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Isaac Stacey

Denise Goldman

Language Arts B2

December 17, 2018

The Effects of Euthanasia and Physician-Assisted

Suicide in Regard to the Value of Life

On February 25, 1990, Terri Schiavo, a 27 year-old woman, suffered a cardiac arrest

resulting from an eating disorder. Several months later, she was clinically stabilized into what

several doctors declared “a persistent vegetative state:” Computed tomography showed a lack of

cortical activity in her brain, and her daily life was lived in open-eyed unconsciousness, unaware

of herself and her surroundings (Weijer). Terri remained in this state for 15 years. Despite the

severity of her condition, however, Terri was not terminally ill. In 2005, her husband requested

the discontinuation of her food and water, but her family protested to such action and disputed

the diagnosis. After further examination from medical experts, claims arose that Terri was able to

respond to attempts to communicate (Pearcey 26). The dispute was elevated to several court

cases receiving heavy publicization, and after the intervention of the US Congress, Terri’s food

and water were cut off. Left to the slow, dying process of either starvation or dehydration, a form

of passive euthanasia, Terri passed away later in 2005 at the age of 41.

Though this dispute was portrayed by the media as a right-to-die case, this was not the

heart of the issue. Such a case would imply that the patient was either terminally ill, in serious

pain, or well on their way to death. Terri’s case does not fit into that criteria.

So what was this really about? If Terri was not already dying, what lead to the decision to

euthanize her? Essentially, the reasoning behind Terri’s euthanization lies in what is called
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Personhood Theory. Personhood theory, which most of secular society has adopted within the

past century, challenges modern endorsers by questioning their confidence in their own

personhood and of those around them (Pearcey 26). It is these practices, with regard to all forms

of physician-assisted suicide and euthanasia collectively, that have effectively changed how

secular society values human life and the definition of personhood.

The rising ethical debates revolving around the topic of euthanasia and physician-assisted

suicide were not always as prevalent as they are today. The attitudes of the Ancient Greeks for

the most part were consensually in favor of the concept; as the teachings of Plato suggest, under

certain circumstances, suicide is morally justified (Amundsen 5). Furthermore, within a hundred

years of Socrates’ death in 399 BC, the Stoics had enforced the perception that suicide was the

“most reasonable and desirable of all ways out” (Amundsen 4). This view also aligns with that of

Ancient Rome; suicide was not viewed fearfully and was a well considered escape in the midst

of certain unfavorable circumstances (i.e. sickness, weariness of life, fear of dishonor). If one’s

decision to end their life was rational, then their choice was not punishable. Among these two

societies, the Pythagoreans were the only minority group who expressed an explicitly different

opinion on the subject (Amundsen 5). Their beliefs stood in opposition to voluntary death as life

was highly valued and considered sacred (Papadimitriou).

Modern Christian ethic agrees with the distaste expressed by the Pythagorean school of

philosophers, but these teachings are not the exact doctrine of early Christianity. No trace or

obvious mention of the immorality of suicide is specifically included in the Old or New

Testament; although, some interpret that the commandment “thou shall not kill” addresses this

issue. However, further debate arises from this proposition (Amundsen 7). Instead, patient

suicide, euthanasia, and physician-assisted suicide (PAS) are never mentioned in ancient,
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patristic medical texts due to the consistent stress of faithful endurance in the midst of suffering.

The concept was purely alien to them; even in the hardest of circumstances, the presumption of

the sovereignty of God still remained (Amundsen 26). The historical distaste for PAS, suicide,

and euthanasia that we see expressed by the modern Christian community is in part derived from

Augustine’s assertive denunciation of suicide as a sin and its rising relevance beginning in the

20th century (Amundsen 7).

This tolerance of suicide and euthanasia/PAS, shown by some early mindsets, did not

concern personhood, however. These practices were considered more as an acknowledgment of

individual autonomy, a value that is not lost overtime and is still expressed by modern advocates

for euthanasia and PAS (Barone).

Even among the tolerant, however, suicide and PAS were not widely popular practices

during the time of historical philosophers such as Plato and Socrates (Frey). The earliest methods

of suicide were most often either violent, painful, barbaric, and/or uncertain. Some common

forms included the killing of infants with serious, permanent birth defects; the voluntary

starvation of the elderly; and the mercy-killing of fellow soldiers in combat, who were either

dying or too seriously injured to be assisted (Frey). Scientific and medical advances in the 19th

century, like the discovery and invention of reliable painkillers, anesthetics, and analgesics,

brought changes to both the methods and attitudes toward euthanasia and PAS (Frey).

Leading up to the 21st century, moral acceptance of euthanasia and PAS began to spread

across the US. Mindsets began to change with further technological advances and inventions

including respirators, intravenous feeding, and dialysis machines. These advances made it

possible to further prolong the life of a dying patient, which in turn dramatically increased the

elderly population and the average human lifespan throughout the 20th century (Frey).
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Social changes within the US began to occur as well; a greater universal value of

independency, individual freedom, materialism, and autonomy progressively eroded previous

emphasis on familial and community membership (Frey). This contributed to the transition of

mindsets towards euthanasia and PAS, and supporters gained greater power with the founding of

the Euthanasia Society of America, which was established in 1938 and still exists today (its name

was changed to its current title in the mid 1970’s: Society for the Right to Die). Once rapid,

painless solutions like opioids and barbiturates were introduced, people showed less revulsion

towards the idea of physician-assisted suicide. Consequently, euthanasia and PAS began to

receive much greater consideration among those suffering either mentally or physically,

especially the terminally ill (Frey).

A major catalyst for the shift in secular mindsets was the publishing of Charles Darwin’s

theory of evolution in 1859. This caused a wide adoption of materialistic mindsets by secular

society and a major conversion from previous religious world-views (Pearcey 23). However, the

concept of life evolving randomly from the process of natural selection in a material machine,

purposeless and with zero intention, brought forth serious considerations: “For if nature was not

the handiwork of God––if it no longer bore signs of God’s good purposes––then it no longer

provided a basis for moral truths” (Pearcey 24). The reality of a morally neutral universe that

could no longer bear a reflection of God’s will left humans with the opportunity to impose their

own will. This materialistic approach to reality allowed secular society to perceive the world as a

“realm of value-neutral facts” (Pearcey 24). Nancy R. Pearcey, a professor and scholar at

Houston Baptist University, and critically acclaimed author, claims that the modern,

individualistic value of autonomy seen in today’s society is derivative of the movements

developed by Darwin’s theory.

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These conditions consequently laid way to the birth of three, crucial ideologies that have

monopolistically swayed the mindsets of modern, secular culture. The first of which, dualism,

comes from the logical processes set into motion by the Darwinistic ripple effect which naturally

led a change in how humans began to perceive themselves in relation to nature: “Because the

human body is part of nature, it too is demoted to the level of an amoral mechanism, subject to

the will of the autonomous body” (Pearcey 24). This implication caused a separation between

mind and body that is still very present today. This is where the term dualism originated: the

theory that reality consists of two substances instead of one (Pearcey 20). Dualism proposes the

coexistence, or dichotomy, of a human’s material, mechanic body and their morally conscious,

autonomous mind. Interestingly, dualism is not exclusive to the secular world-view. Christianity

and Judaism both exhibit their own forms of dualism, however, in their two-piece reality, there is

no dichotomy between body and person; instead, “the two form an integrated psycho-physical

unity” (Pearcey 23). Reciprocally, the dualism presented in secular ideologies often portrays the

autonomous mind working against its material body to impose its own will upon its physical self

(Pearcey 21).

This dualistic separation of mind and body leads to further theological implications in the

second of these three ideologies. Secular society makes a distinction between these two

“substances” and places greater significance upon the mind as what gives us personhood

(Pearcey 24). Personhood is what exercises autonomy and control over the material body, which,

as asserted by materialism, is merely matter. This elevation of mind over body suggests that it is

not the material, human body that gives personhood, but the ability to exercise conscious,

deliberate control over our lives (Pearcey 85). So, the human body is no longer what gives legal

and moral standing, it is our autonomy.

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The third of this ideological trio that aids in the understanding of personhood is called the

Two-Story concept (Pearcey 18). This concept is a visualization, subconsciously or consciously,

used by those holding materialistic and/or secular world-views to portray personhood as a two-

story process, one that includes an upper and lower story. Personhood, our ability to have

autonomy and conscious control over our lives, is the upper story. It has the greatest significance

in relation to the lower story, which is our human body: a part of nature and therefore disposable

as a natural resource (Pearcey 24). Traditionally, “human being” has been assumed to have the

same meaning as “person.” However, a distinction was made by the US Supreme Court in the

1973 Roe v. Wade abortion decision, “which ruled that even though the baby in the womb is

human, it is not a person under the fourteenth amendment” (Pearcey 19). This suggests that in

the womb (or out, perhaps during birth or sometime later), some change happens psychologically

and/or physiologically where the infant changes from just a human (lower story) to a person

(upper story). However, there is no scientific evidence proving the existence of such drastic,

physical development, naming this “promotion” purely theoretical and neither scientific nor

empirical (Pearcey 25).

Personhood theory and the two-story concept present even further implications so serious

that they affect every single human being on a personal level. The declaration of personhood

theory implies that personhood is something that is gained, or even earned. How does one

qualify for personhood? Pearcey proposes that with the acception of personhood theory and the

two-story concept, personhood is most commonly perceived to be gained with the ability to

make decisions, exercise self-awareness, and plan for the future (27). But perhaps this criteria

isn’t universal. In society, couldn’t whoever is in power describe these sets of qualifications

themselves? We’ve seen it happen before: the Holocaust, 20th century eugenics in America,
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race-based slavery. This also raises the question that if personhood is something to be gained, is

it something that can be lost? Looking back at Pearcey’s default criteria, she states it certainly

can: “According to personhood theory, if you are mentally disabled, if you no longer have an

arbitrarily prescribed level of neocortical functioning, then you are no longer a person––even

though you are still obviously human” (26). This suggests that there is the possibility of human

non-persons.

The idea that human membership does not guarantee personhood is one that is well

embraced within today’s circle of modern bioethicists. In a televised debate in March of 2005,

Wesley Smith of the Discovery Institute inquired of Bill Allen, a bioethicist from the University

of Florida, whether he thought Terri Schiavo was, in fact, a person. “‘No, I do not,’ the

bioethicist replied. ‘I think having awareness is an essential criterion of personhood’” (Smith).

Allen’s statement is just one realization of personhood theory in the real world. Bioethicists like

Daniel Callahan assert that once a patient has lost “the capacity to reason, to have emotions, and

to enter into relationships,” they cannot “be called a ‘person’ any longer…It is a mere body”

(Pearcey 86). Peter Singer, another bioethicist, distinguishes membership of the human race from

personhood saying that “it is personhood, not species membership, that is most significant in

determining when it is wrong to end a life” (Pearcey 86). Modern bioethicist and philosopher

Tom Beauchamp goes even further, writing that once these human non-persons “lack properties

of personhood or are less than full persons… they must be aggressively used as human research

subjects or sources of organs” (Pearcey 87). The implications of personhood theory are

embodied in statements like these. Ultimately, personhood theory allows for one’s personhood to

be trimmed from the bookends of their life. Expendability, or disposability, becomes a reality for

those potentially threatened by these claims (Pearcey 85).

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The concept of human non-persons and indefinite personhood is not compatible with the

values of mainstream Christianity and Judaism. These religious communities lay heavy stress on

the assertion that, even from the very beginning, it is God himself “fashioning” and “knitting

together” the infant in the mother’s womb, and that every human being is made in God’s image

(The Holy Bible, English Standard Version, Gen. 1.27, Plm. 139.13-14). Likewise, it is almost

universally accepted in those communities that human life begins at conception. Virtually all

bioethicists, even those holding secular world-views, agree with this statement as well, mainly

due to recent advances in empirical science. However, they tend to disagree with the second

assertion: With human life, undoubtedly, comes personhood (Pearcey 25). These religious

communities believe that it is impossible to be a human being yet not a person. They also reject

both the two-story structure and secular society’s materialistic portrayal of the body; their

version of dualism gives the mind (sometimes described as the “soul”) and body equal

significance, though they are separate: “Body and soul form an integrated unity––that the human

being is an embodied soul” (Pearcey 21). These worldviews conclude that personhood is

something that cannot be obtained, nor can it be lost; it is inextricably bound to the condition of

human life.

Adversely, with the acceptance of personhood theory, members of modern, secular

society have effectively engraved the concept of conditional personhood into their own minds,

elevating their fear of being stripped of autonomy and ultimately losing personhood (Pearcey

91). A study orchestrated in 2014 examining the paperwork and death certificates of patients

who sought lethal treatment provides proof of this fear. Results showed the number one reason

for dying given by the patients who were polled as “losing autonomy (91%).” Next on the list

were “less able to engage in activities (89%)...loss of dignity (81%)... [and] loss of bodily
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functions (50%)” (Barone). Emily Barone, an author at Time Magazine, confirms the

implications of these statistics and addresses the infectious fear behind them: “Most people seek

a lethal prescription because they worry about becoming a burden or losing autonomy––not

because they are experiencing pain from illness or because they can’t afford treatment.” Another

study from the state of Oregon posed a similar inquiry to physicians, who described the number

one reason for requests for a lethal prescription as “severe discomfort other than pain (78%)”

(Meier).

This fear of losing autonomy, and essentially personhood, is the foundation of advocates’

arguments for euthanasia and physician-assisted suicide. Advocates claim that death-with-dignity

laws allow patients, who may already be terminally ill, “to die on their own terms” (Barone).

They argue that “aid in dying provides patients with autonomy” (Barone). This mindset makes

the decision of death one of a struggle for control rather than a struggle for life. Even for those

who are not physically ill, but still feel as though they have lost control over their lives, death has

become their one last hope for autonomy, for personhood.

Personhood theory places incredible value on the ability to have control over one’s life,

but once someone feels as though they have lost that control, they, along with other adopters of

this mindset, begin to perceive their life as worthless, or even disposable (Pearcey 91). They are

perceived as falling from the upper story to the lower story. Once they have fallen to the lower

story, materialism demotes their value to mere matter. As matter, they are not unlike the rest of

the material world. Therefore, with the acception of personhood theory, it is suggested that the

rest of society is free to use them the same as they would any other natural resource.

Personhood, a concept now redefined with the recent prevalence of physician-assisted

suicide and euthanasia, has a personal effect on every human being in existence. Consequently,
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because membership of the human race and the condition of personhood have recently been

distinguished from one another, secular society is presented with a serious question: Who are

people? While religious groups such as mainstream Christianity and Judaism answer this

question by clinging to more idealistic approaches to the value of human life, secular society is

left with a decision to make in regard to PAS and euthanasia. It is not simple by any means; for

some, it is hard to accept the heavy ethical baggage that guaranteed, unquestionable personhood

carries with it, though the other extremity of disposable humans and conditional personhood is

equally as repulsive. Unfortunately, for those pondering this ethical enigma, unless one shares a

set of moral truths held by either extremity of stances, there are no definite solutions nor

compromises that cover all cases. This subject of discussion is one that effectively surfaces the

moral relativity within ourselves, and one that often causes us to question how we value those

around us: Who are people? Our answer to this question can mean the difference between the

preservation or termination of any patient’s personhood, and ultimately, their life.

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Works Cited

Amundsen, Darrel W. “Part I: The Significance of Inaccurate History in Legal Considerations.”

Physician-Assisted Suicide, edited by Robert F. Weir, Indiana University Press, 1997, pp.

3–32.

Barone, Emily. “See Which States Allow Assisted Suicide.” Time, November 3, 2014,

http://time.com/3551560/brittany-maynard-right-to-die-laws/. Accessed 15 Dec. 2018.

Frey, Rebecca J., PhD, and Amy Hackney Blackwell. "Euthanasia." The Gale Encyclopedia of

Nursing and Allied Health, edited by Jacqueline L. Longe, 4th ed., vol. 3, Gale, 2018, pp.

1378-1380. Health & Wellness Resource Center, link-galegroup-

com.ezproxy.hclib.org/apps/doc/CX3662600428/HWRC?u=hennepin&sid=HWRC&xid

=2e6e153b. Accessed 15 Dec. 2018.

Meier, Diane E, et al. “A National Survey of Physician-Assisted Suicide and Euthanasia in the

United States | NEJM.” New England Journal of Medicine, 23 Apr. 1998,

www.nejm.org/doi/full/10.1056/NEJM199804233381706.

Papadimitriou, J. D, et al. “Euthanasia and Suicide in Antiquity: Viewpoint of the Dramatists and

Philosophers.” Journal of the Royal Society of Medicine, vol. 100, no. 1, 2007, pp. 25–

28., doi:10.1258/jrsm.100.1.25.

Pearcey, Nancy R. Love Thy Body: Answering Hard Questions about Life and Sexuality. Baker

Book House, 2019.

Smith, Wesley J. “Personhood Theory: Why Contemporary Mainstream Bioethics Is

Dangerous.” National Review, National Review, 18 Sept. 2012,

www.nationalreview.com/human-exceptionalism/personhood-theory-why-contemporary-

mainstream-bioethics-dangerous-wesley/. Accessed 15 Dec. 2018.

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The Holy Bible. English Standard Version. ESV Text Edition ed. (2016), Crossway Bibles, 2001.

Weijer, Charles. “A death in the family: reflections on the Terri Schiavo case” CMAJ : Canadian

Medical Association journal = journal de l'Association medicale canadienne vol. 172,9

(2005): 1197-8, www.ncbi.nlm.nih.gov/pmc/articles/PMC557072/. Accessed 15 Dec.

2018.