FALL 2019 FEATURE ARTICLE chausa.org/hceusa Ars Moriendi and Society Ars Moriendi and Society Nathaniel Blanton Hibner, Ph.D. As states continue to pass legislation legalizing of these bills argue for and that have resonated physician-assisted suicide (PAS), it becomes in our society. ever more pressing to get to the heart of what is driving this movement. We have seen in A major critique of this autonomy approach surveys from the early adopter states some of emerges when outsiders question whether the main reasons the terminally ill seek out PAS in fact promotes these desired outcomes. PAS prescriptions. This is included in a variety Cathleen Kaveny’s use of political philosopher of publications and will not be examined in Joseph Raz’s version of autonomy calls into depth in this paper. I wish to focus on three question the desired effect of these laws. She underlying forces that unfortunately fuel rightly picks up the cry of most PAS supporters society’s drive towards the suicide solution. that these laws provide more autonomy for the Then I will examine our faith community’s terminally ill. However, she shows the ways response, seeking out areas for further that death with dignity legislation actually development. I hope that this article will decreases a person’s autonomy. The inclusion continue the conversation regarding the ways of PAS as part and parcel of patient treatment the church and its members can assist those choice could lead to the underdevelopment who are near the end of the earthly journey. of other treatments, especially palliative care or hospice services: “The change in law might AUTONOMY abate the urgency of providing other forms of 2 Autonomy in our society usually upholds one’s end-of-life assistance.” It also inherently places independence and freedom to choose. We see a value judgment on those who choose to die this understanding being used by politicians naturally, or in this debate, “without dignity.” and media activists who promote PAS All of this could lead a person to choose death legislation. An editorial by the New York Times prematurely, therefore, undermining the state’s in September 2015 urged Governor Brown interest in protecting the vulnerable from to sign the California End of Life Option coercion or manipulation. With autonomy Act. In this article, the editorial board praised as a rallying cry for pro-PAS activists, it is the ability of taking “control of the timing mandatory that any plan of action to counter of [one’s] death.” This line sounds familiar PAS legislation address this concern. to the mission of the pro-PAS organization Compassion and Choices, which seeks to THE FAMILY “increase patient control” and “access to all end- Autonomy and family go hand in hand in of-life options.”1 Control and access, power this debate. David McCarthy speaks about and options — these are the values promoters the economic forces affecting the modern 15 Copyright © 2019 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. FALL 2019 FEATURE ARTICLE chausa.org/hceusa Ars Moriendi and Society family and the way in which society puts a resources in the community as a whole; for high value on the independence of the family individuals, it can also be exacerbated by unit: “Rather than household management communal expectation that the welfare of one or filial duties, modern families have political should give way to the needs of the family.”5 This and market relations at their center.”3 The communal expectation is similar to the personal wage earner is the spokesperson for the family autonomy situation, where the need to ask for since it is this individual who is the provider. help, even from one’s family, is seen as a loss of The economic character of the family defines independence — loss that is undesirable. its relationship to society. Therefore, a family that does not seek welfare assistance and can CHRISTIAN DUTY TOWARDS BURDEN contribute to the market is valued and upheld The Catholic tradition has tended to place as an exemplary model. McCarthy even dives a high value on bearing suffering for others. into the current family structure to show that The obvious example is that of Christ who, children must also have a level of independence, according to some Christologies, took upon learning “the standards of conduct,” and himself the sins of the world. In one way, contributing to the betterment of the family 4 Jesus’ example can be viewed as a person itself. who conscientiously chose to suffer rather than take the “easy” way out. However, in a These observations on the family reveal another more inherent way, Jesus reveals the model layer of unconscious support for PAS at the end of alleviating others’ pain through personal of life. Terminally ill patients already fear being suffering, through personal choice. By a burden to their family. However, families extension, it is possible that dying patients themselves may desire to avoid being a burden could then find value in making the decision to society, and therefore, decide to keep the to end their lives deliberately, as if this would situation internal. I believe that this could lead eliminate the burden on their family members. them to find solutions that would require the “I will choose when to end my life, so my family least assistance from the greater community, does not have to.” avoiding costly alternative options. Asking for financial support for hospice or long-term We can see this idea borne out in Catholic palliative care would reveal a weakness in the writings on motherhood and the expectations autonomous and independent family unit of a dutiful wife. JoAnne Marie Terrell, for valued in contemporary society. instance, writes a chapter titled, “Our Mothers’ Gardens.” In it she describes the way that Lisa Cahill recognizes this dilemma as a failure certain Christologies have sadly fueled the of social justice for all, which especially affects continued oppression of black women in poor communities. She observes: “The health America. She concludes her reflections on the care situation for disadvantaged populations power of this tradition by relaying the story of is worsened by poverty and constraints on her mother: 16 Copyright © 2019 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. FALL 2019 FEATURE ARTICLE chausa.org/hceusa Ars Moriendi and Society Although I may never be required to give up my life for the sake of my ultimate Cardinal Bernardin chose to claims, the peculiar efficacy of my see his death as another leg of mother’s sacrifice as well as the Christian story prevent me from discarding the the trip, extending “beyond idea altogether, particularly the notion of mortal existence to eternal sacrifice as the surrender or destruction of something prized or desirable for the sake of life.” something with a higher claim …6 This pairing of the two “arts” stems from the These models of virtue indirectly promote teaching of virtue ethics. Virtue ethics promotes the idea that women in particular ought to the idea that all actions have a shaping effect on sacrifice their own bodies and dreams for the the actor’s character. Therefore, virtuous actions betterment of the family. Could then the create a virtuous person, sinful actions create a church’s upholding of such behavior promote sinful person. To become a virtuous person “it the ultimate sacrifice of a terminally ill patient is necessary to engage consciously in practices for the sake of their family? Could these that concretize the good in order to … move Christian models actually increase Christian oneself closer to embracing the good life.”8 willingness to actively embrace and pursue a Vogt and the tradition understand that to help kind of martyrdom? people face death they must have the virtues of hope, compassion, and patience.9 These SOLUTIONS three virtues provide the individual the proper Ars Moriendi inherent disposition to see death not as mere Many theologians draw upon the tradition of suffering, but as a part of our Christian journey. ars moriendi to address the social promotion of It is a personal development that hopefully will PAS legislation. One such author is Christopher reap rewards at the end of our days. Vogt, who devotes an entire book to the subject. In it, Vogt highlights certain virtues in the Cathleen Kaveny offers a similar solution. She tradition that one must develop in their lives draws upon an exemplar of a good Christian in order to face death in a correctly Christian death — Cardinal Joseph Bernardin — to way. He sees a strong connection between ars reveal to the world the power of faith and an moriendi (the art of dying) and ars vivendi alternate approach to death. Using his last book, (the art of living). Vogt writes, “It is by a The Gifts of Peace, in which the Cardinal reflects lifelong effort to nurture faith, hope, patience, on his diagnosis, treatment, remission, and then compassion, and all the virtues of the good the return of cancer, Kaveny wants to show a Christian life that we best prepare ourselves for truly Christian manner of dying. She argues the time of dying.”7 that Cardinal Bernardin’s example can serve as a “framework [that] can facilitate the exercise of 17 Copyright © 2019 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. FALL 2019 FEATURE ARTICLE chausa.org/hceusa Ars Moriendi and Society Razian autonomy on the part of dying patients, and solidarity on the part of those surrounding them.”10 Cardinal Bernardin chose to see his Personal fortitude at death death as another leg of the trip, extending can only lead us so far.