Death With Dignity

This is the second of two week two discussion questions from my Spring 2022 course Making Sense of Theology through Pathways Theological Education.

Read and respond to the case: “Proposed Death with Dignity Referendum.”

Imagine that your state has a referendum on the ballot legalizing physician-assisted end of life, a.k.a. euthanasia, similar to laws passed in Oregon and California.

Content Warning: Obviously this isn't an easy topic, but my discussion of it ended up being way more graphic about causes of death and murder than I expected would be necessary.

 I'm going to start with the fact that since I'm from Oregon, where we twice voted as a state to allow death with dignity, I am seeped in an embedded theology that of course this is good. Since part of that embedded culture is that we often use the word suicide, usually with modifiers, to refer to choosing one's time of death when we know painful death is coming soon, I'm going to use that term here. Rather than the argument given in the assignment that "this is not suicide because something else, often cancer, is the true cause of death," what I hear is simply an acknowledgement that people "died of cancer" or "had cancer and died." I know that my Catholic family members, who do, in general, consider suicide a sin, do not consider this to be sinful. (Also, while it is entirely off topic, I don't think there is any Christian excuse to treat suicide as anything other than a death due to illness regardless of whether it was due to an attempt to avoid a quickly advancing painful death due to cancer or mental illness, that just ends up being hurtful to survivors and keeps those who are struggling from reaching out to religious community.) And, honestly, I think death with dignity passed in Oregon and Washington because we already had a culture where suicide (and in some cases infanticide) in the face of painful death was considered a valid choice. The main issue was we didn't have access to processes that were reliable, didn't leave the family with extra trauma and could still be carried out when patients were physically very weak from their illness. I won't go into the stories I've heard from the 50's, 60's  and 70's, but I personally have never heard condemnation of someone who choose their time of death rather than waiting for "natural death." When I asked a friend who grew up in a rural area if this was the same in their area, he immediately told me that it was called "shotgun therapy" in his area and several of his grandparents' friends made that choice. My dad was essentially offered euthanasia as an option at his brain cancer diagnosis in 1985 in a Catholic hospital by an oncologist who straight out told him that whether or not he choose the treatment he was offering (out of several options), to keep his number as he was available for end of life care and was specifically willing to give as much pain meds as necessary to keep someone comfortable even if that dose came with a risk of stopping breathing if that was what the patient wanted. If I recall correctly, this conversation took place in full hearing of my whole family and several family friends. At least in Oregon, we have a long tradition of individuals being able to choose euthanasia.

My thoughts on this are mostly pragmatic, which probably qualifies as anthropologically based, but I'll go into that in further detail later. Reflecting on what I know about the differences in how people died and whether or not I know anyone who used legal assisted to suicide to die, has actually convinced me that regardless of what I believed divine revelation to say, I would be generally in favor of the law allowing people to choose euthanasia legally. This is because when I reflect on my grandparents generation, almost all of whom died before physician assisted suicide was available in Oregon, Washington and California; I know of several people who choose to end their life on their own, knowing that a painful death was coming. All of these people choose a method that was messy and traumatic for their family. Of my parent's generation, many of who are dying now, I only know of one who choose euthanasia, the father of a friend. Statistics in Oregon show that a significant number of people who get a prescription for assisted suicide, either do not fill the prescription or do not use it. This is believed to be, in part, because for some people, just having the option makes them less stressed and more comfortable waiting as long as they have any good times. I suspect that the reason the numbers of suicide in the face of coming deaths I hear about now that assisted suicide is legal is that most of the methods people used in the past required them to be much more well and fit when they took action than physician assisted suicide does today. People today can wait longer and may die naturally in the meantime in a manner they still find to be good. (I would be remiss if I did not note that people whose illnesses do or are likely to involve swallowing problems regularly show up in the media asking for further assistance to be legal for them, because they don't want to have to choose between ending their life earlier than necessary and having to take whatever pain their body chooses to dole out after they cannot swallow anymore.)  

Continuing on a pragmatic basis, concerns about misuse of these laws are something I think everyone shares. But, unfortunately, neither allowing nor denying death with dignity stops the murders of seriously ill and disabled people in our communities. Yesterday (March 1) was Disability Day of Mourning, a day for mourning disabled people who were killed by a family member or caregiver. According to https://disability-memorial.org/, last year, 5 disabled people were murdered by their caregivers in Oregon, Washington and California. (I'm using those states because they line up with where all the incidents of suicide to prevent painful death I've mentioned above took place and all states with laws allowing individuals to choose euthanasia for themselves.) The numbers are likely much higher, because such deaths are often only investigated when they are obvious. I don't think this means we shouldn't worry about misuse of death with dignity laws, and such laws should continue to include checks and balances, but our concern for unnecessary deaths of sick and disabled people needs to start long before death with dignity laws. For instance, the COVID epidemic saw a push in England for all sorts of people with disabilities to be marked as DNR (Do Not Resuscitate), regardless of their feelings on the matter, solely on the basis of disabilities and not any differences in their likelihood of benefiting from advanced life saving measures. In the US, many states crisis standards of care for medical care when hospitals and medical professionals are overwhelmed were also found to discriminate against people with disabilities, deprioritizing their care for reasons unrelated to survivability or need.

I want to specifically address the argument suggested in opposition to "Only God decides when we die." If God can keep Daniel and his friends safe in the flaming furnace or the lion's den, God can certainly make some meds not work. I'm not saying we should tempt God, but I don't believe God is so limited that we need to avoid possibly getting in God's way. I also think this argument is not necessarily in good faith, because some of the same groups I see touting arguments like this also believe in trying to bring about events their reading of dispensationalism lists as necessary precursors to the second coming. You can't have it both ways. Also, I think arguments like this are often harmful to faith. If "Only God decides when we die", many of those who witness a painful, drawn-out death wonder why God would be so cruel as to wait. Avoiding this type of statement doesn't solve the problem of theodicy, it doesn't reinforce concerns about it either.

As far as my pragmatism about this issue possibly implying an anthropologically based rather than divine revelation based outlook, while I start with looking at how humans are affected, my reason for doing so is based on the belief that humans are made in God's image and all of the many teachings in the Bible about loving our neighbor. Our neighbor is not just our fellow Christian, not only Christians are made in God's image. When we make legal decisions based on ethics, certainly our Christian beliefs might inform them, but if our neighbor is not a Christian, we are not called to force them to behave as a Christian, we are called to love them. (We can argue separately how and when the great commission might call us to do more in the way of evangelism than love our neighbor.) When we try to legislate what we believe to be God's will, we are acting as if we believe our human laws can enforce behavior that God cannot. Treating law as stronger than God's will is idolatry.  This isn't to say that we shouldn't have any laws or any laws that align with God's will, but we should do so in the spirit of Article 3 of the Winchester Profession "We believe that holiness and true happiness are inseparably connected, and that believers ought to be careful to maintain order and practice good works; for these things are good and profitable unto men."  Additionally,  I believe that any type of harm reduction technique falls in the category of loving our neighbor and this does seem to be harm reduction. (I would argue that the "first do no harm" statement often attributed to the Hippocratic oath is not in fact followed, doctors regularly have to choose harm reduction. I am alive today because 9 months ago a doctor cut a huge chunk of infected flesh out of my leg, knowing that he only had about an 80% chance of success if he did and that even if he was successful I might not have full use of my leg, but also knowing that if he didn't I would surely die a painful death. That is harm reduction, not doing no harm.)

I will say that whether or not an individual Christian should avail themselves of assisted suicide in the face of certain and painful death is a separate question and while we can advise our fellow Christians on this topic, we also need to leave space for them to listen to the Holy Spirit, recognize that what the Holy Spirit tells us to do for us may not be what the Spirit tells them, and love them, not condemn them.