When my father was at the end of his life, I had the opportunity to get to know his ICU doctor a little bit. The experience shed some light for me on the question under discussion here.
The context was torturous for many reasons, including that in our family there was no agreement on the question of actively ending my dad’s life.
He had been unresponsive for months in the hospital in Los Angeles and suffered both a heart attack and a stroke in the meantime. There was one, later two, other immediate kin who felt confident he would want to be removed from life support and allowed, quickly, to die. They insisted therefore that this was the right thing to do.
For my part, committed to Orthodox Judaism, I could not give my consent to this—even if others in our family were correct that, had we put the question to him when he was still well, that’s what he would have said he wanted.
With me as an unexpected ally stood the doctor. I say unexpected because the nursing staff and social workers at the hospital made no secret of their own views. One male nurse asked when our family was going to “let him go.” That was always the favored euphemism. I said, “I don’t know. I’m not sure. Not yet,” to which the nurse responded in a brutal, clipped manner that shocked me, “Why not?”
The doctor never had a conversation with me about his own religious or philosophical beliefs. He had a Persian name and an accent that sounded faintly German. Let’s call him Dr. Pahlavi. When other family members pressed him on cutting off life support, he was dismissive, disgusted at the idea. “That’s stupid,” he exclaimed to me. Dr. Pahlavi argued strongly for giving my dad more time to wake up, even if it meant, as seemed certain, that he would awaken to permanently diminished strength and mobility.
Did the doctor have religious beliefs that insisted on the sacredness of life? He gave no indication of it. Dr. Pahlavi explained his view in oddly professional terms: “I worked too hard keeping your father alive to let him die now.” When I told him what the nurse had said about “letting him go,” Dr. Pahlavi was angry and demanded to know, “Who said that? Who?” (I declined to say, not wanting to get anyone in trouble.)
I found it hard to believe that the doctor’s adamancy arose, as he claimed, merely from not liking the idea of having fruitlessly spent his own energies. The strength of Dr. Pahlavi’s feelings, faced with intense opposition from some of the patient’s family, seemed to demand another explanation.
Often we rationalize gut-level responses to experiences, giving a practical or philosophical rationale for something that goes much deeper in us. I agree with Wesley Smith that the sacredness and dignity of life should not have to offer religious defenses for itself. My conversations with Dr. Pahlavi reminded me that it may be possible to call on other instincts. A pre-religious intuition recognizes there is something awesome, worthy of holding in dread—fearful, in the sense that William Blake had in mind when he described the tiger’s “fearful symmetry”—about a human life, even if the person whose life it is can’t speak for himself. We don’t dare hasten its end, even if the patient were to tell us he prefers that, or make use of it for our own purposes.
Fear at the mystery of a human life may be just the right word for what I am trying to invoke. There need not be any shame in speaking in praise of a universally accessible fear, nor embarrassment at the possibility of encouraging a dread superstition. We may feel more comfortable calling up prudential reasons and practical wisdom to do battle for us in public debates. But what people dismiss as superstitions are sometimes just the preserved memories of wisdom.
It’s not religion I am appealing to. However my own faith offers the confirmation that before revelation comes in, healthy instincts instruct us. Jewish tradition distinguishes those of God’s commandments that we know only by revelation from those that long preceded the giving of the Torah to Moses at Mt. Sinai. The group of moral precepts known to the children of Noah, that is to all of humanity before there was ever a Jewish people, fall into seven categories. They are called the Noachide covenant.
The Talmud’s tractate Sanhedrin shows how they can be derived, with their many details, from certain verses in Genesis. Judaism’s opposition to hastening the death of even a very ill and moribund person, like its opposition to abortion, comes from there. Unlike the covenant with the Jews at Sinai, this universal Noachide covenant was never the subject of an explicit revelation. Yet somehow its principles are known, around the world, without the need of a theophany.
The fearfulness that attends the taking of a man’s life is such that it is known not only to men but even to animals. The Talmud records a teaching from a second-century sage:
“Rabbi Simeon ben Eleazar said: A day-old infant, alive, requires no protection from a weasel or from rats. But Og, king of Bashan, dead, must be protected from a weasel or from rats, for Noah and his children were told, ‘The fear of you and the dread of you shall be upon every beast of the earth’ (Genesis 9:2)—as long as a man is alive, the fear of him is laid upon creatures; once he is dead, such fear ceases.” (Shabbat 151b)
Even a weasel, even a rat, instinctively senses the awful potency of a human life, including a helpless one, and holds it in dread. However once a human being dies, including a once-mighty specimen like the monstrous King Og, who slept on a bed nine cubits long or about 13.5 feet (Deuteronomy 3:11), the fear has fled. The same is not true of living or dead animals. They enjoy no aura of sanctity.
Without religion, without philosophical instruction, weasels and rats both recognize human exceptionalism. Compared to these common pests, why are we so much less sensitive to the aura cast by human life? You can attribute that, probably, to the numbing mental habits that come with a culture of materialism. Recovering our sensitivity is probably less a matter of hearing political arguments or absorbing religious teaching than it is of unlearning materialist dogmas.
That happens, among other ways, when we carefully observe the hints of purpose and design in the world, subtle evidence in life, down to the tiniest machinery in the cell and the enigma of the genome, that gesture to some source of immaterial agency and intention operating behind the façade of existence. That’s a different thing from a religious belief or intuition, though not irrelevant to it.
I admit this doesn’t necessarily shed any light on Dr. Pahlavi’s private thoughts about life and medicine. But apart from instinctive dread, I’m hard pressed to think of a reason why people unmoved by religious traditions may still retain the fear of treating life cheaply. I hope that this instinct is only dormant, waiting to be uncovered, among many of us.
My father, in the end, died at the insistence of others in my family and with his own agreement. Or so I was told.
But that was not before a small miracle happened. For months I flew down to Los Angeles from Seattle regularly to visit him, each time finding him unresponsive. Occasionally he would open his eyes, but my dad was already blind when he became ill. With a tube down his throat to help him breathe, there was little hope of his being able to speak even if he did wake up. Social workers urged that he be taken home to die in a hospice setting. At that point I had not been able to communicate with him for more than three months.
Before one visit, though, a friend offered what seemed like a whimsical suggestion: “Maybe he’d like to write. Why not give him a piece of paper and see?” Well, why not? I said I would.
And so, amazingly, it turned out. My dad was now out of the ICU and in a nursing facility but still seemingly unconscious. Minutes after walking through the door of his room I took his hand and put a pen and paper in it. His hand moved, grasped the writing implements. He started writing.
It looked like chicken scratch at first but in a few minutes I could make out what he wanted to say. “Thirsty,” he wrote. “Water.”
I’m compressing a lot here but after being allowed to communicate—as he could not otherwise, being blind and with the tube down his throat—my dad recovered the ability to write and, on my last visit before he died, even to speak if very hoarsely and haltingly, one syllable at a time. He was the same person he always had been, fully lucid, but now, briefly, freed from the prison that being unable to communicate had imposed on him. So many others around him assumed that only his body lived, a husk, an existence unworthy of an animal. “Let him go!”, they said. But they were wrong, and he proved it better than any argument could. He showed us the spark of his entire personality was still there all along, dreaming, waiting to be uncovered.
The exceptionalism of a human being is a fearful thing not entirely capable of being expressed in terms you would call rational, or religious. It’s apprehended more often by a pre-conceptual awareness, much as Abraham Joshua Heschel wrote of the way we recognize God, before being able to put that recognition in words or ideas.
Sometimes, in moments like those I had with my father, it reveals itself more clearly. The challenge for those who would defend the sacredness of life is to help others uncover the awareness, the sensitivity, that waits and dreams in themselves.