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Unformatted text preview: 44 Journal oftheRoyal SocietyofMedicine Supplement No. 22 Volume 87 1994 Physician-assisted suicide Larry R Churchill PhD Professorand Chair, UniversityofNorth Carolina SchoolofMedicine, USA Keywords: suicide;physician-assistance; medical ethics Introduction 'Suicide'as a term isonly 300 years old,but as a practiceitislikelyasoldasourspecies.Itwouldbe prudent to begin with some of the views of our predecessors.Socratesarguedthatpeopleshouldnot take their own livesbut did allow forexceptional circumstances. Believing he had received a divine sign he chose death over exile when his work in Athens was done. The Stoics, especially the late Stoics,Seneca,Epictetus,MarcusAurelius,believed that a person always continued toliveby his own consent,andthiswasunderstoodasapartofhuman freedom.JewishoppositiontothisGreekandRoman traditionwasexpressedbythefirstcenturyGovernor ofGalilee,JosephusFlavius,whoforbadehistroops tocommit suicidefollowinga militarydefeat.The early Christian church, born in a time ofJewish apocalypticism and Platonic dualism, faced the problemofnewconvertswhoengagedinrecklessself- destructiveactstoescape the sinsofthisworldin ordertoembrace,allthesooner,theblissofthenext. Itwas in this context that the classical Christian prohibitionofsuicidewas devisedby Augustine of Hippo.Heinterpretedsuicideasforbiddenunderthe commandment againstkilling.He alsoportrayedthe examplesofRomansuicide,suchasCatotheYounger, as vain and cowardly. Itwas Augustine who gave definitiveexpressiontothetheologicaltrumpcardon suicidestillbeingplayed:thebeliefthatthispresent lifeisa Providentialtestofspiritualworthiness 2. Killingoneselfis,then,anavoidanceofdivinely-given responsibility,a refusaltocompletethe qualifying exam fortheafterlife. Thomas Aquinas added three arguments to the theologicalprohibitionofsuicide.Heportrayeditas contrarytothecharityoneowestooneself,ashirking ofthedutiesoneowestosociety,andausurpationof theprerogativesofGod3.Itislargelyinopposition to Aquinas, or perhaps some eighteenth century Calvinist who knew Aquinas, that David Hume seemedtodirecthisarguments.Montaigneisthefirst in a line ofcontinental dissenters from Christian orthodoxyonsuicide,followednotablybyMontesquieu andVoltaire.Montesquieuassertedthatsuicidedoes notdisturbdivineProvidenceany more thanother interventionsintonature,suchaschangingthecourse ofariver.Hume developedMontequieu'sargument, and those of the Stoics, that if the disposal of human lifewere lefttotheAlmighty,any actionto avoid death would be an infringement on divine sovereignty. IfIturnasideastonewhichisfallingonmy headIdisturb thecourseofnatureandinvadethepeculiarprovinceofthe Almighty by lengtheningout my lifebeyondthe period, which, by general laws of matter and motion, he had assignedtoit4(p583)....
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