October 1, 2003
Stuntman and hype-artist, David Blaine, has just completed a forty-four day starve-a-thon hanging from a crane in a little box above the River Thames, depriving himself of food and drinking only water for almost fifty days. It was a stunt. An act of sorts. A way for his publicist to sell more books and tickets to his next show.
But what if he had died? What if instead of climbing out of his suspended cubicle to the applause of his fans, he accidentally starved himself to death? Some might have said “serves him right,” or “what an idiot.” But others among us would wonder whether such a reckless stunt resulting in a tragic death was morally acceptable. Was such self-destructive behavior really to be condoned and applauded?
Unlike David Blaine, Terri Schiavo was on day six of her own starve-a-thon until the Florida legislature urgently intervened yesterday, but hers was not an act. It wasn’t a publicity stunt either, or even a hunger strike endured for some good and noble cause. Terri Schiavo, as you have undoubtedly heard by now, is a brain-damaged woman that was denied food and water for the past six days because her husband has convinced the Florida courts that daily sustenance is a life-prolonging measure that Terri never wanted.
Oddly enough, many Americans along with Terri’s family did not say “serves her right.” Only a few bioethicists and Terri’s husband have said that.
Bioethics is the study of moral issues in the fields of medical treatment and research. There are many professional fields that deal with medical ethical issues, including medicine, nursing, law, sociology, philosophy, and theology. Although today’s medical ethics is recognized as its own discipline, bioethics traces its roots to several early codes of ethics such as the ancient Greek Hippocratic Oath, which required physicians above all to “do no harm”; and includes the first code of ethics established in 1846 by the founders of the American Medical Association; and also reflects the Nuremberg Code for research on human subjects that was established during the war crime trials at the close of World War II. Modern medical and reproductive technologies represent some of the most interesting challenges for bioethics and public policy.
But lost in the labyrinth of Florida’s legal proceedings and shrouded by the emotion of a bitter family feud is the very basic question of whether it is morally acceptable for a woman to starve herself to death. This is certainly the question we would ask if she was a street magician, or even a death row inmate. And in all likelihood the majority of us would answer no. No, we would say, it is not ethically permissible to starve yourself to death.
Then again, the majority of us are not practicing bioethicists who have rationalized this scenario and have determined that under these sorts of circumstances a David Blaine or a Terri Schiavo really ought to be allowed to die from malnutrition. How is it that my colleagues have gotten so far away from this consensus? Well, they say, because if you really want to die this way, who are we to stop you? This is then reported as the dominant view and foisted on an unwilling public in the name of science.
But if my colleagues in bioethics will return to first principles, I believe we can return to the former consensus that reflects and reinforces centuries of knowledge and understanding. Society should be allowed to stop people who wish to die. Society stops people from inflicting all kinds of harms upon themselves, whether they like it or not. It steps in during moments of self-doubt and prevents individuals from fulfilling their self-destructive desires.
Even if Terri Schiavo could speak today and tell us to turn off her tap water and walk away, we would be morally compelled to ignore her, much as we would ignore an old man’s plea to be lowered into the Niagara River above the falls to go for a swim. We are not obliged to honor such requests.
That is unless we are a strained segment of bioethicists who reject centuries of societal rules and decorum, or husbands tired of caring for our bed-ridden wives, or doctors who extinguish suffering by extinguishing the sufferers. These folks are fond of pointing out that a thorough cost-benefit analysis shows that people in Terri’s condition are really better off dead. It’s better for Terri, they say, because her life isn’t really much of life and so it’s not really worth living; not to mention, it’s an affront to her “human dignity.” And it’s better for the rest of us, too, because the cost of caring for her is really quite high. After all, Terri’s doctors and family will have to keep monitoring her, changing her undergarments, washing her face, and holding her hand; and Terri’s husband won’t be able to marry his live-in girlfriend, because he is already married to Terri. Furthermore, goes the logic, what benefit can come to a woman who more than likely lacks any meaningful consciousness and will never appreciate the sacrifices of her doting family? In cases like these, they say, we should grant the wish to die.
And so unless we challenge this developing consensus, we will find that the only difference between Terri Schiavo and David Blaine is that Terri Schiavo is a burden and David Blaine is not. Were both to profess an interest in actually starving themselves to death, we would save Mr. Blaine from himself and his publicist and let Mrs. Schiavo go. It is this distinction that should really bother us. If bioethics is to serve humanity it is this concern that it should address.
The idea that once a fellow human being becomes too burdensome to bear we can morally honor their most self-destructive tendencies is anathema to an ethic that values the sanctity of human life and actively seeks to preserve it. And it fails to understand infirmity as a significant part of human life that can have meaning or purpose in and of itself.
Finally, it is worth remembering that cutting off Terri’s food and water is not just an extension of her personal autonomy or her private choice. Rather, it demands our participation, making it a communal act requiring society at-large to approve of her self-abandonment. And those who would see her starve have said, “we support her self-destruction so much that we’ll do it for her.”
Perhaps the most urgent ethical, legal and social issue we face with cases like Terry Schiavo is the challenge of weighing norms of valuing personal autonomy against the costs of taking humans into a realm of self-engineering that vastly exceeds any prior social experiments. If we don’t recognize the challenge and choose to develop new rules that reinforce and complement a medical ethics consensus that values life over burdens, there will soon be many among us like Terri Schiavo, balancing high above the crowds, performing feats of death defying courage, with nothing to catch them if they fall.
Nathaniel Stewart is an adjunct fellow at the John M. Ashbrook Center for Public Affairs, and a contributor to several articles in the forthcoming Encyclopedia of Bioethics, 3d edition.