Whose Life Is It Anyway?

• Author: Kam C. Wong
• Position: Associate Professor, Chair, Xavier University, Cincinnati, Ohio.
• Pages: 233-307

Page 233

Kam C. Wong: Associate Professor, Chair, Xavier University, Cincinnati, Ohio. B.A. (Hons.), J.D. (Indiana); Diploma (N.I.T.A. " Northwestern); M.A., Ph.D. (SUNY " Albany " Criminal Justice); Vice-Chair, Hong Kong Society of Criminology; Associate Fellow, Center of Criminology, University of Hong Kong, Vice-President (2001-2), President (2002-3) Asian Association of Police Studies. Managing Editor, Police Practice and Research: An International Journal. All correspondence should be addressed to kcwyyh1@yahoo.com.

It is nevertheless arguable that the right to live entails the right to shape one's life, and this right in turn entails the opportunity, if one wishes, to bring one's existence to an end.

- Laurence Tribe (1978)¹

At the heart of liberty is the right to define one's own conception of existence, of meaning, of the universe, and the mystery of human life.

- Planned Parenthood v. Casey (1992)²

It is indecent to live longer-to go on vegetating in coward dependence on physicians and medications, after the meaning of life . . .has been lost, ought to prompt a profound contempt in society.

- Friedrich Nietzsche (1888)³

Introduction

Since biblical times, a debate over voluntary euthanasia has raged, in various incarnations unabated.⁴ There is no realistic prospect that the Page 234 debate will disappear in the near future.⁵ Every new discovery in medical technology promises hope for a few wishful patients struggling to live, but at the same time provides ammunition for opponents of euthanasia.⁶ Accordingly, "the same medical technology that effects these miraculous cures and gives hope to the afflicted can also sustain biological existence over many years for patients who are, or will soon be, clinically dead."⁷ Looming in the background and always ready at a moment's notice are the "rapid reaction forces" of the pro-life and pro-choice camps. Given an opportunity the advocates both for and against voluntary euthanasia are ready and willing to engage in yet another all-or- nothing epic battle, hoping for a swift and decisive victory, while most of the time anticipating protracted and nondescript exchanges. Viewed in this light, the "right to die" campaign is a long-term engagement, not a one-time encounter. In this regard, the debate resembles more the Vietnam War, with shifting intellectual terrain to be negotiated, than a WWII battle, with distinctive mental territory to be won.⁸ The whole Page 235 "right to life" saga is a remake of All Quiet on the Western Front⁹ with characters taken out of Old Man and the Sea.¹⁰ There is plenty of pain and suffering to go around for the foot soldiers of euthanasia-from frustrated patients to tormented doctors¹¹-but there is also an abundance of courage and perseverance in the patients, in the hearts of the doctors, and in the minds of advocates, that is too awesome to fathom with our conventional wisdom and much too inspiring to capture with our limited vocabulary.

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On the surface the debate appears to be simple and straightforward. It involves two fundamental questions focusing on the power of society versus the rights of individuals-society's asking "how far do we go to save a life?" versus an individual patient's query asking "how much autonomy do I have to live the life I wanted?"¹² However, the issues involved deep down are as complicated as they are morally divisive, intellectually contentious, and emotionally wrenching. As the "right to life" scholar Uhlman writes, the issues are:

What is the value of human life? When does life cease, and what are our obligations when it does? By what moral license may a human being claim the right to end his own life, and what moral duties fall upon doctors or others who are asked to assist him? What, indeed, is the purpose of medicine, and to what extent should the doctor-patient relationship be regulated? Should the law guide or follow behaviors in this area, and who should decide, courts or legislatures?¹³

On a similar point, "[t]o think about these matters is to confront some of the central questions of human condition: belief in God and immortality of the soul, the nature of moral and legal obligation, and the origin of one's duties to neighbor and self, to name only a few."¹⁴ To these questions no agreement is in sight.

This Article represents a continuation and extension of the physician-assisted suicide (PAS) and euthanasia debate. The Article contains a constructed dialogue between a terminally-ill cancer patient suffering great pain and wishing to die a peaceful and dignified death, and a humanistic doctor personally and professionally committed to saving life, who refuses to participate in PAS. This Article is organized into four parts. Part I, Methodology, explains in detail how and why I organized the materials and structured the presentation in the manner I chose. Part II, Context of Debate, consists of two sections-Section A provides a brief overview of the concepts and arguments involved in the "right to die" debate, while Section B addresses the issue of "why is euthanasia controversial?" Part III, The Right to Die Debate, provides a Page 237 constructed interactive dialogue between a doctor and a patient on a range of issues raised by the "right to die" decision-from the "meaning of life" to "absolute rule v. variegated circumstances" to "the problem with the AMA Code of Ethics," and so forth. The dialogue begins with a brief statement of facts and circumstances of the case, pinpointing the dilemmas facing Patient A and Doctor A. For philosophical and stylistic reasons, in Part IV I offer a "postscript" instead of a summary or conclusion.

I Methodology

It is neither the purpose of this Article to break new ground,¹⁵ nor to adduce additional evidence for or against PAS. This has been attempted elsewhere.¹⁶ In fact, many of the arguments presented by my hypothetical Patient A and Doctor B have been made before with much more eloquence, persuasiveness and authority.¹⁷ In its essence, this Article is Page 238 a reassessment of the old and a prospecting¹⁸ of the new. It is a free-flowing piece of random thoughts rather than a meticulous arrangement of organized thinking; spontaneity is what I sought. The enterprise at hand, while not lacking in intellectual challenge, scholarly appeal, or academic rigor, has a most modest agenda: to create conducive conditions for new and creative ideas to emerge in the process of reexamining, reinterpreting, and renewing understanding of old ideas.19 It is further hoped that if such ideas are favorably received, explored, cultivated, and expounded upon they will some day take root and blossom, creating different schools of thought in the near term and making possible a radical paradigm shift in the long term. As such, this Article is as much about taking stock of existing ideas as it is about exciting new thinking and suggesting different approaches. I use "exciting" and "suggesting" to highlight my ultimate purpose in writing: I want to create an opportunity for my readers to rethink their established positions on the range of "right to die" issues; to critically reflect upon basic assumptions of received values with an eye towards discovering viable alternatives and different possibilities.²⁰

It is not my intention to find flaws in my readers' arguments and posit fault with their thinking; much less to get them to agree or disagree with me. Individuals have to come to terms with their own reflective and considered judgments.²¹ Thus, while there are points and counterpoints in the body of the dialogue, there is no definitive answer provided at the end; while the essay has a long introduction, it has no true conclusion. The protocol used in this debate, and the style adopted in the presentation, reflects and reinforces the central thesis of this essay-ethical discourse in general, and euthanasia debate in particular, is an exploratory and tentative process to engage in, and not a purposive Page 239 and definitive outcome to arrive at. Consistent with all other search for knowledge-presumptuously called truth seeking-this debate is an intellectual exercise that is always arriving, never arrived. The most we can hope for is a better understanding of our own thinking through the appreciation of others' arguments.²²

In truth, the search for answers in the "right to die" debate, as with many other controversial issues that split our communities, should begin with and end by looking inward within ourselves-using others only as a sounding board and reflective mirror. In this regard it is instructive to revisit the social and political satire The Wonderful Wizard of Oz.²³ The book speaks of four characters-Dorothy, Scarecrow, Tin Woodsman, and Cowardly Lion-who all desperately desire to acquire from the Wizard of Oz characteristics they find themselves lacking.²⁴ In the end, though, they are told by the Wizard that such qualities were in them all along.²⁵ This story...