|
Death is not the defeat of medicine;
it is one of the basic conditions of life and is a sign of our limitedness.
The
loss of this awareness, supported by the idea that all the phases of
life can be rationalised and managed in line with one’s planning skills,
is one of the reasons (although certainly not the only one) that lie
beneath the latent consensus that is establishing itself around the
theme of euthanasia.
The
refusal to acknowledge the biological limits of existence, and the opportunity
for enlightenment such limits provide for us to grasp the meaning of
existence, somehow leads us to neutralise and tame the issue of euthanasia.
The debate about euthanasia has its own history and a careful analysis
of the problem requires us to make some distinctions, so as to identify
with some degree of accuracy what is meant by euthanasia. Indeed, it
is not difficult to realise how often the meaning of this word relates
to actions differing from each other.
In
this context, in order to allow clear considerations, free from the
pressure of emotions whilst maintaining control over the rhetoric use
of words, in referring to euthanasia we solely and exclusively intend
to designate actions that are directly and immediately aimed at bringing
about the death of a patient, although already terminally ill.
But
what are today the arguments in favour of euthanasia?
In
actual fact, these can be traced back to two basic sources: a compassion
for the dying person and the claiming of the patient’s right to decide
for himself. In the first instance, the reasons are those of the spectator,
so to speak: that is of one who foreshadows his own or another person’s
death and in fact expresses distress faced with a suffering which does
not appear to make “sense”.
In
the other case, instead, reference is made to the self-determination
of the patient and to the alleged right of man to freely dispose of
his own life. Although the purpose is to ground the request for euthanasia
on the patient’s will, or of the person who is legitimately capable
of interpreting the patient’s will, in actual fact it is the physician
who performs the euthanasic act and has to take upon himself the related
moral and legal responsibilities. It is appropriate to consider, even
though only in brief, these arguments in favour of so-called “mercy
killing”.
The
theoretical foundations of the actual defence of the right to euthanasia
relate to the so-called “liberal” culture and express by different rights
an ethics based on feeling and compassion, which has however taken on
subjective hues.
If
these are the aims, that is to suppress pain, avoid an end which is
not in keeping with human dignity and respect for the dying person,
one should establish whether the choice of euthanasia is consistent,
or rather in conflict, with such aims. Within the debate about euthanasia,
the prevailing theme is that of pain, whilst people often neglect the
issue of suffering which may arise also in the absence of physical pain.
Indeed suffering is caused by the deep existential unease of people
who, in approaching the “end” of their life, question the real “end”,
that is the purpose, the direction, the meaning of life. Today, thanks
to the developments of medicine, it is of course easier than in the
past to respond with palliative treatments to the issue of pain; however
the problem of suffering remains open.
The
request for the so-called “mercy killing” is therefore made up of two
separate demands: eliminating or easing the physical aspect involved
by the dying process, and understanding the meaning of this mortal life
of ours. In this technological stage of civilisation, death takes on
an even more distressful aspect, in that it appears to drastically deny
all those promises of happiness and prosperity on which the medicine
of desire and recovery is built.
We
are still mortal, in spite of everything. And in the condition of the
person who is dying, as also in that of elderly or sick people, appears
that aspect of passivity which first appears with birth, when we depend
on other peoples’ care in order to continue to live. This “passivity”
of existence enables us to adequately appreciate the meaning of autonomy,
which is never unlimited. Even without appealing to a religious vision
of life and death, man’s life remains an asset that cannot be disposed
of, not even by the party concerned, because it is the basic requirement
to exert autonomy and freedom. It is not by taking one’s own life, or
by getting somebody else to do it, that man can assert his freedom,
because death is the direct antithesis of freedom and autonomy.
To
accept death as an event that is independent of us means, in the last
analysis, to start understanding human condition. This shows, therefore,
how complex the issue of euthanasia is and the impossibility of dismissing
the matter in terms of medical procedures which will dim, in the name
of autonomy, consensus and so on, a problem relating to the very nature
of medicine in the age of technology. The argument based on the defence
of human dignity to legitimate the medical performance of euthanasia
is based on a misunderstanding. In fact, human dignity does not simply
consist in the exertion of this autonomy (which is always relative and
variable), but in “being a man” even when we are sick, dying or incapable.
This “even when” designates the objective limit of man’s connatural
condition, the region within which his inherent dignity may be dimmed,
but never suppressed.
There
are different considerations that may lead to this inherent dignity:
they may be of a philosophical type or of a religious nature. But in
a civilized and pluralistic society, the assertion of the inherent dignity
of every man should become a postulate, irrespective of the debates
relating to its proper foundation: only in this way can we avoid defeating
the principle of the equality of men, which is not a descriptive but
an evaluative assertion, capable of guiding medical practice.
We
then have a sociological concept of dignity, which pertains to the expectation
of individual societies, to their standards of efficiency and value:
but this concept cannot represent the foundation of the care for the
sick and may promote genuine discriminations based on health criteria.
Indeed the risk, based on empirical criteria and on the cost/benefit
ratio readings, is that of describing not only the life of the person
who is dying, but also that of disabled people, as lives “devoid of
any sense”, involving only social costs and inconveniences for those
who have to provide assitance.
The
reasons in favour of the so-called “good death” may also lead to the
“civil death” of those who, even if not terminally ill, fall within
the categories described by the supporters of the right to die in order
to promote euthanasia. Today, we have many ways of responding to the
requirements of those who are favourable to euthanasia without reaching
the point of having to suppress the sufferer to eliminate suffering.
However, once again, we realise how in today’s medicine there are problems
of meaning rising to the surface which transcend medicine itself, and
therefore cannot be resolved with purely medical arguments.
(traduzione
Interpres sas-Giussano)
|
