I first became interested in the debates surrounding assisted suicide through watching my father battle cancer. His story is, sadly, unremarkable in the sense that like so many before him, he was diagnosed with a disease that killed him a short time later. However, to me, his last months were emblematic of an ethical debate that reverberates throughout the domains of law, medicine, and philosophy.
The 3 months he spent fighting the disease were a sobering window into what dying actually looks like. In his last weeks in the hospital, he slipped from cognizant to delirious—the result of multiple infections he contracted in his drab white room—and eventually into a coma. As his organs failed one by one, their functions were externalized, relegated to machines that filled the room with a mechanical cacophony. When he died, it was as much a relief as a tragedy.
Witnessing the process of his dying made me pursue a study of bioethics, and particularly a study physician-assisted suicide. Watching his suffering made me understand with more gravity than ever before why someone would want to avoid that at all costs, even if that meant ending her life.
Ownership, Stewardship, and Autonomy
Assisted suicide calls these ideas of ownership and stewardship to the surface. The issue isn’t only life or death, but also what our relationship to our own lives is, and whether or not we have an inherent right of determination over them? If we truly own our lives, what holds us accountable to others? If we are stewards of our lives, why is it that we hold self-determination in such high esteem? Do we owe others our presence in their lives, if they have determined that our lives impart great value to theirs? And if we do, to what extent, and at what cost?
The idea that we possess ownership over our lives owes much to the Enlightenment philosophers, and to the subsequent secular moral philosophers that gathered the strands of the individual and attempted to craft her into an autonomous self. Affirmations of individual rights to self-determination are inherent in medical ethics, where we defer to the wishes of the individual regarding treatment through living wills, the right to refuse care, and even through medical proxies who use substituted judgment to determine what a patient would choose for herself.
If ownership was completely uncontested, I suspect the assisted-suicide debate would never have reached the fervent pitch it has today. But something happens to the idea of ownership when that power can be used to end one’s life. Many are uneasy with the prospect of creating legal allowances for assisted-suicide. This uneasiness is expressed not only as concern for a devaluation of an individual life, but as a precursor to a devaluation of all life. Why, then, if I alone am the sole owner of my life, does what I do with that life have any external effect on the value of the lives of others?
One explanation is that while we might be owners of our own lives, perhaps we owe it to each other to act as stewards, either as supporters of their lives, or as supporters of our own lives to the benefit of theirs. But if we have an obligation to act as stewards, what prevents others from overriding our decisions about our own lives for their benefit? The idea that an individual’s will can be rightfully and morally superseded by the will of another only because of this obligation is not only disconcerting, but antithetical to our autonomy.
If ownership is too focused on only the needs of the individual, then stewardship seems to be an appealing alternative. A stewardship model should theoretically preclude anyone from shortening her life in the face of a terminal illness because her life is, effectively, entrusted to others. Does that, then, mean that others can make that decision for her? Can those others determine her suffering and consent to treatment for her?
What is troubling in the stewardship model is not the idea of mutual obligation, but what might be allowable by extension. Does stewardship necessarily entail enduring life as is? Would it preclude other medical procedures—for instance, a medically induced coma in order to be unconscious during a particularly painful and protracted recovery process—because those procedures would interfere with a moral duty to others? Would painkillers, then, or experimental surgeries also be disallowable, or could they be prohibited if others felt they devalued a patient’s life?
Perhaps most importantly, if an individual is a steward of her life, then who holds the decision-making power over her? Does it rest in the hands of others she has endeared or engendered herself to? Does it rest on the determinations of society as a whole, or at least a community in which she is a part? We would protest such a model. An individual indeed has a right to make these determinations for herself.
Reciprocity and Mutual Obligation to Life
Since elements supporting and refuting both the concept of ownership and of stewardship are at play, then perhaps the physician-assisted suicide debate is situated within a structure where we hold both seemingly opposing options to be simultaneously true. What if we do have ownership of our lives, but we own those lives within a context of reciprocity, serving as stewards for one another’s lives, and thereby offering our own lives in services of others’ wills in a pact of mutual obligation? If the individual’s estimation of the quality of her life can be thus embedded in a complex of mutual obligation to one another which stems from the recognition of each individual’s ultimate determination of self, perhaps such a framework would offer a more humane home for such a challenging issue.
Which brings me back to my father. He would have wanted to stay alive as long as possible, to append as many extra days together to his biography as he could. I wanted that, too. But neither of us wanted him to suffer, to endure the pain of his body slowly crumpling under the weight of a terminal disease. Somewhere in the dying process, we encounter the entanglement of ownership and stewardship, where self-determination and mutual obligation might not be a zero-sum game.
While I do not have the ultimate answer regarding assisted suicide, the existing oppositional framework of ownership and stewardship overlooks the very real possibility that the moral framework in which we must situate the debate is not either or, but a hybrid of both, something that is ours to shape for others and for ourselves.
Meghan Guidry (Harvard University) Meghan is a Masters of Divinity candidate at Harvard Divinity School, where she studies bioethics, humanist philosophy, end-of-life care, and health policy. Her research focuses on the disconnection between ethics and technologies, assisted suicide, and other cheery subjects. Her interests include creative writing, swimming, language philosophy, medical sociology, and coffee. You can check out her books at Empty City Press, find her on Facebook, and follow her on Twitter @monocrescent.