Friday, April 15, 2005

The modern-day death cult

The case of Terri Schiavo is a convergent zone for many pressing issues in the culture wars. Although the details of her case are topical, they raise issues of a more general and generally germane nature.

One of the most reprehensible features of the public debate was the way in which those who lobbied for her demise disregarded a whole raft of major moral distinctions. This reflects a frivolous and callous outlook on life.

And that was additional to a careless or calculated oversimplification or even outright misrepresentation of the legal, political, and medical issues.

It was breathtaking to see how many moral and medical barriers were transgressed at one leap. We skipped straight from voluntary to involuntary euthanasia. Our judiciary put to death someone who was not suffering, not dying, not brain-dead, not terminal, not comatose, not on life-support, not guilty of a capital offense. Rather, our judiciary put to death an innocent woman who was mentally impaired, and was being fed through a feeding tube. It wasn't even clear that she needed to be fed through a feeding tube. She was, after all, able to swallow her own saliva.

In the following essay, I'll briefly discuss the Schiavo case in relation to the larger issue of mercy-killing. As far as the facts and merits of the case are concerned, I only know what I read and hear.

I. The Schiavo case

1. The merits of the case

i) Neurologists who examined Terri were divided over her medical status and prospects for rehabilitation.

ii) Nurses who tended to her care day in and day out testified that Terri was responsive.

iii) Michael Schiavo did not allow Terri to receive a PET scan.

iv) Judge Baird, of the Sixth Circuit, actually forbad the FL executive branch from conducting an independent review of Terri's medical status.

v) Although many courts reviewed the Schiavo case, they only ruled on the law, and not on the merits of the case. No new findings of fact were ever entered into the record.

2. The law

Let us remember, at the outset, that due process is not an end in itself, but a means to an end. What is the law for if not to defend the innocent?

According to FL law, Judge Greer was supposed to appoint a guardian ad litem for Terri. Instead, he assume that role himself, in a clear conflict of interest.

According to FL law, guardianship is not unconditional. A guardian is required by law to file an annual heath-care plan for the upcoming year. Michael Schiavo did not comply with that condition, and Judge Greer did not enforce it.

According to FL law, absent a living will, a death-wish must be attested by “clear and convincing evidence.” Instead, it as based on the hearsay evidence of one witness with a conflict of interest--Michael Schiavo.

There is also the question of whether a man who has taken a common law wife is still the husband of his first wife. Isn't bigamy a crime?

Michael Schiavo had at least an apparent conflict of interest on several grounds (the inheritance, a second wife).

When Michael Schiavo testified in the malpractice law suit, he argued for a financial settlement to cover her therapy and hospice care. But later, when he wanted her to die, he suddenly remembered her death-wish in the event of that very condition for which she was to receive therapy and hospice care.

The duly elected representatives of the FL legislature passed “Terri's Law,” to save her life. This was struck down by the FL Supreme Court on the grounds that executive and legislative branches lacked the authority to reverse a judicial ruling by changing the law. This is in direct contravention of popular sovereignty as well as the system of checks and balances. Are we a nation of laws, or a nation of lawyers?

When, on rare occasion, liberals appeal to states' rights, their appeal is limited to state courts, not the executive or legislative branches, or popular referenda and the like.

Jack Kevorkian is serving out a prison sentence for assisted suicide, yet Judge Greer mandated death by dehydration for Terri Schiavo.

According to the US Constitution, Article 3, section 1, Congress wields ultimate authority over the lower courts. Yet when Congress intervened on her behalf, the Federal courts openly defied an act of Congress.

One of the arguments we heard for euthanizing Terri is that her “right to die” was somehow implicit in her “right of privacy.” But, of course, the “right of privacy” is based on US Supreme Court rulings regarding abortion and contraception, which would make it a Federal case.

So the rule of law was systematically flouted in Terri's case.

II. Ethics & metaethics

1. Moral norms.

What are the sources of moral norms? One source is natural law. It is, for example, obvious that heterosexual bonding is natural and normal in a way that homosexual bonding is not.

There are, however, severe limits to natural law theory:

i) In ethics, we are often confronted by borderline cases which present conflicting moral intuitions as well as apparently contradictory moral obligations.

ii) It is possible to be a consistent moral relativist in a way that it is not possible to be a consistent alethic relativist. A great deal of moral reasoning involves reasoning from analogy. And this sort of reasoning assumes an area of common ground between one reasoner and another. For example, prolifers used to argue against abortion on the grounds that the abortion was morally equivalent to infanticide and euthanasia, such that if the latter were unacceptable, then so is the former.

But the more depraved and decadent a culture becomes, the harder it is to find common ground, to come up with a counterexample which is equally unacceptable on all sides. For the unbeliever may be quite willing to call the believer’s bluff, as it were. To a euthanasiast, the comparison between abortion and euthanasia begs the question. He would agree that they are morally equivalent, but conclude on that basis, that both are moral rather than immoral.

So moral intuitions don't have quite the same compelling force as logical intuitions. A moral relativist can, without fear of contradiction, simply deny your moral intuitions. He may be insincere about this, but you can't prove it.

For this reason, among others, we need the moral norms of Scripture to refine and reinforce our moral intuitions. Of course, the unbeliever will deny the authority of Scripture, but we can go beyond raw intuition in arguing for the authority of Scripture.

2. The presumption of life.

Those who oppose euthanasia and forms of murder (e.g., abortion, infanticide) label their position by certain slogans such as “the right to life” and the “sanctity of life.” These terms are of Catholic coinage, but because the prolife movement represents a coalition of the religious right, the terms have been coopted by Evangelicals as well.

There is some value to the “right to life” slogan, for, aside from euphony and brevity, it picks up on legal language from the Declaration of Independence and the 14th Amendment.

Nonetheless, this term, along with the “sanctity of life,” is somewhat misleading, for it has a rather absolutist flavor to it. In Scripture, the “right to life” or “sanctity of life” may be forfeited under special circumstances.

It would be more accurate to speak in terms of the presumption of life. In Scripture, there is a general presumption to preserve and spare life, all other things being equal. This presumption can be overcome under special circumstances, such as the commission of a capital offense. But the burden of proof is to justify the taking of life, not the saving of life.

In Scripture, the presumption of life, and well as special circumstances which supervene on that presumption, are both keyed to the imago Dei (Gen 9:4-5). Man is made in the image of God. And this is not tied to consciousness or a particular stage of life.

3. Omission/commission.

In the debate over euthanasia, it is common to distinguish between killing the patient and letting him die. Now, this practical distinction is not always morally distinct.

On the one hand, there are cases of justified homicide in Scripture. On the other hand, there are other cases in which letting someone die is murder. If, for example, you don't feed a newborn baby, that is murder. To let a baby die of neglect by depriving him of food and water, or other necessities, is murder.

To say, however, that the omission/commission distinction doesn't cover every exception or borderline case is not to say that it is a worthless distinction. Rather, it is a broad and basic moral distinction from which we work our way back. We begin with this distinction, and modify it by the addition certain caveats where necessary.

To put matters more precisely, the omission/commission distinction is a special case of the presumption of life principle. The onus is on the second party to save life rather than to take life unless special circumstances or higher duties supervene.

Certainly there is, in many cases, both a practical and principled distinction between taking the life of someone who is not dying, and extending the life of someone who is dying. As John Frame has put it, we may let the patient die when the patient is actually dying, and we lack the resources to prevent his demise.

There is also a difference between letting a patient die from causes directly related to his injury or disease, and causing him to die by depriving him food, water, oxygen, &c.

4. The meaning of life.

Is suffering a reason to end a life? Many people seem to think so. There are a couple of reasons for this:

i) Those who are not suffering may feel that they don't have the right to prolong the life of those who are suffering. This is part of a larger view of ethics, according to which I don't have the right to speak to an issue outside my personal experience.

ii) Another reason is that we in modern, affluent countries, have become soft and spoiled rotten. In most of human history, and in many parts of the world today, pain is a normal part of life. If you get sick, you stay sick, and you get sicker over time until you finally die.

Christians like Calvin, Baxter, and Christina Rossetti lived with painful and debilitating illnesses as a matter of course. That was an ordinary part of life in a fallen world.

Ironically, the same people who find the care of the disabled the most distasteful are the very people who would most benefit from having to care for the disabled. It would humble their proud and lofty elitism.

Another consequence of affluent modernity is that, on the one hand, we have smaller families (due to abortion and contraception), while, on the other hand, we can afford to contract out the care of the ailing and the elderly to second parties. For example, we warehouse many of our aging parents in nursing homes.

In the past, especially in Christian lands, this was simply unthinkable. It was taken for granted that family members were to care for one another--the young for the old and the old for the young, wives for husbands and husbands for wives. And where the family resources fell short, the church was expected to take up the slack (e.g., foundling hospitals).

You can see this in the Pastorals (1 Tim 5). Families are supposed to take care of their own. And if they can't, the church is supposed to render assistance.

Life was understood to be a life of service, not of self-service. But, of course, the abortion ethic is all about self-service. Motherhood and fatherhood are now treated as an onerous burden rather than a blessing from God.

This is not to say that life was defined by self-denial. For it was also understood that the true source of personal fulfillment came from serving the Lord.

5. The nature of man

Euthanasia defines human dignity and worth in terms of consciousness. The criterion of consciousness also means that those deemed, whether rightly or wrongly, to fall below the threshold of consciousness, can be treated with absolute impunity since they are now non-persons.

Indeed, far from taking a brain-dead or PVS patient off life-support, he is to be kept on life-support to harvest the organs.

i) What does consciousness mean, anyway? Am I conscious when I'm asleep? Is a dog conscious--conscious in the same sense that a man is conscious?

ii) A guiding assumption in the euthanasia debate is materialism--the identity of mental states with brain states. Thus, if the patient loses his higher cortical functions, he is said to lose his personhood and humanity.

a) Historically, Christian theology has held that the seat of personality is situated in the soul, not the brain. And, academic fads in Bible scholarship notwithstanding, I believe this to be Scriptural.

b) In addition, dualism can be defended on philosophical grounds as well.

You can only justify euthanasia by appeal to materialism if you justify materialism.

For further reading:

J. Cooper, Body, Soul, & Life Everlasting (Regent College 1995)

J. Foster, The Immaterial Self (Routledge 1991)

G. Habermas & J. Moreland, Beyond Death (Crossways Books 1998).

H. Lewis, The Elusive Mind (Allen & Unwin 1969)

6. The duty of government.

Many people said they were opposed to gov't intervention in the Schiavo case because it was a private, family matter. That raises raises a number of issues:

i) In this case, the family was divided. Her natural family wanted to keep her alive while her “husband” wanted her to die. So leaving it to the family to resolve the problem among themselves is no solution at all. In the case of a family dispute, who decides?

ii) The gov't was already involved. For the state and federal courts were calling the shots from start to finish.

iii) The police were also involved, in order to enforce court rulings. They were stationed at the door of her room to prevent anyone from giving her a drink. When Michael Schiavo banished her brother and sister from the room, the politice carried out his wishes.

iv) It may be natural knee-jerk reaction for many folks to say that gov't has no business sticking its nose in family affairs, but that is an exceedingly shallow reaction. We cannot allow some family members to do whatever they please to other family members.

Take the example of an ailing parent whose ne're-do-well son or daughter is impatient to inherit the estate. Should there be no laws in place to protect elderly parents from grown children who would hasten their demise to cash in on the estate?

v) Another object to gov't intervention is that an act of Congress violated the separation of powers. But that is wrong on several counts:

a) To begin with, it is Congress which is empowered, under Article 3, section 1 of the US Constitution, to establish all of the lower courts in the first place.

b) At a more fundamental level, this objection disregards the elementary distinction between human rights and civil rights. When, for example, the Declaration of Independence classifies life, liberty, and the pursuit of happiness as inalienable, God-given rights, the point is to treat these rights as human rights rather than civil rights. Human rights are conferred by God. That is what makes them inalienable. Civil rights are conferred by gov't. They can be regulated or repealed by gov't. An example of a civil right would be the right to vote or drive a car.

In our system of federalism, there is a division and distribution in the administration of civil rights. Some civil rights are the purview of the federal gov't, others of state and local gov't, while still others fall under both federal and state law.

But where a human right is concerned, federalism is inapplicable, for every level and branch of gov't has a duty to uphold human rights.

You have something analogous to this in the Mosaic law, where some laws applied across the board, where other laws only applied to Israelites in contrast to resident aliens--such as the duty to obseve the Passover.

c) And at the most basic level of all, the defense of innocent life is the primary duty of gov't. For example, the first revelation we have in Scripture regarding a theology of the state concerns the crime of homicide (Gen 9:5-6).

In Scripture, the state goes back to the family, while the family goes back to the creation mandates (Gen 1:28), which figures in the image of God (1:26-27). For procreation is the way in which the image of God is propagated.

The state is a natural extension of the family. Israel was a tribal society, governed by the chieftains and elders of the clan. Even the monarchy had a familial aspect, being dynastic. The head-of-state was to the nation as the head-of-household was to the family. Hence, execution was eventually transferred to the state, but underwritten by these presuppositions.

III. Euthanasia

1. The right to die

The death-cult speaks very freely about the right to die, as though this were self-evident. But here a number of distinctions need to be drawn.

i) Even if there were a moral right to die, that does not imply a legal right to die; and even if there were a legal right to die, that does not imply a Constitutional right to die. The Constitution is not the source of all moral and legal rights.

A large part of what gives liberalism its foothold is the idea that if I think something is right or wrong, then that should acquire the force of law.

ii) The so-called right to die becomes the right to be killed, which is quite a different thing.

a) It may mean that I have the right to compel a doctor to kill me. Now, even if I have a right to die, does that right compel a second party to kill me? What if that would violate his conscience?

b) In addition, it may mean the right of a second party to kill me without my consent as long as this is deemed, by a second party, to be in my best interests or the best interests of my family or society in general.

In Scripture, there is no moral imperative to die. On the other hand, there is no moral imperative to prolong by any means no matter what. We do believe in the afterlife.

2. The quality of life

Euthanasia is predicated on the quality of life. And this, in turn, leads to the quantification of life, for some enjoy a higher quality of life than others. The distinction isn't limited to disabled. It applies as well to the able-bodied. Human beings are rearranged along a sliding scale of value in the market place of euthanasia. And that, in turn, is the basis of eugenics: not between good and bad, but good, better, and best--however defined.

3. Voluntary/involuntary euthanasia.

i) Voluntary euthanasia hinges on the principle of individual autonomy. My life is my own, and I have the right to end it when I please.

This calls for a number of comments:

a) The principle of autonomy represents one strand of secular ethics. There is, though, another, rival strand of secular ethics in which the will of the individual is subordinated to the common good--however defined.

b) In theology, advocates of libertarian freewill would be predisposed to support voluntary euthanasia.

Hence, there is no value-free way of arguing for or against voluntary euthanasia. It all depends on your worldview and theological belief-system.

c) In Scripture itself, what we have is not personal autonomy, but personal responsibility. Scripture recognizes a principle of diminished responsibility in the case of those who have not reached the age of discretion.

Grown men and women have certain duties proper to maturity. Hence, the principle of personal autonomy is based on a half-truth. This is why, as a rule, slavery is wrong. For it treats adults as children, thereby denying to them their natural duties before God and man.

d) If we assume, for the sake of argument, that voluntary euthanasia is licit, then it follows, by the very same line of reasoning, that involuntary euthanasia is generally illicit. For if voluntary euthanasia is predicated on autonomy, then involuntary euthanasia is generally and directly at odds with the leading principle. For in cases of involuntary euthanasia, the decision is not made by the first party, but by the second party, with or without the consent of the first party.

There is, then, a fundamental conflict between the criteria for voluntary euthanasia and involuntary euthanasia.

e) An apparent exception of this is the living will, in which the patient expresses his wishes in advance.

f) Even this, though, is not a full-blown exception. For it doesn't allow the patient to change his mind. No one wants to go blind. No one wants to be an amputee. That doesn't mean that if you did go blind or become a quadriplegic, that you'd wish to die.

If you pose such a hypothetical to the young and able-bodied, the comparison is inherently invidious. And as long as the hypothetical remains just that--a hypothetical--then it doesn't cost the respondent anything to express his ideal preference. But that is a highly misleading barometer of how he would respond in a real-life situation, where his own fate was hanging in the balance.

4. Life-support.

Euthanasia is said to be justified if the patient is on life-support. But this is very vague.

i) There are cases in which a patient is put on temporary life-support.

ii) There are cases in which someone in a wheelchair may need oxygen or a ventilator. Diabetics need kidney-dialysis. Many of the disabled can carry out a fairly normal life with the aid of some technological assistance.

iii) There are degrees of medical intervention. A baby can't feed itself. It there much difference between breast-feeding or bottle-feeding a baby, and administering food and water through an I.V. or a feeding tube?

5. Terminal illness.

i) Euthanasia is said to be justified in the case of terminal illness. But this is very vague. A patient may be misdiagnosed. He may undergo spontaneous remission. He may libe for a year or two, and be fully or fairly functional for most of that time.

ii) There is sacrificial living, as well as sacrificial dying. To take of concrete example: Martyn Lloyd Jones, the great Welsh preacher, died of terminal cancer. But he voluntarily underwent painful experimental therapy to extend his life so that he could continue his writing ministry for as long as possible.

There's a sense in which we are all dying, for we are all aging, and we are all mortal. So there are degrees of dying, stages of moribundity.

The argument for euthanasia is that if a terminal patient is dying, then why not hasten his death. After all, he's going to die anyway, right?

Yet, even on its own grounds, the logic is hardly compelling. One could just as well reason that if he is going to die anyway, then why intervene at all? Why not let nature take its course? Since he doesn't need any help to die, why put him to death?

iii) This also raises the possibility of conflicting criteria. Is there a single criterion for mercy-killing--or multiple criteria? And if the latter, what happens in the case of conflicting criteria?

6. Suffering.

Euthanasia is said to be justified in case the patient is in acute pain. But this glosses over a number of issues.

i) It should be needless to note that there are degrees of pain and suffering. On a personal note, I know a little something about pain and suffering. I have fibromyalgia, and I'm a cancer survivor. I have better days, and worse days, but I never have good days. That, however, is no excuse to throw in the towel.

ii) It should also be unnecessary to point out that there are degrees of pain-management. You notice that those who lobby for euthanasia act as if we were living before the age of morphine and other painkillers. Never once in these debates have I have heard a medical doctor brought on who is a specialist in pain-management.

7. Mental impairment.

Euthanasia is said to be justified in various cases of mental impairment, viz., PVS, Down Syndrome, senile dementia, a comatose state, &c. By way of reply:

i) Mental function ranges along a continuum. There is a process of cognitive development from conception through childhood. In addition, some people are much smarter than others.

I'd add that, by and large, smart people are not as happy and not as nice as dumb people. So as far as eugenic criteria go, the world would be better off were we to euthanize everyone with an IQ above 120. If, on no other grounds, I'd choose a kid with Down Syndrome over Bobby Fischer every time.

ii) PVS (persistent vegetative state) is a rubbery term, and over the years the bioethics community has given it a more elastic and expansive definition to justify euthanasia.

iii) To say that we should kill the senile or vegetative or comatose because we’d never like to live that way if we were in their place commits an elementary fallacy of psychological projection. For assuming that these patients have no consciousness, they are not conscious of their lack of consciousness. So if it doesn't bother them, why does it bother us?

What is motivating such an attitude is not a concern for the welfare of the patient, but fear of mortality by the young, able-bodied subject who is indulging in this thought-experiment. The subject is afraid of death, and the specter of the nursing home reminds him of a personal prospect that he would rather not contemplate. That’s the real basis for the illusory identification, in which we justify euthanasia by projecting our own fear of aging and dying onto the patient. You see the patient lying in the hospice or the nursing home, and his very presence is a tacit nagging reminder: “You're next!”

This fear is a very natural fear. It strikes at the very core of our very being, as well as those we love. There is a reason why Scripture calls death the “king of terrors” and the “last enemy.”

The only way to overcome the fear of death, and--more importantly--the only way to overcome the curse of death, is through Christian faith.

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