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Chapter Eleven: Euthanasia
and Assisted Suicide
Elizabeth Avon had always been a spunky, energetic, life-of-the-party
type of woman. When her children were young, their friends always
loved to come to the Avon house to play because Elizabeth made everything
seem like such an adventure. Back-yard games, craft projects, story
hour, even watching videos together became times of excitement and
fun under Elizabeth's magical touch
And now she had terminal cancer. The physical pain was not too severe,
but the crushing sense of despair was overwhelming. First chemotherapy,
then radiation were tried, but neither was able to stop the spread
of the illness. Her doctor suggested that she probably would not
live till Christmas, six months away.
She could not get excited about anything or anyone any more. Her
children and her husband did their best to interest her in people,
activities, and social functions. None of her former past-times
seemed to spark any interest. What was the point of all this?
Elizabeth was repulsed at the idea of deteriorating and losing control
in front of her family and friends. She had always been a mover
and a shaker, and she wasn't going to let her loved ones' last memories
of her be those of increasing dependence, pain, and disability.
That was why she carried that Michigan doctor's address in her wallet.
Some people may say bad things about that man, but knowing that
his help was available gave her great solace. When her family was
all out of the house Elizabeth jumped at the chance and gave him
a phone call and made the arrangements. Next month, before the pain
became too intense he agreed he could come and see her. Now she
just had to convince her family.
Betty Krauss sat across the desk from Dr. Dan Smyth. "What
I need to hear from you is that you will honor my wishes,"
she said. "I refuse to die slowly and painfully like my cousin
Sabrina did. When the nausea and weakness become too great I want
to be able to know that you will be in my corner and will help me
depart this 'vale of tears' without a hitch. Can I count on you?"
Dan looked down at his hands. What were things coming to? This was
the third patient this month to approach him with a similar request.
Was it really such a big deal? After all, they were all terminal
patients anyway. What did a few months one way or another matter?
Don Omega, R. N., pushed his medicine cart quietly down the hospital
corridor. The night shift on the surgical ward could be pretty lonely
at times. And speaking of lonely, what about Miss Jennifer Bailey
in 4363? This was her fourth admission to Ben Davidson Hospital
in the last six months. No one came to see her, and each new stroke
left her more debilitated.
Her right side was now functionally useless, and she no longer could
speak in any comprehensible manner. After the first stroke she had
made some recovery, but since then it had all been downhill. She
moaned frequently in a meaningless pitiful fashion, and saliva ran
constantly down her cheek.
He remembered Miss Bailey when she had been a teacher at Park View
High School. What a beautiful, talented, caring teacher she had
been. He remembered how as a junior he had fallen madly in love
with her as he watched her every third period from his seat in the
fourth row. What a knockout! Now he had only pity for her.
Wouldn't it be better to just let her go? He could easily give her
a shot of medicine in her I.V. Since she wasn't on telemetry monitoring,
it would probably be thirty minutes before the nursing assistant
would discover her dead on her rounds to take vital signs. Though
he had been toying with this thought for several nights, it seemed
to come to him in an instant flash of decision. Where was that potassium
vial he had tucked into his pocket last week?
The idea of euthanasia, "good death", has captured public
attention in the last few years. This is particularly due to efforts
by Derek Humphrey, formerly with the Hemlock Society, Dr. Jack Kevorkian,
who has assisted in killing a number of patients-many with non-terminal
diseases, and other similar people. The concept, however, is thousands
of years old. Hippocrates, famous Greek physician and founder of
a school known by his name, said in his famous oath: "…I
will not give poison to anyone though asked to do so, nor will I
suggest such a plan."
Terminology is somewhat murky in regard to euthanasia, but three
distinct categories of death are usually discussed: suicide, assisted
suicide and active mercy killing. Suicide and assisted suicide are
self-evident terms. Active mercy killing can be further subdivided
into voluntary, involuntary (against the patient's wishes), and
non-voluntary (without input from the patient). Each of these three
types of active mercy killing is quite different in moral implication.
Proponents of legalizing euthanasia in the U. S. often tout the
history of euthanasia in the Netherlands. While many Americans assume
that the Dutch experience is one of voluntary euthanasia, a major
study conducted by the Dutch government revealed that many deaths
in the Netherlands fall into the other two categories.
Some use the nomenclature "passive euthanasia" versus
"active euthanasia." This is meant to differentiate between
fatal withholding of treatment versus direct intervention to cause
death. "Passive euthanasia" can again be subdivided into
voluntary, involuntary and non-voluntary categories. Others feel
strongly that refusing to proceed with further treatment is at times
the most humane, Christian action to take. They feel that to besmirch
this with the label "passive euthanasia" is not only unclear,
but also a grave disservice to those loving physicians who offer
this to their patients. They feel that "vitalists," persons
who hold that everything must be done for any patient as long as
there is any remaining life, often inflict unnecessary pain and
suffering on already-hurting families and patients.
This complex discussion revolves around a number of overlapping
questions:
1) Who owns our lives, any way? Do our lives belong to us to
claim at will, or are they trusts lent to us by God? Are we owners
or the fiduciaries?
2) Is it ever moral to hasten someone's death? If it is moral,
on what grounds may we base this decision?
3) When does the imminence of death preempt the need to fight
death as a bitter enemy?
4) Is it possible to over-treat a patient in an attempt to avoid
death? Are we always morally compelled to take all possible action
that might temporarily stave off the inevitable?
Does the Bible speak to us about euthanasia and assisted suicide?
Let's look and see.
Scripture and Discussion Questions
1 Corinthians 6:19-20
2 Corinthians 4:16-18
Exodus 20:13
1 Samuel 31:1-6
Philippians 1:21
2 Samuel 17:23
Psalm 116:1-6
Psalm 139:13-16
1) 1 Corinthians 6:19-20 is often quoted as an argument against
the use of tobacco and alcohol. In the light of today's discussion,
what would these verses say regarding "the right to die"
or "it's my body"? We do not have rights over the possessions
of others.
2) 2 Corinthians 4:16-18 offers great hope to the believer. Does
it also offer motivation to the believer to work diligently to prevent
easing of assisted death laws? If so, why?
3) Exodus 20:13 would clearly apply to premeditated murder. Does
it also apply to active euthanasia? What about passive euthanasia?
4) Saul committed suicide in 1 Samuel 31:1-6 and so did his armor-bearer.
Thus, since the Bible relates a case of suicide when death was imminent,
does this offer us an example of what to do in similar situations?
Why or why not?
5) Philippians 1:21 quotes Paul talking to the Philippians. Is this
a veiled cry for help? Is he advocating that we Christians should
hasten our departure to be with Christ? What is the difference between
suicide and martyrdom?
6) 2 Samuel 17:23 relates the story of a man who was known for his
wisdom. When Absalom rejected his counsel, Ahithophel chose death
over perceived humiliation. Does this have a parallel with Elizabeth
Avon's story? Is this a story of insurmountable pain or remediable
depression? What are the situations in Dr. Jack Kevorkian's assisted
suicides?
7) In Psalms 116:1-6 the psalmist details an account of God's intervention
at a time of great need. But God does not always intervene. Relate
a time when God did not intervene in a way you requested but that
he used, nonetheless, to glorify himself and help you grow.
8) Psalms 139:13-16 describes God's great love and foresight over
us from before our birth till the time of our death. When we take
the initiative and cause our own death are we rewriting our story,
is this what he pre-ordained, or is there another explanation?
9) If you had a chronic illness would you go to a doctor who publicly
acknowledged being in favor of euthanasia? (The vast majority of
patients asked this question said they would not.)
10) As Christians we, of all people, should not be afraid to die.
If this is the case, why don't we volunteer to commit suicide as
our life winds down so that we will spare expense and heartache
for our loved ones?
11) In the first vignette, what is Elizabeth Avon really afraid
of?
Comments
1) Some physicians who specialize in Palliative Care feel that
if any patient dies in any significant pain it means that the doctor
just did a poor job of pain control. They would contend that there
is never a need for euthanasia for pain control. In a recent survey
of Oregon patients who requested physician-assisted suicide, many
claimed that the request was based on irremediable pain.
2) The American Academy of Neurology takes a strong position against
euthanasia. As a secular document it does not quote scripture or
natural law, but effectively uses utilitarian logic. The document
implies that since neurologists care for many patients with chronic
and terminal illness if the doctors ever start employing euthanasia
many of their patients will lose all trust in their doctors.
3) Some people feel strongly that we must avoid the "slippery
slope" of early compromises that might lead to great evil.
Others feel that this is a non-issue. There are many examples from
Nazi Germany and modern-day Netherlands that would seem to support
the first position.
4) The issue of euthanasia really comes back to the question of
who is the owner of one's life. Non-theists obviously would not
give God this honor, but many theists do not, either. Note how autonomy
and complete submission to Christ's authority may be directly at
odds.
5) There is a significant link between abortion and euthanasia.
It might be illuminating for your class to draw up a list of comparisons
on the chalkboard.
6) If euthanasia becomes legal, many fear a new obligation to die.
If Grandma is dying slowly and using up the inheritance she would
have left for her children, she may feel subtle and not-so-subtle
pressures to assent to euthanasia. Some dying patients, based on
surveys from Oregon and Holland, already feel this pressure.
7) Jack Kevorkian has stated that he is performing assisted suicide
to help patients out of their suffering. However, many of his patients
were 1) clinically depressed, 2) not facing imminent death, or 3)
inappropriately medicated for pain.
PRAYER REQUESTS: As you close today's
lesson together, pray that God will help you as you process some
of these questions this week, and as you face these questions in
the future that he will give you wisdom in decision-making. Pray
that he will help you refrain from wrongful acts of commission and
omission.
For Further Reading:
Much of the material for this chapter is borrowed from: Gary P.
Stewart, William R. Cutrer, Timothy Demy, Donal P. O'Mathuna, Paige
C. Cunningham, John F. Kilner, Linda K. Bevington, Basic Questions
on Suicide and Euthanasia-Are They Ever Right? (Grand Rapids, Michigan:
Kregel Publications, 1998). Another Bio Basics Series booklet, this
offers wisdom in a concise format.
Assisted Suicide and Euthanasia-A Christian Perspective (Resource
Notebook), Harold O. J. Brown, Nigel M. de S. Cameron, John S. Feinberg,
Paul D. Feinberg, and John F. Kilner, eds., (Bannockburn, Illinois:
The Center for Bioethics and Human Dignity, 1998). A helpful, concise
overview of these two related topics reviewed by a Blue Ribbon panel
of Christian ethicists, this handy reference highlights a sermon
by C. Ben Mitchell, M. Div. (now Ph.D.), entitled "Physician-Assisted
Suicide and the Great Physician."
Robert Orr, M.D., David Biebel, D. Min. and David Schiedermayer,
M.D., More Life and Death Decisions (Grand Rapids, Michigan: Baker
Books, 1990). Chapter four is devoted to euthanasia and assisted
suicide, complete with discussion questions and references.
John McDowell and Norm Geisler, Love is Always Right (Dallas, Texas:
Word Publishing, 1996). An apologetic for the place of moral absolutes
in Christian problem solving, this readable book offers a solid
foundation for the place of reason and scripture in this process.
Chapter fourteen looks at euthanasia, suicide and capital punishment.
Nigel M. de S. Cameron, The New Medicine-The Revolution in Technology
& Ethics (London, England: Hodder and Stoughton, 1991). Dr.
Cameron examines the Hippocratic Oath, its modifications, and the
evolution of medicine over time with respect to the oath. Chapter
three presents a stunning, sobering picture of the creep of euthanasia
into the Nazi regime, its necessary early rationalizations, and
eventual wholesale acceptance by the German people.
John S. Feinberg and Paul D. Feinberg, Ethics for a Brave New World,
(Wheaton, Illinois: Crossway Books, 1993). Chapter four offers a
very readable, thorough, but concise look at the major elements
and definitions in the euthanasia debate.
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