Guest column: Death or life — both should be with dignity
We generally see life as our own. We can be whom we want and choose how we live, and now we seek to choose when and how we will die. In death, as in life, we see ourselves as autonomous, by which we mean able to make our own law. This is a different meaning from how autonomy was used previously in ethics, whereby people would not make their own law but rather would make the universal moral law their own. Choosing one of these two meanings of autonomy over the other will result in respecting another’s autonomy either by helping them fulfill their desires, whatever they may be, or by seeing each person — and his or her life — as valuable, irrespective of the person’s own view of the matter.
In daily living, there does not seem to be much of a difference, since today we all live very independent and self-sufficient lives, or at least seemingly so. This air of individuality causes us to assume that death, as is life, is a private choice and event. This idea is shared by many in the medical community in the belief that death means something different to everyone and a patient’s understanding of death must be respected when it comes to patient decision-making. However, in actual fact, death is not a private event; it is informed by — and affects — everyone around the person, from the medical team to the patient’s family and support group. Death is also a societal concern not only from a public-health perspective but even in how to define and determine it.
Moreover, patients at the end of life are often in a vulnerable position — emotionally, psychologically and financially — which limits the autonomy we attribute to them when we think in larger, more general terms. Recognition of this is not to deny any value to personal freedom and decisional autonomy. It is just to make aware that in actual practice, the consideration of those values must take other medical and social facts into account.
What, exactly, does death with dignity mean? By legislation, it is not suicide, but in actual fact the distinction is blurred. Semantics aside, the moral outlook with respect to suicide has changed from being unacceptable to acceptable if chosen rationally. Moral consideration is now given to how the person makes the decision and not to death itself. Without even considering the larger societal implications, when discussing death with dignity, we must recognize that the person who chooses to die for fear of losing one’s dignity must also consider the effects death will have on his or her family and friends. We are not autonomous, and we do not exit alone; we live together and leave memories and lessons behind.
On May 26 from 5 to 7 p.m., I will participate in a public conversation, along with Matthew Wynia of the University of Colorado School of Medicine and Sean Jeung, about Colorado’s Terminally Ill Individuals End-of-Life Decisions Act. Please join us at the Aspen Jewish Community Center at 435 W. Main St.
Ira Bedzow is the director of biomedical ethics and humanities at New York Medical College and senior scholar at the Aspen Center for Social Values.