This week, Wesley J. Smith posted a lengthy review of my book, Liberalism's Troubled Search for Equality: Religion and Cultural Bias in the Oregon Physician-Assisted Suicide Debates, in the conservative journal First Things. As a progressive, I don't see eye to eye with Smith on many issues (e.g., although I hate these labels, I often fall on the "pro-choice" side of many social issues like abortion). But we agree that legalized physician-assisted suicide (PAS) in the context of our current health care system--which leaves 48 million Americans without health insurance and many persons with disabilities without the care they need--puts vulnerable patients at risk. I'm grateful to Smith for the review, which reflects a careful reading of my argument.

I've included an excerpt here, with a link to the full article. Smith concludes the review by stating that "Jones’ logically argued and precisely aimed brief against assisted suicide from a liberal philosophical perspective—no call to respect the sanctity of human life here—is a distinct service to the broader debate."

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Liberalism’s Troubled Search for Equality

By Wesley J. Smith

Wednesday, March 5, 2008, 7:30 AM

In Liberalism’s Troubled Search for Equality, Robert P. Jones takes the measure of contemporary assisted-suicide advocacy through a distinctly liberal lens. He has impeccable credentials for this task: He is the director and senior fellow at the progressive think tank Center for American Values in Public Life, given birth by the progressive political-advocacy group People for the American Way. In fact, it is Jones’ fervent liberalism that leads him to declare boldly that legalized assisted suicide violates the principle of “egalitarian justice.”

This is an interesting, and one might even say daring conclusion, particularly given that it conflicts with mainstream thinking of the liberal establishment. This includes the views of liberal guru and philosopher Ronald Dworkin, who has long championed assisted suicide in books, articles, and amicus court briefs.

Jones deeply admires Dworkin, yet he doesn’t hesitate to hoist the philosopher on his own petard by demonstrating that assisted suicide violates Dworkin’s oft-stated principles of egalitarianism, which Jones laments stem from “peculiar inconsistencies within his theory.” Thus, Jones writes not out of animus but devotion to the cause, hoping that, by extricating assisted suicide from other progressive agenda items, he can help his movement take “a critical step on the path toward a more egalitarian liberalism.”

You can read the rest here.

You can buy the book here:

Labels: end of life, equality, health care, liberalism, physician-assisted suicide

Note: this entry cross-posted at the Common Good Blog at Catholics in Alliance for the Common Good.

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While Catholic opposition to physician-assisted suicide (PAS) is often mentioned in the same breath as abortion and grounded in an appeal to the sacredness of human life, there is a strong but often-neglected argument against the legalization of PAS that also relies on other key principles of Catholic Social Teaching, particularly its emphasis on social justice and the common good.

The 10th anniversary of the Oregon Death with Dignity Act, which made Oregon the only state to legalize physician-assisted suicide (PAS), came and went largely without controversy last fall. But embedded in this issue are important lessons about the interrelationship between protecting life and social justice. In an election year, when complex issues are too often reduced to sound bytes, making these connections is an important moral exercise that helps us re-envision how a commitment to the common good might change our politics.

Many think of debates about PAS as just another round of the “pro-life”/“pro-choice” abortion debates. But choices about PAS, if they are to have moral significance, must be un-coerced, free choices. And meaningful choices must be available not just to the privileged few but to everyone. A common good lens highlights the stark inequalities in our society that too often constrain, threaten, or even prohibit meaningful free choices for many vulnerable citizens on this issue.

It is no secret that the health care system in America needs repair if not complete overhaul. The U.S. Census Bureau reports that in 2006 the proportion of Americans without health insurance rose to 15.8 percent, or 47 million people, and a recent report by Families USA found that almost 90 million Americans under age 65 were uninsured for some or all of the 2006-2007 two-year period. Not surprisingly, minority groups bear a disproportionate brunt of this problem – 21 percent of African Americans and 34% percent of Hispanics are uninsured.

In a context of such health care inequalities, legalizing PAS puts the working poor who lack insurance at risk of reaching for PAS under financial duress. Choosing between spending $40-$150 for a lethal prescription versus tens of thousands of dollars for long-term care is hardly an unfettered choice between equal alternatives. In this situation, the coercive power of scarcity pushes the poor toward draconian calculations that those of us with private health insurance do not have to make. A commitment to the common good calls us to see that any policy that hands the poor tough choices that the rest of us can avoid erodes our sense of solidarity, of belonging to one human family.

The poor, minorities, and the disabled clearly see the problem of coercion. For example, a recent poll by the Pew Forum on Religion & Public Life found that while the general public is evenly divided, 78 percent of minorities with incomes under $50,000 oppose PAS. Ellie Jenny, a person with disabilities and an activist with the group Not Dead Yet, put it this way: “Choice is OK when you have options, but when you live in poverty with rationed care, you don’t have options.” The American Medical Association and other leading national medical associations also oppose PAS because of concerns about vulnerable populations and undiagnosed depression.

Despite these testimonies, many still think of PAS through the “pro-choice” and “pro-life” frames. But if we expand the frame to include the common good, we will find that there is common ground that protects life and meaningful choice for all. At a minimum, both groups can agree that concerns for the poor and vulnerable demand that universal health care (or at least universal palliative care) ought to be in place before PAS could be legalized. This would not ultimately solve the debate, but if we could see this complexity and make progress here, it would bode well for so many other issues where the old binary divides fail us.

You can read more of this social justice perspective on PAS in my recent book, Liberalism's Troubled Search for Equality: Religion and Cultural Bias in the Oregon Physician-Assisted Suicide Debates (University of Notre Dame Press, 2007).

Labels: catholics, common good, physician-assisted suicide