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Speak yet again: on euthanasia (1)

Thus death reigns in all the portions of our time; the autumn with its fruits provides disorders for us, and the winter’s cold turns them into sharp diseases, and the spring brings flowers to strew our hearse, and the summer gives green turf and brambles to bind upon our graves. Calentures and surfeit, cold and agues, are the four quarters of the year, and all minister to death; and you can go no whither but you tread upon a dead man’s bones. — Jeremy Taylor, Holy Dying.

I looked at the nurse in the hallway outside the patient’s room and saw there the same sort of grieved helplessness that was besetting me. “I can’t give him any more, ” he said, referring to the pain medication — probably morphine, but I didn’t know for sure — and looked down, tears welling up in his eyes. Inside the room, an elderly man I had come to respect was writhing in pain, with his tearful daughter looking on. I had come to the room that day at a time when I felt like I was finally beginning to “fit” into my role as chaplain. I entered a situation I was unprepared for, and the memory of the sights and sounds still arrests me from time to time. I went into the room ready to pray with them, never considering that the utterances of physical affliction might make prayer or psalms inaudible. But I did pray with his daughter, at his bedside, while he, in the words of my supervisor, “hurt everywhere more than anywhere in particular.”

This is the sort of situation I think of when people discuss euthanasia — or more precisely, voluntary active euthanasia (subsequently, euthanasia) — approvingly, and talk about how it could prevent unnecessary suffering at the end of life. But there are others as well.

When I was little I used to go almost everywhere with my dad. Because he’s a natural connector, that often meant visiting people. Some of them were people in the community that my dad had known while he was growing up. One such man, Judd, lived just up the road from us, in a little house on top of an adjacent mountain. We used to go and visit with Judd and his wife periodically, just for brief conversations. When I was seven or eight, Judd’s wife passed away, and we went to go see him in the days following the funeral. I don’t remember much of the visit, having just vague memories of him coming out the front door and greeting us on his porch before we walked inside to sit and talk. Not long thereafter my dad told me that Judd was dead. He found out after his wife died that he had an advanced cancer. He decided to end his life rather than undergo treatment, and he was found in his living room by someone who went to check on him.

These are two stories from my past that fit into the narratives often chosen to establish why assisted suicide ought to be legalized. Such stories have been shared around water coolers and on back porches for a long time. I recall the regular refrain of an older relative, a committed and active Christian. When the topic of terminal disease, or lingering death came up: “We treat dogs and horses better than we treat people. We wouldn’t let our dog go through that, but it happens with people all the time. When my time comes, if I can’t do _____, then I hope someone will shoot me.” Recently however, these issues seem to have become a more and more frequent issue not just in conversation, but in our politics.

Oregon, Washington, and Vermont are the only states to have legalized assisted suicide. Massachusetts narrowly defeated “Death with Dignity” Legislation in 2012, California has been flirting with the prospect of putting the issue up for a vote, and it has been a pressing topic in the UK, drawing opposition from the current Archbishop of Canterbury, Justin Welby, and many other religious leaders. It was “resoundingly rejected” in the House of Commons last Friday. On the same day, the California legislature approved the practice.

Last year, the story of Brittany Maynard captivated the attention of America for a few 24-hour news cycles. Even though Maynard’s situation stood out because of its rarity — at 29 she was diagnosed with terminal brain cancer — and hers is not the usual picture of someone facing death (something that actually increased interest in her story), it does seem that her desire for the right to end her life is illustrative of a trend. In a recent article, “The Death Treatment“, The New Yorker, discussed the trend in Belgium of expanding euthanasia to people without terminal illness, and referenced the greater visibility of the right-to-die movement, and its particular support among younger people:

The right-to-die movement has gained momentum at a time of anxiety about the graying of the population; people who are older than sixty-five represent the fastest-growing demographic in the United States, Canada, and much of Europe. But the laws seem to be motivated less by the desires of the elderly than by the concerns of a younger generation, whose members derive comfort from the knowledge that they can control the end of their lives (emphasis added).

The article specifically highlighted the support of the “worried well,” people who, according to Diane Meier, a professor of geriatrics and expert in palliative care, “are terrified of the unknown and want to take back control.”

I want to say that the gravitational pull toward euthanasia, so much a response to the over medicalization of death, serves as a countervailing pole in our cultural psyche, precisely because both actions result from the same impulse: the self-deception of control. Indeed, these two poles exert themselves as well in the way we treat people who remind us of our own frailty. When we give in to these poles, we either warehouse the weak and infirm, or we kill them. Often the differences aren’t that distinct.

In his book Naming the Silences: God, Medicine, and the Problem of Suffering, Stanley Hauerwas quotes Daniel Callahan, who argues that legalizing euthanasia

rests upon precisely the same assumptions about human need, health, and the role of medicine that have created our present crisis — the right to, and necessity of, full control over our fate.

Callahan continues:

By assuming that, in the face of a failure of medicine to cure our illness or stop our dying, we should have the right to be killed, the euthanasia movement gives to the value of control over self and nature too high a place at too high a social cost (Naming the Silences, p. 110).

This impulse is precisely why euthanasia is so dangerous. The logic of the Compassion & Choices movement (the misleadingly rebranded Hemlock Society) rests upon having folks think about how they would like to exercise ultimate control over themselves, but the illusion of self-control among humans can only rest and feed upon the control — and destruction — of others.

The current evolution of the Right to Die movement in Belgium and the Netherlands illustrates this point. One of the original supporters of the movement in the Netherlands, Protestant ethicist Theo Boer, who initially supported the movement out of a deep respect for personal autonomy, warned the UK against passing the measure that was before its parliament; euthanasia is becoming the normal way for cancer patients to die in the Netherlands, something that was never envisioned before the law was passed. Additionally, what was initially conceived of as a compassionate option for the terminally ill has expanded to include people with no terminal illness, such as the mentally ill.

A recent case concerned a young woman of twenty four who, dealing with intense clinical depression, was granted the prescription because, to quote one doctor involved, “If you ask for euthanasia because you are alone, and you are alone because you don’t have family to take care of you, we cannot create family.”

Such examples, including the possible over representation of women among those who have been euthanized for psychological reasons in Belgium (raising the specter of past abuse of women by the psychological profession), lend credence to Archbishop Welby’s statement that “some slopes are slippery.

It is important, and I want to stress, that firm Christian opposition to the legalization — and therefore normalization — of euthanasia should not be coupled with any stigma toward depression or other mental illness. Indeed, I believe the Church has been correct to move away from theologies that support a view of suicide as the “unforgivable sin,” and to allow for the pastoral care of families whose loved ones have taken their own lives, including through performing burial services for those who have died at their own hand. This change is an appropriate response to the recognition that suicide is not legitimately seen as a choice, but as a compulsion resulting from illness.

In part, it is precisely because of our concern for the health of those so afflicted that we cannot support the legalization of voluntary active euthanasia. It’s a fair question to ask whether such legalization might increase the number of suicides by those already prone to suicidal ideations, given the persistent evidence — despite no quantifiable methodology — that suicide is contagious (the so-called Werther effect), even leaving aside the question of the sort of creep we’ve seen in the practice in Belgium and Holland.

At the heart of this debate is a sad misapprehension that, in some cases and in some jurisdictions, has become tragic. Those who speak in favor of euthanasia appeal to compassion, but in so doing often set up a false dichotomy of either accepting euthanasia or dying in an ICU on a breathing machine, with a feeding tube and with a resident at the ready with the defibrillator to try once more to bring you back. This dichotomy, which I believe has been espoused by none other than Lord Carey, seems to result from an ignorance or dismissal of the hard and meaningful work done by doctors and nurses, supported by chaplains and others, in the realm of hospice and palliative care.

I don’t think that there are many folks around arguing in favor of the over-medicalized approach to death as a good thing. We need better ways to die, but euthanasia will not provide them.

The practical dangers of the acceptance of euthanasia are real, and I’m thankful that so many, especially those in the important field of palliative medicine, are critiquing it on those grounds. But, for the Christian, the ultimate opposition to such thinking stems from a source deeper than pragmatism. I’ll explore just such an opposition in tomorrow’s post.

Fr. Jody Howard’s other posts may be found here. The featured image is the battle for the soul at death from the Grandes Heures de Rohan. It is licensed under Creative Commons.


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