Death with Dignity: Questions, Concerns, Dangers

Regensburg (kath.net/Diocese of Regensburg). Internationally renowned philosopher Prof. Robert Spaemann speaks in this interview with Julia Wächter about the paradoxical shifts in the concept of dignity, about the dangers that would result from the legalization of assisted suicide, and about the duties of the Church and of every individual human being.

Julia Wächter: The expression “death with dignity” is used both by advocates and by opponents of assisted suicide. How did we arrive at this apparent shift of meaning in the concept of dignity?

Prof. Robert Spaemann: A human being possesses dignity, not as an exclusively organic living being, but because he is a spiritual subject, an “I”. However, increasingly intense efforts are being made to separate the human being as a biological entity from an “I” that hovers over matter. Advocates of suicide say that this “I” will disappear with the occurrence of death. Consequently the human being, who would then no longer be a human being, would cease to have dignity. In this view he is not understood as a body-soul composite but rather—you would actually have to say—as a mere soul. That is of course paradoxical, because most of these people adhere at the same time to biologism and materialism. Actually they ought to be advocating the diametrically opposed theory. All modern ideology suffers from a deep internal contradiction, and this is apparent precisely in the double meaning of the word “dignity”.

Wächter: Assuming that a person who commits suicide is convinced that everything ends at death: how can such a person, despite the harshness of his existence, prefer what from his perspective is “nothingness”?

Spaemann: This person’s existence becomes increasingly unpleasant to him, and this leads to a calculated suicide [Bilanzselbstmord]. Someone weighs the advantages and the disadvantages and then decides which side outweighs the other. The person thereby makes himself into a thing. Here we need to recommend solidarity with the sinner but clear disapproval of the sin.

Wächter: Is it possible to justify, even for non-believers, the view that a human being cannot be the absolute master of his own life?

Spaemann: That is not a Christian invention. Even Socrates wrote that life is given to us as a gift. A non-believer, nevertheless, does not believe that a human being has a master. At most he might regard arguments based on the natural law as meaningful. Thus the prohibition against helping to kill can be elucidated in terms of the requirements of public safety. In relation to all his fellow human beings, a human being must be perfectly sure of his life. And he is no longer sure of it if there is a permission to kill. A human being is not the absolute master of himself but must respect others also. If he really is a non-believer, he may not even respect his duty toward his neighbor. Then arguing with a stubborn non-believer does not lead to success.

At any rate there are few people who are really certain that there is no God. Most people today [in Germany] are agnostics: “I do not know whether there is a God, maybe yes, maybe no.” With such a person you can still argue, for example with Pascal’s Wager: If nothing were at stake, it would perhaps make no difference whether God exists. But if it is a question of eternity and if someone harbors just a hint of a doubt about the utter absence of a God, then it makes sense to act as though it were true [that God exists]. Faith is a great joy and a consolation. What would you have lost if [it turned out that] God didn’t exist? Nothing at all.

Wächter: Is there an objective right and wrong in the case of dying, or can everyone decide for himself what is “dignified”?

Spaemann: Ultimately this final step of dying is no longer taken with complete consciousness. But that is exactly the same in the case of the suicide as in the case of the person who dies a natural death. Death with dignity is a death that is a process involving both body and soul. A human being dies when his soul is separated from his body. The physical organism does not die by itself, and the soul does not die by itself, but rather death is something related to the entire human being.

This is important too for criteria of death in view of the debate about brain-death. When does death actually occur? Traditionally a human being was declared dead when he had stopped breathing. Back then, just to be safe, people called in a doctor, who was supposed to determine whether the relatives, who saw that the person was dead, were right or whether there was still some life left. In those days, therefore, they brought in the doctor in order to be sure of not killing someone prematurely. And sometimes he could say: Just a minute, this person is not yet dead. There is still a trace of breathing, for example. Now, though, it is exactly the reverse. In the case of the artificial prolongation of life, when a human being is hooked up to machines and remains alive only with their assistance, it is often said that the person only appears to be alive, he is still breathing and still has a rosy complexion, but all that is only on account of the machines. In reality, though, he is dead—so call the transplantation team to harvest his organs. The doctor now plays exactly the opposite role. Earlier it was to be cautious so as not to bury anyone too early. Now his job is to set aside scruples and say: “Let him go, he is dead.”

In the Harvard definition the death of a human being was brain death. The consequence of this was that they were taking organs from people who were not really dead at all, and deep down the doctors knew it, too. Otherwise why did they give those people anesthesia while removing their organs? Does anyone give anesthesia to corpses? Meanwhile it has become clear that the whole brain-death definition is not right. Some draw a conclusion from it: “Stop, you cannot remove these people’s organs; they are not dead.” Others say: “Well, then, we will pass a law now that allows killing.” At the basis of the latter position is the notion that the person is dead and ceases to be a person if he can no longer be addressed as a person. This distinction between being a human being and being a person, though, is quite ominous. A human being as a whole is a person and finds himself in personal relationships: The person is a father, a mother, a daughter, an aunt, et cetera. All of these are personal roles that do not come to an end at the moment when the human being is unconscious. The extreme proponents of the contrary position maintain that a human being has stopped being a person when he sleeps. When he wakes up again, he is not the same person as the one who went to sleep. He just inherits certain scraps of memory.

Therefore, their argument goes, if I remember my childhood, that is not really me. Ultimately a conflict like that can no longer be decided scientifically, for the question, “When is a human being dead?” is not a question posed to science, but rather is subject to the perception within a society. We perceive dead people as dead people, we treat them as dead people, and we treat the dead body accordingly. That is why it is also a catastrophe that the Catholic Church goes along with cremation, for this practice is increasingly gaining ground because of its low cost. I have always recommended that congregations pitch in when someone cannot pay for a burial. If the Church did not go along with cremation, many people would not have it done.

Wächter: Do you also think that something similar would happen if they legalized [mercy-] killing and assisted suicide?

Spaemann: Yes.

Wächter: Many people prefer cremation on account of the high cost of the alternative and out of consideration for their relatives who must pay those expenses. Applying this to the debate about “aid in dying”: Will people have to justify themselves for continuing to live?

Spaemann: This argument plays a major role and is already a reality today. We have to be able to reassure the patient: “It is not your fault that your relatives have to pay so much.” But we can say that only if there is no other way out for the relatives. If it were punishable by law, then that would make such a wrong way out impossible, for then the person who is willing to die cannot demand it. Here we have to bring in the major difference between suicide and assisted suicide, which is that suicide need not interest the legislator. There are countries in which attempted suicide is punishable by law. I consider that wrong. A human being can get out. Whether that is morally justified is another question. As Christians we would regard it as not allowed. But the secular legislator can cite the argument that he has no jurisdiction over someone who wants to die and to get out of the whole societal system. At any rate, the law steps in at the moment when two persons are involved. And it must step in. What one human being does to another is subject to legislation. That is why we must not conclude that since suicide is not forbidden, then aid in dying must be allowed too. Besides, it is making a big mistake to say that suicide is allowed. It is neither allowed nor not allowed. Here the state has no business requiring or forbidding. If in the case of assisted suicide, however, the law did not step in, then the pressure to commit suicide would increase. To the point where the converse happens: that people in countries where assisted suicide is legal are being killed without their consent. Out of fear, [elderly] people come to Germany [from the Netherlands], because they feel safer here.

Wächter: You have already addressed the importance of the doctor. Would the doctor’s attitude change if he were authorized or obliged to kill?

Spaemann: Absolutely. It is the destruction of professional ethics for doctors. The physician’s ethos is defined by the imperative to heal, to put an end to suffering or to alleviate it. But not by doing away with the suffering person! That is where the physician’s task ends. The patient must have the feeling: “I cannot persuade anyone to kill me.” And that is comforting. It is disastrous for the doctor’s authority the moment the patient has the feeling: “He is so nice right now, but tomorrow he will kill me.” Then the doctor becomes a decision-maker [ein Macher] who determines who lives and who dies. That is terrible. Another thing, likewise, is that you can never try to liberate someone from his life, because liberating presupposes a state that the person who liberates is striving for. The paradox is that the one and only action in life that is completely autonomous is suicide. But being dead is not a state that I can strive for, because then I do away with myself as a subject of free will.

Wächter: A human being needs trust. Many people give up their desire to die, despite persistent pain, because they experience the love and care and support of other people. How are we to deal appropriately with this experience? Is there also a real desire to die that cannot be set aside by trust and love?

Spaemann: Many people who are seriously ill have the desire to die. But that is something completely different from the desire to be killed. The request, in any case, is addressed to God: “Call me!” Assuming that a person with whom I am close were to present to me the request to help him die, [in other words] to kill him, then I would have to answer: “You cannot ask me to say about you that you should no longer exist. That goes beyond what a human being is allowed to do and say.” That person could request anything, but he cannot ask me to want him to vanish. And if he were to ask whether I would take him to an assisted suicide organization in Switzerland, I would try to talk him out of it. I would not help him, but I would nevertheless care for him and remain with him. But he must know that I consider what he is doing to be fundamentally wrong. He should think it through to the end. That is solidarity, even with the sinner. Regardless of what he does, I stay with him. But no one can perform a work of mercy by encouraging sin. “Love the sinner and hate the sin,” Saint Augustine writes.

Wächter: The topics of death and dying are taboo in our society. Why do people push death, suffering and pain out of their field of vision? Do they do it out of fear? Out of uneasiness?

Spaemann: It is unpleasant. And behind this phenomenon is the notion that there is no truth, only likes and dislikes. If there is no such thing as a truth about a human being, and consequently no truth centered on God as its fixed point, then the conclusion is that everything is allowed.

Wächter: Is it possible to reintegrate a culture of dying [well] into society?

Spaemann: Only within limits. Relatively little can be done politically to affect society directly, but it should be done. Given what is going on today, in the gender debate too, we have to fight. But there are many things, major trends that are difficult to influence. The only thing we can do is to try to live rightly ourselves, and to do so in a group of people who are also trying to live rightly and can exert a great power of attraction over others. In the sea there have to be islands of right living.

Wächter: What could such islands be? Individuals, the Church?

Spaemann: Above all the Church is the big island. But such islands exist wherever there are people who live as if God existed. Then you have done what you can. The Church must not waste too much time reflecting on how we can reach modern men. Yes, that is a question which of course must also be asked. But the decisive question is instead: What must we do, in an age that is hostile to God, in order to live according to God’s will? What does such a life look like?

This interview was first published on January 29th on the homepage of the Diocese of Regensburg (Germany), which kindly granted permission to kath.net to repost it. Translated into English by Michael J. Miller.