Christian Bioethics, 13:183–197, 2007

Copyright © Taylor & Francis Group, LLC

ISSN: 1380-3603 print / 1744-4195 online
DOI: 10.1080/13803600701473695

Publicly Accessible Intuitions: “Neutral

1744-4195Bioethics,
1380-3603
NCHB
Christian Bioethics Vol. 13, No. 2, June 2007: pp. 1–23

Reasons” and Bioethics

ANGELA MCKAY
PubliclyMcKay
Angela Accessible Intuitions

The Catholic University of America, Washington, DC, USA

This article examines Leon Kass’s contention that a choice for phy-
sician-assisted suicide is “undignified.” Although Kass is Jewish
rather than Christian, he argues for positions that most Christians
share, and he argues for these positions without presupposing the
truth of specific religious claims. I argue that although Kass has
some important intuitions, he too readily assumes that these intui-
tions will be shared by his audience, and that this assumption
diminishes the force of his argument. An examination of the
limitations of Kass’s argument is helpful insofar as it illustrates the
real challenge faced by religious believers who wish to defend their
beliefs in the “public forum.” For it illustrates that what needs to be
made “accessible” is the Judeo-Christian understanding of man
and his place in the world. While I do not wish to claim that this
task is impossible, I do think that it is far more difficult than most
realize. Like all important tasks, however, unless we wrestle
with the difficulties it raises, our arguments will strike many as
unconvincing.
Keywords: bioethics, moral intuitions, neutral reasons, christianity

I. INTRODUCTION

The question of how Christians and members of other religions should

argue for their views in the “public forum” has received a great deal of
scholarly attention. Some scholars maintain that Christians should offer
“neutral” reasons for their beliefs—reasons that are “accessible” even to

Address correspondence to Angela McKay, Ph.D., School of Philosophy, The Catholic

University of America, 620 Michigan Avenue, NE, Washington, D.C. 20064, USA.
E-mail: mckay@cua.edu

183
184 Angela McKay

those that do not share their religious commitments (see, e.g., Rae and Cox,
1999; Mahoney, 2003; Audi, 2000). Other scholars maintain that Christians
should not shrink from offering “robustly Christian” defenses of their
beliefs.1 The debate is complex, and it is further complicated by the fact that
it is not at all clear what a “neutral reason” is, or what would make a given
argument “accessible” to the broader public.2 It is not even clear, for that
matter, how the broader public should be characterized.
Although debates about the appropriate manner of Christian participa-
tion are typically conducted at a highly theoretical level, it seems to me that
we might gain some clarity about the issues at stake and the feasibility of
offering “neutral reasons” if we examine the sorts of arguments for Christian
bioethical positions that are found in a typical undergraduate anthology of
bioethics, and which are typically used in undergraduate philosophy
courses in bioethics, for two reasons. First, however we are to characterize
the “public forum,” it seems to me that an argument has a far better chance
of succeeding when offered to an undergraduate audience than it does in
the public forum, and consequently if a given type of argument cannot suc-
ceed in an undergraduate classroom it will have little chance of succeeding
with the broader public. Second, the type of argument that appears in an
undergraduate bioethics course is likely to be somewhat similar to the type
of argument that those who insist on the need for “neutral” or “publicly
accessible” arguments have in mind.
In this paper, after offering a general characterization of a typical
undergraduate audience and of the arguments typically offered to such
audience, I examine a specific example of one such argument, namely Leon
Kass’s contention that a choice for physician-assisted suicide is “undigni-
fied.” Although Kass is Jewish rather than Christian, he argues for positions
that most Christians share, and he argues for these positions without pre-
supposing the truth of specific religious claims. I argue that although Kass
has some important intuitions, he too readily assumes that these intuitions
will be shared by his audience, and that this assumption diminishes the
force of his argument. An examination of the limitations of Kass’s argument
is helpful insofar as it illustrates the real challenge faced by religious believ-
ers who wish to defend their beliefs in the “public forum.” For it illustrates
that what needs to be made “accessible” is the Judeo-Christian understand-
ing of man and his place in the world. While I do not wish to claim that this
task is impossible, I do think that it is far more difficult than most realize.

II. NEUTRAL REASONS

I proposed above that we assume the “public” in question to be the student

population of a typical undergraduate philosophy course for nonmajors.
Such a public, I propose, is in the typical case intelligent, but at the same
 Publicly Accessible Intuitions 185

time possesses very little knowledge of specific philosophical positions, and

may or may not have specific religious commitments. Even when—as is the
case for those of us who teach at religiously affiliated schools—our students
are predominately members of a specific religion, it is often the case that
their moral beliefs are not determined by their religious upbringing. To the
contrary, even those who have been raised to believe that, say, abortion is
wrong, are still making up their minds on the matter, and while they often
want to believe that the morals they have been raised with are correct, they
also—quite rightly—want reasons why they should believe this. Most stu-
dents, moreover, want reasons that do not presuppose the truth of a certain
religion or even the existence of God.
What sort of reasons, then, can be offered to such an audience? What-
ever the reasons that can be offered to such an audience, certain types of
reasons are offered to such an audience, namely the arguments that are
found in the anthologies of bioethics typically used in such classes. These
arguments can be characterized in the following way: (a) they contain no
religious claims: while they may refer to the Bible or to other religious texts,
they do not treat these texts as authoritative; (b) they do not presuppose
any sophisticated philosophical knowledge or that the reader ascribes to
any particular theory of the good; and finally, at least when such arguments
are convincing, (c) they rely heavily on appeals to the reader’s intuitions
and common sense to argue for the veracity of their claims.
The last of the three requirements is, it seems to me, necessitated by the
first two. For such a public needs some kind of motivation to believe the
things they are told, and in this case the motivation can only come from an
appeal to their experience, their common sense, or their intuitions. It is not
enough, for instance, to simply tell such an audience that it is wrong to take
innocent human life and expect them to concede the point. Such an audi-
ence will rightly demand an explanation of why it is wrong to take innocent
human life, and will rightly raise some very difficult examples of situations
where it seems that it would be right to take an innocent human life. The only
convincing response must take the form of an intuitively appealing argument
that demonstrates that it is in fact not right to take life in those situations.
As I shall argue, it is the necessity of an appeal to intuition and com-
mon sense that presents the biggest stumbling block to religious believers
who wish to offer “neutral” arguments for their bioethical positions. For the
Judeo-Christian worldview is radically different from the secular worldview,
and it follows that the intuitions that seem natural given a Judeo-Christian
understanding of the world and man’s place in it will not seem at all natural
under a more secular worldview. Those who wish to offer neutral argu-
ments for these positions, then, face a Herculean task: they must make
Judeo-Christian intuitions accessible to nonbelievers. Kass’s argument
against physician-assisted suicide, I will argue, demonstrates just how diffi-
cult such a task must be.
186 Angela McKay

III. KASS AND NEUTAL REASONS

Leon Kass has written a great deal about bioethical issues, and the manner
in which he addresses these issues makes the arguments he offers ideal can-
didates for inclusion in anthologies of bioethics. For Kass approaches bioet-
hical issues in a way that appears to meet all three of the criteria outlined
above. First, although he makes frequent references to biblical ideas about
man and man’s place in the world, he does not treat these claims as author-
itative, but rather uses them as examples that help make his point. Second,
although Kass himself is clearly influenced by Aristotelian ideas, he does
not presuppose that his readers possess sophisticated philosophical knowl-
edge. Finally—and this may explain why Kass’s arguments appear so fre-
quently in anthologies of bioethics—Kass’s arguments appeal to the
intuition and the common sense of his readers.
In what follows, I address a small portion of a broader argument
against euthanasia and physician-assisted suicide put forward by Kass in his
Life, Liberty and the Defense of Dignity, namely Kass’s argument that a
choice for physician-assisted suicide is “undignified.” Although I share
Kass’s intuitions, his argument has several important weaknesses, and these
weaknesses, I will argue, are illustrative of the gap between Kass’s intuitions
and those of his readers.

IV. “DIGNITY”

Before delving into the details of Kass’s argument, it is important to clarify

the term “dignity.” This term arises frequently in discussions about euthana-
sia and physician-assisted suicide, and is appealed to by both those who
oppose such practices and by those who favor them. These appeals are
complicated by the fact that the same term can be and is used in many dif-
ferent ways, leading some to argue that “dignity” is a useless term that
should be removed from ethical discourse about bioethics.3 While the term
“dignity” is far from useless, it is certainly important to specify how the term
will be used and what it will mean. Since I will be concerned with Kass’s
arguments about a specific sense of dignity, and since Kass uses “dignity” in
two different senses in the article we are concerned with, it is important to
distinguish these at the outset.4
One sense of “dignity,” which Kass refers to as universal dignity, refers
to the dignity or status that a thing possesses simply in virtue of being the
kind of thing it is. This sort of dignity is the dignity that a thing is said to
possess simply in virtue of its membership in a given species, and those
who possess this sort of dignity are said to command respect from others,
not in virtue of any qualities they themselves possess, but in virtue of the
kind of thing they are. This is, I take it, what opponents of the death penalty
 Publicly Accessible Intuitions 187

have in mind when they say that the death penalty is “contrary to human
dignity.” The claim is not that the criminal himself has character traits that
command our respect, but rather that the criminal is a human being and
that all human beings deserve at least some minimum of respect from us.
A second sense of “dignity,” which Kass refers to as full dignity, refers
to the dignity that is exhibited in the individual actions or character traits of
a given individual. This is the sort of dignity we have in mind, I take it,
when we assert that certain actions are “undignified” or say that something
is “beneath” our dignity. While the former sort of dignity is something that is
ostensibly possessed by every member of a kind, the latter is something that
only some members of a kind possess, and which may or may not be
exhibited in action. When we describe actions as dignified, then, we are
claiming that they exhibit “full dignity,” and when we describe actions as
undignified, we are claiming that they are incompatible with full dignity. In
what follows, I will be concerned to examine Kass’s argument that a choice
for physician-assisted suicide is contrary to full dignity.

V. KASS’S ACCOUNT OF FULL DIGNITY

In the course of a broader argument against all forms of euthanasia, Leon

Kass offers an argument designed to show that one acts in an undignified
way when one opts for physician-assisted suicide. There are, it seems to
me, two distinct features of this argument. First, Kass offers a general
account of what full dignity is. Secondly, Kass argues that given such an
account, a choice for physician-assisted suicide is undignified.
Since Kass’s definition of full dignity derives from his account of uni-
versal dignity, it is necessary to begin with a brief account of Kass’s under-
standing of universal dignity. Kass believes that there is something about
human life as such that commands a “proto-religious” respect from us. It is
this intuitive recognition that there is something “special” about human life,
he believes, that ultimately grounds taboos against murder, cannibalism,
and incest: we sense that certain actions violate the respect that must be
shown to human beings (Kass, 2002, p. 238). What we recognize, moreover,
is that humans are special because they, alone among other things, are
capable of “god-like” actions: “man has a special standing because he
shares in reason, freedom, judgment and moral concern, and as a result, he
lives a life freighted with moral self-consciousness” (p. 242). Many features
of Kass’s account of universal dignity, of course, merit further examination,
but such an analysis is outside the scope of this paper. The details men-
tioned here are important for our purposes only insofar as they provide the
background for Kass’s account of full dignity.
Membership in a species capable of noble or godlike actions is what
grounds man’s universal dignity, but it is the realization of these capacities
188 Angela McKay

that confers full dignity on human beings. Man achieves full dignity, that is
to say, when he acts in a manner that reflects the nobility, god-likeness, and
uniqueness of his species: “this universal attribution of dignity to human
beings pays tribute more to human potentiality, to the possibilities for
human excellence. Full dignity or dignity properly so-called, would depend
on the realization of these possibilities” (p. 247). Given Kass’s previous
account of what it is that is “god-like” about human beings, it would follow
that a man achieves full dignity when he actualizes his capacity to live a life
“freighted with moral consciousness”; i.e., when he lives a good life: “dig-
nity would seem to depend mainly on having a good moral life, that is, on
choosing well. Is there not more dignity in the courageous than in the cow-
ardly, in the moderate than in the self-indulgent, in the righteous than in the
wicked?” (p. 247). An act is dignified when it reflects man’s highest quali-
ties, and conversely an act is undignified when it is unbefitting man’s special
status.
It is worth pointing out that the definition of full dignity offered above
leaves room for a class of human action that is neither dignified nor undig-
nified. Drinking a glass of water (at least under normal circumstances) nei-
ther reflects the nobility, god-likeness, and uniqueness of the human
species nor undermines it. In fact, the adjective dignified seems reserved for
especially good actions (or, when used to describe a character trait, for
especially good people), and similarly, it seems that we would not say that
an action was undignified in the full sense unless it exhibited an absence of
what should be present. Most human actions, it seems, would fall some-
where in between.
Kass’s definition of full dignity is, or at least ought to be, relatively
uncontroversial. Indeed, it is either echoed by or compatible with the
accounts of dignity offered by other philosophers, even those who disagree
with Kass about the acceptability of euthanasia and physician-assisted sui-
cide. For example, Jyl Gentzler, who argues that a choice for death is—at
least in some instances—acceptable, gives a definition of dignified action
that is remarkably similar to Kass’s. Gentzler argues that “dignified” choices
or actions are those that exhibit human excellences or virtues. After examin-
ing several insufficient descriptions of human dignity and noting that these
descriptions, while inadequate, still seem to capture something of what
those who propose them mean by dignity, Gentzler argues that when we
describe an action or a person as dignified we likely mean something simi-
lar to what Aristotle meant with his notion of the fine or noble (2003,
p. 477). What we mean by a dignified life, Gentzler argues, is likely a life
that exhibits virtue. It follows that what we mean by a dignified death is
likely a death that exhibits virtue. A choice for death, she concludes, will be
dignified if that choice exhibits human virtue (Gentzler, 2003, p. 478).
Kass’s definition also seems to capture what many proponents of physi-
cian-assisted suicide mean when they argue for a right to “die with dignity.”
 Publicly Accessible Intuitions 189

John Hardwig, for instance, argues that in some circumstances individuals

have a “duty” to die, and then claims that a choice for death in those cir-
cumstances is dignified (2005). Similarly, in her excellent study of Roman
suicide, Miriam Griffin shows that Stoic philosophers were preoccupied
with the question of whether suicide exhibited virtue, and that they con-
doned or condemned suicide on precisely these grounds (1986, p. 75). All
of these uses appear to link a dignified death with a noble or virtuous
death.
Although it is true that some thinkers simply equate dignified action
with autonomous action rather than with some specific kind of autonomous
action, even this understanding is compatible with Kass’s claim that digni-
fied actions are those actions which express what is highest about human
beings. It would merely be the case that—as such a definition seems to
imply anyhow—the “best” actions that human beings are capable of are free
actions, and that no one free action is to be preferred over any other.5 Fully
to express one’s humanity, on such a reading, is to direct the course that
one’s life will take, not to realize some specific goal.
Kass’s definition of full dignity, finally, seems to fit our own ordinary
descriptions of dignified action. We tend to say, for instance, that certain
things are “beneath one’s dignity,” or that certain actions are “undignified.”
What we seem to mean in those circumstances is that such actions fall short
of the way the individual in question ought to behave. If we claim that
menial tasks are “beneath the dignity” of a queen or head of state, what do
we mean, other than that the person in question is supposed to act in a cer-
tain way, and that the acts in question fall short of the standard? Or if we say
that it is “undignified” for a lawyer to wear sweatpants to court, what do we
mean but that lawyers are supposed to present themselves in a certain way
and that this lawyer has not done so? It would only make sense that when
we say that a certain choice for death is “undignified,” it follows that such a
choice is inconsistent with the way that human beings ought to behave.
There seems to be room for general agreement, then, that “full dignity”
has to do with those actions that are in keeping with or at least not contrary
to the special status that we have as human beings. Obviously, one’s
account of what is or is not dignified will vary, depending on precisely what
it is one thinks is special about human beings, but the fact remains that—at
least at a sufficiently general level—there is some relative agreement about
what is under debate when we consider the question of whether a choice
for physician-assisted suicide is dignified.6

VI. FULL DIGNITY AND PHYSICIAN ASSISTED-SUICIDE

To this point, Kass has succeeded in offering an account of full dignity that
(a) makes no religious claims, (b) is accessible, and (c) is highly intuitive. It
190 Angela McKay

is at precisely this point, however, that the real work begins. For Kass must
now show that a choice for physician-assisted suicide is an undignified
choice. At this stage, the task becomes more difficult, for while many—
perhaps most—would agree that an action is dignified if it exhibits what is
highest and best about mankind, views about which actions do or do not
exhibit mankind’s nobility differ widely. Kass, then, must find some way of
arguing that a choice for physician-assisted suicide is undignified, and given
the parameters laid out in the first section, he must make this argument
largely on the basis of an appeal to intuition and common sense.
Kass acknowledges that assisted suicide can appear to be a dignified
choice. Yet he proposes two arguments designed to show that such a
choice is in fact undignified. The first argument he proposes has to do with
the choice for death in such a circumstance, while the second has to do
with the decision, in such a circumstance, to ask for assistance in dying.
Both choices, he argues, fail to exhibit the “nobility of soul” that is a neces-
sary component of a dignified death.
Although those who maintain that individuals should be allowed to
choose death typically argue that such a choice “affirms the dignity of free
will against dumb necessity,” Kass claims that (a) this is not the real motive
behind most such choices and that (b) when this is the motive, it is a motive
that is paradoxical at best (p. 251). The real motive behind such choices,
Kass believes, is in the typical case not a desire to affirm free will in the face
of dumb necessity, but a desire to end pain and trouble. While we might
empathize with and understand such a motive, however, such a motive can-
not be considered dignified. Truly dignified action consists in summoning
the courage to face one’s troubles, not in running from them. To kill oneself
to avoid pain and trouble, then, is undignified because it is a cowardly thing
to do. Courageous individuals do not run from hardship; they stand and
face it.
Not all people, of course, opt for death merely out of a desire to avoid
pain and trouble. However, Kass claims that the alternative motive—the
affirmation of free will in the face of dumb necessity—is paradoxical at best.
One cannot, he argues, honor oneself by eliminating oneself. To the con-
trary, it is an embarrassment if “autonomy reaches its zenith precisely as it
disappears” (p. 251). For both of these reasons, Kass believes that a choice
for death cannot be a dignified choice; it is not a choice that reflects the
special nobility of which human beings are capable.
It is still less dignified, Kass maintains, if one’s choice for death is such
that it involves asking other people for assistance. To ask someone else for
assistance because you cannot end your own life is to inflict a terrible duty
on someone else: it is to demand that someone else become your killer. This
is not a duty that someone “in full possession of their dignity” should inflict
on anyone they truly love, nor is it a duty that one should impose on the
very physician from whom one demands humaneness and respect (p. 252).
 Publicly Accessible Intuitions 191

As before, Kass’s arguments are guided by important intuitions. The

guiding intuition behind the claim that a choice for death is undignified is, I
take it, the intuition that those who wage a valiant war with their illness,
who endure it with grace and courage, who amidst all the pain nonetheless
manage to show a cheerful face to the world, exhibit more nobility than
those who seek death as a way of avoiding the difficulties their end will
involve. Similarly, I take it that Kass is arguing that the individual who is
truly noble or truly dignified would love others, be they his family or his
physician, too much to foist such a terrible choice on them. What I wish to
examine, however, is whether Kass has made a case against assisted suicide
that will convince those who do not already share his intuitions.
Let us begin with Kass’s first claim, namely that a choice for death is
never dignified. As Kass describes the situation, a choice for death is either
(a) an attempt to escape from troubles and pains or (b) an eminently futile
way of raging, so to speak, against the dying of the light: one asserts one’s
autonomy by eliminating oneself. To choose death for reasons of type (a) is
undignified because “there is more dignity in courage than in its absence,”
and to choose death for reasons of type (b) is impossible because it is
paradoxical.
Although Kass’s first claim has a certain appeal, the appeal weakens
when we begin to ask ourselves exactly why such a choice would exhibit
cowardice. It is certainly true that in many instances, an attempt to escape
from trouble and pain is cowardly. But surely not every attempt to escape
trouble and pain exhibits such cowardice. If it did, then there would be
something cowardly about taking aspirin for a headache.7 We do not think
it is cowardly, moreover, to run from a burning building or from a bomb
that is about to explode—or at least, not in every circumstance. When do
such choices become cowardly? They become cowardly, it seems, when one
chooses to escape trouble and pain rather than engage in some noble,
important, but painful and difficult task. It is not cowardly to run from a
burning building if the building is empty, but if there are small children who
need to be saved, and if one has the means of saving them but chooses not
to out of fear, then the choice to escape trouble and pain exhibits coward-
ice. Similarly, an individual who knows how to disable a bomb that threat-
ens the lives of many people but who instead flees the scene is cowardly,
because such an individual places the avoidance of pain and trouble before
something noble, important, and choice-worthy.
All of this allows us to offer precision to argument (a). It is cowardly to
run from pains and troubles if one chooses to avoid pain and trouble over
some higher, more noble, but also painful and troublesome alternative. To
state this precision, however, is to see what is incomplete about Kass’s argu-
ment. For Kass’s argument to go through, there would have to be some-
thing noble about living one’s life through to the very end, about seeing it
out rather than ending it. There would have to be something heroic about
192 Angela McKay

not ending one’s life in the same way that there is something heroic about
risking one’s life in our other examples. Absent such an account, we have
no reason to agree that it is “cowardly” to seek an end to pains by ending
one’s life.
But is there something noble about seeing one’s life through to the
end, something so noble that one exhibits cowardice by ducking out early?
If so, exactly what is noble about enduring a painful and debilitating disease
through to the end? Exactly what is noble about continuing to live, even
when it means becoming incontinent, demented, and dependent? If we are
to abide by the requirements outlined at the beginning of our discourse, we
need to offer an argument that is intuitively appealing, one that demon-
strates, on the basis of common sense alone, that there is something noble
and important about such a life. The problem here is that the intuitions are
all too often on the other side. Roman and Greek philosophers, who, as
Miriam Griffin points out, tended to exhibit a less favorable attitude towards
suicide than their peers, typically included debilitating pain and illness
among the things that rendered suicide acceptable, especially if one’s illness
made virtuous actions more difficult (1986, p. 74). Even Plato in his Laws
appears to include illness among those things that render suicide acceptable
(1961, p. 1432). Possible exceptions are found in Aristotle, who asserts that
it is cowardly to kill oneself to avoid pain (1985, p. 116a15), and in Socrates’
argument in the Phaedo that even if we long for death, the god has placed
us on earth to perform a certain task, and it is wrong to desert our posts
ahead of schedule. Even here, however, Aristotle does not offer an explana-
tion for his claim, and insofar as Socrates bases his argument against suicide
on an appeal to the need to perform the tasks that the god has given, it is
not at all clear that such an argument could be included in a contemporary
anthology of bioethics. Kass, then, needs to offer some intuitively appealing
account of why it is important to remain alive, even when continued life
promises pain, suffering, and humiliation. If we are allowed recourse to reli-
gious claims or even to posit God’s existence, of course, we can make such
arguments. But how are such claims to be made appealing without them?
The case becomes all the more difficult when we consider those cases
where the choice for death is not motivated solely by a desire to avoid
future pain and degradation. Kass asserts that when one’s choice for death
is not motivated by a desire to “escape from pains and troubles,” the choice
for death exhibits a paradoxical attempt to assert one’s autonomy. In the
event that such a choice really is an attempt to assert autonomy, then there
is a certain amount of sense to Kass’s claim that it is paradoxical. A choice
for death certainly is an exercise of autonomy, but it is an exercise of auton-
omy that, so to speak, also eliminates one’s autonomy once and for all.
The problem that arises here, however, is that it is not at all clear that
Kass has sufficiently outlined the motives. It may be true that many kill
themselves because they wish to escape from pain and trouble, and it may
 Publicly Accessible Intuitions 193

also be true that many kill themselves in an attempt to assert autonomy in

the face of circumstances beyond their control, but surely these two motives
do not exhaust the options?
Leaving aside for the moment the question of the choices for death that
occur in the context of assisted suicide, it is clearly untrue that suicides in
general need be motivated by one of these two goals. It is easy to find
examples of suicides that appear to have been motivated by neither a desire
to avoid pain nor a last, paradoxical attempt to assert freedom in the face of
necessity, but by the noblest of motives. What are we to say, for instance, of
a secret agent who swallows a cyanide capsule to avoid betraying his coun-
try’s secrets? Or of someone who kills himself in an attempt to preserve his
family’s honor? Suppose, alternatively, that there is not enough food for my
family, that I am old and infirm and cannot help to find food, and that I kill
myself so that my grandchildren will have more food to eat. In all of these
situations, it looks like the suicide stems from a noble motive.
If suicide can sometimes be motivated by a noble desire, then it seems
as if we should at least entertain the possibility that a choice for assisted sui-
cide could also be motivated by a noble desire. Could not such a choice be
motivated by a desire to spare one’s family pain or to relieve them of a bur-
den? While it is probably true that many of those who claim to have such
motives do not, we still must acknowledge the possibility of such motives. It
seems that we should concede, then, that at least some choices for assisted
suicide stem from noble motives.
Although this makes Kass’s task harder, it does not make it impossible,
for noble motives do not guarantee good or noble actions. What needs to
be shown, however, is that a choice for death, even one motivated by the
best of intentions, is still an ignoble or undignified choice. But this, again, is
not something that is intuitively obvious, particularly if one’s intuitions are
not Judeo-Christian intuitions.
Kass’s final claim, namely that it is not dignified to ask someone else to
be one’s executioner, succeeds or fails depending on whether or not a
choice for death can be noble or at least avoid being ignoble. For while it is
indeed undignified to ask someone else to do something base or ignoble,
there is no dishonor in asking someone for assistance in other endeavors.

VII. PUBLICLY ACCESSIBLE INTUITIONS

In the above, I argued that Kass’s case against physician-assisted suicide

falls apart at the crucial moment, and that it falls apart for the following rea-
son: although Kass’s argument is motivated by important intuitions, it is not
at all clear that a secular audience will share those intuitions. Kass faces a
peculiar sort of problem: he must find a way to make his intuitions accessi-
ble to his audience. Kass’s arguments stop, that is to say, at precisely the
194 Angela McKay

point they need to begin. The question, however, is whether these intui-
tions are even the sort of thing that can be made accessible to a secular
audience. At this point it might be helpful to say a bit more about Kass’s
particular intuitions.
I noted above that Kass’s arguments appear to be motivated by two
equally important intuitions. The first of these is that there is something
valuable and important about living one’s life through to the end, some-
thing so important that one exhibits cowardice by ducking out early. This
means, among other things, that even if one knows with a high degree of
certainty that one will soon become demented, that one will soon be unable
to control one’s bowels, and that one will soon be the source of pain, trou-
ble, and even discord among one’s family, there is still something valuable
and important about one’s continued life. The second intuition is that the
task of living one’s life to the end is so important there is no motive, how-
ever lofty, that could give one good cause to end one’s life. Even if one
could spare one’s family a great deal of difficulty, financial hardship, and
emotional pain by taking one’s life, one would still exhibit more dignity in
living.
I believe that Kass’s intuitions are both important and correct. They are
also, however, intuitions that stem from a Judeo-Christian understanding of
man and his place in the world, and it is not immediately obvious that one
who does not share such an understanding would or even could share
these intuitions. It is probably not even true, in fact, that all practicing Chris-
tians share such intuitions. Christians believe that these things are true, to be
sure, but they quite often believe these things in spite of conflicting intui-
tions. In fact, to develop one’s ability to see that all human beings—not
merely some—are worthy of love, and that all human life has value is argu-
ably part of what it is to grow in faith. It seems to have been obvious to
Mother Teresa that the lives of the demented, poor, incontinent, and infirm
had value, but it is not at all clear that this is always intuitively obvious to
everyone, even to those who fervently believe that such lives do have
value.
Those who wish to argue for Christian positions in the public forum,
then, have a unique and difficult task. For they do not merely need to
appeal to the intuitions of their audience; they need to find a way to make
their intuitions accessible to their audience, for their intuitions are not the
sort of thing that a secular audience readily shares. It is necessary, then, to
find some way of helping one’s audience to appreciate the depth of these
intuitions.
If what I have argued above is correct, then the question we are faced
with is whether it is possible to make Christian (or in Kass’s case, Judeo-
Christian) intuitions accessible without resorting to overtly religious claims.
While I am skeptical about the extent to which it is possible to do this, I do
think that one can go some ways towards making such intuitions accessible.
 Publicly Accessible Intuitions 195

In what follows, I want to point to one instance where I think such an intu-
ition was—at least in part—made “publicly accessible.”
The movie “Million Dollar Baby” met with much critical acclaim and
violent opposition from right-to-life groups, who argued that the movie was
propaganda for the euthanasia movement. Rightly understood, however,
the movie actually goes a long way toward making the sorts of intuitions
that Kass has accessible to those who do not share them. “Million Dollar
Baby” tells the story of a young woman, Maggie Fitzgerald, who wishes to
become a boxer, and who convinces an embittered old trainer, Frankie
Dunn, to teach her. During the course of the training, Maggie and Frankie
develop a beautiful relationship, and it is clear that each finds in the other
the love for which they desperately long. For Frankie, Maggie is a replace-
ment for his estranged daughter; for Maggie, Frankie is the father she lost.
However, when Maggie’s spinal cord is crushed and she is paralyzed,
Maggie decides that she wants to end her life. As she sees it, she has done
everything she needed to do. She has fulfilled her dreams, she is peaceful,
and she sees nothing of value in the idea of continuing to live as a quadri-
plegic. Although Frankie does not want Maggie to die, he blames himself
for her accident and feels that he is selfish for wanting her to continue to
live. So, when Maggie attempts to kill herself by biting off her tongue,
Frankie finishes the job.
If Maggie and Frankie are taken to be the moral mouthpiece of the
movie, then the movie might indeed be little more than propaganda for the
euthanasia movement. But it is obvious throughout the movie that neither
Maggie nor Frankie have a clear conception of what is most meaningful
about their lives or even about their relationship. This is because the movie
is narrated by an individual—Eddie Dupris—who, if he is not the moral
mouthpiece, is at least closer to one than either Maggie or Frankie. Eddie is
an ex-boxer, and Frankie’s only friend. Eddie has also suffered a career-ending
injury, and Frankie blames himself for Eddie’s injury, just as he blames him-
self for Maggie’s. Eddie, however, has realized what neither Frankie nor
Maggie can. It is evident from Eddie’s narration that both Maggie and
Frankie misunderstand Maggie’s situation in an important way. What Mag-
gie does not see is that Frankie needs her; that she gives purpose and
meaning to his life. She would be a burden, yes, but she is a burden that
Frankie desperately wants and needs. Frankie, similarly, cannot see past the
fact that Maggie has suffered a debilitating injury that he perceives to be his
fault.8 He cannot see that he has given Maggie something far more impor-
tant than boxing instruction. The tragedy of the movie, in fact, is that
Frankie never tells Maggie that he needs her, and never even tells her that
she is “his darling” until he is in the very act of killing her. This is tragic, of
course, because the knowledge of Frankie’s need for her is perhaps the
only thing that would have enabled Maggie to see some value in her contin-
ued life.
196 Angela McKay

Understood in this way, the movie “Million Dollar Baby” provides a

“publicly accessible” defense of Kass’s intuition. For the noble thing for
Maggie to do would be to endure a painful and debilitating condition for
the sake of the man who loves her and who desperately needs her in his
life, and it is obvious that she—albeit unwittingly—does a very terrible thing
when she asks such a man to be the agent of her death.
Even a defense such as this one, however, can only go so far. The
movie illustrates an important truth, and a truth that one can comprehend
even without overtly religious claims. The movie illustrates the truth that
human beings need love more deeply than they need anything else in life,
and that one does those one loves a terrible harm by deserting them, let
alone by asking them to take one’s life. To state this truth, however, is to
see the limitations of it. For we who share Judeo-Christian intuitions about
man and his place in the world also think that even those who are alone
and unloved, whose families are clearly waiting for them to die and are
annoyed that they have not; we think that even these lives are important
and valuable. While I am hopeful that there is a way to make this intuition
“publicly accessible” without making “robustly Christian” claims, I must also
confess that I am not sure how one would do so.
I often hear it said that the truth of certain Christian ethical positions is
“obvious,” so obvious that one could not deny these positions without pos-
sessing, to use Anscombe’s famous phrase, “a corrupt mind” (1995). I think
it is important for religious believers, however, to acknowledge that these
truths are not always as obvious as they seem, particularly when one does
not presuppose the truths of faith or even the existence of God. There may
well be a way to make these truths intuitively obvious, and the attempt to
do so is both necessary and important, for believers and nonbelievers alike.
Like all important tasks, however, it is also a difficult one, and unless we
wrestle with the difficulties it raises, our arguments will strike many as
unconvincing.

NOTES
1. Among those who argue that Christians need not and indeed should not attempt to find such
reasons are Gilbert Meilander and H. Tristram Engelhardt, Jr. See for example Gilbert Meilander (2005)
and H. Tristram Engelhardt, Jr. (2000).
2. For an excellent discussion of this question, see Jeremy Waldron (1993).
3. See for instance Ruth Macklin (2003). Macklin argues that the term dignity is invariably reduced
to either (a) autonomy or (b) respect for persons, and that when it does not reduce to either of these
two terms it is used as a meaningless rhetorical slogan.
4. Scholars have proposed a variety of different names for the senses of dignity that I will distin-
guish in the following paragraph. The sense of dignity that I call ontological is sometimes referred to as
“intrinsic” or “connatural” dignity, while the sense of dignity that I call moral is sometimes referred to as
“manifested” or “existential” dignity. See for instance Patrick Lee (2001) and Luke Gormally (2004).
5. Jyl Gentzler does a nice job of pointing out that those who propose such a definition often
involve themselves in contradictions, because they simultaneously assert that everyone should be able to
 Publicly Accessible Intuitions 197

direct their lives in any way they desire and claim that certain actions, such as smoking, are reprehensi-
ble (2003, p. 475).
6. In email correspondence, Christopher Tollefsen offered a neat formulation of this view, noting
that: “‘dignity’ is a kind of summarizing term that supervenes on whatever we have to say about a) the
specialness of human persons and b) whatever moral consequences that has. It’s not a foundational
term—it is available to any ethicist who has an account of why we are valuable, and what the conse-
quences in some domain are of that.”
7. Thanks to Michael Gorman for offering this example.
8. Many critics argue that because Eddie Dupris tells Frankie that if Maggie were to die, she would
die thinking “I done alright,” Eddie Dupris ultimately tells Frankie to kill Maggie. To say this, however, is
to take the quote out of context. Eddie tells Frankie this in response to Frankie’s claim that he “killed
her” by allowing her to fight. Eddie, like Frankie’s priest, is merely attempting to convince Frankie that
Maggie’s condition is not his fault. It is important to remember, moreover, that although Eddie has an
inkling of what Frankie might do, Frankie does not discuss the prospect of killing Maggie with Eddie.

REFERENCES

Anscombe, E. (1995). ‘Modern moral philosophy,’ in S. Cahn (Ed.), 20th Century

Ethical Theory (pp. 351–364). New Jersey: Prentice Hall.
Aristotle. (1985). Nichomachean Ethics, T. Irwin (Ed.). Indianapolis: Hackett Pub-
lishing Company.
Audi, R. (2000). Religious Commitment and Secular Reason. Cambridge: Cambridge
University Press.
Engelhardt, H. T. Jr. (2000). The Foundations of Christian Bioethics. Lisse: Swets &
Zeitlinger.
Gentzler, J. (2003). ‘What is a death with dignity?’ The Journal of Medicine and Phi-
losophy, 28(4), 461–487.
Gormally, L. (2004). ‘Pope John Paul II’s teaching on human dignity and its implica-
tions for bioethics,’ in C. Tollefsen (Ed.), John Paul II’s Contribution to Catholic
Bioethics (pp. 7–33). The Netherlands: Kluwer Academic Publishers.
Griffin, M. (1986). ‘Philosophy, Cato, and Roman suicide: I,’ Greece and Rome, 2nd
Ser., 33(1), 64–77.
Hardwig, J. (2005). ‘Is there a duty to die?’ in J. Hardwig (Ed.), Is There a Duty to
Die? (pp. 119–136). London: Routledge.
Kass, L. (2002). Life, Liberty and the Defense of Dignity. San Francisco: Encounter
Books.
Lee, P. (2001). ‘Personhood, dignity, suicide and euthanasia,’ The National Catholic
Bioethics Quarterly 1(3), 329–344.
Macklin, R. (2003). ‘Dignity is a useless concept,’ BMJ, 327(20), 1419–1420.
Mahoney, J. (2003). ‘Christian doctrines, ethical issues, and human genetics,’ Theo-
logical Studies, December, 719–749
Meilander, G. (2005). ‘Against consensus,’ Studies in Christian Ethics, 18(1), 75–88.
Plato. (1961). The Collected Dialogues of Plato, E. Hamilton (Ed.). Princeton: Princeton
University Press.
Rae, S. & Cox, P. (1999). Bioethics: A Christian Approach in a Pluralistic Age.
Michigan: William B. Eerdmans Publishing Company.
Waldron, J. (1993). ‘Religious contributions in public deliberation,’ San Diego Law
Review, 30, 817–48.