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Death by Choice
By Daniel C. Maguire
Garden City, Doubleday, 1974. 224 pp. $6.95.

There can be no doubt that the technology that we have fashioned in matters of living and dying has and will continue to magnify and intensify the complexity of decision making at the point of death for dying persons and their families. Literature in response to the unavoidable decisions at the inception or termination of life has tended to be either an impassioned plea for rights (cf. Last Rights: A Case for the Good Death by Marya Mannes) without sufficient considerations of moral implications or ethically sophisticated arguments (cf. The Patient as Person by Paul Ramsey) that are not easily understood by the individuals who must decide for life or for death.

Daniel C. Maguire's book, Death by Choice, is a noteworthy ad-

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dition to the literature on death because a) it takes human freedom seriously, b) it does not get bogged down in the misplaced ethical debate between context and principles, and c) it proposes a usable methodology for moral decision making when death is inevitable. While I would applaud the demise of thinking in rigidly absolute moral categories in favor of a more contextual approach to the inception or termination of life, I agree with Maguire that the need remains for principles that are adaptable to an increasingly technologized dying process and a method of practical moral rationality that bridges those ethical principles with the necessary, sometimes tragic, action in the face of inevitable death. Maguire closes his book with the following quote that affirms both the sacredness of life but also the awesome freedom that humans have to choose death in the midst of life:

Life is the good thing and the precondition of all good things. Any decision to end it in any context, for self or for another, must be slow, deliberate, and reverential. But the life that is good, also bears the mark of the tragic. There are times when the ending of life is the best that life offers. Moral man will see this, and then, more than ever, he will know the full price of freedom (p. 221).

Within that context of human sacredness and freedom, Maguire introduces the principle of "proportionality" that begins with the premise that there are few absolutes in life and lots of proximate values. Taking life is one of those absolutes that is in principle wrong unless there is proportionate reason to do so. That proportionality is determined by careful and realistic consideration of the factors involved in making a decision such as acting to end a terminally ill life. The circumstances of any given ethical case (Maguire refers to this as the "moral object") are determined by asking questions of "what, why, how, who, where, when, what are the effects and the alternatives" (p. 90). In addition, Maguire affirms "what the heart knows" (Gemut) as another faculty for moral discovery. Therefore he insists on adding to the universality of principles the irreplaceability of the deciding subject because "truth in moral matters is often found by way of affectivity and intuitive feeling and by creative imagination" (p. 108). The wedding of principles and affects is never an easy one, but Maguire has enriched moral decision-making by investing limited confidence in intuition and therefore insisting that principles (relevant generalizations about the normally valuable) are also limited and need to be informed by that which is highly personal. In the end, every principle and every exception to a principle are good if they express the concrete demands of the sacredness of human life in a specific situation.

Fairly general consensus has emerged in recent years in support of passive or indirect euthanasia for the terminally ill person. By that is usually meant choosing against extraordinary means to prolong the dying or withdrawing life-sustaining medical procedures, either of which has the effect of ending a life. Maguire's argument is that dis-

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tinctions between omission/commission or direct/indirect measures to end a terminally ill life can be made regarding both intent and effect. I think this is straining at gnats. As the title suggests, he does not stop there. Maguire argues in favor of the possibility that choosing to effect the end of one's life by active means may in certain circumstances be a moral act according to the principle of proportionality if it can be understood that the primal value of life was affirmed. Those who are inclined to object to death by choice on the grounds that it is "playing God" will encounter in Maguire a persuasive argument against the assumption that is frequently ritualized in Christian contexts by the phrase "the Lord gives and the Lord takes." The necessary and unavoidable human task of finding proportionate and good reasons to exercise moral dominion over our dying is not to play God but to play man. "It is to do what is proper to man as man, a being with power to deliberate and to act on his deliberations when that action appears to achieve what is good" (p. 145).

There is nothing timid about Maguire's position. Choosing to end one's life may be an appropriate act of human freedom. Despite that boldness regarding direct euthanasia, i.e., mercy killing, and despite his conviction that ethics must always be moving ahead, Maguire recognizes the need for balance between "carefulness and daring" as in seeking for humanized ways of expressing freedom in a complex technologized society. This same tension is reflected in his response to the debate between Fletcher and Ramsey. While being justifiably critical of Fletcher for being insufficiently principled in his ethical approach, he also moves beyond the conservative position taken by Ramsey on "only caring for the dying." Care for the dying, argues Maguire, "might involve positive acts to hasten death even before the extreme conditions stipulated by Ramsey" (p. 67). I agree.

The major flaw in this book is that when Maguire applies his method of moral decision making to the issue of abortion, suddenly there are only a few instances in which abortion would be a moral choice according to the principle of proportionality. It is puzzling to me in a way that can only be understood by acknowledging Maguire's Roman Catholic heritage that he is in principle prejudiced in favor of the fetus. There is an aura of romanticism on the matter of abortion inconsistent with the rigor of his method that is reflected in his assertion that "the unborn sends a message to the born to strain their imagination in any conflict situation to find a way for his life" (p. 202). The application of his ethical method to other situations that involve taking life such as capital punishment, war, and suicide is provocative but a bit uneven. Capital punishment is uniformly immoral while both war and suicide may at times be moral even though tragic.

Even though I do not always agree with his conclusions and even though I wonder whether the principle of proportionality may not be an ethical slight of hand which has solved one problem by labeling a new one and even though I am reluctant to designate any choice as

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moral because of the ambiguous nature of human intention and action, yet I would encourage wide careful reading of this book because it suggests a method for the exercise of human freedom in dying that can affirm the sacredness of life while allowing for the moral possibility of death by choice.

How one implements this ethical method or any other in the concrete human situation is left unsaid. That is the enormously important pastoral task providing moral guidance at the boundaries of life and death for which is required the collaboration of ethics and care. Since my own area of expertise is primarily pastoral care rather than ethics, I may have overlooked critical problems in Maguire's position having to do with the science of ethics because of the overarching compassion and personal Gemüt with which he addresses dilemmas in living and dying. Ethical neutrality in pastoral care and personal objectivity in ethics are both myths that often prevent us from exercising our imagination and reason in the interest of enabling people to develop a practical moral rationality that is not timid on the point of human freedom. Given the close connection between moral theology and pastoral care in the Roman Catholic tradition, it is not surprising that I found Maguire's book to be a challenge to explore the interfaces between ethics and care in moral decision making, especially for those who are dying.

Herbert Anderson
Princeton Theological Seminary
Princeton, New Jersey