Exit or Requiem
On January 18, 2014, Fr. Jean-Michel Gleize, a professor at the International Seminary of St. Pius X, gave a conference in the Swiss canton of Valais on the question of “assisted suicide.” In it he analyzed the liberal ideology on which the so-called “right to die with dignity” is based, a right advocated by the Swiss organization Exit and other international organizations in favor of euthanasia.
The Philosophical and Political Grounds for Assisted Suicide
The argumentation given here is taken from the brochure produced by the Dignitas Association whose motto is “To live with dignity, to die with dignity.”
Introduction: The philosophical and political basis [for assisted suicide] “resides in the fundamental values which have been the pillars of the Swiss State since the creation of the modern Confederation in 1848, as well as in the evolution of these values since that date. The point of departure is, then, the liberal attitude that holds that the individual, in a liberal State, disposes of all the freedoms so long as their exercise does not harm either public interests nor the justified interests of third parties.” Among these values they list: “defense of freedom and self-determination against third parties who try to limit these rights for whatever reason, be they of ideological, religious, or political origin”; “the defense of plurality as guarantee of the constant evolution of society on the basis of the free competition of ideas” (p. 23).
“Respect for the freedom of the individual in favor of the enlightened and responsible citizen is shown by, among other things, the fact that positive legislation currently in force does not punish attempted suicide, contrary to former legislation” (p. 23).
“Every person on Swiss territory has a right to the freedom to live his life independently of the individual ideological, religious, or other ideas of third parties....No one has the right—nor by any dispositions of the State---to impose on another his individual ideas in the matter of ideology, religion, or politics, nor even a right to try to do so” (p. 24).
“Since experience shows that it is difficult to interpret the rather vague terms humanity, respect, and dignity as such, it is less by trying to interpret these terms than by reflecting on the actual role of medicine that will enable us to advance.” The role presented by Dignitas has been formulated by Edgar Dahl, a German specialist in medical ethics, in his essay on the Hippocratic Oath published in 2008. He takes notice of the fact that until the present, medicine has been defined as having as its object the maintenance of health; this is what is said in the Geneva Oath (“I consider the health of my patient as my first concern”). Dahl considers this formulation to be incomplete, since the activity of doctors is not limited to the maintenance of health. The proof of this, he argues, would be that palliative care specialists take care of patients who in any case will never recover their health. That is why, he writes: “It seems, then, much more appropriate to consider the relief of human suffering as the role of medicine....The struggle against illness is not an end in itself. To the contrary, it is undertaken with the aim of keeping us from the physical or psychological suffering which generally accompanies sickness. By accomplishing the task of relieving the suffering of human beings, medicine ought always to respect the self-determination of their patients. No one has a right to treat a patient against his will....For example, it always and exclusively depends on the agreement of the concerned patient that a measure aimed at prolonging his life be implemented or halted. When medical ethics is based, as I have just explained, on the relief of suffering and respect for self-determination, it seems evident that it is absolutely compatible with assisted suicide, for a doctor who satisfies the request of a patient in the terminal stage to cease all therapies and to prescribe a lethal drug, relieves his sufferings and respects his autonomy. A political policy that aims at preventing at all costs any suicide without concern for the person involved violates the laws of humanity” (pp. 24-25).
“Democracy and fundamental rights.” According to a poll taken in 2008, 75% of the Protestant population and 72% of the Catholic population want for themselves the possibility of assisted suicide.
The first objective is the solution towards life; if that does not work out (for objective medical reasons or for subjective psychological reasons) arrangements for an accompanied suicide are made...
This Philosophy Scrutinized
The basic principle invoked is liberalism. This term must be understood in the strong sense, apart from its usual applications (political, economic, or religious), taken in its root. The principle is the following: “Liberty is the fundamental good of man, a sacred and inviolable good; this unlimited liberty is the basis upon which are founded all the initiatives that man can undertake in private and public life, and the absolute norm according to which all his initiatives will be judged.”1 And as Pope Leo XIII shows in his Encyclical Libertas, the principle of liberalism is itself but the expression of the autonomy of conscience or of individual reason.
This principle is granted from a legislative standpoint since it is inscribed in the political constitutions of all contemporary democracies. From it flows logically the right to suicide, whether assisted or not, and also the right to assist someone who wants to commit suicide. However, this logical outcome of liberalism has not yet been unanimously deduced by all the partisans of liberalism at the legislative level, since assisted suicide is only not punishable; that is to say, not authorized but tolerated. And it is only tolerated at present in some countries, not all. Additionally, the right to assisted suicide is not recognized by medical ethics; indeed, it is even challenged. In fact, the opinions of members of the medical profession are still very divided. Edgar Dahl is obliged to acknowledge as much in quoting passages from the Geneva Oath. Nevertheless, if medical ethics were to be governed by democratic political principles, by granting the principle of liberalism it would have to grant the consequences that flow from it. One may say, then, that the debate over assisted suicide contains a latent contradiction, or at least a timorous indecision or compromise. One dare not justify in theory or else one refuses to demand in practice what is (whether one will or not) inscribed in the principle. The strategy of organizations like Exit or Dignitas lies precisely in showing the conclusion that logically flows from the principle, whether one likes it or not.
Our answer must successively address, first, the root, which is the false principle of liberalism; and then a couple of weeds that stem from it: assisted suicide and the new definition of medicine.
1. Refutation of Liberalism
“The fundamental principle of liberalism is absurd, against nature, and chimerical” (Billot). In effect, liberalism postulates that the principal and supreme good of man is liberty. Now, the good of man can only be conceived of in two ways: as an end (the principal and supreme good that represents the goal of man’s life and which he must attain in order to be happy) or as a means towards an end. Where does liberty fit in? Certainly not at the level of an end, for liberty corresponds to a power or faculty of acting, and every power or faculty exists for the sake of something else, even if that is its own operation, which in this life consists in the search for a good, genuine or apparent. Then it obviously follows that liberty is to be ranked among means. And it is a means that can be badly used, which is why it is necessary to control liberty, to educate it, to guide it, to direct it, and sometimes even to limit it in order to protect it from itself. “If one denies this obvious fact by subscribing to the fundamental principle of liberalism, one will be led necessarily to either of two absurd consequences: one will either maintain that liberty, even in this life, is confirmed in good, or else that the best situation is one in which one may entrust oneself to one’s defectible liberty so that it may retain in every circumstance the use of its deficiency. Is this not the height of madness?” (Billot). Liberty is not the principle and supreme good of man. It is a good, we won’t deny, and we are not against liberty. But it is not the supreme, principal good of man which should prevail over all the others.
2. Refutation of the Right to Suicide
This consequence is the application of the principle to a particular case. If liberty is the supreme good, it outweighs life. Better to be free by taking one’s life rather than to not be free by conserving one’s life. Notice that, from this viewpoint, the position of Dignitas is perfectly coherent, in spite of the appearances. Their published position is that their first objective is the solution towards life, but, should that fail (for objective medical reasons or for subjective psychological reasons) arrangements for an accompanied assisted suicide may be made. This statement implies that life still remains the greatest good after freedom. So, if one can save both liberty and life, it is better. But if it is necessary to choose, preference is given to liberty to the detriment of life. Consequently, if Dignitas defends in a certain measure the solution towards life, this is not done in the name of life but always in the name of liberty. Let’s not be taken in by appearances. If there is an apparently dissuasive attitude regarding suicide, which may reassure the naïve, it rests on a radically false principle.
In reality, life is a good superior to liberty because it is prior to liberty, not only chronologically (in the sense that one is living before being free, and one comes into the world before making any decisions), but also ontologically, that is to say, by definition (in the sense that one must always be living in order to be able to be free). In its root, liberty presupposes life, and it cannot be exercised by choosing against life. Suicide is at the same time a choice both against life and against liberty: it is an alienation. Therefore it is sophistical to say: “Better to be free by taking one’s life rather than to not be free by conserving one’s life.” The sophism consists in the fact that the alternative does not exist, since one cannot be free by taking one’s life: the taking of one’s life is concomitantly the taking of one’s liberty.
More profoundly, an essential distinction must be made among the goods man possesses. There are those he possesses by his own will by reason of a free choice. By an act of human liberty one may keep these goods or give them up. For example, someone who freely buys a house or even freely accepts it as a gift, always retains the freedom to get rid of it, to sell it or to give it away to someone else. There are other goods which man possesses by nature necessarily, without any choice on his part: man is not the master of these goods and may not dispose of them according to his own will.2 He receives them by reason of the choice and of the liberty of another, but not by reason of his own choice. This is the case with life, since it is prior to liberty as a foundation is prior to what rests on it. Life is received as the root of liberty and thus as a good that cannot be the object of a decision or a choice of liberty. It is not a gift freely accepted, but a deposit of which one only has the usufruct and not the ownership. Contrary to what is asserted by very many people to justify the right to suicide within so-called just limits, life is not a gift which one is free to dispose of the moment it becomes too cumbersome or too heavy to bear. A gift belongs to us because we have accepted it freely; whereas life does not belong to us , and we have not accepted it freely. It is a deposit which has been imposed on us, and it is not up to us to decide when and how we can get rid of it.
Notice that the refutation of the first consequence of liberalism, assisted suicide, is itself the consequence of the refutation of the principle (liberalism).
This refutation supposes a reference to external reality, to the reality of nature, which is at the foundation of a certain necessity. This implies that liberty is not absolute, but is relative to nature, which is the absolute. Liberty is the means given us in order to make good choices and to cultivate as we should the nature we have received, our humanity. Understood in a good way, the laws of humanity are the laws of nature which liberty is held to respect. Contrariwise, ideology makes reference not to the real, but to preconceived ideas. Liberalism is among these ideologies that make reference to the idea of liberty conceived as the foundation of everything else. Liberty is not governed by nature; one no longer acts in conformity with what one is, but with what one wants. Hence divorce, abortion, euthanasia, homosexual marriage, gender theory. In all these instances, one makes an object of choice of something that cannot be an object of choice.
3. Refutation of the New Definition of Medicine
Edgar Dahl’s argumentation is substantial this: (a) The doctor’s role is first and foremost the alleviation of suffering. (b) Now, the relief of suffering may lead to the suppression of life. (c) Therefore the doctor’s role may lead to the suppression of life.
Refutation of (a). Suffering is the perception (sensible or spiritual) of an evil (corporal or spiritual). The sensible perception is uniquely that of a physical evil which is pain, whereas the intellectual perception of an evil whether corporal or spiritual is sadness. Suffering is thus a subjective factor, like all knowledge: whether I know it or not, the objective reality remains. So, there can be suffering with or without illness. And there can be sickness with or without suffering. To attack suffering is not necessarily to attack the illness. And to attack the illness is not necessarily to attack suffering. If the doctor’s role is first and foremost to relieve suffering, that means that medicine is reduced to dispensing palliative care. In reality, that represents what medicine can do at best in certain extreme cases; but ordinarily, medicine has as its object to preserve health, that is to say, life. Health is defined, in effect, as a state of optimal life. We do not deny that the role of medicine involves the relief of suffering, but we say that that is an accessory or occasional role, and that its principle and essential role is to preserve health and hence life. It is true that the fight against sickness is not an end in itself. But the end in itself is not to preserve from suffering, which is a possible but not necessary consequence of sickness. The end in itself is to preserve someone from declining and from death, which is to say from the failing and cessation of life, which are not only possible but necessary the consequences of sickness. Mr. Dahl’s argument is an inconsistent sophism that abounds in confusions and amalgams. It is an absolutely gratuitous conjuring trick, a vain and weak attempt to demonstrate the indemonstrable.
Refutation of (b). Suffering supposes a living being who is suffering. The cessation or the relief of suffering supposes a living being who no longer suffers or who suffers less. To suppress life is to suppress the sufferer, not suffering. The problem is not resolved, but eluded. It is an evasion. And it is also an absurdity, for it supposes that suffering is an evil worse than death, and that quietude (the absence of suffering) is a greater good than life. The absurdity of this presupposition leaps out: quietude in effect supposes life, and that is why one cannot suppress life to safeguard quietude. From the very fact that you suppress life, you make quietude impossible. It is better to suffer than to die because life is a greater good than quietude, and death is an evil worse than suffering. I’m showing this by an abstract reflection, but the truth can be verified by experience: except in relatively rare cases, among persons who are morally perverted and denatured or whose judgment is diminished because of a mental disorder, there is normally an innate instinct for survival. One may say what one likes ahead of time, but once faced with suffering, even extreme, our natural reflexes react in favor of life.
1 Louis Billot, L’Église, vol. 3, L’Église et l’État (Courrier de Rome, 2011), No. 1114, p. 3.
2 Cf. St.Thomas Aquinas, Summa Theologica, I, q. 82, art. 1.