Ethicist and author, Mark Carr, shares from his own heart as he examines tough questions about ethics and end of life decisions.I never imagined that I would be climbing the bluff overlooking the Bristol Bay with my father’s cremated ashes in a small box. Together, my boy and I scrambled about 70 feet up the sloping bluff. We settled into a spot just 20 feet from the top where the breeze from the water curled up and over. There we prepared to spread Dad’s ashes.
Two years prior our family had been hit with the ugly diagnosis of Dad’s lung cancer. With courage, he had faced radiation and chemotherapy. He had been a career Army officer and was a soldier at heart. Like many members of the military, he did not want to be a burden to his family. The worst thing he dreaded was becoming weak and unable to care for himself. I wondered if he was going to ask me or someone else in our family to help him die sooner than would naturally happen.
We were all Christians, so the thought of taking Dad’s life into our own hands was strange. But there seemed to be something compassionate about the idea that we could help reduce his pain and suffering at the end. I’m glad Dad didn’t ask me to help; he died quietly at home around midnight with my mother holding his hand. The morphine kept his pain under control and our family’s love kept his mental anguish at a minimum.
I wonder sometimes if this was the kind of death that God approves of. Perhaps it’s just a bad question to ask, but in our day and age we cannot avoid it. We must ask how God would have us die. Should we press to keep our loved ones alive at all costs and with all available technologies? On the other hand, should we shun all this modern technology and simply go home and put our loved ones down like we would our beloved pets?
In the United States right now there are seven states pushing forward with legislation that would legally allow physicians to help their patients end their life, if and when they are diagnosed with a terminal disease. The state of Oregon has lived with such a law since 1997 and hundreds of patients have requested a prescription that if taken would end their life. In the Netherlands, a certain type of euthanasia is legal. When the patient and the family and the healthcare team are in agreement, the physician may take action to end the patient’s life. Is this God’s will? Are these options acceptable for those who follow God’s will and struggle with ill health?
Determining God’s will for our lives in situations that are not fully and explicitly addressed in Scripture is sometimes difficult. Two particular revelations of God may help our thinking here. The first is a hard and fast rule from the Old Testament. Exodus 20 lists the 10 Commandments God gave his people. One of these commands is very clear with regard to taking life. We should not kill; not others, not ourselves. Some press the interpretation of this verse to mean we should not commit murder and thereby justify some types of killing. But most who simply read this verse take it to mean we should not kill ourselves or our patients at the end of life.
The second revelation of God that seems completely relevant for how we can approach issues at the end of life is that of Jesus himself. Jesus’ life was significantly focused on a ministry of healing. Of course, he generally healed people by enhancing their health as opposed to ending their life. Unfortunately, for us, we do not have the same success rate when it comes to healing ministry. Not everyone we try to heal will live and so we are faced with the reality of helping them die comfortably, both physically and spiritually. With the compassion of Christ we aim to help those who will surely die. But how do we do this well?
It is essential to be clear about the terms and concepts used in our familial and societal conversations about caring for people who are dying.
1. First, let’s be clear that we are focused on the reality that death will come to our loved patients. No doubt God could and occasionally does perform a miracle in the life of dying persons. And though we may pray for such a miracle, we must, nonetheless, proceed with the realization that death may come.
2. Second, what are the terms used:
Euthanasia is the term frequently used to denote an action taken upon a patient by the physician or member of the care team. This action is intended to end the life of the patient. We have several terms that are used to further identify what kind of euthanasia it is.
Active Euthanasia: intends to end the life of the patient
- Voluntary, active euthanasia: The patient wishes for and requests to be killed.
- Non-voluntary, active euthanasia: The patient’s wishes are unclear but the care team moves forward with euthanasia anyway.
- Involuntary, active euthanasia: The patient makes it clear that she/he does not want to be euthanized but the physician goes ahead with it anyway.
Passive Euthanasia: does not intend to end the life of the patient, but does intend to cease aggressive treatment efforts to extend the patient’s dying process. Many people simply do not like this terminology since it doesn’t capture what they feel themselves to be involved in. Many patients (families and care teams) decide to stop fighting their inevitable and close death and seek instead to be cared for in such a way that they do not suffer any physical pain. The terms most commonly used for this position are withholding or withdrawing aggressive treatments. In such cases, physician and healthcare teams continue treating the patient with what many call “comfort only care.”
The Cause of Death
In all of the previous discussion of terms and concepts, there is no question about the cause of death. The cause of death is one of the two following reasons: because she/he is suffering some grave condition or because in light of this condition, the care team ends the patient’s life.
Physician assisted suicide is something different. Again, the context is unavoidable death, but in this case, the cause of death is the action of the patient him/herself. By definition when someone ends her/his own life, it is considered an act of suicide. The “assistance” offered in the case of physician assisted suicide is simply writing a legal prescription for a lethal dose of drugs. When filled by a pharmacist and taken by the dying patient, suicide properly defines the action taken.
So much more can be said about end of life care for the dying. Perhaps in successive columns we can come again to this issue. Suffice it to say, we need to be clear on what we are talking about and how it is we care for our loved ones who are dying.
My family cared deeply for my father and that care extended to fulfilling his wishes about where his remains should be placed. As my boy and I spread Dad’s ashes on to the slope of the bluff, the breeze from the Bay caught the lighter particles and carried them up and over the top of the bluff. Our beloved memories of Dad’s life are prompted each time we pass by that spot, and that’s good.
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Mark F. Carr, PhD. writes from Alaska.© 2002 - 2023, AnswersForMe.org. All rights reserved. Click here for content usage information.