[1] In several ways this book brings an innovative approach to the treatment of some wide-ranging subjects regularly addressed in social ethics courses. The subject of death functions as a blanket concept in analyzing the ethical issues surrounding abortion, the death penalty, war, suicide, physician-assisted suicide, and euthanasia. The focus on death and dying provides an opportunity for philosophical and theological reflection that gives added depth to the consideration of these topics. In the book’s introduction the authors state, “Our effort in these pages is to deliberate on the moral meaning of death for the living.”
[2] Another innovative feature is the collaboration of a philosopher and a theologian in producing this book. Lloyd Steffen is professor of religious studies and university chaplain at Lehigh University in Bethlehem, Pennsylvania, and Dennis R. Cooley is professor of philosophy and ethics at North Dakota State University in Fargo, North Dakota. After a brief introduction to each chapter, each author writes his own short essay on the topic. This is followed by questions that each addresses to the other, with a concluding section in which each responds to those questions. They call this method “dialogic engagement” that brings out the assumptions and perspectives found in their two disciplines.
[3] The initial chapter serves as an introduction to ethical reasoning. Each author offers his view on the normative principles and values that underlie ethical decision making and which enter into their approaches to the subject of death and dying. The usual three theories are discussed – deontological/Kantian ethics, utilitarian/consequential ethics, and virtue ethics. In addition Steffen discusses a natural law ethic which he himself espouses, but noting that he is critical of the way in which it has been interpreted in Roman Catholicism. His preference for it is based on what he calls its “flexibility,” which he believes allows him to affirm aspects of the other theories while avoiding their weaknesses. He concludes with a brief description of “divine command” ethics, a specifically religious theory espoused notably by Karl Barth. Steffen questions, rightly in my view, whether this position can escape the fact that every divine command – typically found in a religion’s sacred scripture – involves human interpretation and thus does not eliminate the problem of conflicting views on the meaning of a given command.
[4] Cooley concludes that there are universal ways around the world in which people think about morality, reflecting the fact that both deontological and consequential thinking are applied depending on the circumstances. He combines these two theories under what he calls a “Pragmatic Principle” that allows for the circumstances in a particular situation to influence one’s ethical decision. Both authors recognize the impossibility of absolutizing one particular ethical theory, and both are open to the values and insights that each theory can contribute to ethical situations. The end result is what they call a “hybrid ethic,” with duties, consequences, and virtues all having a role to play. I think Steffen makes an astute observation here: “Ideology, religious teachings, relationships, assumptions (many of them unexamined), and empirical realities all play a huge role in our decision making – and our theories sometimes do not or cannot deal with all of these factors.” (50)
[5] Turning to the social issues that are addressed, I found the substantial analysis of each issue to be quite helpful in bringing out the complexities they pose for ethical decision making. The discussion was balanced, and in a way that would encourage open discussion should the book be used as a classroom text. In regard to abortion, both authors allow for justifiable abortions but also emphasize that while morally permissible, the decision to abort is always a tragic choice. In light of the extensive religious response to this issue, Steffen briefly discusses the positions of various traditions. Cooley suggests that the notion of stewardship, while usually not appearing in discussions of abortion, applies well in describing the appropriate attitude of a pregnant woman. She does not “own” the life in her, but under normal circumstances has a steward’s obligation to it.
[6] The death penalty and war are two issues that focus particularly on the state rather than the individual. The authors recognize that capital punishment is embedded in the history of a Western culture dominated by Christianity, but both of them believe that its actual practice compels one to repudiate it. Any reasonable list of criteria establishing what would be a just death penalty is contradicted far too often by the way it is applied. A strong case is made on the “morally defective” nature of our judicial system, betraying an unsettling degree of racism, sexism, and classism. Cooley argues that those in favor of capital punishment invariably hold an idealized view; their thinking would likely change if each jury member were required to be at the switch executing the victim.
[7] The authors are more open to the possibility of justifiable war, but express reservations about just war thinking. If it is to avoid becoming a routine means of justifying the use of violence, it must become a just war ethic that proceeds with the moral presumption that conflicts should be settled in some way other than by war or a use of force – a kind of “practical pacifism” stance. Steffen sees a just war ethic as the best resource for doing a moral analysis of war, while Cooley, when it comes to the use of violence, is impressed by the stance of non-violent resistance in the mode of Gandhi and Martin Luther King.
[8] I found the chapters on suicide, physician-assisted suicide, and euthanasia particularly rich in their reflections on death and dying – not surprising given their intensely personal nature. Each of these three acts is given a particularly extensive analysis, helping the reader to grasp their highly complex nature. Both authors allow for suicide as a rational choice, with Cooley arguing that it can be an authentic act if it is consistent with one’s life story. Steffen notes that 90% of all suicides involve mental illness, leading him to conclude that a suicide committed for morally justifiable reasons will be extremely rare. While holding a relatively open approach to suicide, both authors bring a moral presumption against the act of suicide. While the word itself carries the onus of disapproval, there has been a significant evolution in moral judgments of suicide marked by greater compassion and a deeper understanding of human psychology. They welcome this development.
[9] Both authors acknowledge a valid presumption against physician-assisted suicide (PAS), but they refuse to absolutize it. They respect the patient’s desire to die (under acceptable conditions) as a valid factor in assessing the situation. Steffen holds in high regard the moral thinking that lies behind Oregon’s Death with Dignity Act, the first to legalize PAS in the United States when it was signed into law in 1997. That Act includes extensive regulations (over 70 different qualifications, restrictions, authorizations, and conditions) that he believes might well serve as a model for other states, and he proposes ten conditions of his own that would insure a responsible exercise of PAS. He notes that under the Oregon law 115 prescriptions were written in 2012 and 77 people followed through by choosing to hasten their deaths – 77 out of 32,475 deaths in Oregon that year.
[10] Steffen acknowledges that religious traditions have been quite negative in their response to PAS, but he sees significant diversity on the issue within most traditions and anticipates that diversity to increase as end-of-life issues press on more and more families. The Christian sees life as a gift of God, but when that gift has turned into an endless, excruciating journey that begs for a merciful release, is there a place for PAS? The authors consider the arguments against it, including one that I have found particularly troubling: As it becomes more extensively legalized, the practice of PAS may quite possibly create the expectation and eventually the duty of the patient to submit to it. This feeling could particularly affect women since they tend to live longer than men and are more likely to face poverty from reduced financial circumstances. Cooley recognizes the possibility of people experiencing a “duty to die” as a social norm, but believes that it need not happen “if the system is set up correctly,” meaning a wise administration of comprehensive and stringent regulations that respect the freedom of the patient to make his or her own decision.
[11] The chapter on euthanasia includes discussion of futility as a viable concept: There are conditions worse than death, which means that life is not an absolute good. Steffen lists six conditions that justify withholding treatment and letting the patient die, which is not “killing” the patient. He regards the principle of double effect, from the Roman Catholic ethical tradition (as well as Buddhist and Islamic ethics), as a useful guideline in conducting palliative care. This leads to one of the more notable disagreements between the authors. Cooley regards palliative care as “passive” euthanasia, and he accepts James Rachels’ oft-cited argument that there is no moral distinction to be made between passive and active euthanasia. To distinguish between “letting die” and “killing” is little more than attempting to salve one’s conscience, he says, an obfuscation we should avoid. I’ve always agreed with Paul Ramsey’s refutation of Rachels’ argument, and think that Steffen has the stronger position on this issue. In bringing out the moral complexity of euthanasia, Cooley concludes that “it might be impossible to make any moral judgments on euthanasia’s morality in general.” (296) The extensive analysis of this issue and the spirit of humility generated by its complexity are two aspects of this chapter’s discussion that I found commendable.
[12] In a brief, concluding chapter Steffen reflects more broadly on the meaning of death in human life. He sees a dialectic in the human experience of death, revealing both negative and positive values. In the ethical issues discussed in this book, death is seen primarily as an evil and a threat that must be held at bay, but the authors do not conclude that life must be maintained at all cost. So much of the organized activities of a society is aimed at preserving and sustaining life so that the threatening experience of death can be avoided. And yet there is a positive value in death intertwined with the negative, a value that is expressed in different ways in both religion and nature. Death is the necessary prelude to new life, the setting for resurrection in Christian faith and integral to the flourishing of the natural world. The human encounter with death, while bringing the tragedy of separation, can also evoke engagement with meaning and value at their deepest level. This book makes its contribution to the achieving of that goal.