Always to Care, Never to Kill:

The following declaration was produced by the Ramsey Colloquium of the Institute on Religion and Public Life in New York City. The Colloquium is a group of Jewish and Christian theologians, ethicists, philosophers, and scholars that meets periodically to consider questions of ethics, religion, and public life. It is named after Paul Ramsey (1913–1988), the distinguished Methodist ethicist, who was a pioneer in the field of contemporary medical studies. An abbreviated version of the declaration appeared in the Wall Street Journal of November 27, 1991.

We are grateful that the citizens of Washington State have turned back a measure that would have extended the permission to kill, but we know that this is not the end of the matter. The American people must now prepare themselves to meet similar proposals for legally sanctioned euthanasia. Toward that end we offer this explanation of why euthanasia is contrary to our faith as Jews and Christians, is based upon a grave moral error, does violence to our political tradition, and undermines the integrity of the medical profession.

In relating to the sick, the suffering, the incompetent, the disabled, and the dying, we must learn again the wisdom that teaches us always to care, never to kill. Although it may sometimes appear to be an act of compassion, killing is never a means of caring.

The well-organized campaign for legalized euthanasia cruelly exploits the fear of suffering and the frustration felt when we cannot restore to health those whom we love. Such fear and frustration is genuine and deeply felt, especially with respect to the aging. But to deal with suffering by eliminating those who suffer is an evasion of moral duty and a great wrong.

Deeply embedded in our moral and medical traditions is the distinction between allowing to die, on the one hand, and killing, on the other. That distinction is now under attack and must be defended with all the force available to us. It is permitted to refuse or withhold medical treatment in accepting death while we continue to care for the dying. It is never permitted, it is always prohibited, to take any action that is aimed at the death of ourselves or others.

Medical treatments can be refused or withheld if they are either useless or excessively burdensome. No one should be subjected to useless treatment; no one need accept any and all lifesaving treatments, no matter how burdensome. In making such decisions, the judgment is about the worth of treatments, not about the worth of lives. When we ask whether a treatment is useless, the question is: “Will this treatment be useful for this patient, will it benefit the life he or she has?” When we ask whether a treatment is burdensome, the question is: “Is this treatment excessively burdensome to the life of this patient?” The question is not whether this life is useless or burdensome. Our decisions, whether for or against a specific treatment, are to be always in the service of life. We can and should allow the dying to die; we must never intend the death of the living. We may reject a treatment; we must never reject a life.

Once we cross the boundary between killing and allowing to die, there will be no turning back. Current proposals would legalize euthanasia only for the terminally ill. But the logic of the argument—and its practical consequences—will inevitably push us further. Arguments for euthanasia usually appeal to our supposed right of self-determination and to the desirability of relieving suffering. If a right to euthanasia is grounded in self-determination, it cannot reasonably be limited to the terminally ill. If people have a right to die, why must they wait until they are actually dying before they are permitted to exercise that right? Similarly, if the warrant for euthanasia is to relieve suffering, why should we be able to relieve the suffering only of those who are self-determining and competent to give their consent? Why not euthanasia for the suffering who can no longer speak for themselves? To ask such questions is to expose the logical incoherence and the fragile arbitrariness of suggested “limits” in proposals for legalized euthanasia.

We must not delude ourselves. Euthanasia is an extension of the license to kill. Once we have transgressed and blurred the line between killing and allowing to die, it will be exceedingly difficult-in logic, law, and practice-to effectively limit the license to kill. Once the judgment is not about the worth of specific treatments but about the worth of specific lives, our nursing homes and other institutions will present us with countless candidates for elimination who would “be better off dead.”

In the face of such mortal danger, we would direct public attention to four interwoven sources of wisdom in our cultural heritage that can teach us again always to care, never to kill.

Religious Wisdom

As Christians and Jews, we have learned to think of human life—our own and that of others—as both gift and trust. We have been entrusted to one another and are to care for one another. We have not been authorized to make comparative judgments about the worth of lives or to cut short the years that God gives to us or others. We are to relieve suffering when we can, and to bear with those who suffer, helping them to bear their suffering, when we cannot. We are never to “solve” the problem of suffering by eliminating those who suffer. Euthanasia, once established as an option, will inevitably tempt us to abandon those who suffer. This is especially the case when we permit ourselves to be persuaded that their lives are a burden to us or to them. The biblical tradition compels us to seek and exercise better ways to care. We may think that we care when we kill, but killing is never caring. Whatever good intentions we might invoke to excuse it, killing is the rejection of God’s command to care and of his help in caring.

Moral Wisdom

We may possess many good things in life. Although we benefit from such goods, they do not constitute our very being. We can, if we wish, renounce such goods or give them into the control of another. Life, however, is not simply a “good” that we possess. We are living beings. Our life is our person. To treat our life as a “thing” that we can authorize another to terminate is profoundly dehumanizing. Euthanasia, even when requested by the competent, can never be a humanitarian act, for it attacks the distinctiveness and limitations of being human. Persons—ourselves and others—are not things to be discarded when they are no longer deemed useful.

We can give our life for another, but we cannot give ultimate authority over our life to another. The painfully learned moral wisdom of our heritage is that persons cannot “own” persons. The decision for euthanasia is not an exercise of human freedom but the abandonment of human freedom. To attempt to turn one’s life into an object that is at the final disposition of another is to become less than human, while it places the other in a position of being more than human—a lord of life and death, a possessor of the personhood of others.

Human community and the entirety of civilization is premised upon a relationship of moral claims and duties between persons. Personhood has no meaning apart from life. If life is a thing that can be renounced or taken at will, the moral structure of human community, understood as a community of persons, is shattered. Whatever the intentions of their proponents, proposals for legalizing euthanasia must be seen not as a solution to discrete problems but as an assault upon the fundamental ideas undergirding the possibility of moral order. The alternative to that moral order is the lethal disorder of a brave new world in which killing is defined as caring, life is viewed as the enemy, and death is counted as a benefit to be bestowed.

Political Wisdom

We hold these truths,” the founders of our political community declared, and among the truths that our community has held is that the right to life is “unalienable.” All human beings have an equal right to life bestowed by “Nature and Nature’s God.” Government is to recognize and respect that right; it does not bestow that right.

This unalienable right places a clear limit on the power of the state. Except when government exercises its duty to protect citizens against force and injustice, or when it punishes evildoers, it may not presume for itself an authority over human life. To claim that—apart from these exceptions—the state may authorize the killing even of consenting persons is to give state authority an ultimacy it has never had in our political tradition. Again, legalized euthanasia is an unprecedented extension of the license to kill. In the name of individual rights it undercuts the foundation of individual rights. An unalienable right cannot be alienated, it cannot be given away. Our political tradition has wisely recognized that government cannot authorize the alienation of a right it did not first bestow.

Institutional Wisdom

Legalized euthanasia would inevitably require the complicity of physicians. Members of the healing profession are asked to blur or erase the distinction between healing and killing. In our tradition, medical caregivers have understood this to be their calling: to cure when possible, to care always, never to kill. Legalized euthanasia would require a sweeping transformation of the meaning of medicine.

In a time when the medical profession is subjected to increasing criticism, when many people feel vulnerable before medical technology and practice, it would be foolhardy for our society to authorize physicians to kill. Euthanasia is not the way to respond to legitimate fears about medical technology and practice. It is unconscionable that the proponents of euthanasia exploit such fears. Such fears can be met and overcome by strongly reaffirming the distinction between killing and allowing to die—by making clear that useless and excessively burdensome treatment can be refused, while at the same time leaving no doubt that this society will neither authorize physicians to kill nor look the other way if they do.

Conclusion

This fourfold wisdom can be rejected only at our moral peril. By attending to these sources of wisdom, we can find our way back to a firmer understanding of the limits of human responsibility, and of the imperative to embrace compassionately those who suffer from illness and the fears associated with the end of life. Guided by this wisdom, we will not presume to eliminate a fellow human being, nor need we fear being abandoned in our suffering. The compact of rights, duties, and mutual trust that makes human community possible depends upon our continuing adherence to the precept, Always to care, never to kill.

Hadley Arkes, Amherst College
Matthew Berke, First Things
Midge Decter, Institute on Religion and Public Life
Rabbi Marc Gellman, Hebrew Union College
Robert George, Princeton University
Pastor Paul Hinlicky, Lutheran Forum
Russell Hittinger, Catholic University of America
The Rev. Robert Jenson, St. Olaf College
Gilbert Meilaender, Oberlin College
Father Richard John Neuhaus, Institute on Religion and Public Life
Rabbi David Novak, University of Virginia
James Nuechterlein, First Things
Max Stackhouse, Andover Newton Theological School