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Harriet S.MeyerMD, Contributing EditorDavid H.MorseMS, Journal Review EditorRobertHoganMD, adviser for new media
Surely, anyone with a little imagination can think of a situation in which it is plausible to say that someone has "a duty to die." For example, it seems plausible to refer to such a duty in relation to a clandestine Central Intelligence Agency agent who is captured by terrorists and who has previously agreed to kill himself so that he will not be forced to reveal critical secrets. However, the focus of Is There a Duty to Die? is on a more controversial range of cases: those in which a person is dying or has substantial physical or cognitive impairments and whose care is very costly or burdensome.
Is There a Duty to Die? does not provide a simple answer to this question, but it at least helps to explain why it is mistaken to expect a simple answer. As several contributors to the anthology aptly demonstrate, the question itself is ambiguous. Are we asking in specified circumstances whether people have a duty to take their own lives or allow themselves to be killed; or whether people have a duty to forgo life-extending medical care? Are we asking in specified circumstances whether people have a duty to intend their own deaths; or whether people have a duty to make choices that they know, or have good reason to believe, are likely to result in their own deaths? Are we asking in specified circumstances whether others can legitimately demand that individuals perform certain actions or make certain decisions and be held morally accountable if they refuse; or only whether people can have a "personal" (unenforceable) duty to perform those actions or make those decisions? Are we asking in specified circumstances whether people have an actual duty (ie, a duty that is not overridden by other moral considerations) to perform certain actions or make certain decisions; or whether people have a prima facie duty (ie, a duty that can be overridden if there are other, more compelling moral considerations) to perform those actions or make those decisions?
The contributors, most, if not all, of whom are philosophers, provide different answers to these questions. Since there are significant differences in their conceptions of a duty to die—that is, in their understanding of the nature and meaning of such a duty—they are not all addressing the same question when they consider whether or not there is a duty to die.
Most of the 12 contributors affirm that there is a duty to die. However, just as all are not answering the same question, all do not provide the same justification for an affirmative answer. According to Jan Narveson, a duty to die is a self-imposed (nonenforceable) duty that is based on a commitment to people who matter, eg, close family and other loved ones. Other efforts to ground a duty to die include beneficence-based, justice-based, virtue-based, and contractarian justifications. Whereas some contributors focus on duties owed to intimates, others also consider duties to strangers (eg, other members of one's health plan or society). Margaret Battin appeals to considerations of "global equity."
Three contributors present criticisms of a 1997 article by John Hardwig in the Hastings Center Report, which is also entitled "Is There a Duty to Die?"1 Hardwig answers in the affirmative: People who are dying or severely impaired are said to have a duty to die to spare loved ones financial, physical, and emotional burdens. Rosemarie Tong and David Drebushenko respond that insofar as there is a duty in such contexts, it is a duty that applies only to "saints" and "heroes" and not to ordinary people. That is, a willingness to die for loved ones is said to be an act of "supererogation" rather than a moral requirement. Tong also argues that the language of "duty" is inappropriate in such contexts. A willingness to die in order not to burden loved ones is said to be more appropriately viewed as an expression of "caring." Drebushenko observes that whereas people may not be obligated to make tremendous sacrifices for dying or disabled loved ones and may justifiably refuse to do so, it does not follow that the dying or disabled person has an obligation to die. Ryan Spellecy accepts Hardwig's claim that there is a duty to die but challenges his contention that deciding whether or not a person has a duty to die is a family decision. Judith Lee Kissell critiques beneficence-based and justice-based justifications of a duty to die by offering a parody-laden discussion of what it would mean to consistently apply these principles.
Although the contributors provide different accounts of the nature and meaning of a duty to die and disagree about whether there is such a duty, there is an important point of agreement: it is appropriate for people who are dying or seriously ill to consider the needs and interests of close family and friends. Whether or not those needs and interests give rise to a duty to die, they are morally relevant factors for dying or seriously ill patients to consider. The anthology may not provide a definitive answer to the question in its title, but it does make a significant contribution to an important issue within bioethics.
Ethics: Is There a Duty to Die? JAMA. 2000;284(19):2526–2527. doi:10.1001/jama.284.19.2526-JBK1115-3-1
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