Government Death Panels and a Duty to Die
It’s health reform crunch time and the propagandists are busily at work. Increasingly louder are cries that government “death panels” will oversee end of life care, eager to pull the plug on grandma to cut costs. Advocates of a government option quickly dismiss the idea as a shameless scare tactic, something no civilized people could ever entertain. Life is sacred, and of course we’ll gladly extend human life as long as technologically possible. But is it OK for us to ask our fellow citizens to bear the costs of an excessively long death? Is it even OK to ask our families to bear those costs–the emotional and financial burdens of stretching death for weeks? Months? Out of respect of our loved ones, John Hardwig says no, and here I apply that same logic to the bigger picture, extending his “duty to die” onto anyone receiving healthcare at the taxpayers’ expense.
It is these connections that can, tragically, generate obligations to die as continuing to live takes too much of a toll on the lives of those connected to us.–John Hardwig from Is There a Duty to Die?
Hardwig famously (famously within bioethicist circles, anyway) argued that sometimes, perhaps often, we have a duty to die–to refuse life-extending treatments or even actively kill ourselves, rather than slowly waste away.
“Our individualistic fantasy about ourselves sometimes leads us to imagine that lives are separate and unconnected, or that they could be so if we chose. If lives were unconnected, then things that happen in my life would not or need not affect others. And if others were not (much) affected by my life, I would have no duty to consider the impact of my life on theirs… But this is morally obtuse. The fact is we are not a race of hermits — most of us are connected to family and loved ones. We prefer it that way… But being with others is not all benefits and pleasures; it brings responsibilities as well. For then what happens to us and the choices we make can dramatically affect the lives of our loved ones. It is these connections that can, tragically, generate obligations to die, as continuing to live takes too much of a toll on the lives of those connected to us” (Is There a Duty to Die?, 2000: page 14).
If his argument works, wouldn’t similar logic also saddle recipients of government healthcare with a similar duty to die? The emotional burden would be absent, for I am unaware of countless strangers suffering their final days at this very moment. But the financial burden is very real, though not as direct. Funds used to extend their lives aren’t taken directly from my savings account, and the bill isn’t mailed directly to my home. But my and your tax dollars are indeed used to pay the doctors and the hospitals that keep them alive, perhaps at some point excessively and unnecessarily so.
What do I mean by “excessively” long deaths or people kept “unnecessarily” alive? I have in mind those with qualities of life so diminished that their existence is hardly recognizably human. I’m not talking about an otherwise healthy and young person, with much of their lives in front of them, who suffers some tragedy and needs time to heal. Those folks can actually get better, and so resources used for their benefit seem well spent. But in cases where there is little or no hope for recovery (especially for the elderly, with little life left to live, even if they do recover), and a daily routine that consists of little more than pain and delusion, not only is the individual left to suffer, but so too are their familial witnesses. The case is even stronger when a person permanently loses consciousness. Extension of such a life seems pointless–even harmful–and thus unnecessary and excessive.
But keep in mind–Duties and obligations are not absolute. They never exist in isolation, and are rarely powerful enough to compel action on their own. Particular duties must be balanced against other competing duties before we can decide what we all-things-considered should do. So even if it’s the case that I may someday have a duty to my fellow citizens to refuse life-extending treatments out of concern for the federal budget, that doesn’t mean this duty couldn’t be overridden by supervening obligations to a grandson–to see him graduate high school, to my wife–to see her through our 75th anniversary, or to my readers–to complete one last blog post. Thus, the duty isn’t all-powerful or in all cases reason enough to pull the plug. All I am arguing is that the duty to die is real and sometimes powerful, and that not only does it obtain out of respect for one’s family, but sometimes out of respect for one’s fellow citizens.
None of this is to say that the so-called “death panels” are necessarily a good idea. With limited resources and promotions on the line, I can certainly see the opportunity for abuse. But if we think sometimes people should just go ahead and die, and that lives aren’t always worth the cost of extension, maybe the idea isn’t as ludicrous as it first sounded. And if you buy that, there’s no reason to wait for socialized medicine to call your Congressperson–millions are already dependent on Uncle Sam for their end of life needs–just take a look at Medicare.
