Death by deliberate dehydration and starvation: silent echoes of the Hungerhäuser.

During the final days of his life, Oscar Wilde, aware that death was imminent, lost interest in food but drank whenever one of his visitors brought him a bottle. In reply to a friend's warning that his drinking was self-destructive, Wilde said: "You are qualifying for a doctor. When you can refuse bread to the hungry, and drink to the thirsty, you may apply for your Diploma." (1) Wilde was a master of hyperbole. He was, after all, the playwright who assured us that "nothing succeeds like excess" (2) and who is reported to have declared, while sipping champagne on his deathbed: "I am dying as I have lived: beyond my means." (3) His deathbed quip about the ability to refuse bread to the hungry was a preposterous characterization of the qualifications of a nineteenth-century physician; but, incredibly enough, as our own century draws to a close, we have among us individuals prepared to take seriously Oscar Wilde's specifications of the requirements for a physician's diploma. It is a remarkable circumstance that, in a nation whose wealth and resources are so vast as nearly to defeat the imagination, scholarly conferences, articles in learned journals, and courts ponder the question whether we can be justified in deliberately causing death by withholding food and water. Dostoevsky remarks that one may judge the degree of civilization in a society by entering its prisons. (4) He measures a society's civilization by gauging the fate it accords some of its most wretched members. In the same spirit, others argue that the correct measure of the degree of justice in a society is the lot it accords its least fortunate citizens. Rawls's theory of justice holds that a just society is one which, in addition to according each of its citizens the largest amount of political liberty compatible with each enjoying the same liberty, also allocates all other goods that arise from social cooperation (wealth, income, privileges, and so on) in accordance with a scheme designed to maximize the welfare of the least advantaged representative persons. (5) And Christ's teaching was: "Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me." (6) The present task is one of casuistry. In the case proposed for analysis, certain family members are asking the officers of a nursing home to stop supplying nourishment and fluids to a relative who resides in the home administered by those officers. The relative in question is an unconscious man who has been diagnosed as being in a "persistent vegetative state." Thus, we have before us someone wholly defenseless and vulnerable. If any one fits the biblical description, surely Mr. Stevens, the defenseless disabled man whose nutrition may be cut off, counts as "one of the least of [our] brethren." Our assignment is to state principles that should be applied in the case at hand and to recommend a course of action. The next section of this article articulates three principles that bear on the case and draws the conclusions they dictate. The sections that follow examine some of the details involved in the case and express some reflections on the moral climate of a society in which cases such as the present one are viewed as presenting a serious challenge to moral intelligence. The thesis defended here is that the central question raised by the case under discussion is whether it is every permissible to arrange deliberately for a disabled person who is not terminally ill to die of thirst and starvation. It is worth recalling that the Phoenicians, who devised the method of execution known as crucifixion, originally employed the technique as a method of killing by deliberate dehydration and starvation. (7) The earliest 'cross' was actually just a vertical stake to which the condemned was tied and left to expire from thirst and starvation. (8) It is remarkable that physicians and laymen are now seriously contemplating adoption of a method of killing that was regarded as particularly cruel and degrading in the ancient world and was, among the Romans, who inherited the technique from the Phoenicians, "reserved for slaves and the worst of criminals. …