Commentary, March 1990.

Abstract:

Dedicated to the memory of my mother, Chana Kass (1903-1989), my first and best teacher regarding human dignity.

“Call no man happy until he is dead.” With these deliberately paradoxical words, the ancient Athenian sage Solon reminds the self-satisfied Croesus of the perils of fortune and the need to see the end of a life before pronouncing on its happiness. Even the richest man on earth has little control over his fate. The unpredictability of human life is an old story; many a once-flourishing life has ended in years of debility, dependence, and disgrace. But today, it seems, the problems of the ends of lives are more acute, a consequence, ironically, of successful—or partly successful—human efforts to do battle with fortune and, in particular, to roll back medically the causes of death. While many look forward to further triumphs in the war against mortality, others here and now want to exercise greater control over the end of life, by electing death to avoid the burdens of lingering on. The failures resulting from the fight against fate are to be resolved by taking fate still further into our own hands.

This is no joking matter. Nor are the questions it raises academic. The emerge, insistently and urgently, from poignant human situations, occurring daily in hospitals and nursing homes, as patients and families and physicians are compelled to decide matters of life and death, often in the face only of unattractive, even horrible, alternatives. Shall I allow the doctors to put a feeding tube into my eighty-five-year-old mother, who is unable to swallow as a result of a stroke? Now that it is inserted and she is not recovering, may I have it removed? When would it be right to remove a respirator, forgo renal dialysis, bypass life-saving surgery, or omit giving antibiotics for pneumonia? When in the course of my own progressive dementia will it be right for my children to put me into a home or for me to ask my doctor or my wife or my daughter for a lethal injection? When, if ever, should I as a physician or husband or son accede to—or be forgiven for acceding—to such a request?

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