Recently the story of Brittany Maynard, a woman with terminal cancer, has been in the news a great deal. She moved to Oregon in order to take advantage of the Death with Dignity law that allows for physician-assisted suicide. On November 1 she chose to use the medication and ended her life. I wanted to discuss the topic of physician-assisted suicide, though not specifically Maynard’s case. Her choices are her own and her death deserves the respect and honor we would accord to any life.
I happen to live in Oregon, and have my entire life. I was young when the Death with Dignity act was passed — it was first passed in 1994 and was reaffirmed in 1997. In order to qualify under the law, terminally ill patients must prove their residence in one of the states that allows it (Washington and Vermont also have similar laws), be over 18, be able to make and communicate their own health care decisions, and be diagnosed with a terminal illness that will lead to death within six months. Two physicians must determine these criteria. The residency requirement does not have a time specification, just proof that you live here so some people, including Maynard, move from their home states in order to gain access to the program. Statistically she was an exception, but it happens. There are a number of safeguards in place to insure that only the patient can procure the drug for self-administration, that it cannot be done rashly or quickly and the family must be notified, among others. When all conditions are met, a patient can receive a dose of fatal medicine that can be taken at the time and place of their choosing.
The church’s position on this is fairly clear. The handbook states that “Euthanasia is defined as deliberately putting to death a person who is suffering from an incurable condition or disease. A person who participates in euthanasia, including assisting someone to commit suicide, violates the commandments of God.” My own feeling with moral issues is that the church handbook is never the final word. I do not reject what it has to say, but I think there is value in wrestling with moral questions without presupposing the answer is obvious and unquestionable. If you only accept one possible answer from the outset, you aren’t really asking the question. In this discussion (which I hope commenters will weigh in on) I want to clearly distinguish this case, doctor-assisted suicide, from other topics such as suicide or involuntary euthanasia programs. I think the moral issues are distinct, and this is worth considering on its own.
I have pondered this question for the last several weeks — as an LDS person, with a testimony of the Gospel and of Christ, do I believe physician-assisted is morally right or wrong? What would I do in that situation? What would I be okay with my husband, mother or other loved one choosing? I don’t have a definitive answer, but I have some thoughts.
Thoughts against physician-assisted suicide:
-The Plan of Salvation necessitates suffering. We came to Earth to gain experience, including very hard, very unpleasant experiences. That is the fulness of humanity.
-Death is one of the great unifying experiences of humanity. As members who understand the Plan of Salvation, we do not have to fear death, we can accept it whenever it may come.
-Even in the extremity of pain, we are not alone in our suffering. Christ has walked every path we will ever walk, individually and personally.
-We have a great deal to learn from death, both from our own and that of others. When my grandmother died, my aunt remarked to my mother about how even to the very last mothers continue to teach their daughters — that dying, and having my mother care for her and witness her in that final process, taught us about death, and about how to die. This is one of the important lessons we learn in life, and God set up our existence to allow for it to happen, almost always with an element of unpredictability that is in itself an opportunity to learn and to teach.
-Taking a human life is wrong. The scriptures are quite clear on this (despite some murkiness involving Laban, and quite a bit of the Old Testament). It is not for us to choose when we leave this life.
-Doctors take an oath to do no harm. Isn’t hastening death the definition of doing harm?
-If we as a society decide that it is okay to end lives that seem too painful, or meaningless, isn’t that perilously close to euthanasia that is not chosen by the patients? This has an appalling history.
Thoughts in favor of physician-assisted suicide:
-Suffering is part of the human experience, but it is not the point of our existence. God allows us to suffer, but does not rejoice in our pain or deliberately cause it. When we are able to prevent or palliate pain, God allows it and rejoices, at least in other situations.
-Often a long process of dying is not edifying to the person who dies or to those around them. Instead it can be traumatic, financially or emotionally draining and horrifically painful. Some illnesses rob the patient slowly of their personality and brain function. How can this be a learning experience for the person, if they are not capable of learning or being themselves? Are months of horrible memories so great a gift to those who are facing bereavement?
-This is distinct from suicide in that it is not a choice based on not wanting to live. Living is not an option in any case. The patient will die soon. It isn’t ending a life that would otherwise be full of opportunities to teach and grow, it is a matter of choosing a moment to say the goodbyes you need and leave in as much peace and dignity as possible. It isn’t choosing death over life, it is choosing a good death, when death is the only choice.
-Not all pain is redemptive. For some it brings them closer to Christ but for others it can be destructive and isolating.
-What constitutes hastening death medically is actually a bit fluid and this is not as cut and dried as it might seem. Often dying patients receive doses of morphine that relieve pain but also hasten death. Similarly the church is okay with not taking extraordinary and heroic measures to prolong life. Is this substantively different?
-Capital punishment is legal, with a strong scriptural precedent. How can we say it is okay to end people’s lives involuntarily, but deny people the right to choose for themselves?
-We came to earth to use our agency. This is an opportunity to have some control over one’s final days in the face of a disease that may rob the patient of all decision making ability.
As I thought about these considerations, my own conclusion is that I would not choose physician assisted suicide for myself, or for my family members. I would gladly have doctors administer large doses of painkillers to provide as much relief as possible, even if it meant hastening the end, but I do not think I would choose the pills available in Oregon. Perhaps those two are not so different, but in my mind they are. When it comes to my loved ones, I guess I selfishly want every scrap I can have. I was glad for my grandmothers when they had release from pain, but I still wanted and treasured every little moment we had, even though their final weeks were hard physically for them and emotionally for everyone. As for myself — I don’t feel I could ask my family to stay for my sake if I wasn’t willing to do the same for them. Even if it meant they mentally went and I only got to hold a warm hand, I think I would want that time.
I know that not everyone feels that way. I am glad that Oregon has the law, not because I personally would choose it, or because I think that God sanctions it regardless of church position. I think, however, that people should be free to choose for themselves and to seek guidance from God and family in making life and death decisions. It may be that in some cases this would not be God’s will, but in others perhaps it would be. I don’t know.
What do you think? What arguments do you see in favor or against physician assisted suicide? How have your experiences informed your feelings on this issue? What do you think you would choose?
assorted maladies and suffering terribly. He’s decided to stop eating, which is considered a natural way to die. Should we force him to eat because of misguided devotion to some arcane notion about the sanctity of life? I believe the choice to end one’s life with dignity in the company of family and friends is a deeply personal decision and should be left to the individual.
It looks like part of your comment may have been cut off or erased. I am okay with Oregon having this law. There have been no recent efforts to repeal or amend it. To me it is okay for states to allow freedom of choice on this issue, in part because what I feel is right for me and my family is not necessarily a moral absolute. I can certainly see cases or experiences that would dictate the other choice, which is why I tried to think about this fairly. In some ways the fact that there is a choice gives more meaning to what you choose, regardless of what it is. The option to choose death with dignity is empowering. The choice to die without physician assistance is only really a choice if there is an alternative. As with a number of issues, I feel that I would probably choose one thing for myself but do not think my beliefs should determine the law for everyone.
I so appreciate how thoughtful you are in exploring this question. My physician sister named me her executor in nearly everything except in questions of her life and death. She did not trust me to “pull the plug” if her life ceased to be what she considered worth living. Although not exactly the situation you are exploring, it has led me to question my own feelings. And she is probably right. As much as I respect her definition of life, I would probably cling to the most basic evidence and hope for a miracle. But for me personally? Not sure. Such is the complication of the issue. Excellent post, thank you.
As a side note, I just asked my husband about this. He said he is in favor of physician assisted suicide and would want that in his case if his pain became unbearable. I was a little surprised — I guess like you Pandora I should not be trusted to be the one to make the decision, because I would hope for miracles and minutes even if it was consummately selfish to do so. Know thyself I guess. Thanks for the comment.
Freedom to choose, freedom to do what we want… wasn’t that what we fought for in heaven? Didn’t many of us fight even those we loved to bring them to the light?
Ultimately, I believe it is up to the individuals that are in each case. Safeguards should be kept as they seem to be in place in Oregon – but they shouldn’t be too restrictive in my opinion. God has given us our agency for a reason. All things we knowingly did in a right state of mind will be brought before us, and those things we unknowingly did. What exactly each person will be held accountable for is between them and God.
God can give one person an answer of yes to a question, and yet give another the answer of no to the exact same question. His ways aren’t our ways, and he has his reasoning. It doesn’t mean he’s lying to either person, he knows things that we don’t. In many cases there are multiple rights and multiple wrongs. Just like there is much more light than we can see, there are that many possibilities and answers to each question.
We tend to see through a glass darkly, I do a lot of the time, and am surprised when I realize things I have held onto for years end up being not as noble as I had once thought them to be.
I may have given a confusing answer, but it seems to make sense to me.
If a loved one were to go through excruciating pain and only had a few months left to live and God didn’t give one soul a yes or no answer to whether physician assisted suicide is the answer… it would be the decision of the one struggling with the pain.
But, I would have one remember that one of the very few God ‘powers’ that Christ used while suffering was to prevent his own death and go past the pain threshold where a normal human would pass out. Sometimes, suffering in itself seems to have no purpose when we go through it, but we are only experiencing a token, if even that, of what Christ himself experienced.
Your answer made sense to me. Some might say the idea that God would say yes to one and no to another is moral relativism, but I don’t think so. The reasons for major life decisions are complex and involve issues of the spirit and the heart that are really only knowable to the individual and God — and really in a lot of cases, only God. The fact that it is available in Oregon does not mean that huge numbers of people have chosen this path. I read today that about a third of the people who get the prescription end up choosing not to use it after all (they keep very careful tabs on every case).
I am grateful that people can choose freely here, and I wish others had that freedom in their home states so they didn’t have to choose between family and dignity. But I dread seeing this become a hot button political issue with all the attendant demagoguery when it is such a sensitive topic.
It seems like there’s some general movement in our society away from the extreme embrace of quantity over quality of life that has been so prevalent for decades. I just heard an NPR story a few weeks ago about a man who is working to revolutionize nursing homes by giving residents greater freedom of choice. For instance, residents are given access to a kitchen and they can eat what they want. That means that a diabetic might choose to eat a candy bar and put herself in danger, but it also means that a 93-year-old has the right to decide what she eats. For too long we’ve acted as if living longer, no matter what the cost, is the only concern.
My husband is a physician and the time he has spent guiding people through the end of life has convinced him that he wants little to no medical intervention if he is faced with a terminal diagnosis. I can imagine him taking that to the next step of wishing for assisted suicide under certain circumstances. Those last few weeks or months (or years!) can be so brutal and most of us don’t have to witness it close at hand. As you said, suffering in itself is not redemptive, although we sometimes act as if it is.
Sign me up. I am not interested in medical interventions to keep me alive longer than I should be, and I also have no interest in suffering protracted pain with no hope of a good outcome.
I refuse to financially bankrupt my loved ones from heroic medical treatments and I refuse to emotionally bankrupt them from watching me suffer, wither and die a tortured death.
Give me the pill and I’m out.
I am not afraid of being dead, I’m afraid of dying the way American’s consider ‘brave’, ‘fighting’, ‘faithful’ or whatever the latest lingo is on not accepting death with grace.
I love talking about this subject! Particularly how you presented it as a dialogue instead of a debate. This is a topic that is near to my heart because I’ve been a nurse for 10 years with most of the time caring for the elderly and dying. You listed several good pros and cons for Physician Assisted Death. (suicide is illegal but death is not) Of note, I practice in Washington State which does have a DwD Act. I’ve never participated in DwD because I disagree with it.
Two stories that may add to this dialogue.
One of my colleagues was visiting a retired man who knew he was going to die soon. He was not on hospice at that point as he was still doing well. One day my colleague arrived at the house at the same time the wife came home from the grocery store. When they walked into the house they found the man had shot himself in the head. This was a traumatic experience for my colleague but more so for the wife and family. Plus they had to clean up the living room after his body was removed. While I disagree with the DwD Act it does provide a cleaner way of dying. I’ve had patients that announced to me that they will be dying on a certain date. It feels weird and not normal or natural for this to happen. I’ve never had the opportunity to talk to family after the death to see if they feel cheated by the persons early death.
The other experience is in caring for the dying who are allowing nature to take it’s course. I find caring for them to be rewarding and empowering. At times I have felt it was a honor for me to give someone what will probably be their last bath, last meal, and talk with them before they loose consciousness. The veil can be thin at times and the Spirit is sometimes stronger than when I’m in the temple. Close to death patients have shared the sum of their wisdom to me and this has helped guide my life. I also find joy in seeing them make emotional closure with their life as they realize it is time to go. I guess the point I’m trying to make is that when we die it is process. By picking a date someone can loose out on the spiritual and emotional preparation for death.
By the way – I do not want aggressive treatment when I’m old. Just give me nice morphine drip to be comfortable.
LivinginZion summed up my feelings perfectly. I do believe in senseless suffering, and I think that giving terminally ill patients this choice is an act of love and mercy. Call me faithless but I never would have taken Isaac up the mountain to murder him. If Gods laws defy logic and compassion and mercy and respect, I just can’t get on board.
I appreciate you weighing in on this issue with your medical background. It does seem strange to choose a death date, yet if a person is going to choose suicide I would far rather it be peaceful and humane. My great aunt took her own life in similar circumstances — she couldn’t face the pain of her final illness and took a more violent path to end it. Traumatic as it would be to watch your loved one take a pill and drift away, it can be the best option.
I think it is hard in some ways to talk about what the experience of dying is supposed to teach us because none of us have been there. It seems to me like often in those times of flitting in and out of consciousness you might learn things about the Spirit, or the Spirit world that you maybe wouldn’t learn another way.
I grew up in Oregon as well, and remember many a discussion about this topic in (young) classroom settings. I remember one of the things that often came up was that most people agree that it is compassionate to end the suffering of a beloved pet by putting her or him down, while not as many persons agree that it is compassionate to end the suffering of a beloved person.
A thought I had just now after reading Deborah’s comment about her patients knowing the date that they would die, and it feeling a bit unnatural is about how in the church we talk about how birth and death are part of the same plan, and how those two book ends of life are up to God, so there are choices that we should and should not make (generally surrounding sex and/or murder).
We call birth “natural” when the expecting parents allow the baby to come without interference. I chose it for my own birth in part because I trust that the majority of babies know when they are ready, and can indicate such by coming. We call birth unnatural when the expecting parents interject in some way, through such means as induction or scheduled c-sections. It is legal, and we don’t call it a sin or say that they interfered with something that is only in God’s domain.
There are instances when the “unnatural” methods of induction or a scheduled c-section are the safest options for mom or baby. This makes me think that there may be instances when the “unnatural” methods of doctor assisted death are the safest options for the person dying. Maybe persons dying know when they are ready to go.
I still have a lot of things to mull over, including the sanctity of suffering. Part of me wants suffering to be sacred, even though another part of me feels that there is suffering that is real suffering that is senseless, that should try to be reduced, not merely lived through. I also think God doesn’t try to add to our suffering, that it is just something that happens here.
Thank you, Em, for your thought provoking post.
I like your thoughts Rachel. But what I think is interesting is that in fact we DON’T call C-sections or inductions unnatural. We imply it, by only using the term natural to refer to births that are completely unmedicated. But actually usually “natural” in that context also implies no pain relief either, except hot baths or massage. When it comes to birth, our definition of natural is that it be (fairly) unexpected and extremely painful. Yet as you say, there isn’t any moral stigma to choosing one of the “unnatural” paths, except perhaps in unfortunate games of mothering one-upmanship.
One of the differences I guess in that comparison is the amount of time we’re talking about, which I think also enters into the physician-assisted death discussion. While a C-section or an induction might vary from the baby’s timetable by a few days, it rarely goes beyond that. It seems like one of the biggest objections to choosing time of death is the feeling that there might have been weeks, or months more that could have been lived, and that is the real problem. When in fact the issue is only a matter of days or hours, there is no moral stigma (or legal objection) to giving the patient pain medication in doses that probably hasten death even as they relieve pain. So is the problem choosing death, or is the problem that we’ll never know how much life might have been left?
One of the more compelling arguments I’ve seen against physician assisted suicide is the impact the US insurance system has on it. There are stories of people being denied coverage for life saving treatments but given an addendum stating that treatments for physician assisted suicide are covered fairly cheaply. Unless we’re on a system where medical assistance is free for everyone, this seems like an opportunity for pressuring people to end their lives simply because it would be less expensive. Makes it feel like we’ll shortly be seeing commercials extolling euthanasia drugs, with all the other drug commercials we get. Life slips quietly into being a commodity.