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What we lose when we gain the right to die

David Goodall’s physician-assisted suicide raises wider questions.

David Goodall To End His Life In Switzerland Sean Gallup/Getty Images

David Goodall killed himself earlier this month.

He was 104. He was not terminally ill, nor was he in physical pain. But as the Australian scientist and right-to-die advocate told the New York Times, “I no longer want to continue life, and I’m happy to have a chance tomorrow to end it.” And so he traveled to a Swiss clinic to die via physician-assisted suicide.

His death, as the Times portrayed it, was a celebration of the “dying with dignity” movement: a chance for a man who had lived a long and full life to exit this world on his own terms. His death was entirely on script — he died, the Times tells us, to the closing strains of Beethoven’s “Ode to Joy,” the very song he’d chosen.

Goodall is far from the first person to have chosen physician-assisted suicide (when the doctor prescribes fatal medication for a patient to take) or euthanasia (when the doctor causes death directly). In states like Oregon and Washington, where physician-assisted suicide is legal, the numbers of those who have chosen to go it have risen steadily.

By and large, media coverage of cases like Goodall’s has been positive. Those who make the decision are generally characterized as brave pioneers.

But Goodall’s case and the right-to-die movement have their critics, in both the religious and the secular sphere. And end-of-life debates more generally — whether they’re instances of suicide like Goodall’s or controversial cases like that of terminally ill UK infant Alfie Evans, whose parents lost the fight to keep him on life support — raise vital questions for which we, as a society, do not have fully articulated answers.

Who has the right to end a life — and why? And what does it mean to make assumptions that a life is, or is not, worth living? At what point do the sometimes competing ideas of “best interest,” individual freedom, and the inherent goodness of life overlap, and where do they contradict each other? And what does the increasing medicalization of death say about our attitude to life?

Goodall was one of many right-to-die activists prominent in the media

A number of right-to-die activists, including Brittany Maynard (who ended her life in Oregon at age 29 after discovering she had terminal brain cancer) and Nan Maitland (who ended her life at a Swiss clinic) have, like Goodall, spoken publicly before going ahead with the procedure. In most cases, those who have chosen the “death with dignity” route are those suffering from terminal physical illnesses. But this is not always the case. Among the most controversial cases in recent memory was that of Aurelia Brouwers, a 29-year-old Dutch woman with mental health problems who successfully convinced courts after an eight-year battle that her severe depression made life unbearable.

But what makes Goodall’s case particularly distinct was that he was not ill and was in fact, though frail, in good health. He simply did not want to live any longer. And, he argued, nobody else should have to either. He hoped he would live on “as an instrument of freeing the elderly from the need to pursue their life irrespective.”

A number of public figures and activists have expressed similar sentiments. NPR host Diane Rehm, for example, has been an outspoken advocate of the “right to die” movement after witnessing her husband’s excruciatingly slow death.

In each case, the idea of freedomthat it is a human right to decide how and when one will die — trumps the idea of life itself as a moral and existential good.

Catholic end-of-life social teaching is more complicated than media coverage would suggest

Traditionally, the most vocal opposition to any form of assisted dying has been the Christian (and particularly the Catholic) Church. Not only has the church been historically opposed to medically assisted suicide and euthanasia, its representatives have often vocally advocated on behalf of keeping terminally ill or vegetative patients on life support indefinitely. In the 2005 case of Florida woman Terri Schiavo, who was in a persistent vegetative state following an accident, the Catholic Church vocally opposed withholding artificial administration of food and water from Schiavo to hasten her death.

But Catholics have often been divided on interpretations of what end-of-life care should be. Generally speaking, a vast body of church documents and teaching holds that life should be preserved, but not necessarily at the cost of artificial or extraordinary measures. Where the line falls between “ordinary” and “extraordinary” measures, therefore, is a subject of extreme debate among Catholics.

As John Paris, a Jesuit priest and a bioethicist at Boston College, put it, the standard Catholic view of end-of-life care, that “life is a gift from God and the determination of life is for God to make,” worked “perfectly fine” until the 13th century, when medieval technological and medical advances began to change the nature of what medical care and intervention meant.

He’s wary of those Catholics who, as in the Evans case, demand that the terminally ill or those on life support be kept alive at whatever cost. All too often, he says, Catholics “don’t have nuanced thinking about complex issues” — simplifying the idea of the “culture of life” to the idea that unnecessarily burdensome treatments on the terminally ill must always be carried out.

Life at all costs — life prolonged through painful or uncomfortable medical procedures — has “never been what the church has taught.” Just recently, Paris said, the Jesuit priest Howard Gray was taken off a ventilator after being injured in a car accident, and this was hardly controversial among his Jesuit brethren.

But when it comes to the right to die at will, Paris is far more critical. “This is not a part of our tradition,” he says. Referencing a body of pro-euthanasia and “right to die” work, including Jo Roman’s 1980 book Exit House, which advocated for assisted suicide on demand, Paris expressed concern over an approach to life that emphasized human sovereignty and agency over the sheer fact of existence. “The idea that everyone is sovereign” — and should have control over all aspects of their life and body — is itself a flawed one, he said. He joked that “if that were true, I’d be 6-foot-2 and have a full head of hair.”

The worry, he says, is that life is seen as something that is only worth living if it possesses certain qualities, and that life is therefore not seen as worthwhile for its own sake.

“What kind of a society wants to do that? Life is made simply an option that you have when you’re happy. But if you become distressed or depressed you can end it. You shouldn’t have to suffer for anything,” he says.

For Catholics, Paris says, suffering is understood as a natural, if undesirable, part of life: “You don’t have to suffer the use of unnecessarily medical interventions. But you have to take life as it comes. Or as God gives it.”

There is a solid humanist argument against the right to die

Those sentiments might not be surprising coming from a Jesuit priest. But some humanists, too, have expressed similar concerns about the way the rhetoric over the right to die renders life itself something that is not to be prized for its own sake. Spiked Online journalist Brendan O’Neill, a controversial figure in the UK due to his vocal dislike for “political correctness,” has been one of the most public critics of the idea of the right to die on humanist grounds.

O’Neill has frequently been critical of the way that views on the right to die have neatly cleaved along class lines, with a pro-euthanasia stance becoming identified with upper-middle-class, progressive social shibboleths. As he put it in a 2010 Spiked article, referencing popular UK intelligentsia class signifiers: “you read the Guardian, you shop at Waitrose, you go to the National Theatre, you support assisted dying.”

O’Neill’s objections to assisted dying are twofold. First, he argues, it brings what should be an intensely personal sphere into the world of bureaucracies and tribunals, causing unnecessary suffering for the dying. Second, he says, it fosters a culture where those who are terminally ill, or disabled, might be led to believe that their own lives — or indeed, life for its own sake — is not valued.

Indeed, O’Neill’s argument is very similar to Paris’s when he writes that debates over euthanasia have “become bound up with society’s broader inability to value and celebrate human life today. It is clear that society finds it increasingly difficult to say that human existence is a good thing — you can see this in everything from the environmentalist discussion of newborn babies as ‘future polluters’ to the widespread scaremongering about the ‘aging time bomb.’”

O’Neill further clarified his argument in a telephone interview with Vox. He sees a certain “moral exhaustion” in a society that no longer sees life for its own sake as a de facto good.

“It’s very important that society doesn’t give the green light to suicide,” he said. “That life is worth living, however difficult it might be … is valuable.” Saying to people, “Well, maybe your life isn’t worth living and maybe you should give up,” is an example of what he calls “moral defeatism.”

Debates about euthanasia involve making a value judgment about the limitations of freedom

To suggest that societally, we have become (to use a phrase popular with Pope Francis) a “culture of death” might be overstating the case.

But despite their differing theological stances, Paris and O’Neill ask a vital question about how we as a culture conceive of the value of life. Is life essentially a neutral phenomenon, a biological accident — life can be either worth living or not worth living, but is not de facto valuable? Is the “sanctity of life” a term so mired in the cultural coding of the abortion debate that it no longer has any validity outside it?

In both the abortion debate and the euthanasia debate, we find a natural tension between the idea of choice — people should have the right to choose what happens to their own bodies — and the idea that it is always necessary to preserve life, in the abstract, at all costs. Within many religious paradigms, traditionally, one’s own life takes on a sacred quality; it is, as Paris put it, a “gift from God.” It’s sacred because it is God-given.

In the absence of that theistic paradigm — at least, at a societal, cultural level — we haven’t necessarily come to a collective conclusion about what life means.

Societally speaking, as we move toward a cultural paradigm that increasingly sees individual liberty as the ultimate moral good, we have to reckon with those instances in which life and liberty do not coincide. As Americans, we’re supposed to be allowed “life, liberty, and the pursuit of happiness.” The question of when one infringes on the other is less clear.

Few people would argue that individual liberty is a bad thing. But it’s worth recognizing what we lose when we collectively change our value system to accommodate its supremacy.

What Paris and O’Neill both tap into, despite their differing perspectives, is that we haven’t necessarily found a way to talk about existence or life as entities in themselves. Is life “worth living” for its own sake? As a culture, we lack a secular vocabulary to talk about what Catholics sometimes call the “sanctity of life.” But for both Paris and O’Neill, it’s a vocabulary we need.