Can A Christian Support “Physician-Assisted Suicide?”

If you expect me to take a definite stand for or against Physician-Assisted Suicide (PAS) you will be disappointed. This blog is a place where I often reflect about difficult and controversial issues; I don’t always take a stand about them. One of my goals as a Christian theologian and educators is to help people think through doctrinal and ethical issues critically and reflectively but not always to a definite conclusion. I have been doing this within myself about the issue of PAS for years. And, as I age and face the possibilities inherent in that process, I increasingly wonder if this issue (PAS) is as black-and-white as many people, especially Christians, have thought.

What exactly is meant by PAS? Here I can only state what I mean by it. The concept has many variations. What I mean by PAS, and therefore what I am musing about, is this: A person in great suffering for which there is no available relief asks a medical professional to help him or her die in the quickest and most painless way possible. Usually in PAS the suffering person himself or herself performs the final act that immediately results in death. The physician only provides the means. However, in some cases, the physician must go further and actually use the means on the suffering person. This kind of PAS is legal in some countries and a few states—with many qualifications and safeguards against abuse.

Of course, a background theological issue, especially for Christians, is whether suicide is a sin. Most enlightened Christians, and others, will say it is at best tragic but only sin when done for purely selfish reasons and where there are other possible remedies for the emotional or physical trauma and turmoil not tried. Few enlightened Christians believe or argue that everyone who commits suicide is automatically thereby condemned to hell. That was a common medieval belief still held by only a few. The question this raises, however, is whether PAC, assuming it is a last resort, is a selfish act. One would have to ask the suffering person’s loved ones. In the kinds of cases I’m thinking about, all empathetic and reasonable loved ones would give their own right arms to see the person’s suffering cease.

So, in order to shed light on this difficult subject, it is helpful to state more specifically and clearly what kinds of cases I’m thinking of as possibly justifying PAS. Some years ago I read about an elderly mother of two adult sons who were both suffering a debilitating disease that rendered them completely paralyzed. (I remember the name of the disease; I’m just not mentioning it here to avoid a flurry of comments about it.) It was a genetic disease that often leads the person to a near vegetative state of tremendous pain and paralysis. There is no treatment for that pain and paralysis in the late stages of the disease. Her sons were confined to beds in a nursing home where she visited them daily. She watched them slowly suffering in great agony while unable to communicate let alone take care of their own automatic bodily functions. Finally one day she brought a pistol to the nursing home and shot both of them. The jury gave her ten years’ probation. I sympathized with that jury and with the mother even as I felt tremendously conflicted about her act of euthanasia.

As I have aged and I have had more contact with elderly people whose quality of life is extremely poor—down to nothing. Some people, for reasons of disease or age, come to the point where they have no quality of life. Medical provision has often kept them alive years beyond their ability to live a life of dignity and even relative physical comfort. I know elderly people who live with severe pain all the time and who cannot feed themselves or take care of their own bodies and who express the wish to die daily.

Some years ago, of course, Dr. Kevorkian brought this issue to public attention in the U.S. by stepping across professional and legal boundaries to aid suffering people to commit suicide. I watched one television news “magazine” segment that focused on one of his cases. The patient was suffering the last stages (but with perhaps months to go before natural death) of ALS (“Lou Gehrig’s Disease”). The man had reached a stage where he could no longer move any part of his body except his eyelids and a finger and indicated that he was in tremendous pain that pain medicines alone could not alleviate. He requested Dr. Kevorkian’s assistance in ending his misery and Dr. Kevorkian complied by setting up a contraption the patient could use to push down a plunger to release a stream of poison into his bloodstream through an IV to which he was already connected. He died painlessly and quickly.

Some patients simply choose to forego all treatments for their terminal disease and die naturally. Usually this also involves gradually starving to death or dying by dehydration. It can take weeks. Few people blame them or even call it “suicide.” And yet, in a way, it is suicide.

Some years ago I had the privilege of teaching nurses in several cohorts in a “degree completion” program. My course, which they were required to take as part of their studies, was called “Developing a Christian Worldview” and included a unit on Christian ethics. We talked about the ethical issues surrounding death including suicide. One thing that struck me was that almost all the nurses who worked in hospitals agreed that PAS is quite common. They said that in many terminal cases a doctor will order pain medicine in gradually increasing doses that eventually suppress breathing. And that so long as the doses are necessary to alleviate pain, even if they result in death, most district attorneys will not prosecute the doctors or nurses involved. They said it is one of the best kept secrets in the medical profession—given how common it is.

And yet we criminalize the same practice if it is done earlier than that and outside the context of a hospital. What sense does that make? Okay, well, the legal argument is that injecting someone with a dose of pain medicine strong enough to suppress breathing is not PAS so long as the intention of the act is only to relieve pain. But how different is that from other PAS the intention of which is only to relieve otherwise unrelievable pain? Greyness surrounds the issue at such a point.

I do not have all the answers to this, but I believe it is worthy of renewed discussion both among ethicists and lawmakers. First, can PAS ever be ethically justified? Let’s not begin with the worst case scenarios in which it might be abused to kill people without their consent. That’s not even in consideration here. Let’s start with the worst case scenarios of people in tremendous suffering that cannot be relieved any other way than PAS. Second, can laws be crafted that absolutely de-criminalize PAS that also guard against abuses?