Article

Is physician-assisted suicide ethical?

Apr 17, 2019

When I was a child, one of my relatives developed a debilitating disease that attacked the nervous system. He gradually lost his abilities to speak and to dress himself, and fits of choking seized him at every attempted meal. As a fiercely brilliant man who prized his self sufficiency, over time his loss of independence fractured his spirit. One morning he took his own life. In a letter on the kitchen table, in a shaky scrawl that remained emblazoned upon my mind years later as I donned my white coat, he wrote the words, “Support Kevorkian.”[1]

Over the ensuing years, as I witnessed suffering well up from every corner of the hospital, I would remember that letter and wrestle with the idea of physician-assisted suicide (PAS). In PAS, now widely called “medical aid in dying,” physicians prescribe a lethal dose of medications for a terminally ill patient to self-administer. Proponents of PAS argue that compassion mandates we honor requests for a peaceful death. Compassion for Choices, the oldest nonprofit organization in America that advocates for PAS, explains, “Our vision is a society where people receive state-of-the-art care and a full range of choices for dying in comfort, dignity, and control.”[2] The practice is legal in seven states, offering one in 5.5 people in the U.S. the option to end their own lives with the approval of a doctor.[3]

While few could argue against “choices for dying in comfort, dignity and control,” PAS warrants debate. The American Medical Association condemns PAS in its code of medical ethics, stating, “Physician-assisted suicide is fundamentally incompatible with the physician’s role as a healer, would be difficult or impossible to control, and would pose serious societal risks.”[4] Skeptics warn that the imbalance of power between physician and patient risks coercion of the dying.[5]

Even in the public sector, PAS generates uneasiness. In a 2012 Gallup survey, 64 percent of respondents agreed that doctors should painlessly end a terminally ill patient’s life upon request.[6] However, when the phrasing of the question was changed to include the term suicide, support dropped by 10 to 15 percent.[7] This jarring change of opinion with substitution of a single word captures the ethical dubiousness fundamental to its debate.

Compassionate, but unbiblical

Anguish afflicts those with terminal illness, and we must minister to our dying neighbors in tenderness (Matt. 22:39; John 13:34–35). But Scripture points us to the sanctity of mortal life, and to our imperative as God’s image bearers to protect life and commit our days to his glory (Gen. 1:26; Exod. 20:13; 1 Cor. 10:31; Rom. 14:8; Acts 17:25). Compassionate intent doesn’t change the fact that in cases of physician-assisted death, demise is artificially—and intentionally—hastened. This is true even while terminal illness broils in the background, and even when death’s purpose is to alleviate suffering.

Advocates for PAS uphold individual autonomy as the greatest good. The human right to self-determination, they reason, includes control over how we die. In the Bible, however, true freedom comes not from individualism, but from using all we have and are to glorify God. In his first letter to the Corinthians, Paul reminds us that while we remain free in Christ, the cross must temper our conduct (1 Cor. 6:19–20). Furthermore, from Colossians 3:17: “Whatever you do, in word or deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.” While God endows all of us with free will, our identity in Christ compels us to exercise our autonomy in faith, as an instrument of service. Our God-given ability to make individual choices doesn’t justify the active taking of life through PAS.  

Options in suffering

The emergence of PAS in courtrooms and clinics signals our failure as a society to support the dying, particularly as illness disables us. The most common reason that people cite for pursuing PAS is not intractable pain, but rather loss of independence. A review of data in Oregon from 1998–2016 revealed that 79 to 92 percent of people who committed suicide with physician assistance cited loss of autonomy, inability to engage in activities that make life enjoyable, and loss of dignity as their motivations for ending life.[8] The intractable pain we might assume at the end of life was a factor in only 25 percent of cases.[9] These alarming statistics suggest not a solution in PAS but rather a gross failure on the part of our society to uplift people with progressive and debilitating illness.

As believers, we need to offer our dying neighbors better than the end so many face, a dwindling existence bereft of joy, confined to a medicalized institution. We’re called to care for those afflicted with severe illness (Matt. 25:36–40). We need to advocate for hospice and palliative care, and most importantly, to freely offer Christian love. In Christ we cleave to the assurance of a new heavens and a new earth, when disease no longer cripples our bodies. As we face death, reminders of this truth can offer light and air when the grief descends. Through such support, we grasp his grace. Through such compassion, we may escape the lie that suicide is the best option.

Notes

  1. ^ Dr. Jack Kevorkian was an American pathologist who staunchly advocated for euthanasia in the 1980s and 1990s. He personally assisted in the deaths of over one hundred people, and in 1999 was convicted of second-degree murder for administering a lethal injection to a patient with amytrophic lateral sclerosis.
  2. ^ Compassion and Choices, “About Compassion and Choices” (2016), accessed January 8, 2018,  https://www.compassionandchoices.org/wp-content/uploads/2016/02/About-Compassion-and-Choices-Brochure-FINAL-4.05.16-Approved-for-Public-Distribution.pdf.
  3. ^ United States Census Bureau, Population Division, “Annual Estimates of the Resident Population for the United States: Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2016,” United States Census Bureau (December 2016), Accessed January 8, 2018, https://www2.census.gov/programs-surveys/popest/tables/2010-2016/state/totals/nst-est2016-01.xlsx.
  4. ^ American Medical Association, “Chapter 5: Opinions on Caring for Patients at the End of Life,” American Medical Association Principles of Ethics (2016), accessed January 8, 2018, https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-5.pdf.
  5. ^ Ewan C. Goligher, E. Wesley Ely, et al., “Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues,” Critical Care Medicine 46, no. 2 (2017): 149–55.
  6. ^ Emaniel et al., “Euthanasia and Physician-Assisted Suicide,” 81.
  7. ^ Ibid.
  8. ^ Charles Blanke, Michael LeBlanc, and Dawn Hershman, “Characterizing Eighteen Years of the Death with Dignity Act in Oregon,” Journal of the American Medical Association Oncology 3, no. 10 (2017): 1403–6.
  9. ^ Ibid.

Kathryn Butler

Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma surgeon who is board certified in surgical critical care and served on the faculty at Massachusetts General Hospital and Harvard Medical School. After a decade of experience in... Read More