Intending Death: Moral Perspectives
by Kenneth Vaux
Dr Vaux is professor of theology and ethics at the Institute of Religion, Baylor Medical School, Houston. This article appeared in the Christian Century January 26, 1977, p. 56. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
The morning news, Monday, September 27, 1976:
New York city: An elderly Chinese couple today took the proceeds from the sale of their laundry -- some $100,000 -- ignited it into a small bonfire in their apartment (an ancient ritual investment in immortality for oneself and one’s ancestors), then with their daughter leaped from their window to their death.
Sun City, Florida: Doctors gave George Beysle, a 77-year-old cancer patient, only a few days to live. His devoted wife could not bear the thought of being left alone. They called their daughter to the apartment and then sent her out on an errand. She knew something was up. While she was away, Beysle placed a mat on the floor, lay down, shot his wife, then himself, in the head. When the daughter returned, she found them in a death embrace on the floor.
And the news January 17, 1977:
Salt Lake City, Utah: After two unsuccessful suicide attempts, Gary Gilmore has been granted his wish to die. Convicted of murder, Gilmore had begged the state to shoot him in what has now become the first execution in the U.S. since 1967.
Dramatic examples of “intending death.” Public response to such events is ambivalent. Whether the persons be renowned -- like former Union Seminary president Henry Pitney Van Dusen and his wife, Elizabeth, whose “suicide pact” made headlines -- or just common ordinary folk, we experience strangely mixed emotions. We feel sad and proud. We see the acts as horrible and courageous. We feel sympathy: Why did it have to happen this way? -- so young -- we didn’t know they were lonely. Often we feel strangely triumphant: ‘You pulled it off, Gramp. You really pulled it off! You beat the system that says the natural way to die is under intensive care.” We should not be shocked at these conflicting emotions. They are fully human. Love of life and its undercurrent fear of death, along with the subconscious fear of life and yearning for death, are present in all persons -- all creatures.
Will to live and willingness to die abide in tension in every living organism: Lebenslieben and Todeslieben, biophilia and necrophilia. To follow the Freudian. picture, there is oral receptivity -- openness to life, to the new, to the future. There is also the desire for closure, going back, nostalgia, retention, stillness. Tropical birds, René Dubos reminds us, present this dual intentionality: the cocky and strutting male of the species is brightly colored -- red, purple, green, blue. His beauty ensures ongoing life and death -- attracting the mate for procreation but attracting the predator as well. The female’s dull plumage serves to protect both the mother and her nest of eggs or offspring.
So in the human being: a highly developed cortex and nervous system make possible both ecstasy and suffering. Aging seems to be written into the genetic code which is the secret of growth. Cancer can be seen as life gone wild. The treatments must be antilife. One of the most dramatic agents used to fight cancer -- methotrexate -- is an antivitamin. In humanity life and death intermingle. Conception is a kind of death. So is birth. Dying is a kind of birth.
Thwarting the Death-Desire
The moral heritage of our culture finds the intention of death unacceptable. It is alien to the tradition. To take one’s life, to wish one were dead, to request death for one whom we represent is -- medically, legally and spiritually speaking -- a sickness, a crime, a sin. Medical doctors and psychiatrists are trained to identify death-desire as abnormal: the result of disrupted body chemistry, drug influence, debilitating pain, temporary insanity or the green apples you ate. They are licensed to thwart this intention with injections, psychotherapy, behavior modification, or straps, straitjackets and padded cells. So far as the law is concerned, although suicide no longer carries the punishment of decapitation, disinheritance and burial outside the Friedhof, the place of peace, we are most reluctant to give people the right or the liberty to die. Our confused jurisprudence, which results in inconsistent law, is reflected in the “now this -- now that” of the Karen Quinlan case, and the numerous euthanasia cases, most recently the Zigmaniac case in the U.S. and the Hammerli case in Switzerland where the mercy killers were convicted, then pardoned. Legislative policy is similarly confused. The new California Natural Death Act, signed on October by Governor Edmund G. Brown, Jr., after weeks of prayer (that he thought he had left behind in the seminary), is the sole right-to-die law in the Western world undergirding both medical and legal thought. Similar proposals have been defeated in at least two dozen states.
Theology inherits the Sinai tradition, much compromised especially by those who wear the badge of Sinai and Golgotha: Thou shall not kill!
“The Lord gives -- the Lord takes away.” At a black Baptist country church in Texas the pastor says in his eulogy: “Death’s angel comes for each of us -- we can’t hurry it, we can’t delay it.” I’m afraid that is true only at a very profound level. It appears that we can hasten or delay death’s call. But should we? Does our dominion extend over our own body? The heart of this whole tradition is that death stings because we love life. We feel obligated to protect one another from inflicted and intended death. This impulse roots our social contract. To illustrate the shape of the traditional prohibition, let us recall Sir William Blackstone’s Commentaries on the Law of England:
Self murder, the pretended heroism but real cowardice of the Stoic philosophers who destroyed themselves to avoid those ills which they had not the fortitude to endure. The law of England wisely and religiously concurs that no man hath a power to destroy life but by commission from God, the author of it, and as their suicide is guilty of a double offence, one spiritual, in evading the prerogative of the Almighty and rushing into his immediate presence uncalled for, the other temporal against the King, who hath an interest in the preservation of all his subjects [Commentaries, Book 4, Chapter 14].
Departing from Inherited Wisdom
Today there are reasons to modify this composite tradition; to differentiate qualities of the “intention to die”; to open up options in medical practice, legal practice and pastoral ministry to understand, allow, perhaps even encourage and help persons who wish to die. This should be done only with the gravest reservation and deepest reverence for personal life. There are times and circumstances when we must recognize exceptions to our inherited moral wisdom. What developments make this necessary? I mention four reasons: (1) life-prolonging techniques, (2) the economy of living, (3) iatric disease (disease caused by ourselves) and (4) common sense.
1. One such development is the panorama of life-prolonging techniques, ranging from functional supports like mechanical respirators to sophisticated abilities to supply and control the elements of vitality: electrolytes, metabolites, salts, fluids, nutrients, blood components. Sometimes medicine can slam the door on death’s face for the time being with these techniques. At other times death keeps its foot in the door and our ministrations only prolong dying. Some would argue today that, with thousands of Karen Quinlans lying near and far, we have for the first time in human history made it possible for people to outlive themselves.
2. The second argument must be used with utmost caution. It has to do with the economy of life. We live in families, in towns, in societies, on a globe with limited resources. Savings run out. Anyone under the age of 40 who has any confidence that Social Security, Medicare or Medicaid will still be there when we retire is a fool. Should society expend so much of its youth, its wealth, its energy in attending the dying? Should college plans be dropped, family life destroyed, the lives of caretakers shortened because of the sheer weight of attending a loved one? The desire to do everything possible is a questionable motive. Sometimes wanting the very most, the very best for our dying friends and relations is only easing our own guilt for ignoring them while they were living. We very likely need to learn the first skill of lifesaving, which is self-preservation, and not feel guilty about it. We may need to hear afresh the command in Jesus’ words “Let the dead bury their dead.”
3. A third circumstance that renders death-acceptance or death-election a different kind of question today is the changing face of disease. Much illness today is iatric, human-made. We have polluted all that we breathe, drink and ingest. Our indulgent, indolent and frantic life styles have triggered the new plagues of vascular disease, cancer and the now epidemic depression and senile dementia. In some future day we might find that all our illnesses and deaths are self-elected. In light of this possibility it might be argued that if we have already chosen modes of self-destruction, it would be absurd now to introduce at death’s threshold heroic countermeasures -- costly, caustic extensions and intensifications of the suffering we have deliberately chosen.
4 Fourth, there is the wisdom of simple common sense. Futurist Herman Kahn announces that some day people will live for 150 years, immunized against all diseases, anesthetized from all pain, able to hibernate for decades or centuries if they desire. He looks for ecstatic glee in our response and finds only a shrug of the shoulders. It sounds boring and sad. People don’t want to be immortal, at least when the wish is actualized. In a story from Greek mythology, Tithonus is granted the gift of immortality by the gods, yet he spends the rest of eternity yearning that he might die. Seneca, in his tract on suicide, wrote: “The wiseman lives as long as he should, not as long as he can.” And George Bernard Shaw, that saintly cynic of a much later generation, writes in The Doctor’s Dilemma: “Do not try to live forever, you will not succeed. Use your health even to the point of wearing it out. That is what it is for. Spend all you have before you die, and do not outlive yourself.”
There are certain inherent dangers in the movement toward qualifying the tradition and welcoming death. Let me cite several developments that signal the shift. There is a widespread tendency in our culture to naturalize death and to discern the dying process in terms of predictable stages. Simple schemata are as dangerous for petty functionaries in health care as in education. They start believing in the stages. The Beatrix Cobb -- Elisabeth Kübler-Ross sequence of pre- and “post”-death stages has been criticized for its Greek naturalism, which strips death and immortality of their rich senses of terror and mystery -- meaning implicit in Hebrew-Christian thought. Studies show that today’s physicians do not fear death as did their fathers. Withdrawal of some life supports has been allowed in the Karen Quinlan case. The California Natural Death Act has also been mentioned. We might see in these developments a maturation of our views, a diminishing of our repressions; a step forward. Why do I suggest implicit danger?
Thomas Hardy paints the plight of modern “unnoticed” man in his 1890 novel, Jude the Obscure. Jude and Susan have just discovered the lifeless bodies of their three children hanging in the chamber room of the inn where they are staying. The older boy, young Jude, has left a note saying “Done because we are too menny.” Susan blames herself because she spoke with young Jude of the enlarged impending burden with a new child on the way.
“No,” said Jude. “It was in his nature to do it. The doctor says there are such boys springing up amongst us -- boys of a sort unknown in the last generation -- the outcome of new views of life. They seem to see all its terrors before they are old enough to have staying power to resist them. He says it is the beginning of the coming universal wish not to live.”
Important sociological studies today are showing that the technological cultures of the West, shaped by the secularistic world views derivative of Protestant religious traditions, are dramatically shifting the balance of “intended death” away from homicide to suicide. Death claims us in three ways: accidents, natural death from illness, and intended death -- homicide and suicide. Of the total mortality, intended death is increasing in percentage along with accidents, which have certain affinities to both suicide and homicide. Death from disease, natural causes alone, is diminishing proportionally.
One might interpret this statistic as a profound cultural phenomenon related to certain biological adaptations to environments having limited carrying capacities. In any animal population, crowding results in diminished fertility and heightened violence, including self-destruction.
The import of this point is to show a tendency in our culture to rationalize the wish to die or the intention to bring death to others as something natural, even noble. Awareness of this phenomenon should heighten our critical scrutiny of right-to-die proposals in the spheres of personal life choice and public policy.
We must also examine the emotional structure of human life. Here also we find reason for caution as we seek to affirm morally the “intention to death.” Often, though not always, wanting to die proceeds from the collapse of hope. Hope is born in self-esteem, seeing one’s life as meaningful, having a sense that one’s existence has purpose. Jürgen Moltmann has shared, in a recent conversation, his experience as one of the 15-year-old recruits to Hitler’s army during the waning days of the Third Reich. They were willing to die, courageous, blind to danger because they hated themselves. Those not afraid to die often have “love failure” -- the joy and sustenance of loving and being loved has collapsed. Death comes quite smoothly, naturally to those who have fallen out of love.
Understanding human emotions, wherein love and fear of death are joined, as are loss and willingness to die, helps us to be personally more sensitive and tough. Sometimes the statement “I wish mother could be spared this pain and suffering” means “I’m weary and want to go home.” Sometimes the cry “I’m sick to death and am going to end it all” means “Help!” There are times when the intention to die, the willingness to die, even the merciful desire to end one’s misery or that of another, flows from mature decision, love of life and self -- not hatred. Here we should stand near in support. But often the motives are mixed and confused. Here we need the staying power to struggle through the conflict with another. Sometimes the motives are sheer selfishness, expediency, institutional efficiency, or creature comfort. The worst thing we can do is applaud this “sickness unto death.” Here we should resist and rush in with aid, knowing the enduring bitterness and pain of conscience that result from such decisions to let go.
Awareness of this point would have important bearing on public policy. It is estimated that from 150,000 to 300,000 young men evaded the draft or deserted during the Vietnam war. Studies indicate that the vast majority of these were conscientious objectors by disposition. But because of an outmoded Selective Service understanding of psychic-emotional structure and the failure of religious sanctions, we took the “life lovers” of one whole generation and labeled them “cowards.” And we wonder what is the source of moral emptiness in our culture. One way to put this tragic era behind us would he to revise our amnesty program, which has been a complete flop. Only 27,000 exiles have re-entered the country. Recognizing the moral legitimacy of the will to live and the intensification of Lebenslieben in the hundreds of thousands who now live in Canada, Sweden and elsewhere, why not require of these young men two years’ voluntary service as ombudsmen for welfare recipients as our amnesty requirement? I believe we would discover that the human qualities of these men would assist thousands of the down-and-out with their specific life problems -- employment, housing, child-rearing, crime, drugs -- and would significantly relieve the national plagues of millions of dispossessed, angry and disengaged citizens.
Death as the Enemy
Sweet death comes hard. Theology has always known this. Dietrich Bonhoeffer wrote from Spain: “It is only when one loves this life and this earth so much that without them everything would be lost and gone -- only when one cherishes this life can he believe in the resurrection.” Pagan notions of immortality still tease our culture. How many times have we been assaulted by our parishioners when we challenge the notion of the immortal soul. Death for the Christian is total, final; body and spirit. The soul does not float out to rejoin the great soul. We affirm the resurrection of the body.
Oscar Cullmann has sketched the differences in Socrates and Jesus by contrasting their deaths. Plato’s account of the death of Socrates in the Phaedo sublimely expresses the Greek notion of the immortality of the soul. The essence of the belief is that the mortal physical body must be shed as an outer garment, that the essential soul can then be liberated to its eternal home. Death is good and natural because it releases the soul from its prison in the body. The body can be destroyed; the soul is eternal. Those who describe the natural stages of death, and speak of death as a part of life, are invoking once again this Greek sense of immortality.
Jesus, by contrast, approaches his death with trembling and distress (Mark 14:33; 15:34; Luke 12:50). He is afraid of impending death, sharing as he does humanity’s natural fear. In the Semitic perception, death is dreadful and terrifying. Jesus cries to be released from “this cup” (Mark 14:36). Death is an enemy of humanity, an enemy of God. It is the last enemy to be destroyed (I Cor. 15:26). It is not the natural order of things. We die because of our sin; Jesus dies atoning our sin. Only in Jesus as Christ is death stripped of its terror. Now, although we must taste death, it has no sting. The shadowy belief in resurrection in Hebrew faith now becomes a full-blown hope in the resurrection into life.
The Gifts of Caring
The present revisions of our “winnowed wisdom,” tempered by the cautions proposed for cultural, psychological and theological reasons, will work only if we reaffirm the ancient impetus to care for the dying with pastoral tenderness. Cicero saw life as a sober yet joyous task, “dying men caring for dying men.” The Medieval and Renaissance worlds studied the ars moriendi — the art of dying. Today, with our tendencies to regularize, institutionalize and codify death, to make it a noun, tegether with the inclination to abandon, hide and camouflage those who are dying, we might profitably examine with a pastoral eye our “death policies and practices.”
We must agree with Ivan Illich when he claims that a society’s understanding of death also controls its understanding of health. An indicative characteristic of our culture is the fact that in cocktail-party chatter, sex and death are no longer repressed subjects -- indeed they are the hors d’oeuvres, the subject of unending banter. Religion is the repressed, forbidden topic. Even the presidential candidates, who by disposition would have loved to talk about their faith, were warned by their advisers to contain it -- talk about morality, integrity was acceptable, of course, but not about religion. The unreality of our culture is seen when in death we can speak only of life: “Oh, you’ll be all right. Come on now -- chin up.” And in life we can speak only of death. Nietzsche is a helpful corrective at this point:
The Thought of Death. -- It gives me melancholy happiness to live in the midst of this confusion of streets, of necessities, of voices: how much more enjoyment, impatience, and desire, how much thirsty life and drunkenness of life comes to light here every moment! And yet it will soon be so still for all these shouting, lively, life-loving people! How everyone’s shadow, his gloomy traveling companion stands behind him! It is always as in the last moment before the departure of an emigrant-ship; people have more than ever to say to one another, the hour presses, the ocean with its lonely silence waits impatiently behind all the noise -- so greedy, so certain of its prey! And all, all, suppose that the past has been nothing, or a small matter, that the near future is everything: hence this haste, this crying, this self-deafening and self-overreaching! Everyone wants to be foremost in this future-- and yet death and the stillness of death are the only things certain and common to all in this future! How strange that this sole thing that is certain and common to all exercises almost no influence on men, and that they are the furthest from regarding themselves as the brotherhood of death! It makes me happy to see that men do not want to think at all of the idea of death! I would fain do something to make the idea of life even a hundred times more worthy of their attention [Joyful Wisdom: The Philosophy of Nietzsche (Mentor, 1965), p. 640].
Pastoral care, leading each other to water, restoring souls in conviviality, making to lie down in green pastures, leading beside still waters, bridging passage over troubled water, preparing tables, anointing with oil -- these arts, ancient and blessed, must be relearned. Above all, we must gently lead each other to the Great Shepherd of the sheep.
In California, hospitals must hire bedsitters to hold hands and accompany the dying. Where is the church? Have we sold out to that frightful isolation and anonymity that contemporary America values so highly?
Persons with pastoral gifts are in our churches and in the community. The nurturing of these gifts requires vigorous discipline. Mayeroff notes eight ingredients in caring: knowing, alternative rhythms (knowing when to give, when to withdraw), patience, honesty, trust, humility, hope, courage. Caring is rooted in human nature as benevolent. It will flow as we nurture intrinsic humanity in our common life. Death in the modern experience, then, is terrifying bliss. We rage against the dying of the light. We yearn for sweet death. We extol medicine’s march against death’s causes.
We graciously accept the truth that life must pass on. Our modern experience thus rediscovers the ancient yet ever-new Bible story about our story. Death is the bittersweet end which is beginning, that judgment which is mercy, that terror which is peace. It is surprise! When did we see you hungry? Didn’t we cry Lord, Lord”? Death is crisis. We meet Satan, who is the sum of our rebellion, our distraction, our laziness. We meet God, who is the culmination of what we foretaste in life as love, freedom, knowledge. We meet this day -- day of wrath and doom, day of reckoning, day of paradise -- not alone but with our Savior, safe in his grace.