Physician-Assisted Suicide: When Values Collide

May 22, 2016

Romans 5:1-5

In March 2011 The United Church Observer published an opinion piece about assisted suicide by Sheila Noyes of Westminster United in Thunder Bay, who had seen both her mother and her sister die difficult deaths. Her mother died from multiple strokes and her sister from cancer that eventually metastasized in the spine.  Noyes, who is co-president of Dying with Dignity Canada, wrote: “To force someone to suffer is, quite simply, barbaric. Our faith calls upon us to love and serve others, to seek justice and to be merciful. The United Church of Canada should be a leader in the movement to allow for compassion in dying.“ The Observer followed with a poll of readers on the issue.  It seems that 79% of Observer readers supported assisted suicide in cases of intolerable suffering.    Subsequent polling indicated that, much to the pollsters surprise, while Observer readers like most Canadians believe that physician-assisted suicide should be allowed under certain circumstances, they were actually more strongly in favour of it than other Canadians!  http://www.ucobserver.org/columns/observations/2011/06/

The value that was most referred to in Christian arguments for physician-assisted suicide, was compassion for terrible suffering.  The value referred to in secular arguments was as often autonomy – the right to make decisions about one’s own life.  What interested me was that most of the people who shared their opinions on the subject, Christian or not, did not speak about Biblical teaching or the historical teachings of the Christian church about the sacredness of life.  The only exceptions were the Roman Catholic and Evangelical Christian groups that were interviewed.

The issue of whether or not people should be allowed to end their lives with assistance and without penalty for those who assist is an issue where values collide – and a place where liberal Canadian values and liberal Christian values may at first appear to be the same.  Should they be?  And what do we do when Christian values THEMSELVES point us to different positions?

Here are some of the values at play in this discussion:

Autonomy:  is autonomy a Christian value?  Christianity in fact teaches that the well-being of the community comes before individual autonomy.  (Remember Paul’s argument about whether or not to eat meat sacrificed to idols?  He says, if it hurts another Christian’s conscience, don’t do it.)  Christianity also teaches that Christian freedom is not freedom to do whatever we want, but freedom to choose a life that fulfills God’s purposes.  Discernment is necessary.  “I want to do this, so I will” doesn’t wash as an argument for Christian ethical thinking.

Related to autonomy is the question of the will of God.  The argument made by Roman Catholic and Evangelical groups is that to take a life is to take away a power reserved for God; it denies the sacredness of life and violates the commandment against killing.  Of course, that commandment is also violated when we train people to kill in war or in defence of another person, so a simple black-and-white interpretation of the commandment doesn’t seem to hold as strongly as it does in some stricter communities of faith who forbid all killing of any kind.

A United Church Observer article in February 2015 called, “Dying with Dignity?” said ‘the Evangelical Fellowship of Canada expressed “deep” disappointment with the [Supreme Court’s] judgment and said that the court had decided that in some circumstances, “the killing of a person will be legal.” The Catholic bishops also expressed their dismay, saying that “helping someone to commit suicide is neither an act of justice or mercy, nor is it part of palliative care.”’   Of course, we have already extended human life long past what might be considered a natural lifespan, so one can understand the counter-argument that ending unnaturally extended life does not contravene God’s order for creation, but in fact, restores a more natural balance.

Compassion:  compassion literally means “suffering with”.  That’s an interesting definition, especially for us privileged First World people who have an increased ability to avoid suffering that is common to many parts of the world: hunger, civil war, sexual violence, curable diseases going untreated, homelessness, etc.   It’s not surprising to me that the places where physician-assisted suicide are now legal are some of the most privileged regions in the world. Control over one’s life or death is a privilege many cannot even imagine.

What does it mean to feel compassion for those who are suffering at the end of life?  No-one wants to see someone they love suffer needlessly; this is why improving access to good palliative care is so crucial.   Many advocates for PAS would say that there is some suffering even the best palliative care cannot alleviate, and this appears to be true.   One of my worries about this whole debate, though, is that our own exhaustion, grief and suffering as caregivers may cause us to misjudge the suffering of those we care for.  For example, I’ve heard many people say, “Shoot me before I get that way” in reference to people with grave cognitive or physical challenges.  Yet I have known and cared for many people with such challenges whose existence, while difficult, is not without value or without joy.  Our compassionate hearts do not want others to suffer what we would not want to suffer ourselves; that’s a good operation of the “love your neighbour as you would love yourself” approach to Christian ethics.  But what if my neighbour – my mother, my spouse, my child –  has a different tolerance for what they are experiencing than I do?  This is why I am pleased that the bill being dealt with by the Canadian government insists on individuals making the choice for themselves, rather than having the choice made for them by others, however well-meaning they might be.

The value of the body vs. the value of the soul:  As Christians we believe that the essential self is made up of both the material and the immaterial.   In cases where the body or brain’s inability to function inhibits communication, how are we to know what the immaterial part of us is experiencing?    The soul is very much present, despite appearances to the contrary.  A person’s essential self is still there.  As people of faith, we believe that as long as there is life, there is still a SELF, a psyche, a soul.

Then there’s the question of suffering itself.  Is the experience of suffering always without value?  Is suffering always bad?  Christian faith has said resoundingly over the centuries that some suffering has value; in fact, suffering can even be redemptive – such as the suffering of Jesus on the cross at Calvary.  That’s how I ended up with this sermon topic this week, by the way: the passage from Romans that argues that “suffering produces endurance, and endurance produces character, and character produces hope, and hope does not disappoint us, because God’s love has been poured into our hearts through the Holy Spirit that has been given to us. ….”  Paul is, of course, speaking of suffering experienced for the sake of witnessing to the story of Jesus and the hope he brings.  It may be hard at times to imagine how the suffering of devastating illness might testify to the goodness of God; and yet, I have known cases where it has – where an individual’s peace, strength and even joy in the face of great hardship has been a testimony to the power of Christ working in him or her.  I will not say this is true in all cases, or perhaps even in most, but it is true for some.

Does Paul encourage us to seek out suffering or to suffer without a good reason?  By no means!  In fact, the early church had to actively discourage people from pursuing gruesome death and torture as extreme signs of their faith.  But Paul recognized that suffering can teach us things that a peaceful, calm, easy life free of pain and hardship cannot.  When we are pushed to the utter end of our own resources, it is there that we find the grace of total dependence on God’s unconditional love that has been poured into us by the Spirit.

In a book we looked at together on Monday afternoons a few studies back, one of the authors, a gerontologist and long-time family caregiver, talked about what she calls “dedicated suffering” – a concept that was new to me.  Jane M. Thibeault encourages a form of spiritual practice in which each person who is facing unavoidable suffering prayerfully dedicates her suffering energy for another person or cause, by offering that suffering to Jesus or God and asking that it be transformed into God’s loving energy for the other person or group or situation.  (From “Pilgrimage into the Last Third of Life” .)   Folk who have practiced this “dedicated suffering” often report a reduction in their own physical, mental or emotional symptoms.  Perhaps this is one way that suffering can be redemptive in our own time and place.  Jane adds in her book “No Act of Love is Ever Wasted”: “ …the last lesson parents teach our children is how to die well – and gracefully.” (p.24)

Another Christian value is that death is not the enemy.  For those who trust in the resurrecting and renewing power of God in the midst of death, fear of dying is often reduced.  In fact, in an interview with Gloria Taylor, the first woman given permission to end her life with a physician’s assistance and a long-time UC member diagnosed with ALS, the interview asked:

“This year The Observer’s reader survey showed that churchgoing readers support assisted dying more than non-churchgoers. Does that surprise you? Gloria responded: No, because they’re not afraid to die. They have a strong faith. “

So for Gloria, death is definitely not the enemy.  Interestingly enough, Gloria fought for the right to PAS, despite the fact that she still loves life and has no intention of taking her own life any time soon.  In fact, this is what she said: “If I choose assisted dying, that’s only under excruciating, excruciating pain. And knowing me, and knowing how strong I am, and how I like life and I love nature and I love my family — I love my granddaughter to pieces — I can’t see me wanting to end my life because I’m in a wheelchair all the time, because I’m bedridden, because I’m incontinent. We’ll work that out somehow. I totally live a one-day-at-a-time life. Sometimes it’s down to one breath at a time, you know? And that’s the way I’ve got to look at it.”

Whether or not you agree with Gloria’s case, you have to admire her strength, and the faith that gets her through.

One more Christian value I want to mention is the value of self-giving: of offering ourselves in the service of others, even to the point of offering one’s life.  How might that value be brought to bear in this debate?  Perhaps the insights of our faith-based value system can help others wrestle with these issues?  Can we be present to people who are struggling with decisions about their own life or death or that of their loved ones, or physicians and nurses who may find themselves in a position of being asked to take a life, or longing to end another’s suffering?  Can we offer care of the spirit and the heart in the end stages of life while the medical system struggles with care of the body?  Can the decisions we make about our own end-of-life care be a testimony to our faith?

The United Church of Canada does not have an official position on physician-assisted suicide.  Gary Paterson, when he was Moderator, published a piece on his blog in which he ventured a tentative opinion in favour of it under controlled circumstances – the kind of circumstances prescribed in the Bill that is being considered in parliament.  One of the questions he asked is “What is a good life?”  People of faith may define that differently from some others.  That is the question we need to consider with all the resources at our disposal, including the resources of our faith tradition, because our definition of “a good death” will depend very heavily on our definition of “a good life”.

Does a good life require freedom from suffering?  Does a good life mean a life lived according to God’s will – and how would we know exactly what God’s will is?  Is a good life a life that is preserved at all costs?   Is a good life a completely autonomous life?  Is it a life accountable to community?  Is a good life an embodied life, a thinking life, or something else?  Is a good life a life in which life is allowed to end when health ends, as one terminally ill patient put it?  Is a good life a life of service?  A life of self-giving?

Gone are the days when the church can dictate to society what it must do.  Gone are the days even when the preacher in the pulpit – at least a United Church pulpit – could tell her or his congregation what is absolutely right or wrong.  But as Christian people we must seek out the values that come from our faith, and seek out the Spirit of true wisdom  – diligently and with eyes wide open to all the ramifications for our common life. We do have a voice, and we do have a responsibility to one another.  Let us hold each other, and our nation, in prayer, as we seek to discern God’s will for our lives and for the path we tread together, from the beginning to the end of all our lives.  Amen.

Articles and videos referred to in preparing this reflection:

 

Supreme Court ruling:

http://www.cbc.ca/news/politics/supreme-court-says-yes-to-doctor-assisted-suicide-in-specific-cases-1.2947487

 

The decision is silent, for example, on whether depression or mental illness counts as a medical condition. The court does include psychological pain under the criteria of enduring and intolerable suffering.

 

Palliative care and PAS:

http://www.cbc.ca/radio/whitecoat/palliative-care-vs-assisted-suicide-a-false-dichotomy-1.2860454

 

pro-euthanasia position

http://ethics-euthanasia.ca/legislation/

 

A perspective from the Jewish Community:

http://www.cbc.ca/news/canada/manitoba/physician-assisted-dying-jewish-community-perspective-1.3509370

Pope Francis:

http://www.huffingtonpost.com/2014/11/17/pope-francis-assisted-suicide_n_6172982.html

 

 

April 2016: Bill C-41

 

http://www.cbc.ca/news/politics/canada-physician-assisted-death-law-1.3535193

April 2016  http://www.ucobserver.org/common_good/2016/04/bill_c14/

 

Doctor-assisted death will be restricted to mentally competent adults who have serious and incurable illness, disease or disability under new legislation tabled in Parliament today.

The long-awaited bill also sets out safeguards to protect vulnerable Canadians, but does not include some of the most contentious recommendations from a parliamentary committee, including extending the right to die to “mature minors” and the mentally ill, and allowing advance consent for patients with degenerative disorders.

 

United Church views:

 

The Right to Die by Sheila Noyes  http://www.ucobserver.org/columns/2011/03/my_view_march_2011/

 

http://www.ucobserver.org/2011/03/poll/assisted_suicide/

 

Dr. Ian Reid · 258 weeks ago   comment “Dying with Dignity” editorial in Observer

The Senate reviewed the status of terminal care in Canada, and discovered that close to 80% of the terminally ill do not have access to optimal palliative care. With skilled care, well over 90% of patient symptoms can be well controlled, allowing death with dignity. The drive to physician assisted suicide grows out of this unmet need, and the desire for control in a setting where control is eroding. Until all the terminally ill have access to optimal pain and symptom control, any national debate on physician assisted suicide is premature, and expedient. It has been well shown that patient requests for assisted suicide usually disappear once optimal palliative care is applied.

We need 1) urgent attention to remedy access to skilled palliative care
2) education of medical professionals and then the public as to what can and should be accomplished with good palliative care

Then, and only then can the difficult debate concerning the few cases beyond effective palliation be discussed.
Be mindful of the Swedish experience, where now over 20% of physician assisted suicides are involuntary – ie. the patient is not the decision maker.  (THIS COMMENT WAS LATER CORRECTED TO A REFERENCE TO THE NETHERLANDS)
Dr. Ian Reid,
Charlottetown, PEI

Please go to: www.bioethics.org.au/Resources/Online%20Articles/…

Or read: The Lancet, 338:8768, September 14, 1991, 669

I.J. Keown, “The Law and Practice of Euthanasia in The Netherlands”, in The Law Quarterly Review, 108, January 1992, 7-8

 

Another view on the same evidence: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652799/

 

Another perspective from the Comments section: I am an attorney in Washington State, where assisted suicide is legal. You may be interested in the my article, which includes this introduction:

“Legal physician-assisted suicide is a recipe for elder abuse. It empowers heirs and others at the expense of older people. It empowers health care providers at the expense of patients. In Oregon, where physician-assisted suicide is legal, legalization is statistically correlated to an increase in other suicides.”

To read the whole article, go here: http://margaretdore.blogspot.com/2011/05/physicia…

 

 

 

 

May 2012 analysis of Observer survey results on various scenarios around end-of-life issues:

 

http://www.ucobserver.org/features/2012/07/choosing_death/?sortby=7

 

http://www.ucobserver.org/common_good/2015/02/dying_dignity/

 

http://www.ucobserver.org/essays/2015/02/gary_paterson/

 

http://www.ucobserver.org/2012/07/uco%20survey_pressrelease.pdf

 

Gloria Taylor’s story  http://www.ucobserver.org/features/2012/09/gloria_choice/

ALSO  http://www.cbc.ca/news/canada/inside-gloria-taylor-s-battle-for-the-right-to-die-1.1186092

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