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    Final Exit

    Is physician-assisted suicide really “death with dignity”? June 9, 2015
    Filed Under:
    Opinion & Critical Thought
    In this series, Colonel Bob Ward, who retired in 2013 as the territorial commander in Pakistan, and Major Amy Reardon, corps officer at Seattle Temple in Washington, U.S.A., discuss issues of the day.

    DEAR BOB,

    If I understand correctly, Canada has opened the door to making physician-assisted suicide legal, starting in 2016. In Oregon, just south of where I live, the practice has been legal for more than 20 years, and in my state, Washington, since 2008. Here it's called the “Washington Death with Dignity Act.”

    What do you think of the title “Death with Dignity,” Bob? I have trouble with it. In fact, I have some trouble with the whole thing.

    Physician-assisted suicide (PAS) is when a doctor provides information or materials that allow a person to end his or her life in order to put an end to great suffering. Most definitions state or imply that the suffering is physical. I think that's what most of us have in mind when we think of PAS: a person who is already dying from a serious disease and wants to bring an immediate end to unbearable physical pain. Even those who find any suicide immoral have some degree of sympathy for these situations. If death is coming anyway, and if the demise is slow and awful, we can appreciate why people want out. I think of the case of Kay Carter, who covertly left Canada for Switzerland, where assisted suicide is legal, so she could drink a lethal dose of pentobarbital. She described herself as dying “inch by inch.” It isn't hard to understand her desire to quicken what was inevitable.

    What's really troubling me is that it isn't just—or even mostly—physical pain that is prompting the deed. A February 2015 report from the Oregon public health division lists reasons patients gave for why they wanted to end their lives. Only 33 percent mentioned “inadequate pain control or concern about it.” Forty-two percent were worried they would be a “burden on family, friends/caregivers.” But 96 percent of those who chose to end their lives cited “losing autonomy” as a reason, and 91 percent said they were “less able to engage in activities making life enjoyable.”

    Do you find it surprising that some people would rather die than face a less-fulfilling life, even though their physical pain wasn't intolerable?

    In an opinion piece in the Los Angeles Times, Ira Byock, MD—who does not support PAS—wrote: “The mission of Final Exit Network, one of the key groups supporting [legalized PAS], is to enable all competent adults to end their lives whenever they deem their physical quality of life is unacceptable.”

    Honestly, Bob, I find that terrifying. Is it acceptable for someone to take her life if she loses her sight? What if a person is traumatized over the loss of a limb, not realizing that a day may come when he adjusts and rediscovers happiness?

    The Oregon study reports a mix of reasons for dying, from physical to emotional suffering. In other parts of the world, people are given permission to end their lives solely based on emotional suffering. I'm a pastor, and have been through some very dark times. I've learned that “weeping may remain for a night, but rejoicing comes in the morning” (Psalm 30:5). I've seen people go through difficult situations, barely able to hang on. Eventually, though, the sun begins to shine again.

    Now imagine if people had the legal right to kill themselves in their darkest hour. Not only that, but they've been told it is dignified. (There's no turning back, of course. Studies show that these assisted deaths are completed within a matter of hours and have a 100 percent “success” rate.) I wonder, will the shattered family members they leave behind think it was a “death with dignity”?

    AMY




    DEAR AMY,

    Yes, in February the Supreme Court of Canada made a decision to remove the current criminal sanctions against anyone, professional or otherwise, counselling a person to end his or her life, or a person consenting to have “death inflicted on them.”

    Fortunately, the genie is not completely out of the bottle—the lid has merely been loosened. Unlike the states of Washington and Oregon, Canada has not created new legislation permitting assisted suicide; it has declared the current legislation unconstitutional and given the government 12 months to create a regulatory framework.

    The Canada and Bermuda Territory's position statement is unequivocal: “The Salvation Army believes that euthanasia and assisted suicide are morally wrong, and holds that they should continue to be illegal under Canadian law.”

    The Salvation Army's international position statement starts the same way, but goes on to list four principles:

    • All people deserve to have their suffering minimized in every possible way consistent with respect for the sanctity of life

    • It is not suicide for people to choose to refuse or terminate medical treatment

    • It is not euthanasia for health-care professionals to withhold or withdraw medical treatment that only prolongs the dying process

    • To provide supportive care for the alleviation of intolerable pain and suffering (e.g., by way of analgesics) may be appropriate even if the dying process is shortened as a side effect


    While the “sanctity of life” philosophy can be used as an argument against PAS, the international statement expands the phrase: “Respecting the sanctity of human life means we value all human beings irrespective of age, health status, gender, race, religion, social status or their potential for achievement.” It does not seem to directly equate sanctity of life with opposition to PAS.

    From a compassionate standpoint, the statement allows doctors and patients (and, by extension, family) to make the best treatment decision to alleviate pain, when mortality is the probable outcome, based on the condition of the patient.

    Loosely applied, the international statement is not at odds with the Supreme Court decision, where one treatment option would allow a physician to knowingly shorten the life of someone suffering intolerable pain through the use of strong pain killers. Killing the pain may also be fatal to the patient. Many families are familiar with this experience.

    Some argued the ruling is a compassionate move. It reminds me of Jesus' teaching about the Sabbath in Matthew 12. The religious leaders criticized the disciples for gathering grain to eat on the Sabbath and breaking the fourth commandment. Jesus answered the critics by saying, “If any of you has a sheep and it falls into a pit on the Sabbath, will you not take hold of it and lift it out? How much more valuable is a person than a sheep! Therefore it is lawful to do good on the Sabbath.” Then he healed a man. In this case, it was to save a life, not take one. The command to keep the Sabbath still stands, but compassion and response to urgent needs permitted exceptions.

    This principle, applied to the legislation, was argued as providing the thin edge of the wedge to more permissive legislation that would be repugnant to most thoughtful Christians. However, the Supreme Court's decision dismissed the “slippery slope” argument, concluding that one must show faith in the legislators to consider the current values of Canadians, without conflicting with the Constitution.

    Naive, some would say. But legislation is our only method of determining what Canadian society can or cannot accept. The ball has been, rightly, thrown back to the lawmakers to accept their responsibility.

    What is the line between The Salvation Army's position that “people deserve to have their suffering minimized in every possible way” and an executor of a potential estate consenting to euthanize a severely disabled adult?

    There isn't much time for the government to develop a response. Perhaps, however, it is time to rethink a more realistic and helpful approach to our position on physician-assisted suicide that takes into account the new legal reality, shaping the resulting legislation without running roughshod over our current position.

    BOB




    DEAR BOB,

    The Army's international position statement is difficult to decipher. Perhaps it was written that way purposely, so that there is some flexibility with individual cases.

    If there is anything to be said in favour of legalized PAS, it is that the government thereby gives great freedom to individuals. People can make their own moral choices.

    If I understand the idea behind the second and third principles of the Army's international position statement, blessing is granted to the executor who might say, “Let's not keep grandfather alive through artificial means any longer.” Most people would agree that using a ventilator to extend physical life for a long time after a patient has been declared clinically brain-dead becomes nothing but financially and emotionally exhausting for the family. In the case of younger people, we are more resistant to end life support, but even then families often make that decision.

    It's the fourth principle of the statement that I find so difficult. It doesn't sound as though it condones intentional death. But perhaps it does leave a loophole.

    Still, hastened death in response to unbearable pain or a hopeless comatose state is one thing. Taking one's life because of emotional despair is quite another. Certainly the government may say they can be trusted and there will be no slippery slope. But things change. Fifty years ago, I suppose no one would have thought that any sort of suicide would become acceptable—and certainly not considered “dignified.” Morality and Christian sensibilities can be worn down in small increments. Perhaps 50 years from now, euthanasia for emotional reasons will be considered normal and we'll be debating whether or not the euthanasia laws should apply to children. The thought of that gives me the chills.

    AMY




    DEAR AMY,

    Morality and Christian sensibilities can be worn down, particularly when rigid, difficult-to-defend positions are taken. At the same time, I see the Christian faith as dynamic, where attitudes are adjusted to reflect the increased knowledge of the world around us. Otherwise, we would still be accepting the 6,000-year chronology Bishop Ussher superimposed on the biblical creation narrative. More rigid stances become worn down faster in these times when decisions of life and death are being faced in hospitals and at bedsides every day.

    As an international social welfare organization, The Salvation Army is known to be pragmatic and reasonable, a voice that should be included in the conversation. A “no, you can't/yes, we can” argument will not assist government in forming good legislation. What can we accept, short of total agreement? Physical pain? Emotional or psychological distress? Loss of autonomy? Injection of a lethal drug?

    I urge the territory to participate in the discussion in a helpful and meaningful way in order to manage the next steps. It may require a review of our current position statement to identify and articulate what thoughtful Canadians consider reasonable boundaries. But we have the opportunity to help develop legislation that can help Christians and others make good decisions when facing the emotional issues around impending death preceded by intolerable pain and suffering.

    BOB

    Comment

    On Thursday, July 9, 2015, Heather Allington said:

    I was greatly encouraged by the opinions of Major Juan Burry in the July issue of "Salvationist", entitled, "Playing God". I particularly concur with his statement that we allow the health care system to "play God" all the time if it means keeping us alive. I think the same philosophy occurs in the matter of birth control. I wonder how many lives that God planned to be brought into being have been prevented by parents using various means of birth control - something of which we Salvationists have long approved. We say that Heaven is our ultimate goal. Why, then, are we so reluctant to let go of our earthly life, or to help someone else who is especially eager, because their life here entails great suffering and/or lack of quality, to reach the goal?

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