Moral confusion at life's end

Nothing simple about end-of-life decisions

January 03, 2011|By Alexander E. Hooke

A kind and good-natured neighbor died last week. He always wanted to die in the peace and comforts of home, as his wife did 15 years ago. After a bad fall, an ambulance whisked him away. He wound up in a strange and sterile room, his body invaded by wires and tubes to the very end.

Will last year's health care overhaul — or any other proposal — be able to address this moral travesty? Public responses to this all-too-familiar experience are often sparked by those gifted in stoking the rhetorical flames of outrage and feigned compassion. "Death panel, "playing God" or "dying with dignity" are nice catchphrases, but they do little to clarify the obstacles before us.

A major problem is that we rely on several different moral guidelines. While helpful for everyday matters, they have shortcomings when applied to life-and-death issues. For example, a version of the golden rule appears in nearly every major religion. Its secular variation appears in the seminal thought of Immanuel Kant, who believed we should never treat another rational being solely as a thing or object.

Yet the golden rule is not particularly adept in helping us prepare for suffering and dying. The axiom that "I treat others as I would want to be treated" obscures the fact that humans are quite distinct in their ways of dealing with mortal issues. I may be a wimp when it comes to pain and suffering, but for others pain inspires creativity, heroism or insight. To have them be treated as I would like to be treated is presumptuous on my part.

Contemporary health care is also a capitalist mega-industry. According to business writer Albert Carr, following the golden rule in a business climate is tantamount to inviting bankruptcy. Despite well-intentioned efforts to discuss candidly patients' preparation for dying, doctors and administrators work within the shadows of billion-dollar enterprises where deception and manipulation often prevail.

Some thinkers contend that a universal respect for individual human rights is a sensible alternative to the Golden Rule. Let rational individuals decide for themselves the circumstances in which they choose to live or die, then be sure to inform family and medical experts of these decisions.

Yet even this concept has drawbacks. It professionalizes death by requiring the oversight of lawyers as well as medical and psychological experts. Moreover, the wishes we announce when vibrant and healthy can alter when we start to deal with various stages of illness and disease. Numerous psychiatrists claim that a wish to die is not an expression of a rational mind but rather a symptom of depression. So the proper response may be treatment instead of granting the wish.

A third moral approach, social utility, is not anchored by the premise that all human lives have inherent and equal value. Guided by the "greatest happiness for the greatest number" principle, this approach looks to actions and laws that assess the benefits we receive from and the contributions we make to the overall good. Individual lives have relative worth. Today's most prominent advocate of social utility is Peter Singer. He has argued, for example, that a seeing-eye dog offers greater utility than a severely handicapped newborn, and hence is more deserving to live. This would also apply to the elderly who need extraordinary and expensive medical care.

This approach works when dealing with distant strangers, but it can be unwieldy when our friends or family members are involved. Mr. Singer himself was unable to follow social utility principles when his aging mother became very ill and he opted for extraordinary measures to sustain her. His critics were aghast. And his own response was somewhat flippant — that he, too, has trouble living up to his own ideals.

In any event, thinkers and moralists since Socrates and Seneca have encouraged humans to learn the art of dying: to prepare to live their last days on their own terms. Encumbered by medical advances, financial drives and litigious fears, the lessons of the sages remain more elusive than ever, as family members of my very kind neighbor sadly realized.

Alexander E. Hooke is a professor of philosophy at Stevenson University and editor of "Virtuous Persons, Vicious Deeds." His e-mail is

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