Your Rights, Whether You Want Them Or Not
Editorial
by Stanley Schmidt
"Human rights" is, of course, a tremendously important concept, and one of the foundation stones of what we think of as civilization. It's particularly fashionable right now: there have probably been few times in history when people did as much talking about their "rights" as they've been doing lately. Which is probably, on the whole, a good thing. Much of history has consisted of one group of people riding roughshod over what should have been considered rights of some other group, and anything that reduces that tendency is a step in a desirable direction.
The trouble is that "right" is also a slippery concept, hard to define precisely or to get people to agree on. As a result, the word often takes quite a beating. People pushing just about any cause have been known to appropriate it and twist it to describe anything other than what they want as an infringement of somebody's rights. Proponents of book banning or imposing moral criteria for artistic funding, for example, have been known to speak of people's right to be protected from offensive material. Militant feminists have sought to stamp out "exploitation" of women as housewives or Playboy centerfolds. Among other arguments advanced against allowing abortions, I have heard them characterized as "abuse of women."
Never mind that when someone wants an abortion it is usually the woman herself. Never mind that some women like being housewives or Playboy models. Never mind that some people want to read or view or listen to artistic work that others find offensive. Such facts are apparently irrelevant to those who use this kind of argument. They've made up their minds what's good for you, and by golly, they're going to see that your "right" to it is protected, no matter what you think you want!
Naive as I am, I find it blatantly self-contradictory to speak of protecting somebody's "right" to something that they quite plainly do not want by forcing them to accept it. A right that has to be shoved down somebody's throat is no right at all; to say that it is makes a mockery of the word and the concept. The only thing that could reasonably be called a right in my examples would be the right to decide for oneself whether one wants to read Huckleberry Finn, devote one's life to raising a family, or pose for Playboy (or Playgirl).
In other words, the fundamental right is the right to choose, in just about any case where there is not some overriding reason (such as consequent harm to another person) why choice should not be allowed. That is the fundamental concept of individual freedom: that every individual should, whenever possible, be free to make his or her own choices about how to live. (I don't think, by the way, that it has ever been a really popular concept, despite abundant lip service. Most people want freedom for themselves to do what they want, but balk at letting others do things that they don't like.)
There is one especially fundamental category of such choices that has been very much in the news, and in public and private debates over "rights," in recent years. That is the one that Hamlet summed up as "To be, or not to be. . . ." The question of not only how, but whether to live, is considerably less simple now than it was in Hamlet's day. He and his contemporaries could, under duress, consider stabbing or poisoning themselves; or they could do nothing and live until "natural causes" caught up with them. There was relatively little that medicine could do to delay that, when the time came for it to happen.
Now, however, there is a great deal that medicine can do to prolong life -- and a steadily growing controversy over whether it should always do so. If any exceptions are to be permitted, who decides what they are and when they are appropriate? Medicine is in what might be viewed as a transitional stage of development: good enough to keep many patients alive, by at least some measures, for many years; yet not good enough to make their lives the least bit rewarding by normal human standards.
More and more patients spend years or decades in deep, unchanging comas, getting nothing out of it themselves and draining the financial and emotional resources of their families. A growing number of people who have not reached that state have thought about what they would want to happen if they did, and decided that they would rather die completely than be artificially suspended in such a limbo and thereby do what that would do to their surviving families. Living wills and "right-to-die" societies grow steadily more popular. More and more court cases deal with when it is permissible to disconnect life support from comatose patients with negligible prospects for improvement. The Supreme Court, in the recent case of Nancy Cruzan (a young woman kept physically alive by an abdominal feeding tube since a car accident in 1983), cautiously recognized the right of a "competent person" to refuse unwanted medical treatment.
And some look on in horror that such "rights" are even considered, claiming that they are assaults on a "right" to Life No Matter What. No matter, for instance, whether the person involved wants that kind of life.
A particularly interesting case was that of Janet Elaine Adkins, who last June quietly "put herself to sleep" with the help of Michigan physician Jack Kevorkian's "suicide machine," a simple device which, under her control, injected her with an anesthetic followed by a lethal poison. Newspapers and magazines were full of the story, and I heard several people say, "Isn't it terrible?" or words to that effect.
To which I could only answer, "Well, I'm not so sure it is. . . ." Unlike Nancy Cruzan, who couldn't be asked, when the decision needed to be made, Mrs. Adkins was, by all reports, a very "competent person." She was intelligent, with wide-ranging interests and an abundant supply of joie de vivre -- and the early signs of what was diagnosed as Alzheimer's disease. She knew what she could expect of the future -- the slow, steady loss of all the things that had made her enjoy life so much -- and she consciously decided she did not want to go through that. She wanted to quit while she was ahead.
I don't think I would have made the same decision she did -- perhaps never, and certainly not that early. I think I would have clung, at least for a while, to the hope that the diagnosis was wrong, or that some unexpected breakthrough would make my deterioration reversible before it went too much farther.
But what I would have decided is completely irrelevant. It was not my life in the balance.
It was hers.
I understand and sympathize with the dread she felt, and I respect her decision to do something about it. But that's irrelevant, too.
Even if I did not sympathize or respect her judgment, the fact would remain that it was not my life (or yours, or anyone else's). It was hers, and hers alone.
Mrs. Adkins knew what she was doing, and it was nobody else's business. Her family had a legitimate interest, of course, but she worked things out with them. I find it very hard to support the claim that anybody else deserved any say in the matter. Yet thousands of outsiders were appalled and outraged that Dr. Kevorkian provided a way for Mrs. Adkins to get exactly what she wanted.
I haven't actually heard anybody say publicly and in so many words that Mrs. Adkins' "right to life" should have been forcibly protected, but her case is clearly in the same arena as the ongoing controversy over patients who aren't in a position to express their desires so unambiguously. I did see one particularly interesting comment by another doctor on Dr. Kevorkian's role in Mrs. Adkins' suicide, judging it unethical on the grounds that all doctors have taken the Hippocratic Oath, pledging, among other things, to "do no harm."
I submit that the Hippocratic Oath itself may be due for reexamination and possibly amendment. The idea is not as radical as it may sound. No one even knows whether Hippocrates was one person or several, and the oath bearing his/their name already exists in several forms. In practice, it has also already undergone several changes. Nobody seriously expects modern doctors, for example, to "swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and take to witness all the gods and all the goddesses," or to observe the ancient prohibition against performing lithotomies. Times change, and an oath formulated more than 2400 years ago just may not cover everything that it now needs to cover.
The basic idea of the oath -- solemnizing the principle that physicians have strong and special ethical obligations to their patients -- is one we still need. And I certainly have no quarrel with "do no harm" as its basic precept. After decades of looking, I know of no solider foundation on which to build a system of not only medical, but general ethics.
The difficulty in putting such a system into practice lies in defining exactly what is meant by "harm" -- and that is not only difficult in any time and place, but can change with circumstances.
The ethics of using water, for example, are very different in a desert and in a rain forest. The detailed ethics of medicine may be very different in societies which have or lack the ability to sustain life long beyond its natural tendency to stop.
The medical ethicist who thinks that Dr. Kevorkian's making a suicide machine available violates the Hippocratic prohibition on "doing harm" may have to look a little harder. I respectfully suggest that forcing someone to live a life she no longer enjoys or wants may be doing harm in a deeper and more serious sense, and that eventually medical ethics will have to catch up with medical technology in addressing such issues.
When you develop new abilities, you are inevitably faced with new choices about how best to use them. Refusing to make those choices -- simply clinging to old ones as if the new options did not exist -- amounts to refusing to accept the responsibility that comes with expanded power. Thinking through the ethics of a new situation cannot be expected to be easy -- but it has to be done.
And in doing that thinking, it would be well to remember that a "right" that has to be forced upon someone is a contradiction in terms.
