Assisted Suicide and the Ailments of Culture

Assisted suicide, or what is called “medical assistance in dying (MAID)” in Canada, is no new topic in our cultural. During my childhood, the name “Jack Kevorkian” became a byword and a punchline due to his advocacy for medical professionals helping their patients die instead of helping them live.

To those immersed in the flood of modernity with its emphasis on the radical autonomy of the individual, it is only logical that someone should be permitted or even encouraged to end their life in a clinical, sanitary manner. Why create a mess or a scene of horror for a loved one to find when you can end your existence with a slow wave of drowsiness wafting over you from the silent dripping of a potent fluid in a shapeless plastic bag?

Such an end is no more than what US Supreme Court Justice Kennedy argued for in the infamous Planned Parenthood v. Casey decision in 1992:

“At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life.”

That philosophy was, until the recent Supreme Court decision, sufficient to permit the killing of a child in the womb. It is a reflection of an entire cultural ethos that echoes that famous hymn of hell: “I Did it My Way.”

A recent ad from Canadian retailer La Maison Simons, or Simons, presents assisted suicide as a heroic, beautiful, and self-fulfilling way to die. Were the subject not so macabre, it would be a lovely video to watch.

(Note that the ad, originally published on October 24, 2022, has been pulled by the retailer due to negative reaction.)

For the Christian, of course, life is sacred. Whether in the womb or in the last moments of natural life, there is goodness and beauty in life. David taught us this is Psalm 139:16 while speaking to God:

“Your eyes saw my unformed substance;
in your book were written, every one of them,
the days that were formed for me,
when as yet there was none of them.”

 So, for the believer in Christ, of course intentionally ending one’s life is sin. For those of us who recognize that God’s laws are universal, there is no question, then, that assisted suicide is a sign of a corrupt society.  

But how dare we argue against the non-Christian’s right to day at the hour of his choosing? Is this not an example of “forcing our religion” on others? Or, what if this is really a big problem that will create social injustices and it is simply because of our knowledge of the goodness of God that we are able to see its horror and where it will inevitably lead? 

It is not too hard to see right now that the assisted suicide train is running away on the tracks. In Canada, since 2016, there have been over 31,664 reported deaths through MAIDs with 10,000 of them in 2021. This amounts to approximately 3% of all deaths. 

The current debate in Canada is whether mental illnesses, like depression, should be considered a justifiable reason to request the state to terminate the requestor.  

In the discussion offered in the report to the Canadian Parliament, the authors seem to recognize how dangerous making this option available to  those suffering from mentally ill. However, they also seem to shrug, noting that the original language of the statute allows assisted suicide for “that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.”  

This is “the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life.” It is the right to die. If you don’t like the conditions under which your pain can be alleviated, then you have the right for the state to kill you. 

It does not take much to see how this right to die can quickly become the easy way out. How it can become a convenient way to avoid the hassles of a system built to make more expensive treatments hard to get. It can be an option so that “inconvenient” people who rely on care and accommodation from others can be “conveniently” encouraged to ease the burdens of others. It takes little imagination how the “beauty,” as the Simons ad calls it, could be a way to end a period of sorrow or struggle that might have made the person or their neighbor a little better as a person. That convenience may remove a whole lot of beauty from the world. 

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend's were.
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.
-          John Donne

Between Life and Death - A Review

Every birthday I have to remind myself there are only two options: Getting old or dying. Each year my mortality becomes a little more real as the physical symptoms of age and decay overtake me and as more people that I know experience medical treatments for major trauma or age-related organ failure.

Other than the drama of television and movies, my first glimpse into the world of the ICU came as a young naval officer, when one of my sailors died due to complications from a surgery. He was in one of the top hospitals in the nation and they couldn’t prevent the problem. That forced me to realize there are limits to the ability of medical professions and available technology to preserve or repair life.

Seeing that formerly jovial, proud sailor wired and tubed in the hospital bed was jarring. I was certainly not prepared to see a 34-year-old (which seemed old at the time) inert and unconscious. Thankfully, I was not part of the decision about future medical intervention, because I was entirely unprepared.

I was, however, in the room when the ventilator was removed at the doctor’s recommendation and at the families’ request, which was supported by the documents he had left behind. He was functionally brain dead, so the only thing keeping him alive were the machines forcing his body to keep working. Once the ventilator was removed, the end came peacefully and swiftly. It seemed merciful, but at the same time left me with questions about whether removing organ supporting medical interventions was, indeed, moral.

Such end of life decisions are difficult for several reasons. First, we do not always understand what the function of specific medical interventions are. Which ones offer remedial help and which ones simply sustain animal functions so the body’s other processes can continue? Second, non-medical personnel have little frame of reference for whether a particular condition is likely to be recoverable. What are the odds that any intervention, no matter how expensive and traumatic, are going to be successful? Third, we often have little idea how damaging the attempt to fix one problem will be and what the likelihood of complications will be. Will a heroic attempt to fix one problem likely doom the patient to major problems later? Fourth, too often we have failed to consider end of life care, even for those who are reasonably approaching the end of life. It is understandable for a family to have no guidance for end of life medical care for a teen or someone in their twenties or thirties. However, by the eighth or ninth decade of life, there is little reason for the individual and their family not to have already discussed options and made some decisions.

Summary

Kathryn Butler’s book, Between Life and Death: A Gospel-Centered Guide to End-Of-Life Medical Care, is an extremely helpful volume in learning about various critical medical treatments, which can help make the cost/benefit analysis for choosing to continue with interventions. She also carefully sorts through the biblical data to consider whether an ethic of life, which is demanded by Scripture, entails pursuing every medical treatment possible no matter the cost, the low likelihood of success, or the trauma to the patient. Butler, a trauma and critical-care surgeon, has worked at several significant medical facilities and brings her experience and expertise to bear in a compassionate manner in this book.

The book begins by considering the place of death in the human experience. It is unnatural, in that it is a result of the fall, but it is a normal expectation for humans that walk the earth. She also roots her ethic in the authority of Scripture, which reassures the reader that she is beginning from Scripture and interpreting medical technology through that lens, rather than the reverse.

In the second section of the book, Butler offers chapters on resuscitation for cardiac arrest, and intensive care treatments such as mechanical ventilation, cardiovascular support, artificially administered nutrition, dialysis, and brain injury support. The key message here is that whether one of these treatments is warranted is really based on whether it is likely to be a temporary support while the body recuperates or whether it is merely prolonging the inevitable. The medically accurate data in these chapters helps inform the conversations that Butler outlines in the third section of the book.

In part three of the volume, Butler provides an outline of what is constituted by palliative care and hospice, how that is different from physician-assisted suicide, the importance of advance care planning, and the role of individuals designated to make proxy decisions. After the conclusion, Butler offers several appendices that include summaries of organ supporting measures, a sample advance directive, and some Scripture passages that offer comfort for those making these decisions.

Analysis

Between Life and Death is an important book. It was written at an accessible level both theologically and medically. It helpful translates some difficult medical terminology and sometimes confusing ethical language that can make an otherwise painful decision unbearable.

Butler does very well dealing with the difference between killing and letting die. There is a pervasive myth among many American Christians that unless we are doing absolutely everything to sustain life for as long as possible, we are “giving up on” or “killing” the patient. Butler shows that many of these support measures are bringing their own additional trauma, prolonging the inevitable for a short time, and actually increasing suffering. Ceasing supposedly heroic medical interventions is not killing an individual, it is merely allowing the process of dying to take its course. Butler’s book helps readers develop the wisdom to understand the counsel of physicians and make compassionate, Christ-honoring choices.

If this book is revised in the future, it would benefit from a deeper discussion on the nature of and purpose of suffering. The topic is explored somewhat, but Butler’s expertise is really on the technical side of the discussion, so the development of a theology of suffering (which is very important in making these decisions) is a bit thin.

Conclusion

Between Life and Death is the single best book on this topic that I have encountered. It is pastoral, technically accurate, and scripturally framed.

This is a book that belongs in the library of every pastor. Not only that, but it should be read, underlined, and outlined by elders and deacons as they prepare for making hospital visits, offering counsel, and seeking to comfort the sorrowful. This is the sort of book that a senior’s group at the local church would greatly benefit from discussing as they prepare for inevitable decisions. The time to read Butler’s book is not when the beeps and whistles of the ICU are surrounding a patient, but rather months or even years before any such condition is highly likely.

Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care

By Kathryn Butler

Buy on Amazon

NOTE: I received a gratis copy of this volume from the publisher with no expectation of a positive review.