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A Time to Die

January 14, 2014

There is a time for everything,

and a season for every activity under the heavens:

a time to be born and a time to die 

(Ecclesiastes 3:1-2)

The genesis of this post was my listening to a discussion of the medical and moral issues raised by euthanasia aired on CBC Radio’s The Current with Anna Maria Tremonti.  Having enjoyed varied careers in the field of healthcare, and having worked extensively with those whose lives in the opinion of many were of little apparent value, the program’s subject caught my attention.  I have been attendant to my share of suffering and death, and have also been on several occasions witness to passive euthanasia.  For me, those experiences debunked some of the pro-euthanasia arguments and entrenched my views on the issue.  In the words of Dame Cicely Saunders, founder of the modern hospice movement, “How people die remains in the memory of those who live on.” 

I wrestled with the whole idea of entering into the fray, writing in fits and starts, working on my draft, revising and rewriting, and then considering abandoning it altogether, unsure that my touching upon this emotionally charged issue served any purpose.   That was until I happened upon this declaration by Nobel Prize-winning writer Albert Camus, surprising since he himself is a non-Christian:

The world expects for Christians that they will raise their voices so loudly and clearly and so formulate their protest that not even the simplest man can have the slightest doubt about what they are saying. Further, the world expects of Christians that they themselves will eschew all fuzzy abstractions and plant themselves firmly in front of the bloody face of history. We stand in need of folk who have determined to speak directly and unmistakably and come what may, to stand by what they have said.

Camus’s words are a formidable challenge, but after some musing I have decided not to quail from them, but to pick up the gauntlet, unashamedly presenting a Christian perspective.  I will not stoop to deriding or demonizing those who hold opinions differing from mine, in virtue of disagreement need not entail disrespect.  My objective is not necessarily to convince anyone, but merely to boldly proclaim my truth, what I believe is God’s truth, for consideration.  And as always, I write in hope that the exercise might prove transformative, that I might see the issues more clearly, and perhaps come to view them and my relationship to them with a new mind and a new heart.

I will dispense with defining euthanasia in its many forms, though I believe clear definitions essential to the broader argument since the waters have been muddied by misconceptions and euphemisms.  In a war of ideologies, the first casualties are the definitions of the terms used. Neither will I delve into the history of euthanasia as these subjects can easily be found elsewhere by any interested party.  I will, however, begin with a brief overview of current legislative issues as these have of late become relevant to the Canadian landscape. 

“I will give no deadly medicine to any one if asked, nor suggest any such counsel.” 

— The Hippocratic Oath

 

Recently in Belgium, a draft bill passed in the Senate by a strong margin and is now before the country’s Chamber of Representatives.  This bill proposes extending the reach of the country’s 2002 law legalizing euthanasia to those under the age of majority, allowing doctors, with parental consent, to end the lives of children on the grounds of “compassion.”  The bill is expected to pass easily.

Belgium is one of only three countries in the world—the others being the Netherlands and Luxembourg—in which euthanasia is legal.  Other countries have considered allowing euthanasia, but after looking at the experience of the countries where it has been legalized, have deemed it unwise to follow suit.  A delegation from Quebec, however, returned from Belgium with a glowing appraisal, reporting they saw no problems with the implementation of that country’s euthanasia law.  As a consequence, the Quebec National Assembly is conducting a committee study of Bill 52, which would legalize “medical aid in dying,” the current deceptively noble-sounding euphemism of choice.  Champions of the bill are undaunted by the fact that as recently as 2010, Bill C-384, Right to Die with Dignity, which would have legalized euthanasia, was voted down in Canada’s House of Commons 228 to 59.

Although proponents vehemently reject any suggestion of “slippery slope,” the evidence is in.  In European nations that have legalized euthanasia the rate of increase of reported euthanasia has accelerated over the past few years.  In the Netherlands, official figures show increases of 13% in 2009, 19% in 2010, 14% in 2011, and 13% in 2012, with euthanasia now accounting for one in thirty deaths.  Belgium saw a 25% increase in 2012, euthanasia accounting for a full 2% of all deaths.  Unofficial sources suggest that the true figures are much higher as many deaths go unreported. 

The criteria set out in the 2002 legislation under which euthanasia is permitted in the Netherlands are no longer respected. There are numerous accounts of those not meeting the eligibility requirements “physician shopping” until they find a doctor who will carry out the procedure.  Proponents keep adding to the list of groups of people they would like to see euthanized, lately including psychiatric patients and those suffering with dementia.  A poll undertaken in the Netherlands showed that a substantial minority of the Dutch public supports physician assistance in dying for older people who are not ill but merely “tired of living.”  Although child euthanasia is not permitted under the law, the Groningen Protocol, created in 2004, contains directives with criteria under which physicians can perform “active ending of life on infants” without fear of legal prosecution.  It is not uncommon now for people to be euthanized without their consent or knowledge. There is pressure on the aging and infirm to choose measures to end their lives.  Opting for palliative care has come to be seen as rather selfish.  The “right to die” quickly becomes an expectation, and finally a duty. 

The march toward euthanasia seems to hinge on the humanist postulations of autonomy (self-determination), individualism, quality of life and suffering.   The first two of these are antithetical to Christian thinking.  Quality of life as promoted by humanists is a concept foreign to Christianity.  Suffering for the humanist is an unmitigated negative that robs life of its meaning and ultimately outweighs the value of continued life.  Although in this world suffering is a stone-cold reality for Christians, an inescapable constituent of God’s gifts of life and free­dom, one thing is sure: suffering is an important element of the Christian faith.

From a Christian perspective, life is a gift. Created in the image of God, our lives have intrinsic and immeasurable value and an inherent God-given dignity.  Human life is sacred, set apart for the distinctive destiny of sharing in God’s life, and therein has an eternal meaning and purpose.  Human value, dignity, meaning and purpose, being extrinsic, are therefore not vulnerable to the ebb and flow of self-esteem.  It is God who rightly defines us, not ourselves.  This is the essence of the “sanctity of life” concept:  there is no such thing as a life not worth living.   The severely damaged, those in a persistent vegetative state, those with mental or physical handicaps, the sick and the old who are near the end of earthly life, all have the same infinite worth as any other human being.  This intrinsic, God-given value of our lives is not reduced by circumstances.  The Christian sees satisfaction, contentment, happiness, and fulfilment not as the litmus test of life’s value, but as blessings arising from a right relationship with God, regardless of prevailing circumstances.

As Christians, we recognize we are under the lordship of God, that we are stewards rather than the owners of our lives.  Although He has vouchsafed us free will, God remains sovereign.  Our individual autonomy is limited by His moral law.  Therefore to attempt to choose the time of my death, or to presume to choose the time of another human being’s death, would be to reject God’s sovereignty, usurp His authority, and interfere with His gracious plan for my life or for the life of another (Jeremiah 29:11).

According to the Christian worldview we are part of community joined to each other and to God.  We are not autonomous. As John Donne said, “No man is an island, entire of itself; everyone is a continent, a part of the main.”  The fact is that when an individual opts for euthanasia, it has a profound and unavoidable effect on the lives of those around them. The individual exerting their right to autonomy has removed the same right from the survivors.  Choosing to do so is a flight from the duties of love and justice owed to both those survivors and to society as a whole, flouting one of the commandments Jesus declared to be the centrality of the Biblical message, “Love your neighbour as yourself”.

To me, any serious discussion of suffering without reference to the suffering of Jesus is an absurdity.  Jesus Christ Himself suffered.  He knows what it is like to experience betrayal, abandonment, indignity, pain, torture and a gruelling death.  The God in whom I believe and trust is a God who Himself suffered, and through His suffering transfigures the suffering of His people.  Therefore my suffering, though sometimes bewildering and mysterious, is not without meaning.  It has a special place in God’s saving plan; it is a sharing in Christ’s passion.

For Christians, “We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed” (2 Corinthians 4:8–9).  Neither suffering nor death get the final word, God does.  Our circumstances are not the true measure of reality, God is.  We hold fast to our hope in Christ, trusting the Author of life to allow only what ultimately benefits us to befall us.  Only Jesus Christ can speak to the reality of suffering and death, for only He has died and risen again. 

As a Christian I am not threatened by my own mortality.  End of life is not end of existence.  I know that I am a temporary resident here in the world, that Jesus has secured my eternal life and that my true home is in His kingdom. This hope destroys the power of death and the fear it engenders.  Any worldview that cannot cope with death on its own terms, unpalatable as those might be, is fatally deficient.

It seems to me a perverse sense of compassion that looks to end suffering by meting out death.  True compassion leads to sharing another’s pain, offering the love and supernatural warmth so needed by those who suffer.  Suffering happens in community and equips us for ministry.  Paul writes in 2 Corinthians 1:4 that God “comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God.”  What I experience from God, I can give away in increasing measure to others.  Therefore suffering and impending death are opportunities for ministering to the weak and vulnerable, and reciprocally, occasion for the weak and vulnerable to provide windows of opportunity for others to serve Christ, for Jesus said in Matthew 25:40 that caring for “the least of these” is ministering to Him.  Providentially, it is also an opportunity for the weak and vulnerable to minister to us in powerful ways.

Another of the counterintuitive truths about suffering is that it prepares Christians for more glory. Paul writes in 2 Corinthians 4:17–18, “This light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal.”  Paul also tells the Corinthians that our sufferings produce endurance, character and hope (Romans 5:3-4).

Christians must not stand mute on the issue of euthanasia.   We must assert our beliefs strongly and eloquently.  But more than that we must as Camus said stand by our words, taking action beyond parliamentary yelling at those in the benches across the aisle.  We must seize opportunities to minister God’s love to the suffering and dying, as well as their families, communicating the merciful presence of God through concrete action, bringing them hope, affirming their dignity, reassuring them that their lives have meaning, reminding them of their honoured place in the community, and letting them know that they are loved.

We must move with Jesus into the dark places of sufferingto shepherd “those who all their lives were held in slavery by their fear of death” (Hebrews 2:15), on their walk through the valley of the shadow of death.  As Christians we can show how love can overcome the pain and fears of dying, being uniquely equipped for this ministry, God having bestowed upon us the love that casts out all fearLifting the afflicted and their problems to God in prayer, we can communicate that the time and manner of our dying is appointed by God, and that God is in our dying.   We can offer a reason to live through companionship and meaning in suffering.

During my career in healthcare I knew no greater honour than ministering to my patients in their final hours.  For me, attending at a deathbed was to be on holy ground.  It was a privilege to offer my presence to the dying, to be invited into their most private moments, and to listen to their stories, their hopes and their fears.  My faith both equipped me for caring for them and informed me of my limitations, allowing me, when I had done all that I was able to in human terms, to commit the situation to the Lord, leave it at the foot of the cross and walk away. 

A component too often missing from the debate on euthanasia is palliative care.  I firmly believe that there never exists a situation where the insistent necessity of compassionate care is outweighed by the pragmatic need for a prematurely induced death.  What the terminally ill want and need is pain relief, not an end to life. 

Knowledge of symptom control has vastly improved over the last several years, thanks to medical research and the development of new drugs.  It is now comparatively rare not to be able to find a medication that provides good pain control and is well tolerated.  Most pain can be managed with inexpensive oral drugs given a good assessment of pain and systematic choices of analgesics.  Despite this, in my experience and that of many others, pain is still often under-treated. 

But palliative care is much more than drugs.  It is helping the dying live death well.  Thus it is critically important that we take measures to advance palliative care, providing support that regards dying as a normal process, provides impeccable assessment and treatment of pain and other problems, intends neither to hasten nor postpone death, affirms life and maintains dignity.  At present the level of provision remains inconsistent due to lack of funding; that must change.  According to the Canadian Hospice Palliative Care Association, less than a third of Canadians presently have ready access to palliative care.   Although most say they would like to die at home surrounded by their loved ones, 70% of Canadians die in hospitals. 

The trump card for those campaigning for euthanasia is people’s fear of seeing those they love, including themselves, enduring a horrid, distressing and lingering death—fear of uncontrollable and unbearable pain, fear of being subjected to the indignity of medical technology, fear of the losses that inevitably accompany aging and sickness, fear of dependence and the humiliation of total helplessness.   When palliative care is weak or absent, we are playing into their hand.  Witnessing the death they fear makes people look for a way to avoid it.  As seen in those countries where euthanasia is legal, when it takes hold, palliative care cannot advance.

Lisa Birnie, the Australian author who penned The Death and Life of Sue Rodriguez, writes,

“I am … convinced that the research required to find the solution to extreme pain in all cases will never be done if euthanasia is permitted simply because it is the cheapest and easiest solution in a world where health budgets are tight, solutions are judged by practical results, and moral standards are determined, essentially, by expediency”.  

If death comes to be seen as a treatment, an accepted medical solution to patients’ pain and suffering, then medicine will allocate more and more resources to develop the technological advances to improve this treatment.  As a consequence, there will be neither the incentive nor the resources to develop programs that provide modern effective pain control for patients.

“Unfortunately, in end-of-life care, we do not have a vocal constituency: The dead are no longer here to speak, the dying often cannot speak, and the bereaved are often too overcome by their loss to speak.”

— Harvey Chochinov, MD, PhD

If we as Christians truly believe in the sanctity of life, we must act like it.  We cannot stand by wringing our hands, for in the oft-quoted axiom from Edmund Burke, “The only thing necessary for the triumph of evil is for good men to do nothing.”  We must plant ourselves firmly in front of the bloody face of history to become that vocal constituency for the suffering and dying, raising our voices loudly and clearly within our families, our churches, our communities, and our country, speaking out against euthanasia and advocating for strengthened palliative care.

Further, the role of caregiver is a natural fit for Christians.  For centuries it was Christians who cared for the sick.  It has not been so very long since healthcare was handed over to governments. Perhaps when considering a career or volunteer service more need to carefully consider the implications of Jesus’ words, “I was sick and you looked after me” (Matthew 25:36). 

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