“In the midst of life we are in death.” The old Prayer X Book’s admonition has never been more true or less understood than it is today. Modern man, despite his refusal to consider his own mortality, is busily politicizing all the little decisions and circumstances that attend his departure. Death penalty statutes, abortion regulations, right-to-die initiatives, and national health care plans have all been major political issues in recent years, although the connections between these issues are generally overlooked.
On the very day of the Washington State referenda on both abortion rights and doctor-assisted suicide, the New York Times was also reporting on the effects of a decision expanding the scope of Medicare. Most future Medicare recipients will now be guaranteed the right to purchase so-called Medigap policies to supplement the state-provided medical services. In other words, some insurance-buyers will be forced to subsidize the retirees who either failed to purchase supplementary policies or else squandered their money on the expensive plans huckstered by Ed McMahon and Art Linkletter.
While the nation’s insurance commissioners were at work staving off mortality, the people of Washington were considering a proposal to legalize medical killing (as well as a proposal to incorporate the language of Roe v. Wade into state law). Despite polls showing widespread support for doctor-assisted suicide, voters at the last minute got cold feet, apparently preferring to take their chances with black market euthanasia. Are they afraid that some day, recovering from heart surgery, they might inadvertently blurt out a wish for easeful death? Do some of them suspect, I wonder, that family members and health care bureaucrats might have palpable economic motives for granting a request for “death with dignity”?
The Dutch experiment in euthanasia has been much publicized as the result of a book by Carlos Gomez, Regulating Death. Gomez presents sobering evidence that regulations designed to facilitate voluntary suicide are now being used to justify involuntary suicide. But even the Dutch practitioners of euthanasia are disturbed by similar American proposals, according to John Keown. Writing in the Wall Street Journal (November 5, 1991), Keown reports that Dutch physicians were afraid that in a society without national health care a patient’s relatives might well have economic motives for administering the poisoned chalice.
But are patients really safer in the hands of a national health system? On the contrary. As health care costs are transferred from individuals and their families to the general population, a cost-cutting bureaucracy will inevitably be tempted to encourage, if not compel, euthanasia. Even in “the United States, where health care is only partially nationalized, there is already a lively discussion over the excessive social costs. A few years ago Daniel Callahan created a controversy by suggesting that our resources were not infinite, that the more we subsidized organ transplants for drug addicts, the less money we had available for prenatal care. Callahan was attacked as an inhuman monster, but under any national health plan, the logic of his arguments cannot be escaped. Some British defenders of their own system will tell you candidly that one of socialized medicine’s great advantages is that it lowers the overall cost of medical care. By this they mean that very sick people often die before they can receive treatment. The rich, it goes without saying, make their own arrangements.
National health care is only a synecdoche for the entire apparatus of socialized welfare that has replaced the informal structures of family and community. In primitive and premodern societies, individuals and families are generally responsible for most of the portfolio once held by the Department of Health, Education, and Welfare. Parents reared and educated their own children, took care of the elderly members of the family, and saved what they could against the eventual rainy (more likely rainless) days. While rulers—kings and emperors, churches and commonwealths—might be expected to provide certain forms of emergency assistance, the general rule was that each man took care of his own.
All this has changed over the last hundred years, and the reigning assumption today is that the state is responsible for guaranteeing the physical health, mental and moral training, and life success of all its subjects. In a traditional order—in an ancient polis or an Italian commune—the political community could assume a certain responsibility for the general welfare without posing a danger to individual liberty or family autonomy. Government in such an order, even in the Roman empire, was comparatively weak, while the informal institutions were flanked and backed by traditions and precedents that could not easily be overwhelmed.
But these irrational safeguards against state power were destroyed by the progress of European liberalism that whittled away the authority of churches and destroyed the last remnants of feudalism, all in the name of individual liberties. (The American version is only transatlantic knockoff.) There was a positive side to the old liberalism, especially in its British phase. British liberalism exalted the dignity of the individual at the expense of the church, class distinctions, and irrational traditions. It placed the tremendous burden of civil obligation upon the middle classes, but it also helped to create the Victorian character that was able to carry the load. It was the creed of sober gentlemen and disciplined men of business, and if it crushed much, if not most, of what was valuable in the old order, it also checked the growing power of the state. The French might have been oppressed by kings and consuls, but the propertied classes of Britain—so long as they could restrict the franchise—were secure in their rights of property and contract.
Such a system could not endure. It was threatened by the entire course of the 19th century, by what was called progress; the rapid pace of industrialization, the political claims of the poorer classes, and the growing fear of Red revolution. A purely negative conception of liberty offered few consolations to an unemployed millhand, and under the circumstances the old paternalistic Toryism began to look better and better. Some theory, inevitably, had to be found that would justify a vigorous state intervention into matters of childrearing, public health, and relief of poverty. Perhaps it did not really matter how coherent such a theory was, so long as it was couched in the reassuring accents of Whig liberalism. The man of destiny turned out to be the mediocre professor of philosophy, T.H. Green.
What Green did, in essence, was to take the old liberalism, with its insistence upon individual liberty, and turn it into the new liberalism, with its acquiescence in socialism. To do this was a simple trick of synthesis: he rewrote Kant and Hegel in the terms of Locke and Mill; that is, while repeating the old arguments in favor of negative liberty, he introduced the notion of positive liberty, which is the freedom to approach moral perfection. Since the individual’s moral perfection contributed to the common good, it was the right of the state to take such steps as would insure everyone’s ability to aim at perfection. In practice, this meant compulsory school attendance, regulation of spirits, and rather sweeping restrictions on the rights of property and contract.
Green was not alone in his attempt to socialize liberalism, but after his by no means premature death at the age of 46, he emerged as the symbolic figurehead. Closer to our own day, British social theorists have rung the changes on Green’s conception of positive liberty. Since the common good (or the national interest) depends on the welfare and responsible character of individuals, it is the state’s duty to see to it that every member of society has a more or less equal chance to “fulfill himself” or “reach his potential.” R.H. Tawney in Equality conceded that men were born with different talents, but they are, nonetheless, “equally entitled as human beings to consideration and respect.” The state will, therefore, increase “the well-being of society . . . if it so plans its organization that, whether their powers are great or small, all its members may be equally enabled to make the best of such powers as they possess.”
In Britain debates over welfare were concentrated on the different methods by which relief was provided to the indigent. Until the 20th century, England was in principle a Christian society that relied upon the parishes as the providers of food and shelter to the poor. So long as England retained some of its feudal or medieval character, the king could undertake the Christian obligation to assist the poor. But this obligation,, although it was severed from the Crown along with the head of Charles I, has haunted the English as much as King Charles’ head bedeviled the conversation of Tristram Shandy’s Uncle Toby.
To some extent, the English have seen themselves as participants in a national community. Despite profound ethnic differences between Scandinavian, Saxon, Norman, and Celtic elements in the population, the people of England were unified in the Crown, the Parliament, and in a legal and administrative system that has been far more centralized than anything in the American experience. As a result, the main figures of British political philosophy—Hobbes, Locke, Hume, Mill, and Bentham—have tended to reduce their discussion to the simple polarity of the subject (or citizen) and the sovereign. In its various phases, this was a tradition of natural rights and individual liberties. It begins with Hobbes’ assertion of the sovereign’s role in establishing civil order and ends, in the later 19th century, with the declaration that the state is the ultimate guarantor of the common good.
In America the transformation has been somewhat retarded by the peculiarities of our federal system, but in the more centralized states of Europe—Britain, France, Sweden, the Netherlands, and Germany—the process has proceeded rapidly to the logical conclusion that the state holds ultimate responsibility for the well-being of all its citizens. Since the British disease was carried to the United States by immigrants from Great Britain, it is only a matter of time before this country succumbs, not only to such symptoms as national health care, but to the pandemic plague of social democracy.
In fact, the entire American discussion of socialized medicine consists in a debate between two British positions: the rigid socialism of the Labor Party, as mimicked by Ted Kennedy and Joe Biden, and the more moderate Toryism that combines the old Liberals’ concern with economic freedom (and efficiency) with the old Tories’ regard for the national welfare. The Tory critique is offered, not surprisingly, by an Englishman at the Heritage Foundation, and it is to a large extent endorsed by other English conservatives resident in America. Like most of their countrymen, English journalists persist in regarding the United States as a wayward colony and can never succeed in understanding that the American track record on “democracy” is longer and better than the British.
What few Englishmen have ever appreciated (Burke and Acton being great exceptions) is the diversity of the American regions and states. Our federal system was not invented by Madison and Hamilton; it was the only possible expression of the facts of our political life in the 18th century. By the time of our secession from the Crown, Britain was already a highly centralized state, and what little was left of local jurisdiction, as in Scotland, was already being swallowed up by a national government that would, under the influence of a political Cagliostro (Trollope’s term for Disraeli), assume the name and trappings of empire. Of course they could not understand the petty grievances of Massachusetts merchants, much less the loftier motives of the statesmen of Pennsylvania and Virginia.
The English did not understand us then, and they do not understand us now. The tragedy is that we once fought a war to be free of Britain, and now two hundred years later, when we have lost almost all the virtues of our British ancestors, we still cannot free ourselves from their worst moral and political vices.
We will have national (as opposed to county or state) health care, because we can no longer think as Americans, and because we no longer trust either the strength of our social institutions or the character of our people.
The British disease is as deadly as AIDS and much more communicable. In practice the malady is a kind of arteriosclerosis, a progressive constriction of a people’s will to do something for themselves. It is the result (as Mancur Olson has pointed out) of too many years of democracy, too many years in which petty interest groups have managed to direct the nation’s resources and energies in the direction of union members, bureaucrats, and other privileged classes. But there may be deeper causes. Britain is one of the first nations to discard its religious faith. I can count on the fingers of one hand the English Christians—even nominal Christians—I have met over the years. Their churches and cathedrals minister the sacraments to a handful of maiden ladies and eccentrics. A few years ago I spent several days in the company of a fine and proper English family. Together we visited a great Catholic cathedral in Europe. The children were fascinated. “Who’s that person, mummy?” they asked. “Why that’s a man, dear, his name was Jesus.” “Jesus? Why is he hanging up there on that wood thing, and who are those people with wings?”
The mother went on at some length, explaining each Christian story, patiently pointing out that they were simply stories that some people used to believe but no longer did. Her husband confessed to me that he was a little nervous bringing the kids into a place like this. All the art and music in Catholic Europe was great stuff, but too bad it had to be connected with something so corrupting as religion. He was right to be afraid, I told him, since the best way of making Christianity attractive to children is to expose them to its beauty and then forbid it, like a dangerous sweet.
England did lose its faith, and we are not slow to follow. As Nietzsche knew all too well, man cannot live without God, without some promise that life has meaning, if not here and now, at least in some other dimension, where things are as they ought to be. Growing ever more fearful of the grave, we cling to the things we can buy or consume; unable to worship a being beyond ourselves, we turn our bodies into temples of self-worship and spend enormous amounts of time and money on keeping the temple in good repair. Even so-called Christians are not exempt. Fundamentalist and Pentecostalist ministers are often fanatics on financial planning and diet crazes. Do they think they are going to live forever? In this same unregenerate flesh?
If the English find it difficult to understand either our virtues or our political arrangements, they comprehend our vices all too well. In our rapid descent from republican virtue to imperial decadence, the English can see themselves parodied and distorted. The spectacle is as amusing as it is disturbing, something like the behavior of monkeys whose antics remind us uncomfortably of our own foibles.
English visitors have often commented on “the American way of death” and the almost Egyptian lengths to which we have been willing to go in the conduct of funerals. But this extravagance is not so much an American as a Californian trait, and Evelyn Waugh set The Loved One not in Des Moines but among the lotus-eaters of Southern California. To the extent that all America is turning Californian, it is a nation in flight from every reality, not least the reality of death.
The fear of dying trumps even our fear of death. Let me live, we tell ourselves, a solid seventy-five to eighty years in good health, patched up from time to time by the surgeons, and then let us “go gentle into that good night” without pain or fear. To escape the torments of dying, we are willing even to kill ourselves. For a Christian, self-murder is a sin against the Holy Ghost, an act of ultimate denial and despair. I am not dogmatic on this subject; there are some circumstances in which suicide might be the least evil choice, but those cases are as rare and exceptional as the scenarios designed by professors of ethics.
For most of us, suicide is a cowardly rebellion against the God who made us, whether we acknowledge Him or not. It is a denial of the goodness of creation, a repudiation of all—the good as well as the bad—we have experienced. It is an annihilation of our very lives, and if there is an afterlife for the suicide, it is the torture of the amnesiac who knows he once had a real existence somewhere, but he has lost it. He will look upon the faces of wife and children, parents and friends, and be told, “these were all you loved, were all you were,” and yet feel nothing but the despair that comes from feeling nothing.
To escape dying by compassing our own death is the very opposite of all the world’s wisdom. The end of life is death, and he that would live well had best prepare to die well. That is the burden of Jeremy Taylor’s wise and beautiful book, The Rule and Exercise of Holy Dying. “He that would die well,” says Taylor, “must always look for death, every day knocking at the gates of the grave; and then the gates of the grave shall never prevail upon him to do him mischief.” So far from being an exclusively Christian message, Taylor recognized that “this was the advice of all the wise and good men of the world.”
In the days when all educated men knew a good deal of Latin, if not of Greek, this wisdom could not be escaped. transaction No one who has read Horace or Sophocles can fail to appreciate the pagan understanding of mortality as the great fact that gives shape and meaning to human life. Even the erotic poets harp on death as much as love, as if life’s sweetest pleasures derived added piquancy from the bitter gall of the grave. The Iliad is an endlessly illustrated sermon on death, and its hero, Achilles, was in legend given the choice between a short, glorious life and a protracted existence without glory. His Trojan opponent. Hector, is no less tragic in his awareness. In the same breath that he advises his wife to rear their son to be a brave champion, he tells her, “I know full well the day is coming when holy Troy will perish.” Scipio Africanus is said to have quoted these lines at the destruction of Carthage, prophesying a similar fate for his own, for the moment, triumphant nation.
All this we have forgotten, our philosophy along with our faith, our history along with our Latin, and much of what we call the welfare state—and all our schemes for socializing health and dying—is no more than a giant tomb we are constructing as a refuge from the fact of death. As John Gray observed some time ago in this magazine, there are virtues in both Christian and pagan cultures, but for an ex-Christian culture, for a nation that has lost its faith, there is no hope, because it transfers its impossible longings for immortality into the present sphere and gives to government the power that only a god can exercise.
The state, to use Hobbes’s language, is no longer a mortal god but one that claims immortality along with infallibility. As that god assumes all power over life and death, it can brook no rival, have no other god before it. At the end of Brave New World the world-controller explains that the state depends on the illusions of permanent health and happiness, because the sick and the aged begin to think queer thoughts about God. “God isn’t compatible,” he pointed out, “with machinery and scientific medicine and happiness. You must make your choice. Our civilization has chosen machinery, medicine, and happiness.”