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[Below is an article I wrote for the St. Benedict’s Anglican Catholic Church newsletter in 2002. It is a theological response to Professor Jonathan Hardwig’s position that terminally ill elderly people may have a duty to die, in some cases even a duty to commit suicide, if they are a burden to their loved ones. (Professor Hardwig is Chairman of the Philosophy Department, The University of Tennessee at Knoxville). I sharply disagree, and below is an argument against Hardwig’s position based on the doctrine of the Trinity.]

It is interesting that the longest season of the church year, the Trinity season, is focused on what seems to be the most esoteric doctrine of the Christian Church.  Not only is the doctrine of God being three persons in one nature a mystery, but it also seems so distant from our everyday lives.  If I am struggling with a moral dilemma, I may consult what scripture and tradition say, may ask myself what the Christ-like thing to do would be, but I normally do not contemplate the Trinity to help me make a decision.

But since God, our Creator and Lord, is God in three persons, surely this has implications for the way we live our lives.  For example, that fact that God is three persons who love and communicate with each other is a model for the love we should have for each other as human beings.  This love within God Himself can give us insights into how we should behave towards others.

There are some situations which test the limits of relationships, of love, and of faith.  One such situation is when one of us or someone we love becomes seriously ill.   Serious illness hits us hard, for we realize our limitations more keenly than in almost any other situation, and we may have to face the possibility of being much more dependent on others than usual.  Illness is particularly hard to bear when we are dependent on those we love the most, and we may feel that we are being a burden to them.  Those who write about medical ethics have had much to say concerning the moral obligations of the health care providers who care for the seriously ill patient.  But more recently, one finds, in the medical ethics literature, a position which should be deeply disturbing to everyone, especially to those who are orthodox Christians.  This position concerns the moral obligations of the seriously ill patient, and asserts that when a person is old and has lived his life, and is ill to the point of becoming a serious burden to his family, he has a “duty to die,” including the duty to commit suicide.  This is actually set forth as the “loving” and “unselfish” thing to do.  Although this is an extreme position, many people say, “I don’t ever want to be a burden to my family.”  While this is understandable—who would want to be a “burden” to anyone—it can too easily lead to the position that “I WILL NOT be a burden on my family, and I will not put my loved ones in a position of having to take care of me.  I will NOT put myself in the position of being dependent on others!”  To be concerned about the burden loved ones would bear taking care of me when I’m sick is consistent with love and with Christian ethics.  To refuse care from loved ones due to such a fear is not, and if followed consistently, leads ultimately to the extreme position that there are situations in which we have a “duty to die.”  There are a number of reasons that the latter position is not Christian—one is simply that the family may not think it is a burden to care for someone they love.  Even if they did find such care a burden, there are more than enough good reasons to show that the attitude of so many Americans (who often seem to value “self-reliance” and “personal autonomy” above everything else) on this issue is fundamentally wrong.

An understanding of the love relationship between the Father, the Son, and the Holy Ghost can help to see what is wrong with a refusal to receive help from loved ones.  As some recent theologians and philosophers (such as Hans Urs von Balthasar and Fr. Norris Clarke) have pointed out, the relationship between the Father, Son, and Holy Ghost is one of mutual giving—and receiving.  The Father, the Source, gives Himself, His goodness, love, and being, fully to the Son and Holy Spirit; the Son and Holy Spirit receive this gift gratefully, and freely give their love, sharing their goodness totally with the other members of the Trinity.  It is not that the Son or Holy Spirit lacks anything–they are fully God, and lack nothing; the point is, that in God Himself, there is not only giving between the persons of the Trinity, but gracious receiving.  If the love within God himself, who has no need, includes receiving—how much more should we, who are finite and weak and have so many needs, graciously receive gifts from God—and from other people.  Human beings should both give and receive from each other—both giving and receiving are necessary parts of human love.  The baby’s receiving care from his mother and father is just as much a part of love as their giving in taking care of his needs.  Applied to the issue of illness, the sick person’s gracious receiving of help from loved ones is just as much a part of love as the loved ones being willing to take care of the sick person.  To say “I’m not going to put my loved ones in the position of having to take care of me” is not giving them the opportunity to love, and may speak more of pride and selfishness rather than love.  It fails to give loved ones an opportunity they may want because they love their family member.  It fails to be Christ-like, for Christ’s loving the Father and Holy Spirit includes receiving as well as giving.  Surely we do not want to claim to be better than God!  Let us, then, be willing to help those we love, no matter how inconvenient it might be to our so-often spoiled, rich lifestyle.  But let us also be willing to receive care, to love our families by receiving care, if we, sadly, find ourselves in a situation in which we need it.

Physician Assisted Suicide and the Ends of Medicine

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When I ask my medical ethics students whether they support physician assisted suicide (in the sense of the physician prescribing a deadly dose of a drug, usually barbituates, for the patient to take when he wishes), the vast majority raise their hands. Even most students in my classes who oppose abortion support physician assisted suicide (PAS). To me this is disturbing, especially since the strongest support for PAS has been in my class of future physician assistants.

What is so wrong, you may ask, about physician assisted suicide? After all, even with ideal pain control, some terminally ill patients either remain in a great deal of pain or have to be totally sedated. Why not allow such patients to “control the time and manner of their own deaths?” Surely PAS will encourage more dignified deaths among patients in intractable pain. And in referendums, Oregon and Washington have passed laws permitting PAS. Shouldn’t this practice spread to other states?

Although PAS sounds attractive, its practice would be a fundamental distortion of the proper goals of medical practice. The internal goods of medicine include restoring a patient to health, and when a patient cannot be restored to health, to make that patient as comfortable as possible. But supporting a patient’s suicide indirectly involves the physician in killing a patient. Physicians have a great deal of power over patients, power which, if misused, can lead to pain, suffering, and death–as the Nazi medical experiments and the Tuskegee Syphillis Experiment revealed. Now a physician can withhold or withdraw medical care that is only prolonging the dying process. The goal is not to hasten death per se, but to relieve the patient’s suffering. But prescribing a deadly dosage of a drug is designed to let the patient hasten his death. One may say that the motive is to relieve suffering, but there is a difference between allowing the disease process to take its course and giving a drug so a patient can actively commit suicide. This abuse of medical power has already spread in the Netherlands, where PAS is legal, to doctors actively killing patients without the patient’s permission or the patient’s family’s permission. Once the line forbidding a physician from assisting in a patient’s death is crossed, it will be difficult to turn back. Doctors participating in PAS will not be practicing medicine, but doing something else entirely–being accessories to suicide.

There is an assumption in the modern world that pain is the worst thing that a person can experience. That was not the view of the premodern world. Socrates was willing to suffer pain and death to keep his integrity. The early Christians suffered excruciating torture via persecution–they believed that they were sharing in the sufferings of Christ. And without modern pain control methods, people suffered far more from diseases than they do today, yet the drive for PAS is a modern movement (David Hume was among the first to defend suicide as an option in a person in great pain). This does not mean that we should not try to stop pain as much as possible short of actively killing the patient or giving the patients the means to suicide. Relieving suffering is a moral obligation of physicians as long as medical power does not cross over the line into aiding a patient in his active demise. Even in this post-Christian world, would secularists really want doctors to cross the line into PAS? Could PAS be controlled once the genie is out of the bottle? I do not believe so–but even if PAS is the only line that is crossed, it remains inimical to the ends of medicine and is wrong.