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Suicide and Euthanasia: Historical and Contemporary Themes PDF

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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

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