THE IMPACT OF NEW MEDICAL TECHNOLOGY UPON ATTITUDES TOWARDS EUTHANASIA
Advancement in modern medical technology has unleashed both relief and challenges to human beings everywhere. Regardless of where one lives, there is no immunity to the radical and sweeping revolution in medical intervention technology. Nowadays machines are even breathing for human beings. Advances are so cumulative that the standard definition of biological death is being revised constantly within the medical research world, especially in light of successes with organ transplantation. The main questions addressed in this essay are: How do contemporary Akans of Ghana1 regard the practice of euthanasia? And given the current emphasis on civil rights in public discourse, how do Akans understand human rights and dignity, individual freedom and integrity, when considering the possibility of medical intervention in matters of life and death?
The Akans, believing in nkrabea (destiny), appreciate human mortality to be inevitable. This fact is itself not a provocative issue for an Akan: it is a simple and unalarming fact that each person must die. What is highly contentious for Akans is the appropriate human response to the controllable state or condition under which the event of a human death takes place. Hence for Akans the questions that concern dying quite naturally are these: Should one interfere with the circumstance or state of affairs that prevails when a death occurs? If so, what should be the extent of such interference?
Fifty or so years ago, no one would have ventured to ask such questions because of the belief that one only attracts evil upon oneself by talking about tampering with ‘nature’, destiny or taboo — and for the Akans, death constitutes all three of these. On a general scale, it is safe to maintain the belief that nkrabea is dear to the Akans, particularly where life and death issues are at stake. The absolute sanctity and dignity of life, as well as reverence for life, and the analytic claim that every event has a cause, are among the everyday truisms which go unquestioned even when state-of-the-art medical wonders appear to challenge the given realities of the natural world. Such convictions concerning nkrabea or destiny run contrary to approving of euthanasia. Euthanasia requires that one be assisted by another in one’s dying — either by their act of omission or commission. Mercy killing (passive or active) raises questions of moral legitimacy about one’s right to bring about the death of another, given that he or she appears in dire need of release from life. For the Akan, there would be no euthanasia, let alone the problems associated with it, were it not the presence of another human agent involved in the action.
On the one hand, the Akans have a belief expressed in the saying: Fedee ne owuo a enee fanyinam owou. [Given humiliation or indignity versus death, the Akans prefer death]. This wisdom certainly condones euthanasia. On the other hand, belief in nkrabea is very strong. Destiny not only transcends all human ability to resist it, but any human attempt to resist it is regarded as evil and self-denigrating. Therefore the Akan’s attitude to the course of destiny, i.e. to any act of nature or of God, is one of wholly complacent receptivity. So there exists a moral tension between humble acceptance of destiny and noble preference for death over a life of indignity and humiliation. If a suicide is performed, its legitimacy is acknowledged by an Akan, but at the same time it is generally regarded as staining the honor and dignity of the family and clan of the suicide.
Given this ambivalence, what may be troubling to an Akan about euthanasia — as distinct from suicide — is not that the individual chooses to take his or her own life, but rather that another human agent is involved in the demise of a human being. In other words, if euthanasia were suicide, then there would be little to fuss about for an Akan, since a suicidal death is preferable to an ignominious or humiliating life. But since euthanasia necessitates the intervening agency of another person, the Akan’s attitude towards death here is not so sympathetic. For what justification does one person have in killing, or in assisting to kill another person deliberately by passive or active works? Is this not interfering with nature, or playing God?
To defend ‘mercy killing’ by appeal to the fact that it has been invited, contracted and is legally permissible, is unacceptable to an Akan. And yet certain circumstances require the cooperation of others in order for an individual to take his own life. So one might question the Akan’s claim that everyone has a ‘right to die in dignity’?
In this era of our nation’s ‘infant democracy’, human rights issues are at the forefront of Ghanaians’ continual struggle for the defense and protection of their individual freedoms. The ‘right to live and die in dignity’ is just one of many contested civil rights that have recently earned considerable attention. Nowadays, radio and television exposes the Ghanaian public to debates and controversies on all topics. Individuals feel that they should be free to interrogate the authority and legitimacy of ancient taboos, norms and traditional beliefs about life, death, marriage and family. The public is no longer taking traditional views for granted, but rather testing and challenging them. For example, economic conditions today have reinforced and intensified the youth’s unfavorable attitudes toward polygamy, raising many children and other traditional extended family practices including a host of financial and ceremonial obligations beyond the nuclear unit. One might suppose it is consistent for the contemporary Ghanaian to challenge his tradition’s passive submission to destiny as well. However, in the case of euthanasia and the modern technological ability to control the time of death’s occurrence, the Akan would still unequivocally disapprove of mechanistic intervention to pre-empt a painfully slow death. In the Akan’s mind it is the height of presumptuous folly — dangerous and futile — to fight with God. Nkrabea rather should be left alone, respected and appreciated.
Thus the Akan’s negative attitude towards euthanasia is grounded on two principles. First, the sanctity of nkrabea psychologically prohibits entertaining ideas about tampering with the pace of dying. Secondly, the Akan’s logical objection to euthanasia is that its defense may be based on a conceptual confusion about the nature of a human right.
THE ‘RIGHT TO LIFE’: A CONCEPTUAL CONFUSION?
For the sake of argument, suppose that if one chooses to die, then one has a right to die; in accord with the defendant of euthanasia: ‘It is my life. So if I see in it no worth, nor good, nor meaning, nor happiness or purpose — but only irrevocable pain, prolonged suffering and an impending death — then if I do not want it, morally I am not obliged to keep it.’ If one chooses to die, then one must be permitted morally to die as one desires. On first consideration this argument appears simple, clear and reasonable enough; because forcing someone to live an unwanted, useless, suffering, painful and dying life against his or her will seems to be a species of cruel and unusual punishment, which is uncontroversially a bad practice. But on closer examination the argument is not as simple as it looks.
The focus of the objection here lies in this assumption: if one’s life is indeed one’s very own — one’s private property, as it were — then one should be morally entitled to do with it as one wishes, including terminating it. That is, one has a moral entitlement to give consent or to permit oneself to die. Proponents of euthanasia respect the right of an individual who gives such consent to follow through with the expressed intention. They seek legislative and statutory backing from governments to defend such a freedom. But consider the source of this right: it seems to be one that is granted as a self-given entitlement. This strictly self-given right, therefore, appears to be an entitlement that each and every one has according to their desire. So when I exercise or want to exercise the desire to die, I thereby give to myself (or thereby simply exercise) my own right to die as wish. But then the proponent of euthanasia seems to be saying that your right to die is just as irrevocable, valid for you, as mine is for me. This is so because the desire is subjective; its validity is justified solely in virtue of its authenticity. It follows that if I really want to die, then I thereby have the right to do so. Therefore the occurrence of a desire in a mad person is just as irrevocable and valid for him as the occurrence of a desire for a sane person. The desires of the patient are as authentic and therefore as valid as those of the doctor; the preference of the expert is as valid as that of the ignorant; a pro-attitude of the wise has the same status as a pro-attitude of the fool, and so on. Such a right as follows inherently from the occurrence of a desire holds for whoever claims genuinely to be aware of the occurrence of the desire. Strictly speaking on this view, no one — sick or healthy, poor or rich, stupid or wise — can be challenged or turned down in the exercise of this purely ‘subjective’ right on any grounds whatsoever. But the threat of absurdity must surely force us to draw a line somewhere concerning the validity of this entitlement. If no interference can be permitted in the exercise of this relativistic ‘right to die’ then we are in practical trouble. For in practical terms there needs to be some criterion for determining the validity or coherence of an individual’s claiming this right: he or she must be of sound mind, fully apprised of the available alternatives, under no external duress, free from psycho-physiological compulsion, and so on. From an Akan’s point of view there is, therefore, an inherent difficulty that arises from this ipsilateral, purely subjective ‘right to a dignified life or death’.
Arguably, this subjectively determined right can be defined in a way that specifies conditions for its legitimacy. Then there remains a second logical basis for objecting to euthanasia. Let us suppose that A has a right to die if A wishes, with no moral culpability. But then for A to elicit B’s merciful assistance in dying raises questions about the civil legitimacy of B’s execution of the requested help. For the use of this help ends a human life that is not B’s own. The question arising here is whether a subjectively determined right or entitlement is transferable to a second agent. When euthanasia is performed, the individual always incurs another person’s merciful help to die as desired. In this respect euthanasia is critically different from the standard case of suicide. In the Akan’s mind, it is this introduction of another moral agent into the act of intentionally terminating a human life that breeds insuperable moral complications.
CLAIMING THE UNCLAIMABLE:
ANOTHER CONCEPTUAL CONFUSION
More profoundly, it does not make sense to talk seriously about having rights at all where they cannot objectively exist. In the Akan’s view, such is the case with one’s claim to life or to death. If these are events that lie beyond human power to bring to pass, then it does not make sense to seriously talk about having a right to control them. Whereas an individual may have access to a drug or machine that will end his life if it is working properly, he does not determine whether the drug or machine will in fact work properly on the occasion that he is relying upon it. God determines this. For the Akans, we neither choose nor design our individual lives, of which we are each but a manifestation. Nor is it the event of death over which we mortals have control. It is, rather, the conditions under which a life transpires or a death occurs that humans may control; we may be able to do as we please in this respect alone. Hence it is in this limited respect of controlling the conditions under which a death occurs that one can meaningfully condone or descry the practice of euthanasia. A category mistake is being committed if one assumes that one is free to choose, select or pick which kind of death or life one wants in the sense that one is free to select the style and color of one’s shoes. Indeed, if we were actually capable of choosing or picking the type of life or death we are to undergo, there surely would not be any need for the practice of euthanasia in the first place — let alone any basis for concerning ourselves with the moral problems entailed by it. For we each would choose the best life there is for ourselves — or, to use Rilke’s words, the most
. . . polite death of the better circles with which, so to say, the funeral first class and the whole sequence of its touching custom begins . . . one that is so agreeably, and with so much gratitude toward doctors . . . and nurses, one would die a death prepared by an institution.
Talking about one’s ‘right to life’ or ‘right to die’ — in the Akan’s view — exposes a conceptual confusion about the very nature of life and death as properties attributable to oneself.
For the reasons just discussed, it is rather the conditions of one’s life and death — not the very occurrence itself — that one may coherently regard as the object of entitlement. Thus one may coherently claim to have a right to remain free from conditions characterized as cruel, inhumane, unnecessary and unusual suffering or punishment. Thus viewed by the Akan, what is morally significant and a matter of ethically responsible choice concerning euthanasia is that this practice yields certain conditions of death. It is not the event of death itself via euthanasia that is a matter of human deliberation or moral culpability. It could not be; for God alone is responsible for the event itself. Human controls can rather fashion a kind of ‘living death’ whereby a person is made a biological appendage to some machine in order to sustain life. This might strike the Akan as an utterly shameless lust for physical survival. Alternatively, a human death can be designed via euthanasia to forestall a humiliatingly or excruciatingly prolonged dying process. Under certain conditions, then, the Akan point of view may be sympathetic to euthanasia, since the practice may be an expression of a noble aversion to indignity or ignominy. At the same time, an Akan might be averse to associating with an expert in this medical practice who hastens or facilitates the death of another with the motivation of ‘mercy killing’.
In sum, the impact of modern medical technology on the Akans’ cultural attitudes is to accentuate a profound ambivalence concerning euthanasia, the aged and the infirm. An Akan
would neither live in shame, nor play God. The former moral imperative impels an Akan to sympathetically approve of euthanasia as a noble alternative to an artificially perpetuated life dependent upon the vain heroism imbibed in modern medical machinery. The latter instinctive distaste for presumption would certainly motivate an unsympathetic disapproval of practicing euthanasia on two grounds:
(1) The practice entails a confused presumption of individual entitlement, based on a mistaken conception of living and dying as attributes that an individual can freely pick and choose for himself.
(2) One might extend the grounds that the practitioner appeals to justify committing euthanasia, and further justify killing ‘on request’. This has disturbing consequences for society overall. Even without such implications, the practitioner of euthanasia acting on another’s behalf, appears to be ‘playing God’ and thereby exhibiting an unseemly lack of respect for nkrabea. The Akan’s ambivalent attitude towards euthanasia is an expression of a fundamentally consistent moral aversion both towards ‘playing God’ and towards living in ignominy.
1. ‘Akan’ is a fluid linguistic category depicting communities in the central and southern belts of Ghana who are neither Ewes nor Gas, and who speak Twi or Fante as their mother tongue and usually can understand both. Some groups whose identity was formerly distinct are gradually becoming Akan; for instance separate television programming exists for Akan and Nzema speakers, but nowadays an Nzema might take offense if you suggested she or he is not Akan. Correlatively, the Wassaw language is disappearing with disuse as Wassaws nowadays exhibit a preference for Twi or Fante and thus identify themselves as Akan.
2. Rilke, "The Notebook of Malte Laurids Brigge," in Kaufmann (ed.), Existentialism (New York: Meridian Books, 1956), p. 114.
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