"The Good Death and the Ethics of Dying Well" 

Notes and Resources

Notes

[1] It is important to pay attention to the particularity of our post-modern condition, which also leads to a particular attitude toward death. For an historical analysis, see the classic works of Phillippe Ariés, Western Attitudes toward Death: From the Middle Ages to the Present (Baltimore: Johns Hopkins University Press, 1974), and Images of Man and Death (Cambridge, MA: Harvard University Press, 1985).  

[2] James Rachel, The End of Life: Euthanasia and Morality (New York: Oxford University Press, 1986).​

[3] T. L. Beauchamp, J. F. Childress, Principles of Biomedical Ethics, 7th edition (Oxford University Press: New York, 2013).  The first edition of the text was published in 1979.  As one knows, “principlism” has been the subject of sharp criticism in the debate over the method of bioethics, both in the United States as well as in Europe. See, E. R. Du Bose, R. Hamel, L. O’Connell (eds.), A Matter of Principles? Ferments in U.S. Bioethics (Trinity Press International: Valley Forge, 1994); H. Ten Have, “Approcci europei all’etica della medicina clinica,” in C. Viafora (ed.), Comitati etici. Una proposta bioetica per il mondo sanitario (Gregoriana: Padova, 1995), 91-118; G. Khushf (ed.), Handbook of Bioethics: Taking Stock of the Field from a Philosophical Perspective (Kluwer Academic Publishers: Dordrecht, 2004).

[4] For a criticism of bioethics as a purely secular field of investigation, autonomous with respect to any moral substantial premise of content, therefore, as a purely formal endeavor, see J. H. Evans, Playing God? Human Genetic Engineering and the Rationalization of Public Bioethical Debate (Chicago University Press: Chicago, 2002).  Evans’ analysis, which turns on Weber’s distinction mentioned above between formal and substantial rationality, refers to the discussion on genetics and genetic research. Nevertheless, in its basic meaning, it could obtain for the whole of bioethics, as it has developed in the United States. For a more generous account of the history of bioethics as public discourse, see A. R. Jonsen, The Birth of Bioethics (Oxford University Press: New York, 1998), in particular pp. 352-376.

[5] Thus, von Hildebrand, commenting on Pascal (Pensées, VI, Frag. 347) writes: “And so (Pascal) alludes to in a singular manner the contradictory nature of the metaphysical situation of mankind, in part due to the fallenness of life, yet also to the ineffable survival of his personal condition after death.” D. von Hildebrand, Über den Tod (EOS Verlag: St. Ottilien, 1980), 33.

[6] In this distinction I rely upon Louvain’s philosopher William Desmond.  See his “Pluralism, Truthfulness, and the Patience of Being,” in C. Taylor, R. Dell’Oro, Health and Human Flourishing: Religion, Medicine, and Moral Anthropology (Georgetown University Press: Washington, 2006), 53-68.  This distinction can be understood in light of the complete work of Desmond, above all, his metaphysical trilogy, Being and the Between (State University of New York Press: Albany, 1995); Ethics and the Between (State University of New York Press: Albany, 2001); and God and the Between (Blackwell Publishing, 2008). For a study of Desmond’s thought, see T. Kelly (ed.), Between System and Poetics: William Desmond and Philosophy after Dialectic, (Ashgate: Burlington, 2007).  An entire issue of the journal Ethical Perspectives has been entirely dedicated to a discussion of Desmond’s ethics.  See Ethical Perspectives: Journal of the European Ethics Network 8 (2001) 4.

[7] W. Desmond, Ethics and the Between, op. cit., 17-47.  

[8] W. Desmond, Ethics and the Between, op. cit., p. 29 (emphasis in the original).

[9] According to Leo Scheffczyk, this is the final outcome of Heidegger’s reflection, which, if on the one hand, recognizes death in its inevitability of fact that occurs, on the other, tends to overcome it “trans-subjectively”: “For Heidegger’s Being and Time, death as the end of earthly existence no longer constitutes a philosophical term in and of itself, rather the ultimate attitude toward an inevitable fact. In this sense, death cannot be completely absorbed by subjectivity.  It is precisely in death that the limits of existence and human action become clear. Nonetheless, to the extent in which death is no longer viewed as the ‘ultimate enemy’ of human life (...), rather, it is interpreted as the highest point of human maturity and perfection, it becomes necessary to understand the facticity of death ‘trans-subjectively’.” L. Scheffczyk, “Die Phänomenologie des Todes bei Dietrich von Hildebrand und die neuere Eschatologie,” in Truth and Value: The Philosophy of Dietrich von Hildebrand (Peter Lang: Bern, 1992), 271.  In an analogous manner, Viafora, too, qualifies Heidegger’s zum-Tode-sein as a turning point: “It is a turning point in the sense that the question of death is no longer posed in light of the idea of an ‘end’, nor of the idea of ‘passing’, rather it is now considered to be an expression constitutive of, and inseparable from, the human condition. Above all, it is a turning point because “being unto death” is no longer a source of nonsense, rather, and on the contrary, as the singular source capable of opening up the authentic sense of existence.” C. Viafora, “Le figure del morire nel mondo occidentale,” in M. Bonetti, M. Rossi, C. Viafora (eds.), Silenzi e parole degli ultimi giorni di vita (Franco Angeli: Milano, 2003), 71.

[10] William Desmond renders the Greek thaumazein with “agapeic astonishment” in Being and the Between, op. cit., 3-46.

[11] This inevitably entails a de-mystification of the modern ideal of autonomy, a recognition that, in the long run, Kantian autonomy degenerates into will to power, as in Nietzsche. On this, William Desmond, Ethics and the Between, op. cit., in particular 17–47.  Theologian Romano Guardini shares in the assessment that Nietzsche stands in the “effective history” of Kant.  See his Das Ende der Neuzeit (Werkbund Verlag: Würzburg, 1951).  Also Henri de Lubac (ed.), Le drame de l’humanisme athée (Éditions Spes: Paris, 1945).  For a different, more positive interpretation of modernity, with respect to the ideal of autonomy and its possible Christian reinterpretation, see J. Schwartländer (ed.), Modernes Freiheitsethos und christlicher Glaube (Kaiser: München, 1981), especially the contributions of Schwartländer, Honecker, Kasper and Böckle.​

[12] From a Christian point of view, this acceptance concerns both suffering and death, and yet not in the sense of a masochistic passivity.  Klaus Demmer writes: “In the end, the Christian faith is anything but an ideology of suffering. Even for the Christian, suffering does not possess value in and of itself, and therefore it is never sought for its own sake. Rather, one accepts it, almost as an anticipation of death, which, too, must be accepted,” Klaus Demmer, Leben in Menschenhand: Grudlagen des bioethischen Gesprächs (Herder: Freiburg, 1987), 146. On the topic of suffering, see the reflections of Max Scheler, “The Meaning of Suffering,” in Max Scheler (1874-1928): Centennial Essays, ed. Manfred S. Frings (The Hague: Martinus Nijhof, 1974), 121- 163.  From a strictly theological perspective, see Dorothee Sölle, Suffering (Philadelphia: Fortress Press, 1975).

[13] Eberhard Jüngel, Death: The Riddle and the Mystery (Westminster Press, 1975), 85.

[14] Norbert Elias, The Loneliness of the Dying (Continuum: New York, 2001).​

[15] On prayer as a dimension of the ars moriendi, see Warren Reich, “L’arte del prendersi cura del morente,” in Itinerarium 4 (1996): 31-43.

[16] I am thinking here, most obviously, of the so called “naturalistic fallacy”.

[17] Retrievable at https://bioethicsarchive.georgetown.edu/pcbe/reports/taking_care/index.html

[18] Pat McCarrick (ed.), “Living Wills and Durable Power of Attorney: Advance Directive Legislation and Issues,” Scope Note 2, National Reference Center for Bioethics Literature, Georgetown University, 1992.  

[19] With reference to the distinction of Bonhöffer,  see Paolo Cattorini, “Tra resistenza e accettazione: indicazioni etiche per superare accanimento vitalistico ed eutanasia,” in P. Benciolini, C. Viafora (eds.), Etica e cure palliative. La fase terminale (CIC: Roma, 1998), 77-87.​

[20] Michel Maret defines euthanasia as “the paradoxical figure of autonomy.” See, M. Maret, L’euthanasie. Alternative sociale et enjeux pour l’éthique chrétienne (Editions Saint-Augustin, 2000), in particular pp. 71-100. For an articulation, both anthropological and theological, of the dialectic of activity and passivity in dying see K. Demmer, “Handeln als Einüben des Sterbens. Ein Kapitel theologischer Anthropologie,” in A. Holderegger (ed.), Das medizinisch assistierte Sterben. Zur Sterbehilfe aus medizinischer, ethischer, juristischer und theologischer Sicht (Herder: Freiburg, 1999), 175-191.

[21] Jay Katz, The Silent World of Doctor and Patient (Johns Hopkins University Press: Baltimore, 2002).​

[22] For an empirical analysis of the relation between doctor and patient with respect to death, see the instructive study of K.K. Curtis, M.G. McGee, “An Overview of Physician Attitudes toward Death and Dying: History, Factors, and Implications for Medical Education,” in Illness, Crisis, and Loss 8 (2000): 341-349.

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