The then governor of Colorado Richard Lamm in April 1984 made a statement that;Elderly people who are terminally ill "have a duty to die". Like leaves which fall off a tree forming the humus in which other plants can grow, we've got a duty to die and get out of the way with all of our machines and artificial hearts, so that our kids can build a reasonable life(1)."

This provoked an uproar with confrontations with various public groups and calls for his resignation. His intent was actually to highlight the fact that due to advances in medical science, people who would normally die of terminal or debilitating diseases are being kept alive for much longer - often at huge expense and with no improvement in quality of life (or indeed being aware of it). Paying for this life extending treatment has the potential for destroying entire families financially, and even when the line is drawn and the loved one is allowed to die there is enormous guilt attached causing family members to feel that they are somehow responsible for the death. John Hardwig was one of the few who decided to look at this “Duty to die” idea clearly, and even though at the start of his essay “Is There a Duty to Die” he clearly states that “It goes without saying that there is no duty to die(2).” (Throughout this essay I will be referring to this work.) He nevertheless goes on to say that he believes that he may one day find himself having a duty to die. In this essay I will attempt to explain how Hardwig understands why there might be a duty to die, and show that while there cannot be a circumscribed set of circumstances where death is expected by duty, it is possible that we as individuals may feel that we do in fact have a duty to die at some point, probably for the benefit of our families. After all most of us spend our lives taking care of others in our family, what is death but another hurdle to be overcome in order to help them?

Hardwig believes that some day he will arrive at a time where he might have a duty to die. He talks of “lifeboat cases” (e.g. Capt. Oates) where he thinks that almost everybody would agree that there could be a duty to die, and of cultures where the old and infirm felt (duty bound) that they should end their lives and were supported by the whole community in preparing for this. In speaking of these cultures and of our inclination to dismiss their practices he says that we have come to think we are exempt from any duty to die because wealth and technology are saving or extending our lives; soon we may overcome diseases like AIDS, cancer, stroke and the rest. However the dark side is that these medical triumphs are delivering us to chronic illnesses and eventually the need to have others care for us for longer when we become unable to care for ourselves. Hardwig polled his undergraduate students (while this is not strictly speaking an acceptable tool for statistical purposes it would seem to agree with the feelings of all of the people I have personally spoken with on this issue) and found that young people agreed with many older people in not wanting to become a burden to their families due to requirements for their care. The burden of care can cause the lives of caregivers to become impossible - 24 hour a day care continuing for years can destroy their lives. What Hardwig calls the “individualistic fantasy” implies that our lives are our own, and that any choices we make and any support we obtain do not affect the lives of others. This is of course incorrect in so many ways and not just from the point of view of close family members who are providing the care. They can be unable to form and maintain friendships, or work, or study and may find themselves also unable to interact with other members of the family in the way that they should. The costs involved in full time professional care for an affected family member often become prohibitive, ending up with them being sent home to be cared for by the family and often that duty of care will fall more

heavily on one member of the family who from duty to the rest of the family feels unable to complain about the burden it imposes. As Hardwig points out, the total cost is not just financial; loss of income, inability to pursue study or employment or other business interests all add up to much more. Members of families have duties to each other to protect and nurture and do not usually make choices that adversely affect the future and well being of other family members and this includes a duty to care for those family members who may be infirm or otherwise unable to care for themselves. He says that caring for family members who are no longer able to care for themselves can often be a positive experience and that while it is, there can be no duty to die. However this is not always the case, and being a member of a family is a two way street - in the same way that we have a duty to care for the infirm, they have a duty to consider the well being of other family members being affected by their own condition and may have to make hard decisions about their own future including whether to die whether by refusing life prolonging medical support or by other means. It occurs to me that even thinking about whether your family will be better off without you is an acceptance that you can see that there can in fact be a duty to die. Discussing this with other family members can be problematical from several viewpoints - family members love us and feel guilty when even the thought of allowing us to die is mentioned, even if we decide we cannot go on the family may feel obliged to insist that we accept life prolonging procedures and technology. This is where living wills and advanced directives must be put in place and be supported by the legal and medical systems.

Hardwig addresses three possible objections to there being a duty to die;1) There is a higher duty which always takes precedence over a duty to die. 2) A duty to end one's own life would be incompatible with a recognition of human dignity or the intrinsic value of a person. 3) Seriously ill, debilitated, or dying people are already bearing the harshest burdens and so it would be wrong to ask them to bear the additional burden of ending their own lives(3).

Answering 1) he says that it is not clear that religion is holding life as sacred in the way that is commonly understood and points to Christian theology as not clearly stating that death is evil and anyway most people do not agree that life should be preserved at any cost. This is also my view. I also think that those who formulated those religious directives hundreds or thousands of years ago could not have had any conception of a medical method of keeping what amounts to a corpse technically alive indefinitely by using machines. Answering 2) Hardwig makes the point that making the choice for death gives one moral dignity and is selfless helping those who are important to us. This is also my own personal opinion - setting a dignified example for the rest of my family will, I hope, give them the courage to face their own mortality when the time comes for them, and to consider it from others viewpoint as well as their own. Responding to 3) he uses examples of people choosing not to die and causing severe, often irreparable damage to the lives of those who had to care for them and asks which is the greater burden, the destruction of a life that has many years to run, or the loss of a life which has a span only measured in weeks or months?

I believe that there can be a duty to die but the choice to end your own life would (I imagine) require great strength of character and determination to carry it through and those who cannot make this choice should not be condemned for it - there can be, after all no legal duty to die. Those who reach the point where they feel that there is

nothing to be gained by anybody in prolonging their lives should be allowed to decide how and when to end their lives, and be allowed to do so with dignity. The choice should be theirs as to whether their own loved ones can take part in this decision. For those who are no longer able to choose for themselves there cannot possibly be a duty to die, but family and expert medical and psychological opinion should be sought as to validity of the reasons for ending life if it should come into question. There can be no “Duty to Die” as something that applies to all people.

1. http://www.time.com/time/magazine/article/0,9171,952398,00.html#ixzz1b54R9kyG

2. John Hardwig, Is There a Duty to Die, Hastings Center Report 27, no. 2 (1997): 34-42.

3. John Hardwig, Is There a Duty to Die, Hastings Center Report 27, no. 2 (1997): 37