Steve Choe Reviews Margaret Pabst Battin's Ending Life: Ethics and the Way We Die
Margaret Pabst Battin.
Ending Life: Ethics and the Way We Die.
Oxford: Oxford University Press, 2005. Pp. 344.
Following the precedent set by her earlier work, Professor Battin’s new book demonstrates an unusually wide range of thought on the ethics of death and dying in the American context. But the arrival of this very informative, well-balanced collection of essays is also quite timely in that it offers some much needed sobriety on several issues raised by recent current events. In spring of 2005, the media inundated us with a deluge of information and opinions around the case of Terry Schiavo, a Florida woman who, after experiencing cardiac arrest, was subsequently diagnosed to be in a persistent vegetative state. Public debate raged around whether her husband and guardian, Michael Schiavo, had legal right to remove the gastric feeding tube that was keeping Schiavo alive. This case threw the most polarized ethical positions into political dead lock, each side vociferously arguing for their position right up to Schiavo’s unfortunate end. Indeed, the circus of events that transpired foregrounded the highly-charged discourse that was generated within and around the finer points of the ultimately heavy-handed slogan, “culture of life”. While Battin’s book does not directly comment on this particular case, this reader of January 2006 could not help but to reflect on this recent current event while working through the essays. Instead of participating in the political inebriation that characterized the contentious discourse that circulated in the media, Ending Life remains committed to such events by clarifying much broader issues, the ethical and philosophical stakes implicitly raised by the question of assisted death, whether that be of the loved other or the self.
The book is divided into three parts: “Dilemmas about Dying”, “Historical, Religious, and Cultural Concerns”, and “Dilemmas about Dying in a Global Future”. Each part contains five or six essays, each of which are short enough that they could be read in a single sitting. Most of them have already been published by academic journals in the bioethics or medical fields. They span several genres and serve varied functions: some simply dispense information, some are historical, others are more or less case studies. However all are fascinatingly speculative. Ending Life also contains two chapters that are chiefly works of fiction. These short stories not only break away from the traditionally dry style of most professorial writing, but are also quite moving, performing in a narrative form some of the ideas Battin’s book puts forth. Simply by being embedded within a collection of academic essays, they implicitly raise the question of what it means to write about death.
First and foremost Battin wants to challenge her readers to reexamine his or her assumptions regarding what it means to live and to die. “I want to talk in this collection about dying,” she writes in her very first sentence, “about how we do it – and how we could do it, if we weren’t so caught up in conceptual confusion, misleading assumptions, bad argument, and political friction over this issue.” (3) Throughout this “could” becomes emblematic. Battin’s analyses often begin with a wealth of information and extensive critique of the salient arguments that cluster around a particular debate. But they quickly move to proposals that call for the reassessment of commonly held attitudes and opinions on death and dying. The temporality of possibility, this “could”, stands in for the peculiar way in which death must be spoken of, a possibility, both definite and uncertain, each one of us will eventually confront in the future. At the same time she is keenly aware that the philosophical critique of death and dying must be considered as embedded within the context of real world political institutions. The power of Battin’s work lies in this precarious balance: that between keeping open the pure mystery of a future death while remaining attentive to the social and cultural circumstances that inflect its understanding it in the here and now. By walking this tightrope, she in effect strips away the dross that clouds clear consideration of this event, calm consideration which is crucial for owning up to the responsibility that death’s finality demands of each of us. Appropriately enough, one might notice how the verb tense of Battin’s writing throughout the many essays collected here so often tends toward this futurity, addressing at each moment how we will die and also how it could alternatively be carried out.
In “Euthanasia and Physician-Assisted Suicide”, as the title suggests, Battin presents the types of arguments that have been put forth, for and against, in the debates around euthanasia. In a succinct sentence, she writes that the debate pits “arguments about autonomy and about relief of pain and suffering on the ‘for’ side, versus arguments about the intrinsic wrongness of killing, threats to the integrity of the medical profession, and potentially damaging social effects on the ‘against’ side.” (18) She then proceeds to systematically discuss each of the specific arguments one by one, providing objections, counter-objections, and, in some cases, subsequent counter-counter-objections. For example, for a terminally ill patient whose only way of avoiding suffering is by merciful death (an oft-cited argument for euthanasia), Battin objects that the available techniques of pain management, which can virtually remove all suffering, effectively make the option of death wholly unnecessary. She then counters this logic by arguing that “‘virtually all’ is not ‘all’” (29), such that the terminally ill might still be confronted with death as the only option to intolerable pain. However, she counters again that even in such cases, complete sedation can be employed. And so the debate presumably continues, pivoting in this way between for and against. Her method here is to follow each of these arguments as far as they will go, along the way performing polarization in order to demonstrate how such heated debates in fact “may or may not be appropriate to a particular topic, depending on, among other things, the degree of infancy or maturity of the debate.” (35) She seems to suggest that such arguments, if allowed to continue indefinitely this way, soon begin to gain a kind of arbitrariness. And such debates, particularly those that transpire in the mainstream media, often unwittingly deploy ideologically-laden rhetoric, preventing unfettered access to the more essential issues. Consequently, Battin calls for other possibilities:
The benefits of polarized, for-and-against discussion have now been largely gained in ongoing argument about assisted dying; it is time to turn to exploring the possibilities for resolution. Advance personal policy making together with public policy that recognizes a default-with-other-options may be only one of these, through I think it is a promising combination for both theory and practice. (41)
While such options have yet to be made manifest, Battin later in the text clearly articulates the situation she sees will eventually come to pass: dying, she writes, will be “no longer something that happens to you but something you do.” (324) This scenario does not simply mean the moral victory of the “for” side in the debate on assisted suicide, but, as she repeatedly argues, is a personal decision which will be seen as increasingly inevitable.
One of the principal factors that inflects this debate is religion. Within the Judeo-Christian tradition, suicide is regarded in virtually all cases to be an act of sin, except in those cases of self-martyrdom where the acceptance of death attests to one’s faith and perhaps to seek salvation. This attitude is echoed in other situations of assisted death in the West, whereby the taking of human life is considered flat-out wrong because it violates the first commandment, “Thou shalt not kill”. Battin suggests that it is perhaps because of this Judeo-Christian foundation that wider American culture tends to cast death in a negative light, taking it as a kind of failure, submission to defeat, or even a pathology. In a chapter called “Collecting the Primary Texts: Sources on the Ethics of Suicide”, Battin proposes a program of research to bring primary religious texts to bear on the question of suicide. It comes as no surprise that all the major world religions see suicide perjoratively. But Battin reminds us that it would be impossible to treat suicide as linked solely to religious concerns, for the act of suicide is necessarily connected with background views about the meaning of death, the value of life, the relationship between the individual and the community, the nature of suffering, the significance of punishment, the existence of an afterlife, the nature of the self, and many other deep philosophical questions. (173)
A cross-cultural analysis of suicide cuts through all of this. As a cultural universal of a sort, at least from a religious perspective, an analysis of the ethics of suicide provides insight into how each cultural situation appropriates this fundamental taboo. Accounting not only for such religious differences, say between Islamic, Buddhist, and Hindu traditions, but also for cultural variation intrinsically complicates the issue incommensurably. In a provocative essay called “The Ethics of Self-Sacrifice: What’s Wrong with Suicide Bombing?”, Battin analyzes why we in the Judeo-Christian West find this practice so repugnant. She argues that it is impossible for us to condone such action because our ethics accord absolutely no reverence for such a deployment of one’s own body as a “weapon” in war. Religious differences are obviously significant here, but radical cultural incongruity, Battin suggests in addition, must be accounted for. But, “just one thing is clear,” she continues, “a comprehensive collection of sources cannot start with the assumption that all suicide is pathological, or that it can be attributed either to pathological mental states or mental illness, or that it is a matter of biochemical abnormality, or that it is always wrong, or that there are no real ethical issues about suicide.” (173) Her ideal reader thus might be one whose assumptions, often part and parcel of the very apprehension of suicide, are constantly kept in check. In order to gain insights into the question of death within our own cultural situation, we must understand how our everyday presuppositions constitute it in the first place.
In mid-January 2006, the Supreme Court, in a 6 to 3 ruling, blocked the attempt to punish doctors who help terminally ill patients die, effectively deciding in favor of Oregon’s assisted suicide law. This ruling, Gonzales vs. Oregon (previously Oregon vs. Ashcroft), is perhaps a sign of developments to come. In “Genetic Information and Knowing When You Will Die”, she reminds us that, “in earlier periods of human history, most people were killed by germs and worms; now most people in the developed world fall apart from malfunctioning of their own systems.” (256) As a result of improving medical technology, it will be increasingly the case that our current aging population will die from degenerative disease – cancer, heart and respiratory failure and so on – conditions that are much more predictive as far as the character and length of one’s deterioration. In this connection, as life expectancy increases with the length of terminal suffering, end-of-life issues will correspondingly become increasingly urgent. The recent ruling reflects this possible future development, and the need to institute more extensive policies for advance decision-making, by allowing the small number of the terminally ill to plan a dignified death. Battin makes clear that assisted death should in no case be a “desperate last resort or reactive escape from bad circumstances, but a preemptively prudent, significant, culminative experience.” (330) “Death with dignity”: is there a place for such a possibility, one that is safe, legal, and rare, within our current “culture of life”?
I’ve traced only one line that threads its way through Battin’s Ending Life. However, so as not to misrepresent the wide variety of issues addressed in this text, I should mention that other essays include: “High Risk Religion: Informed Consent in Faith Healing, Serpent Handling, and Refusing Medical Treatment”, “Extra Long Life: Ethical Aspects of Increased Life Span”, “New Life in the Assisted-Death Debate: Scheduled Drugs versus NuTech”, “Is a Physician Ever Obligated to Help a Patient Die?”. It is a collection that will be informative for anyone interested in the topic. There are helpful endnotes to every chapter and an extensive, eleven-page index as its conclusion.
One final thought. The fictional pieces, as has already been mentioned, raise the question of what it means to write about death. One concerns a woman, who actively plans and strategies the moment of her death, and the resistance she encounters as a result of her resolve. The other poses the question of the sacrifice of laboratory animals in the name of science. But it is their very demonstration of the theoretical ideas, in an imagined form, that remains significant here, for they perform how dying and death could be done as a kind of “just so” story. Instead of telling, discursively, analytically, and theoretically, a futural logic of assisted death, she effectively shows us in these fictional short stories how it might be possible to think such thoughts at all. These narratives encourage her readers to seriously contemplate how dying in America might be possible, by showing how we might begin to write our own futural death.