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Thomas F. Tierney
Suicidal thoughts
Hobbes, Foucault and the right to die
Abstract Liberal articulations of the right to die generally focus on balancing individual rights against state interests, but this approach does not take full advantage of the disruptive potential of this contested right. This article develops an alternative to the liberal approach to the right to die by engaging the seemingly discordant philosophical perspectives of Michel Foucault and Thomas Hobbes. Despite Foucaults objections, a rapprochement between these perspectives is established by focusing on their shared emphasis on the role that death plays in the order of modernity. After the article has established the complementarity of Foucault and Hobbes, Hobbes unique stance toward suicide is rst viewed in the context of the early-modern hostility toward suicide, and then contrasted with Foucaults Stoic-inspired afrmation of suicide. This comparison of these two philosophers positions on suicide opens to contestation dimensions of modern subjects that remain undisturbed by liberal approaches to the right to die. Key words bio-power Michel Foucault governmentality Thomas Hobbes liberalism right to die self-preservation Seneca Stoicism suicide
[N]ecessity of nature maketh men to will and desire bonum sibi, that which is good for themselves, and to avoid that which is hurtful; but most of all, the terrible enemy of nature, death, from whom we expect both the loss of all power, and also the greatest of bodily pains in the losing; it is not against reason, that a man doth all he can to preserve his own body and limbs both from death and pain. (Hobbes, 1640[1839]: 83) [I]f you take proper care of yourself, that is, if you know ontologically what you are, if you know what you are capable of . . . if you know what things you should and should not fear, if you know what you can reasonably hope for and on the other hand what things should not matter to you, if you
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Of the many bio-ethical dilemmas that have appeared on the moral horizon of medically advanced cultures over the last three decades, one of the most visible and divisive issues is the recently asserted right to die.1 This right usually appears in public discourse in the form of physician-assisted suicide (PAS) and/or the related practice of euthanasia, but also includes the less controversial right to refuse life-saving treatment. While the right to refuse medically necessary treatment has been widely accepted for decades, the right to hasten ones death with the help of a physician, either through assisted suicide or euthanasia, was contested in the legislative and judicial forums of many nations during the last decade of the 20th century. Australia, Canada, Columbia, England, France, Germany, Israel, Japan, New Zealand, the Philippines, South Africa, Sweden and the United States all dealt with attempts to legalize PAS and/or euthanasia during the 1990s. Although none of these nations legalized either form of life-terminating act, the Northern Territory of Australia authorized both PAS and euthanasia in 1996, but the Australian Senate quickly overturned the policy in 1997.2 In the United States, the citizens of Oregon legalized PAS in 1994 through the ballot initiative known as the Death with Dignity Act, and in 1996 defeated a repeal measure; the law went into effect in 1997, making Oregon the only American state in which assisted suicide is legal. Holland has, of course, been the center of attention in discussions of PAS and euthanasia. Since 1973 the Dutch allowed, and gradually formalized, an exception to the national prohibitions against killing and assisted suicide, and in 2001 the Netherlands became the rst nation to legalize both PAS and euthanasia when it passed the Termination of Life on Request and Assisted Suicide (Review Procedures) Act.3 The next year Belgium followed the Dutch example, in part, and legalized euthanasia but not PAS (Watson, 2001: 1024). Recently, Switzerland has become Europes center for suicide tourism due to a unique provision of its 1942 law against assisted suicide, which allows anyone to assist in a suicide for altruistic reasons (Hurst and Mauron, 2003: 2713). Clearly, the right to die will continue to be a hotly contested topic of public discourse in the near future. Since the right to die usually appears in a juridical context in liberal democratic cultures, involving legislatures and/or courts, the issue is normally addressed as a question of balancing the right of individuals to end their lives in a manner of their own choosing, against the states interest in preserving life. For instance, in 1997 the US Supreme Court
With the introduction of the concept of bio-power in the rst volume of The History of Sexuality (1976[1980a]), Foucault clearly moved beyond the repressive and militaristic conceptions of power. By biopower he was referring to a positive, productive form of power that does not so much restrict or limit dangerous activity, as promote or facilitate socially valuable behavior. This positive form of power does not operate primarily through laws or interdictions issued by sovereign authority, but works instead through the dissemination of standards and norms derived from the study of populations by the human sciences and other surveillance techniques. In describing the historical emergence of bio-power Foucault focused on the relation between death and power, and presented it as the culmination of a gradual reversal of the traditional form of power that had been exercised by medieval sovereigns. For a long time, claimed Foucault, one of the characteristic privileges of sovereign power was the right to decide life and death (1980a: 135). But in that period between the Renaissance and the 19th century, which he called the Classical Age, the sovereigns seemingly absolute right to kill subjects took a considerably diminished form as liberal political theory established limits on the exercise of sovereign power. Death could be inicted directly on subjects only as a punishment for injuries or threats to the sovereign, and could be inicted indirectly when the sovereign compelled subjects to risk their lives in his defense. Since the classical age, however, a very profound transformation of these mechanisms of power has occurred:
This death that was based on the right of the sovereign is now manifested as simply the reverse of the right of the social body to ensure, maintain, or develop its life. . . . But this formidable power of death . . . now presents itself as the counterpart of a power that exerts a positive inuence on life, that endeavors to administer, optimize, and multiply it, subjecting it to precise controls and comprehensive regulations. (1980a: 1367)
With the emergence of this positive, non-repressive form of power, death could be directly or indirectly inicted by the state only to the extent
And while The Birth of the Clinic has been accurately characterized as the most neglected of Foucaults works (Jones and Porter, 1994: 31, also 12; and Armstrong, 1997: 1920),6 this early examination of medicine ts quite well with his later claims about bio-power. For just as bio-power emerged out of a transformation in the relationship between power and death, Foucault revealed in The Birth of the Clinic that the normalizing power of modern medicine also developed out of a fundamental reorientation in the relationship between medical knowledge and death. Prior to the 19th century, Foucault claimed, the knowledge of life was based on the essence of living and an immemorial slope as old as mens fear turned the eyes of doctors towards the elimination of disease, towards cure, towards life (1973a: 1456). Around the turn of the century, however, the great break in the history of Western medicine occurred as physicians directed their gaze at that great dark threat in which [the doctors] knowledge and skill were abolished death (1973a: 146). Foucault attributed the birth of this anatomico-clinical gaze to Marie-Franois-Xavier Bichat, who posed the following challenge to his fellow physicians:
. . . for twenty years, from morning to night, you have taken notes at patients bedsides on affections of the heart, the lungs, and the gastric viscera, and all is confusion for you in the symptoms which, refusing to yield up their meaning, offer you a succession of incoherent phenomena. Open up a few corpses: you will dissipate at once the darkness that observation alone could not dissipate. (quoted in Foucault, 1973a: 146)
And beyond grounding the medical gaze, Foucault also recognized that the anatomical illumination of death provided an epistemological model for all those sciences that objectify man. As he put it,
. . . positive medicine marked, at the empirical level, the beginning of that fundamental relation that binds modern man to his original nitude. Hence, the fundamental place of medicine in the overall architecture of the human sciences. . . . This is because medicine offers modern man the obstinate, yet reassuring face of his nitude; in it, death is endlessly repeated, but it is also exorcized; and although it ceaselessly reminds man of the limit that he bears within him, it also speaks to him of that technical world that is the armed, positive, full form of his nitude. (1973a: 1978)
So as sovereign power turned away from the threat of death and the scaffold in the early-modern period and gave way to a positive form of power that administered life, medicine assumed a crucial role in the exercise of this new form of power by turning toward death to establish a foundation for the human sciences that underlie bio-power.7 However, what seems to be missing from Foucaults account of this shifting relationship between power, medicine and death is some indication of
Foucault was certainly correct in excluding Hobbes from the line of thought he was examining in this course; for Hobbes, the rst law of
From Foucaults perspective, therefore, Hobbes was at best a classical theorist of sovereignty who was on the way toward governmentality, and was at worst an opponent of the warlike conception of power that was developed by other early-modern theorists. In either context, Foucault found Hobbes to be of little value and discouraged any serious consideration of his role in laying the foundation of modern forms of power. However, I think Foucault overlooked certain dimensions of Hobbes thought that not only illuminate the relation between death and power in modernity, but also complement Foucaults own analysis of this relationship in interesting ways. For one of the insights provided by Foucaults reconceptualization of power was that rather than asking ideal subjects what part of themselves or their powers they have surrendered in order to let themselves become subjects, we have to look at how relations of subjugation can manufacture subjects (2003: 265; cf. 1997c: 59; and 1980d: 15). Even though Foucault explicitly emphasized that this process of subjugation would be precisely the opposite of what Hobbes was trying to do in Leviathan (2003: 28; cf. 1980c: 978), my admittedly presumptuous claim is that Hobbes is most illuminating precisely in regard to this manufacturing of subjects. Indeed, I will argue that the Hobbesian subject is perfectly suited, if not a prerequisite, for the exercise of bio-power in a system of governmentality. In order to reveal Hobbes crucial contribution to the juridico-medical complex of modernity we must look rather closely at Leviathan (1651), but our primary concern is not to discover how a multiplicity of individuals
In general, therefore, a law of nature was not just an obligation or limitation that humans naturally recognize; it was rather a limitation on the fundamental right to do what one thought would best preserve ones life. According to the very idea of natural law one could not reasonably exercise this right in a manner that would actually lead to ones death, and furthermore one must do, or as Hobbes put it, one was forbidden to omit doing, that which one thought would best preserve or prolong ones life. In comparison with its Stoic predecessor, Hobbes conception of the natural law of self-preservation was uniquely modern. For Hobbes, the primary objective of this law of nature was to preserve physical, corporeal existence, while the Stoics were concerned with preserving something other than the body. This distinction becomes clear when one compares Hobbes corporeal conception of self-preservation with Ciceros description of the Stoic doctrine of self-love:
[S]ince love of self is implanted by nature in all men, both the foolish and the wise alike will choose what is in accordance with nature and reject the contrary. . . . When a mans circumstances contain a preponderance of things in accordance with nature, it is appropriate for him to remain alive; when he possesses or sees in prospect a majority of the contrary things, it is appropriate for him to depart from life. . . . And very often it is appropriate for the Wise Man to abandon life at a moment when he is enjoying supreme happiness, if an opportunity offers for making a timely exit. For the Stoic view is that happiness, which means life in harmony with nature, is a matter of seizing the right moment. So that Wisdom her very self upon occasion bids the Wise Man to leave her. (1967: III, 601, 27981)
For the Stoics, the law of self-preservation or self-love did not preclude the possibility of sacricing ones life in order to preserve ones virtue or tranquility, but as we will see, for Hobbes there was never a good reason to abandon ones life. (I will discuss this Stoic willingness to choose death over life in more detail later in this article.)
Hobbes personal behavior in regard to his health, as well as his theoretical portrayal of a rational subject that is governed by the fear of death, may appear unexceptional today. After all, one of the distinctive features of modern culture is the tremendous extension of human life expectancy that has been accomplished largely through the development of medical knowledge and techniques. Reasonable individuals have been eager participants in this modern project of death deferral, and remain exceedingly concerned about their health and quite willing to spend time and money to follow the latest regimental advice disseminated by
Beyond outlawing the conscious taking of ones own life, which he identied as direct self-murder, Sym also used the natural law of selfpreservation to condemn the much broader category of indirect selfmurder, which he dened as the intentional pursuit of some good by means that expose one to mortal danger without any respect, or expectation of death thereupon ensuing (1988: 856). He further divided this category of indirect self-murder into deaths that occurred due to commission, such as the excessive use of food or drink, or association with dangerous individuals, and deaths that resulted from omission, such as refusals of necessary medicine or surgery, or refusals to ee from avoidable dangers (1988: 91100). This category of indirect self-murder involves behavioral requirements that were very much like those Hobbes followed in his personal life, such as taking care of his health and eeing the Civil Wars, but there is an important difference in the justication Hobbes and Sym relied upon to support such behavior. For Sym would have his readers avoid dangerous commissions and omissions in order to escape the sin of self-murder, thereby preserving their souls, while Hobbes followed such advice on the basis of his rational commitment to the natural law of self-preservation, and the desire to add a few years to his earthly life. In other words, Syms embrace of corporeal selfpreservation involved a tension with his other-worldly commitments, while Hobbes embrace of this concept was free from any such tension. Although Syms hostility to suicide was indicative of the punitive attitude that prevailed in the 16th and 17th centuries, there were at that time a few voices raised in opposition to the punishment of self-murder. In the late 16th century Montaigne published essays that endorsed some prominent Roman suicides (one of which I will briey discuss at the end of this article), but the rst treatise-length defense of suicide was written in 1608 by John Donne, a young poet but not yet cleric, under the unwieldy title of Biathanatos: A Declaration of that Paradoxe, or Thesis, that Self-homicide is not so Naturally Sinne, that it may never be otherwise. This work is divided into three parts, each of which deals with a specic type of law that might be used to ground the prohibition against suicide: the law of nature; the law of reason; and nally,
When the student replied that it was necessary to prove that individuals were compos mentis before they could be deemed felo de se, the philosopher wondered, How can that be proved of a Man dead; especially if it cannot be proved by any Witnesses, that a little before his death he spake as other men used to do. This is a hard place; and before you take it for Common-Law it had need to be cleard (1971: 117). Hobbes lenient position on suicide, therefore, was distinct not only from Syms hostile stance, but from Donnes moderate position as well. Given his non-corporeal conception of self-preservation, Donne could allow that suicide might be a form of self-preservation in some circumstances, but for Hobbes suicide was clearly a violation of the law of selfpreservation in the corporeal sense in which he, and Sym, understood it. Yet unlike Sym and the many other 17th-century condemners of suicide, Hobbes did not feel compelled to punish this violation. Ironically, Hobbes moderate stance toward suicide can be explained precisely by his unalloyed embrace of the corporeal law of selfpreservation. For Hobbes had no doubt that all living things aim at their own preservation, and because his commitment to the other-worldly ethos of Christianity was rhetorical at best, he also had no moral compunction about claiming that individuals ought to do whatever was
Foucault on suicide
In a 1983 interview that was published in English as Social Security, Foucault discussed the necessity of limiting the level of security that the state could be expected to provide individuals, indirectly indicating how far we have come since the 17th-century concern with establishing a theoretical foundation upon which the security state could be erected. During this interview he described the current experience of death, and employed terms quite different than those famously fearsome phrases used by Hobbes. Generally speaking, Foucault remarked, people die under a blanket of drugs, if not in some accident, so that they lose consciousness entirely in a few hours, a few days, or a few weeks: they are obliterated. We live in a world in which the medical and pharmaceutical accompaniment of death deprives it of much of its pain and drama (1988: 177). While Foucault cautioned against nostalgia for a more authentic experience of death that probably never existed, he was nevertheless disturbed by the meaninglessness of the current experience, and ended the interview with the suggestion, Lets try rather to give meaning and beauty to death-obliteration (1988: 177). What Foucault had in mind for such meaning and beauty was intimated earlier in the interview, when he discussed the issue of suicide. In response to questions about the best approach for limiting demands on the health care system, Foucault emphasized that the decisions made ought to be the effect of a kind of ethical consensus so that the individual may recognize himself in the decisions made and in the values that inspired them (1988: 174). When the interviewer asked, How, in fact, can the social security system contribute to an ethics of the human person?, Foucault answered:
The idea of bringing together individuals and the decision-making centers ought to involve, at least as a consequence, a recognized right for everybody to kill himself when he wishes in decent conditions. . . . If I won a few billion francs in the national lottery, Id set up an institute where people who wanted to die could come and spend a weekend, a week or a month, enjoying themselves as far as possible, perhaps with the help of drugs, and then disappear, as if by obliteration.
There is an obviously important difference between thinking about ones eventual death, on the one hand, and thinking about taking ones life, on the other, and many ancient schools of thought, such as Platonism, encouraged the former while condemning the latter. Stoicism, however, explicitly linked the melete thanatou and suicide, and Foucault was keenly interested in this school in the last years of his life. Seneca, in particular, appeared in his 19812 course, and also gured prominently in his last publication, The Care of the Self, where this Roman Stoic was frequently cited to provide examples of the ancient imperative to perpetually cultivate oneself (1986: 3968). Unfortunately for our purposes, the discussion of Seneca in The Care of the Self was focused largely on sexual pleasures, passions and desires, and not on the melete thanatou or suicide. However, Foucault did discuss Senecas stance toward death in an important interview conducted just ve months before he died, titled The Ethics of the Concern for Self as a Practice of Freedom. Although this late interview was concerned primarily with the second and third volumes of The History of Sexuality, at one point an interviewer asked about the relation between Foucaults recent interest in the care of the self and a theme that concerned him throughout his career: But doesnt the human condition, in terms of its nitude, play a very important role here? . . . It seems to me that this problem of nitude is very important; the fear of death, of nitude, of being hurt, is at the heart of the care for self (1997a: 289; for an alternative translation, see Foucault, 1987: 9).21 Foucault responded to this crucial
Although there certainly is room to challenge Foucaults claims about the Stoic stance toward death and the afterlife, not to mention the value that the Stoics placed upon worldly reputation, this is not the place to engage in these quarrels. What is crucial for our purposes is that Foucault clearly appreciated Stoicisms undeniable acceptance of death as an unavoidable and natural part of life, and not as a punishment that needs to be avenged by a savior, as in Christianity, or as an evil that needs to be postponed as long as possible, as in Hobbesian modernity. While Senecas longing for death was particularly intriguing to Foucault, it is important to note that Seneca also emphatically endorsed suicide as a crucial facet of the care of the self. Although Foucault did not discuss Senecas stance toward suicide in any of the interviews, courses, or publications from the 1980s, his claims about suicide in The Simplest of Pleasures were remarkably similar to the advice Seneca offered in letters to his friend Lucilius. For instance, while Foucault claimed that ones suicide is a project that exists only for oneself, Seneca wrote:
Nowhere should we indulge the soul more than in dying. Let it go as it lists: if it craves the sword or the noose or some potion that constricts the veins, on with it, let it break the chain of its slavery. A mans life should satisfy other people as well, his death only himself, and whatever sort he likes is best. (Seneca, 1958: 204; also see Motto, 1973: 76; and Alvarez, 1990: 80)
Both also seemed to agree that one ought to think about, and be ready to perform (rather than commit), ones suicide, and Foucault would likely concur with Senecas judgment that [i]t is a great man who not
Without doubt, many contemporary arguments for the right to die also emphasize quality of life, but such quality is determined by the conditions of a persons impending death, and is fundamentally different than the determination of quality that Seneca and Foucault had in mind. According to these current arguments, death is an appropriate choice when illness or age has brought a person close to death and robbed him or her of the ability to take care of his or her own bodily functions, experience worldly pleasures or interact meaningfully with others. The qualityof-life considerations Seneca and Foucault thought relevant for the suicide decision, on the other hand, were not determined by the conditions of a persons imminent death, but were rather focused upon the moral and aesthetic quality of the life the person had actually lived. If it would be difcult to continue living a good and beautiful life, whether or not death is imminent, then suicide may be the appropriate choice. This emphasis on the moral and aesthetic quality of ones life, instead of the circumstances of ones death, is reected in Ciceros shocking claim that Stoics frequently judged it best to end their lives at a moment of supreme happiness. A provocative example of just such a suicide was provided by the essayist Montaigne, who preceded Donne in challenging the punitive attitude toward suicide that emerged at the outset of modernity. In his essay The Custom of the Isle of Cea (15734), Montaigne approvingly recounted Sextus Pompeius account of the suicide of an elderly, respected woman of authority from this island. Although Sextus Pompeius tried to convince her to abandon her publicly announced intention of taking her own life, she justied her decision by saying: For my part, having always experienced the favorable face of Fortune, lest the desire to live too long may make me see one of her contrary faces, I am going to dismiss the remains of my soul by a happy end, leaving two daughters of my own and a legion of grandchildren (Montaigne, 1958: 251).22
Conclusion
Over the course of his career Foucault revealed that modernity is grounded in a dual inversion in the status of death, both in the realm of medicine and in the exercise of power. On Foucaults account the illumination of death by pathological anatomy provided an epistemological
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Notes
1 This article is derived from fragments of several chapters of a larger project that is tentatively titled The Government(ality) of Health: Death, Medicine, and the Health-Conscious Subject. 2 One of the leading proponents of PAS and euthanasia in Australia is Dr. Philip Nitschke, who is often portrayed as Australias equivalent of Americas Dr. Death, Jack Kevorkian; see Beam, 2003; McInerney, 2000: 148; Mydans, 1997: 3; Singer, 1994: 1389; and ERGO!: 2005. 3 Dutch Upper House Backs Aided-Suicide, The New York Times, 11 April 2001: sec. A, p. 3. For critical discussions of the Dutch practice of euthanasia and PAS, see: Smith, 2000: 10911; Hendin, 1997: 49, 758; and Welie, 1992: 4237. For a more complete and less damning examination
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