At its best Roman Catholic piety can be enormously powerful. It offers what we may call a way of affirmation—a sacramental understanding of the countless ways in which we meet the holy God in the everyday life of bodily gestures, repetitive prayer, candles, motherhood. And it does this without losing an equally powerful way of negation, which forbids us to suppose we can capture or control the presence of the transcendent God in such ways. But precisely because this intricate system of spiritual practice is so powerful, it can also go bad in powerful ways. Affirmation is safe only when negation is also present. One can become fascinated not so much with God as with one’s own experience of candles, beads, genuflection, and a virgin mother. And then one may lose the transcendent otherness of that God in a way that would hardly be possible for, say, a serious Calvinism (which would, of course, have its own way of going bad).
This was, I have to confess, my first thought after reading “At His Own Wake, Celebrating Life and the Gift of Death,” a recent New York Times article about the death by euthanasia in Canada of a man named John Shields. Clearly intended to elicit pathos in its readers, the account is, by my lights, drowning in bathos. Let me admit straightforwardly at the outset: I don’t much like the John Shields portrayed in this article, though he was much loved by some who knew him. I like even less some of the other characters who play significant roles in Mr. Shields’s death—as, for example, Penny Allport, the “life-cycle celebrant” whose task it was to orchestrate and choreograph the homemade rituals, drawn from countless different (and incompatible) cultural and religious traditions, that shaped Mr. Shields’s last hours and his death. I am not at all fond of Dr. Stefanie Green who, needing “a better life-work balance” than her practice of maternity and newborn care permitted, turned to a focus on implementing Canada’s year-old legalized “medical assistance in dying.” “Birth and death, deliveries in and out—I find it very transferable,” she says. “Both are really intense and really important.” (Is it just an accident that the title of the Times article celebrates life—not the gift of life—while celebrating “the gift of death”? Perhaps the two are not so transferable after all.)
These are minor dislikes, however, compared with my reaction to the shameful inability of the Times and its journalist/reporter/essayist, Catherine Porter, to help readers not just to sympathize (as we should) with Mr. Shields in his suffering but also to think critically, distinguishing bathos from pathos. Evidently Ms. Porter was present as a silent participant throughout the events recounted in her article, an article the Times deemed important enough to run on its front page. Indeed, it is hard to detect any critical distance at all in her authorial voice. In the context of our society’s deep divisions and confusions about the practice of euthanasia, this article amounts to a puff piece aimed at evoking support for one side of a complicated moral argument. A shorter piece on the op-ed page would have been more honest.
John Shields was evidently a man with great energy and a capacity to take interest in many aspects of life, though also in his own perceived “uniqueness.” Ordained a priest in the Roman Catholic Church, he left after four years, though not before being prohibited from preaching and teaching at his parish in Austin, Texas. After that he became a social worker and, later, president of the British Columbia Government Employees’ Union, over which he presided for fourteen years. After his first wife died of lymphoma he eventually married for a second time. He studied some Gestalt therapy, learned dowsing, and came to regard himself as a “spiritual cosmologist, believing that the universe was conscious and that everything was inextricably connected.” Having left institutional religion for a kind of generalized spirituality strikes me as rather less countercultural than Mr. Shields’s self-image would suggest—and certainly far from unique. “I come forth at this precise moment to contribute my unique gifts to the great unfolding,” he wrote in a memoir. And while this does not exactly bring Hegel to mind, we get the idea and can see why Ms. Allport would call his death his “great blooming.”
His character was marked by the twists and turns of the several directions his life had taken. “He loved rituals, which began with the Catholic Masses of his childhood.” To be of service was a central theme in his life, as was the theme of freedom. “He was always growing and exploring.” Sadly, though, in his mid-seventies he was diagnosed with amyloidosis, a disease in which abnormal proteins accumulate in the body’s organs, eventually causing death. Mr. Shields gradually lost feeling in and use of his arms and legs, finally having to enter hospice care. In his debilities he felt a loss of dignity, a diminished condition that he found “demeaning” and “unacceptable.”
As it happened, the man and the moment were well matched. For only a year before Canada had legalized what it calls “medical assistance in dying.” This permits not just assisted suicide but also euthanasia, in which a physician actually administers the death-dealing drugs. The law does prohibit euthanasia that is nonvoluntary—that is, when the dying person is, for whatever reason, no longer able to consent at the time the drugs are actually administered. This was in fact a worry for Shields and his wife: as his condition swiftly declined, they feared that if he waited too long, he might be unable to give his consent when the chosen day arrived. And, in fact, it is hard to believe that this restriction can long survive—at least in British Columbia where, according to the Times article, an increasing number of patients are eagerly embracing euthanasia. Dr. Green herself, while adhering to the law’s limits, suggests that there should be more “flexibility” in the law, a flexibility that would permit euthanasia for those who requested it before reaching a condition in which they are unable to consent.
The Canadian law also specifies that, in order to qualify for euthanasia, an adult must be in an irremediable medical condition, experiencing suffering he or she finds intolerable, and likely to die fairly soon in any case. It is just as hard to believe that these conditions can hold for too long. Patients with severe but not life-threatening disabilities may well find their condition demeaning and undignified. Why exactly the fact that they are not likely to die soon should matter more than the felt indignity of their condition is far from clear.
In short, the Canadian law tries to ground permission for euthanasia in both compassion for those who suffer and a freedom to make important choices about the course and duration of one’s life. But, as Daniel Callahan noted years ago, these criteria are on a collision course. If freedom and self-determination are this important—so important that we have a right to help in ending our life—how can we insist that such help may be offered only to those who are suffering irremediably? On the other hand, if the suffering of others makes so powerful a claim upon us that we should be willing to cause their death in order to end the suffering, it is not clear why we should limit our merciful help only to those who are still able to request it. After all, fully autonomous people are not the only ones who can suffer greatly. We may safely predict that the limits will gradually be extended.
Self-determination and compassion. Those are the two considerations upon which the case for euthanasia is based, and it is worth our thinking briefly about each. Living in a relatively individualistic society, it seems to us natural to say: “This is my life. Why shouldn’t I be able to do with it as I please, so long of course as I hurt no one else in the process? I have been making important decisions along the path of life for years. Who should have the authority to tell me that I may not decide to end that life and to find a willing person to help?”
Understandable as this is, and appealing as it is bound to seem to almost all of us in certain moments, we need to remember that the basic premise is false. I may not do just anything I want with my life. The rest of you will not let me. I may not engage in deadly duels (even with a willing adversary). I am prohibited from taking certain drugs, from marrying my sister, from marrying more than one person, from selling my kidney for transplant to the highest bidder. And, of course, you will not let me sell myself into slavery.
Now, to be sure, about any of these I might want to argue. I might argue that we should not prohibit dueling, ingesting certain drugs, marrying one’s sister, marrying multiple spouses, or selling a kidney—or, perhaps, getting help to end one’s life. But the point is that this is now a public argument. I need reasons to offer you. I may not simply say, “this is my life, and I may do with it whatever I want.” Bumping up against the limits to my self-determination, I must realize that what we actually have here is a question about what it is reasonable (or not) to leave to private choice.
Perhaps, in fact, we can press just a bit more on the claim to self-determination. In a class discussion years ago, one of my students, talking about a cousin of hers who had committed suicide and the effect that had on his family, said: “He didn’t just take his own life; he took part of theirs as well.” I went back to my office, wrote it down, and have been quoting her ever since. We are never quite the independent, self-determining individuals we like to think we are. Our lives are always connected to others—as connected as we were at the beginning by the umbilical cord that sustained us. We should not pretend otherwise as we near the end, claiming an illusory freedom to determine when the game is no longer worth the candle and asking others to sign on to that determination.
Compassion is at least as complicated as self-determination. Our compassion for one another ought to be the compassion of equals. Not of some who are gods for others who are human beings. Not of some who are human beings for others who are beasts lacking dignity. Our equality is grounded in the fact that we do not make each other. Who does? Well, God does. Or, as John Shields would no doubt have preferred, Nature does. But we are equals because none of us is the life-giver. I cannot say that it is time to snuff out your life. And you should not give ultimate authority over your life to me.
Thus, although compassion surely moves us to try to relieve suffering, there are things we ought not do even for that worthy end—things that would not suit our shared human condition. There may be some suffering that must be accepted and endured—suffered—because we can find no right way to relieve it entirely. So the virtue of compassion has a shape and has limits; it is not just a formless emotion. And the imperative that governs this virtue is not “minimize suffering,” but “maximize care.” Quite often, no doubt, these will come to the same thing, but not always. Apart from such limits the task of medicine is no longer to care for us and keep company with us in our dying. Instead it becomes the task of medicine to judge whether our life still has meaning and purpose. But that is a question far too profound for medicine to suppose it is fit to handle.
John Shields, alas, did not share such concerns. Of far greater significance, though, is the fact that the Times article, in its cloying way, never really raised them for serious exploration. So on March 23 of this year Mr. Shields, along with family and some friends, held his desired Irish wake before, not after, he died the next morning. I cannot bring myself to recount in detail the rituals devised by that life-cycle celebrant for Shields’s “great blooming.” The image of her crouching on the floor to thank the earth for carrying his body and summoning ancestors to guide his journey, which I will not soon forget, is like a reductio ad absurdum of the attempt to create one’s own traditions and rituals. It is hard to believe that this sort of spirituality lite can for long sustain us in the face of death.
What are Christians to do in the midst of such cultural trends and their hagiographic celebration in the press? Perhaps we need to place a little less trust in our own spiritual insights and permit a genuinely transcendent, iconoclastic God to shatter our homemade pieties. We need to learn to live within the church’s teachings and liturgies, allowing them to shape our feelings rather than supposing that our feelings should govern what we do. We need, in particular, to see to it that our funerals are less celebrations of our lives than of the hope of the resurrection and new creation. And in the face of a culture intent on teaching that to experience decline and loss of capacities is to lose dignity, we need to insist that each of us, whatever our capacities, is equidistant from eternity, and that no one for whom Christ was content to die can lack human dignity.
