Choosing to die

April 1, 2016
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Source photo © Katarzyna Bialasiewicz

Right-to-die legislation will go into effect this year in California, which will join Oregon, Montana, Vermont, and Washington in providing for physician-assisted suicide. According to a Gallup poll last year, 70 percent of Americans believe that doctors should be allowed to help terminally ill patients end their lives—and that figure has been on the rise for several years.

In this issue, two writers take a hard look at the practice of physician-assisted dying. Both tell cautionary tales.

Dutch ethicist Theo Boer examines the effect of laws in the Netherlands in place since 1994 which have allowed physicians to assist in deaths. He argues that once laws permitting physician-assisted dying are established, they change people’s expectations in facing death. Once the door to assisted death is opened, it seems, it’s difficult to keep it from opening further.

Boer, who reviewed many cases of physician-assisted death in the Netherlands as part of a government panel, noticed that the number of physician-assisted deaths began rising sharply in 2007. Requests were coming not only from terminally ill patients in extreme pain—the expected profile—but from people who might otherwise live for years.

Joseph Kotva probes the results of the 1994 right-to-die law in Oregon, which pioneered physician-assisted dying in the United States. Like Boer, Kotva notes that a strong concern for autonomy and self-sufficiency undergirds support for physician-assisted death. He finds that those seeking to end their lives were less likely to have intimate and trusting relationships, and they often perceived themselves as having few social supports.

The Netherlands presents an irony when it comes to the notion of individual autonomy: given a choice between having a physician administer a lethal dose (euthanasia) or having the physician merely provide a lethal dose (physician-assisted suicide), 95 percent choose euthanasia. They prefer that death come literally at the hands of another.

These articles should lead Christian communities to reflect on their own practices of care for the dying. The church has long been a central place for practices that address the isolation and the fear of isolation that often come at the end of life. It can be both a space for difficult conversations about choices at the end of life and a place for communal care.

No matter how compassionate a community of care is, two critical questions remain: Where assisted dying becomes legal, can it be limited in such a way as not to undermine human solidarity and the holiness of every life? Where assisted dying is prohibited, can communal practices of medical and pastoral care be robust enough to prevent people from dying in loneliness, pain, and despair?

Comments

I am glad to see The

I am glad to see The Christian Century inviting this discussion on dying and how we die. By and large the church in general has failed to make the space for these difficult questions. Church folks still die often enough in isolation and pain. The head count around the death bed tends to fall as the last breath gets nearer. With respect to the "two critical questions," based on performance to date, I fear the answer to both is 'NO!" I hope to be proven wrong.

Bill Holmes M.D., M.Div.
Louisville, KY

Dying

Having worked, in the early 90s, with Michigan Hemlock, Dr. Kevorkian and Janet Good, I've heard all the "cautionary" tales of this editorial and the two lead articles.

What I find interesting and disappointing, sort of like conservative anti-abortion rhetoric, there is nothing new here under the sun. Though it goes away for awhile, it always returns, in pretty much the same form. Though this observation: both articles, and the editorial, resist the slam-dunk condemnation of the less moderate, but however phrased, the articles, and those who write them, coming from an ideological position rather than the bedside, leave the patient in much the same state as 25 years ago - "let 'em suffer, and let 'em hang in there. You will be surrounded by caring people who'll sing hymns to you," or something like that.

Claims for pain management are over-blown. And what's all the fuss about "autonomy" (the great boogeyman of religious conservatives)? Isn't autonomy the very gift of God? And the word "secular" is used as if it were poison, which it isn't.

Sadly, both of these articles reflect a profound ambiguity to the patient, much like anti-abortion rhetoric - women are not to be trusted, even as "tears" are shed (*wink, wink*) for the unborn ... and for these two articles, patients are not to be trusted, either. While talking piously, both articles finally disregard the patient.

Death may be the "final enemy," but it's not physical death to which Paul alludes ... frankly, these two articles reflect the "power of death," because both articles are suffused with fear of it, and a deep distrust of the patient ... and like all cautionary tales, always the slippery slope. The upshot? life, of any quality, becomes then a fetish, and the patient suffers all the more as the healthy around them relish their own piety.

Let's be honest: in the West, nearly all suffering is medically induced. We've eliminated all the quick-killing diseases; what's left, is the slow and painful, degrading and humiliating. If medicine got us to this point, let medicine help us in finally dying. I deeply regret these two articles in the Christian Century.

Medically-Induced Suffering

I agree with castaway5555, in that much--though certainly not all--pain associated with terminal illness is medically induced. As a former physician colleague once commented, in many cases, modern medical technology just guarantees that "patients will die sicker than they used to." But I don't see this as founding an argument for physician-assisted suicide. Rather, it is an indictment, not just of the medical community, but of the culture at large that has eaten of the Forbidden Fruit of modern technology and sees death as life's defeat, not its natural completion. When confronted by a serious illness, perhaps the first question to ask is not, "What do we do?" but rather, "What time is it?" or more specifically, "What time is it for THIS person?" Breast cancer in a 75 year-old woman with multiple comorbidities is not the same as breast cancer in a 25 year-old otherwise-healthy athlete who competes in marathons. We need to have serious discussions in our spiritual and religious communities about these issues, but I don't often see them happening outside of a crisis. One doesn't attempt to give swimming lessons to the drowning, but that's an apt analogy to what I see in too many situations today.

Chaplain Larry Hansen, BCC, CT
Portland, Oregon

End of life

What seems to be missing from a religious publication is to think "what does God want to have happen" in a myriad of end of life situations, ranging from excruciating pain, to debilitating loss of function and humanity from dementia, Alzheimers and the like, to people in decline in your neighborhood nursing home. This may be different from the desires of the person him/herself, family members who may face an emotional and financial ordeal, to the person's insurance company and fellow taxpayers, and to the general society which can be organized to treat human beings according to their profitability and expediency. Is "palliative care" really as great as these articles let on, and if so why isn't it better accepted? Is it just another term for being drugged out? Supposedly many people get approved for euthanasia and don't do it but want to have an out if things get unbearable. According to the articles, people prefer to have the doctor do it than do it themselves. Otherwise in an America of gun owners, what need is there for a doctor? Do we want doctors to kill people? Do we want a cumbersome and often inhumane death bureaucracy like the one he have to see who gets social security disability benefits? Do people in debilitated conditions still have good to do, as one article suggests? Are the real problems loneliness, isolation and lack of self worth aggravated by lack of a future in a society where people are supposed to be workers and consumers? Do treatable mental illnesses push people toward earlier death? Few of us have more than occasional anecdotes about what happened to friends, relatives and other church members, to deal with situations with emotional, moral and ethical turmoil that is hard to anticipate. In the Bible most people who reach old age are honored and vigorous and go to sleep with their ancestors without the kind of end of life issues we have today. So what does God want to have happen? These articles don't really say.

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