The Gift of Finitude

I’ve been thinking a lot lately about finitude. About limits. Incompleteness. Even failure.

Like the friend of a friend who is dying and has just been admitted to hospice, whose young teenaged daughter is facing the prospect of a life without her mother.

Like the colleague who is grieving the loss of both a spouse and a parent within a month of each other.

Like my power wheelchair that keeps breaking down, making everyday activities significantly more challenging.

Like the never-ending “to-do” list that seems to be anything but finite, and never quite seems to get any shorter.

Life is, in a word, full of limits. Boundaries. Unavoidable stopping points.

Or is it?

What if we could transcend our limits, as recent developments in genetic and related technologies (e.g., CRISPR) seem to promise? What if, through genetic manipulations of various sorts, we could significantly reduce our limitations—eliminate specific diseases and disabling conditions, improve cognitive function, “select” for desired physical traits, and so on?

If we could do these things, should we do them?

Of course, as anyone who has followed the field of bioethics for even a short period of time knows, these questions are neither new nor hypothetical. In many ways, the “future” is already here: we “enhance” ourselves, “transcend” limits and boundaries, and otherwise seek to “overcome” finitude in a myriad number of ways, on a daily basis. And much of this is salutary.

Still, it’s always worth pausing to consider: supposing finitude could be eliminated entirely from our lives (which seems extraordinarily doubtful), is it the sort of thing we ought to try to eliminate? Put differently: is there anything good about finitude, such that we ought to embrace it (even if in a qualified way)?

Gilbert Meilaender, a bioethicist and Distinguished Fellow of The Center for Bioethics and Human Dignity, suggests that there is something good about finitude. In a reflection on the “created duality” of our human nature—we are simultaneously both “free” and “finite”—Meilaender observes that this “two-sidedness” to our nature both opens up possibilities and imposes certain limits upon us. We are, he observes,

created from dust of the ground—finite beings who are limited by biological necessities and historical location. We are also free spirits, moved by the life-giving Spirit of God, created ultimately for communion with God—and therefore soaring beyond any limited understanding of our person in terms of presently “given” conditions of life…. Made for communion with God, we transcend nature and history—not in order that we may become self-creators, but in order that, acknowledging our Creator, we may recognize the true limit to human freedom. Understanding our nature in this way, we learn something about how we should evaluate medical “progress.” It cannot be acceptable simply to oppose the forward thrust of scientific medicine. That zealous desire to know, to probe the secrets of nature, to combat disease—all that is an expression of our created freedom from the limits of the “given,” the freedom by which we step forth as God’s representatives in the world. But a moral vision shaped by this Christian understanding of the person will also be prepared to say no to some exercises of human freedom. The never-ending project of human self-creation runs up against the limit that is God. It will always be hard to state in advance the precise boundaries that ought to limit our freedom, but we must be prepared to look for them.[1]

I am inclined to agree with Meilaender. Moreover, as I have shared in an autobiographical essay published recently,[2] my own experiences as a person with a physical disability have taught me valuable life lessons that, arguably, might not have been learned otherwise—lessons such as the value of patience and endurance, accepting my limits (an ongoing struggle, I must admit!), and even the importance of having a sense of humor at the (sometimes ridiculous) circumstances in which one finds oneself. Our limits shape our character, our career, and our life choices as much as do our “freedoms”—often in surprising and unexpected ways, and frequently for the better.

None of these reflections, of course, even begin to scratch the surface of the “what?”, “where?”, “when?”, “how?”, or “why?” questions related to the ethical permissibility (or lack thereof) of pursuing various genetic, reproductive, or other technologies. Nor do they, by themselves, tell us whether (and when) we ought or ought not to avail ourselves of abortion, physician-assisted suicide, euthanasia and the like.

They do, however, remind us of one very simple, yet all-too-often overlooked fact: finitude is, in many ways, a gift. Let us not neglect it.

 

[1] Gilbert Meilander, Bioethics: A Primer for Christians, 3rd ed. (Grand Rapids, MI: Eerdmans, 2013), 3-5.

[2] See “Why am I Disabled? Reflections on Life’s Questions and God’s Answers,” in the Beyond Suffering Bible (Tyndale, 2016), available at beyondsufferingbible.com and http://www.joniandfriends.org/bible/.

Excuse Me, Doctor, What Exactly Do You Profess?

The late Edmund Pellegrino, M.D., revered medical educator, ethicist, and physician, often made the point that a professional professes something. Merriam-Webster  confirms that the etymology of the word, profession, includes the Latin for “public declaration.”

The Hippocratic Oath, probably penned by members of the Pythagorean sect, according to Ludwig Edelstein (see Ancient Medicine: Selected Papers of Ludwig Edelstein. Baltimore: Johns Hopkins University Press, 1987), has for centuries been accepted as the gold standard for the practice of medicine. Nigel M. deS. Cameron (The New Medicine: Life and Death After Hippocrates. Chicago: Bioethics Press, 2001)
 explicates the Hippocratic Oath as containing four parts:

1.   Covenant with Apollo and others

2.   Duties to teacher

                            Regard teacher as equal to parent

                            Treat him as a partner in livelihood

                            Share money with him when needed

                            Consider his children as siblings

                            Teach medicine to own children, children of teacher, and pupils who take the oath

3.  Duties to patients

                            Use treatment to help the sick, never to injure or wrong them

                            Give no poison to anyone though asked to do so, nor suggest such a plan

                            Give no pessary to cause abortion

                            In purity and in holiness to guard the practitioner’s life and art

                            Use no knife on “sufferers from stone,” but allow others trained to do so

                            Enter houses to help the sick, not to participate in wrong doing or harm

                            Keep oneself from fornication with woman or man, slave or free

                            Not to divulge, but guard as holy secrets those things that are heard by the practitioner

4.  Sanction

Oath-taking by medical students has increased in the last 50 years, as reported by Neil Chesanow, in “Is it time to retire the Hippocratic Oath?” Medscape, 25 Jan 2017.  The form of oath taken by medical students has also changed. Many schools have re-written the oath in “updated” language, and a good number of students craft their own.

Do they swear not to have sex with their patients? Do the medical students or newly minted physicians now swear not to give poisons or pessaries? What oaths are taken in those states where physician-assisted suicide has been made legal? It would be good for the public to know. Perhaps it is time for physicians to post on their walls (actual and virtual) exactly what it is they profess to be and to do.

 

— D. Joy Riley, M.D., M.A., is executive director of The Tennessee Center for Bioethics & Culture.

 

Christians and Physician Assisted Suicide

In my experience working with terminally ill patients over the past seven years, I have often seen people of the Christian faith go all out in the ICU, wanting “everything done” for a terminally ill loved one. In these circumstances, when I speak with family members of the patient, they tell me they will continue to pray for a miracle to happen. As a person of faith, I respect their faith and their right to exercise it. When appropriate, I gently remind them that ultimately we all die and that, in the case the miracle does not happen, it is good to have an end-of-life plan in place.

This experience came to mind when I read a recent article in www.time.com by Corinne Johns-Treat, a cancer patient who has decided that she wants “death with dignity.” The article stands out because she explains how she came to that decision in the context of her faith: “…[T]he more I learned about the safeguards and autonomy in the law, and the more I prayed about it, having seen people suffer so much at the very end of their lives, I came to believe in that it fit into my faith. I found comfort in this law” (California’s ‘End of Life Option Act’).

As I read her thoughtful article, several familiar themes arose: autonomy, personal suffering, and the painful experiences of others. These, of course, are used by others defending PAS who do not necessarily have a particular faith commitment. To place her decision within the framework of her Christian faith, Johns-Treat adds this thought: “If God grants us the intelligence to enable doctors to offer treatments that prolong life—that have prolonged my life—wouldn’t that same logic apply to those of us nearing the end of our life? When science can’t offer life-sustaining treatments anymore, then the role of medicine should be to relieve suffering.”

I don’t know anyone in the medical field who would disagree with the goal of “relieving suffering.” The question is how to define it. Cannot palliative care offer more to the dying patient than PAS? My work in hospice showed me that death does not need to be anguish for patient and family alike during the final hours of life. Palliative care physicians and their teams do tremendous work every day to relieve the terminally ill of their suffering. As the field of palliative care continues to deepen and grow, and as people become more aware of their mortality, I hope that PAS does not become the default method of “relieving suffering.”

Christians – and members of other faith groups – will undoubtedly continue to wrestle with these issues in the coming days. This is important because they are indeed matters of life and death.

A novel strategy for suicide prevention

In the Netherlands, a doctor will not be prosecuted for assisting a patient to die either through euthanasia or assisted suicide (EAS) if certain conditions are met, among which are the following: The patient’s request for aid-in-dying must be voluntary and well-informed, without coercion from others, and uninfluenced by psychological illness or drugs; their suffering should be unbearable and hopeless, with no prospect for improvement and without reasonable alternatives; and an independent physician should be consulted, who should concur with the aforementioned conditions. Supporters aver that these guidelines have made physician-assisted death safe and have avoided the “slippery slope” that detractors and fear-mongers fulminate about.

A commentary (preview available here) in last week’s JAMA gives cause to question the rosy picture some paint of the Netherlands experience. The commentary refers to a study that appeared in the April 2016 JAMA Psychiatry. The study describes the practice of EAS for psychiatric disorders in the Netherlands, reviewing 66 patient reports filed by physicians from 2011 to 2014. Surprisingly, only 49 of the 66 patients experienced depression. Thirty-four had at least one prior suicide attempt. Six had substance abuse, two a diagnosis of autism. Thirty-four had personality disorders; 13 had never had a psychiatric hospitalization; 37 described social isolation or loneliness. Thirty-seven of the patients had refused some recommended treatment. In eight cases, the involved psychiatrist believed that the criteria for EAS had not been met. Eighteen cases involved physicians who had not cared for the patients before the EAS request; most had met the patients through mobile euthanasia clinics. (As Paul Appelbaum writes in an accompanying editorial [preview available here], “One might wonder whether a clinic intended to make assisted death more available will have a lower threshold for approving requests.”) In 16 patient cases, three independent physician reviewers could not agree among themselves as to whether the patient was making a competent request, or whether there was treatment that offered some prospect of improvement.

The description of some of the patients is compelling. The study reports that a “woman in her 70s without health problems … and her husband had decided some years before that they would not live without each other. She experienced life without her husband, who had died 1 year earlier, as a ‘living hell’ and ‘meaningless.’ A consultant reported that this woman ‘did not feel depressed at all. She ate, drank, and slept well. She followed the news and undertook activities.’ ” About patients who reported social isolation or loneliness: ” ‘The patient indicated that she had had a life without love and therefore had no right to exist’ . . .  and ‘The patient was an utterly lonely man whose life had been a failure.’ ” A Dutch regional euthanasia review committee found one case that did not meet due care criteria: “. . .a woman … in her 80s with chronic depression who sought help from the End-of-Life Clinic. The clinic physician met with her 2 times (the first time was 3 weeks before her death), and the patient was not alone on both occasions, with family members present. The physician was not a psychiatrist, did not consult psychiatrists, was unaware of the Dutch Psychiatric Association Guidelines, and yet ‘had not a single doubt’ about the patient’s prognosis.”

These stories are tragedies. I do not deny that the patients in this study were truly suffering. But is EAS really an appropriate way to treat the suffering, by killing the sufferer? If someone fails in an “illegal” suicide attempt, can they just go to the doctor and have it done legally? Is EAS to be the new solution for loneliness, social isolation, and grief? Is it not a slippery slope to go from “Doctors must not kill,” to “Doctors can kill in the case of terminal illness,” to “Doctors can kill people who don’t have a terminal illness but just want to be dead”?

Medical errors and more medical errors

Last week the BMJ reported that annually, there are 251,000 hospital deaths due to preventable medical errors in the US. There’s some debate about the calculations that they used to arrive at that number, and about what exactly constitutes a medical error. However, rather than quibble over the fine points, let’s acknowledge that medical errors are an ethical problem that must be addressed. In this post I would like to widen the conversation beyond the hospital walls. Below is a sample of some deaths due to preventable medical errors that weren’t included in the BMJ calculations (most of these ones happen outside of hospitals); nevertheless, they too affect thousands of people annually. I will also attempt to provide a taxonomy of the relevant errors.

Deaths due to the inability of the patient to obtain medical care because they couldn’t afford the care or the insurance — unknown number. The medical error here is a systemic one, the rationing of health care on the basis of who can pay for it.

Deaths of patients due to their being the subjects of human research — unknown number. This is peculiarly prevalent among embryonic patients (as Jon Holmlund wrote about last week). The medical errors include the failure to extend to embryonic research subjects the protections enumerated in the Declaration of Helsinki. There is also a category error: classifying embryonic patients as something other than human beings.

Deaths of embryonic or fetal patients through elective induced abortion — 977,000 (2014 data). The same category error as previous comes into play here: the failure to recognize the humanity of the unborn human.

Deaths of patients from drugs prescribed by their physician for the purpose of suicide — the numbers data is incomplete. The number is relatively low but projected to grow as more jurisdictions legalize physician-assisted suicide. The errors here include a professionalism lapse (forgetting that the professional status of medicine was established, among other things, on the dictum that doctors do not give deadly drugs, even if asked to do so). There is also the error of hubris: the belief that doctors can decide that someone should be allowed to kill themselves.

Preventable medical errors, all.

Oh, Those Darned Terms!

In a recent post Jon Holmlund cited Thomas B. Edsall’s op-ed in the New York Times, “The Republican Conception of Conception.” Edsall was referring to the concept that life begins at conception. It is his hope that Republicans either stake a consistent position regarding the morality of post-conception “contraception” and incur the disfavor of the electorate, or abandon their “moral purity” in favor of “pragmatism” and agree that post-conceptional interventions are acceptable.

Edsall’s states it thus:

By this logic, a presidential candidate seeking to live up to the standards set by Sedlak and others in the anti-abortion community must then agree that the IUD and morning after pill cause abortions.

The problem is that Edsall challenges GOP candidates to take an informed and consistent position, while depending on the electorate not to. His strategy relies on manipulative use of terms to produce the opposite of clarity in moral reasoning. First, he speaks of medical interventions described as “contraceptives” that act in ways beyond merely preventing conception. But he does not give them the label “abortifacient” (the proper term for an IUD should be “contraceptive-abortifacient”); the term is simply omitted. That is the best way, of course, to ensure that users of devices such as the IUD are unaware that it may act after creation of an embryonic being.

Such a position is facilitated by ACOG’s definition of pregnancy as beginning at implantation, which Edsall also hangs his hat on. This is a willful dodge. “Pregnancy” refers to the state of the woman. To claim that pregnancy doesn’t begin until implantation fails to refute the notion that an embryonic human being is in existence before then. So the woman isn’t “pregnant”….the human being is still alive, moving toward implantation. And, if the woman isn’t “pregnant” during the time after the embryo is fertilized and before it is implanted, what is her state? Is it not different than before she conceived? Does that not deserve a name? The absence of a name for such a condition is no accident, because the unnamed state is far more difficult to assign a moral status to.

This same “reasoning” behind the proposed bill in the California State Legislature  also recently mentioned in this blog by Jon Holmlund:

“The bill would provide that nothing in its provisions is to be construed to authorize ending a patient’s life by lethal injection, mercy killing, or active euthanasia, and would provide that action taken in accordance with the act shall not constitute, among other things, suicide or homicide.”

So, according to this draft bill, one can take one’s own life and not commit suicide. The attempt to separate the actions that this bill would legalize from the term “suicide” is to attempt to prevent citizens from properly interpreting those actions using the moral values they have already acquired.

Are moral discussions about conception, contraception, abortion, and assisted suicide too painful for our electorate, having what Edsall describes as “its complex views and…pragmatism”? For many, yes, as proven by our unwillingness to clarify the terms needed to elucidate the moral issues regarding medical interventions blocking implantation. However, such discussions are not unwanted by all, but simply unknown to them. Remaining uninformed by the medical profession of the mechanisms of action of “contraceptives,” they are never given a chance to make an informed moral decision. Edsall (to achieve his desired virtue of consistency) would more properly make his challenge to all of us, to demand that each voter take a stance on the morality of embryocidal interventions. It is only then that they could properly interpret the candidates’ responses that Edsall so fervently desires.

Physician-assisted suicide, torture, and Hippocrates: He may be old, but (let’s hope) he ain’t dead yet

A recent op-ed piece in the Chicago Tribune avers that Hippocratism is dead; and since Hippocrates’ oath is all that stands in the way of that particular exercise of compassion and patient autonomy known as physician-assisted suicide (PAS), let’s just acknowledge the oath’s irrelevance and wash our hands of it so doctors can get back to the business of killing patients. The oath has “marginal relevance” today, it is a “flimsy shield” which cannot withstand “the drumbeat of change.” “Since medicine has already discarded the vast majority of the Hippocratic oath why adhere to” the bit about not killing patients?

I have not time or space to address all of the specious arguments put forth in the editorial. But in light of the recent Senate report on CIA torture tactics, which revealed the collusion of physicians in planning and carrying out that torture (as publicized by Atul Gawande on Twitter), we had better hope that the op-editors are wrong about Hippocrates’ demise. Because if society needed a shield like the Oath to protect it from the powers of its physicians back in Hippocrates’ day, it needs it even more desperately now, when the powers of medicine to perform evil have increased as immensely as its powers to perform good. I do not know what motivations were behind the actions of the physicians who worked for the CIA: Patriotism?  The desire to protect loved ones from terrorists? Whatever they were, it is clear that even good motivations — compassion (in the case of PAS), patriotism (in the case of torture) — can lead physicians to perform unethical acts, acts whose effect is to knowingly cause harm those under their “care.” The Oath’s power to protect patients comes because the Oath doesn’t appeal to elastic concepts like “compassion,” “dignity,” or even “sanctity of life”; instead, it simply says, “I will not kill. In the course of my work I will do what is best for my patients” — not what’s best for me, or my country, or my family, but my patients.

So instead of euthanizing Hippocrates, we should be doing everything to reinvigorate the ethical values associated with his name. Because if the op-editors’ dream ever comes true — if Hippocratism dies out — then we are all in trouble; because any one of us may find ourselves at the mercy of an unrestrained, powerful techno-medicine, especially if somebody thinks we are too old, or too sick, or too weak, or too poor, or too disabled, or too inconvenient, or too suspicious-looking. . .

Bioethics Exam

In keeping with the evaluation-obsessed spirit of the time, here is a little bioethics test. No multiple-choice fill-in-the-bubbles here, no simple true/false; but bioethics usually isn’t so simple, is it? So it’s OK if you don’t have a No. 2 pencil, you can still take today’s exam!

_______________________

1. The patient-physician relationship depends on trust, and close observation, and appreciating subtleties, and giving one’s full attention to another person. So, who thought that making the doctor spend the office visit typing into a computer was actually a good idea???

2. Why does the NRA know better than physicians in Florida what they should be saying to their patients in the exam room?

3. What is just and right about a medical insurance system in which people have to stay in jobs they hate because of the fear of getting sick, and which bankrupts many people who get a serious illness? Give examples to support your answer.

4. If doctors have huge malpractice premiums, which they pay for by charging patients more for medical care, then essentially patients are paying doctors so the doctors can protect themselves from patients. Does this make sense? Explain.

5. Compare and contrast: Why should taking one’s own life be considered a more dignified death than any other? Is there really any dignity in death itself, or is it in the way that we face it?

6. Why should doctors be trusted more than anybody else with the right to kill someone?

7. If all of these prenatal genetic tests weren’t developed and marketed for specifically eugenic purposes, then just what were they developed and marketed for?

8. Is there any evidence that “evidence-based medicine” (aka statistic-based medicine) is better than whatever we did before?

9. Is abortion the problem, or is it the symptom of a lot of other problems?

10. In the DSM-V (the latest version of the official guidebook to diagnosing psychiatric illness), grief over the death of a loved one that lasts longer than two weeks can now be considered a disease and treated with medications. What will be the next normal human experience to be turned into a disease?

EXTRA CREDIT:

11. What does it mean to be human? Who gets to decide?

*  *  *

Since this is an ethics blog, you’re on your honor to score yourself fairly. Good providence!

Dying and Dignity

On November 1st, Brittany Maynard, a 29 year-old Oregonian with an incurable brain tumor, took her own life using a medication prescribed by a physician specifically for this purpose. The medication, legal under the Oregon’s Death With Dignity Act, was prescribed weeks earlier.

The case is well-known because Brittany became a spokesperson for efforts to expand “assisted suicide” laws to other states. Through her own efforts, her story appeared in numerous publications and websites, and has been held up by the organization “Compassion & Choices” as exemplifying the justification for making assisted suicide legal nationwide.

Brittany feared many things about dying with brain cancer—her own physical pain, progressive debilitation, dependency, seizures, as well as emotional pain for her family. To avoid these through her own choice, was to die with “dignity”. This term has been held tightly by assisted suicide advocates, such as by the Swiss group “Dignitas”. The organization “Compassion & Choices” holds to a few more terms it wishes to apply to assisted suicide.

When reading the stories about Brittany it is difficult to bring oneself to find fault with her decisions, knowing the heartbreak that she and her family were going through. It is as if such conversations themselves are too painful, and so, like Brittany Maynard did of her life, we terminate them before they’re complete.

But there is much to critique about “assisted suicide”. What is striking is the usurpation of terms, most notably the term “dignity”. It is a shallow interpretation indeed, for according to the website http://www.thebrittanyfund.org, to die with dignity is to die “in control”. The term “dignity” is reduced to describe the ultimate act of autonomy. To give it the imprimatur of compassion and approval, a physician prescribes the fatal medication; we know full well, however, that physicians are not necessary participants should one decide to end his or her life.

Real dignity is much more. I thought about the young Mrs. Maynard today after I visited a friend dying of cancer. And I thought back to my own parents’ terminal illnesses, including one with a tumor in the brain. Somehow I can’t fit the term “dignity” into any circumstance in which one of them would have willfully avoided their final moments. Those are painful days, hours, and minutes, but precious nonetheless. They bring us together, force us to cast off trivialities, and sharpen our focus on what is most important. They call out the best in us, and send us away with a sense of something greater…including perhaps a resolve to make something more of the life we are given. After all, why does God give us death but to remind us how to live?

My wife said of my mother, “She showed us how to die.” There, in a debilitated and helpless state, was true dignity. I am eternally thankful for every moment.

Euthanasia, pediatric and adult, and the underlying concept of a life not worth living

Jon Holmlund’s recent post about pediatric euthanasia in Belgium made me think about what I had posted a couple of weeks ago about PGD and lives not worth living. There is a way in which the concept of a life not worth living underlies a whole spectrum of ethical issues from PGD and selective abortion to pediatric and adult euthanasia. There is a basic conflict between those who take different ethical positions on these issues over whether there are certain quality of life issues that can allow one person to decide that another person’s life not worth living.

For those who take the position that it is permissible for couples who are at risk to have a child with a serious genetic disorder to use PGD or prenatal diagnosis with selective abortion to try to insure that any child that is born is free from the genetic disorder, a part of the argument for their position is that it is permissible to discard the embryos found to have the disorder or abort the fetuses found to have the disorder due to the poor quality of life that would be experienced by those children if they were born. That is saying that the lives of those children would not be worth living. That decision is being made by the parents for their children and being confirmed by the physicians and others who participate in the process.

Those who support the permissibility of active infant euthanasia as practiced in the Netherlands under the Groningen protocol are also saying that the infants whose lives are being ended have lives that are not worth living. Again this decision is being made by the parents and confirmed by the physicians involved that the infant’s life is not worth living.

The situation with voluntary euthanasia of children as it has recently been allowed in Belgium is more complex. If the child does not actually have full decision making capacity or is being overtly or covertly coerced, it is again someone other than the child who is making the decision that the child’s life is not worth living and the situation is similar to infant euthanasia. If the child has full decision making capacity then it could be reasonable to consider the situation to be the same as adult voluntary euthanasia.

With adult voluntary euthanasia some would argue that the concern about one person deciding that another person’s life is not worth living is not an issue because it is the one whose life is being ended who is making that decision. However, whether what is being done is voluntary active euthanasia in which a physician is administering a lethal drug or physician assisted suicide in which the physician prescribes the drug with the intent that the patient will self-administer it, the physician who is involved must make the decision that the act of ending that patient’s life is warranted. Few would be willing to take respect for autonomy so far as to say that anyone who requested assistance to end his or her life should be provided the means to do so without a judgment by the physician that the decision to do so was an appropriate one. Assisting someone to commit suicide who is despondent over a break-up of a relationship is irresponsible. Thus physician participation in voluntary active euthanasia or assisted suicide requires an independent decision by the physician that the decision to request assistance in ending life is reasonable. The only way a physician can make the decision to participate is to decide independently that the patient’s life is not worth living.

The only situation in which ending a life to avoid a poor quality of life could be done without one person deciding that another person’s life is not worth living would be unassisted suicide. There are Christian and Kantian arguments for why that is not morally permissible, but that lies outside the realm of these thoughts.

Since all of these actions, from PGD to adult voluntary assisted suicide involve one person making a decision that another person’s life is not worth living, a crucial issue is whether it is morally permissible for us to make such a decision about another person’s life. For those of us who have an understanding that every human life has value simply because of being human, we must answer that it is not permissible to make that decision. We understand that no matter how difficult a life may be that person still has value and our response to those whose quality of life is poor and who are having to endure more suffering than it would seem that they ought to is to affirm the value of that person’s life by caring for the person’s needs. We cannot say that another’s life is not worth living.