A Theologian Comments
Bernard Bard is a loving man. He is not a vitalist—which is the label philosophers attach to those who make an idol of life. To them life is the highest good, regardless of the situation. But he loves people too much to absolutize mere biological process. He cares too much for human happiness and peace and kindness and loving concern to subordinate every other consideration to merely keeping breathing a sadly non- or un- or sub human creature.
I agree with Mr. Bard that we ought to be able to do something about such tragedies, something that he calls “a sane and civilized and humane approach to euthanasia.” There is no good reason why he and Mrs. Bard and Stephen and a host of friends and medical and paramedical helpers should quit in dumb resignation to that mysterious, disastrous forty-seventh chromosome.
Out of respect for the Mongols, by the way, and to keep the peace with my own son, who is a specialist historian of Central Asia, I prefer to speak of this pathology as an embryonic anomaly or, specifically, Down's syndrome.
Dr. F. has to act within the law, at least as far as policy goes. Nobody knows for sure what doctors do in practice, sometimes. For example, to stop the pain of terminal patients they sometimes give them rapidly increased doses of morphine in order to reach the fatal, toxic level. And at the other end of the life spiral, at delivery, they often refrain from respirating “monsters.” But our statute and common law—that is, our official morality—is thoroughly idolatrous and vitalistic. It prohibits our ever ending a life directly, except when necessary in defense of one's own life.
In short, the official morality and conventional wisdom are not only vitalistic and idolatrous; they are selfishly so. “All life is sacred, and my life most of all.”
It is the sacrosanct notion of life which is challenged by Bernard Bard. He is saying that we are not helpless and hopeless in the face of adversity and suffering. He rejects fatalism. Fatalism attributes cosmic evil (evil not due to human cause or choice) to God, perhaps, or nature, or chance, or to some weird combination of all three, and then it decides that we ought not to do anything about it even if and when we could!
Look carefully at what Dr. K. told him. The “sanitarium” where Philip was taken immediately from the hospital only cares for a Down's case physically, and only in a minimum way at that. They keep no oxygen, give no inoculations against disease. Nothing is done to keep death away. On the contrary, it is welcomed as a friend. Kant once said that if we will the end we will the means, and morally surely he was right. The official morality in this matter is plainly of the primitive taboo order. “Life is untouchable; don't dare the lightning of the gods.” This is not rational or responsible.
This policy we can call indirect euthanasia, achieved by deliberately omitting to do what is possible to preserve life, thus bringing death about left-handedly. It is really dys-thanasia, not euthanasia; a bad death, ugly and prolonged, rather than a good death, merciful and quick. One morality lets death drag out, willy-nilly; the other shortens it by a morally authentic decision.
Dr. F.'s professed policy, in which death is desired but not devised, is public simply because it has general acceptance. To give him the credit due, Dr. F. did say to Mr. Bard that if euthanasia were legal, he would be inclined to end the lives of grossly retarded infants like Philip. But behind the reigning official morality lurks a religious or taboo morality. In formal teaching Roman Catholics, Protestants, and Jews, at least as far as their moral theologians and ethicists can speak for them, are agreed that we are not obliged in conscience to preserve a life, just so long as we don't do anything directly to end it. Pope Pius XII, in saying so in 1957, added that we may never choose to let sufferers “go” except when extraordinary means would be required to keep them alive. Doctors and moralists, however, cannot agree about what is extraordinary, and even if they could, it would become ordinary very quickly because of the rapid advances of medical care.
Whether at the start of life, as with fetal and neonatal defects, or later on, in terminal and senile illnesses, the moral problem is essentially the same; if we can justify wanting death to come, is it ethical to sit by waiting fatalistically for whatever blind, brute nature happens to “do” about it?
There are some who object that “the end does not justify the means.” This is an old bromide, and basically quite an irrational one. Nothing at all can justify what we do, or make good sense of it, except the goal or purpose which gives an act its character as a “means,” or to put it differently, makes it meaningful. Otherwise any act would be random, pointless, non-sense.
The only serious ethical question about means and ends is, “Is the flame worth the candle?” Is the cost of the necessary means proportionate to the value of the end sought? Is the payoff worth the input? This is a decision which depends on the facts in each situation; there are no general formulas, no absolute or universal requirements and prohibition s. In dealing with Down 's cases, it is obvious that the end everybody wants is death. What is at issue is the means. Shall it be indirect, by omission, as in the official policy, just letting it all hang on chance? Or shall it be direct, by commission, resulting from responsible choice?
What Mr. Bard is pleading for, on behalf of millions of blameless and miserable people, is direct euthanasia. I almost said “honest” or “straightforward” euthanasia. Bard's belief is that it is dishonest or phony to will the end but not the means. I agree with him. Absolute taboos, with their underlying mystique about life, make a farce of human freedom.
All such taboos cut the ground out from under morality because nothing we do lies in the moral order if it is not humanly chosen. The atom bomb dropped on Hiroshima in 1945 (tragic and debatable as it was) was morally significant, but the Krakatoa volcanic earthquake off Sumatra in 1883 wasn't. If Philip's life, such as it was, had been brought mercifully to a close, that would have had ethical value; but with its sudden end by “heart failure and jaundice,” neither his life nor his death had any moral meaning whatsoever.
Pause for a moment to consider preventive abortion, of the kind that so many women underwent during the thalidomide snafu a few years ago. There is no reason in the world (other than the vitalist mystique in its extreme form) why a pregnancy should not be stopped at once if there is a solid ground to believe or even to fear that it will result in a mentally or physically deformed child.
This is, in a manner of speaking, fetal euthanasia. Mrs. Finkbine was on a morally sound course when she went to Sweden for an abortion after an Arizona court found that our American laws are too vitalistic to allow her to make a morally responsible decision.
Now, then, if through ignorance or neglect or sheer chance (like the forty-seventh chromosome) the damage has not been ended prenatally, why should it not be ended neonatally? To have given birth innocently to a Down's case, when we would not have done so if we had known the truth, does not of itself justify our extending the tragedy. By stubbornly persisting we only compound the evil; we make ourselves “accessories” after the fact of a monstrous accident. We cannot be blamed for what we did not know, but we can be blamed when we do know.
The only difference between the fetus and the infant is that the infant breathes with its lungs. Does this make any significant difference morally or from the point of view of values? Surely not. Life and human being is a process, not an event; a continuum, not an episode. It is purely superstitious to assert that life “occurs” at fertilization or nidation or embryonic formation or fetal animation (movement) or birth or at school or voting age.
To be a human is to be self-aware, consciously related to others, capable of rationality in a measure at least sufficient to support some initiative. When these things are absent, or cannot ever come to be, there is neither a potential nor an actual person. To be a person is a lot more than just to be alive—as any student of the human struggle for maturity and well-being knows perfectly well. The fact that a biological organism functions biologically does not mean that it is a human being. There is a difference between a man and a brute. Even if it is a difference only of degree, it is still a difference.
There are many variants or variables situation ally, of course. What has been said here is directed only against absolute prohibitions of euthanasia, maintained legalistically and regardless of relative circumstances. On the other hand, however, there is no logic in slipping into the opposite error and absurdity—insisting that euthanasia is always the right thing to do in all cases of retardation! This would simply be a reverse legalism. There is, on the contrary, a strong case to be made for the medical distinctions between idiots, cretins, and morons.
The Kennedy Foundation will no doubt help us eventually to correct the condition of some retardates. Whether we ought to do so or not should depend on each particular situation. Neonatal intensive-care units in maternity hospitals are having increasing success in overcoming hypoxia (lack of oxygen), hypoglycemia (lack of sugar), bilirubin (a blood chemical causing jaundice and anemia), and infections of the central nervous system. But the core of the moral problem is still the freedom of people to choose, to be responsible, in every situation.
How strange and contradictory it is that people should deliberately assume the responsibility to initiate a life, and to control its creation contraceptively, but still fail or refuse to terminate it, no matter what the actual situation is. Some vitalists, the archaically intransigent ones, flatly refuse to terminate reproductive failures either before or after birth, and in a way perhaps this kind of whole-hog opposition makes more sense than a willingness to do it before respiration (abortion) but not afterward (euthanasia). The archaists at least have a consistent and radical fatalism.
People in the Bards' situation have no reason to feel guilty about putting a Down's syndrome baby away, whether it's “put away” in the sense of hidden in a sanitarium or in a more responsible lethal sense. It is sad, yes. Dreadful. But it carries no guilt. True guilt arises only from an offense against a person, and a Down's is not a person. There is no cause for remorse, even though, certainly, there is for regret. Guilt over a decision to end an idiocy would be a false guilt, and probably unconsciously a form of psychic masochism.
There is far more reason for real guilt in keeping alive a Down's or other kind of idiot, out of a false idea of obligation or duty, while at the same time feeling no obligation at all to save that money and emotion for a living, learning child. The learning child might be a retarded one with a viable potential, or just an orphan in need of adoption.
To “feel” obligation to prolong “life” in the Down's case while failing utterly to see or accept any responsibility in the promising child's case is moral confusion worse confounded. From a human or moral point of view it is irresponsible.
Theologically oriented people often get the idea that life is God's alone, to deal with as He wills or pleases. (They stick to this idea even if they practice birth control! The really consistent vitalists are across the board opposed equally to contraception, abortion, sterilization, euthanasia—that is, to any form of human initiative and responsibility whatsoever.) One moralist has said that euthanasia is a “destruction of the temple of God and a violation of the property rights of Jesus Christ.” Bu t this divine-monopoly theory logically militates against medicine itself, which is trying to lengthen life and defend it from “nature's” threats.
The belief that God is at work directly or indirectly in all natural phenomena is a form of animism or simple pantheism. If we took it really seriously, all science, including medicine, would die away because we would be afraid to “dissect God” or tamper with His activity. Such beliefs are a hopelessly primitive kind of God-thought and God-talk, but they hang on long after theologians generally have bid them good-bye.
The notion that life is sacrosanct is actually a Hindu idea, although Hindus practice things like suttee. It is not Christian or biblical. If it were, all heroism and martyrdom would be wrong, to say nothing of carnivorous diet, capital punishment, and warfare. The sanctity (what makes it precious) is not in life itself, intrinsically; it is only extrinsic and bonum per accidens, ex casu—according to the situation. Compared to some things, the taking of life is a small evil, and compared to some things, the loss of life is a small evil. Death is not always an enemy; it can sometimes be a friend and servant.
Life is sometimes good, and death is sometimes good. Life is no more a good in itself than any other value is. It is good, when and if it is good, because of circumstances, because of the context. When it is not good, it deserves neither protection nor preservation. Our present laws about “elective death” are not civilized. It is high time we had some constructive guidance, perhaps from a model code committee of the American Law Institute. Let the l aw favor living, not mere life.