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In my last column I wrote that there comes a time to turn off life support mechanisms (which support what I called “artificial life”) and thus allow a person to pass away. It is, I believe, the compassionate and proper step to take in some situations. The next logical question is to ask, what about euthanasia?
Euthanasia is, according to the American Medical Association, “the administration of a lethal agent by another person to a patient for the purpose of relieving the patient’s intolerable and incurable suffering.”
Euthanasia is, in other words, the intentional ending of life in order to spare an individual from some type of incurable or tragic medical situation or from the pain and suffering associated with their condition.
Euthanasia is opposed by the American Medical Association and is illegal in all 50 states. There are, however, four states that allow for physician-assisted-suicide (Washington, Oregon, Montana and Vermont).
The difference between euthanasia and physician-assisted-suicide is in who administers the procedure that results in the death of the patient. Physician-assisted-suicide provides the means – such as a lethal dose of medication – but does not administer the procedure. In physician-assisted-suicide the patient is the one who initiates the process that brings life to an end, not the doctor or health-care provider.
As both procedures – the removal of life support and euthanasia – result in the death of the patient, is there a difference between the two? If both procedures produce the same result, are both morally acceptable?
If it is proper to turn off life support, which causes death and is an acceptable alternative to most people, does it then follow that euthanasia is also an ethical and proper practice? Do individuals have not only the right to refuse treatment, but also the right to choose the manner in which they will die?
Is it proper to help a person, in the name of compassion, to end their life?
These are just a few of the very complicated questions involved in the general debate about end-of-life issues, and in particular, the debate about euthanasia. The answers, I think, are neither easy nor simple.
There is, first of all, a very significant difference between the actions of removing life support and that of euthanasia. Removing life support is an act that allows “nature to take its course.”
The term “life support” is somewhat of a contradiction, as it is not supporting life as much as it is an interruption of the dying process. Removing life support allows the process of death, already begun, to come to completion.
It is, then, a passive and natural form of allowing death to occur, as it removes the medical and technological impediments that have prevented death.
Euthanasia, on the other hand, is an active method of bringing about death, because it can be initiated well before the dying process actually begins, such as when a person receives a terminal diagnosis and elects to end their life before the suffering related to the disease begins.
It is in this difference that we find the central question about euthanasia. It is one matter to allow death to take place by the removal of life-supporting technologies; it is a very different matter to initiate the dying process.
I am not generally a fan of the “slippery-slope” type of argumentation, but I do believe that once we cross the line of passive to active engagement in the death of individuals we begin a process that is riddled with many moral, legal, and ethical questions.
Is that a step that we, as a society, are willing to take? And if so, should we take the step? Once euthanasia becomes more acceptable as a moral act – and a legal one – there is the very real question of whether or not we gradually will move from the decision resting in the hands of the ill person and into the hands of another person. When we arrive at the point where one person makes the decision to end the life of another person, we arrive at a very troubling point.
I understand there is, among many people, empathy toward the idea of euthanasia; I often feel that empathy myself. Over the course of my ministry I have walked with many people through their suffering and, eventually, their deaths. I understand the fear and anxiety people have about the process of dying and what come with that process.
It’s hard then, at least emotionally, to make a persuasive argument against euthanasia because we are at heart a compassionate people. We do not want to see our loved ones suffer, and if we can help a loved one avoid that suffering, why not choose to do so? This desire for the comfort of our loved ones then, brings about at least a sympathetic openness to the idea of euthanasia for many people.
In considering all the questions, I have come to a few conclusions about euthanasia, conclusions that are not based upon any medical expertise, but from my personal experience of walking with many people through the process of dying.
I believe, first of all, as I stated in my previous column, that it is both the compassionate and proper decision to, at some point, turn off life-supporting technologies. To do so does not initiate the dying process, but allows it to continue. This is not the same as initiating death, which is the action of euthanasia.
I believe that in the far majority of cases, pain can be treated and comfort measures adequately provided, so euthanasia does not need to be considered as a possibility in the far majority of circumstances. There is absolutely no reason for anyone to suffer in pain with the medical care that is available to us today. There are, however, some cases that go beyond simply the question of comfort.
There are medical conditions that occur where there is a grave deterioration of a patient’s physical, but not mental, condition, leaving them trapped in a non-functioning body while maintaining an acute mental awareness. I can understand, in those instances, a person’s desire to end their life – which will, at some point, absolutely come about because of their illness – as a way of avoiding a deeply unsettling process of dying.
In such a situation I would neither fault nor condemn a person for doing so, and if they are aided by a medical professional – in a passive manner – I do not believe there should be any legal consequences.
I believe the medical care given to provide for pain relief and comfort care sometimes hastens a patient’s death, but that is not the same as euthanasia. The treatments given to provide comfort and to ease pain and anxiety will sometimes hasten the death of a patient, as they are eventually given in doses that begin to suppress body functions and bring about death.
Known by the medical term “double effect,” it recognizes that a desired outcome, such as pain relief, has a secondary effect – the suppression of a necessary biological process – that results in the death of the patient, which is not the intention of the act. The provision of medical treatment, in some instances, may be a factor in a patient’s death, but their death is not the intention of the treatment and is not then, euthanasia.
I believe that our moral and legal systems are lagging far behind the necessary discussions surrounding euthanasia. I suspect that our society will move increasingly in the direction of physician-assisted-suicide, with some further legal recognition of the practice, but for the most part it will be informal practices that will be adopted within the medical community, and left unprosecuted by the legal authorities. In our contentious political environment, coming to any large-scale legal consensus on this issue will be mostly impossible.
I believe that when a person ends their life for medical reasons, it is not the mortal sin many would consider it to be. I know the theological reasons for such a belief, but my own theology stands in opposition to that belief. To imply or teach that the ending of life in such a circumstance results in a person’ condemnation by God adds to the pain and tragedy of an already painful and tragic circumstance.
I realize that in the space of this column I am leaving many questions unanswered and a lot of holes in my arguments. Space limitation is one of the problems, as are misunderstanding and misinterpretation of what I have written. This was the most difficult column I have written thus far for The Sentinel-News, and it was difficult not only because it touches on a contentious topic, but also because I have mixed emotions about some of what I have written.
I believe that life is a precious, precious gift and is to be valued and protected to the greatest of our abilities. I believe life is a gift of God, not a random occurrence, and when we breathe our last, we return to the mercy and care of God.
How we arrive at that last breath is an incredibly important question, and one we will not adequately answer any time soon.
Dave Charlton is pastor of First Christian Church. His column will appear every other week. You can reach him at email@example.com.