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Palliating Nihilism by Physician Aid-In-Dying

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Palliating Nihilism by Physician Aid-In-Dying Palliating Nihilism by Physician Aid-in-Dying: On Compassion, Autonomy, and the Question of Suicide Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Arts in the Graduate School of The Ohio State University By Ethan Schimmoeller, B.S. Graduate Program in Bioethics The Ohio State University 2020 Thesis Committee: Matthew Vest, Advisor Ryan Nash Dana Howard Copyright by Ethan Schimmoeller 2020 Abstract This thesis argues that the right to die should be understood as an attempt to palliate nihilism due to the encounter of an existentially impoverished ontology with death, informing clinical, ethical, and political accounts of physician aid-in-dying. Following Heidegger’s critique of technology, contemporary medicine espouses a Nietzschean metaphysic predicated upon reducing its objects into ‘standing reserves’ on call for efficient manipulation. Physicians become passive, anonymous technicians responding to technological frameworks, bodies become resources for maintenance and re-creation, and death appears an obstacle to overcome in this active nihilism. In this context, the birth of bioethics can be appreciated as a response to the hegemony of techno-logic at the end of life. I argue, however, that it has largely failed by capitulating to a similar procedural rationality, at best, and endorsing autonomy as a manifestation of the will to power at worst. After the death of God, ethics must be radically reframed as a human project resembling a cafeteria of lifestyle aesthetics where the moral good easily becomes free choice. The liberated, autonomous individual playing a leading role fits hand in glove with techno-logic. Thus, assisted suicide may appear as a personal ‘death-style’ for fashioning the illusion of meaning and transcendence by the will, particularly in the post-Christian, generic spirituality of hospice and palliative care. Patients with existential or spiritual suffering – lives not worth living – can be relieved of the human condition within liberal politics, signifying new, deceptive rites for the end of life, an ars ad mortem. At the end of the day, however, the choice for suicide is predestined by the techno-logic critiqued in this thesis, suggesting that it may not, in fact, be the triumph of autonomy but rather of a violent nihilism and despair. This critique, then, moves towards clarity in the right to die movement regarding its quasi-religious foundations, and seeks alternative, poetic ways of being in the world that can wed wisdom with medical arts and care for the dying. i Acknowledgments I am grateful to The Ohio State University Center for Bioethics and Medical Humanities, as a whole, and for the unique opportunities to engage the richness of biomedicine and beyond through this master’s program, including many classmate interlocutors. I could never have foreseen how much I would receive in the five years following that first undergraduate bioethics course offering. Gratitude is also due to the University of Cincinnati College of Medicine, especially the office of student affairs, for supporting my detour on the route through medical school. This project would have been unthinkable outside the bounds of patient care and clinical education introduced to me by many good physicians. To Ashley Fernandes, for his enthusiastic support over many years now to pursue medicine and bioethics. Encouragement at every step has been appreciated. To Ryan Nash, for personal and professional guidance on matters as diverse as specialty choice and what to do in San Antonio. To Matthew Vest, my advisor, for introducing me to Walker Percy, Gregory Palamas, and a whole world. This project would not have been possible without many reading recommendations, dedicated attention, and creative suggestions. To my parents, siblings, the Elsmere community, and many friends, for the sincere interest and support in bringing this project to completion amidst global shutdown for COVID-19. Also to Maria Lees for reviewing the document for errors. Finally, to my wife, Carol, for humoring me by posing tough questions at every turn of this project as in life. Gratia plena. ii Vita 2012 ............................................................................ Fort Jennings High School 2016 ............................................................................ B.S. Biomedical Science, The Ohio State University 2016 ............................................................................ Medical Student, The University of Cincinnati College of Medicine 2017 ............................................................................ Graduate Student, Center for Bioethics and Medical Humanities, The Ohio State University Publications Schimmoeller, Ethan. “Opioids, (Non)-Medical Marijuana, and the Cult of the Body.” Linacre Quarterly 86, no. 1 (Feb 2019):47-55. Schimmoeller, Ethan. “Hospice Care and the Denial of Death.” McGrath Church Life Journal, April 29, 2020. Accessible at: https://churchlifejournal.nd.edu/articles/hospice-care-and-the- denial-of-death/ Schimmoeller, Ethan. “On Martyrdom, Suicide, and Christian Bioethics.” Linacre Quarterly published online June 2020. Fields of Study Major Field: Bioethics iii Table of Contents ABSTRACT............................................................................................................................................ I ACKNOWLEDGMENTS ......................................................................................................................... II VITA .................................................................................................................................................. III TABLE OF CONTENTS .......................................................................................................................... IV 1. DOES ASSISTED SUICIDE IMPOSE ON US THE WAYS IT SHOULD BE USED? .......................................... 1 2. THE NIETZSCHEAN TECHNO-LOGIC OF MODERN MEDICINE ............................................................... 8 2.1. HEIDEGGER’S HISTORY OF BEING: FROM ANCIENT TECHNE AND PHYSIS TO MODERN SCIENTIFIC OBJECTIVITY .......... 10 2.2. THE QUESTION CONCERNING MEDICAL TECHNOLOGY .................................................................................... 16 2.3. NIHILISM, SUICIDE, AND THE CULMINATION OF METAPHYSICS ......................................................................... 19 2.4. TECHNO-MEDICINE ................................................................................................................................. 22 3. BIOETHICS BEYOND GOOD AND EVIL .............................................................................................. 27 3.1. CONSTRUCTING SECULAR BIOMEDICAL ETHICS .............................................................................................. 29 3.2. PATIENT RIGHTS AND THE END OF LIFE ........................................................................................................ 33 3.3. BIOETHICS IN THE RUINS ........................................................................................................................... 37 3.4. AFTER ENGELHARDT: FROM ETHICS TO LIFESTYLE AESTHETICS ......................................................................... 41 4. OVERCOMING DEATH, PALLIATING NIHILISM ................................................................................. 44 4.1. SPIRITS HAUNTING HOSPICE AND PALLIATIVE CARE ....................................................................................... 46 4.2. SUFFERING FROM EXISTENCE ..................................................................................................................... 50 4.3. CURING BEING, CAUSING DEATH: GERMANY’S TRIUMPH OF AUTONOMY .......................................................... 54 4.4. ARS AD MORTEM .................................................................................................................................... 58 5. TIMOTHY QUILL, META-PHYSICIAN ................................................................................................ 62 5.1. THE TRIUMPH OF NIHILISM ....................................................................................................................... 63 5.2. MEDICAL POETICS AND NOETICS ................................................................................................................ 67 BIBLIOGRAPHY.................................................................................................................................. 71 iv 1. Does Assisted Suicide Impose on Us the Ways it Should be Used? Death is an outrage. It is terrible that people who deeply love each other, who prop each other up, are suddenly parted. You spend a whole lifetime becoming two into one and then one half is taken away. It is an outrage that a young mother should leave her children, who perhaps are going to have real problems because they haven’t had her. It is an outrage that people should have pain and problems, in one sense. Anyone who works in our field and has no questions shouldn’t be there – Dame Cicely Saunders1 It is quite likely that more words have been written about death and dying in the last century than preceding ones. We should expect, then, to have a rich way of being mortal in the western world, honed and clarified through our discursive practices, as well as being enhanced with modern pharmacology and rational policies. Surely we appropriate death at least as well as our ancestors. Dan Callahan suggests otherwise.
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