Do many of us really believe that no one ever has a duty to die? I suspect not. I think most of us probably believe that there is such a duty, but it is very uncommon. Consider Captain Oates, a member of Admiral Scott's expedition to the South Pole. Oates became too ill to continue. If the rest of the team stayed with him, they would all perish. After this had become clear, Oates left his tent one night, walked out into a raging blizzard, and was never seen again. That may have been a heroic thing to do, but we might be able to agree that it was also no more than his duty. It would have been wrong for him to urge—or even to allow—the rest to stay and care for him.
This is a very unusual circumstance—a "lifeboat case"—and lifeboat cases make for bad ethics. But I expect that most of us would also agree that there have been cultures in which what we would call a duty to die has been fairly common. These are relatively poor, technologically simple, and especially nomadic cultures. In such societies, everyone knows that if you manage to live long enough, you will eventually become old and debilitated. Then you will need to take steps to end your life. The old people in these societies regularly did precisely that. Their cultures prepared and supported them in doing so.
Those cultures could be dismissed as irrelevant to contemporary bioethics; their circumstances are so different from ours. But if that is our response, it is instructive. It suggests that we assume a duty to die is irrelevant to us because our wealth and technological sophistication have purchased exemption for us . . . except under very unusual circumstances like Captain Oates's.
But have wealth and technology really exempted us? Or are they, on the contrary, about to make a duty to die common again? We like to think of modern medicine as all triumph with no dark side. Our medicine saves many lives and enables most of us to live longer. That is wonderful, indeed. We are all glad to have access to this medicine. But our medicine also delivers most of us over to chronic illnesses and it enables many of us to survive longer than we can take care of ourselves, longer than we know what to do with ourselves, longer than we even are ourselves.
The costs—and these are not merely monetary—of prolonging our lives when we are no longer able to care for ourselves are often staggering. If further medical advances wipe out many of today's "killer diseases"—cancers, heart attacks, strokes, ALS, AIDS, and the rest—then one day most of us will survive long enough to become demented or debilitated. These developments could generate a fairly widespread duty to die. A fairly common duty to die might turn out to be only the dark side of our life-prolonging medicine and the uses we choose to make of it.
Let me be clear. I certainly believe that there is a duty to refuse life-prolonging medical treatment and also a duty to complete advance directives refusing life-prolonging treatment. But a duty to die can go well beyond that. There can be a duty to die before one's illnesses would cause death, even if treated only with palliative measures. In fact, there may be a fairly common responsibility to end one's life in the absence of any terminal illness at all. Finally, there can be a duty to die when one would prefer to live. Granted, many of the conditions that can generate a duty to die also seriously undermine the quality of life. Some prefer not to live under such conditions. But even those who want to live can face a duty to die.
(John Hardwig, "Is There a Duty to Die?" Hastings Center Report 27 [March-April 1997]: 34-42, at 34-5 [endnote omitted])
Keith Burgess-Jackson, J.D., Ph.D. 