A Duty to Die?

By Nat Hentoff

Saturday, May 31 1997; Page A19

The Washington Post

While he was governor of Colorado, Richard Lamm became, for a time, a troubling national presence, not as a result of his politics but because of the challenge he issued to the citizenry in every state. At an autumnal age, he said, it is a moral responsibility to make room for the young. As leaves fall from the trees in the fall, so old people have a duty to die.

The governor and I were asked to debate this proposition at Pennsylvania State University. When we arrived at the hotel in the afternoon, he urgently asked the desk clerk if there was a gym nearby where he could have his customary workout. It occurred to me that he wanted to delay the day, as best he could, when his own leaves would fall.

As a consequence of the current national debate on physician-assisted suicide, its opponents have predicted that if assisted suicide is legalized, people whose illnesses are costly and long-term may be convinced they have a duty to die. Feeling guilty because of the burden they have become to their families, they -- with suicide now approved by society -- may ask their doctors to help them die.

Now, in certain bioethical circles, the morality of dying as a utilitarian imperative is being advanced. Those who mocked Gov. Lamm's advice to go responsibly into the good night may have been premature.

The Hastings Center Report is one of the more respected journals dealing with the nature of human nature and medical ethics. The leading article on the cover of its March/April issue is John Hardwig's "Is There a Duty to Die?" The author teaches medical ethics and social political philosophy at East Tennessee State University.

At the start, Hardwig declares that "modern medicine and an individualistic culture have seduced many [into believing] that they have a right to health care and a right to live, despite the burdens and costs to our families and society."

Hardwig recognizes that there already is a legal right to refuse life-prolonging medical treatment. But, he claims, "a duty to die can go well beyond that. . . . There may be a fairly common responsibility to end one's life in the absence of any terminal illness." Indeed, "there can be a duty to die even when one would prefer to live."

After all, "the lives of our loved ones can be seriously compromised by caring for us. . . . There is a sense in which we fail to respect ourselves if in the face of illness or death, we stoop to choosing just what is best for ourselves."

Years ago, Michigan University law professor Yale Kamisar predicted that with the coming of assisted suicide, precisely this kind of argument could well persuade vulnerable patients to let themselves slip into eternity -- rather than remain a burden.

Hardwig also makes the stern point that as we grow older, the duty to die becomes more compelling because "we will be giving up less . . . we will sacrifice fewer remaining years of life." (Perhaps copies of Walter Huston singing "September Song" may ease the way.)

Hardwig presses on: "To have reached the age of, say, 75 or 80 years without being ready to die is itself a moral failing, the sign of a life out of touch with life's basic realities."

Will octogenarians who are not ready to die be publicly shamed as the moral community shuns them?

There is another criterion for being ready to join the falling leaves in autumn. "A duty to die," says Hardwig, "is more likely when you have already lived a rich and full life. You have already had a full share of the good things life offers." I assume that the chronically poor as well as long-term prisoners are given compensatory time to stay alive.

But there is a way out for most of the rest of us. If, Hardwig says, the society is willing to "pay for facilities that provide excellent long-term care (not just health care) for all chronically ill, debilitated, mentally ill or demented people in this country . . . the duty to die would then be virtually eliminated."

Hardwig, however, is a realist: "We Americans seem to be unwilling to pay for this kind of long-term care, except for ourselves and our own." There will be no escaping, then, a duty to die provided, says Hardwig, we have the courage to die in order to protect our loved ones from the costs, financially and emotionally, of our staying on.

John Hardwig is not alone. I have heard doctors say that certain patients, taking up expensive space in a hospital, have a duty to die because they will never be able to walk out of the hospital. Dr. Jack Kevorkian is his own kind of ethicist, but if his bedside manner were not so startling, he would be seen as not far from the current ready-to-die mainstream.

John Hardwig says, "We fear death too much." My sense is we do not fear bioethicists enough.

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