August 26, 1977
Death, Dying, and the Biological Revolution, by Robert M. Veatch, Death, Dying and the Law, edited by James T. McHugh, Who Shall Live?, by Leonard J. Weber, and Should Treatment Be Terminated?, by Thomas C. Oden
Every seminarian learns of the Babylonian epic of Gilgamesh, the ancient pagan myth of Edenic morality. Gilgamesh, half-god and half-man, searches for immortality only to have the hope taken from him when he least expected to lose it. The moral theme of this story is that since Gilgamesh cannot escape from death, he must come to terms with it. These four books seek to bring us mortals to a similar point.
We seem to think that medical science has thrust upon us new moral choices with which our ancestors did not have to wrestle. Such arrogant foolishness! Do we really think that during the plagues of Egypt there was no anguish in the Egyptian families as their loved ones died excruciatingly painful deaths? Are we to suppose that during the horrible bubonic plague years in Europe family members never thought of suicide or homicide (“mercy-killing”) in the face of the terrible suffering? Death and its attendants, sickness and suffering, have dogged mankind since the Fall. Francis Schaeffer has rightly noted the profundity of Genesis 5:5.
Since 1969, when Elisabeth Kobler-Ross’s seminal work On Death and Dying appeared, an entire literature on death has developed. These four books fit into that genre and are above average in clarity and usefulness.
Robert Veatch has written perhaps the benchmark volume on death and medical science- It deserves a place on every serious Christian counselor’s bookshelf, not because its author is an evangelical (he is not) or does any exegesis, but because he has given us the most comprehensive discussion of death now in print. Unlike the other three books, this one is heavy going. It is for the reader with the time and stamina to do some detailed study in the area of death and could well be considered a companion volume to Kubler-Ross’s work.
Seeking to define death, Veatch concludes that it occurs when all spontaneous respiratory, circulatory, and cerebral functioning has irreversibly ceased. The patient (or family) will set the criteria in the final analysis, he says, and the death-pronouncing physician shall not have conflicting interests (i.e., the possibility of transplanting organs from the patient after death).
Veatch moves through chapters dealing with the patient’s (or family’s) right not to “prolong dying” and to refuse treatment. Underlying these chapters is the clearly stated assumption that the physician is an agent of the patient and must respond in a way that benefits the patient. As he points out, “The right to refuse medical treatment, for any reason, is well established in the Western legal tradition.” Veatch has a tendency to beg the question in these chapters by using such quality-of-life rhetoric as “prolong the dying process” and “death prolonging treatment.” He calls such treatment in some cases “torture,” and a judge who allowed such “torture” to be stopped (and the patient to die) “compassionate.” Unfortunately, he has not proven his ethical reference points well enough for those characterizations to be valid.
Veatch spends a good deal of space differentiating between “death prolonging treatment” and “lifesaving treatment.” His conclusion is that it is really the patient’s choice how long and under what circumstances he or she wants to continue life.
In the last half of the book, Veatch makes specific proposals for public implementation of the conclusions he drew in the first half. The first half, therefore, has the best chance of retaining its importance, since after the current legislative season the last chapters may be passe. He discusses the mechanics of decision-making (e.g., ad hoc committees and “living wills”) and the legislating of a decision-making structure. He stresses the need for truth-telling in the near-death situation, but before doing this he gives a helpful survey of the argument over this point, which is currently getting a lot of attention in the medical community. He devotes a chapter to organ transplants and ends the book with a call for a national public policy committed to the goal of extending life as long as possible and yet enabling death to be as uncomplicated as possible. In the end, the Judeo-Christian ethic continues to be persuasive, even in thanatology (the science of death); Veatch concludes that we need to affirm “simultaneously that death is an evil and yet certain deaths ought to be accepted.”
James McHugh, a pro-life priest in Washington, D.C., has compiled four essays into the little volume entitled Death, Dying and the Law with the intention of illuminating the legal and medical issues surrounding euthanasia. Although the authors are Roman Catholic, they do not use the standard casuistic approach to their morality. James Doyle notes three reasons for the current interest in death: new medical technology, the advancing “art” of transplantation, and the contemporary “rights” movement. McHugh calls us a “comfort-oriented society” that rejects physical suffering as an inhuman indignity. Ned Cassem gives us five reasons why the “death with dignity” movement has met with well-founded opposition: (1) the moral domino theory; (2) the difficulty of defining irreversible illness; (3) the fear of being accomplices to suicide; (4) the fact that it limits care for the sick; (5) the distrust of human nature. The final essay, written by McHugh and Michael Taylor, makes the crucial point that laws defining death must deal with the death of a human being, not simply the cessation of vital functions of cells, tissues, or organs. They write, “Human life exists in a human person, and the absence of certain qualities or the inability to perform certain functions does not reduce a human being to the animal level or to being nothing more than a ‘human vegetable.'”
There are several appendixes dealing with legislation and euthanasia. Although written in 1976, this section is already dated, in view of the recent developments in California, New Jersey, and Tennessee. There is also a limited but useful bibliography of books and films.
The Leonard Weber book deals with medical intervention in cases of deformed infants. Like McHugh, Weber is a Roman Catholic who does not emphasize the casuistic approach to moral problem-solving. His book is eminently readable and instructive. He clearly sees the logical extension of the question of the minimal criteria for humanness (the question being asked in the abortion context)—that if the question is asked with the unborn, it will in time be asked of the born also. Indeed, Joseph Fletcher has already asked (and answered) the question. Incidentally, Weber claims that the minimal requirement for humanness is the ability to reflect consciously.
The author sees two prevailing points of view in the current discussion of death and medicine. One view sees life as a pos¬session that the possessor can handle however he or she wants (Veatch), while the other sees life as a gift with certain limits on what can be done with it (Weber). He also sees three main categories of “value-of-life” positions: one claiming that life counts for everything; one claiming that life counts for much; and one claiming that only a life free from suffering and pain counts for anything.
In the chapter entitled “The Debate,” Weber outlines six current positions on treating the handicapped newborn infant and sees that their proponents can be roughly divided into those who want to decide in terms of the child’s interest (as they see it) and those who want to decide in terms of society’s interest.
Other chapters in this small volume cover such topics as who should make the decision to treat the child and the “role of the public” in this matter. There is also a profound chapter entitled “The Value of Life,” in which the author moves with eloquence through the moral landmines of death and medical technology. He writes in one place, “The fight against discrimination has been made by insisting that, once you get beyond the individual differences, we are all equally good. The quality-of-life ethic (as opposed to the sanctity-of-life ethic) says that once we get beyond the circumstances there is nothing of value whatsoever.” In another place he writes, “To say that life is good and that its value is not man’s to give or take or decide upon is to stand before life with an attitude of acceptance rather than one of control.” Finally, he draws the bottom line when he states, “For an adult who has long had a grasp on life, success may be interpreted in terms of the fullness of life; for the infant who has never really had much of a grasp on life, just to be alive may be a great success.”
Thomas Oden is a Protestant ethicist who in Should Treatment Be Terminated? posits forty-two ethical guidelines to help families of the seriously ill deal with their traumatic situation. Putting himself in such heady company as Ramsey, Vaux, Gustafson, and Thielicke, Oden argues for the sanctity of life. And yet his list of seven factors to be considered in each case of serious illness lacks an important eighth factor, the philosophical appreciation of life. Furthermore, in an amazing bit of ethical game-playing he used a computer and some colleagues to develop an order of priority for his twelve guidelines for determining when to withhold treatment from a deathly ill patient. Between them, the academicians and the computer relegated “religious beliefs or moral convictions” to last place on the death-determining dozen.
Despite the omission on the list and the grotesquely absurd computer game, Oden shows himself elsewhere to be a person of moral courage and sensitivity. For instance, he notes that a severe temporary depression may come on a patient during major illness or surgery and that the physician, knowing this, has an obligation to the patient to prolong his or her life during this phase, despite the expressed desires of the distraught patient.
He also notes that there is almost complete freedom for any person to control his or her last days outside a hospital but that the hospital, by moral necessity, assumes a degree of surveillance and medical control over the person committed to its care. Oden correctly states that consensus ethics is foolhardy ethics and yet that poll-taking does give us an idea of what will constitute workable legislation.
He later writes, “There is a serious danger that ‘quality of life’ can inadvertently become an upper-class elitist concept. ‘Equality of life’ is more likely to be, preferred by the poor as a principle for making treatment judgments.” Oden calls the practice of applying the term “vegetables” to deathly ill or comatose patients “a pejorative, prejudicial, and dehumanizing use of metaphor.” A target hit!
Oden waits until the last chapter to open the Scriptures, but when he does so he takes them seriously and knowingly. He brings the Word of God to bear at several crucial points in his sanctity-of-life position. I wish he had given us the benefit of his exegesis throughout his book.
My recommendation on these four books is this: if you area Christian counselor by profession, you need the Weber, Oden, and Veatch books. If you are a pastor doing counseling, then Oden and Weber ought to be in your study. If you are a layperson who wants to begin a study of death, then Weber is your best bet.