In medicine and in our culture, there is a growing acceptance for what is now being referred to as “medical aid in dying.” The term sounds compassionate, loving and merciful but what this phrase is referencing in practice is nothing more than physician assisted suicide.
Sadly, more and more people are fighting to legalize physician assisted suicide. They see it as justified. As of January 2020, eight states plus Washington DC will have legalized physician assisted suicide in the United States.
Don’t be confused by semantics. Even though it may be referred to as medical aid in dying, it is still physician assisted suicide.
The American Medical Association (AMA) defines physician assisted suicide as a situation “when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g. the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).”
Proponents of such actions, however, do not like the term “physician assisted suicide.” They prefer the term “medical aid in dying,” or terms such as “death with dignity” or even “compassionate dying” among others. Such thinking is very clear. Omitting the word ‘suicide’ makes the action sound more acceptable.
Physician assisted suicide proponents hold the idea of seeing ‘end of life acts’ as ‘suicide’ is hurtful, shaming and/or causes guilt. They believe that the characteristics of those who commit suicide are distinct from those who seek out a physician to assist death. As such, they do not want the terms linked. And because of these views, it is even being explicitly written into the legislation that these acts are not equivalent to suicide, euthanasia or ‘mercy killing.’
Some use the terms physician assisted suicide and euthanasia interchangeably. But most in health care make a distinction. The AMA defines euthanasia as “the administration of a lethal agent by another person to a patient for the purpose of relieving the patient’s intolerable and incurable suffering.”
In cases of euthanasia, the physician could administer the lethal agent but this is not always the case. Regardless, the physician is usually involved in some way whether indirectly by providing the means (physician assisted suicide) or directly being the agent giving the lethal agent (euthanasia). But this involvement is why some argue the terms are foundationally interchangeable.
It is also important to recognize euthanasia can also include the omission of a treatment. The Declaration on Euthanasia, from 1980, defines euthanasia as “an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. Euthanasia’s terms of reference, therefore, are to be found in the intention of the will and in the method’s used.”
Legalization of Euthanasia and Physician Assisted Suicide
In the United States, euthanasia is illegal. A physician cannot directly administer a lethal agent. And the US laws that have been enacted to permit physician assisted suicide have been crafted with provisions limiting the ‘medical aid in dying’ to the terminally ill. But this is not the case throughout the world. In the Netherlands, the law permits euthanasia in cases of “hopeless and unbearable suffering” – a subjective phrase open to varied interpretations.
The Dutch law includes the criteria that there are to be no other reasonable alternatives and another physician’s opinion is to be sought. But this is not binding. It also states there must be informed consent without coercion. According to the law, those twelve and older can make a request for euthanasia. It also permits euthanasia of infants in some situations.
There is a push by some in that country to expand the law. They want to include elderly persons who simply feel tired of life. They also want to allow it for anyone who feels they ‘have completed life.’
The argument is being pushed that those who have lost independence, are lonely, or who are burdened by the deterioration of life should have a right to end their life with dignity. But there are many – including Theo Boer, a Dutch professor and a former supporter of euthanasia – who see a slippery slope with such laws and who are speaking out about the dangers.
Attempting to Justify Medical Aid in Dying
Many arguments are being made in an attempt to justify ‘medical aid in dying.’ Some claim that if a person wants to die to end their pain and suffering (preferring death over life) we should let the person have control over how his or her life ends. In other words, we should not prevent interventions that comply with the person’s request.
Proponents argue that many with terminal illnesses choose to end their life because they feel a loss of dignity in having to depend on others. While some feel they are a burden to their families, others simply no longer want to live plagued with pain or unhappiness. Since often in these situations death is imminent, why not intervene to avoid prolonged and meaningless suffering if the patient so chooses?
Along these same lines, it is argued that medical professionals should always put the patient first. So if we have methods available to end a life of suffering and if the person is not harming anyone else, the person should have the right to die in the way they wish. How can one person impose his or her views on another and prevent that individual from having control of how he or she dies? How can one person know what is best for another individual? It is cruel to force a person to continue to live in agony.
Some advocates for these practices also argue that these choices to end one’s own life should fall under the law protecting freedom of religion. They assert that not everyone is Christian and, for some, their ‘religious’ values hold that quality of life matters above all else. They say that prohibiting those who want to die from doing so should be against their first amendment rights.
I understand why some people may, at first glance, see euthanasia and physician assisted suicide as acts of love and compassion for others. We all would like to find ways to restore others back to health or, at a minimum, find a way to end their suffering. And I can also appreciate that among some there may be a deep-seated fear of experiencing pain which can lead a person to consider all extremes to avoid it.
But, regardless of the reasons used to try to justify these acts, the reality is that both practices involve directly killing an innocent human person. This is always immoral.
As Christians we believe that human beings are given existence as a gift from God. And because we are each recipients of life from our Creator, we are not masters over life or death. All life is sacred. It is in God’s Hands, not ours.
Sacredness and Dignity of All Life
The value of life is not based on utility (how useful we are), intelligence, physical strength, age, physical health or other attributes. All human beings have an inherent dignity and worth because we are created out of love by God. Therefore, all life is to be protected and respected.
While there can be mitigating factors that decrease one’s culpability, intentionally taking the life of an innocent human being (or taking one’s own life) is committing an act of the utmost gravity. Such an act is always wrong. This is an offense against the fundamental right to life that belongs to every human being. It opposes God’s sovereignty and loving plan for that person’s life.
The Church clearly prohibits practices related specifically to actions taken to directly end the life of those suffering. The Declaration on Euthanasia, from 1980, says:
“It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.”
Medical Professionals Should Do No Harm
Some people claim medical providers should directly act to assist a person in ending his or her own life. But it is not only Christianity that sees this as immoral. There are secular institutions that also hold this is immoral and that these actions are incompatible with the role of medical professionals.
Over the centuries physicians have been entrusted with a duty of helping patients with the expectation they would never intend to do harm. The Hippocratic Oath (written around 400 BC) is the earliest expression of medical ethics. It says:
“(I will) abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel…”
This oath prohibits both euthanasia and physician assisted suicide. And it has been a long-standing view among many in the profession. But modern medical schools have altered the words of the Hippocratic Oath when it is professed today.
In recent years, references to controversial issues such as euthanasia/physician assisted suicide and abortion have been removed from the oath. Nonetheless, the fact the oath is still taken by many signifies the value and respect of its ethical principles in general.
Medical associations like the American Medical Association (AMA), the American Psychiatric Association and the National Council on Disability also have ethical concerns. The AMA has specific policies that forbid the practices of euthanasia and physician assisted suicide (here and here). The AMA states that not only are these acts against a physician’s mission of healing, but they would ultimately cause more harm than good.
Caring within Our Limitations
Medical providers have a duty to care for patients and help alleviate suffering. But there are limitations. The notion that “the patient comes first” should not mean that simply because a patient requests an intervention or medication the physician is to grant every request. Sometimes patients make requests that could be harmful or not in their own best interest. So physicians must be prudent and practice evidence-based medicine.
Additionally, patients put their trust in their physicians to never act in ways that will directly do harm. So engaging in assisted suicide is hypocritical to the foundational duty of non-maleficence.
When a person is experiencing pain and suffering, medical professionals must be compassionate and try to find medications or interventions to alleviate the pain as much as possible. And we must never forget that a person is more than just a body with physical pain. We must be cognizant of emotional and spiritual suffering as well.
While it is true not all pain can be eliminated by available interventions, great strides have been made with advancements in palliative care and hospice care (though further progress is always needed) and these should be utilized. Nonetheless, even if our efforts are not fully effective, the reality remains that to perform an act that has the direct and intended consequence of ending the life of a person is always immoral. The ends do not justify the means.
The Catholic Response
While wanting to respect the sacredness of all life, some may still have intense fears and anguish at the idea of suffering which can make physician assisted suicide and euthanasia tempting. But we cannot buy into the blindness of the world that sees suffering merely as meaningless and to be avoided no matter the cost.
The Catechism of the Catholic Church expresses how the Church fully understands the misery humans can endure with injury, illness or at the end of life. Sometimes our agony can lead people to search more deeply for God, but it is also possible suffering can lead some into despair and to revolt from God. The Catechism says: “Illness and suffering have always been among the gravest problems confronted in human life. In illness, man experiences his powerlessness, his limitations, and his finitude. Every illness can make us glimpse death” (CCC 1500).
Because of God’s love and mercy for us, He became man. He not only permitted the sick among us to touch Him, Christ made our miseries his own. The Catechism continues:
“On the cross Christ took upon himself the whole weight of evil and took away the “sin of the world,” of which illness is only a consequence. By his passion and death on the cross Christ has given a new meaning to suffering: it can henceforth configure us to him and unite us with his redemptive Passion.” (CCC 1505
God Himself took on flesh and suffered with us and for us. And by His Passion and death on the cross, He transformed human suffering. This does not mean it will be easy, but He has given our suffering meaning. When we unite our pain, distress, miseries and afflictions with Christ, He allows us to participate with His act on the cross. We can offer up our own sufferings for ourselves and others.
As we unite our sufferings to Christ on the cross, we suffer for the kingdom of God. And God sanctifies us by his grace – making us “mature enough to enter this Kingdom,” as John Paul II wrote in Salvifici Doloris (21). But ultimately, in the midst of suffering, it is crucial we do not lose sight of the fact that God transforms our suffering and gives it a redemptive value.
Choices Have Consequences
Some argue a person should have complete autonomy. So if someone wants to die rather than suffer, they should be aided in this since, after all, a person does have the free will to act. However, we must be careful that we do not exalt our individual autonomy to the point we forget we are creatures with a God-given purpose. Living without recognizing our dependence on God and failing to see that God created us for heaven, we can choose to act in ways that are harmful with eternal consequences. These truths should be ever before us in the choices we make.
Physician Assisted Suicide vs. Moral Options
Some contend that since the Church permits the withdrawal of extraordinary measures in the medical care of patients that this is essentially no different than physician assisted suicide/euthanasia and so our opposition as Catholics is hypocritical. However, this argument fails to see a very significant distinction. This will be the topic covered in Part II, tomorrow.