Physician-assisted suicide (old interview with ChristianWeek)

As I was prepping for a lecture on euthanasia, I found an email interview I did with ChristianWeek about three years ago on physician-assisted suicide. CW only used snippets of the interview for their article (which is fine), so I post the whole interview here in case it's helpful to readers.  And here is a link to the CW article: Assisted suicide case raises alarm bells.

Thoughts about Susan Griffiths and Physician-Assisted Suicide

ChristianWeek interviews Hendrik van der Breggen, PhD, Associate Professor of Philosophy, Providence University College, about Susan Griffiths and her recent assisted suicide.

CW: As a Christian and as a philosopher, what is your response to the Susan Griffiths story?

VDB: Susan Griffiths is the Winnipeg woman who recently travelled to Zurich, Switzerland, for an assisted suicide. Assisted suicide is legal in Switzerland but not in Canada, and Griffiths wanted to avoid suffering from multiple system atrophy, a degenerative disease that would leave her in a severely disabled condition. Griffiths also wanted her death by assisted suicide to serve as a public statement to fellow Canadians. Here is Griffiths' message (from CBC News, April 25, 2013): Canada should make physician-assisted suicide legal so Canadians will "have control of their life and their death," thereby "making the end of people's lives a lot easier than mine has been."

As a Christian who is a philosopher, I find the Susan Griffiths story troubling. There are three sources for this trouble.

First, I am troubled that the biblical teachings which make it clear that suicide isn't morally right are not taken seriously. (I discuss these teachings in more detail below.) I believe that we should take relevant biblical teachings seriously. Of course, I realize that many persons disagree with these teachings, that is, I realize that Canada is a secular and religiously pluralist country. Still, if one thinks that the Bible truly is God's Word and that the teachings therein are truly from God—and that God tells us suicide is wrong—one should be troubled when our society turns (further) away from God. As the Bible makes clear, turning from God isn't wise.

Second, I am troubled by the poor reasoning that characterizes the discussion of assisted suicide. For example, Griffiths (and the media) seems to present us with a false dichotomy coupled with a false assumption. We seem to be presented with only two options for the terminally ill: physician-assisted suicide, or a lonely agonizing death. Sadly, what's missing is a third alternative, i.e., palliative care. Palliative care is medical care that allows terminally-ill patients to die with dignity, with little or no pain, and surrounded by genuinely caring people. Moreover, fueling this false dichotomy seems to be an assumption or "subtext," the alleged truth of which should be challenged. Here I appeal to an insight from Amy Hasbrouck, a spokesperson of Toujours Vivant - Not Dead Yet (a project of the Council of Canadians with Disabilities, an agency which ensures that Canadians with disabilities enjoy full human and equality rights). Hasbrouck observes: "The subtext is that, as a person with a disability, [Griffiths] believes she will be less worthy, less dignified, less than fully human." But, Hasbrouck quickly adds, "In point of fact, disability is NOT a fate worse than death." In other words, the Susan Griffiths story signals faulty reasoning that reveals not only an ignorance of palliative care but also a deeply negative attitude towards the worth of the disabled.

Third, I am troubled that Griffiths' justification for the legalization of physician-assisted suicide is couched primarily in terms of personal autonomy, i.e., the individual's choice in response to suffering, with no regard for broader concerns. Yes, freedom is important. But, surely, the freedom to exercise one's choice is not absolute. I do not have the freedom to shout "Fire!" in a crowded theatre if there is no fire and if the shout will cause a stampede to the exits resulting in injury to others. In other words, we do not live in a social vacuum: our choices affect others. How our choices affect others should be explored.

Permit me to put the matter in a slightly different way. Griffiths sets out an argument in favour of physician-assisted suicide (in terms of the individual's personal freedom/autonomy), but she really doesn't address any arguments against it (at least not in the media reports I've read). She sets out a pro consideration, but not any cons. As careful thinkers we should look at pros and cons, not just pros.

Are there any cons or concerns about legalizing physician-assisted suicide? I can think of at least three.

Con/concern 1. Keep in mind that the law is, among other things, a teacher. If physician-assisted suicide is made legal, then our society will probably tend to see suicide more and more as a legitimate way of solving an individual's problems. Got a problem that makes you suffer? Don't forget you can get help to kill yourself! Also, if the choice of the sufferer constitutes sufficient legal grounds for the sufferer to end his/her life, then suicide intervention or counseling against suicide may become grounds for a lawsuit against the intervener or counselor. There will probably be a chilling effect against suicide intervention and counseling. If physician-assisted suicide is made legal, the law will promote moral callousness—hard-heartedness.

Con/concern 2. Again, keep in mind that the law is a teacher. If physician-assisted suicide is made legal, then life will no longer be seen as society's default position. This means that our most vulnerable citizens—the disabled, the elderly, the terminally ill—must begin to justify the continuation of their lives. Surely, this is a nasty burden to place on people when they're already down, physically and emotionally. Surely, this is a kick in the teeth! Surely, this is wrong.

Con/concern 3. If physician-assisted suicide is made legal, then there is a non-fallacious, logical-legal slippery slope argument that looms large. Reasons for one action sometimes also justify other actions which are unintended. The alleged right to end one's life because one is suffering may justify not only the assisted suicide of the terminally ill but also the assisted suicide of the non-terminally ill, the elderly, the disabled, the parent suffering the loss of a child, the person with chronic back pain, the depressed LGBTQ teenager, the bullied adolescent, etc. Think about it: Once we accept personal autonomy of the sufferer as the fundamental principle to justify assisted suicide, then all sufferers have the legal right to assisted suicide. Legal safe-guards (to limit assisted suicide to a particular group) may help for a while, but only for a while. Courts will do what courts do: promote the consistent application of the fundamental principle that the sufferer has the right to assisted suicide.

So, yes, I am troubled about the Susan Griffiths story—especially her call to legalize physician-assisted suicide—because (1) it doesn't reflect biblical teachings (more on this below), (2) it presents a false dichotomy fueled by a subtext/assumption that falsely views disabled Canadians as less worthy than able-bodied Canadians, and (3) it fails to look at both pros and cons, of which the cons outweigh the pros. In other words, I think that Susan Griffiths' call to legalize physician-assisted suicide is mistaken, morally and logically. Moreover, in view of Susan Griffiths' actual assisted suicide, I think that her call to legalize physician-assisted suicide is also tragically mistaken.

CW: Are there biblical teachings you think are important for Christians to keep in mind when they discuss the issue of assisted suicide? Why do you think these teachings are important?

VDB: There are at least five biblical teachings that are relevant to the issue of suicide and assisted suicide. The teachings are important because they reveal God's will, which reflects God's character, which is the ground of all goodness.

1. That God is the highest good, that humans are created in God's image, and that God's image is a reflection of this good—these biblical teachings logically imply that the deliberate destruction of God's image is an evil. The deliberate destruction of the highest good is an evil, suicide is the destruction of the being made in God's image, i.e., a being that reflects the highest good, so suicide is an evil.

2. The sixth commandment says, "You shall not murder." It is reasonable to think that this command applies to human persons who are innocent, that the individual considering suicide is a human person who has not committed a capital offence, and hence that the command prohibits self-murder.

3. The facts that God reveals Himself most clearly in Jesus (the incarnation of God), that Jesus' teaching in word and deed provide us with a moral standard, that Jesus taught that we ought to care for others by feeding, healing, clothing, and sheltering them—not by encouraging them to self-destruct—these facts logically imply that suicide is wrong. Moreover, Jesus commands us to love others as we love ourselves. Implicit is the assumption of self-love. Christ's acts of love show that they are acts for the betterment of the individual, not the individual's destruction. Therefore, self-love is not self-destructive.

4. The facts that God advises Joshua to be strong and courageous in the face of danger and difficulty, that Joshua carries out this advice not by self-destructing but by working hard in the face of the danger and difficulty, and that God very apparently approves of Joshua's response to God's advice—these facts logically imply that we ought to be alive to do God's work on earth, that doing God's work is right, and that suicide is not only morally wrong but also an act of cowardice.

5. Paul's life and teaching also logically imply that suicide is wrong. According to Paul, we are to spend our lives in service to others (Galatians 6:9-10). Clearly, Paul's example shows that this requires us to be alive as we serve others. Paul suffered immensely (see 2 Corinthians 11), and he wished to be with Jesus (i.e., be physically dead), yet he continued to serve without committing suicide.

To be sure, the Bible does mention some cases of suicide—think of Judas the betrayer of Jesus, or think of Saul and his armor bearer. It's important to keep in mind, however, that in these cases the Bible merely describes suicide; the Bible does not prescribe it.

Thus, it is reasonable to believe that the Bible morally condemns suicide, whether assisted by a physician or not. Moreover, the examples and teachings of Jesus and Paul make it clear that instead of encouraging suicide, we should work to enhance the physical, emotional, and psychological well being of those who suffer.

At this juncture, Christians should pause and ask: Does the biblical case against suicide mean that there are never circumstances in which a suffering, terminally-ill person should simply be allowed to die? The biblical answer seems very much to be No. Ethicist Scott Rae explains:

"[T]he Bible also affirms that death is a normal and natural part of a person's life 'under the sun,' or on this side of eternity (Eccl. 2:14-16; 2:19-21; 5:15-16; 9:1-6). Death is seen as both an enemy and a normal part of life, due to the pervasiveness of sin in the world. But from the perspective of the cross and resurrection of Jesus, for the Christian, death is also a conquered enemy, having been vanquished by the death and resurrection of Christ. Thus, since death for the Christian is a conquered enemy, it need not always be resisted." (Rae, Moral Choices, p. 218.)

In other words, the Bible condemns suicide, but, as Rae rightly points out, the Bible also recognizes that earthly life is "a penultimate good," whereas the ultimate good is "eternal fellowship with God." (Rae, Moral Choices, p. 221.) There is a time for death.

This means that what we should remember that withdrawing or withholding extraordinary, burdensome, or medically useless treatment from a terminally ill patient and thereby allowing the patient to die of the illness running its course is an ethical (and already legal) part of medical/ palliative care. It's important to remember, too, that this does not require the legalization of physician-assisted suicide.

CW: What impact, if any, do you think this case will have on Canada's medical system?

VDB: I suspect that if Canadians follow Susan Griffiths' advice and example, fewer public dollars will be devoted to palliative and hospice care. After all (and please excuse the callous language), it's easier and cheaper simply to knock somebody off. I believe that physician-assisted suicide, if made legal, will, with time, become more socially acceptable (remember that the law is a teacher). So, with time, more people will be calling on Canada's medical system to provide physician-assisted suicide. As Canadians continue to choose killing as a solution to medical, social, and psychological problems, Canada's medical system will reflect what Pope John Paul has aptly called the "culture of death."

But medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

CW: How do you think Christians are called to respond if they are suffering from an incurable disease?

VDB: I think we are called to look to the God-man Jesus and His suffering. Suffering may seem meaningless, as even Jesus seemed to think when He questioned the Father as Jesus suffered so horribly on the cross. Yet Jesus trusted the Father, and we are called to do the same. It's good to remember that we have the promise of joy—as the reality of Jesus' physical resurrection reveals.

I think that we're also called to look to the example of those persons God has placed among us to witness to Him in their suffering. I'm thinking of Joni Eareckson Tada (1949- ), who broke her neck as a teenager and has lived her life as a paraplegic. Joni has suffered immensely, yet she carries on. I and no doubt thousands of others (even millions of others) have learned much from and have been deeply inspired by Joni. I recommend her autobiography Joni: The unforgettable story of a young woman's struggle against quadriplegia and depression (Zondervan), and I recommend her devotional book Secret Strength…for those who search (Multnomah Press). Joni also is an artist and she directs the organization Joni and Friends, whereby she serves as an advocate for disabled people.

How are Christians called to respond in the face of suffering? We are called to obey biblical teachings. To allude to a book by Thomas à Kempis, we are called to imitate Christ.

CW: How can Christians best help people they know who are living with an incurable disease?

VDB: I must confess that I struggle with this question, for I have stumbled in my efforts to help those who are living with an incurable disease. My mother died from a stroke in 2011, having suffered for an extended time with Alzheimer's disease. My family, of which many are not Christians, pulled together and helped wonderfully. I live a seven hour drive away from my mother and father's home, which made it difficult for me to help regularly in person. Nevertheless, my wife and I helped financially, and sometimes I was able to spend vacation time cleaning my parents' home with the help of one of my sisters. My brothers (especially my youngest brother) and sisters-in-law live close by and were unfailingly self-sacrificial and Christ-like in their care-giving. There were also grandchildren who pitched in. I suppose that the best practical advice I can give is this: help in whatever way you can.

Having said this (and realizing my personal shortcomings and my need to work harder at helping others in practical ways), I remain convinced that on the issue of assisted suicide there is also a battle of ideas—a battle between truth and falsehood—which is raging and which requires the attention of thoughtful Christians. The Susan Griffiths story is a case in point: see my critique above. I believe that failure of Christian thinkers to engage in this battle of ideas is to betray our fellow humans: it is to fail to speak up in defence of the weak, i.e., the elderly, the terminally ill, the disabled, the depressed, and others. I believe too that a failure to engage in this battle of ideas may also betray our humanity. On the betrayal of our humanity, see below.

CW: Is there anything you would like to add?

VDB: Yes. Don't get fooled by what I call the "we-put-down-pets-so-let's-put-down-people" argument. The argument (which I've seen often in comments sections of online news stories) goes something like this: When it comes to suffering animals, such as the family dog, we show compassion by euthanizing them, therefore we should show similar compassion to people when they suffer. It's a strong argument, if you don't think about it too much.

But the argument is deeply problematic, for at least three reasons.

First, it's simply not the case that we treat people more humanely when we put them down when they suffer. The humane, compassionate response to a human being who is suffering pain and his/her prognosis is not good is palliative care. As I've mentioned above, palliative care is medical care that allows terminally-ill people to die with dignity, with little or no pain, and surrounded by genuinely caring people. Surely, the humane thing to do is provide comfort and pain relief for people who suffer, not take their lives.

Second, we should also remind ourselves of this fact: withdrawing or withholding extraordinary, burdensome, or medically useless treatment from a terminally ill patient and thereby allowing the patient to die of the illness is already both a legal and ethical part of palliative care—and does not require the legalization of physician-assisted suicide. Different people have different thresholds for enduring pain and suffering. We should acknowledge this, while also acknowledging that this doesn't require physician-assisted suicide. (We should also remember that there is a treatment called palliative sedation, which can minimize pain as death runs its natural course. For more on palliative sedation, check The Journal of the American Medical Association, available online: http://jama.jamanetwork.com/article.aspx?articleid=201675.)

Third, the legal acceptance of physician-assisted suicide—i.e., the deliberate, active killing of a suffering human being—signals the culture's embrace of death as a solution to medical, social, and psychological problems. Call me a defender of some old-fashioned ideals of human civilization, but (as I've said previously) it seems to me that medical, social, and psychological problems require medical, social, and psychological solutions—not killing. To embrace death as a solution is (as I've said previously) to embrace what Pope John Paul II called the culture of death. Surely, we should embrace a culture of life.

I strongly suspect that if we had better palliative care—i.e., medical care that allows terminally-ill people to die with dignity, with little or no pain, and surrounded by genuinely caring people—we would also have fewer people calling for physician-assisted suicide.

Maybe instead of calling for a right to physician-assisted suicide, we should be calling for a right to top-notch palliative care? Surely, administering top-notch palliative care would be more humane than putting down a loved one as if he/she were a pet.

Recommended Readings (recommended by Hendrik van der Breggen)

● Paul Chamberlain, Final Wishes: A Cautionary Tale on Death, Dignity, and Physician-Assisted Suicide (Eugene, Oregon: Wipf & Stock, 2009).

● Amy Hasbrouck, "Suicide Celebration Instead of Suicide Prevention," available online: http://www.ccdonline.ca/en/humanrights/endoflife/press-release-23April2013.

● Scott B. Rae, Moral Choices: An Introduction to Ethics, 3rd edition (Grand Rapids, Michigan: Zondervan, 2009).

● Hendrik van der Breggen, "The Image of God: Why Life is Worth Defending Against Physician-Assisted Suicide," Focus: Faith & Practice, Christian Medical & Dental Society, Volume 31, Number 2 (Spring 2011), pp. 8-13; available online: http://apologiabyhendrikvanderbreggen.blogspot.ca/2016/11/the-image-of-god-why-life-is-worth.html

See too the following installments of Hendrik van der Breggen's newspaper column "Apologia" (available online):

● Physician-Assisted Suicide Is a Slippery Slope

http://apologiabyhendrikvanderbreggen.blogspot.ca/2011/12/physician-assisted-suicide-is-slippery.html

● Slippery Slope Arguments (Part 1)

http://apologiabyhendrikvanderbreggen.blogspot.ca/2011/04/slippery-slope-arguments-part-1.html

● Slippery Slope Arguments (Part 2)

http://apologiabyhendrikvanderbreggen.blogspot.ca/2011/04/slippery-slope-arguments-part-2.html