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The Fragility of the Human Being and the ‘Right’ to Die: Biojuridical Considerations

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Book cover Human Dignity of the Vulnerable in the Age of Rights

Part of the book series: Ius Gentium: Comparative Perspectives on Law and Justice ((IUSGENT,volume 55))

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Abstract

The chapter analyses thoroughly, in the perspective of philosophical anthropology and philosophy of law, the meaning and relevance of the final phase of human life. The author’s analysis ends up overturning the most common attitude, that multiplies rights forgetting about duties and suggests a rehabilitation of duties also in the final phase of life: duties of the dying, as of his relatives and of the sanitary personnel taking care of the person. The concluding proposal is to re-elaborate the concept of human dignity, subtracting it from the arbitrarily subjective perspective to which it has been recently linked (by its very nature impossible to be central to a proper juridical protection), and inserting it in a vision capable of treating fairly both the structure of the human being and his relations, and true lawfulness.

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Notes

  1. 1.

    As is well known, this subject is studied in depth by Martin Heidegger, Sein und Zeit (1927). For further commentary on the subject, see F. D’Agostino, ‘Fragilità’, in Id., Bioetica e biopolitica. Ventuno voci fondamentali, Torino, Giappichelli, 2011, pp. 119 et seqq.

  2. 2.

    J. L. Borges, The Immortal, en Id., Fictions, (1957), translated by A. Hurley, London, Penguin, 2000, p. 434.

  3. 3.

    See L. Polo, Quién es el hombre. Un espíritu en el tiempo, Madrid, Rialp, pp. 53 et seqq.

  4. 4.

    A. MacIntyre, Dependent Rational Animals. Why Human Beings Need the Virtues, (1999), Carus Publishing Company, Open Court, 2001, p. 73.

  5. 5.

    MacIntyre, Dependent Rational Animals, p. 74. In Italian literature, we wish to point out the work of G. Pontiggia, Nati due volte, Milano, Mondadori, 2001: this novel reflects on physical disability (in this case triggered by a trauma at birth for which the healthcare professionals are at least partially responsible) in the context of a re-thinking of the very concept of ‘normal’.

  6. 6.

    A reflection on the position of MacIntyre and other important contemporary authors can be found in A. Musio, Autonomia come dipendenza. L’io legislatore, Milano, Vita e Pensiero, 2006.

  7. 7.

    In various well-known works, beginning with M. Nussbaum, The Fragility of Good, 1986, and arriving to Creating Capabilities, 2011.

  8. 8.

    For a recent work, refer to Nussbaum, Creating capabilities. The Human Development Approach, Cambridge (Mass.) – London, The Belknap Press of Harvard University Press, 2011, passim.

  9. 9.

    R. Guardini, Le età della vita. Loro significato educativo e morale, (1957), Milano, Vita e Pensiero, 1997, p. 74 (the translation from the Italian version is ours).

  10. 10.

    Guardini, Le età della vita, p. 75.

  11. 11.

    Guardini, Le età della vita, p. 32.

  12. 12.

    Guardini, Le età della vita, p. 74.

  13. 13.

    For more, see the pages dedicate to these issues in I. Kant, Grundlegung zur Metaphysik der Sitten (1785).

  14. 14.

    S. Cotta, Giustificazione e obbligatorietà delle norme, Milano, Giuffrè, 1981; D’Agostino, Corso breve di filosofia del diritto, Torino, Giappichelli, 2011, p. 49.

  15. 15.

    Lastly, there is the general proposition of J. Stuart Mill (On Liberty, del 1859) on the relation between legal rules and individual freedom. We find here the theoretical roots – elementary but incisive – of philosophical and political liberalism.

  16. 16.

    On which, among many others, we suggest the contributions of L. Palazzani, Introduzione alla biogiuridica, Torino, Giappichelli, 2002; F. Freni, Biogiuridica e pluralismo etico-religioso, Milano, Giuffrè, 2000; A. Ollero, Bioderecho. Entre le vida y la muerte, Cizur Menor, Thomson Aranzadi, 2006; E. Hernández – J. Ballesteros (eds.), Biotecnología y Posthumanismo, Cizur Menor, Thomson Aranzadi, 2004.

  17. 17.

    Concerning the cultural and spiritual origins of secularism we could unfold a much larger discussion that goes beyond the scope of this work. Among others, see: M. Weber, Die protestantische Ethik und der Geist des Kapitalismus (1904), and Wissenschaft als Beruf, 1917; also the papers by R. Guardini, Die Macht (1951), and by H. Cox, The Secular City (1965), and more recently by C. Taylor, The Secular Age (2007).

  18. 18.

    This is emphasized with preoccupation by S. Amato, ‘La lotteria naturale è giusta?’, in AA.VV., Verso la salute perfetta. Enhancement tra bioetica e biodiritto, L. Palazzani (ed.), Roma, Studium, 2014, p. 67; and for ample reading on the subject by the same author, see Amato, Biogiurisprudenza. Dal mercato genetico al self-service normativo, Torino, Giappichelli, 2006.

  19. 19.

    See Guardini, Die Macht. Versuch einer Wegweisung (1951).

  20. 20.

    I. Mancini, L’ethos dell’Occidente. Neoclassicimo etico, profezia cristiana, pensiero critico moderno, Genova, Marietti, 1990, p. 67.

  21. 21.

    Cotta, Il diritto nell’esistenza. Linee di ontofenomenologia giuridica, Milano, Giuffrè, 1991, p. 96 (translation is ours).

  22. 22.

    P. Donati has contributed to the subject – in a perspective that is not only sociological – a thorough and lengthy reflection. For our present discussion, see P. Donati, La società dell’umano, Genova, Marietti, 2009.

  23. 23.

    Aristotle, Nicomachean Ethics, V, 32 (1129b).

  24. 24.

    Very opportunely, Amato observes this element as the first among those that characterize the idea of justice in Cotta: A.C. Amato Mangiameli, Arte e/o tecnica. Sfide giuridiche, Padova, Cedam, 2012, p. 23.

  25. 25.

    Cotta, Il diritto nell’esistenza, p. 66.

  26. 26.

    Cotta, Il diritto nell’esistenza, p. 69.

  27. 27.

    Unavoidable is the reference implicit in the Bergsonian idea of durée (H. Bergson, L’évolution créatrice (1907), on which one can refer to G. Saraceni’s study, Il profeta e la legge. Riflessioni bergsoniane di filosofia per il diritto, Torino, Giappichelli, 2005). But, at the heart of the matter, we are again looking at the essential historicity of the human being, as discussed above.

  28. 28.

    Cotta, Il diritto nell’esistenza, p. 72.

  29. 29.

    Cotta, Il diritto nell’esistenza, p. 72.

  30. 30.

    Cotta, Il diritto nell’esistenza, p. 73.

  31. 31.

    I will not enter here in the merit of the interesting distinction made by Amato in Eutanasie. Il diritto di fronte alla fine della vita, Torino, Giappichelli, 2011, p. 107, between “death” and “dying” that would be developed from the bio-technological reworking of the end of human life. In any case, such a distinction confirms the marked indigence of the subject, which is the aspect I intend to highlight here, especially in reference to the task of the law.

  32. 32.

    A reflection on Freud’s observations in this respect is found in D’Agostino, ‘Vita’, in Id., Bioetica e biopolitica., p. 229.

  33. 33.

    See in any case D’Agostino, ‘La riduzione moderna della persona: l’esempio del suicidio’, in Id., Bioetica nella prospettiva della filosofia del diritto, Torino, Giappichelli, 1996, pp. 207 et seqq.

  34. 34.

    M. Heidegger, Sein und Zeit, 1927, II, § 53, n. 263 (translated by J. Macquarrie and E. Robinson, Oxford, Blackwell, 2001, p. 307).

  35. 35.

    “It is indeed very far from being true that, literally understood, one dies of this sickness, or that this sickness ends with bodily death. On the contrary, the torment of despair is precisely this, not to be able to die. So it has much in common with the situation of the moribund when he lies and struggles with death, and cannot die. So to be sick unto death is, not to be able to die -- yet not as though there were hope of life; no the hopelessness in this case is that even the last hope, death, is not available”. S. Kierkegaard [Anti-Climacus], Sygdommen til döden (1849) (translated by W. Lowrie, Princeton, NJ, Princeton University Press, 1941, p. 15).

  36. 36.

    In Belgium there was a recent case of a criminal with a life sentence who requested euthanasia in line with the laws presently in force in that country. The law was clearly adapted, extending the requirement of ‘intolerable suffering’ to his situation of deep affliction arising from the impossibility of reinsertion in society. The predictable reaction of opposition on the part of relatives of the victims of the serial killer’s crimes goes beyond an irrational desire of vengeance, and, in relation to the present discussion, directs us to a deontological interpretation of life and death that seems unlikely to go away. The example of course is extreme, and it is impossible to equate a life sentence and an illness; but in any case it confirms that – on an horizontal and not a vertical plane – our existence and our death are not at our full disposal, because there are values and meanings connected to them that go beyond us. This is an ancient intuition by Aristotle, who condemns suicide as an unjust not so much towards one’s self (strictly speaking, it is impossible to commit injustice towards ourselves), but rather towards the polis (Nicomachean Ethics, V, 11, 1138a).

  37. 37.

    Some considerations on this different but similar paradox in D’Agostino, La sanzione nell’esperienza giuridica, Torino, Giappichelli, 1999.

  38. 38.

    Euripides, Alcestis, 779.

  39. 39.

    See S. Weil, L’enracinement. Prélude à une déclaration des devoirs envers l’être humain (1949).

  40. 40.

    D’Agostino, Filosofia del diritto, Torino, Giappichelli, 1996, p. 245 (Translation is ours).

  41. 41.

    In line with the expression in vogue since a long time in Bio-juridical particularly American literature, at times softened by adding, though increasing ambiguity, with the reference to dignity: see R. Dworkin, Life’s Dominion. An Argument about Abortion, Euthanasia, and Individual Freedom, New York, Vintage Books, 1994.

  42. 42.

    It is telling that when the Italian National Bioethics Committee tried to confront with justice the tensions that accompany the therapeutic relation in view of the patient’s death, the proposed solutions were found unsatisfactory even by the same Committee. See the document Rifiuto e rinuncia consapevole delle cure (October 24, 2008). It seems clear therefore that the attempt to outline such a particular relastionship in terms of reciprocal rights and duties is destined to failure, even more so if we intend to propose a law with general a value.

  43. 43.

    For a concise commentary of this text, see also C. Sartea, ‘Verso una deontologia medica europea. Analisi della Bozza del Documento di Consenso di Sanremo 2010’, in Medicina e Morale, 4/2010, pp. 535 et seqq.

  44. 44.

    I am following here a philosophical and characteristically European perspective, or, at least, not pragmatic like that which is habitually used in the euthanasia debate in the Anglo-Saxon world. For a clear explanation, see G. Dworkin – R.G. Frey – S. Bok, Euthanasia and Physician-Assisted Suicide, Cambridge University Press, 1998.

  45. 45.

    Cotta, ‘Aborto e eutanasia: un confronto’, in Id., Diritto Persona Mondo umano, Torino, Giappichelli, 1989, pp. 213 et seqq.

  46. 46.

    It is noted that this type of argument does not counterpoise two moralities, but rather reflects on the characteristic structure of the juridical relation, which is what is in question when we discuss euthanasia. In this perspective, the observation by U. Scarpelli, misses the mark, see Bioetica laica, Milano, Baldini&Castoldi, 1998, p. 124, according to which “law cannot be here, on the contrary, above all it must not become and instrument to impose a certain moral point of view at the sacrifice of another”.

  47. 47.

    For a detailed analysis of these legislations please see E. de Septis, Eutanasia. Tra bioetica e diritto, Padova: Edizioni Messaggero, Venezia: Marcianum Press, 2007.

  48. 48.

    On this argument, see also D’Agostino, Parole di bioetica, Torino, Giappichelli, 2006, pp. 77 et seqq.

  49. 49.

    Dworkin, Life’s Dominion, p. 26.

  50. 50.

    Dworkin, Life’s Dominion, p. 184.

  51. 51.

    Dworkin, Life’s Dominion, p. 179.

  52. 52.

    Platone, Repubblica, I, 338c.

  53. 53.

    D’Agostino, Parole di bioetica, p. 171.

  54. 54.

    A. Pessina, Bioetica. L’uomo sperimentale, Bruno Mondadori, Milano, 2000, p. 155 (the translation is ours).

  55. 55.

    C.-H. Wijkmark, Den moderna döden (1978). For some bio-juridical consideration on this story see C. Sartea, ‘Tra antico e moderno: di quale morte dovremo morire?’, in Teoria del Diritto e dello Stato, 2010, 1.

  56. 56.

    This is very clear in D’Agostino, Bioetica e biopolitica, pp. 51 et seqq.; for other views please refer to S. Rodotà and P. Zatti (eds.), Trattato di Biodiritto, Milano, Giuffrè, 2011.

  57. 57.

    For a penetrating criticism on jus-positivism, remains unchallenged the lesson of L. Lombardi Vallauri, Corso di filosofia del diritto, Milano, Giuffrè, 1981.

  58. 58.

    D’Agostino, Parole di bioetica, p. 84.

  59. 59.

    This is not a purely factual argument, but rather a structural limit of the legal rule, inapt to regulate in general and in abstract situations that by definition are always extreme: “Any law on euthanasia, even motivated by the best of intentions, inevitably bureaucratizes the dying process, arbitrarily expands the doctors’ power; it strips human death of that tragically exceptional character that belongs to every death, reducing it to a standardized medical treatment. It also provokes a real and true deformation of conscience, causing a rupture between the legal words and their application” (D’Agostino, Parole di bioetica,, p. 87; the translation is ours). On the basis of similar considerations, and developing a delicate and important psychological side, see also Amato, Eutanasie, p. 134: “To strip euthanasia of its dramatic exceptionality, to normalize and trivialize it, transforming it into one right among others, to be noted and categorized in some log, could end up making anyone who chooses not to exercise this right feel guilty” (the translation is ours).

  60. 60.

    The complexity of the situation and its paradoxical nature, is sensed in the tormented Opinion of the National Committee on “Refusal and conscious renunciation of care” of which we have spoken above.

  61. 61.

    On this see also V. Tambone – D. Sacchini – C.D. Cavoni, Eutanasia e medicina. Il rapporto tra medicina, cultura e media, Torino, UTET, 2008, pp. 23 et seqq.

  62. 62.

    The tragic story of Brittany Maynard recently made its way around the world, the American woman in her thirties who, following a diagnosis of incurable cerebral cancer, requested physician-assisted suicide in conformity with the laws in place in her state, triggering a vast discussion on the presuppositions and limits of self-determination in the terminal phase.

  63. 63.

    On this point, all bio-ethical, bio-legal and deontological literature are in agreement: even if there is a foreseeable oscillation between more objective attitudes and positions that produce very idea of “disproportion” (and therefore of futility) starting from the subjective perceptions of the patient: the first ones naturally do not destroy them but are mediated by the evaluations of the competent healthcare professionals.

  64. 64.

    Among the most recent cases we wish to point out that in which even the European Court of Human Rights intervened with a conclusive sentence, Gross vs. Switzerland, Application no. 67810/10, Grand Chamber, 30 September 2014, available online, http://hudoc.echr.coe.int/sites/eng/pages/search.aspx?i=001-146780. Although in the first instance the decision had been in favour of the woman who had solicited the recognition of her right to assisted suicide despite the absence of the grave health reasons required by the law in Switzerland, in the name of the right to privacy sanctioned by art. N. 8 of the European Convention of Human Rights, the Grand Chamber annulled the previous sentence. The case was studied with clever criticism in M. Albert, ‘Derecho a morir y abuso del derecho. La inadmisibilidad del caso Gross v. Suiza. Comentario a la Sentencia de la Gran Sala del Tribunal Europeo de Derechos Humanos de 30 de septiembre de 2014’, in Medicina e Morale, 6/2014, pp. 1027 et seqq.

  65. 65.

    In this respect, I also share the considerations of Amato, Eutanasie, p. 135: “Only the profound spiritual crisis of our time can cause to emerge the claim of a right that denies the very value of the subject exercising it, altering the structure of the medical relation and modifying the sense of legal service”.

  66. 66.

    D’Agostino, ‘Biopolitica’, in Id. Bioetica e biopolitica, 2011.

  67. 67.

    We must remember that this hermeneutic was actually only used in one case, by the Italian Constitutional Court, in sentence 438 of 2008, on which the following author writes at length and positively: Rodotà, Il diritto di avere diritti, Roma-Bari, Laterza, 2012, pp. 261 et seqq.

  68. 68.

    Among others, see the recent proposal by A. Nicolussi, ‘Enhancement e salute nel rapporto medico paziente’, in AA.VV., Palazzani (ed.), Verso la salute perfetta, pp. 89 et seqq.

  69. 69.

    It has also been well written that “the body is not an aspect of will that one can dispose of as per any other good, but a guarantee of freedom. It is not the dimension of the owner, but that of identity that develops and feeds the demand to build a protective sphere impassable by the prohibition of any kind of bodily invasion” (Amato, Eutanasie, p. 85; the translation is ours).

  70. 70.

    I refer here to the well-known proposal by I. Berlin, Four Essays on Liberty (1969).

  71. 71.

    The most striking case is the opening of euthanasia to minors in Belgium (integrations of December 2013 to the law on euthanasia of 2002).

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  1. Dipartimento di Diritto Pubblico, Facoltà di Giurisprudenza, University of Roma-Tor Vergata, Roma, Italy

    Claudio Sartea

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  1. Faculty of Law, University of Valencia, Valencia, Spain

    Aniceto Masferrer

  2. Department of Political Sciences, Ethics and Sociology, CEU Cardenal Herrera University, Alfara del Patriarca, Valencia, Spain

    Emilio García-Sánchez

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Sartea, C. (2016). The Fragility of the Human Being and the ‘Right’ to Die: Biojuridical Considerations. In: Masferrer, A., García-Sánchez , E. (eds) Human Dignity of the Vulnerable in the Age of Rights. Ius Gentium: Comparative Perspectives on Law and Justice, vol 55. Springer, Cham. https://doi.org/10.1007/978-3-319-32693-1_12

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