Is Our Changing Definition of Death for the Better?
USA Today, May 18, 1995
After ruling our thoughts and our decisions about life and death for nearly 2,000 years, the traditional sanctity of life ethic is at the point of collapse. Consider the following signs of this impending collapse:
-- In February 1993, Britain's highest court allowed a doctor to undertake a course of action explicitly intended to end his patient's life, on the grounds that the patient's life was no benefit to him.
-- In November 1993, the Netherlands Parliament finally put into law the guidelines under which Dutch doctors have for some years been openly giving lethal injections to patients who suffer unbearably without hope of improvement and who ask to be helped to die.
-- In May 1994, 12 Michigan jurors acquitted Dr. Jack Kevorkian of a charge of assisting Thomas Hyde to commit suicide. The acquittal was a major victory for the cause of physician-assisted suicide, for it is hard to imagine a clearer case. Kevorkian freely admitted supplying the carbon monoxide gas, tubing and a mask to Hyde, who then used them to end a life made unbearable by a rapidly progressing nerve disorder.
-- In November 1994, Oregon voters favored allowing physicians to help competent, willing adults who are terminally ill commit suicide. Although the change in the law has been held up by a court injunction, the vote remains a sign of changing public opinion.
-- In March 1995, the chief minister of Australia's northern territory introduced a bill to legalize voluntary euthanasia. The bill is considered to have a good chance of passing. Other bills are expected to be moved soon in other Australian state legislatures.
These events are the surface tremors resulting from major shifts deep in the bedrock of Western ethics. We are going through a period of transition in our attitude toward the sanctity of human life. Such transitions cause confusion and division.
The constant factor that has pushed us to the brink of change has been our growing technical capacity to keep human beings alive. This has forced us to face up to some implications of the sanctity of life ethics that we previously could evade. Now we find that we can no longer accept the ethic of the past.
The first step was the acceptance of brain death -- the permanent loss of all brain function -- as a criterion of death. This has been widely regarded as one of the great achievements of bioethics, one of the few issues on which there has been virtual consensus. This change in the definition of death has meant warm, breathing, pulsating human beings are not given further medical support. If their relatives consent (or in some countries, as long as they have not registered a refusal of consent), their hearts and other organs can be cut out of their bodies and given to strangers.
It is curious that the change in our conception of death that excluded these human beings from the moral community met with virtually no opposition. It is hard to avoid the conclusion that supporters of the traditional view of the sanctity of life, from the pope down, were conned into believing this was a purely "scientific" or "medical" matter. The prevailing view at the time was that those who are brain dead have suffered total systems breakdown, and can at best only be supported for a few hours or a day or two. Now, 25 years later, we have women like Trisha Marshall of Oakland, Calif., who was kept breathing for more than three months after she had been declared brain dead in order to allow her fetus to develop enough to survive.
The next step was made by Britain's highest court, the House of Lords, in the case of Anthony Bland, a 17-year-old soccer fan caught in a crush in 1989. He was deprived of oxygen, and the parts of his brain associated with consciousness were irreversibly destroyed; but he was not brain dead because he had some brain stem function. In deciding his fate, the courts were realistic enough to do something U.S. courts have been reluctant to do: They were prepared to judge Bland's life was not worth living. The House of Lords agreed with Lord Keith, who said "to an individual with no cognitive capacity whatever, and no prospect of ever recovering any such capacity in this world, it must be a matter of complete indifference whether he lives or dies." The Bland case pushed British law to accept the concept of quality of life, rather than sanctity of life, as the basis of decision-making.
This acceptance is one of the two central planks of the new ethic being forged in the hospitals, courts and parliaments of the Western world. The other plank is the desire for greater autonomy over our lives. We want to be able to say how we die, as we want to be able to say how we live. It has led the push for medically assisted dying in the Netherlands, in Oregon and now in Australia. There can be little doubt that over the next decade, others will follow the Netherlands in granting this right to its citizens. In those that do not, courageous figures like Kevorkian will become folk heroes, and "how-to" books like Derek Humphry's Final Exit will be best-sellers.
At this point opponents of change will tell us that once we judge some lives to be not worth living, we are again on the road to the gas chambers. But unless we are to rescind the idea of "brain death" and try to maintain the lives even of those whose brains have totally ceased to function, we are already committed to making quality-of-life judgments. Instead of bemoaning this fact and uttering dire predictions about where it will lead us, we should face the future and discuss how to make better quality-of-life judgments with adequate safeguards against abuse.