ENSOULMENT / DE-SOULMENT

When is it that I—my body and its various components, that is—stop being me? Or put another way, at what point do I experience de-soulment? Actually, there's no such word, but I didn’t make it up from the whole cloth. Ensoulment—usually spelled without a hyphen—can readily be found in the dictionary. It’s an ecclesi- astical term that describes the entering of the soul into the body, the soul in this view being sent from God as the defining human characteristic, the essence of what makes me, me, and you, you.
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Ensoulment is also a very un-favorite term as far as the Right to Life Movement is concerned, because over the centuries religious authorities have placed ensoulment at a range of times during pregnancy. These have included quickening (e.g. when the baby is felt to move independently of the mother) to more arbitrary markers such as one hundred days of gestation, or as late as partition (e.g. birth). Only rarely has the moment of conception been hypothesized as the moment of ensoulment, which means that the very early stage fetus would be only proto-human, and not yet a fully human entity.
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Renowned thinkers such as St. Augustine and St. Thomas Aquinas have weighed in on this question without reaching back as far as conception. Also, among bio-ethicists a leading idea has been that the emergence of consciousness might represent a science-based moment of ensoulment, although mention of the soul as such doesn’t figure in.
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But the emergence of consciousness can’t be detected all that precisely, so a working proxy is brain-stem life, which is detectable. The Right to Life Movement hates this line of reasoning too, because ninety to one hundred days gestation is about when brain-stem life can be verified. For purposes of this blog, let’s simply note that the first trimester standard for legal abortion in the US, which has been law for close to half a century now, is right in the mainstream of this thinking, then move on to my real topic, de-soulment.
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What I'm suggesting is that a symmetry exists at the end and the beginning of life. In the concept of ensoulment we have a proto-human cellular entity being animated with a soul at some later time and thereby becoming fully human. Similarly, at death, typically defined as brain-stem death for clinical purposes, one’s residually human and still cellularly alive organs can be harvested for medical use in some other person. So de-soulment would coincide with death, though in some religious traditions this is thought to happen just prior to death, with the soul hovering nearby in a bardo state until the body expires.
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True, neither the soul nor its apocryphal 21 gram (0.75 oz.) weight have any basis in science. With no religious connotation intended, I employ it here purely as shorthand for the ultimate essence of a living human. Yet my symmetry idea will nonetheless draw howls of protest. How could anyone equate a developing, first-trimester fetus, which is day-by-day becoming a human being, with harvested organs that will never develop into anything beyond what they already are?
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Simple. Cloning. Legality aside, with massive medical inter- vention, it would apparently be possible to use harvested tissue to create a whole new me. It’s freakish, and I'm doubious that such a clone, even with a complete transfer of brain content, could conceivably be me. Or not on the soul level posited above. But who can say? It would clearly be very me-like. And in terms of massive medical intervention, how different is this from the extremely exotic petri dish it would take to grow an early stage fetus into a baby were its mother to die while pregnant?
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So I do see a symmetry. We are brought into the world by acts on the part of our biological parents: acts of love, or of lust, or of simple heedlessness. And also by the act of our mother’s not ending her pregnancy, which women who don’t want a child have done in various ways throughout human history. Then, becoming somewhere along the line fully human, we are born, and until the age of our legal majority, our families function as regents, with a legal duty to nurture and safeguard us.
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After that, we are each in the driver’s seat, and have broad legal control over our destinies. Except at the very end. Brought into the world by the acts of others, sometimes taken from it by the acts of others who do us harm, and reliant on others when we become frail or infirm, it is nonetheless illegal to receive help in ensuring that we die a dignified death. Well, in Oregon we can, but nowhere else in the US right now. Instead, if desperate enough, we must turn our hands against ourselves with whatever weapon we can manage.
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And finally, following death, no matter how it has come, is the stage of de-soulment, during which our tissues and organs remain sufficiently alive to be put to other uses, assuming we’ve so authorized under the laws of our state. As actual human beings, though, we would by then be gone.

KNOW THINE OPPONENT

On the political right there’s a popular saying that "A conserva- tive is just a liberal who’s been mugged," and in some cases it’s probably true. Also true is that Death With Dignity (DWD) advo- cates, whatever their prior view of the subject, have often had exposure to tending a loved one through a lingering and intrac- tably pain-ridden departure from life.

DWD’s staunchest opponents, for the most part, are those lucky enough not to have witnessed such a thing and who don’t them- selves suffer from ALS, bone cancer or similar conditions likely to leave them in an uncomfortable, hopeless and helpless state for a prolonged period. In a culture so assiduously death-denying as ours, few, especially from the younger, healthier cohorts, give any thought to what could befall them as their lives end. It’s just not the sort of thing you want to dwell on. Besides, the kinds of truly bad deaths I refer to are a small minority among the many thousands of deaths that occur on any given day.

At the opposite end of the spectrum, deaths which might be cal- led good—i.e. peaceful, relatively expeditious and with family and friends having a chance to say goodbye—are rare as well. The great majority of deaths are merely deaths, no better or worse than the norm. Ah, you say, "’Twas ever such." But actually, it wasn’t. Modern medicine not only works cures and promotes recoveries that previous generations couldn’t have imagined, it can and does greatly extend the lives of hopeless cases where quality of life isn’t meaningfully taken into account. And one of those cases might be you.

Yet who’s to decide if or when enough is enough? That, pure and simple, is the crux of the DWD issue. My answer is the ill person him- or herself; never the government, never insurance compan- ies or healthcare providers, and never family members unless expressly designated by the ill person to make that decision. I see it as one of the absolute rights of person-hood, which medical practitioners should be as bound to follow as they are other direct instructions from a mentally competent patient.

DWD opponents, meanwhile, believe the decision is solely God’s, or in the case of nonbelievers, that it’s best left to chance. After all, miraculous recoveries have been known to occur. Nor do I doubt the sincerity of people holding that view. I accept that many of them fully intend to, and do, endure as a matter of faith or principle, whatever suffering may come their way. It’s a brave choice, and not easy to carry out, though it barely qualifies as choice, since the alternative possibilities—jumping off the hos- pital roof if you’re ambulatory or securing assistance if you’re not—are either heavily stigmatized or legally foreclosed.

Another popular saying, "God never gives you more than you can stand," sums up that view. My problem is in finding that view, when it is forced on others as a matter of law, to be immoral, and on the very basis it stakes for itself—the sanctity of human life. If there is sanctity to human life, and I believe there is, then respec- ting the wishes of the person whose life is involved follows from that sanctity.

Placing a higher value on human life in the abstract than one does on individual instances of it seems a very odd business. More- over, the notion that God never gives you more than you can stand is palpably untrue. What is death but God’s having finally given a particular human entity more than it can stand?

In addition, DWD opponents argue that the imperfections of hu- man nature mean no safeguards can ever be devised that will prevent government agencies, insurance companies, healthcare providers and unauthorized family members from seizing the opportunity and putting terminally ill and mentally or physically handicapped people to death. However, the Oregon record over ten years of DWD shows no such occurrences nor have any, to my knowledge, been documented in other countries with DWD laws. In fact, opponents who make this slippery-slope argument often contradict themselves by supporting the death penalty, despite its enabling statutes having been devised by imperfect human beings and despite its proven risks of executing innocent persons.

So what we have in regard to DWD is essentially a religious dis- pute, although anti side has so far been more successful in legislating and enforcing its view through government inter- vention. The same, of course, can be said of the pro side on legalized abortion, though I support that, because it expands individual autonomy in deciding whether or not to have a child without compelling any particular decision. Nonetheless, it’s a tougher call. While a fetus gestated less than 100 days can’t exist in any real way separate from the mother, it is still a human entity. Even so, within that timeframe I’m willing to weigh the mother’s autonomy, privacy and dignity as superior to the fetus’s not- withstanding that the fetus itself isn’t requesting abortion or giving informed consent.

While the two issues are frequently equated, DWD is altogether different. The human entity making the request and giving con- sent is the human entity whose life is offered up. What is free will, be it derived from God or not, if it doesn’t include the moral right to end one’s life or order it ended? But that’s not how things are in the US of A, or not yet.

Still, I understand why many people regard DWD as immoral and respect them for that. It’s a principled view. But like me, they’ve chosen to live in, and support with their patriotism, a country that has a bedrock constitutional prohibition against established religion. Where we part ways is that they want our government to behave as though it does have such a religion and I don’t. Under our system, blanket limits on individual choice in an area as fundamental as determining the circumstances of one’s last days aren’t properly a government matter.

But trying to put yourself in the other guy’s shoes usually helps in any disagreement. Let’s hope everybody now knows everybody else a little better.

LIFE AND DEATH IN THE GREAT NORTHWEST - PART II

Picking up where my last post (Life and Death in the Great Northwest – Part I) left off, Montana’s foray into Death With Dignity isn’t via legislation, as in Oregon and Washington, but via a court case known as Baxter et al v. Montana, filed in October 2007. In it, two severely ill men claim a right under the Montana constitution to physician assistance in ending their lives when their situations become unbearable.

Robert Baxter, 75, has advanced leukemia, and Steven Stoelb, 53, suffers from Ehlers-Danlos Syndrome. The kicker is the Montana constitution. In 1972 the state adopted a new document con- taining express guarantees of privacy, and in a second pro- vision, dignity. Wow! Anyone putting a high stake on personal autonomy has to love that. Also, since privacy and dignity are fundamental to the view that individuals should be able to end their own lives on their own terms, it’s readily believable that Baxter and Stoelb could win. Even so, judicial outcomes are tough to predict and groundbreaking outcomes harder yet. The Cali- fornia Supreme Court’s recent decision finding a constitutional right to gay marriage—i.e. no compelling state interest to forbid it—caught almost everyone by surprise.

So, what would a Death With Dignity court victory in Montana mean? The Montana legislature could pass a law, presumably like Oregon’s, regulating how that right should be exercised. In the interim, or if political opposition prevented the passage of a regulating statute, Montana physicians would seemingly be free to prescribe life-ending medications without fear of prosecution if, in their medical judgement, the patient’s request was war- ranted. Similarly, family members would likely be free to witness or perhaps even hand the lethal dose to a willing but enfeebled person.

One nearly certain result would be fierce backlash from religious conservatives, who would try by initiative to delete the operative sections from Montana’s constitution. Otherwise, broad latitude for pregnant women in that state to choose abortion would seem to follow the same logic as a right to Death With Dignity. But the fact that those two sections were included to begin with is evi- dence of how libertarian Montana is, so predicting the success or failure of such an initiative is a roll of the dice. It makes one wonder, however, about the wording that might be in the con- stitutions of two other famously libertarian places, Idaho and Alaska.

That question I’ll research for a future blog. Still, Idaho, which constitutes a buffer zone of sorts between Oregon/Washington and Montana, may be less ripe a field for Death With Dignity. Religious conservatives wield greater power there, reinforced by a fairly large Mormon population in the south along the Utah border. And Utah, well forget it.

Early this decade, when the issue was being debated and defeated at the Federal level, Utah Senator Orin Hatch said such a law was simply unnecessary. "We already have the Second Amendment. Anyone who’s that concerned about ending their life can just buy a gun." Which suggests that a Death With Dignity program in Utah or Idaho might consist of a voucher to pay someone to save your family from having to clean up your house after you’d done the deed. Or would that be deemed a needless state expense?

LIFE AND DEATH IN THE GREAT NORTHWEST - PART I

Since Oregon has always been a socially pioneering sort of place, we can’t be surprised that the Portland metro area is the nation’s most successful example of containing sprawl by setting and sticking to an urban growth boundary. Or that, in an effort to boost turnout and reduce costs, Oregon is unique among the fifty states in holding all statewide elections entirely by mail-in ballot.

More notoriously, of course, Oregon is also unique in having passed, and after many subsequent challenges, having retained on its books for over ten years now a straightforward Death With Dignity law. As ultimately upheld by the US Supreme Court, terminally ill Oregonians, subject to specific conditions and safeguards, have the right to physician assistance in dying. Once those conditions and safeguards are met, the assistance takes the form of a physician prescribing a lethal dose of an approved drug, which the patient then ingests, or not, at a time and place of their own choosing, according to the directions provided. The physi- cian is not expected to be in attendance, nor are physicians re- quired to offer this assistance if they have a moral objection.

After a decade of experience, fewer than 350 persons (1/10 of 1% of all Oregon deaths) have availed themselves of that option, although another 200 have received the prescribed drug and chosen, for whatever reason, not to proceed. Forty individual physicians have participated. No coercion toward a hastened death from family members or the government is permitted, and to my knowledge there have been no documented cases of abuse. What is known, however, is that terminally ill patients who have gotten the drug, whether they use it or not, report a having a greater sense of control over their destiny and feeling more peace of mind in facing the continued deterioration of their health.

This is old news, you say, so why do I belabor it? Two reasons. First, the November 2008 election in Washington, Oregon’s neighbor to the north, will put before voters an initiative statute, I-1000, closely modeled on the Oregon law. If current polls can be believed, it will pass, and the campaign in favor is being led by a popular former governor, Booth Gardner, who is visibly af- flicted with Parkinson’s Disease. Besides, Washington, though not as socially pioneering as Oregon, is itself a fairly independent-minded place.

There is opposition, as one would expect. As in Oregon, religious conservatives, especially the Catholic Church, can’t find enough ways to condemn the idea. Virtually all religions seek control over the births, marriages and deaths of their parishioners, the reasons for which are obvious. And since church affiliation in the US is freely chosen, no harm done. It's a voluntary compact. Whether government should intrude itself to insist that death occur in a way that ignores the wishes of the dying person and ignores the contributions modern medicine can make to that event is another question. Where, for instance, is the compelling state interest? I am fascinated to see what the Washington voters have to say about it. Church groups, meanwhile, are pumping millions into ads urging No on I-1000.

But perhaps the most interesting new development along these lines is occurring in Montana, a famously libertarian state that is separated from Washington to the east by only a thin neck of Idaho. We’ll discuss both Idaho and Montana in my next post.

FULL DISCLOSURE - I GUESS I'M A PRAGMATIST ON TOP OF IT ALL

To kick things off, I ought to state my biases, at least those rele- vant to hosting this site. I’ll admit, for instance, to being very much a libertarian on social issues, and a bit more reluctantly,
to being a pragmatist as well.

It’s a combination that probably implies a third label too, moral relativist, though I won't cop to that one full bore. Not only are there some things I believe to be absolutely wrong, they will no doubt enter the discussion here on occasion. I just don’t plan to go into them now. Rather, let’s spend a little time on pragmatism.

Inasmuch as humans openly and without a second thought intervene under any number of circumstances to terminate the lives of other creatures we share this planet with, and inasmuch as there have always been grounds—war, self-defense, crimes of passion, and mental incapacity of the perpetrator, to name a few—that are deemed to jusify terminating the lives of even our fellow humans, I thought I’d hatched out a set of very comfortable and, more to the point, consistent positions on the four current biggies regarding sanctity of life.

Even as a church-going church member, I'm fine with stem cell re- search using freely donated embryos, as I am with freely chosen abortions being legal during the first trimester of a pregnancy and legal after that if the life or health of the mother are seriously at risk. I wholeheartedly endorse the idea that persons at the end of life should have a physician’s aid in dying if they wish it, and for many years supported capital punishment for those found guilty of murder.

You can see, then, why I lay claim to social libertarianism, the principle that government should butt out of all such areas unless a compelling state interest can be demonstrated. Still, careful readers will note that my support for capital punishment is in the past tense. That’s because I no longer do, even though I accept that the state has a compelling interest in preventing people from murdering one another; which is where pragmatism sneaks in and consistency goes out the window.

With the advent of DNA evidence having recently invalidated so many murder convictions, with the science on eye-witness testimony consistently showing how unreliable it is, and with the deterrent effects of state-sanctioned executions only vaguely ascertainable, I can’t justify the irreversible step of putting some- one to death as compared to imprisonment for life. Nor am I sure which punishment is worst. I can easily imagine preferring the Big Sleep to waking up behind bars day after day, year after year. So yeah, pragmatism. There it is.

But the purpose of this site is to focus on end of life (EOL) issues. There are already plenty of blogs discussing embryonic stem cells, abortion and capital punishment, and those subjects get tons of coverage in the mainstream media. Frankly, I’m much more interested in the EOL stuff, such as the value of privacy and dignity, who one’s life really belongs to, whether there’s a so-called slippery slope aspect to laws like Oregon’s, how we recon- cile conflicts between the quality of life and the duration of life, and the evolution of law and public opinion on all these matters.

So that’s what you can expect in the weeks and months ahead. Thanks for tuning in, and for commenting if you’re inclined to. Just keep it respectful, and to the greatest extent possible, based on verifiable facts.