Reasons to live: the rational case against euthanasia.

You could be forgiven for forgetting, during the recent drama about Terri Schiavo, that assisted suicide is illegal in Florida--as it is in every state but Oregon. Commentators on the Schiavo case discussed whether a life like the one she had over the last 15 years is worth living or whether bringing about her death would be the right thing to do. They asked what her preferences were, or would be now. They debated whether Florida law was wise to give her husband Michael Schiavo the right to make the life-or-death decision.

But Florida law doesn't recognize Mrs. Schiavo's right to kill herself, let alone her husband's right to make that choice for her. If she had (miraculously) recovered enough faculties to have been able to beg a physician to give her a lethal injection, and had done so, her wish could not legally have been granted. If she had recovered her faculties and then refused to eat or drink, the response of her caregivers would almost certainly have been to try to talk her into changing her mind.

Florida law allows patients to turn down medical treatments and, when they cannot make medical decisions, designates others to decide for them. Turning down treatment can, of course, cause the patient to die. The decision to turn down treatment may even be made with the precise intention of causing death, as was the case with Michael Schiavo's decision.

Yet Florida does not allow assisted suicide. Why does the state allow patients to die the potentially agonizing death of starvation but not receive a quick, painless lethal injection? That question was frequently asked, for various polemical purposes, during the Schiavo controversy.

One possible answer to the question is that the law is simply inconsistent. Floridians, like most people, have muddled views on medical ethics. For some emotional or esthetic reason, they prefer that death be accomplished by starvation. Perhaps starvation preserves the illusion that the patient is merely being "allowed to die," while a lethal injection would dispel it.

It is possible, however, to take a different view that makes almost complete sense of the law. There are many reasons a patient might wish to decline certain medical treatments (or a husband might wish to decline treatments for his incapacitated wife). Perhaps the treatment would involve pain. Perhaps the patient would rather spend her final days at home among loved ones, even if those days would number more in a hospital. Nobody believes that these are illegitimate choices or that the law should prevent them from being made. Nobody believes that there is any moral imperative to do everything possible to extend a person's lifespan--although such was the heat of the Schiavo debate that pro-lifers were sometimes unfairly accused of holding something like that view.

LIVES 'NOT WORTH LIVING'

lf the law allows a patient to decline treatment, it will have to allow him to decline treatment even when he is declining it solely for the purpose of hastening or causing his own death. In the case of incapacitated patients, it will have to allow the decision-maker to decline treatment even if the decision-maker's intent is to bring about the patient's death. The legislature, in allowing such scenarios to take place legally, is not prospectively blessing these "choices for death" (to use liberal legal theorist Ronald Dworkin's approving phrase). Otherwise, it would repeal or relax the laws against suicide and assisted suicide. It is, rather, viewing these choices as abuses that must be tolerated in order to achieve the good of letting people make medical decisions for themselves and their family members.

The difficulty here is that the Supreme Court in 1990 defined food and water as a medical treatment, and required that all states allow patients to turn it down (or allow their surrogates to turn it down for them). Florida law follows the Court's ruling. But in almost every case, the only reason to disconnect an incapacitated patient from a feeding and hydration tube will be to cause that patient's death. The law, on this point, really is muddled. The Court seems to have taken the nation a half-step toward assisted suicide without quite realizing what it was doing--because, again, if it did realize what it was doing, there would be no reason to allow state bans on assisted suicide.

For those who favor euthanasia, then, the next step is clear. The Schiavo controversy has revealed widespread support for the notion that some lives are so terrible that they should be ended. It would not be surprising if in the next few months and years there were moves for other states to follow Oregon's lead and legalize assisted suicide.

The path ahead for opponents of euthanasia is less clear. Oddly, the Schiavo controversy drew almost no attention to the principled case against euthanasia. This is not only, or even mostly, the fault of the media. Pro-lifers hardly made the case themselves. In a way, this failure was understandable. For political and legal reasons, it made a kind of tactical sense for those who wanted to keep feeding Terri Schiavo to deny that she was in a "persistent vegetative state"--but in denying that, pro-lifers let the notion that it is acceptable for people who are in that state to be starved to death slide right by. It made tactical sense to question whether Mrs. Schiavo really would have wanted to die this way--but in asking it, pro-lifers failed to challenge the notion that it is acceptable to kill those who wish to be killed.

The concept of the "sanctity of life" was a spectral presence in the debate, never given a rational form. So it was easy for people to fall into the assumption that it was an essentially religious concept. Proponents of feeding Mrs. Schiavo were, by and large, Christians, and Christian conservatives at that. They often claimed, or implied, that they were doing God's will. Resisting euthanasia thus came to be seen as somehow theocratic, and certainly irrational. Pro-lifers were "emot[ing] with bug-eyed religiosity," the Financial limes calmly opined. Hendrik Hertzberg called them "Christianists" in The New Yorker, comparing them to bin Laden.

Yet this view turns matters upside down. There is a perfectly rational case against euthanasia. The case for it, on the other hand, almost inescapably rests on what might be described as a kind of irrational spirituality.

The case against starts with the idea that human beings have inherent worth and dignity, and therefore are equal in fundamental rights, simply by virtue of being human--a premise that, when it is brought to bear on other issues, is usually not rejected as religious in its origin. If that premise is true, then these rights cannot depend on particular qualities that some human beings have and others do not. The right to life has to be among these rights, which means that it cannot depend on race, or age, or health, or sex. It cannot depend even on whether the person who has it wants it: He doesn't cease to be a human being with the full complement of rights simply because he wants to die. (It is because the right is intrinsic to human beings that it is also inalienable, as our Founders, who were not theocrats, put it.)

If all human beings do not possess basic rights simply because we are human beings, on the other hand, then it must be the case that some human beings have them because of qualities they, in particular, have. So, for example, we could hold that only human beings with the immediately exercisable capacity for abstract mental functioning have the right not to be killed--which would make it possible for us to allow abortion, research that destroys human embryos, and euthanasia of the permanently comatose or persistently vegetative. But since the capacity for abstract mental functioning varies continuously, we will have to both identify a non-arbitrary minimum level it is necessary to have to possess rights and explain why people who have more of that quality should not be regarded as greater in worth and dignity than people who have less of it. It is impossible to do either.

Thus it ends up being impossible to confine the category of lives deemed unworthy of protection to the unborn and the persistently vegetative--impossible not just practically, but in principle. We have seen how this works at the beginning of life: Whether our criterion is the ability to reason, self-awareness, or the capacity to experience pain, newborn infants do not differ from late-term fetuses. Pro-choicers who find Peter Singer's advocacy of infanticide repulsive cannot come up with a persuasive argument for why he is wrong. He differs from them only in his willingness to embrace the logical consequences of the premises he joins them in affirming.

FAILURES OF LOGIC

For the law to allow people to take innocent human lives--even their own--is necessarily for it to regard some lives as not worth living. This is perhaps especially the case when the law restricts the "right" to commit suicide to specific categories of people, such as the severely disabled and ill. As bioethics writer Eric Cohen noted in The Weekly Standard, at least one Florida appeals court that considered the Schiavo case made this move without even realizing it. It simply assumed that the only reason anyone--including Mrs. Schiavo herself, or rather the Mrs. Schiavo of the past looking at the situation--could want to keep the tube connected was the possibility that "a miracle would somehow recreate" her cerebrum. It assumed, that is, that Mrs. Schiavo would not have wanted to continue living indefinitely in a persistent vegetative state, because no one would. It was all right to end her life, that is because it was, objectively, not a life worth living.

The common description of Mrs. Schiavo as "brain dead" is also worth noting at this point. Here is Christopher Hitchens, who used the Schiavo controversy as the occasion for another of his denunciations of "religious fanatics": "The end of the brain, or the replacement of the brain by a liquefied and shrunken void, is ... if not the absolute end of 'life,' the unarguable conclusion of human life. It disqualifies the victim from any further say in human affairs." Mrs. Schiavo, he writes, was already Michael Schiavo's "ex-wife" before the tube was pulled. (I assume the echo of the dead-parrot routine is intended.)

Hitchens's statement, taken literally, is truer than he appears to realize. Most people accept brain-death as the criterion for death. But the prevailing standard has required the death of the whole brain, not just the cerebrum. If the cerebrum is gone, the higher mental functions are gone as well. But when the whole brain is gone, the body ceases to be able to direct and integrate its own functioning. At that point, there literally is no longer a living organism. Fudging the issue--treating the (contested) diagnosis of the liquefaction of Terri Schiavo's cerebrum as though it meant brain-death--is a way of moving the goalposts. Once that has been done, all kinds of consequences follow. As Wesley Smith has reported, some "bioethicists" have proposed taking usable organs from people in situations like Terri Schiavo's.

The argument--that allowing euthanasia violates a basic human right, denies the ground of human equality, and would also in principle require acceptance of evils that almost everyone can recognize as such--has only been sketched here. To be airtight, it would have to be elaborated, and defended against criticisms. (These things can be done.) The argument's conclusions correspond with the Judeo-Christian tradition. But it does not at any point rely on the premise that God is a Trinity, or that He even exists, or that the pope or the church can teach infallibly in moral matters.

VOODOO BIOETHICS

It is remarkable, however, how often the argument for euthanasia seems to depend on a kind of superstition: on a dualism that separates a person from his body. This dualism holds a person, understood as a consciousness, to be important and worth protecting, but does not so hold the physical organism that this person merely "inhabits." The person is the "ghost in the machine" or, to use Anna Quindlen's more recent metaphor, the tune in the music box. Libertarian commentator Glenn Reynolds took this valorization of the willing, desiring self pretty far: "If Terri Schiavo's desire is to die, then in fact, you're making her into a non-person by not following it." Not to kill her was to destroy her personhood because it was to disregard her will.

This dualism facilitates the denial of a right to life in cases where there is no reasoning, conscious self--as in abortion and the euthanasia of the "vegetative." As such, it is open to the same egalitarian objections mentioned earlier. But it is also untenable. It contradicts everyday experience: We sense and perceive, which are clearly bodily actions, but also engage in conceptual thoughts, which cannot be reduced to bodily actions; and it is clearly the same subject who does both types of things. The dualist refutes his idea in the act of uttering it.

During Terri Schiavo's last days, we heard, perhaps, too much about God, and not enough about justice. I say this not because I think that religious arguments about public policy are somehow inadmissible, or for that matter because I doubt that God wanted us not to kill Mrs. Schiavo. But this conviction of mine derives from my prior conviction that God wants us to do justice to one another. (Kant: "Suicide is not abominable because God forbids it; God forbids it because it is abominable.") To say that God wanted us to save Mrs. Schiavo from starvation, without explaining why justice required us to save her, was conclusory. And it had two negative consequences. The first was that our commentariat, all too eager to engage in hyperbolic arguments about theocracy, now had a perfect excuse to do so rather than to deal more directly with the ethical issues involved in the Schiavo case.

The second was that a conclusory religious argument to save Mrs. Schiavo opened the door to a sloppy religious argument to end her life. The argument here, which quickly became a favorite of the anti-tubists, was that Christian conservatives were behaving faithlessly by striving to keep Mrs. Schiavo from attaining her eternal reward. If they really believed in the next life, went the argument, they would not have gone to such lengths to prolong this one. They were guilty of theological hypocrisy.

This was an extremely careless argument. To begin with, plenty of Christian conservatives do not believe that everyone (or anyone) is guaranteed admission into Heaven. But the more important flaw in the argument is that it wholly ignores the distinction between not prolonging someone's life and deliberately ending it. Nobody involved in the Schiavo case argued that heroic measures must always be taken to prolong the lives of dying patients (which, incidentally, Mrs. Schiavo was not until the tube was disconnected). Everyone, if asked, would have to concede that it could sometimes be permissible to take someone off life support, even when death was a predictable consequence of that action--if, for example, the patient preferred to die at home rather than in a treatment center. Nobody, with the possible exception of the DEA, opposes the use of pain medication to relieve suffering in every case where its use risks causing the patient's death. The claim that pro-lifers are "absolutists" on life cannot survive even cursory examination.

What pro-lifers opposed was an action, removing the tube, that not only resulted in death but the entire point of which was to cause death. To pretend that this distinction did not exist was to beg the question, short-circuiting the charge of hypocrisy. For if the action in question was an unjustified killing--and not a mere "allowing to die," as the popular euphemism had it--then surely it is obvious that Christians could not favor it on the theory that Heaven would be on the other side of it. Churches would then, to be truly consistent, have to fund death squads to usher even more people into paradise. Liberals who do not understand this point should imagine what their reaction would be if someone had said to Martin Luther King Jr., "Why are you carrying on about justice? If you really believe that the world has been redeemed by the Lord, what's the point?"

People die every day, and people get killed every day. The Schiavo case was a tragedy not because the government failed to stop it from happening, but because it directed it to happen--with the apparent support of most Americans. The danger is not that the slope is slippery, but that we have already slid too far down it.