Helping People Die … Forcing People to Live

THE OPEN MIND
Guest: Peter Steinfels
Title: “Helping People Die”
VTR: 4/8/97

I’m Richard Heffner, your host on The Open Mind. And our program today will surely in many ways echo a discussion at this very table ½ dozen years ago with Peter Steinfels, the former editor of Commonweal, whose New York Times column entitled “Beliefs” enables him to bring a religious perspective to the news.

Now, in 1991, we discussed a Washington state vote that by a surprising 54 to 46 percent margin voted down a state initiative that would have permitted doctors to help terminally ill patients who asked to die to do so. Just a month earlier, an opinion survey showed that 61 percent of Washington state’s likely voters at that time approved of the physician assisted suicide initiative, a statistic reflected in national opinion surveys as well, but one whose reversal on Election Day led Peter Steinfels to write in the Times that “The prospect of hanging, Samuel Johnson had pointed out after visiting a condemned prisoner, concentrates the mind wonderfully. It seems that the same thing can be said of lethal injections or euthanasia.”

Well, many times since that vote my guest has returned to the issue in print, frequently seeing in the debate over assisted suicide and voluntary euthanasia a real tension between what he has called “rival views of freedom and politics that have informed the American tradition.” And today I would first ask him to explain that formulation, and to tell us whether over the years since we last discussed the issue he has at all modified his point of view. Peter?

STEINFELS: Well, I think six years ago my major concern was the quality and the nature of the debate that we were having about what is an enormous step morally that the country faces. And my major concern then was that, for example, an issue like this would be resolved on that kind of spontaneous reaction that opinion polls produce rather than on a very serious discussion. We’ve had, I would say, a better discussion; one which, in the last year, and with an accelerating speed now, I think, is really picking up about the nature of this particular step involving euthanasia or physician assisted suicide. But even at the time I wrote then, after the vote in Washington, and then there was a vote following that in California before Oregon passed a physician assisted suicide statute, the kind of debate that took place, I have to confess, still left me dissatisfied in this sense: a lot of the debate focused on extreme cases with people on the one side who felt this was an option that individuals should have, getting a doctor’s help to either inject them with a lethal medication or to give them medication that they could used themselves. Those who thought that this was an option that people should have were apt to bring forth very heart rending cases, tragic cases of people in pain who wished to end their lives. On the other side were those who argued that even the various kinds of safeguards that were being imposed would never prevent terrible abuses of such a legalization of euthanasia or physician assisted suicide.
In both cases, I think this is legitimate material. And it’s obviously the kind of thing that gets underlined in television campaigns when you’re in an election situation. Nonetheless, I didn’t think in many ways it was getting at some of the basic moral and social questions that this kind of a step involves.

HEFFNER: But you must admit, I’m sure, that I and others who consider this are going to think in terms of those personal choices in terms of our personal situations.

STEINFELS: I would grant that it’s, in a way, an automatic response. It’s a natural response. But I think, even on second thought, without having to get to third thought or fourth thought, you can think in different terms. You can realize, for example, how this has a future aspect. This not only provides a kind of response to situations that now exist, for example, those who are in pain which there’s a great difficulty in alleviating, those who are in conditions that are degenerating and they feel that their human dignity is being lost. But we can think also of how this will act to form our various kinds of responses, the expectations that we have from our physicians, the kind of relations between younger people and their parents, or the kind of obligations that older people feel toward their adult children, the way we think in the future about dying, which is something that all of us are going to do. In other words, I think we need to think about this not just in terms of the solution – some would say good, others would say terrible and bad – to a limited number of hard cases, but something which will shake the way all of us think about the end of life, about chronic and difficult disease, about family relationships, and about health care.

HEFFNER: But it seems to me you’re still talking about what I think about those future concerns when, when you write, as you did not long ago in February, February 8, ’96, you wrote about this new book, Democracy’s Discontent by Harvard political theorist Michael Sandel, and you wrote about something larger. You wrote about something that goes beyond a concern about my children and my doctor, or children and doctors and relationships between and among them. You wrote about something much more philosophical. You’re not going to abandon those thoughts now, are you?

STEINFELS: Well, I think there are philosophical issues here about the nature of life. But I wouldn’t want to suggest that those philosophical issues and the way the positions one take don’t have a really payoff in the way we live and the way that we relate to people. In other words, I think, for example, if one has, as the Ninth Circuit Court of Appeals decision suggested, a view of human dignity which stresses, for example, that you are still in control of your body, that you are continent and et cetera, et cetera, that has a certain payoff in terms of what we consider to be human indignity and what we consider to be valued and to be taken care of. I think the, in the last thing I wrote about this, I quoted a line from the political philosopher Michael Sandel who said he’s searching for some way to “reverence that which we cherish, not just that which we choose.” In other words, the underlying philosophical issue here, I suppose, is whether human dignity is so tied up with our capacity to choose and to control our fate that we might, in fact, remove that kind of dignity and the protections that go with it from those who are not in control of their fate.

HEFFNER: Well, you use the word “reverence.” And isn’t that a clue to what the basis for your thinking is?

STEINFELS: Well, I think that certainly a lot of people would connect an issue like this with the question of whether they believe in God, whether they believe that ultimately there is a sacredness to human life that humans don’t have the right to impinge on directly. I think that forms the background for the fact that laws throughout most societies have forbidden most direct assaults on human life. So that’s the kind of reverence for life.

Now, how specifically a religious basis you have for that, how, whether there is a secular equivalent that one could have for that, et cetera, there are certain limits that we draw and where we don’t believe that human control should operate. I think that’s an open question. I think that you could find, indeed, both secular basis for that and a wide range of religious foundations for such a view.

HEFFNER: You think you can find a secular basis for setting aside as, as I read you, I think you would, this individualistic tradition in American democracy? I mean, when you quote Sandel, you make use of the dichotomy he sees between traditions in American life. And one is this individualistic tradition.

STEINFELS: Right. Right.

HEFFNER: The one that has to do with my image of myself in pain …

STEINFELS: Right.

HEFFNER: … and wanting someone to put an end to it. And are you going to prevent me from doing that? Well, you bring in another concern, a larger and perhaps much more important concern, for society at large, and/or for something beyond human society.

STEINFELS: I think that, in his argument, for example, he mentions that this kind of view, which has been eloquently stated by a number of political philosophers, stressing the individual’s right, the individual’s right to write the last act of the drama that is his or her own life. Sandel points out that that view not only runs up against many religious traditions which suggest that life is not drama which is written by the individual, but it’s a drama which has a larger playwright, the individual’s right to write the last act of the drama that is his or her own life. Sandel points out that that view not only runs up against many religious traditions which suggest that life is not drama which is written by the individual, but it’s a drama which has a larger playwright elsewhere. But he also argues that he even runs up against the origins of the liberal political tradition into which many of those adherents of individual rights appeal in pointing out that both John Locke and Emanuel Kant, two of the philosophical founding fathers of modern liberalism, were opposed to suicide, for instance, thought that the limits to control one’s self and one’s own fate, ruled that out just as for Locke they ruled out the ability to sell yourself into slavery.

But I think that there are also practical, social arguments in the sense. A philosophical argument, if you will, but one that has to do with the nature of the society that argues that the individualistic rule perspective is simply not a realistic one in terms of the way that people facing chronic illness, pain, dying are embedded in families and social settings and a complicated, interrelated health care system, for example. So I think there are good social arguments on Sandel’s side, as well as these larger ones that bear on the ultimate metaphysical questions.

HEFFNER: Well, I agree with you. But how likely is it at a time in the country that puts its emphasis increasingly on the “I’m all right, Jack; the Devil take the hindmost,” that philosophically, economically, in its politics and its economics, in its social philosophy, in its dealing with the poor, seems to be saying, “I’ve made mine, and I’m going to hold onto it”; an individualistic philosophy that certainly doesn’t fit in with what you’re suggesting or with what he’s suggesting. How likely is it that the courts will turn to the states, to the public, to the democracy at large, and find anything other than that “I’m concerned about me?”

STEINFELS: Well, right now I think this is a debate which both sides have some strong points. I really do think that there is some real hesitation on the part of the courts, on the part of the public, and on the part of the medical profession and some of the people who are closest to this to take this step. I think there are a lot of people, for example, who, on an ultimate philosophical level they’re not sure where they stand. And they can even see some instances that they have encountered in their experience as health care providers where they would be hard put to refuse someone help in dying. But they nevertheless see, for example, the kind of social selfishness, if you will, also the simple fact of the extraordinary turmoil that the whole health care system happens to be in at this moment. They see the overload, the social overload on courts. And for all these reasons, they may be quite reluctant to go ahead, at least in any sweeping way, in this field. I get a sense from even some of the advocates that maybe they would prefer that we gather a little bit more experience. If Oregon goes forward on the state level, if we study the situation in the Netherlands where this has, there’s a wide practice of euthanasia, and yet its legal status is unclear and the results and so on are highly debated. Even, I think, some of the advocates would like to go slowly here. So there are forces on both sides in this discussion.

HEFFNER: Well, certainly any man or woman who is wise has some concerns about the brave new world of which this would be a part. Burt I wanted to ask you whether, in your estimation, the hesitancy here, particularly within the medical professions, or on the part of advocates who say, “Well, let’s go slowly,” isn’t a reflection of the fact that what others are asking for here really is a fact, that there is physician assisted suicide. Indeed, there is. Why say it out loud? Why incorporate it in our legal system and bring on all the other problems that come with it?

STEINFELS: Well, you point to a very real fact in the discussion. There are those who would say, “In extreme cases this may be a resort that we want, but we just think, in order to keep us honest, in a way, we ought to leave it against the law so that we have to anguish about it and, in those extreme cases, then take what measures we will.” There are those who also say, “Well, this is being widely practiced, and therefore we need a change in our laws in order to regularize and regulate and oversee it.” The latter position I would like to know more about. I feel that some of those who propose that are confusing cases where people in treatment with cases where they would take actual active measures to either help someone commit suicide or either to carry out a killing of a person through lethal injection, for example. I’m not sure how many of the active cases actually exist. And I think we should be careful about how that gets thrown around.

Incidentally, just one thing. I think it’s very important to realize this debate is not going to be limited to physician assisted suicide. We are going to move, even in the court decisions as they have been written now, this is, overlaps with what has traditionally been called “active euthanasia,” where doctors don’t just provide the means for a competent, able person to take his own life, but they carry it out themselves.

HEFFNER: To the degree that in your writings and in your teaching you do not use a religious basis for your elaboration upon the issue, do you think you’re more persuasive … “Persuasive” may not be the right word … that you reach more people? That if you did use a theological …

STEINFELS: No. I should explain that, in my role as a religion correspondent of The New York Times, which was a reporter’s role, and in the column that I continue to write there, I’m not writing an opinion column in the same sense that the people on the editorial pages are. I try to analyze the discussions. I have my leanings, but I try not to resolve them ultimately.

In terms of the social debate, I would say appeals to religion are politically effective in this country. We’re a religious country. But I also think that, you know, there are limits in terms of separation of church and state, that we are also a pluralistic country. And that presents serious problems. Now, I get worried when, for example, in this kind of debate, people begin to equate religious or ethical positions, saying that, you know, the society has no right to establish a religious or ethical position that would keep an individual from doing what he or she wanted to do. That seems to me to be an extension of the First Amendment provision against the establishment of a church to an argument against the establishment of an ethical position which, in fact, I think is an unworkable thing. I think the society has to have some ethical positions in common. Which ones are necessary and on what grounds, where we can leave individuals total leeway is the complicated question.

HEFFNER: Is it unfair, then, to ask Peter Steinfels, citizen, where you come out in this question? Not as an editorialist, because you’re not.

STEINFELS: Morally, in terms of my own actions or people advise me what to do, I think I would be largely opposed to physician assisted suicide or euthanasia. There may be hard cases, as there are in other areas of war and so on, where I’m hesitant to say ahead of time exactly what I would decide. Legally, it’s a more complicated question. Legally, I think we should not make this, we should not constitutionalize this question, because we don’t have enough experience with it. And I think we should proceed very warily and probably hold off in terms of the legal situation.

HEFFNER: Well, we haven’t constitutionalized, but we may not. But we have legalized it. We have legislatively set our canon for or against. I mean, what we’ve been asking for is that this be permitted. The assumption is it is not permitted. Physician assisted suicide is not permitted.

STEINFELS: That’s right.

HEFFNER: It is against the law.

STEINFELS: That’s right.

HEFFNER: So, when you say you don’t want us to constitutionalize it, aren’t you hedging your bet here? We have made it a legal matter. We’ve made it a mater of the law.

STEINFELS: Well, it’s different between making it a legal matter and making it a constitutional matter.

HEFFNER: Granted.

STEINFELS: That is to say that, if you declare it a constitutional right, then any step of developing safeguards, of extending this, as I think will be the case, from those who are competent and mentally alert and able to those who are no longer competent but who may have, before they lost their casualties, have indicated some desire that would suggest that they would like to be euthanized. I think that each one of those steps, rather than to be subject to public debate and legislative action and so on, will be taken to the courts and examined in terms of constitutional rights. I think that’s a legal and philosophical straitjacket that we shouldn’t put on the debate at this point.

And, incidentally, I also have a kind of commitment to democracy. So I think a major kind of mind boggling step in some ways in terms of past history, departure from past history, should not be undertaken without a thorough going public debate. Now, I think, more than anything else, that has probably fueled my writing on the subject.

HEFFNER: When you come back here at the end of this century, what do you think the public debate will have resulted in?

STEINFELS: I think that there will be some limited … I mean, if you’re asking me just as a prediction, whether I’m for it or against it …

HEFFNER: Right. Look in the crystal ball.

STEINFELS: I think that there will be some limited legalization of physician assisted suicide. And I would hope that the debate about that would have produced a lot of progress in terms of care for those who are in pain, those who are facing these difficult decisions, so that other alternatives are real ones that people have.

HEFFNER: Ultimately there isn’t very much of an alternative, is there?

STEINFELS: Oh, I think there is. I think that, for example, we’ve learned that many of the cases that have been previously presented in terms of physical pain are actually, can be dealt with medically. And it’s interesting that the debate is increasingly posed not in terms of physical pain, but in terms of mental anguish for people who foresee a decline physically or mentally.

HEFFNER: Well, if you see, looking into the crystal ball, that by the end of the century we may have made, taken steps in that direction of physician assisted suicide, what do you see in terms of the larger concerns you have or have reported about the social consequences, the ethical consequences, theological consequences?

STEINFELS: I can foresee the possibility that a society in which there was a model of a kind of stoic taking of one’s own life when one began to decline, or the model that supposedly we know from Eskimo society whether (I’m not that knowledgeable about it), where the elders went off on an ice floe because they didn’t want to put the, burden the youngers.

HEFFNER: Or their children put them out on the ice floe.

STEINFELS: Right. That’s true. That’s true.

I can see that possibility as not necessarily leading to a total collapse of society, and even in some ways leading to a higher consciousness about some aspects of the value of human life. But, by and large, I would be pessimistic about that kind of development. And I would hope that the other was true: that there was more and more consciousness of the way in which people do not live all alone, isolated masters of their fate, but the reality of a greater sense of the community, of being indebted, of having mutual obligations that are not played out in the way that the current debate suggests.

HEFFNER: And in a society that has gone back to the 19th Century conceptions of the self made person writing that last act, as you expressed it before, is a dangerous business.

Peter Steinfels, thank you so much for joining me on The Open Mind.

STEINFELS: Thank you.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. Now, if you would like a transcript of today’s program, please send $4 in check or money order to: The Open Mind, P.O. Box 7977, FDR Station, New York, NY 10150.

Meanwhile, as an old friend used to say, “Good night and good luck.”