IS THERE A DUTY TO DIE? edited by James M. Humber and Robert F. Almeder. Totowa, New Jersey; Humana Press, 2000. 221 pages, index; notes. Hardcover; $49.50.
In 1987, Dr. Margareth Battin posed to the academic world this question: are there circumstances in which there is a "duty to die" in order to make more equitable a just cross-generational distribution of limited health care resources? Rephrasing this, would any of us, assuming life is still worth living, consider it a duty to refuse medical treatments meant to extend our life span because of the costs these treatments would impose on others? As we approach the beginning of the third millennium (January 1, 2001), this question is becoming one of debate. At what point should some of us "just say no" to continued medical intervention?
This is a book of essays, twelve in all, written by respected academics from eleven different institutions. Seven of the essays are sympathetic to Battin's claim; including one by her, and five are critical of it. The book is the seventeenth annual volume of BIOMEDICAL ETHICS REVIEWS.
While the editors attempt to provide a balanced discussion across a wide range of opinions on the issues, they have failed to do so. Had this volume been developed 100 years ago, it would, without doubt, have been filled with reasoned discussion of religious -- Christian -- concerns. I find it disconcerting to find no such discussion in any of the papers. Perhaps the arguments would have been much the same, but I surely would have liked to see a contribution from one or more Christian ethicists to help put the others in perspective. I do not wish to label all the contributors as "non-theists," of course; they simply write as if God did not exist. For me, this is not acceptable.
Margaret Battin, University of Utah, leads off with arguments related to "global equity," that is, one might decide to forgo medical treatment because in doing so others, in Africa for instance, might benefit. She makes a good case for a moral obligation to work for better distribution of health care around the world (16% of the world's population enjoy 89% of all health care expenditures), but does not, she admits, succeed in her primary argument. She argues, however, that should redistribution ever develop, her argument would succeed.
Jan Narveson, University of Waterloo, argues that the duty to die is morally correct, as long as we see it primarily as part of our commitments to our loved ones and not as a duty entailing enforceable requirements. If it is my duty to die, that is my duty, it is not one which another can place upon me or attempt to enforce. This is one of the better papers in the collection.
Marilyn Bennett, College of St. Catherine, examines several hypothetical cases, concluding that the claim is morally defensible, at least under some circumstances. I found her arguments clear and easy to follow; she establishes the claim with strong arguments.
Robert Ehman, Vanderbilt University, argues for the claim on both teleological and contractarian grounds, finding the first to be more persuasive. He also spends some time examining the meaning of "duty to die," distinguishing it from other types of rights and duties. I found his arguments tough reading.
Michael Almeida, University of Texas at San Antonio, considers two arguments sometimes made which extend the claim to include a right to active euthanasia (the "off grandpa and spend our inheritance" position). He finds these arguments to be flawed. As a grandfather, I'm rather glad of that.
Paul Menzel, Pacific Lutheran University, discusses certain implications of the claim. He contends that it is (1) only a prima facie duty, one that can be outweighed by other moral forces, (2) it is better stated as "a duty to let death come relatively cheaply," and (3) it is a personal duty, one that does not give others the right to enforce it. With those considerations, Menzel argues that it is a valid claim, a passive "let death come," not more generally a duty to die.
J. Angelo Corlett, San Diego State University, supports Menzel and extends the argument to cases of criminal justice, showing an inconsistency in Kant's argument against suicide. This paper, while interesting, is off topic.
Rosemary Tong, University of North Carolina, argues that the claim is not safe in our particular society. Her most persuasive points are that the claim should be restated as "the option to die" and that the claim should be described in the language of caring and choice rather than duty and obligation.
David Drebushenko, University of Southern Indiana, argues against the claim, observing that the dying one's assets are, after all, his to allocate and that other family members are free to withhold their support from him. He does not argue that it is not a "good thing to do" in some circumstances, but only that it is not a duty. I suspect that much of his argument would collapse were he and his opposers come to a common agreement on the meaning of terms.
Susan Anderson, University of Connecticut, examines six cases, starting with the now-famous (infamous?) "attached violinist" case, to ask the question "do we ever have a duty to die?" She concludes that finding such a case is "extremely difficult," but perhaps not impossible. She concludes that while the claim may not be justified, a weaker claim, "sometimes we do not have the right to something that may be necessary to sustain our life" can be defended.
Judith Kissell, Georgia College and State University, argues that the implications of the claim leave us in a "strange moral situation." She raises many questions, most of which do not appear to be solvable. It was perhaps in reading this paper that I felt the most need for a theistic perspective.
Ryan Spellecy, University of Utah, concludes the book by arguing that, while the claim might be valid, implementation problems probably make it infeasible.
In spite of my concerns expressed above, I recommend this book. It is well worth reading, possibly worth keeping. It has encouraged me to look for some of the past sixteen volumes in the series and to look forward expectantly to volume eighteen, PRIVACY AND HEALTH CARE, due out in 2001.
John W. Burgeson
First Presbyterian Church
Submitted to PERSPECTIVES,
the quarterly journal of the ASA, April 6, 2000.