On September 11, 2015, the California State Legislature approved a bill called the End of Life Option Act, which would allow doctors to prescribe medicine to help terminally ill patients end their lives. Currently four states—Oregon, Washington, Montana, and Vermont—allow some form of physician-assisted suicide, or “aid-in-dying,” as supporters call it. As the New York Times reports, advocates hope that the addition of California will represent a significant turning point for the movement.1 That deadly possibility makes this an ominous Act.
Liberty and the Right to Die
While SCOTUS has denied a constitutional right-to-die,2 the Court has left open the possibility that states could permit physician-assisted suicide, and states that have made such provisions have accepted right-to-die arguments. Proponents appeal to the highest of American values, individual liberty and autonomy, which are presented as essential to human dignity. Suffering, extreme pain, and disease that rob patients of their autonomy represent an attack on human dignity, and compassion demands that we help to end the suffering of those who wish to die. Physician-assisted suicide laws testify to the desperation experienced by those facing suffering and death, who see no better option than to choose death before death chooses them. At least then they are in control, and the choice represents to them “death-with-dignity.” But is it?
The Death of Dignity
It is certainly a terrible thing to suffer, and to have a disease take away our independence, little by little. Having learned to prize autonomy, to be in control of our lives, it is a devastating thing to lose. It seems undignified to become once again like a child, dependent on others. This explains why polls tell us that almost 7 in 10 Americans agree that doctors should be permitted to help a patient commit suicide if the patient requests it. Such numbers suggest that there will be more victories for “death-with-dignity.”
This is tragic, for the victory of death is the defeat of dignity for those who are suffering and facing the end of life. The argument for autonomy is grounded in the fiction that we must be, or can be, or are in control of every aspect of our lives. Indeed, suffering and the approach of death are vivid reminders that we do not possess such control. Christians understand that as human beings we are not our own. Life is a precious gift from God, and while God has given us great freedom, the truth is that we are finite and frail beings from conception until death, dependent on one another and dependent on God for life and breath. Human dignity and meaning is grounded not in our autonomy, but in our relations with God and one another. To assert absolute autonomy is not dignity or liberty but bondage to deception.
The Death of Compassion
One of the most influential organizations backing “aid-in-dying” is Compassion and Choices, which suggests that death-with-dignity links compassion with the freedom to choose death. However, we should be suspicious of a dignity and a compassion that wills death. Like other virtues, compassion can be distorted into a vice. Killing or assisting in death is not compassion. However well intentioned, it is abandonment: those who are suffering need comfort and care, not confirmation that their only or best options are despair and death. This denies rather than affirms their dignity, reinforcing their fear that they are a burden.
Compassion is the virtue that moves us to suffer alongside those who are hurting, and to seek to lighten their burden. Jesus had compassion for and ministered to those who were weak, sick, hungry, and helpless (e.g., Mt 9:36, 14:14, 15:32; Lk 7:13). We ought to have compassion for those who are suffering and in great pain. We ought to care for them and comfort them as much as possible. But we ought not to kill them, or affirm or defend their killing. Compassion that is rightly ordered to human dignity will not promote or tolerate such a view, but will instead seek to comfort and care for those who are suffering because they matter to us, and they have immeasurable value as human beings made in the very image of God. Their value is not lost because they are increasingly dependent on us, and are no longer “useful” to us. By contrast, Dr. John Wyatt cites a slogan of the hospice movement, “not only will we help you to die in dignity, but we will help you to live before you die.”3
It is sometimes said that if we have compassion on animals, which we mercifully “put to sleep” when they are suffering, why would we not have the same compassion for human beings? In response, it may simply be noted that human beings are different from animals, and we treat them differently in countless ways. It may also be said that we do not wait for animals to request aid-in-dying; rather, we make the judgment on their behalf. Should we take seriously, then, the suggestion that humans be treated like animals?
The Death of a Profession?
One of the ominous aspects of the passing of California’s End of Life Option Act is the implicit endorsement given to it by the California Medical Association. The CMA has long been a vocal opponent of physician-assisted suicide, which has kept many lawmakers from supporting such a bill. A significant reason that the law was able to pass is that in May, 2015, the CMA dropped its opposition, adopting a neutral position, and calling the matter a personal decision for doctors and patients to make.4 As R. Albert Mohler points out, the CMA’s policy change is an act of cowardice in the face of pressure, for it is not merely taking a neutral stance, but it amounts to support for physician-assisted suicide, since the CMA knew that their change would contribute to the bill’s passing. Indeed, their opposition was dropped in order that the bill could pass.5
This is an astonishing abdication of professional and moral responsibility, and of one of the most basic moral commitments held by physicians for over two millennia.6 Physician-assisted suicide is not merely a matter of personal liberty, for it requires the assistance of a physician—who by profession is committed to healing and caring, and sworn not to kill or assist in the death of a patient. This, as Archbishop of Canterbury Justin Welby argues, crosses “a fundamental legal and ethical Rubicon.”7
It is interesting to note that while the California legislature passed the assisted suicide bill, the British parliament soundly rejected a similar measure, which was modeled on laws in Oregon and other states that have legalized assisted suicide. The reasons for the British rejection of such a measure include the protection of people who are vulnerable, and a belief that it is better to focus on palliative care and comfort.8
A Dangerous Path
One of the concerns about legalizing physician-assisted suicide is the unintended consequences, a slippery slope that endangers the most vulnerable and leads to a duty-to-die for those who have become a burden to society. Many defenders of a right-to-die dismiss the slippery-slope argument as fear-mongering. But, in talking about many of the dubious consequences that may accompany the “right-to-die,” Archbishop of Canterbury Justin Welby rightly asserts that “some slopes are indeed slippery.”9
The slope in the case of “right to die” is indeed slippery, as it has been observed in several European countries.10 Once it is acknowledged that there is a right to die, and that doctors can and should assist patient-dying, there is subtle coercion for those who are suffering to choose death rather than to burden their loved ones. Safeguards to ensure against such coercion are undermined by the clear message that at some point the choice of death is the best option, the means of preserving dignity.
Once in place, the “choice” of death may also be a way of containing health care costs. As preposterous as this sounds, in the New York Times article cited earlier, this concern is raised by Dr. Aaron Kheriaty, who points to the case of Barbara Wagner in Oregon, “a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for ‘physician aid in dying.'”
Care, Compassion, and Dying Well
Is it possible that the idea that a chosen death is a good death—a “death with dignity”—is fueled in part by not knowing—or forgetting—what it is to die well, and to care well for those who are suffering? Is it possible that the fear of suffering and death is driven by a fear of other things, such as the loss of autonomy, the loss of dignity, and isolation? That such fears may be especially acute with diseases such as Parkinson’s and Alzheimer’s, with their “death before death,” is no surprise, for the losses are magnified. Further, those fears are also reflected in “the social deaths created by the sequestration of the elderly” in institutions that many people would like to avoid.11 We need to relearn how to express true compassion and to care well for those who suffer and fear suffering. We need to relearn how to die well, and with true dignity, and to resist the enemy who delights in death. Otherwise we ought not to be surprised to find that more people will seek to take control of their dying and to make an early exit their final act of self-expression.
We need not do everything possible to keep someone alive, but “letting die” is not the same as choosing death. There comes a time when we recognize that treatment is futile and death has won a temporary victory. Death is thereby acknowledged but not chosen. Yet, we must train medical practitioners who are fully committed to healing and caregiving, who refuse to become killers. Otherwise doctors will merely be purveyors of medicine and equipment that is used at times for life and at times for death, not according to whether they advance life, but whether the life in question is worth advancing.