specifically, our biological and intellectual components are as they are independent of our will, and so they cannot be compared very well to works of art. (Even the aspect of us which we do constitute by our choices, our moral character, is not exactly like art, in that art is an external product produced by external actions.) Thus, the goodness or badness of these dimensions of ourselves is not constituted by our designing or shaping them. Human life (including health) and knowledge of truth are in themselves good prior to their being pursued by choice, and their structure is not directly subject to free or artistic design. Failure to understand these points perhaps explains in part the initial appeal of arguments like Dworkin's.
However, the most important point is that, the death itself is simply not an artistic product. There may be various desirable effects of the death; for example, its timing may be more or less apt for various reasons. But the death itself is the destruction of a life.
One's own death itself is plainly not an act that one performs. That is, although one can perform the act of choosing to kill, and one can do something that causes one's death, one's actual death is something that, whether one wishes it or not, occurs to a human being rather than an action one performs. This is because it is a ceasing to be, not the actualization of any potentiality that one possesses. Therefore, death as such is the privation of the life of an organism, and so the death itself is in no way a good. There could be aesthetic effects of one's dying, or there could be a certain appropriateness about when one dies, but these are in reality distinct from the death itself. One might as well face it: death itself is an indignity. In some ways it is the supreme indignity -- the point at which lower forces finally submerge the life of a person.24 That being so, the object of choice in a suicide remains the destruction of one's life, even though adopted as a means toward making one's "life as a whole" more apt in some way (though how remains obscure, to say the least). Hence such a choice is morally wrong.