The Catholic Transcript, the newspaper of the Archdiocese of Hartford, has started a new feature: a monthly column on bioethics by Fr. Tadeusz Pacholczyk, a priest from Fall River, MA and director of education at the National Catholic Bioethics Center in Philadelphia. Fr. Pacholczyk’s column this month was on physician assisted suicide, a topic of considerable interest here in Connecticut: it has been raised a couple times in the state assembly, and supporters will probably attempt to bring it up again this year. (The column appears in several papers; the particular one I am interested in has not been posted on the Transcript website, but can be found here.)
In his column, he commented on a recent article from Time magazine (reprinted here, I believe) that drew a connection between physician assisted suicide and the people who died after they jumped out of the Twin Towers on 9/11. I want to quote him in full:
In the public discussions that have ensued, some have ventured to argue that suicide under such desperate circumstances [dying of brain cancer] would, in fact, be justifiable. A recent on-line article from Time magazine observed that few fault those who were trapped on the top floors of the Twin Towers on 9/11 when they jumped to their deaths below as the flames surged around them. Similarly, the article suggests that those who face the prospect of a difficult, pain-racked death from a terminal disease should be able to take their own life through physician-assisted suicide without fault or blame.
For those jumping out of the Twin Towers, however, we recognize a horrific situation of desperation, and even the possibility of a kind of mental breakdown in those final panic-stricken moments. Their agonizing choice to hurl themselves out of the building to their deaths below would be, objectively speaking, a suicidal act, and would not represent a morally good choice, but their moral culpability would almost certainly be diminished, if not eliminated, by the harrowing circumstances in which they found themselves, driven by raw terror more than by anything else. Clearly, grave psychological disturbances, anguish, or grave fear of suffering can diminish the responsibility of the one committing suicide.
Until I read this I had never stopped to think about this in any careful way. Reading this column, however, my gut reaction to his argument was negative, partly because his analysis is so clinical. But, while moral intuition is important, it can be misleading. So I have had to stop and ask myself: was this suicide? And to what extent does this matter?
In a precise legal sense, it was not suicide: the NY medical examiner ruled that all the deaths in 9/11 were homicides: according to Wikipedia, they argued
A ‘jumper’ is somebody who goes to the office in the morning knowing that they will commit suicide. These people were forced out by the smoke and flames or blown out.
This designation matters legally: for instance, it affects the payment of insurance benefits, as some life insurance policies will deny claims if the policy holder commits suicide. (This may have been moot: after 9/11, no insurance company could have survived the backlash resulting from denying benefits under these circumstances, even if it were conclusively shown to have been suicide.) But it does not settle the ethical question of whether this was suicide.
This is a tricky question to answer, and while I have some ideas, I am not sure if they really resolve the issue. So I welcome commentary and corrections to what I write. On the one hand, it does seem plausible to describe the act of jumping out of a window on the 80+ story of building as an “objectively suicidal act.” Anyone doing it would know that his or her death was a certain outcome. But does this make it a suicidal act? There are similar actions which do not constitute suicide and I want to try to reason by analogy with them.
In doing so I am going to touch on the principle of double-effect. As I have said in the past, I am uncomfortable with the principle of double effect but this might be a case where it is useful. In this earlier blog post I considered the problem of ectopic pregnancies, but there was a wide-ranging and detailed discussion of the principle of double effect that at one point touched on this very question and suggested that it was not suicide. I will consider the argument made in this comment below.
The classical example of a superficially suicidal act that is not (I believe) considered suicide is a soldier who throws himself onto a hand grenade that has landed in his foxhole. In doing so he is deliberating consigning himself to death, but this is not regarded as suicide. In the same way, people who throw themselves over others to shield them from a gunman or soldiers who act in ways leading to their certain death in order to save the lives of their comrades (e.g., PFC Rodger Young in WWII) are not considered to have committed suicide, even though they knowingly brought about their own deaths by their deliberate actions.
The rationale for not calling these suicide lies in discerning the intent of the persons acting: their intention was not to commit suicide but rather to protect others at the cost of their own lives. In a word, self-sacrifice. That they would know that their actions would lead to their death is secondary to the moral analysis. This would seem to be very much in line with the principle of double effect. To apply it properly, I would have to examine more carefully the object, intent and circumstances of their actions, but I will admit that I have a hard time parsing the difference between object and intent, and so am going to go with this more informal analysis for now. (Readers are welcome to fill in the details, for or against, in the comments.)
However, while the distinction between suicide and self-sacrifice is useful, it does not fully explain the morality of their actions: self-sacrifice is not, in and of itself, a sufficient justification. For instance, a person may not donate his heart to be transplanted into another person in order to save that person’s life but resulting in his own death. (Cf. the Catechism 2296.) And here is where I get hung up in ways that bother me when I try to apply this to the case at hand. I am not sure how to distinguish between the act of throwing yourself on a grenade from the act of having your heart removed in order to save the life of another. (To avoid introducing a third party, we can pretend that robot assisted surgery is sophisticated enough that you could program a machine to remove your heart, so in fact you are removing your own heart. I have no idea if this is possible now, but I suspect it soon will be.)
The only distinction I can see lies in the circumstances and in particular in the temporal constraints surrounding the act. In the case of a soldier throwing himself on a grenade (or the other actions outlined above), these must be spontaneous, or nearly spontaneous decisions. The person making them has seconds or at most a few minutes in which to decide. The decision to sacrifice oneself by removing your own heart seems much more deliberate and drawn out. One could, I suppose, construct circumstances in which this decision must be made immediately, but even in these the time scale would be much longer—hours or days rather than minutes.
But that a decision is made under pressure does not seem to me to effect the moral status of the decision: it bears only on the moral culpability of the person making it. It might be a morally wrong act, but one’s responsibility is lessened because of the circumstances. (This is the essence of what Fr. Pacholczyk argues above.) But then I come back to my original problem: how to distinguish morally between throwing oneself on a grenade and donating one’s heart?
I want to now return to the original moral problem: the act of jumping out of a window to avoid being burned to death. Obviously, in one way this is very different from the cases considered above because there is no self-sacrifice involved. The only person affected is the person jumping. (One could imagine a hypothetical situation–not one that occurred on 9/11–where a person chooses to jump and take a small child with him/her. This provides some interesting complexity but here I want to focus on the actual case at hand.) The two points of similarity are the basic question of intention and the time constraints under which the decision is made. The question of intention is muddy because it can be read two different ways: is their intention to avoid death by burning, or is their intention to choose the manner of their death, for whatever reason believing that death by impact after jumping is preferable to death by fire. (We can guess that the latter is an easier death than the former, but it seems hard to draw objective conclusions.) In the latter case it might be argued that it is a suicidal act; in the former, I could envision an application of the principle of double effect to argue that it is not suicide, death was a foreseeable, indeed certain outcome of their actions, but it was not their intent. However, harkening back to my post on ectopic pregnancy and the principle of double effect, it seemed to me that the discussion bogged down (and the principle lost its moral utility) in hair-splitting discussions over this kind of distinction.
The issue of time constraints is also important here: in this situation, after some point the person will have to make an immediate decision: jump, or be consumed by the flames. I think this point is very important because it goes back to the original point being made by Fr. Pacholczyk. The article he was rebutting wanted to draw a moral parallel between jumping and taking barbiturates to die so as to avoid a prolonged and painful death. While these two actions seem similar, they must be done on very different time scales: weeks and possibly months in the latter case. (There are some grey areas here as well, such as a patient, in the final days of life, being given such massive doses of morphine or heroin that death is almost surely hastened. But again, let’s concentrate on the sharper distinction.)
But, as I noted above, time constraints may lessen moral culpability, but they do not seem to affect the morality of the act itself. Therefore, if my original intuition is correct, that jumping out of a window is not suicide, then we need some other grounds for distinguishing it from overdosing on barbiturates. Here is where completing the analysis of self-sacrifice above should be helpful: drawing the moral distinction between jumping on a grenade and donating ones own heart should help here.
Finally, I want to turn to the related question: what good will come from deciding that throwing oneself from a burning building is in fact suicide? Moral codes should guide our actions in a prior sense; they should not simply be there to past judgement after the fact. But I cannot envision any time we would counsel another person in this particular situation: “do not jump out the window, it is an sinful act.” So what is gained by this stance? Does it exist simply as a firebreak, as Fr. Pacholczyk uses it in his article, to draw clearer lines around actions we would counsel people against before they do them? And does this justify the potential pain such an argument would cause: e.g., the pain felt by the survivors of someone who did indeed die by throwing himself from the Twin Towers?
The short answer to all of these questions is that I am not sure, and I am interested in your thoughts on these questions.