Medical Ethics and Euthanasia

[SERay]

Johanna and I discussed the case of Brittany Maynard, the 29-year-old with advanced Stage 4 glioblastoma, who moved to Oregon so that she can legally gain the drug pentobarbital (also known as Nembutal) that will end her life under the "Death with Dignity" program. This law allows mentally competent, terminally-ill adult state residents to voluntarily request and receive a prescription medication to hasten their death. This is one of many end-of-life care options available in Oregon, Washington, Montana, Vermont, and New Mexico. The requisitum is terminally ill patients must be registered state residents who have less than six months to live.

Her dilemma is genuinely grave. She considered passing away under hospice care, but even with palliative medication, she could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind. The prescribed full brain radiation side effects include first-degree burns on the scalp, along with all the other typical complications arising from treatment.

Being a full time pastor in the 80's-90's, I visited many in hospitals dying from horrific, painful terminal illnesses. To the point of walking out of rooms speechless and shocked at how incredible suffering can really be. I can immediately relate to this woman who does not wish to spend possibly months in incontinent, pain-racked, totally dependent existence exacerbated by watching the suffering of her family as they care for her. She has stated that she was “immensely grateful” that she could end her life in a dignified and compassionate manner. Many assert that the Church and State must remain separate. They ask, "What right has anyone because of their own religious faith to demand that a terminal person make choices according to their rules until an omniscient doctor decides that they must have had enough and increases my morphine until I die?"

Just how did society arrive at the present impasse where we heatedly debate “right-to-die” legislation? In the past most people died relatively quickly as a result of accident or illness. Nowadays, the rapid increase in medical knowledge, technology, and intervention often allows the terminally ill to linger, sometimes extensively. Despite the advances in palliative care the death process is too often protracted, painful and undignified. Therefore it is hardly surprising that in both the United States and Australia public opinion polls have consistently supported physician-assisted death.

So I was thinking through the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. In the United States autonomy or the principle of individual decision making is highly valued. The “liberty interest”, an individual's right of choice, is guaranteed in the Fourteenth Amendment to the United States Constitution. Thus the issue of physician-assisted death is as much about control as about dying.

What about the moral theology of physician-assisted death, or the direction one might follow by noting supportive Biblical perspectives? One example is that of religious freedom. This doctrine is well illustrated in the story of the fall of Adam and Eve. The value of their freedom to choose was deemed greater than the catastrophic loss for all humankind that followed their choice. A second example, the traditional concept of life after death would seem to question the value of eking out every moment of life when the whole of existence goes far beyond temporal death. The Bible portrays a God who values quality of life (both personal and communal), as seen in the story of the patriarch, Moses. In the Biblical portrayal of the conclusion of Moses's life, his health, long life and great contribution to the Hebrew people are more eulogized than his death lamented.

I have a hard time labeling Brittany's choice suicide, where it is better defined as voluntary euthanasia, which comes from two Greek words which literally mean a ‘good death’ or to ‘die well’. Suicide to escape the trials of life in general is without argument unfaithful stewardship of life and health. The bible speaks of several instances of suicide through characters such as Abimelech, King Saul, Ahithophel, Zimri, and Judas Iscariot. In each case, it was a coward's escape, which was not dignified or morally sound. There is no direct reference or instruction about suicide in the Scriptures to quote. The closest I can recall is Ecclesiastes 8:8 which declares, “No man has power over the wind to contain it; so no one has power over the day of his death.”

In the book of Job, when Job is under great distress and in great pain, his wife says to him “'Do you still hold fast your integrity? Curse God and die!' But he said to her, 'You speak as one of the foolish women speaks. Shall we indeed accept good from God and not accept adversity?' In all this Job did not sin with his lips.” (Job 2:9-10). Basically, Job's wife wanted him to euthanize himself to avoid the pain of his life, but Job refused to do so, and in this he did not sin. However, there is nothing in the Bible that tells us we must do everything we can to keep someone alive for as long as possible. Less unspecific biblical direction, opponents stress that there is no provision for killing on grounds of diminished responsibility (on the basis age or illness) and there is no provision for compassionate killing, even at the person's request. Similarly there is no recognition of a 'right to die' as all human life belongs to God.

I agree that only the government has been given authority by God to take a person’s life and that is only in the case of Capital Punishment. Physicians are nowhere in Scripture given authority by God to take someone’s life. Apart from the government in the case of capital punishment, all other human beings are given the commandment “Thou shalt not kill,” Exodus 20:13 and “Thou shalt do no murder,” Matthew 19:18. Under the Old Covenant God authorized or permitted killing in three situations: in the context of holy war, for capital offences and in self-defense (Exodus 22:2). God only authorized the killing of the guilty. 'Innocent blood' could not be shed intentionally under any circumstances and the shedding of innocent blood is in fact uniformly condemned throughout Scripture.

Anglican Archbishops and Bishops from all over the world met in London in 2005, where they outlined what they called ‘five bedrock principles’ which should undergird all discussion of euthanasia. They are these:
1) Life is God-given and therefore has intrinsic sanctity, significance and worth.
2) Human beings are in relationship with the created order – a relationship characterized by such words as respect, enjoyment and responsibility.
3) Human beings, whilst flawed by sin, nevertheless have the capacity to make free and responsible moral choices.
4) Human meaning and purpose are found in our relationship with God, in the exercise of freedom, critical self-knowledge and in our relationships with one another and the wider community.
5) This life is not the sum total of human existence; we find our ultimate fulfillment in eternity with God, through Christ.

An argument Chuck Colson used to condone suffering under terminal illness is Proverbs 31:6, “Give strong drink unto him that is ready to perish, and wine unto those that be of heavy hearts.” He said, today we have many drugs and painkillers that help relieve some pain as strong drink did in Solomon’s day. People with religious beliefs share with others that human life is special and every effort should be made by individuals, communities and nations to preserve it and to improve its quality, I agree. However in the case of someone terminally ill, facing a certain and excruciating death, I have a hard time theologically or ethically judging Brittany, against the backdrop of God’s mercy. I cannot be emphatic on this subject, drawing a line in the sand… seeking other opinions.

[Dana Sue]

I've been torn between the 2 sides of this issue, so I'm not sure exactly how I feel about it.

I have seen first hand much suffering from illness, and I've seen people who are just not doing life very well. There is a huge difference. Are there limits to how much pain a person can or should tolerate? Where can the line be drawn and most importantly, by whom?

I've been hearing about death panels, wouldn't this fall right along with Euthanasia?

[Kelly Lee]

With the exposure to the medical field and patients from my journey, I would hope to pattern after Job.

God is Creator. We can't add one cubic to life The Word says, so why would one think they would be right to end their life? So many medicate to try to avoid pain and suffering, The pain killers bring destructive symptoms on the body too. Nothing is ever a surprise to our Creator! Whatever circumstances He has us face---- He is the way maker, The Author & Finisher of our faith.

Jesus bore & defeated ALL illness and infirmity. I see a individual reasoning that God doesn't know everything, when Jesus felt all.

[Katherine]

On the other hand, in our society it seems that it is deemed "immoral" not to do everything in our power to heal a sick person. Some of our medical practices seem very close to sorcery though. Especially when you get into the pharmaceuticals.

It is my desire to die at home without pharmaceuticals because honestly they seem like witchcraft to me in many ways. As Christians I think we have bought into this myth that all of modern medicine is God given because it saves lives but I find so many practices to be very questionable and just because a life has been prolonged does not mean that the methods used to prolong it were Godly. Have you noticed how heavily persecuted you are when you resist even a little to the medical system in place? And we know who is behind the persecution. Satan wants us to worship modern medicine and to put our hope and trust in it. I find it very hard to obey God and have very much to do with the practice of medicine of any kind. Certainly we need broken bones reset and babies delivered and sometimes surgery but how far can we take it? Are organ transplants really okay? I personally am not a donor because I don't know the answer to that question. Are drugs treating mental illness okay for believers or are these spiritual matters requiring healing from the Lord? And even pain medication, opiates are so damaging that they even alter your DNA and even that of the next generation. spiritual curse?

I wonder if we would die easier if we were not to put our hope in modern medicine but in the Lord. What if we had faith that Jesus heals and is in control of our life and death and our first call when in trouble is not to our doctors but to our elders. Scripture says that if any of us are sick we should ask for our elders to pray over us. It doesnt say anything about seeking out a doctor. Is is a touchy subject I know. I personally lost my grandfather to an infection that should have killed him quickly but instead his life prolonged painfully and he wanted to die. It would have been better for him to have died right away, but his family wanted him alive and would have been considered evil had they let him die on his own. Perhaps this is just another area to trust in Lord because until we are personally faced with these decisions how can we know for sure what our true convictions and even fears are. May we have compassion on those who we do not agree with and pray fervently that our hope and faith be upon Him who is truly worthy of all honor and glory, so that when the time comes we may be unashamed.

Blessings and wisdom to you all in Jesus Christ our Lord.

[Johanna]

We know by experience that going through trials/suffering is one thing and talking about it from a comfortable chair is another. Also, we must consider how different the approach of a believer is compared to an unbeliever.

However, in terms of general perspective, and in light of the teachings of the Lord that we are to apply whenever the need arises, it is my understanding that taking our life is not the way of the Lord. So I do consider Brittany Maynard's decision a suicide. My heart aches for her and her suffering, as I think she does not know the Lord and His comfort, peace and power.

On the other hand, I have seen many believers, when it has come to it, to turn down medicine when it means it will prolong their life (e.g. their suffering) when they know their body is in the path to death. They choose to allow their bodies to do their job. They choose death. They choose to let life run its course. I do not believe this is suicide because the body is already in its way to death but there is no active decision to shut it down, just to withhold an external, unnatural means to keep it running.

Like Katherine said, there is a role of current medicine to help us out with our physical crisis but we have given it way too much of a priority when it comes to all our pains and crisis. We trust it even with our life! I do believe it is a sort of idolatry in the end.

When we believe in God, we trust He is with us in our suffering, we have an active participation in deciding what medicine we want and do not accept all of it just because. Through it all, we are given an opportunity to glorify our amazing God in the midst of an unbelieving world--we have the chance to show His power in our weakness.

I humbly pray, may the Lord help us to put this into practice whenever suffering strikes.

[SERay]

Very grateful for all the input thus far. It is a difficult subject for me.

I am normally quick to a firm resolve on most moral issues by reflecting on Scripture, but this situation challenges me. I having personally helped our father along on his journey, who insisted on death when death was imminent versus life prolonging options. The horror to watch a close and devout Christian cousin swell up to an inhuman looking form, fully consumed with cancer as brutal medical methods tortured her over and over only to die quickly anyway. Many of bodies I have watch perish under the heavy hand of extended agony and suffering, when it was simply time to let go.

Does Brittany offend the moral principals taught within religious ideologies, to evade predictable suffering by means of pharmaceutical escape? I simply can't find solace in judging her actions as morally wrong when I take reality into consideration. It is hypocritical for me to eat junk food, sip sodas and consume other cancer advancing content, which is a slow but calculated suicide, but then pronounce damnation on one who is seeking refuge from suffering by means of a distinct "end all" event. What really is the difference? Time is relevant and the causation is the same! If I look at another person with desire when married, Jesus said it was the same as adultery. If then after, I would pronounce the platitudes of hell and damnation on another Christian for active adultery, I am then a hypocrite.

In the end, I must as those around the woman caught in adultery, throw down my stone and walk away without as much as a mutter against her, and pray I face such a situation with a clear leading from the Lord.

[Carol W.]

At this point , in most hospitals, a patient who is suffering a painful, terminal illness is given higher than normal doses of morphine if the patient or family request it. The morphine eventually suppresses the ability of the lungs to function at a level to sustain life and the patient usually dies quietly in his or her sleep before long. So, in this manner no one really controls the day or the hour of the person's death, the person is too sedated to feel pain, and the family does not have to witness the agony of a loved one's anguish and suffering.

I think this is a more humane and ethical approach to take than most other options. Every situation is different. On 9/11,as those who chose to jump from 20-30 floors up as the building became a towering inferno, I doubt that God was angry about their actions.

So, many things must be honestly dealt with and prayed about in order to make the best choices in each individual situation.

[David J.]

While I don’t agree with suicide, I think Brittany has to make that decision for herself. Just as anyone who has a terminal disease makes the decision to fight it. Each of us has the right to do what we think is the best for ourselves. I think she’s brought this subject to the forefront and got people to talking about it. That’s something good.

So far, every argument I have read to disqualify Brittany's choice has been a straw man, putting words in the mouths of those with a different perspective. Claiming one can only be courageous between fighting cancer and choosing to prevent needless suffering is completely disingenuous. We all respect and admire those who fight cancer to literally their dying breath and celebrate those who survive, but not everyone chooses to fight, and not everyone has a fighting chance. Her decision to create a foundation to help others, publicly share her story, and putting herself in a position to be judged by those who will never be in her position certainly qualifies as courageous given the vicious and divinity nature of the religious elite. People are so wrapped up in their own heads to consider the perspectives of others. Christians, who’s beliefs about death are tightly held and generally not up for debate or discussion, do not respect perspectives not aligned with their personal understanding of what is right.

I spent time under the knife and on chemo for a couple years and beat it. I got to know people on the oncology ward with me. I watched some of them with incurable cancer struggle in pain for each breath listening to their lungs filled with fluid barely able to talk drowning in their own fluids in pain. Then find out they died the very next day. Some of those very people weeks before saying they wish it would just be over. I even had a 14 year old friend who had leukemia refuse treatment after 5 years because he was sick of all of it. He would pull out the IV lines from his broviac. I just had a close friend die from Brittany's diagnosis. She’s 24 and everyone around her watched her suffer. She had brain surgery and ended up losing her ability to walk, talk, and complete everyday activities.

Anyone who has witnessed first hand the ravages of cancers understand this young woman’s choice. When it is 100% certain to be fatal then the choice should become the person who it dying. To force a person to live through the pain and agony just so others can feel they are beating back the “Culture of Death” is simply a sad commentary of the religious right. Will these people be at this woman’s side when the morphine can no longer kill the pain, when the strongest drugs make the person half alive and half dead, causing the patient and family intense and agonizing pain in the suffering so other can champion life? Terminal illness is tragic especially when so young but to prolong the suffering for no other reason than to uphold a personal theological principle, when the person suffering wants to no part of it is 100% wrong.

We, as conservatives do not want government stepping in and telling us what to do with our own lives. We dislike any type of interference with our lives; however, many of the same people turn around and want to interfere and pass judgment on this woman for what she wants to do with her own life. It’s easy to dissect and criticize when you have never had to face the future with cancer. It is personal choice, one that will have to be made by everyone that ponders this subject. She is an adult, competent in her decision making and if this is the way that she wants to go then who am I to judge and condemn. Walk a mile before passing judgment, it’s very easy myself included to judge, so unless facing a horrible painful death, DON’T JUDGE.

[Roger]

I agree with you Steven, we slowly kill ourselves with bad habits. It amazes me how someone will come into church and pray for healing and then go outside and smoke a cigarette.

Unfortunately, having lived and been a caregiver for a terminally ill wife I have an experiential perspective on this subject. My wife died of carcinoid cancer which, had spread to her liver, lymph nodes and beyond. There is no known cure and the treatments are only palliative. In an effort to sustain her life we prayed and went to Cancer center in Greenwood Mississippi. She was in so much pain she was only comfortable in a La Z boy recliner which, she basically lived in, so I packed it with us. There she went through radiation and experimental treatments from Europe. At the end she was worse off and her lymphatic system was compromised. Her body filled with fluids, she had a hard time eating, breathing and moving. We shipped in a pressure pump and pants from Israel and with the aid of a great Christian nurse, who herself is a cancer survivor; we worked to alleviate the swelling and toxins built up in her legs and torso from the compromised lymphatic system. Because of her disabilities my mother and her sister assisted me with her care in the final months. Her death was steady and painful but, we never lost hope. We prayed and believed God for a miraculous healing even while she was at home under hospice care. I was praying with her and then watched in horror, with her sister, when she started purging and basically drowned in her own fluids. It was the most horrible thing I ever went through. God had healed her – not in the way we wanted and she was graduated to glory.

So, based on my faith, which was tested but not lost, that we have been bought for a price and our lives are in God’s hands, if we have been born again and belong to Jesus, at the end of our suffering we will get our great reward. On the other hand, if an unregenerated chooses to step into eternity in an attempt to stop their suffering a horrible reality awaits them. It will be the beginning of greater suffering. Our prayers should be that they meet Jesus now before they meet Him as Judge.

I might add to this, my mother, siblings and I also went through watching my father die along with a long horrible death by cancer just prior to this. He died at home under hospice care; while we prayed and just before sunrise the he looked up and got the greatest smile on his face and left his tormented body.

The question that is being raised by Brittany Maynard’s case is personal choice, government intervention and sanctions. The real question should be do you want "Death with Dignity" Or “Life with Hope”? Will euthanasia alleviate their short term suffering or will it put them into eternal torment? Being a compassionate person I hate to see suffering. I am not their Judge Jesus is. This is a subject that people need to prayerfully consider—especially where they stand in God’s eyes!

"5 For we know that if the tent that is our earthly home is destroyed, we have a building from God, a house not made with hands, eternal in the heavens.2 For in this tent we groan, longing to put on our heavenly dwelling,3 if indeed by putting it on we may not be found naked.4 For while we are still in this tent, we groan, being burdened—not that we would be unclothed, but that we would be further clothed, so that what is mortal may be swallowed up by life.5 He who has prepared us for this very thing is God, who has given us the Spirit as a guarantee. 6 So we are always of good courage. We know that while we are at home in the body we are away from the Lord, 7 for we walk by faith, not by sight. 8 Yes, we are of good courage, and we would rather be away from the body and at home with the Lord." 2 Corinthians 5:1-8 English Standard Version (ESV)

[Reed]

Living through terminal and other debilitating illnesses is actually a work for God. We are called to do good works, that others would see the hope within us, and not giving up but trusting our last breath to Him is part of that. Death is the last enemy, but it is defeated through Christ's resurrection and no longer to be feared.

I am so sorry, Roger, to hear of the horrible sufferings of your wife and father. I, too, watched my mother die slowly of leukemia over two and a half years, with my father present for half of that until he died of sudden stroke. It is one of the hardest things I've ever had to do, but grace was there with them and us through it all.