Euthanasia and complacency in bioethics: an

approach based on suicide.

Jos Migul Srrano Ruiz-Caldro n.

Univrsidad Complutns d Madrid.

In th tratmnt accordd to uthanasia in our tims, whthr as an

inalinabl right of an indpndnt modrn subjct or, in a pculiar
paradox, as a right that cannot b dnid to a subjct who is no longr
indpndnt and that may b xrcisd prcisly du to th subjcts loss
of indpndnc, two opposing discourss hav gnrally arisn.

Th first has focusd on individual indpndnc, assimilating uthanasia

to a form of suicid philosophically dfind as th act charactristic of
such indpndnc, and which constituts its principal contnt; it has
bn dfind as th right to a dignifid dath. This right was cratd on
th basis of th uthanasia movmnt whn th ugnics movmnt of
th 1920s and 1930s lost its pr-minnc. In Hoch and Bindings work,
for xampl, as many pags wr dvotd to ugnics as to xtolling dying
with dignity.1 This nw right divrgs, in a sns, from th pr-minnt
position of suicid in postmodrnity. Hr, thn, suicid dos not rstor
dignity in th classical sns that a good dath justifis an ntir lif, but
rathr appars as th nd to an unjustifid lif. In th nihilistic approach,
and dspit Cioran2 affirming with a crtain irony that non commit
suicid mor frquntly than lapsd optimists, suicid appars as a form
of invitabl dstiny, a way in which on xrciss a frdom without
maning, an xit. Th Columbian thinkr Nicola s Go mz Da vila 3 rmarkd
with havy sarcasm that h did not bliv in th honsty of a gnuinly
modrn (on may rad postmodrn) man who had not committd suicid.

In opposition to this claimd right to a dignifid dath, rathr than to a

nihilistic suicid, thr is gnrally a rligious argumnt, with all th
ngativ connotations that rligious limits fac in our ag, charactrisd
by so-calld bars to furthr inquiry. This argumnt is always
constructd as clarly prjudicial, a limiting, irrational prjudic that
concals som will to dominat or som atavistic unrasonablnss. It is
clar that prjudic has a poor rputation in our ra, in contrast to th
archaic aphorism th sam author mntiond abov: prjudics protct
us from idiotic idas. To b clar, I do not sk to ntr hr into a
dfnc of prjudic, but instad to obsrv crtain of its social functions.

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Howvr, attntion is not always paid to th fact that so-calld prjudic is
not ncssarily rligious in th sns that it ncssarily dpnds on th
prohibition upon taking a lif that blongs to a jalous God-Fathr. On th
contrary, prjudic appars in th varid dfinitions of th ordr, as
Voglin might say, with gratly varid justifications. Crtainly, Plato and
Socrats analys th inability to dispos of ons own lif on th basis that
it dos not blong to us. But w may insist that this lack of full ownrship
has a multitud of xplanations. W might argu that th prjudic is
sufficintly intrrligious that w could glan from it an ssntially
gnralizd social conditioning opposing th fr limination of ons
own lif whn it is so dsird or whn on simply fars an ill. In principl,
disposing of ons own lif has suffrd from a ngativ rputation and
has givn ris to mistrust, as is amply shown by th rligious rituals that
aggravatd th tratmnt dispnsd to thos committing violnc upon
thmslvs in comparison with thos committing violnc against othrs.
On this point, burial rituals hav bn particularly rigorous. But it is no
surpris to obsrv that social conditioning also rigns in crating an
obligation in th opposit sns, in rclaiming suicid as a mandatory act,
that is, whn custom indicats that in crtain cass what th subjct will
b bound to do is prcisly to kill thmslvs, or at last that th
prfrrd social modl is that of on who commits suicid, or if on
prfrs, that th act of suicid is undrstood, praisd and laudd.

Th scond discours would oppos uthanasia. It is th approach I hav

supportd in th works I hav publishd on th issu, including in
Euthanasia and dependent life.4 This discours includs thos of us who
prfr to analys uthanasia from th prspctiv of a transitiv act (that
is, an act that on dos not prform upon onslf but rathr that on
subjct prforms upon anothr), carrid out by a doctor, by way of which
a particular socity dms it appropriat to kill patints with crtain
charactristics, among which th subjcts will to di is of cours
somtims highlightd, with th subjct rciving dath as a bnfit.
Along ths lins, w hav oftn rfrrd to what John Kown and Etinn
Montro hav calld th logical slippry slop or, if on prfrs, to th
dfining fatur of uthanasia bing th objctiv conditions upon which
it dpnds, rathr than voluntarinss.5

Without altring th position adoptd in my prvious writing on th

mattr, I bliv that in th study, mor than in th dbat on uthanasia,
in ordr to b honst w must transcnd ths camps and sk to
undrstand th rasons and, in no fw instancs, th masks that xplain
th various attituds. First, w ar awar that our opinions do not

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ncssarily intrst anybody. It is also doubtful that th dbat as it xists
today in acadmia would b particularly ffctiv in building social
majoritis. For majoritis, th rationality of argumnts is oftn irrlvant,
bound as thy ar to crtain idological prjudics. Put diffrntly,
rcognizing that th illusion of having a dcisiv influnc through
acadmic dbat is vain may rsult in avoiding its gratst risk; that is,
falling into apologtics.

Howvr, this obsrvation should not lad us to passivity in th sns of

rnouncing th prsonal lucidity arising out of a tast for larning. In this
rgard, th not that I prsnt today is abov all an attmpt at clarifying
th link btwn suicid and uthanasia, a link of social and normativ
transcndnc, in which I naturally bliv that suicid has a social aspct
gnrally ignord by thos who mak th lap from an ssntially
prsonal xplanation that is, suicid as invitabl consqunc of slf-
dtrmination to th appraisal of suicid as xplicabl on a mdical
basis.

Today I shall commnc from prmiss that diffr somwhat from th

grounds on which uthanasia has bn approachd on prvious
occasions. First of all, without dismissing th pathological natur of a high
numbr of suicids, I hav my doubts that this kind of approach to dath
by ons own hand may not b a fundamntally idological xampl of
what has bn calld th mdicalization of suicid. It is th cas that a fw
short yars ago, in th Spanish Snats Committ on Euthanasia, th
argumnt was mad that 95 pr cnt of suicids wr du to pathological
causs. Yt this dscription is too dpndnt on th tndncy to trat both
attmptd and succssful suicids in a psychiatric fashion. In dscribing
dath by ons own hand in this way, as a symptom of a pathology, it
would appar that w ar constantly participating in a kind of bgging th
qustion, in stablishing th link that dfins th approach to this act in
th twntith and twnty-first cnturis. Howvr, it is not difficult to
obsrv that classical suicid, habitually dscribd from a cultural or
humanist standpoint, has probably bn bhind and formd th basis of
argumnts rgarding dignifid dath through uthanasia in contmporary
socitis that ar at last as idological as th psychiatric approach that
w hav criticizd. Not all suicids will b nihilistic such as that of th
daughtr of th Russian official who commits suicid in Paris as dscribd
by Dostoyvsky, or th countrpoint of th hoplss adolscnt who kills
hrslf in Saint Ptrsburg, prgnant, clutching an icon, but nor, of cours,
do thy appar significant or particularly dscriptiv of th rality of
attmpts, succssful or othrwis, to imitat th dath of Socrats. 6

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Scond, I find growing difficultis in th truism rgarding th anti-natural
charactr of suicid from a natural law prspctiv. In a crtain sns,
wishing for dath appars to b a vry common fact in humans, which
must of cours ovrcom crtain instinctiv rsistanc. This rsistanc,
howvr, can b qulld: not only by panic, a circumstanc shard with
animals, but also by th impact of th imagination. Th powr of th
imagind or suffrd ill, its immdiat prsnc in human natur,
provids a highly dirct xplanation of th dath wish and th dcision to
bring dath upon onslf. But for prcisly this rason, thr appars to
b a crtain frivolity in th naturalization of suicid or in its convrsion
into a mor or lss normalizd act. It cannot b forgottn that in many of
our countris, suicid is th commonst form of violnt dath, xcding,
for xampl, traffic accidnts, and with th not inconsidrabl pculiarity
that suicid is probably th form of violnt dath that is most hiddn, to
countr th ffcts of contagion and du to its social stigma. Nor can w
disrgard its irrvrsibl charactr. I admit that all acts ar in som sns
irrvrsibl, it not bing possibl for us to prvnt thir having appard
in th world through mr dsir. But th irrvrsibility of dath, xcpt
in th cas of xtraordinary rsurrction, has a radical quality for us.

I wish to stat that analysing uthanasia as a drivativ of suicid dos

not mrly rquir a focus on th most obvious diffrncs, th first bing
that in uthanasia th subjct would lack full autonomy to rqust
assistanc in th form of dath or would rciv it as a mdical act, an
aspct w hav idntifid on othr occasions. Rathr, w must considr
two dfining lmnts. On is th constant prsnc of suicid as a
tmptation for th human subjct. This has appard across all storis
sinc Antiquity, but has bcom a ky topic in modrn and postmodrn
litratur. Th othr is th social natur of suicid, vn whn sking to
approach it from th most autonomous prspctiv of subjcts isolatd
from thmslvs and vn, if on wishs, from God. What I sk to argu
is that on cannot ignor th social opinion of suicid, which is always
prsnt in all cass and across all ras in th ruls that govrn th sacrd,
custom or th most strictly lgal (on th basis, naturally, that at many
cultural momnts thr is no distinction among ths ways of dscribing
th ordr).

In his outstanding work Semper Dolens: A History of Suicid in th Wst,

Ramo n Andr s7 tlls a story from Roman history that, in good masur,
summarizs th position I sk to adopt in my txt, focusd this tim on
th rlationship btwn uthanasia and suicid. W hav avoidd this
rlationship in th anti-uthanasia discours, highly focusd on mdical

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thics and on th transformation of th halthcar function within a
socity whr killing bcoms a prmittd, or, prhaps, a mandatory act.

To b frank, I must stat that th author I am citing would probably

disagr to a larg xtnt with th conclusions that I shall tak from th
data h provids. Howvr, th solitud of th writr in stablishing
company with th solitud of th radr dos carry ths risks, risks that
I also assum on making ths statmnts rgarding uthanasia.

I trust that th radr will prmit rfrnc to b mad to a classic

xampl, takn from th aformntiond work by Ramo n Andr s.

Th sexagenarii de ponte wr th Romans who, on bing dnid th right

to vot upon raching sixty yars of ag, thrw thmslvs into th Tibr
du to th sham of having lost th powr to xrcis th most important
political rights. A symbol of th dcay to which man is subjctd in an on-
going procss of loss of powrs and hnc possibilitis, which bcoms
clar at a particular momnt and in a sns provoks, if th pun may b
prmittd, a dcisiv lap. Sinc Antiquity thr has bn no shortag of
thos who would prsnt this act as bing of th highst dignity and w
know that what is ncouragd is praisd. Two radings may undoubtdly
b mad: on of an xtraordinary, almost unblivabl act of hroism, and
anothr of a mor or lss nforcd act. 8

Howvr, a simplifid or laudatory rading of th honour of th

sexagenarii de ponte, as so oftn occurs in tals of voluntary actors or of
altruists partly forcd into suicidal acts such as th Japans Kamikaz,
may quickly b placd undr suspicion. A tal rgarding th origin of this
custom rvals its mandatory or havily rgulatd natur, almost as
occurs in th famd tals of Spartan womn. Without disrgarding a
crtain assumption of dignitas, th caus may b mor xtrnal and, if on
wishs, utilitarian. As th sam author nots, it appars that during th
Gallic invasions of Rom and givn th scarcity of food in th city, it was
customary to throw th ldrly off th bridgs of th Tibr. Facd with a
viw of th invitabl fat that awaitd thm, a good numbr prfrrd to
voluntarily throw thmslvs in, giving ris to th custom that has bn
so favourably rportd.

Projcting this xampl from th past upon our currnt civilization would
suggst that w ar fr from th most acut risks. Th wlfar socity
should not b xposd to immdiatly utilitarian prssur in th sarch
for food. Crtainly th modl of subjcts who njoy and do not suffr, or
prhaps njoy mor than thy suffr, could gnrat and has in fact givn

5
ris to a crtain similar trnd, though lss dignifid than th on w saw
dscribd in th first xplanation of th lap into th Tibr. Th socity of
lisur, in th lssr sns that th trm has for us, may lad to an xit
whn on is no longr capabl of njoying lisur. But thr ar othr
possibilitis to tak into account.

It is vidnt that, in gnral, w ar not living in a socity subjct to th

prssur to surviv xrtd by th Gauls on Rom or by th Romans on
Numancia. Howvr, if w accpt that our community is govrnd by what
has bn dnominatd th prformanc principl, th apparanc of
socially rcommndd suicid is a ral risk, and not a strang slippry
slop argumnt usd to dny th xrcis of frdom by a subjct who
chooss an xit that is not ncssarily pathological, as w shall s.

Among many othrs, thr is a classical tal that can illustrat for us this
ida of socially rcommndd suicid as an xampl of whr crtain
changs in prspctiv with rspct to voluntary dath or dath by ons
own hand may lad us.

On of th suicids that is most moralizd, xaltd and to an xtnt

dfining of a social rathr than prsonal modl, is that of th Roman
Lucrtia. W may rcall that this xampl is found at th bas not only of
th canon of Roman womn, but also in th idalizd humanist
rconstruction of authntic dignity. What is mor, from th political point
of viw, Lucrtias suicidal rspons to hr rap rsults in th dstruction
of tyranny framd by th Tarquins and th commncmnt of aristocratic
Roman frdom.9 Facd with hr suicid, inspird in th scns of th
Trojan War and according to th magistrial dscription by Shakspar,
thr is no othr suitabl rspons from hr fathr and husband than th
rvolt that frs Rom.10

Th rap and rsulting suicid ar hnc linkd to ral Roman frdom.

On th contrary, th most critical intrprtation occurs at th nd of th
historical priod, whn Saint Augustin answrs thos who rproach
Roman virgins that hav not committd suicid in th wak of th
barbaric mass rap committd upon th sacking of th city, as th much-
laudd Lucrtia would hav don.

In his dfnc of th bhaviour of th Christians in Rom, undoubtdly in

application of th principl that lif blongs to God but also with th
conviction that a survivor of rap has don nothing dsrving of moral
rproach, Saint Augustin taks a dcisiv stp. 11 Saint Augustins
tratmnt is morally rigorous, though I far that it had lss of a social

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ffct than its moral rigour mritd. And this is not th momnt to ngag
in a complx xamination of th so-calld sns of honour, of which Spain
has providd particularly harsh xampls in th form of th Caldronian
honour sn in th works of th Baroqu writr Caldro n d la Barca.

In any cas, Saint Augustins argumnt is a post acto libration of th

abusd woman insofar as it frs hr from moral obligation and, on this
point, from th moral us, in its full sns of bing rlatd to mors, of
suicid.

At this point I am not addrssing th cas of a woman who prfrs suicid

to th brutality that awaits hr, as happnd in various nations from
China to Russia and Grmany during th Scond World War; in this cas,
insurmountabl far or awarnss of th brutality that may occur
provids a clar xplanation for th choic, without th nd for othr
conditions. My focus, thrfor, is on situations such as that of Lucrtia;
that is, on womn who surviv and find thmslvs facd with a moral
judgmnt that th appropriat conduct is to commit suicid, as has
occurrd on a mass lvl in Bangladsh, for xampl, and in othr cass of
th India-Pakistan conflict.

Th much-laudd suicid, far from offring libration, carris with it an

incrasd numbr of possibilitis and opportunitis to bcom a path that
can only lad to dath.

My point, thn, is that thr is an insufficintly addrssd risk in

considring uthanasia as a form of suicid; a risk that impacts upon its
supposd voluntarinss vn whil it rtains th formal charactristics of
a voluntary act.

Brifly summarizing, w can say that th lgalization of uthanasia has

facd th following objctions, among othrs:

Th most important is th impossibility of rstricting cass to th limits of

th will of th ptitionr, rcipint or bnficiary of th uthanasia. That
is, th cas of th so-calld slippry slop. Th vidnc of th risk that
th incidnc of involuntary uthanasia may grow has bn compild in
th countris whr uthanasia has bn lgalizd.

From th logical standpoint, rfrnc has also bn mad to a so-calld

logical slippry slop; that is, that sinc it is th condition of illnss and
not intnt which dfins th lgalization of uthanasia, thr will
invitably b cass of so-calld involuntary uthanasia, in which patints

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hav not statd thir will to undrgo uthanasia and cannot b askd
about thir wishs. Whn th objctiv circumstancs point to
uthanasia, it may b applid.

Th scond is th objction to a prson killing anothr vn if th lattr

rqusts it. Profssor Lon Kass has rightly addrssd this mattr in
linking th dbat to th social rasons for protcting human lif, vn
against th ptitionrs will and vn without qustioning th altruistic
motivs of th uthanasia practitionr. On may think, for xampl, of a
mothr calld upon to kill a child.12

In th cas of halthcar profssionals, th mn and womn who would

b profssionally calld upon to practic uthanasia within th contxt of
a mdical indication, much has bn said about th total transformation
of mdical thics.

Rlatd to th forgoing, for xampl, is th argumnt of thos who s in

th lgalization of uthanasia a total transformation of th valu of
dpndncy and of what Alasdair MacIntyr has calld th virtus of
acknowldgd dpndnc.13

Th third is linkd to th fact that whn th possibility is cratd for

compassionat killing to b on of th options availabl to a prson in a
situation of svr dpndncy, far from incrasing frdom, th nw
possibility incrass th potntial prssur upon that prson to forfit
car that was prviously considrd mandatory.

I sk to prsnt this objction by analysing th xampls of moralizd

suicid; that is, th cass in which th social ordr favours somon
taking thir own lif. In uthanasia, this masking bcoms vidnt. On is
obligd to construct a supporting argumnt basd on th dmands of
car, on th burdn that is placd upon othrs, on th slfishnss of
continuing to xist. Against this, what is moralizd is doing what is usful
for othrs, or falling into th tmptation that afflicts us all.

Paralllism cannot b takn vry far, howvr, vn whn w rcogniz

th social transcndnc of suicid. Ultimatly, w would almost all b
ashamd to argu ovr suicid with a prson who sks or attmpts it.
This sham disappars whn w ar facd with th ida of a mdical act
consisting of on prson rplacing anothrs act of suicid. Mdically
prscribd homicid is a lgal problm of th first ordr.

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NOTES

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1 Klaudia Schank t Michl Schooyans, Euthanasie: le dossier Binding & Hoche,, Traduction d l'allmand,
pr sntation t analys d "La lib ralisation d la dstruction d'un vi qui n vaut pas d' tr v cu", txt int gral
d l'ouvrag publi n 1922 a Lipzig, Ed. L Sarmnt, 2002, Coll.: Un autr rgard sur l'homm.

2 Cioran, E, Syllogismes de lamertume , n Ouvrs, Quarto Gallimard, Paris, 1995, 783.

3 Si no s suicida, l ato no tin drcho a crrs lu cido Go mz Da vila, N. Escolios a un txto implcito. T I ,
Instituto Colombiano d Cultura, Bogota 1977, 474.

4 Srrano Ruiz-Caldro n, J M Eutanasia y vida dependiente, EIUNSA, Madrid, 2001.

5 Kown, J. Euthanasia, Ethics and Public Policy. An argument against legalization, Cambridg Univrsity Prss,
Cambridg , 2002.

6 Dostoivski, F Dos suicidios, Diario de un escritor, octubre 1876, Pa ginas d Espuma, Madrid, 2010, 892.

7 Andrs Gonzalz-Cobo, R. Semper Dolens: historia del suicidio en Occidente, El Acantilado, Barclona, 2015.

8 Andrs Gonzalz-Cobo, R. Semper Dolens: historia del suicidio en Occidente, El Acantilado, Barclona, 2015, 123.

9 Andrs Gonzalz-Cobo, R. Semper Dolens: historia del suicidio en Occidente, El Acantilado, Barclona, 2015, 123.

10 Shakspar, W Th rap of Lucrc, The Oxford Sakespeare, The complete works, d Jowtt, J t all, Oxford
Univrsity Prss, Clarndon Prss, 1986

11 Agustn d Hipona, Civitas Di, I, 22

12 Kass, L. Life liberty and the Defense of Dignity, Encountr books, San Francisco, 2002, 203

13 MacIntyr, A. Animales racionales dependientes , Paidos, Barclona, 2001, 142