“TAKING LIFE SERIOUSLY”
A Sermon by the Rev. Bruce Clear
Sunday, April 10, 2005
All
Last week I made a bit of a confession. In a very different context from the topic I am to address this week, I admitted that I have some reservations about the goal of being entirely and inflexibly consistent in our views. There are several reasons why I say this, not the least of which is the acknowledgment that we can never be entirely certain about what is true and right. I also mentioned that I admired those who do aspire to consistency, even though I find I can't always do so.
That confession goes double for today, because if ever there were a subject about which a rigid consistency doesn't seem to work, it is the question of life -- the sanctity of life and the quality of life. This subject is translated into personal values when we approach real issues that have a life-and-death dimension in our society. The issue of life -- what it is and when it ends -- is a philosophical and moral issue, but inevitably in our world it will be considered as a political issue.
I speak today of how we may view life. There are at least four life-and-death issues that we as a society continue to wrestle with, all of which concern our belief about human life. They are, in no particular order: abortion, "death with dignity", the death penalty, and war. All of these issues ask the question about respect for life. All of these issues require us to examine our attitudes and, more importantly, our values about life itself. All of these issues are challenging us as a people, as a society, to come to a consensus, and so far we have not been able to find it.
I don't want my comments to be simply a defense of my own views, though some of that may be there. Rather, I hope I can be able to raise questions, look at perspectives, and set a stage where careful thought and discussion can continue. Since I don't intend this simply to be a defense of my opinion, I suppose it might be helpful for me to begin by simply listing, without much comment, my positions, my biases, on these four issues. I expect many of you will disagree with some, maybe all of my positions. I hope there is healthy disagreement. But I warn you, in hearing my positions, don't look too closely for consistency.
On the question of abortion, I support the right of a woman to make that choice. There are legitimate objections that ought to be addressed, and at minimum, both sides need to join together to find ways to reduce the number of abortions, but for me, the question of choice is paramount.
On the question of "death with dignity," again I come out on the side of choice. In many ways, this is the most complex of all the issues. There is an umbrella word "euthanasia" which identifies many different practices -- from withholding life support when requested by the terminally ill, to assisting them at their request with shortening the dying process. I could use that word "euthanasia" here, but it is often reserved for the more extreme procedures rather than passively ending a life. While recognizing so many different nuances to the issue, and admitting that on this question every single case is unique, in general I support the right of a dying person to make such a choice.
On the question of the death penalty, I oppose capital punishment. My reasons are not entirely about life-and-death issues, and the recent discovery by DNA of how many people we are executing who are innocent should give us some pause. But my reason for opposing the death penalty has, in many ways, more to do with the damage it does to our society than the damage it does to the accused.
And on war, I am not a thorough-going pacifist -- I believe it can have legitimate uses, such as actual self-defense -- but I find it rarely acceptable and even when it is, I find it to be a threat to the highest principles of human dignity and life.
So there's a thumbnail of my personal views. My main concern this morning is to try and understand what we mean by the value of "life" in all of these issues, but I would like to be honest and up front from the beginning about my own prejudices.
And I warned you not to look for too much for consistency in my views; it isn't necessarily there. It seems to me that while all of these issues involve life-and-death concerns, each issue weighs those life-and-death concerns differently, and against very different competing values. Each issue, it seems to me, needs to be viewed according to all the other values that are raised.
As I say, I do respect those who seek a consistent view on life and death issues. Among those who are most consistent in their approach is the Catholic Church, and though I disagree with them on a number of the issues, I have deep respect for that consistency. Their approach is sometimes labeled support for a "seamless garment of life" beginning from conception and ending with natural death. Life should not be terminated, they say, at any point on that garment. Therefore, not only do they oppose abortion and euthanasia, but unlike many of their Protestant "pro-life" allies they also oppose the death penalty and, in most cases, war.
On close
inspection, though, Catholic doctrine does allow for some nuance of compromise
on these issues. In other words, their
consistent "pro-life" doctrine is not as rigid as it may at first
seem. In the case of "death with
dignity," for example, they do allow for extreme cases of withholding life
support, which sometimes seems the most compassionate thing to do. The opposition of the church to abortion is
also not absolute, allowing for the procedure if it is to save the life of the
mother. And while they have a fairly
strict guideline for justifying war, they have endorsed some wars -- such as
the Bosnian action by the UN and the attack on
The consistency of the Catholic approach to life-and-death issues is impressive though, and it makes the Protestant right-wing pleas of an inviolable "right to life" sound somewhat empty. Many Protestant evangelical voices are easily raised in support of government-sponsored killing through the death penalty and war. I can't help but hold some real respect for those consistencies which characterize of the Catholic tradition.
And yet, as I say, though there is much to admire about consistency, for me it is not necessarily the primary virtue to guide us on all ethical questions.
One issue that needs to be addressed at the outset is the idea that these cases, especially with abortion and euthanasia, are tantamount to interfering with "God's plan" for a person's life and death. It is charged that those who approve these are "playing God." Some would suggest that on life-and-death issues, we should "let God decide."
It seems to me that such a view is at least risky. If we let "God decide" on such issues, that would mean, it seems to me, that we forgo any medical care at all. Letting God decide means that if we expect the mother would die by carrying a fetus to term, we should let her die. Or if both mother and child are at risk, we should allow God to let them both die. I wonder if people believe that part of God's plan is to have a child conceived through rape or incest?
Or consider this: are we "interfering" with God's plan when we undergo a heart by-pass or transplant? Maybe God had a timetable for that person's death that we now violate. And if extending a person's life is not violating God's plan, then why would alleviating the pain of dying and shortening the process be somehow "playing God"? Are we interfering with God's plan when conjoined twins are separated, or when a baby's cleft palette is repaired. Is it playing good to give a vaccine or prescribe blood thinning medicine or anti-depressants, or even to take an aspirin to stop a headache? Perhaps that headache may have been part of God's plan!
The question is also relevant to capital punishment and war. If letting a terminally ill patient die a little early is playing God, how much more is the Governor of a state, say Texas, playing God when he signs a death warrant for a healthy human being. Or when war is declared that results in the death of nearly a hundred thousand innocent civilians, as has happened in Iraq?
Perhaps the better approach is to design public policies as if we weren't personally privy to the mind of God, and just do the best we can to relieve human suffering and enhance the dignity of human life. If there is any agreement about God's plan, in any religion, it is a belief that God approves of compassion.
Having addressed that somewhat misleading issue, I want to look more closely at the values that guide us in these life-and-death issues.
First of all, when we say "pro-life," nobody means "life" in its broadest sense. It means, it has to mean, "human life." Otherwise, we would morally prohibit the killing of animals and vegetation, both of which have "life." Prohibiting the killing of vegetable life would of course also condemn all human life.
So the question focuses a little more clearly from what we mean by "life" to what we mean by "human life." There are legal definitions, medical definitions, religious definitions, and philosophical definitions to this term. All definitions are different.
As this issue has unfolded, there are two sides that seem to have been pigeonholed into a battle between two sets of values. One side advocates what it calls the "sanctity of life," the other side defends what is called "the quality of life." I believe this characterization is unfortunate, for a variety of reasons.
The heart of the matter in this debate is what we mean by human life. It may sound like an easy question, but close inspection shows it to be highly ambiguous.
A Canadian medical ethicist and legal specialist, Edward Keyserlingk, has written the clearest statement I have found about the problem. There are, he said, these two very different approaches to the meaning of human life. One approach allows for human life to be defined only in its biological sense, and that is to be considered what is of ultimate value. The other approach says that biological life, the physical body, is simply a means or a tool toward what is really human -- experiencing, communicating, thinking. The second approach questions whether a human body can really be considered "human" unless it is capable of, and has potential for, experiencing anything, communicating anything, or thinking anything. Keyserlingk writes:
"Such a life is still human in the (biological) sense -- it was born of humans and is a potential source of human organs. But such a life is no longer and in some cases never will be human life in the second sense, that is a human life capable of experiencing, communicating, or being responsible for its actions. This we would call human 'personal' life. From the ethical as well as the medical standpoints, the real and crucial question in decision-making is not whether the patients or newborns are human (they are) but whether they are any longer, or can ever be 'persons'."
So the question seems to be whether our identity as humans is reducible to simple biological life, or is there something else that accounts for our person-hood. Some cases are easy, Keyserlingk says. An anencephalic newborn is born without a brain, and therefore is incapable of experience, and that body will soon die for lack of a functioning brain. There is no question that the baby, even without brain activity, is biologically human, and that it has "life." But there is little medical, legal, or philosophical sense that we could consider that newborn a "person," since experience is not possible without a brain.
Likewise at the other end of life: such as when a patient who is brain dead, and where the brain no longer functions, though other vital organs such as heart and lungs are artificially kept going. Without a functioning brain, we can say that a body is biologically human and alive, but we cannot say the "person" is alive, or even "there." Any attempt to keep that physical body alive has no effect on keeping the person alive.
Kyeserlingk sees these cases as obvious, but other cases tend to be far more ambiguous as to whether we're talking about just a biological body or a "person." Close to the case of brain death is that of persistent vegetative state, when the brain may have minimum involuntary functions, but there is no conscious awareness, and no chance of conscious experience, by the patient about the world around them. This also seems to deny the existence of a person, in spite of the existence of life.
The difference between biological life and biological death is easy to decide. The difference between the life of a person and the death of a person seems to run along a more vague continuum.
This may be why I'm uneasy with the phrase "quality of life" being juxtaposed to the phrase "sanctity of life." The word "quality" can evoke images of comfort or even luxury. As in: "Ah yes, I'll have some red wine with my salmon, thank you! Now this is the life!" In the context of this issue, nothing could be further from that sense of "quality." By "quality of life" we refer to whether someone can think or experience things at all, or have any miniscule capacity for self-determination. Quality of life means at least whether there is a potential of experiencing oneself as a person.
This, it seems to me, is the critical issue to be addressed by the end-of-life questions. There are layers of circumstances, each case having unique circumstances, that involve whether to hook up a respirator or detach it, whether to provide artificial food and water, or withdraw it, or how far to extend life beyond its natural end, and so forth.
One layer of circumstance on this question concerns who is to decide when to end a life when the person is in the dying process. It seems to me an obvious ethical truth that the dying person, when possessing sound mind, has the ultimate voice on this matter. That person's opinion trumps everyone else. This is why the Living Will is increasingly important in our world where medical science can continue biological life so much longer that the life of the person.
In the absence of the written or oral instructions of the dying person, the spouse or other family members are given voice. States have different rules on this. In most cases, this is sufficient for a decision, but as we have seen in the recent Terry Schiavo case, it is vital that we have our wishes expressed in writing. I might say that, at least for me, on the long list of people I do not want deciding my fate, near the top of that list would be my congressman or congresswoman, whoever that may turn out to be.
One other layer of circumstances that surround this issue concern the reasons for deciding about the timing of the end-of-life. Again, it seems to me that the patient is the ultimate arbiter of this question. Each of us may have different standards for ourselves concerning when our life has lost sufficient quality to have meaning. If we are talking about the rights of a person, rather that a more impersonal "right to life," the most fundamental personal right we can imagine is the right to self-determination -- the right to make choices about our own lives. It is that right that allows, or should allow, each person to decide for themselves.
In my case, though this may not be true for others, that standard includes the extent to which my continued existence as a mere physical body becomes a burden on those who care for me. The question of ending my physical pain or suffering is less important to me than the pain I would feel knowing that my artificially extended life has made someone else's life more painful and difficult.
This question also brings us to perhaps the most controversial part of the "death with dignity" issue -- that which is called "voluntary active euthanasia," meaning causing death rather than just letting it happen without artificial life support. Sometimes this has been called "physician assisted suicide," when doctors are allowed to prescribe lethal doses of medicine to dying patients, who would then self-administer them. I could spend an entire sermon discussing the nuances of this question, but it is not the focus of my topic today. Suffice it to say that I support this under very controlled circumstances. This practice has been legalized in Oregon for several years now, and there has been no evidence of abuse of its intent.
I have spent far longer on the end-of-life issues than I intended to do, but it helps to put in perspective some of the concerns around other life-and-death issues I have raised earlier.
For example, on the issue of abortion, the concept of "person" is at the heart of the legal issue. As with end-of-life questions, the difference between "human life" and "human person" has also been central in the legalization of abortion. As Edward Keyserlingk made a medical distinction between biological life, on one hand, and human person-hood on the other, so also the Supreme Court used that concept to make a legal distinction.
The Constitution gives certain inalienable rights to "persons," but it doesn't define the word. When the word is used, of course, it implies someone who was already born. So the Court reviewed medical references to make a determination.
We cannot grant "person" status to something that has only potential for becoming a person. If that were the case, any unfertilized human egg contains such a potential -- all it needs is to be fertilized. And that fertilized egg isn't a person anymore than a newborn without a functioning brain can be considered a person. Somewhere in the nine-month process of pregnancy, though, person-hood seems to appear. Reviewing the medical evidence available, the Court concluded that a fetus becomes a "person," in that legal sense, when its brain and vital organs are developed enough to survive outside the womb. This they called the point of "viability."
I won't say much more about this other than to point out that again we see a distinction between biological life and human person-hood. That distinction can be made medically, and it can be made legally. By the way, though I didn't include it in my list of "life-and-death" issues, the question of embryonic stem cell research is also addressed by this distinction between biological life and human person-hood.
These issues, though, are ultimately based on choice. Therefore, we cannot criticize someone for choosing differently than we would in the same circumstances. I might also add that the "sanctity of life" position does us all an important service in keeping before our eyes the seriousness of these questions, insisting that no life-and-death choices should be casually made.
The doctrine of the "sanctity of life" seems unable to allow for such a distinction. I think it is an important one. The right of self-determination for a living human person, and in this case of abortion rights that's the mother, is greater than any theoretical right of a potential, but not an actual, "person."
The distinction between "human life" and "human person-hood" is not a significant part of analyzing the other two life-and-death issues: the death penalty and war. In these two cases, the policy of killing human life is clearly that of killing persons.
Those who hold a "pro-life" position on some issues tend to qualify it when approaching these issues, saying that they wish to protect only what may be called "innocent" life. I understand the distinction, though it seems to me to weaken substantially any overall doctrine of "sanctity of life." Something other than the "sanctity of life" must be guiding their values. Something is more important than biological "life" to these "pro-life" advocates.
As I said in the beginning, my opposition to the death penalty has less to do with the issue of life as it does with the issue of what kind of society we live choose to have. There is no question that America is the most violent society of any modern Western country in the world, and practically the only one that approves of killing as punishment. Again, this is the subject of another full sermon, but I believe that capital punishment perpetuates that culture of violence, affirming that killing is a legitimate form of problem-solving. In any case, approving of capital punishment is declaring that some things are more important that the protection of human life.
War is another exception for many to the pro-life doctrine of the "sanctity of life." That exception is again based upon the principle that only "innocent" life counts as life worthy of being protected. In fact, war is never restricted to killing the enemy. Among the hundred thousand Iraqis who have died since we began the war, the vast majority have been "innocent" civilians. Again, I do believe there is a place for some kind of policy of a "just" war of self-defense. But I also think that anyone who approves of any war should be willing to admit that they are loyal to some principle greater than protecting human life -- even innocent human life.
From the beginning, I said that you shouldn't look too closely for consistency in my comments this morning. I am not looking for some over-arching principle of value that can be applied to every life-and-death human situation. Human situations have an aggravating habit of not fitting neatly into our intellectual categories.
Most ethical dilemmas in life involve a clash of competing values, all of which are probably good values, though they are incompatible. That is why we call them "dilemmas." We weigh those values according to the circumstances, and then choose the ones that seem most important. We all do. That is why a "pro-life" advocate can approve of killing in some circumstances but not in others.
In each issue, we can make a list of values that inform us, but those values will be incompatible. Let me use capital punishment as an example. Here is a list of values that support the policy:
-- Protecting society from killers
-- Deterrence of future violent crimes
-- Support for victims
-- Retribution for violent attacks against others
And here are some values that oppose capital punishment:
-- Rejecting violence as a part of our society
-- Avoiding the execution of innocent people
-- The "sanctity of life"
When I look at this list of incompatible values, I am more persuaded by the second list. I can understand how others can choose differently. There is no absolute right or wrong on any of these issues, and none of us can fully aspire to consistency in choosing about these issues.
The other life-and-death issues have their own similar lists of competing values. With regard to abortion and euthanasia, I find the distinction between biological life and human person-hood to be the most compelling point. On the issue of war, recognizing that innocents will be killed, the most important question for me lies in the reasons given to justify war.
There are people who will look at these issues and their accompanying clashes of values, and decide on competing values different from the ones I have chosen. That is not only fine with me, that is important, even essential, for progress in society. It is helpful to this nation if we have respectful disagreement and the give and take of ideas.