Alternatives in Jewish Bioethics

2. Death: Natural Process and Human Intervention

2 Death: Natural Process and Human Intervention 1. The 'Active/Passive' Distinction Regarding Euthanasia Euthanasia only becomes morally conceivable when, due to great suffering, it is against a person's interest to go on living.I In many situations, primarily where the person is unable to express his or her position, determining that it is best for someone to die is very complicated. But sometimes a mentally competent patient, undergoing great suffering and expecting no improvement. expresses a rational wish for release through death. In many instances, the primary moral response should be a greater commitment to pain control;2 nevertheless, there are, and perhaps always will be, situations where there is no painless alternative. Complying with such a wish to die constitutes "voluntary euthanasia," which is the subject of the following discussion .3 In contemporary policy regarding euthanaSia, the most crucial factor is the significance attached to the 'active/passive ' distinction (killing vs. letting die).4 In most jurisdictions , active cooperation with a patient's request to die would be criminal, while passive cooperation-such as, through foregoing certain possible treatments which the patient has either refused or simply not authorized-is normally obligatory. The distinction is Similarly held to carry decisive weight in the Jewish tradition. The following statement by Isaac Klein, a prominent Conservative rabbi, is fairly representative: 38 Alternatives in Jewish Bioethics Human life is precious, and its preservation takes precedence over every other consideration.... [This] includes the obligation of forbearance from doing anything that might hasten the death of a sick person, no matter how serious the illness (Maimonides, Hi!. Aveil 4:5). Hence, euthanasia is forbidden under any circumstance. However, if death is certain, and the patient suffers greatly, it is permissible to desist from postponing death by artificial means.5 This statement reflects a recognition that life can sometimes continue only at the cost of great suffering, and that from the perspective of the patient's interests, death may then be preferable. That is what justifies "desisting from postponing death"-passive euthanasia. But if a swift death is the preferred result, why may it be produced passively, which is often not the most humane way, but not actively? can a good account be offered for the distinction between the modes whereby this desired death is brought about?6 This has been the subject of much debate amongst moral philosophers, one which often forms along the lines of the confrontation between consequentialism and deontology . As might be expected, consequentialists tend to deny that the 'active/passive' distinction carries any moral significance; for them, it is the foreseen result that determines an action's moral character, rather than its mode of execution. A deontological perspective, however, might support the distinction, since deontology consists in judging not by the result alone, but rather by the character of the (prohibited) act; for example, the act of killing. The basic problem for a deontological stance is how to avoid being authoritarian. "This deed is evil," but why, apart from its consequences, is it evilT If killing is bad because it brings about another's death, then letting die is equally bad, for its result is certainly the same. Accounts of deontological judgments necessarily focus instead on the agent's perspective. This is sometimes said to involve a focus on intention; that in itself, however, is too vague, Death 39 since intentions have more than one aspect. After all, killing does not differ from letting die in its intended result; if there is a difference in intention, it must derive from a difference in the nature of the (intended) act. Judging an act to be prohibited in itself, that is, by virtue of its very description or character, involves viewing it as having a certain inherent (negative) value apart from its consequences. This seems to imply a reification of evil; the act is deemed bad in itself, prior to any judgment relating to the persons involved. The deontological approach thus shows a close affinity to religious traditions, which are frequently characterized as involving reified symbolic representations . No doubt, there are secular deontologists, but insofar as they do not rely exclusively on dogmatic pronouncements, their moral explanations will necessarily have this quasi-religious character.s Let us explore the accounts offered, in the Jewish tradition , for its presumably clear opposition to voluntary active euthanasia. Through this analysis, some of the strengths as well as the limitations of a...