In one sense, dying is the most personal and private of all events. Each of us comes to the end of a unique life and dies his or her own death. Along with birth, death sets the natural boundaries of a particular life's trajectory. But unlike birth, the consciousness of death can define a person's plan of life. In existential terms, the consciousness of an inevitable person death provokes an anxiety that is radically individuating. The fact of my death makes this my life.(1)
Yet no aspect of human experiences is wholly personal and private. Like birth, our knowledge of death comes from others. The way we die--when, under what circumstance, and from what cause or reason--is shaped in profound ways by relationships with others and by large social and institutional forces. The symbolic significance attached to death is derived from religious and cultural realities that precede and survive individuals. And it is precisely because death is such as intensely personal and private event, so defining of the individual, that the social arrangements that attend death are so important. What could be more important for society than events that shape individuals?
The character of dying and how th dying are cared for has changed in profound ways in the last several decades.(2) In all of our prior history, death for those who reached adulthood came generally in what is now mildlife. It came swiftly, "a thief in the night." It came without significant resistance from medicine; little could be done to ward off impending death. Now death is generally an event of old age. It typically follows a long pattern of chronic illness and decline. It comes only after exhaustive medical interventions, some of which plainly increase the length and intensity of suffering and all of which increase costs to the health care system.
This change in dying, and especially its impact on the deaths of individuals, has produced a social consensus over the last two generations on a patient's or proxy's right to refuse life-sustaining medical measures, a hospice movement designed to improve the quality of life in dying, and a growing debate over legalization of doctor-assisted suicide and active euthanasia. What are the social dimensions of these developments, especially the third, since it stands before us as a social choice? Aside from real and projected impacts on individuals, how does our treatment of the terminally ill effect society as a whole? How might changes in social arrangements surrounding dying affect the common good?
These issues are taken up here under three headings. First, some general observations are offered about the notion of the common good. Second, some changes are proposed designed to better serve the common good in the way dying patients are cared for. Finally, some reasons are developed to show why legalization of doctor-assisted suicide and active euthanasia cannot serve the common good.
The Common Good
Traditionally, the common good has been the key term of articulating and assessing the implications for society as a whole of changes in social practice or public policies.(3) But the notion of the common good is problematic in our society. The idea comes to us from ancient Greco-Roman civilizations and from medieval Europe. Thus, the birth and development of the notion of the common good is derived from civilizations far more homogeneous than contemporary American. The diversity in our society--of races, ethnic groups, religions, languages, culture, and lifestyle--makes it more difficult for us to understand and assent to the idea that there is some good or goods that are of value to us as members of society irrespective of our many differences.
American politics, especially in the twentieth century, work against generation of a practical consensus on the common good. The checks and balances built into our Constitution hobble attempts to develop unitary policy visions. …