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On Morning Joe a few minutes ago, Pat Buchanan described the fear behind the death panel debate as the fear that old people without anyone around who loves them will be steered in their final years toward elective euthanasia. Surely the steering power of a government authorized to command and control the health care economy would be profound indeed. But the root issue behind the death panel debate is not federal power — it’s human dignity.

The archetypal or stereotypical conservative would say that even an old, isolated person has a reason to reject suicide that reaches to the foundations of what makes us human and what gives humans dignity. The archetypal or stereotypical progressive would say that conservatives need to abandon their romantic and/or religious fantasies that a dying person finds more dignity in enduring great suffering until their body fails than in choosing to die beforehand. Liberals, who, technically speaking, are stuck or torn between conservatism and progressivism, would be torn on this issue too. Liberalism — the political philosophy and worldview, not the ideological position — struggles to square or reconcile two competing visions of human dignity.

It’s tempting to say the first or conservative vision defines dignity in terms of the human race or species, and that the second/progressive vision does so in individualistic terms. On the question of suicide, that may seem true; but on health care more broadly, it’s obviously false. Progressives, not conservatives, are the ones most apt to think that the power of social science to help us all comes from its ability to generate valid predictions based on large-n data inputs — data in which each individual is reduced to their minimal statistical significance, and made mutually interchangeable accordingly. It turns out that conservatives and progressives also harbor an internal tension between thinking of dignity as existing in virtue of our shared human being and dignity as existing in virtue of our individual human being. It’s almost as if that tension reflects something fundamental about being human — both as a member of the human species and as a unique individual person.

But that tension today is colored deeply by our disgusted, despairing sense of nihilism over individual suffering. It’s increasingly difficult for us to conceive of the decision to soldier through a terminal illness as dignified. The problem is exacerbated by the costs of such care. If the stoic sufferer has loved ones, he or she is insensitive to what he or she is “putting them through;” if not, the stoic sufferer is wasting their — if not other people’s — money. For what? Paradoxically, perhaps, even our individualistic attitude toward the worthlessness of suffering lowers our estimation of individualistic pride.

By now it might be clear that I’ve been sliding back and forth between the assumption that enduring a terminal illness will be a natural or hands-off process versus one full of medication, treatment, and care. Possibly the final question about dignity that bears on our health care debate pertains less to choosing suicide than accepting death. But even this question is conditioned by the reality that choosing between acceptance and choice is made more human by doing so with one’s family. Unfortunately, ‘more human’ might not mean more painless or even more uplifting. Struggling with mortality can often be harder and messier with family than in isolation.

So perhaps the root moral issue behind the death panel debate actually just throws us back onto the question of whether we should choose to permit the government to influence this, one of our most difficult decisions, at one of our most vulnerable or susceptible moments. Because it appears the government at that moment would tend strongly to have greater confidence, and less at stake, than any of us.

( Cross-posted )

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