A request to die with dignity

Death vocalist Chuck Schuldiner on album cover Vivus!
Death vocalist Chuck Schuldiner on album cover Vivus! Photo: Relapse Records/ deathband.bandcamp.com

“A request to die with dignity. Is that too much to ask?” – Death, ‘Suicide Machine’

Many of my readers know that I am a fan of the metal group Death. Many of Death’s songs, much to my liking, have philosophical themes which lead listeners to ponder deep questions about human existence.

The songs ‘Suicide Machine‘ and ‘Pull the Plug‘ deal with themes of suicide — particularly assisted suicide/euthanasia — and appear to show support for people with terminal illnesses who, instead of “prolong[ing] the pain,” want to end their lives prematurely.

Vocalist Chuck Schuldiner sang, “A request to die with dignity. Is that too much to ask?,” “In death they now seek tranquility,” “Extending agony they must be blind,” and “Pull the plug let me pass away/Pull the plug don’t want to live this way” making what appears to be a compelling case for supporting euthanasia.

Newlywed Brittany Maynard, aged 29, has recently appeared in various media outlets announcing to the world that she has been diagnosed with brain cancer and has only six months to live. Rather than dying of natural causes and suffering from the brain cancer, Maynard has elected to end her life via physician-assisted suicide in an area where doing so is legal. Maynard has said, “I don’t want to die. But I am dying. Death with dignity is the phrase I’m comfortable using. I am choosing to go in a way that is with less suffering and less pain.”

Religious traditions concerned with a seemingly non-negotiable dignity of life (see here for one example from a Catholic perspective) typically oppose assisted suicide on grounds that because human life has some natural dignity [endowed by God] it should not be willfully ended under any circumstances. Catholics — using this line of thought — will generally also oppose the death penalty, abortion, and murder (although theories of just war and ideas on self defense can seemingly allow for some wiggle room with this idea of natural dignity).

A Catholic perspective arguing against euthanasia runs contrary to [non-Catholic] perspectives on personal liberties and individual autonomy which generally empower individuals to make decisions about their lives absent unjustified harm to oneself and/or others.

In the case of euthanasia, it especially seems to matter that the choice to end one’s life is informed and reasonable lest — as opponents of euthanasia would argue — undue harm is inflicted and self-destructive actions are taken. Is Maynard’s situation one in which harm and self-destructive actions are warranted?

This undated photo provided by the Maynard family shows Brittany Maynard. Maynard Family/AP Photo
This undated photo provided by the Maynard family shows Brittany Maynard. Maynard Family/AP Photo

Surely, not all reasons people have for ending their lives are informed. Mental health professionals rightly pathologize suicidal thoughts coupled with intent, means, and a plan. In the case of a terminal illness, much different than pathological plans for suicide, the case to end one’s life is compelling – there exists a chronic condition which ultimately will end one’s life and an individual wants to avoid a high level of pain. Maynard’s decision is an informed one backed with good reasons made in a right state of mind.

Perhaps this dignity of life Catholics speak of can be preserved through an early ending of life absent a high level of pain caused by brain cancer. Is there much dignity — or really any level of human flourishing — in dying a very painful death in which natural bodily functions may not function in a proper way? Ought Maynard — on a moral and legal level — to be empowered to end her life should she desire and the circumstances warrant it in a society in which we are generally granted personal autonomy and individual liberty?

While individual Catholics or other individuals may oppose euthanasia and not want to end their lives early if diagnosed with a terminal illness, I don’t believe this sentiment should be binding on all within a pluralistic society. Rather than prolonging the pain, individuals ought to have an ability to opt-out — to end their lives early given a diagnosis of a terminal disease — and make choices about their own lives without interference from governmental officials or imposition of Catholic teachings unless, of course, they desire Catholic teachings and interference from government.

We can both value life and support an individual’s moral and/or legal right to make informed decisions about their lives — euthanasia included — especially in cases of ending one’s life prematurely in the case of terminal illness. My valuing of life extends others bodily autonomy and personal liberties by which they can make informed decisions.

As always, feel free to comment below. This piece, designed to be no longer than 800 words, will not fully cover a vast topic such as euthanasia, but hopefully will inspire some self-reflection and discussion.

Justin Vacula

Justin Vacula hosts the Stoic Philosophy Podcast; serves as co-organizer and spokesperson for the Northeastern Pennsylvania (NEPA) Freethought Society; and has hosted monthly Stoic Philosophy discussion groups for the Humanist Association of Greater Philadelphia.

He has appeared on and hosted various radio shows and podcasts; participated in formal debates and discussions; was a guest speaker for college-level courses; was featured in local, national, and international news; and has been invited to speak at various national, local, and statewide events.

Vacula received bachelor’s degrees in Philosophy and Psychology, a minor in Professional Writing, and the distinguished W.A. Kilburn Memorial Award for Philosophy from King’s College in Wilkes-Barre, Pennsylvania. He is currently living in the Scranton, PA area attending Marywood University’s graduate-level Mental Health Counseling program and has worked with the Arc of Luzerne County’s Transition to Community Employment program as a teacher’s assistant and job coach alongside adult learners with intellectual and developmental disabilities.

He also plays poker; volunteers as a member of the website and media team for the Greyhawk Reborn Dungeons & Dragons campaign while playing at events in the Eastern United States; and enjoys metal music.

  • Gabriel Gross

    I want to comment specifically on the following passage, where you say that a suicidal client in therapy is not analogous to Maynard’s case:

    “Mental health professionals rightly pathologize suicidal thoughts coupled with intent, means, and a plan. In the case of a terminal illness, much different than pathological plans for suicide, the case to end one’s life is compelling – there exists a chronic condition which ultimately will end one’s life and an individual wants to avoid a high level of pain.”

    First you say that it is warranted to consider “suicidal thoughts coupled with intent, means, and a plan” as pathological. Isn’t this precisely what Maynard is doing? Call it suicide or euthanasia, she has thoughts about ending her life, intends to end her life on a specific day, has the means to end her life, and a plan of action. I see no difference there. Both the suicidal client and Maynard both desire to die prior to their time of natural death; it is a choice they willingly make.

    You further discuss that the difference between the suicidal client and Maynard exists in that the latter has a “chronic condition which ultimately will end [her] life.” So too does the suicidal client–either his human mortality or a severely debilitating mental and/or physical disorder that causes dysfunction, danger, and which deviates from our traditional conception of what it is to be “healthy.” (I can’t recall the 4th “D”. Do you remember it, Justin?)

    Your last justification: “the individual wants to avoid a high level of pain.” So too does the suicidal client who cannot stand to suffer the throes of deep depression, the delusions of schizophrenia, the flashbacks of a traumatic abusive event, or the never-ceasing anxiety that medication cannot placate. These are but a few examples of who we might be dealing with as the “suicidal client,” but I maintain that the client is highly analogous to Maynard, and so if you as a soon-to-be mental health practitioner would not make an exception for the suicidal client, then you ought not make an exception for Maynard, and others like her.

    • Thanks for the response. In the piece, due to its shorter nature, I didn’t expand on DSM-5 criterion for major depression (which often correlates with suicide or at least increases risk factors) or explain why mental health professionals would distinguish euthanasia from pathological suicide.

      When individuals contemplating suicide enter counseling or have made suicidal attempts, it’s likely the case that cognitions are distorted, recovery is possible/the situation can be improved, regret exists (people say the suicide attempt was a bad idea), and people have a mental diagnosis. With euthaniasia, these elements are absent although — as you said — there is despair/lack of hope, but in the euthanasia case the despair is rational – there also is no hope of recovery, no distorted cognitions, etc.

      • Gabriel Gross

        Those are helpful clarifications that flesh out your (dis)analogy a bit more. Of course, if we assume that life (in any/all conditions) is intrinsically valuable and preferable to death, then it would qualify as a distorted, maladaptive, irrational cognition to believe that euthanasia in this instance is preferable to waiting until one’s death.

        • As I explained, there can be rationality — an informed decision made — in a person deciding life is no longer worth living [particularly because a high amount of pain could be averted (through death) and is undesirable]. I suppose framing in this way avoids the odd phrasing of ‘death is preferable to life’ – instead focusing on an individual making a rational decision that life is no longer desirable.

          The value of life, as I mentioned is clearly negotiable (evidenced by Catholic just war theory and self defense – and even non-Catholic perspectives will argue that the taking of life in some cases is justified); other considerations (such as averting pain) trump the value of life in some cases.

          Personal value judgments, then, can lead someone to change ideas about the value of their own life and through rational argumentation I can accept some of these arguments…but clearly will not ‘go nuclear’ and accept a moral relativism in which some perhaps glibly say ‘well, if morality is not absolute then how can you say murder is wrong…’ I might not want to end my life if afflicted with a terminal illness (and might also not engage in prostitution, drug use, and some other ‘big choices’) but can accept and see others’ justifications as rational. In cases in which the decisions are poorly evidenced or irrational I will contend.

          • Gabriel Gross

            I agree that we ought not descend into moral relativism, but that it may in some cases be possible to hold one value judgment while still respecting an alternate value judgment as rational.
            I’m interested in the notion that “the value of life is clearly negotiable.” This would entail that life at Point A in one’s lifespan is of greater value than life at Point B in one’s lifespan–that is, that one’s life varies in value at different moments of one’s life. By what criteria do you judge this to be the case, other than when one’s continued existence poses a threat to another’s continued existence; when pain leads one to rationally believe that life is no longer worth continuing?

          • What I mean by the value of life being negotiable is that it’s not — for many — a concept which may not be adjusted; in some cases other concerns trump the value of life and would lead others to infringe upon the value of life by killing someone [in self-defense or in a deemed just war].

            Joe Shmo, for instance, is considered to have ‘value of life’ (meaning people think his life should not end prematurely under any circumstance) up until the point in which he unjustly opens fire on police officers or kills someone because he saw a ‘dirty look.’ People would argue that if he were not able to be detained killing him would be a just act – that this ‘value of life’ would not extend to this circumstance, perhaps because he forfeited rights to live his life free of intrusion from others.