By RICARDO EVANDRO S. MARTINS*
Considerations on the biopolitical issue of assisted death
A dignified death
Stoicism has been getting a lot of attention lately. For some reason, the philosophy whose ethics involves an apathetic and ataractic attitude towards the hardships of life has been popular. I dare to hypothesize that perhaps there is some coincidence occurring between the ancient world and our current time that explains the resurgence of interest in Stoic ethics, although with the big difference that the ancient “philosophy of the stoa” is being consumed in a vulgar way and in a self-help tone. coaching, typical of late capitalism.
Perhaps there is some repetition between the context of current life forms, despaired of by contemporary imperial powers, and the political context of life forms under the rise of the Empire of Philip of Macedon and then under the time of the Roman Empire. At a time when it is easier to imagine the end of the world than the end of capitalism,[I] when even the end of the story has already been announced[ii] and the victory of neoliberalism, the arcane empire Contemporary times seem to lead people, once again, to think about a way of living, a philosophy of life concerned with the brevity of life, with its precariousness, in short, with the death that awaits us, and that is expected everywhere.[iii]
The contemporary world, then, seems to be trying to understand the stoic maxim of the Roman philosopher and jurist Marcus Tullius Cicero, when he said that to philosophize is to learn to die and when he saw at least four reasons for finding old age detestable: (i) the withdrawal from active life; (ii) the weakening of the body; (iii) the deprivation of the best pleasures; and (iv) because old age would bring us closer to death.[iv]
But it is another Cicero, from another life and another death that I discuss here in this text. A Brazilian poet, essayist and philosopher, born into a privileged family, he studied the Greeks and Latins, became an immortal of the Brazilian Academy of Letters, and, in addition, was a great lyricist of music. pop Brazilian: Antônio Cícero Correia Lima. Brother of the Brazilian singer Marina Lima, he was the composer of hits such as the melancholic – but, in fact, romantic – Winter (1994), a song made famous by Adriana Calcanhotto.
On October 23, Antônio Cícero died in Switzerland, through a procedure called “assisted death”. Unlike euthanasia, assisted death is the act of committing suicide with some medical assistance and with motivation in accordance with the law. The truth is that, as a rule, the Swiss Penal Code prohibits participation in suicide when it has selfish motivations.[v] However, exceptionally, assisted death, or prescribed suicide, is permitted upon proof of intense physical and psychological suffering, which could motivate the voluntary act of administering to oneself, accompanied by a medical team, a drug that would lead to the patient's death.
In Brazil, the “right to die” is regulated by the Code of Medical Ethics. In Chapter V, there are a series of articles that state what is prohibited for doctors working in the country. And specifically in Article 41, it states that doctors are prohibited from “[a]bbreviating the life of a patient, even at the request of the patient or his/her legal representative.”[vi] However, the sole paragraph of this same Article no. 41 makes an exception: “In cases of incurable and terminal illness, the physician must offer all available palliative care without undertaking useless or obstinate diagnostic or therapeutic actions, always taking into account the expressed will of the patient or, if this is not possible, that of his/her legal representative.”[vii]
Our Code of Medical Ethics follows the Brazilian Penal Code, in its Article 122, which criminalizes inciting and assisting suicide.[viii] Therefore, any possibility of euthanasia or even assisted death is illegal in Brazil. Furthermore, so-called dysthanasia, that is, the insistence and futile maintenance of the survival of a terminally ill patient, is also illegal. On the other hand, what is legal in Brazilian law is so-called orthothanasia, or the possibility of letting the patient die, but with the provision of palliative care, which minimizes suffering.
This is an intriguing biolegal issue because it involves the regulation of public law on sick bodies and on the free will to determine one's own destiny. In truth, it is a biolaw issue, but above all – if one can separate them – it is a biopolitical issue.
We have known since Michel Foucault, in his seminar given here in Brazil in 1974, on the birth of social medicine, “that the body is a bio-political reality.”[ix] In other words, at least since the 18th century, the body has been a socialized space disputed by the political forces of capitalism. It is living that becomes the object of politics, of its power mechanisms. In the famous passage from History of sexuality I (1976), Foucault says: “Man, for millennia, remained what he was for Aristotle: a living animal and, moreover, capable of political existence; modern man is an animal in whose politics his life as a living being is at stake”.[X]
But the issue of the right to die, whether by committing physician-assisted suicide or by “letting oneself” die under palliative care, rather than belonging to so-called biopolitics, is more something that belongs to what the Italian philosopher Giorgio Agamben called “thanapolitics” – the “other Janus head” of biopolitics:[xi] the politics of death.[xii]
Regarding this, it remains to be seen how those devices of power deal with the themes, but now, not with that of life and its living, but with the theme of death and its technological and legal possibilities, and in the name of a coincidentally Stoic principle, coined by that other Cicero, the Roman, when he wrote in his Of duties (44 BC) on human dignity.[xiii]
In his farewell letter to his friends, the Brazilian poet Antônio Cícero explains that, due to Alzheimer's, he has suffered and that his “life has become unbearable.” Then, in the name of the dignity with which he lived his life, Antônio Cícero wrote about how he also hopes to “die with dignity.”[xiv]
Even though Albert Camus said that “suicide is the only philosophical problem”,[xv] In this essay I would like to reflect on a philosophical problem derived from the “problem” of suicide. This is a “more difficult” philosophical question, in the sense in which Antonio Cicero gave the German expression heavier – “heavier”:[xvi] How can we think about the institute of human dignity in light of the management of life and death carried out by technical, scientific and political-legal devices? And I would further question: How does our human dignity resist, while at the same time being constituted and protected by these devices?
Of devices and thanatopolitics
In a 1977 interview, published in the collection named microphysics of power (1979), Michel Foucault defines the term “device” as being, in short, the network that is established between “the said and the unsaid” of the heterogeneous set that “encompasses discourses, institutions, architectural organizations, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral, philanthropic propositions”.[xvii]
But it was at a conference given by Giorgio Agamben, coincidentally also held in Brazil, that a bold genealogy was able to expand the meanings of “dispositif” for Michel Foucault. Used by the French philosopher as a way of expressing “universals”, but without falling back on them, Giorgio Agamben, in turn, expands its meaning by remembering that the term originated from the Latin word Device, as the Greek equivalent of the term oikonomia.
In this essay, however, I prefer to avoid delving into Giorgio Agamben's hypothesis about how Device Latin would be a translation made within the tradition of medieval Catholic theology to express the salvific “economy”, that is, the “administration”, the “governance” of human life by the divine providence of the Son, in the Trinity. To address the philosophical problem of suicide, euthanasia and their variations ensured by technologies and policies of death, I am more interested, now, in the analogy that Giorgio Agamben makes between “dispositif” and the German term forged by Martin Heidegger: frame.[xviii]
Martin Heidegger dealt with the ambiguities of frame in his famous essay The question of technique (1954). The text sheds light on the issue of technology in an original way, although one cannot “forgive” the so-called Black Forest Philosopher for his well-known and much-discussed direct involvement with Nazism. On the subject, Antônio Cícero himself wrote that, “(…) despite Martin Heidegger’s repugnant political affinities, his work cannot fail to be read and discussed by anyone who takes philosophical thought seriously.”[xx]
In Portuguese, the frame can be translated as apparatus, frame,[xx] skeleton, composition, in short, as a technological device. The word technique and its essence have many ambiguities. “Technique” comes from the Greek techne, translated into Latin as ars. The curious thing is that ars in Portuguese can be translated, simply, as “art”. This alone would already show one of the ambiguities, shown by Martin Heidegger, inherent to technique, namely: its relationship with poiesis, with the productive and truth-discovering practice as “unveiling” (aletheia), and also a discoverer of what is current in beauty.[xxx]
But what matters, for now, regarding Martin Heidegger's text on the question of technology, is the German philosopher's statement that “[t]he technology is therefore not a simple means. Technology is a form of discovery.”[xxiii] And, in the case of modern technology, that of modern science, its discovery, unveiling of truth, says Martin Heidegger, “(…) does not develop, however, into a production in the sense of ποίησις [poiesis]. The discovery, which governs modern technology, is an exploration, which imposes on nature the claim to provide energy, capable of, as such, being benefited and stored.”[xxiii]
Thus, Martin Heidegger will say that the essence of technology does not apply to ancient Greek thought when it comes to modern technology because it is “(…) characterized by machines and equipment”. [xxv] And, unlike what one might think about technology as an action of mere means for producing something, Heidegger argued that the essence of technology is not “technical”, that is, it is not an action-means with a determined extrinsic end. Its essence has to do with the act of making nature and also human beings “available”, storable, ready to become natural resources and human resources to be exploited by its machinery.
What Heidegger called the “danger” of modern technology persists as a philosophical provocation in many directions. As a mere act of discovering nature and its potential resources, technology is not dangerous. As he says, “[t]echnique is not dangerous. There is no demonia of technology. [xxiv]. But while being an exploratory composition, the technique can prevent man from discovering something more original, “(…) an experience of a more inaugural truth”.[xxv]
Returning to the question of devices, based on Agamben's boldness, it is in this sense of “storage”, of administration of pantry, of normative organization of the house – that is, the “economy” in its most radical etymological sense, of governance of the house (oikos) – that modern technique can be analogously signified with the meaning given by Foucault to “device”. And the question about technique then also becomes a question about political, medical and legal techniques, demanding, consequently, an ethical question around them.
In this matter, biopolitics and biolaw meet bioethics. In this meeting place, we perceive a borderline zone regarding the technical possibilities of either uselessly and obstinately maintaining the survival of a terminal patient through machines, or of letting a terminal patient die under palliative care, or even of ending the life, or even of assisting the suicide of a suffering patient, of his own free will, as was the case of Antônio Cícero.
The question about the management of the human body by modern medical techniques is expressed by the ethical challenge of knowing: When and for what reason should the machines be turned off so that life ceases, or when should the use of a lethal drug and the imminent death of a terminally ill patient be administered, prescribed or assisted?
Ethics, technique and manner of death
It was one of Martin Heidegger's students – who never forgave his teacher's involvement with Nazism – the German-Jewish philosopher Hans Jonas, who addressed this bioethical question about modern technology in a more profound way.[xxviii] At work Principle of responsibility (1979), Hans Jonas developed Martin Heidegger's concern about the way in which modern technology “discovers” nature by transforming it into a natural resource to be exploited. Jonas called this domineering view of nature the “Baconian program” and argued that this new stance brings with it a contradiction: technical knowledge does not ultimately protect man from natural forces, just as it does not protect him from himself.[xxviii]
But it's in the name text Technique, medicine and ethics (1985) in which Hans Jonas specifically addressed the issue of whether terminally ill patients have a right to die. And in order to think ethically about these cases, it is necessary to make it more explicit that the ethical dilemmas in question involve the doctor-patient relationship and the problem of medical responsibility, criminal legislation on the subject, as well as the principle of free will, the autonomy of patients to dictate their own destiny. As Hans Jonas says, “[b]ut in a terminal state in which curative treatment is no longer possible – this seems intuitively clear to me – the cry for relief outweighs the prohibition of harm, and even that of shortening life, should be heard.”[xxix]
Remembering the verses of the chorale, in the third part of the Theban trilogy, in the tragedy Antigone, by Sophocles, Hans Jonas recalls that, even though there is the capacity to resist the rigors of nature, when faced with death, human beings remain powerless.[xxx] But such impotence refers to the impossible challenge of overcoming death. Still, the question remains: What about the challenge of ending a life already considered unworthy, especially by the patient himself?
We also know that since the psychoanalysis movement, especially since the so-called “second topic”, inspired by the studies of Sabina Spielrein, as well as influenced by the post-First World War context, in Beyond the pleasure bases (1920), Sigmund Freud argued that a self-destructive impulse competes with the Darwinian principle of survival of the species. Breaking with the vitalism of the XNUMXth century, as well as with the Aristotelian-Thomistic tradition on human nature, Freud adhered to an anthropological pessimism and based it on what he called the “nirvana principle”: a drive competing with the life drive, which seeks fundamental homeostasis, a search for the silence of the tensions of pleasure and displeasure of the body, of the “psychic apparatus”, namely, the “death drive”.[xxxii]
Bearing this in mind, is it possible, from Sigmund Freud onwards, to still defend the persistence of human survival, terminal and in suffering, as an ontological impulse that gains a deontological dimension, as if “living”, in any way, under any circumstances, however undignified, were a “duty”? And a duty that is not only ethical for the patient, but also for doctors and their techniques, and could even gain legal status?
It seems fair to me to think of a right to a dignified and voluntary death, but attention and reflection are needed in the field of practical rationality regarding the administration, exploitation and management of lives by medical techniques. We cannot forget responsibility, respect for autonomy and we cannot lose our fear of the future potential of technology – the “heuristic of fear”, as Jonas said. Furthermore, we cannot forget in our reflective horizon the technological potential of the past, or, to be specific, we cannot forget the Nazi history in medicine, and its death policy in concentration and extermination camps, as well as its recent echoes in the Brazilian experience with the pandemic.[xxxi]
The Brazilian poet and philosopher Antônio Cícero said goodbye, leaving behind not only poems, song lyrics and essays on aesthetics, but also, with his “form of death”, a philosophical, ethical, legal and medical discussion. So I remember his poem The Capricciosa.[xxxii] In it, it seems to me that Antônio Cícero poeticized the evidence that “sooner or later” we come across the storms of life, to which “we are all exposed”. But he also wrote a poem about how the night gently intertwines with “mirrors, wines, grapes, bunches of roses, laughter”.
Meanwhile, “on the other side of the crystal sheets”, says Antônio Cícero’s poem, on the other side of the windows of the house, or of the soul (the eyes and their lenses?), “the city dreams” – in the same syntax through which poets “think about the world”.[xxxv] And from this vigil, an act of speech proper to “keeping”,[xxxiv] suddenly one is awakened by the “cell phone”. By a technology, by a device. Then one sees that “[d]eath also has art”, that is, it has technique, but also poetry, the potential for discovering the truth.
Dying can be an art of putting an end to all existential possibilities and, for this very reason, it is an impossible experience, always attempted. But it can also be, as Montaigne said: “To meditate on death is to meditate on freedom; he who has learned to die has unlearned how to serve.”[xxxiv]
Antônio Cícero was awakened while we dream. For him, there is no God on the other side of the “crystal sheets”. Without knowing what is there, we can only continue to dream of the world. Inspired by his work, by his life, Antônio Cícero says goodbye perhaps trying to make us realize that not only death, but also living has its art.
*Ricardo Evandro S. Martins Professor at the Faculty of Law at the Federal University of Pará (UFPA).
References
AGAMBEN, Giorgio. Homo sacer: sovereign power and bare life I. Belo Horizonte: UFMG, 2014.
AGAMBEN, Giorgio. What is a device?. In: Outra Travessia. N. 5. 2005. p. 12. Available at: https://periodicos.ufsc.br/index.php/Outra/article/view/12576
BRAZIL. Medical Code of Ethics: CFM Resolution No. 1931, of September 17, 2009. Brasília: Federal Council of Medicine, 2010.
BRAZIL. Brazilian Penal Code. Available at: https://www.planalto.gov.br/ccivil_03/decreto-lei/del2848compilado.htm.
CAMUS, Albert. The myth of Sisyphus. Sao Paulo: Record, 2006.
CICERO, Antonio. Save. Available in: https://www.tudoepoema.com.br/antonio-cicero-guardar/
CICERO, Antonio. Heidegger and Nazism. Available at: https://www1.folha.uol.com.br/fsp/ilustrad/fq2002201023.htm.
CICERO, Antonio. La Capricciosa. Available in: https://www.tudoepoema.com.br/antonio-cicero-la-capricciosa/.
CICERO, Antonio. Poetry and philosophy. Sao Paulo: Brazilian Civilization, 2012.
CICERO, Antônio. On thinking about the world. In: Poetry and philosophy. Sao Paulo: Brazilian Civilization, 2012.
CICERO, Marco Tulio. Of Duties. Sao Paulo: Edipro, 2019.
CICERO, Marco Tulio. About aging. São Paulo: L&PM, 2007.
CNN. Antônio Cícero left a letter and mentioned going to Switzerland to “die with dignity”. 23.10.2024/XNUMX/XNUMX. Available at: https://www.cnnbrasil.com.br/entretenimento/antonio-cicero-deixou-carta-e-mencionou-ida-a-suica-para-morrer-com-dignidade/.
FISHER, Mark. Capitalist realism: it is easier to imagine the end of the world than the end of capitalism. São Paulo: Literary Autonomy, 2009.
FOUCAULT, Michael. History of Sexuality. São Paulo: Paz e Terra, 2017.
FOUCAULT, Michael. microphysics of power. Rio de Janeiro: Edições Graal, 1986.
FOUCAULT, Michel. Birth of social medicine. In: Microphysics of Power. New York: Routledge, 1986.
FUKUYAMA, F. The end of history and the last man. Rio de Janeiro: Rocco, 1992.
HEIDEGGER, Martin. The question of technique. In: essays and conferences. Petrópolis: Voices, 2006.
JONAS, Hans. Principle of responsibility: an essay on ethics for technological civilization. Rio de Janeiro: Counterpoint/EDIPUCRIO, 2006.
JONAS, Hans. Technique, medicine and ethics: on the practice of the Principle of responsibility. New York: Routledge, 2016.
MONTAIGNE, Michel de. On how to philosophize is to learn to die. In: Essay. São Paulo: Editora 34, 2006.
SWITZERLAND. Penal Code. Article 115. Available at: https://www.fedlex.admin.ch/eli/cc/54/757_781_799/en#art_115
Notes
[I] Cf. FISHER, Mark. Capitalist realism: it is easier to imagine the end of the world than the end of capitalism. São Paulo: Autonomia Literária, 2009.
[ii] Cf. FUKUYAMA, F. The End of History and the Last Man. Rio de Janeiro: Rocco, 1992.
[iii] MONTAIGNE, Michel de. On how to philosophize is to learn to die. In: Essays. São Paulo: Editora 34, 2006, p. 120.
[iv] CICERO, Marco Tulio. On aging. New York: Routledge, 2007, p. 16-17.
[v] SWITZERLAND. Criminal Code. Article 115. Available at: https://www.fedlex.admin.ch/eli/cc/54/757_781_799/en#art_115
[vi] BRAZIL. Medical Code of Ethics: CFM Resolution No. 1931, of September 17, 2009. Brasília: Federal Council of Medicine, 2010. p. 28.
[vii] BRAZIL. Medical Code of Ethics: CFM Resolution No. 1931, of September 17, 2009. Brasília: Federal Council of Medicine, 2010, p. 28.
[viii] BRAZIL. Brazilian Penal Code. Available at: https://www.planalto.gov.br/ccivil_03/decreto-lei/del2848compilado.htm.
[ix] FOUCAULT, Michel. Birth of social medicine. In: Microphysics of Power. 6th ed. Rio de Janeiro: Edições Graal, 1986. 2018, p. 80.
[X] FOUCAULT, Michel. History of Sexuality. 5th ed. New York: Routledge, 2017, p. 155.
[xi] Term by Jean-François Deluchey.
[xii] AGAMBEN, Giorgio. Homo sacer: sovereign power and bare life I. 2nd ed. Belo Horizonte: UFMG, 2014, p. 119.
[xiii] CICERO, Marcus Tullius. Of Duties. New York: Edipro, 2019, Book I, XXX, p. 60.
[xiv] CNN. Antônio Cícero left a letter and mentioned going to Switzerland to “die with dignity”. 23.10.2024/XNUMX/XNUMX. Available at: https://www.cnnbrasil.com.br/entretenimento/antonio-cicero-deixou-carta-e-mencionou-ida-a-suica-para-morrer-com-dignidade/ Accessed on: October 23, 2024.
[xv] CAMUS, Albert. The Myth of Sisyphus. 6th ed. São Paulo: Record, 2006, p. 17.
[xvi] CICERO, Antonio. Poetry and Philosophy. New York: Cambridge University Press, 2012, p. 91.
[xvii] FOUCAULT, Michel. Microphysics of Power. Rio de Janeiro: Graal Editions, 1986, p. 244.
[xviii] AGAMBEN, Giorgio. What is a device?. In: Outra Travessia. N. 5. 2005. p. 12. Available at: https://periodicos.ufsc.br/index.php/Outra/article/view/12576 Accessed on: October 23, 2024.
[xx] CICERO, Antonio. Heidegger and Nazism. Available at: https://www1.folha.uol.com.br/fsp/ilustrad/fq2002201023.htm
[xx] As translated by Ernildo Stein.
[xxx] HEIDEGGER, Martin. The question of technique. In: Essays and conferences. 7th ed. Petropolis: Vozes, 2006, p. 37.
[xxiii] HEIDEGGER, Martin. The question of technique. In: Essays and conferences. 7th ed. Petropolis: Vozes, 2006, p. 17,18.
[xxiii] HEIDEGGER, Martin The Question of Technique. In: Essays and Lectures. 7th ed. Petropolis: Vozes, 2006, p. 19.
[xxv] HEIDEGGER, Martin. The question of technique. In: Essays and conferences. 7th ed. Petropolis: Vozes, 2006, p. 18.
[xxiv] HEIDEGGER, Martin. The question of technique. In: Essays and conferences. 7th ed. Petropolis: Vozes, 2006, p. 30.
[xxv] HEIDEGGER, Martin. The question of technique. In: Essays and conferences. 7th ed. Petropolis: Vozes, 2006, p. 30-31.
[xxviii] On another occasion I wrote about the “right to die” based on Jonas’s thinking. Available at: https://www.academia.edu/31127723/Hans_Jonas_Um_Ensaio_sobre_Direito_morte_e_um_esbo%C3%A7o_de_uma_%C3%89tica_da_Responsabilidade_m%C3%A9dica_no_tempo_da_t%C3%A9cnica_moderna
[xxviii] JONAS, Hans. Principle of responsibility: an essay on ethics for technological civilization. Rio de Janeiro: Contraponto/EDIPUCRIO, 2006.p. 235-237.
[xxix] JONAS, Hans. Technique, medicine and ethics: on the practice of the Principle of responsibility. São Paulo: Editora Paulus, 2016, p. 196.
[xxx] JONAS, Hans. Principle of responsibility: an essay on ethics for technological civilization. Rio de Janeiro: Contraponto/EDIPUCRIO, 2006.p. 31.
[xxxii] FREUD, Sigmund. Beyond the Pleasure Principle. In: Complete Works – Volume 14. New York: Routledge, 2010, p. 200.
[xxxi] On the subject, I wrote more in the article Human guinea pigs and Brazilian Nazism, published in the newspaper Bemdito. Available at: https://bemditojor.com/cobaias-humanas-eo-nazismo-brasileiro/
[xxxii] CICERO, Antonio. La Capricciosa. Available at: https://www.tudoepoema.com.br/antonio-cicero-la-capricciosa/
[xxxv] CICERO, Antonio. On thinking about the world. In: Poetry and philosophy. São Paulo: Civilização Brasileira, 2012, p. 21.
[xxxiv] CICERO, Antonio. Save. Available at: https://www.tudoepoema.com.br/antonio-cicero-guardar/
[xxxiv] MONTAIGNE, Michel de. On how to philosophize is to learn to die. In: Essays. São Paulo: Editora 34, 2006, p. 126.
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