Demanding Murder; Needing Heroes
Rome and New York are similar in many ways. World capitals of fashion, art, and culture, both cities have long been destinations for travelers from both sides of the Atlantic. Today, however, they have a more macabre commonality: they’re both stages for legal and judicial debates over the medicalization of death.
The New York Senate recently passed a bill awaiting the signature (or veto) of Governor Kathy Hochul. If (or rather, when) this bill is signed into law, New York will be the twelfth state to allow medical patients age eighteen and older to request a lethal prescription should they suffer from a “diagnosed incurable disease” that gives them less than six months to live. Besides the certification of two healthcare professionals, the presence of uninterested witnesses, and the retractability of the decision at any time, the bill does not require many conditions: no intolerable pain, no waiting period, no compulsory notification of the patient’s family members, and only a potential referral to a mental healthcare professional (if the attending physician deems the patient lacks the capacity to make an informed decision). The patient would self-administer the lethal drugs. The bill clearly states, however, that this process is not to be deemed a “suicide”: “Action taken in accordance with this article shall not be construed for any purpose to constitute suicide, assisted suicide, attempted suicide, promoting a suicide attempt, euthanasia, mercy killing, or homicide under the law, including as an accomplice or accessory or otherwise.”
Similarly, in 2019, the Italian Constitutional Court significantly reduced protections for vulnerable people, restricting the kinds of conduct that may still be labeled and punished as crimes of assisted suicide. Based on that decision, while assisted suicide is still criminalized, “materially assisting” a suicide is exempt from punishment when: a) the victim is “fully capable of making free and informed decisions,” b) she is “kept alive by life-support treatments,” c) she is “suffering from an incurable illness which is a source of physical or psychological sufferings that she considers intolerable,” and d) such assistance facilitates fulfilment of the victim’s “autonomous and freely formed intent to commit suicide.” When all these conditions are met, their subsistence verified by the national healthcare system, and provided that such assistance is performed in accordance with national regulations on informed consent and advance directives, the person aiding the suicide may not be punished.
As predicted, the Court was later asked to revisit its decision and to further liberalize the practice, which is otherwise still criminal, by exempting from punishment the aid offered to a larger variety of patients, who may not meet one or more of the above conditions. Most recently, the challenge claimed that the existing crime (or what remains of it) is unconstitutional to the extent that it (still) unjustly denies access to suicide for patients who are not dependent on life-sustaining treatment. In May, the Court dismissed that constitutional challenge. Two people, however, had already died. In Italy as in many other states, constitutional judgments are mostly “incidental”: only judges are entitled to ask the court to verify the constitutionality of a law and only when that specific law or provision is both pertinent and relevant to the case they are adjudicating. Hence, to challenge the constitutionality of a criminal law, someone needs to commit the crime and undergo criminal prosecution. The accused may then raise the question with the ordinary judge, hoping that he will agree with him and transmit it to the Constitutional Court.
This week, for the very first time, the same court was asked to evaluate the constitutionality of another crime, that of consensual murder—the equivalent of euthanasia. In this case, the patient who would like to be assisted in her suicide is unable to self-administer the lethal drug, but every other requirement for her suicide to be “legal” is met. In other words, the only thing stopping her from legally dying is that the machine that would allow her to activate her death has not been manufactured yet. The court’s decision is expected in a few weeks.
What Romans and New Yorkers are asking judges to evaluate is whether, to what extent, and under which circumstances our lives are worth living. But this is not the role of courts. It is up to each society to set the standards in these realms.
I am proud of the Italian Constitutional Court’s underlying reasoning in its latest decision, in particular:
Within a historical context characterized by tensions over the allocation of public resources, the so-called “right to die,” claimed in some circumstances, could paradoxically be perceived by the sick person as a “duty to die” so as not to “be a burden,” with a serious lowering of the collective moral sensibility that protects the most fragile, often, moreover, “invisible” people. Such a downhill change would collide head-on with the personalist principle that animates the Italian Constitution. On the contrary, from this principle derives the duty of the Republic to respond to the call of fragility, so that a sick person may feel solidarity around him or her not at intervals, not at prolonged intermittencies, but on an ongoing basis, along a path where the health and social system are effectively taking charge.
Recently, I spoke with one of the attorneys involved in these cases, Carmelo Leotta, a former colleague who is defending the lives and rights of the most vulnerable. With others, he first represented four citizens, all affected by irreversible diseases that cause them great pain and suffering but all opposed to the further liberalization of assisted suicide. None of these people are dependent on life-sustaining treatment, and they petitioned the court to deny exemption from criminal liability in cases like theirs. According to Leotta, “The patients that I had the honor of representing are not asking for less freedom, but for a different kind of freedom. They want to be helped and treated. Theirs too is a plea for freedom: but freedom from pain, from loneliness, and from therapeutic abandonment. They ask for a freedom that is not against life, but rather for the safeguard of the human person as a whole.”
In an interview, one of these patients manifested the desire for the court to clearly state that her life, no matter how sick she is or may become, is important to all. As she pointed out, while not everyone can heal, everyone can be treated.
No one, I would add, can prevent the disease of “life” from eventually killing us all. We are flying on an airplane that will eventually land. I can’t help but wonder if the reason why we do not want to talk about death, why we wish that doctors could choose for us when and how we should depart this earth, is that we forgot that we are flying somewhere; and that it is a unique flight, and a unique destination. No one can ever, or will ever, travel our same path. We cannot predict when and how ours will end. But there is a Pilot who knows what He is doing.
As my friends and colleagues know, I detest writing about these topics. My personal fear of hospitals and disease is intense. It always has been. Yet what I fear even more is a world that forgets how briefly we occupy it and how meaningful our everyday life is in light of that fact. If only we accepted death, truly accepted that we are not the pilots of our own planes, we might perhaps accept life’s challenges as Chesterton sometimes wished we did: as the adventures we read in a novel. The plot twists, the new crosses, the little nuisances of each day: they are not random injustices or accidents, but part of our personal novel, one where our goal is to be the hero of the story.
Just as society must identify and acknowledge the standards for human dignity, it must also define who our heroes are. For some, heroes are the activists who are fighting for our right to die. Some of these activists are even actively killing patients who claim to desire death. For me, heroes are those who stay. Among the ones I know, there is an esteemed friend who spent the past five years accompanying his dying wife to her final and most important day. I was moved to tears when he recently told me how he would read to her every day: he did not know whether she could understand him, but he knew that she liked his voice. In order to be with her, he gave up his whole way of life—his holidays, his friends’ gatherings, and even his work. Just to be with her. In doing so, he reminded me of what love looks like.
Love, first of all, acknowledges that “it is good that you exist”—no matter how—and acts to bring about the good of the other. This, my friend did. In his own life, he acted as the hero of his personal novel, embodying all the virtues that civilization had taught him. Generosity, self-sacrifice, patience, endurance, kindness: this is what an older American man, now in his sixties, was trained to consider heroic. This is no longer the case.
Something that the New York legislature fails to see, as does anyone who thinks that “freedom to choose” should apply to the moment and to the manner of our death, is that life in general is largely out of our control. As a spiritual mentor once reminded me (and keeps reminding me when I need it), one can only discern and choose her next step. That widower did not know the impact that his words would have on me, just as the son who makes coffee for his grandmother does not know when it will be the last time he does so. Every day, every exchange is a page of the book we are writing, one that will determine whether we get to be heroes or not. There is no dull moment, no useless cross, no meaningless chore.
I do not know what it is like to be bedridden for years. I hope I never will. I also wish I never knew what it meant to live through the disappointments, fears, abandonments, or heartbreaks I’ve already endured. But I am glad nobody suggested to me that those pains were too much to bear. That’s not something we should ever suggest to our suffering neighbors.
In the film Arrival, the protagonist learns a language that can travel through time, giving her glimpses of her own future. She thus gets to decide what the hero will do: embody a life of virtue while accepting life’s challenges or alter the story to better fit her desires. I liked what she did—she willingly embraced the future loss of both her daughter and husband to serve a greater purpose. The protagonist’s choice reminded me of the value of embracing suffering, even if we cannot see its fruits. And it reminded me, most importantly of all: the Pilot decides when to land.
Image licensed via Adobe Stock.