Commentary on Aksoy: The Meaning of Life

- 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)
(Email: yeruham@bgumail.bgu.ac.il)

Eubios Journal of Asian and International Bioethics 7 (1997), 104-105.


Sahin Aksoy's article is important because the meaning of life is really the main issue in bioethics. I have been teaching my students for some time now that the four generally accepted principles of bioethics - "beneficence", "non-maleficence", "distributive justice" and "autonomy" - are totally irrelevant to action unless we have a prior understanding about the meaning of life. So there are five, not four, principles of bioethics and "the meaning of life" is a metaprinciple in terms of which the other four must be interpreted.

The meaning of life may be understood on these levels:

1. The meaning of my life in my own eyes

2. The meaning of my life in the eyes of other people

3. The meaning of my life with respect to things above such as God or angels or upper worlds if such things exist.

Existentialists only recognize the meaning of life on the first level because they think only the individual gives meaning to one's own life. Socialists only recognize the meaning of life on the second level because they see one as valuable only insofar as one contributes to society. Narrowly spiritual people recognize only the third level. But a truly comprehensive bioethics must investigate the meaning of life on at least all three levels.

The most important thing about the meaning of life is that we must be humble enough to admit that we probably don't know it. This is because, 1. I cannot know what lessons I shall learn in the future about the experiences I am undergoing now; 2. I cannot know much about the effects of my own actions upon how others understand their own lives; 3. transcendental matters can neither be proved nor disproved scientifically, so we must in our theorizing admit our ignorance of them. And even those of us who believe in God must admit that we know nothing of His thoughts.

The meaning of life must not be confused with quality of life. Quality of life is a quantifiable clinical concept. But it is obvious that one can have a high quality of life with little meaning. Or, conversely, one can have a terribly low quality of life while for the first time reflecting deeply and finding high meaning.

Aksoy mentions the "sanctity of life", but meaning of life is very different from sanctity of life. As friends in the Eubios family know, I try to draw heavily on Israeli tradition in bioethics. And many people think that sanctity of life is part of Judaism. But really I have never found mention of sanctity of life in any traditional Israeli source - Bible, Mishna, Talmud, Maimonides etc. Indeed, Israeli tradition has always recognized that there are fates worse than death. When King Shaul was losing the battle to the Philistines, and wounded by arrows, the Bible records: "Then Shaul said to his armour bearer: 'Draw your sword and pierce me though with it, lest these uncircumcised come and pierce me through and make sport of me'. But his armour bearer would not, for he was greatly afraid. So Shaul took his sword and fell on it" (I Shmuel XXXI,4).

Scholars with whom I have discussed this passage say that Shaul feared homosexual rape. And Israeli tradition also records suicide to avoid heterosexual rape. It is believed that during the time of the First Temple, the Israeli tribe of Dan migrated to Ethiopia. These "Beta Israel" established themselves and were strong until the Amhara King, Sarsa Dengel (1563 - 1597) defeated them in battle. Sarsa Dengel's chronicles, which were translated about one hundred years ago into Hebrew and French by Joseph Halevy, reported that the Amhara soldiers captured Israeli girls, each soldier tying the girl's wrist to his own wrist, and led them off to rape them. As they passed by the top of a high cliff, one Israeli girl shouted: "Hear O Israel the Lord is God the Lord is One" and leapt to her death taking the soldier with her. The other Israeli girls did the same, affirming that some things are holier than life itself.

Another example is the famous mass suicide in the year 3830 (70) at Masada, to avoid capture by the Romans and having to serve "strange masters". Whether one agrees with these suicides is another matter. It can be argued that Jewish law does not endorse them. But they represent a strong element in our tradition.

Active euthanasia is unacceptable in our tradition, not because it violates so-called "sanctity of life" but because it is murder. But Jewish Law under certain extreme circumstances allows refraining from treating a terminal patient or discontinuing treatment, including disconnecting a ventilator. And this is not just my own opinion (I am not a Rabbi myself.) but it is also the opinion of some distinguished rabbinical authorities and I have heard it expressed by the Chief Rabbi of Tel Aviv, Rabbi Halevy, although many disagree with him.

I am, however, unable to ignore a change going on in Israeli opinion in favour of active euthanasia. I conducted an impromptu survey, on the last day of class, of two groups of students in my Ethics elective course in our Masters in Medical Management programme. The students were mostly physicians, nurses and scientists. All the students knew the difference between active euthanasia and discontinuing or refraining from treatment of terminal patients. Almost all had seen the Dutch film "Death on Request". All had heard my arguments against active euthanasia. But when asked: "Are you in favour or against legislation to allow active euthanasia in Israel?" in one group 8 were in favour and 14 against. In the other group, 24 were in favour and 5 against. I suppose I can brag about not brainwashing my students, but this is hollow consolation. Of course the value of in class (and any) surveys can be questioned but it cannot be denied that Western influence is increasing in Israel.

The four "principles of bioethics" are irrelevant without prior discussion of meaning of life for the following reasons:

Beneficence and non-maleficence are inapplicable unless we know what is good and bad. If, as some existentialists think, life is absurd (as Lady Macbeth said, life is "a tale told by an idiot full of sound and fury signifying nothing") then nothing is left but hedonistic pursuit of pleasure and avoidance of pain. But if there is meaning in one's reflections on one's past, making sense of it, or in the effect of one's life on family members, or - if as is said both in mystical Judaism and in Hinduism - we are here to effect certain improvements in our souls, then perhaps a little more life might be worthwhile, even if in pain.

As for distributive justice, it must be based on a basic assumption of equality. One may choose to treat certain patients before others for medical reasons, such as in a multi-victim disaster where the principles of Pre Hospital Trauma Life Support require treating bleeding victims before those whose breathing and pulse have ceased because there is a greater chance of saving the former than the latter. But one must assume a basic equality and not treat one before the other just because the first is a great scientist and the second a petty thief. But, as I learned in a lecture which I heard by the Israeli philosopher Joseph ben Shlomo, no empirical or scientific investigation can show that people are equal. Empirical observation reveals only differences among people. Only transcendental considerations of our relationship to upper worlds can reveal basic equality of meaning of all our lives.

As for autonomy, much can be learned from the fact that we really cannot know the ultimate meaning of life. Autonomy is usually interpreted as the right to informed consent. And nowadays people appeal to autonomy to justify a supposed right to die. But there can be no informed consent to die. For in order to give informed consent to enter into a situation one must have some idea of what that situation is like. But no one knows what it is like to be dead. We haven't even the slightest statistical evidence of what it is like to be dead. Lacking transcendental knowledge of the meaning of life and of the absence of life, there can be no informed consent to die.

Some further points about Aksoy's paper: I think the flaw in the philosophies of Singer and Rachels, who have used Darwinism to oppose speciesism is that they fail to see that one can be a speciesist without thinking that one's species is better than other species, just as one can prefer one's family without thinking that one's family is better than others. Indeed , Darwinism requires that all creatures be speciesists because our species would not have survived unless we had an innate tendency to act in such a way as to ensure the reproduction and survival of our own kind. It follows that speciesism is a necessary consequence of Darwinism. A good Darwinist must recognize speciesism as written into the genes of every creature.

As for the difference between the living and the inanimate, I'm not sure there is a difference. The subatomic processes are the same in humans and rocks. And I don't think these subatomic processes are dead mechanical matter. They may be the spiritual "sparks" referred to in Kabala (Israeli mysticism) but I'm exploring this more deeply in a work to be published elsewhere on the Rights of Rocks.


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