Suicide and Euthanasia: Historical and Contemporary Themes

288 Pages·1989·17.07 MB·English

by  Baruch A. Brody (auth.), Baruch A. Brody (eds.)

SUICIDE AND EUTHANASIA
PHILOSOPHY AND MEDICINE
Editors:
H. TRISTRAM ENGELHARDT, JR.
The Center for Ethics, Medicine and Public Issues
Baylor College ofM edicine, Houston, Texas, U..Ss A.
STUART F. SPICeKER
School ofM edicine, University ofC onnecticut Health Center,
Farmington, Connecticut, U.SsA.
VOLUUMMEE 35
SUICIDE AND EUTHANASIA
Historical and Contemporary Themes
Edited by
BARUCH A. BRODY
Center for Ethics, Medicine, and Public Issues,
Baylor College ofM edicine, and
Department ofP hilosophy, Rice University,
Houston, Texas, U.SS A.
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
Library of Congress Cataloging in Publication Data
Suicide and euthanasia historical and contemporary themes I edited
by ßaruch A. ßrody.
p. cm. -- <Philosophy and medicine ; v. 35)
Includes bibliographies and index.
ISBN 978-90-481-4039-8 ISBN 978-94-015-7838-7 (eBook)
DOI 10.1007/978-94-015-7838-7
1. Suicide--Moral and ethical aspects. 2. Euthanasia--Moral and
ethical aspects. I. ßrody, ßaruch A. 11. Series.
R726.S79 1989
179" .7--dc19 88-34141
ISBN 978-90-481-4039-8
All Rights Reserved
© 1989 by Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1989
Softcoverreprint ofthe hardcover 1st edition 1989
No part ofthe material protected by this copyright notice may be
reproduced or utilized in any form or by any means, electronic or
mechanical, including photocopying, recording or by any
information storage and retrieval system, without written
permission from the copyright owner.
TABLE OF CONTENTS
BARUCH A. BRODY I/ Introduction 1
JOHN M. COOPER I/ Greek Philosophers on Euthanasia and Suicide 9
BARUCH A. BRODY I/ A Historical Introduction to Jewish Casuistry
on Suicide and Euthanasia 39
DARREL W. AMUNDSEN I/ Suicide and Early Christian Values 77
GARY B. FERNGREN I/ The Ethics of Suicide in the Renaissance
and Refornmnation 155
TOM L. BEAUCHAMP I/ Suicide in the Age of Reason 183
JOSEPH BOYLE I/ Sanctity of Life and Suicide: Tensions and
Developments Within Common Morality 221
H. TRISTRAM ENGELHARDT, JR. I/ Death by Free Choice:
Modern Variations on an Antique Theme 251
NOTES ON CONTRIBUTORS 281
INDEX 283
BARUCH A.BRODY
INTRODUCTION
One of the fundamental questions of contemporary bioethics is the treatment
of terminally ill patients and patients (such as persistent vegetative patients)
whose quality of life is very poor. Should such patients receive aggressive
medical care or should they just be kept comfortable and allowed to die?
Should they even be offered the option of assisted suicide or of euthanasia?
What decisional process should be employed in making these decisions? Ever
since the tragic case of Karen Ann Quinlan called public attention to these
issues, the discussion of them has dominated the literature ofbioethics.
Widely divergent positions have developed. They range from the view that
each competent adult ought to have control over his life and ought therefore
to be able to choose the time and manner of his death to the view that each
moment of the biological existence of a member of our species is of infmite
value and that physicians are therefore required to maintain life as long as
that is possible. Many intermediate positions have been articulated as well.
A striking feature of the comtemporary debate is that it has paid little
attention to the earlier discussions of these issues in the history of western
thought. Unlike many questions in bioethics, the questions of suicide and
euthanasia have been discussed at great length and with great sophistication
throughout the history of western thought. Plato, Aristotle, and the Stoics in
the ancient world, the medieval Jewish and Christian casuistrists, and such
important modem philosophers and writers as Donne, Montaigne, Locke,
Hume, and Kant all addressed these issues and had very important things to
say about them.
The goal of this collection of essays - and of the conference sponsored by
the Liberty Fund at which many of the papers were presented - is to make up
for this neglect by carefully surveying the history of western thought on the
questions of suicide and euthanasia and by reexamining the contemporary
debate in light of that reexamination of the historical record.
I
The flrst three historical essays by Professors Cooper, Brody, and Amundsen
attempt to correct certain widespread but mistaken images of the ancient and
1
Baruch A. Brody ( ed.), Suicide and Euthanasia, pp. 1-7.
© 1989 Kluwer Academic Publishers.
2 BARUCH A. BRODY
medieval views on the questions of suicide and euthanasia. It is widely
believed that the Ancients disagreed about the morality of suicide, with Plato
and Aristotle categorically opposing it while the Stoics categorically
approved of it. It is widely believed that Jewish casuistry unequivocally
opposed all forms of suicide and eut..!-J.anasia. It is widely believed that early
Christianity had no objection to suicide, and may even have encouraged it by
the admiration felt for martyrs, and that it was St. Augustine who first
introduced the Christian objection to suicide. The essays in question chal-
lenge all of those beliefs.
Professor Cooper's essay carefully examines the views of Plato, of
Aristotle, and of the Stoics, and shows that the usual picture of their views is
much too simpleminded. The picture of Plato as an opponent of suicide is
based upon his discussion in the Phaedo, and even there he at most tenta-
tively accepts an account of the Pythagorean opposition to suicide. Elsewhere
in his writings, however, he approves of certain types of suicide (in the Laws)
and argues against aggressive medical care in certain cases (in the Republic).
The picture of Aristotle as an opponent of suicide is based on Aristotle's
claim that the person who commits suicide acts unjustly against the state; this
claim is shown by Professor Cooper to involve confusions by Aristotle about
his own views. The Stoics, he shows, were far from holding a categorical
approval of suicide; the carefully formulated early Stoic view permitted
suicide in certain cases (e.g., when beset by mental deterioration or by
debilitating disease or by extreme poverty, or when necessary to discharge
one's duties or to avoid disgrace) but opposed it in other cases (e.g., when
one recognizes that one is likely to continue to do many immoral actions). In
short, then,, PPrrooffessor Cooper's essay challenges many of the standard views
about ancient thought on suicide. It also calls attention to the crucial ideas of
the Neoplatonists Plotinus and Olympiodorus who, at the very end of the
ancient world, actually returned to and defended the original Pythagorean
position that suicide is never permitted.
Professor Brody's essay carefully examines the view that Jewish casuistry
is committed to the belief in the sanctity of human life, the belief that each
moment of biological life of every member of our species is of infinite value.
While agreeing that traditional Jewish casuistry accepts the idea that suicide
is prohibited as a form of self-killing and rejects the claim that one's life,
body, and property are one's own to use as one sees fit, Professor Brody
argues that these claims did not lead the Jewish casuistrists to accept the
sanctity of life position. He shows that traditional casuistrists allowed certain
forms of suicide (e.g., killing oneself out of fear that one will apostasize
INTRODUCTION 3
under torture, penitential and altruistic suicides, and suicides to avoid death
by torture) and viewed the death of some patients as a blessing. As a result,
some even prohibited providing care which prolongs the suffering of a dying
patient and others allowed active pain relief even when that risked the
patient's dying sooner. In short, Professor Brody's essay shows that the
Jewish casuistrists supported a balanced approach among competing values
rather than an absolute sanctity-of-life position.
Professor Amundsen's essay attacks the view that Augustine is the source
of the Christian condemnation of suicide. His strategy involves his arguing
for several different claims: (a) The New Testament, while never explicitly
condemning suicide, does provide a structure of values and hopes inimical to
suicide; (b) These values and hopes provided the foundation of the Patristic
views on life and death, persecution and martyrdom, and sanctification and
suffering. They led the pre-Augustinian Patristic authors to disapprove of
suicide, even though they did approve of the virgins who killed themselves to
avoid sexual defilement; (c) While Augustine may have been the first author
to claim explicitly that suicide violates the sixth commandment against
murder, his position is essentially that of the earlier Patristics except for his
oposition to their approval of the virgins who committed suicide. This led
Augustine to justify the suicides of those virgins who were treated as saints
on the grounds that they acted under the influence of divine inspiration.
Augustine also placed a great deal of emphasis on the virtue of endurance,
but in this he followed many of the earlier Patristics.
file essays by Professors Brody and Amundsen provide a rich body of
material to study the contrast between Jewish and Christian casuistry. Writers
in both traditions discuss the relation between suicide and martyrdom, suicide
and the avoidance of sin, and suicide and disgrace. They seem to come to
conflicting conclusions on many of these issues. There is a need to better
understand the nature of those differences and how they arose.
In any case, then, the first three of our historical essays lead to a rewriting
of the early history of western thought about suicide and euthanasia. The next
two essays, which assess the debate in the sixteenth through the eighteenth
centuries, do not rewrite that history. What they do instead is to enrich our
understanding of a history whose outline is already known.
4 BARUCH A. BRODY
II
The following summary represents what is relatively well known about the
early modem discussion of suicide and euthanasia: Sir Thomas More and
Michel de Montaigne both expressed some support for euthanasia and
suicide. The first great modem defense of suicide was written, however, by
John Donne in his famous Biathanatos. His leading successor was David
Hume, whose essay "On Suicide" is the classic modem defense of suicide.
Other important modem philosophers such as John Locke and Immanuel
Kant opposed suicide. It is out of this dialectic that the modem debate begins.
The essays by Professors Femgren and Beauchamp do not challenge this
picture. What they attempt to do, instead, is to deepen our understanding of
the argumentation employed in these early modem debates. If we are to learn
from these debates, we will of course need to attend to the arguments used by
these important thinkers.
Professor Femgren carefully distinguishes the ideas of Sir Thomas More
and of Michel de Montaigne. It is true that More, in his description of his
Utopian society in his classic Utopia, describes the priests and magistrates as
encouraging those who are suffering from painful and incurable diseases to
put an end to their life or to allow others to release them. But it is hard to tell
which portions of that book were intended by More as serious advice and
which were intended to be just satire. The situation is very different with
respect to Montaigne's essays on suicide. There, the discussion is removed
entirely from its religious moorings, and Montaigne seems to have seriously
advocated the view - basing himself upon many classic examples - that pain
and the fear of a bad death are the best justifications of suicide. In this, he
was followed by his friend and disciple, the priest Pierre Chavron, whose
book on ethics was placed on the Index.
Both Professors Ferngren and Beauchamp carefully analyze the crucial
book Biathanatos written by John Donne in 1606 or 1608 but not published
until the mid-I640s (after his death) by his son. Although he does draw on
some classical allusions, Donne's main strategy is to defend the morality of
certain suicides against St. Thomas's claim that suicide violates the law of
nature, the law of the community, and the law of God. Against the claim that
suicide is unnatural, Donne argues that in some conditions people naturally
desire to die. Against the claim that suicide harms the state, Donne argues
that suicides would nevertheless be justified if the intention of the act were
not self-promoting. Against the claim that it violates the law of God, Donne
argues that none of the scriptural evidence backs that claim. He places
4 BARUCH A. BRODY
II
The following summary represents what is relatively well known about the
early modem discussion of suicide and euthanasia: Sir Thomas More and
Michel de Montaigne both expressed some support for euthanasia and
suicide. The first great modem defense of suicide was written, however, by
John Donne in his famous Biathanatos. His leading successor was David
Hume, whose essay "On Suicide" is the classic modem defense of suicide.
Other important modem philosophers such as John Locke and Immanuel
Kant opposed suicide. It is out of this dialectic that the modem debate begins.
The essays by Professors Femgren and Beauchamp do not challenge this
picture. What they attempt to do, instead, is to deepen our understanding of
the argumentation employed in these early modem debates. If we are to learn
from these debates, we will of course need to attend to the arguments used by
these important thinkers.
Professor Femgren carefully distinguishes the ideas of Sir Thomas More
and of Michel de Montaigne. It is true that More, in his description of his
Utopian society in his classic Utopia, describes the priests and magistrates as
encouraging those who are suffering from painful and incurable diseases to
put an end to their life or to allow others to release them. But it is hard to tell
which portions of that book were intended by More as serious advice and
which were intended to be just satire. The situation is very different with
respect to Montaigne's essays on suicide. There, the discussion is removed
entirely from its religious moorings, and Montaigne seems to have seriously
advocated the view - basing himself upon many classic examples - that pain
and the fear of a bad death are the best justifications of suicide. In this, he
was followed by his friend and disciple, the priest Pierre Chavron, whose
book on ethics was placed on the Index.
Both Professors Ferngren and Beauchamp carefully analyze the crucial
book Biathanatos written by John Donne in 1606 or 1608 but not published
until the mid-1640s (after his death) by his son. Although he does draw on
some classical allusions, Donne's main strategy is to defend the morality of
certain suicides against St. Thomas's claim that suicide violates the law of
nature, the law of the community, and the law of God. Against the claim that
suicide is unnatural, Donne argues that in some conditions people naturally
desire to die. Against the claim that suicide harms the state, Donne argues
that suicides would nevertheless be justified if the intention of the act were
not self-promoting. Against the claim that it violates the law of God, Donne
argues that none of the scriptural evidence backs that claim. He places