- Frank J. Leavitt, Ph.D.
The Jakobovits Centre of Jewish Medical Ethics, Faculty of Health Sciences, Ben Gurion University of the Negev
Beer Sheva, ISRAEL (Home Tel/FAX: +972-2-9963048)
In Judaism we don't deny the existence of death. We have very clear laws and customs about dying patients and mourning. But our Torah was given not for death but for life: "You shall keep my laws and judgments: which one should do and live in them: I am the Lord" (Leviticus 18:5),. We also believe that there are secrets of existence which are not revealed to us. We only know this sensible empirical world: "The secret things are for the Lord our God, and the revealed are for us and our children for all time, that we may do all the words of this Torah" (Deuteronomy 29:28). Among the secret things unknown to us is the meaning of this life, so we really don't know if we belong to ourselves or not and we should be humble enough to recognize that things don't always turn out as planned. (The Law of Induction in Bourgeois Western Science is the impudent idea that reality is "intelligible" and we can know just what tomorrow will bring. This is alright for boring humdrum green pleasant lands, but living in Israel, where the world turns upside down every day, where flat dry deserts turn suddenly to 200 metre chasms and torrential floods rolling huge boulders under a clear blue sky and burning sun, can make one learn to maintain faith in the face of shock, dropping simple induction and turning more to the non-linear functions of ecology for models of real life.) From this point of view the demand for a neat, well-planned "death with dignity" looks a little juvenile.
The idea that we can know anything about death and what the afterlife is like if there is one, is also a little juvenile. This is also one of the secret things, unknown to us. So voluntary euthanasia has nothing to do with autonomy because there can be no informed decision to die. Not knowing what it is like to be dead, no consent to die can be "informed consent". And since death is one of the secret things, there is nothing for us but life. (See the above Scripture).
I thought the emphasis on life, on "Be Here Now" was what Judaism had in common with other Asian ethics of life. Indeed Dr. Cong YaLi tells us that Confucianism and peasant attitudes emphasize life rather than death. Buddhism, Zen Buddhism and the Tao have a lot to teach about living positively and healthily, which should be the first thing in bioethics.
When I visited Japan I telephoned home and my young son, Shookey, asked if everyone there was doing Karate. I smiled at his naivety, but I had been no less naive in expecting to see a lot of meditation and Zen, and people who can explain Shinto. I really saw a lot of post-modernity, and many Japanese were less interested in ancient tradition than in impressing us with their modern scientificity. I suspect this modernity will clear the way for Western boredom with life and fascination with death and euthanasia to pervade the East.
I am not complaining about pro-euthanasia opinions. Every one is entitled to their opinion, and I see little point in trying to browbeat people into thinking as I do. Indeed I have come to learn that many bioethicists are pro-euthanasia because of genuine, altruistic concern for suffering. Although I disagree I respect them for this.
I am complaining about the morbid overemphasis of the morbid subject. Some people involved in bioethics, of course, are physicians and nurses in wards like internal medicine and oncology, who have to deal daily with dying patients, and for whom the end-of-life is the most burning issue in bioethics, and justifiably so. But not everyone is an internist or an oncologist, and for the rest of us there is something sick about this overemphasis on dying.
"Bios" means life, and bioethics should be the ethics of life: What is life? What is the meaning of life? How can we live healthy lives? Indeed I believe that more emphasis on these questions may result in fewer request for euthanasia.
Discussions, for and against, euthanasia, advance directives, DNR, abortion, etc., belong not to bioethics but to Thanatoethics (from "Thanatos" = death). I think the Canadian and American "Hospital Bioethicists" who make their rounds advising doctors on letting people die, should really be called "Thanatoethicists". This Ethic of Death is important but should be put in its proper place and not allowed to monopolize our calling.
Incidentally I'm shocked that the son and the physician (in Dr. Cong Yali's article) were prosecuted and not the nurse. In Israel, nurses are proud, independent professionals who do not carry out doctor's orders unquestioningly. Indeed if the doctor gives the wrong order, either through negligence or in deliberate violation of law or ethics, the nurse must refuse the order (diplomatically if possible, of course). If the nurse carried out the order and the patient suffers or dies, both doctor and nurse will be prosecuted.