Making Choices About the Final Exit
by James M. Wall
James M. Wall is Senior Contributing Editor of The Christian Century. The following essay appeared in Hidden Treasures: Searching for God in Modern Culture, by James M. Wall (The Christian Century Press, Chicago: 1997), pp. 104-106. Used by permission.
A book about how to commit suicide has vaulted to the top of the best-seller lists. New York Times columnist Anna Quindlen admits that she picked up Final Exit out of curiosity, but kept it for another reason. The day may come when she will want to know how to die with a minimum of pain and anguish. And if that day does come, "whose business is it, really, but my own and that of those I love?" Derek Humphry’s little volume went unnoticed until it was highlighted in the Wall Street Journal. Then media coverage was immediate and widespread, pushing the book to the top of the Times best-seller list.
Most commentators make the usual demurs, reminding us that the choice to die should be made in discussions with loved ones and professional counselors. And they point out that teenagers and adults despondent over temporary—or even permanent—burdens are not the book’s intended audience. Only the terminally ill who face prolonged and painful suffering should be encouraged to prepare for the time when, as Quindlen says, "I may feel so bereft of strength, purpose, stamina and the will to live that I may want to know what constitutes a lethal dose of Seconal."
The issue here is clearly one of controlling how and when one dies—the understandable longing of the human spirit to name the time and place for a final exit. In our secular culture this seems an entirely reasonable desire, one which deserves fulfillment. But the desire to take one’s own life is the epitome of modern individualism. If one thinks ultimate reality is located no higher than human personality, what one does with one’s life is one’s own affair. Betty Rollin, who wrote an introduction to Final Exit, is a television journalist who assisted in the suicide of her mother, who was terminally ill from ovarian cancer. Rollin argues that "some people want to eke out every second of life—no matter how grim—and that is their right." But others, she insists, do not, and "that should be their right."
But is it? When Quindlen maintains that her death is her business and that of "those I love," she does not consider the significance of suicide on the wider circles of life that surround her. John Donne’s reminder that none of us is an island speaks to the point: the death of each individual has a ripple effect in the present and into the future.
If, as modernity dictates, the individual is supreme, then our responsibility is only to ourselves, since there is no God who gave us life or who awaits us in death. But if we believe that life derives from a loving Creator, then suicide must be considered within a larger context. In a nonreligious culture, Final Exit assures people that, in the face of death, individual choice is all that matters. Only someone who accepts individualism as the highest good would be so confident that there is an obvious qualitative difference between the "freely chosen" decision to die made by a person facing a terminal illness and a decision made by a physically healthy but mentally tormented individual.
In considering the "right to die," it is important to distinguish between the comatose patient being kept alive by mechanical means and the person still capable of making decisions. When consciousness disappears permanently, a decision to die becomes the responsibility of others, who may reach the judgment that for all practical purposes life for an individual has concluded and that therefore artificial supports need not be maintained.
Richard Lamm, the former governor of Colorado who has campaigned against excessive medical costs, recently cited the case of a patient in a Washington, D.C., hospital who has been in a comatose state since Lamm was a high school student. The patient has survived entirely through artificial means in a condition which benefits neither that person nor society. In this case, the larger community has not acted in the best interest of either the individual or the community. Fear of political and legal retribution from "right to life" activists has forced the medical community to preserve the person’s life. That decision reflects a narrow definition of "life" held by a small but politically strong group of activists.
An individual does have the "right to die" when individual choice has disappeared and the decision on life or death has fallen to the community (primarily the family). That is why it is so important to instruct one’s family in advance not to employ excessive means to sustain life when there is no prospect of recovering consciousness.
But what about a conscious decision to commit suicide? Though an individual may rationalize that his or her death would be to everyone’s advantage, suicide leaves a void in a network of close relationships. Its impact does not stop with "those I love." Friends, former teachers, colleagues, distant family relations, even casual acquaintances are all affected by suicide. The web of life, as Joseph Sittler so aptly put it, is like a spider web: touch any part, and the entire web shimmers.
Despite Humphry’s caveats and warnings, his book is irresponsible. There is, admittedly, a difference between the elderly terminal patient in horrible pain who wants all pain to cease and the despondent teenager whose pain is one of low self-esteem. But the difference is finally one of degree. The terminally ill person, out of personal suffering and a concern for the impact a lingering illness has on family and the immediate human circle, may turn to suicide. But the emotionally distraught teenager or adult may reach the same conclusion: my pain is too great, and my presence is detrimental to those around me. To make that decision before life involuntarily leaves us is a decision we are free to make, but it is a choice that is ultimately selfish. It is not surprising that our culture, which regards individual choice as inviolable, would find so much merit in a book like Final Exit.
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