The impossibility of fulfilling a dying wish

The theologian and ethicist Dr. Heike Baranzke on the controversial discussion of the topic of euthanasia on German television

„One only dies one's own death, but one must live with the death of others", wrote Mascha Kaléko in her poem Memento 1945, formulating in a few words that death not only has an effect on the individual, but always on others as well. Today, our multimedia society gives us every opportunity to express our opinions on almost any subject. We are familiar with this from music shows, where our vote can take a candidate to the next round, or court shows, such as the court show "Wie würden Sie entscheiden?" ("How would you decide?"), which ZDF broadcast until 2000. In a similar format, defense attorney and author Ferdinand von Schirach presents his plays, in which he lets the audience decide how the case should be judged at the end of the performance. His current play "Gott" ("God"), which can currently be seen on German stages and in the ARD media library, deals with the subject of euthanasia. It is about the fictitious case of Mr. Gärtner who wants to die. He is 78 years old and mentally and physically healthy. Three years ago, his wife died and he no longer wants to live. He applied to the Federal Institute for Pharmaceuticals for a lethal dose of sodium pentobarbital, which he was denied. In the play, Mr. Gärtner and his lawyer go to the German Ethics Council. The discussion develops on the basis of the opening question: May a healthy person die? After one hour and 37 minutes, the audience can decide by phone call..

Not for the lazy

The theologian and ethicist Dr. Heike Baranzke considers this form of debate to be far too short-sighted and says: "I have to say, thinking about and discussing such questions is not for the lazy." The experienced scientist with a lectureship in theological ethics of Catholic theology at the University of Wuppertal finds the approach of the Schirach play quite interesting, which the author even pointed to a suicide of a healthy person after the abolition of the euthanasia paragraph 217 in the penal code by the constitutional court this year. Nevertheless, she emphasizes that the discussion was originally domiciled to the problem of end-of-life decisions in the face of medical-technical progress with regard to life-prolonging measures, namely the resulting fear of people to vegetate on tubes. Baranzke misses this framework and criticizes the focus of the discussion on an unrestricted right to self-determination, which gives every person the right to end his or her life at any time. "I think it's very problematic," she says, "that only a negative freedom of every person to do what they want with their life is thematized in a way that leaves out many dimensions."
The fundamental rights to the free development of personality and to the protection of life are both guaranteed in Article 2 of the Basic Law. From this follows: "No one has an obligation to live, there is no compulsion to live, I would also fully subscribe to that, but you can't then address the whole thing from just one actor, but you then have to look at the different roles of the different actors," Baranzke explains, "not just the role of the person willing to commit suicide, but also the role of the legislator, who must also have the common good in mind."

There are no clear yes/no decisions

An essential, common practice in the course of interviews is an unambiguity enforced by yes/no decisions, which Baranzke considers inappropriate in this topic. In this regard, she refers to the polymath Aristotle, who warned more than 2000 years ago against expecting the same precision and unambiguity from ethics as from the logical sciences. "When it comes to ethical questions - and we also notice this in the Corona debate - everyone wants clear answers, clear yes-no decisions. But everyone also wants to be considered in their specific situation. That in itself is a contradiction." In addition to the fundamental right to self-determination, this is also about the high good of human life, she explains, which is a very fundamental legal good, since without the prerequisite of life, one cannot claim the other fundamental rights either. This is not simply a logical problem, but a psychological one, which can therefore never be answered with absolute certainty.

Desire to die or will to die

For good reason, there has been a large area of research into the desire to die, anchored in medical psychology for some years now, especially in the context of serious illnesses, serious cancers, which are very stressful psychologically and physically. It is important to distinguish whether a suicidal person expresses only a temporary wish to die or a permanent will to die. It is necessary to differentiate whether the person is temporarily exhausted due to depression, a crisis of meaning or pain, but then finds the joy of life again with palliative and psychological support, or whether someone actually wants to end his or her life. In any case one must assure oneself of the sustainability, reasonableness, as well as firmness of the will to die, and not frivolously serve dying wishes. "We are here in the empirical lowlands of psychology," says Baranzke, "we can never be sure of making a certain judgment in empirical matters. There always remains a residue of uncertainty, and this residue wants to be answered for, not only by the suicidal person, but also by the person who is to be expected to assist in the suicide." This is not just a technical act, but a moral one that the person assisting here must also be able to live with. "Making such decisions also requires a high degree of human maturity from those assisting."

A duty to the community and to God

Another argument against solitary suicide decisions is the everlasting responsibility that a person has to his or her counterpart. "For me as an ethicist, practical rationality is essential, challenging us not only to give in to our needs, emotions and affects in an uncontrolled way, but to take responsibility for the people who are in a social relationship with us." In the discussion about dying, only negative freedom is always dealt with, but there is also the positive concept of freedom, which includes my responsibility both for my close social relationships and for society. For Schirach has his suicidal man appear with the demand that laws be changed that stipulate a right to assistance in suicide. In other words, he not only wants to find a way to end his life for himself, but to create legal structures with which the state can be legally obligated to create institutions for assisted suicide. This is an enormous society-changing claim that goes far beyond the request of alleviating a private distress.

What kind of society do we want to live in?

Dealing with the self-responsibility of a person willing to die also always has to do with the question of what kind of society we want to live in. Therefore, Baranzke asks very specifically: "Is it about immediate, unrestricted support of a dying intention or is it about caution and attentiveness and the individual examination of this high good called life?"
It makes a big difference whether someone is terminally ill and has reached the limits of palliative care, or whether someone is simply heartbroken or depressed. Therefore, strengthening the area of suicide prevention is also enormously important. In any case, the theologian emphasizes, it is important in the fulfillment of a will to die "that the responsibility for the act should remain as far as possible with the person who wants to commit suicide. That he takes responsibility for himself." Because killing on demand, meaning by the hand of another person, is still forbidden.

You shall not kill

The fifth commandment says: You shall not kill. With the fifth commandment, which is only two words in Hebrew, no law can be spoken. It also does not define a legal case. But it has a fundamental value as a kind of basic law: Man has a right to life. The fifth commandment is thus dedicated to the protection of human life. It stands in a field of tension that every society must face. When is killing permitted and when is it not? - and is still in need of comment today. But does this commandment also mean that suicide is forbidden at the same time? "It is an open secret that this strong condemnation of suicide came into the history of theology only through Augustine (Augustine of Hippo, Doctor of the Church of late antiquity, editor's note). But historical references are not sufficient as justification in the discussion," says Baranzke.
"We cannot simply apply our contemporary historical horizon, our social standards - to pre-modern times. In the biblical horizon, we still have a framework of divine law, and in modern times, we separate between religious and secular justifications and between moral and legal justifications. All these differentiations are not even considered there", she states, and therefore one must beware of anachronistic snap judgments. This commandment was spoken into a threatening and less secure social reality and ultimately also served to protect people from common crimes. "Because for a perpetrator or a murderer applies: do not feel safe if you think that no one is watching you, God sees everything." The prohibition of killing testifies above all to the high esteem in which life was held in a time that had not yet known human rights, Baranzke emphasizes.
"In this respect, I also disliked the theological part that Schirach put into the bishop's mouth: 'All life is suffering'. That is not the gospel! That is Schopenhauer, but not the gospel. That was bad theology! But it follows from this that if it is really a matter of someone wanting to put an end to his life, he would actually be under an obligation somewhere to the community and also to us as a society to explain the reasons, because we as a society also have to live with this further - in any case if he demands changes in the law for this." In theological terms man is a moral subject in responsibility before God. "The gospel is the good news. We believe in a good God who wants a good life for his creatures. If we assume a God who grants us a successful life, loving us always in advance without any performance requirement - we are always already loved and accepted and as such we stand before God - then I believe I have a different attitude toward this life, an attitude that makes it possible to live out of gratitude for all that I have not earned and to use it to bring good into the world to the best of my ability."

Voluntary, involuntary and non-voluntary euthanasia

With regard to the distinction between voluntary and involuntary euthanasia, Baranzke points out that there is also a third variant, namely that of non-voluntary euthanasia, which concerns situations where suffering people are not consulted with regard to life-shortening measures. "This area of so-called mercy killings is a worrying point, which is also observed again and again in relation to the euthanasia practice in the Netherlands" she explains, "here we are talking about cases where, for example, treatment abortion was resorted to without the affected persons having been asked beforehand. If you want to keep the right of self-determination in the question of end-of-life decisions so high, then this is a neuralgic point and this has been observed for years in a number of several hundred cases per year. That has to make you think."

Who owns our life?

So to whom does our life belong? Does it belong to a god? Does it belong to the state? Does it belong to society, family, friends? Or does it belong only to ourselves?
Heike Baranzke would clearly vote no in the vote in Ferdinand von Schirach's play "God" both as a theologian and as an ethicist, "because the neuralgic point in this fictional case is that on one hand Mr. Gärtner refuses to explain his reasons and on the other hand it is not enough for him to seek a way out of life for himself. If he demands from society that the legislature set up these structures, then he is also obliged to give reasons to the community."

Every judgment is exhausting

Everyone has a right to express his or her opinion, only there should be enough background information to be able to represent that opinion.
As moral subjects, we are all called upon to form a judgment, which is correspondingly demanding, because it does not permit any quick yes/no answers out of pity for an individual. Every moral judgment about an individual case has the flip side of having to ask whether it can be generalized and whether it can be made into a law that applies to everyone in society, and how the protection of life can be guaranteed for those who may have recoverable depressive moods, but not a strong will to die. I therefore have responsibility not only when I pass the cup of hemlock, but already when I make an ethical judgment. This dimension is not quite clear to many discussants. From those who want to have a say, I then demand more than spontaneous sympathy, because a socially sustainable judgment is extremely exhausting.
One only dies one's own death, but one must live with the death of others.

Uwe Blass (Interview on 11/30/2020)

Dr. Heike Baranzke is a lecturer in Theological Ethics of Catholic Theology in the School of Humanities at University of Wuppertal.