Intersections

Dying with Dignity

by: 
Megan Best, BMed (Hons), MAAE

Bills to change the law to allow euthanasia and physician-assisted suicide continue to be presented to parliaments throughout the western world, on a wave of overwhelming public support for “the right to choose and have a dignified death.” While it is unlikely the debate will go away, we can still hope for a more honest one.

Sadly, promotion of assisted death often has its origins in a personal tragedy. Many of those who lobby most strongly for a change in the law have experienced the difficult passing of a loved one. While services such as palliative care and hospice can do much to relieve the distress dying people experience, many still do not have access to it. We must do better.

There is much debate surrounding the passage of these bills, but it is lacking needed balance. In what follows, I offer a summary and response to common arguments in favor of physician-assisted suicide and address the oft-neglected case against bills in support of the practice.

In the public discussion of suffering at the end of life, we are hearing stories that muddy the waters of the euthanasia debate. Definitions are confused; medications are misunderstood. It is possible that, in reality, public support for euthanasia is not as high as assumed because many members of the public are neither familiar with what normally happens in end-of-life care, nor clear about what would change if we legalized euthanasia. This is understandable in a country where most people die in hospitals, separated from everyday life.

Euthanasia laws allow a patient’s doctor to kill a terminally ill person who is suffering by administering a lethal injection. The intention is to relieve the patient’s suffering by killing them.

I find it hard to hear some of the stories of suffering presented to support the euthanasia cause. Such terrible suffering is sometimes so easily avoidable. There are stories of patients receiving treatment that they obviously do not want because they do not realize they have the right to say ‘no more.’ But, you can refuse treatment without legalizing euthanasia. This is because sometimes treatments at the end of life that are aimed at prolonging life either stop working—they become futile—or the burden of side-effects such as nausea and vomiting can rule out any benefits by way of extra time. In such a situation, the treatment may not be prolonging life so much as prolonging the process of dying. Stopping such treatment is an ethical choice. No mentally competent person has to undergo treatment they don’t want, even if it means shortening their life. It is not euthanasia because the aim is not to kill the person, but to allow the underlying disease to run its course.

Similarly, some people are anxious at the thought of being kept alive by machines long after their quality of life is gone. But, you can let your loved ones know this is not your wish, and such treatments can also be stopped legally and ethically without a change in the law. Once again, it is not euthanasia. It’s not pulling the plug that kills the patient, it’s the underlying disease that does so. The disease is why they were on life support in the first place.

Sometimes at the end of life, the distressing nature of someone’s symptoms may require the giving of large doses of analgesics such as morphine to manage pain, or sedatives to relieve symptoms such as breathlessness. This is not euthanasia because the aim is not to kill the patient, but to relieve their distress. Some people call this process ‘slow euthanasia’ because of an urban myth that morphine shortens the life of the patient. They argue that if we practice that sort of euthanasia, which they call ‘passive euthanasia,’ why can’t we have the other sort of euthanasia with the lethal injection, which they call ‘active euthanasia,’ to make it quick? But it’s all based on the lie that morphine shortens the life of the patient. In fact, there is much research showing that this is not true.[1] Morphine in therapeutic doses does not shorten life. Therefore, this argument for euthanasia is invalid. Any argument in support of euthanasia needs to look elsewhere to justify the change. And it would be a change. Doctors are taught to be protectors of life, not executioners.

I don’t think this debate is really about pain and physical distress at all. If it were, we would not have started discussing euthanasia at a time when we have more medical cures than ever before. I think it is about a society that has lost touch with existential concerns, and when facing death, its citizens find they do not have answers to the big questions that arise, questions about meaning and purpose and what lies beyond this world. While Christians can understand how we may learn through suffering, such beliefs are not widespread. In a society that has forgotten the meaning of suffering, there is understandably a lack of willingness to endure it. Personally, I can understand why you would want to check out of this life if you thought this was all there was and you were suffering. It’s not that I don’t sympathize. I do. I don’t oppose euthanasia because I don’t care.

My main objection to euthanasia is that, in the countries where it is practiced, abuses occur and some people—over 1,200 in 2010 alone in Holland[2]—are euthanized without their knowledge or consent. It is dangerous to think that some lives are not worth living, and to forget that we are all made in the image of God and therefore to be treated with respect regardless of physical condition.

This debate is uneven. We hear about the people who wish to die, but what about those who wish to live? What about the frail and vulnerable who cannot go on television and talk about their experiences of coercion and being made to feel a burden? Elder abuse is on the rise. The prospect of inheritance brings out the worst in some people. Are we really so naïve about the potential consequences of changing the law?

As Christians we know that that we live in a fallen world where suffering is inevitable. But, we also know that there is a better world to come and that it is wrong to kill the innocent, even when they ask us to do so. This is a challenge for the church—to support those who suffer whenever we can, and to help them learn from the Suffering Savior, because you can only peacefully let your life go when you understand its meaning.



[1] For example, see D. Azoulay, J. M. Jacobs, R. Cialic, E. E. Mor, and J. Stessman, “Opioids, Survival, and Advanced Cancer in the Hospice Setting,” Journal of the American Medical Directors Association 12, no. 2 (2011): 129–134.

[2] B. D. Onwuteaka-Philipsen, A. Brinkman-Stoppelenburg, C. Penning, G. J. F. de Jong-Krul, J. J. M. van Delden, and A. van der Heide, “Trends in End-of-Life Practices Before and After the Enactment of the Euthanasia Law in the Netherlands from 1990 to 2010: A Repeated Cross-Sectional Survey,” Lancet 380, no. 9845 (2012): 908–915.

Editor’s note: CBHD recently published a piece regarding trends in euthanasia in Holland by Jacob Koopman entitled “Developments in the Practice of Physician-Assisted Death Since Its Legalization in the Netherlands.” It can be found at https://cbhd.org/content/developments-practice-physician-assisted-death-its-legalization-netherlands

 

Megan Best, BMed (Hons), MAAE

Megan Best, BMed (Hons), MAAE

Dr. Best is a bioethicist and palliative care doctor who works for HammondCare, an independent Christian charity. She is also at post-doctoral researcher in psycho-oncology at the University of Sydney, NSW Australia. She is author of Fearfully and Wonderfully Made: Ethics and the Beginning of Life (Matthias Media, 2012)