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In June, California became the fifth U.S. state to legalize physician-assisted death, or PAD. Twenty more states are considering legislation. Similar to Oregon’s Death with Dignity Act from 1997, the new California law permits doctors to provide a terminally ill patient with prescription medications the patient can self-administer, ending his or her life at a moment the patient chooses. Last summer, the Supreme Court of Canada struck down that country’s ban on doctor-assisted suicide while delineating numerous protections for vulnerable people. This opened the way for a new PAD law, which passed the Canadian parliament in June.
To qualify for PAD under current laws, a person must be a mentally competent adult suffering from a condition expected to end life in six months or less. The patient must request the drugs in writing, undergo a waiting period, and have two doctors verify mental competence (including the absence of mental illness) and terminal prognosis.
Public opinion in both the U.S. and Canada is in favor of PAD as a legal option. In California and Hawaii, for example, about 75 percent of survey respondents were in favor, according to a recent study published in the Journal of Palliative Medicine. “Even in the subgroups least supportive of PAD,” the abstract states, “the majority supports PAD.” That includes 52 percent of “deeply spiritual” people.
And so we have a whole new set of ethical dilemmas to ponder. What would you do?
You’re the doctor.
You practice in a smaller community, so that your patient with ALS has to travel a couple hours every time he has his appointment with the specialist. The disease is progressing rapidly, and your patient dreads becoming a helpless invalid, slowly suffocating from the disease’s effects. You are a strong advocate for hospice and palliative care, but your town’s palliative care services are quite basic at this point. So your patient can either go to the big hospital, two hours from home, and slowly die there. Or he can die at home, with your help. Many of your colleagues are deeply opposed to PAD. But all you have to do is fill out the paperwork and order the prescription. Your patient—at least for now—can do the rest.
Would you say yes?
You’re the pastor.
You have been visiting a woman in your congregation for the last five years, offering pastoral comfort as she has been in and out of breast cancer treatment. Everyone has prayed mightily, and the woman has enjoyed some brief remissions, but now the cancer has spread to her bones and seems to be progressing quickly. She is in constant pain. Her husband is exhausted. Her children are bewildered. They can’t remember a time when their mother was well. This time, when you visit her, she asks what you think about PAD. She’s not sure it’s right, but she can’t suffer any longer. She knows God loves her, and believes that God is giving her this option as a mercy, to end not only her suffering but to relieve her family. She wants your blessing.
Would you say yes?
You’re the spouse.
Your wife has been suffering from multiple sclerosis for twenty years. For a long time, she managed to enjoy life within increasing limitations. Lately, she is losing her ability to walk, speak, eat. She is more and more helpless. The doctor says it will probably only be a few months before the disease makes it impossible to breathe, although of course it’s hard to say. In any case, she will not be getting better. She is begging you to help her find a doctor who will prescribe the medicine so she can end this on her own terms, while she is still able to make decisions and say good-bye. She is so tired of being dependent and helpless. Here’s one last way she can take charge.
Would you say yes?
You’re the daughter.
Your father is 88. He has a weak heart, diabetes, neuropathy. Now he has colon cancer. He is refusing treatment and has already arranged with his doctor to obtain the medications under the PAD law in your state. He did not ask you or your sister and brother ahead of time. The necessary medications are in the bathroom cabinet. Now he wants you to get the family together one last time. He wants prayer, Bible reading, singing in the back yard. He wants to watch the sunset. And then he wants you to crush the pills into juice and bring him the cup.
Would you say yes?
You’re the person.
You wondered why you haven’t been feeling well, but hey, you’re not as young as you used to be. You go to the doc to see if you can at least get some relief from the back pain. The x-rays reveal the truth: cancer everywhere. Lungs, liver, kidneys. The CT scan shows even more lesions on your spine. The docs don’t even bother to suggest treatment. They start talking immediately about hospice. You have maybe six weeks. Six weeks to make your peace with the end of your life? The truth is, you’re ready. All your financial affairs are in order. You’ve lived a long enough life, and have no major regrets. You know where you’re going when the curtain falls on this life. You could ride this out, whatever pain or indignities might be coming your way. Or you could go quietly, at a time you choose.
Would you say yes?
Only on the last one, would I say, firmly, No. The others, the others are all challenging. I want to say No on them all, I want to keep that door closed on all of them, but I’m not sure I would say No when it came right down to it. I don’t want to say Yes, but I might at the moment. This is one compelling post. I wish Allen Verhey were still with us to weigh in on it. He would have so much to say. Thank you for this, Debra, it’s like an Old Testament prophecy.
Thanks, Dan. And frankly, these are easy scenarios in the sense that they all would fit the strictures of the current laws. Other scenarios could be a lot more challenging: the person is very young, the diagnosis is somewhat more uncertain, the family is divided, the person may or may not have dementia, there is money to be inherited, the person has a disability, the person’s condition will deteriorate but will not necessarily die, and so on. Yikes!
Thank you, Debra. I think I’m where Daniel is: I want to say no, but at the moment I am confronted, I don’t know if I would . . . save in the last case. But, even there, I have seen and pastored people in much worse shape than that person, for whom the end, for whatever reason, isn’t coming so swiftly as it was mean to, people who just don’t know, and who see what their slow death is doing to their families. Then, I’m not sure how I would be, thought I want to say “No.”
Surely there must be some benchmark Scripture texts to further complicate matters. Or to make the issue crystal clear!
Thank you, Debra. I’m no expert, not enough to be absolutely opposed to euthanasia. I was, however, troubled by some of the trends in the Netherlands where it has been legal for a while now. Christian Century had a good piece by a Dutch ethicist last spring, but it is available only to subscribers online. He is quoted extensively, however, in this Newsweek piece http://www.newsweek.com/2015/02/20/choosing-die-netherlands-euthanasia-debate-306223.html
Thanks for this, Debra. Thoughtful and provoking.
Thanks so much for giving us these vignettes to think about. It is a good starting point for many who are facing these issues.