Here in Massachusetts, a question on our ballot on election day would, if a majority votes yes, make it possible for a physician licensed in the state to write a lethal prescription for a patient suffering from a terminal illness and deemed to have fewer than six months to live, which the patient could then self-administer to end their own life.
This “death with dignity” initiative is highly favored among Unitarian Universalists and other religious liberals. Most of us are probably going to vote for it.
My congregation this past week sponsored a week of programming around this question and more broadly around choices at the end of life. Last Sunday, I participated in a panel discussion of local clergy on these issues. In that conversation with my colleagues from across the religious and theological spectrum, something came clear for me.
Autonomy is a cherished value among Unitarian Universalists, as well as among other religious liberals. Political liberalism, too, is founded on individual freedom. The ability of the individual person to make and affect choices in their life is paramount. Any interference in an individual’s ability to choose for him- or herself is anathema.
I certainly affirm the basic principle of having control over my own body and life. There is no way I would give the state more power to regulate what I can and cannot do with my own body. It is a basic freedom for every citizen and person in a democratic society.
Who we have sexual relations with, whether to get pregnant, whether to give birth, whether to eat your broccoli, whether to drink 28 ounces of soda all at once… the state may have an interest in the choices we make in these and other regards, but ultimately the choice is ours to make. And ought to be ours to make.
Autonomy and integrity of the individual person are the starting point for much liberal theological ethics. While I am not interested here in defending or promoting the death with dignity initiative (and certainly not in denouncing it) I do want to reflect on this enthrallment we have with autonomy as the foundation of our ethics.
One of the arguments for physician-assisted dying is the loss of dignity a person experiences when ill or disabled. In a culture like ours that prizes individuality and autonomy, disability is stigmatized in very particular ways. Disability, and people with disabilities, are thought of as a burden; others need to help care for them, sometimes even to do routine functions for them.
Temporarily able-bodied people fear this loss of autonomy and consider it undignified. Impairment, pain, incontinence, lack of control, not being able to feed ourselves—these are conditions many temporarily able-bodied persons want to avoid.
In states where physician-assisted dying is legal, patients often cite “feeling like a burden on others” as one reason for wanting to end their lives. In the name of our dignity, we would rather have the ability to end our lives than endure these circumstances.
And yet people do. Many disabled and elderly people do live with these conditions.
And often enough, they depend on others.
And they do so with dignity. And insist on the dignity and worth of the lives they are living. This insistence, this living with dignity rather than dying for lack of it, rubs against the grain of a culture that does not see, let alone affirm, the worthiness of their lives.
The biblical affirmation (one of my co-panelists reminded us) is that the human person is made in the image and likeness of God. As such, the human person is a reflection and icon of the divine. The sacred worth of the person is intrinsic. It cannot be granted or withdrawn, given or taken away.
The dignity and worth of every person is inherent–inherent in being human.
What is anathema, if we truly affirm the inherent dignity and worth of every person, is to claim that some lives are worth more than others, that some persons are more worthy than others, that dignity accrues to some individuals and not others.
That some lives are not worth living.
I used to be a bookseller in a large bookstore in downtown Toronto. One busy evening, a cyclist came to the cash register. I was training a new cashier and she greeted him and began ringing up his purchase.
She noted that he didn’t have a bike helmet with him, and made a lighthearted remark about biking without a helmet.
This customer answered, “You know, I’m a physician. And I’ve worked in the emergency room. I see what happens to people who survive a car crash on their bike because they were wearing a helmet. Believe me, I’d rather be dead. I’d rather be dead than quadriplegic.”
He took his purchase and cheerfully left the store.
That casual remark has stayed with me all these many years. Partly because it was a customer service training moment (“Just keep smiling!”). Mostly because of the chill it gave me.
My bicycle was my primary means of transportation and I always wore a helmet. I had never thought seriously about surviving a collision with an automobile. Of course, I would get rushed to the hospital and they would do everything they could to keep me alive. That’s how it works. But what if the pain was unbearable? What if I survived but was severely disabled? Would I rather be dead?
His remark was chilling also because this was a physician who had been and would be called upon to treat people with disabilities. What might his attitude with these and other patients be? What level of care would he offer to patients he might think would be better off dead?
If I had a disability or a chronic illness, would I want to be treated by a doctor who thought of me as a waste of a human life?
Would my life, in fact, still be worth living?
Why is depending on others considered undignified? Are we not part of an interdependent cosmos—isn’t all of existence an interrelated network of relationship?
What might our vaunted autonomy and radical individualism look like refracted through the lens of an essentially social reality? Does our affirmation of the intrinsic goodness of the person come at the cost of recognizing that individuals are social beings, socially constituted and interrelated with our social and natural surroundings?
The heroic self, rising above entanglements with others, is not a natural and universal understanding of the human person. It is the heritage of Western, male-centered hetero-patriarchy. (Oh that!). The rhetoric of “being who I am” and “becoming my own person” and “forging my own path” is expressed in everything from artistic sensibility that favors uniqueness and novelty, to psychology that stresses individuation over relation.
It has been, and can be, very liberating.
It can also lead to a distorted individualism that breaks down community. When there is only “me” and no “we,” a commitment to human solidarity and environmental responsibility breaks down. Greed and narcissism, self-indulgence and covetousness, flourish.
What kind of ethics and theology emerge when rather than the radical autonomy of the individual, the individual’s sociality takes center stage? What kind of ethics and theology emerge when the interrelated, interdependent nature of all existence is affirmed as a first principle?