Judging Someone Better Off Dead

John M. Dolan Judging Someone Better Off Dead "The value of a profane thing lies in what it usefully does; the value of a sacred thing lies in what it is." W. H.Auden 1. A DECADE AND A HALF AGO, A PHYSICIAN ofmy acquaintance decided to give a friend ofmine and me some instruction.The doctor was convinced diat the two ofus harbored unrealistically high estimations of the value of human life and unreasonable conceptions of the obligations owed to severely compromised persons. Desiring to bring us down to earth, to introduce an element ofreality into our thinking by exposing us in some detail to the range ofpatients he cared for on a daily basis, he invited us to the hospital at which he worked and conducted us on a tour organized (perhaps consciously) roughly on the model ofDante's tour ofthe nine circles ofhell.The visit opened with conversations with several patients undergoingrenal dialysis on an outLogos 2:1 Winter 1999 Judging Someone Better Off Dead49 patient basis. My friend (who happens to be an eminent philosopher) and I conversed with the patients as they underwent dialysis (their permission having been obtained in advance). It was a bit disconcerting at first to talk with persons whose blood we could see coursing through the transparent tubing linking them to the dialysis machines, but we were interested to hear them describe the adjustments they had made to accommodate the thrice-weekly sessions and to learn how life looked to them under the demanding regimen of dialysis. The next stage of our tour involved visits with patients on wards a few floors away, some able to converse with us, others disoriented and unable to carry on conversation.The last stop in our journey was a ward whose rooms held severely demented or comatose patients. We entered the room of a woman in her late sixties who was unconscious. Because of damage resulting from her diabetes, both ofher legs had been amputated just below the knee. She was a farm woman from one of the plains states. The lines on her face bespoke years of work under the sun.The physician told us abitaboutherbackground and described the physical and mental decline she had gone through in the last few years. He said that she now spent most of her time unconscious and that when she was conscious she often dwelt amid hallucinations of the past. He added that she exhibited signs of terror when subjected to renal dialysis and had to be tied down for the procedure. His gestures and emphatic manner and his intent gaze at our faces suggested thathe was convinced that he had now placed before our eyes ExhibitA in the case against our "unrealistic" conceptions. Standing at the foot of the woman's bed and pointing at her, he asked: "Does this have a soul?"My friend and I at the side ofthe bed were stunned by the brutality ofhis words.Without a moment's hesitation, my friend leaned over and reverently kissed the woman's face.1 Here was a collision of world views, a conflict of attitudes toward human life! "Does thishave a soul?"Indeed! "This"is a human person. "It" has a soul.The doctor made perfectly clear thatthere was notthe slightest doubt in his mind that this woman would be better offdead. In fact, so Logos describing her as a"woman"was already too generous an account ofthe situation from his perspective. His astonishing perspective, which was not exactly rare fifteen years ago, has become increasingly commonplace in the intervening years. "Better off dead"! Clouds of confusion and hate-laced ideologies condensed into a drop oflanguage.2 There are other contexts in which one might hear the judgment that someone would be better offdead, contexts in which a friend or relative, convinced that the end is near, and conscious ofthe struggle a given individual has been waging, expresses the thought that, since the end is fast approaching, it would be better ifit came sooner rather than later, better for the afflicted person. Such ajudgment that someone would be "better off dead" seems to be fully consistent with a deep respect for the sacredness ofhuman...