Healing Faith

cliffsA reader named Katherine recently e-mailed me. She had lost her husband, a man some years older than she, to multiple myeloma and Alzheimer’s disease. She is a Christian, and is struggling to make sense of his death, and the difficult questions of why God allows suffering. She writes, after giving me some details of his life, death, and fine character, and asks:

Why does God allow such terrible illnesses to such a kind person? I know there is really no answer as I know all about Job. The thing I am really afraid is that I prayed for his healing, and it did not happen. When I became a Christian back in the 80’s, the health and prosperity gospel was big at the time, and I guess it really influenced me more than I care to admit as I now know it is false. Even though I know it is false, I have become obsessed that God did not answer my prayer because of not being able to get rid of all the sin in my life (as if this were possible to do). One of the teachings of that movement was that if your prayer for healing went unanswered it was either because of lack of faith or sin in your life. I kept thinking that I don’t always put God first in my life, and that I spent more time reading secular magazines than reading my Bible and listening to more secular music than Christian music. These were my “main” sins, at least in my mind and thinking. Can you shed some light on this for me? I would be very appreciative.

The problem of suffering and evil is an ageless one. It poses a particular challenge for Judaism and Christianity, because of the seemingly insoluble tension between a world filled with suffering and evil, and the belief in a God who is good and all-powerful. Solutions to this dilemma, both adequate and inadequate, abound. It is the desperate hope of the atheist that this logical incompatibility proves beyond question the nonexistence of God. Others, less willing to ditch a Divine order, have concluded that God is good, but impotent; or that God is detached and uncaring, or capricious, or moody, or sadistic — and therefore not good.

It must be said plainly that answers to this paradox are neither simple nor entirely satisfactory. The dilemma as it stands may be solved in a global and satisfactory way — as has been done by both Judaism and Christianity — but invariably the lofty principles seem to break down at the moment when a solution is most needed: in the time of crisis when we ourselves experienced the depths, hopelessness, and irrationality of suffering in our own lives. CS Lewis, whose tightly reasoned treatise The Problem of Pain provides an extraordinarily deep and thorough discussion of this dilemna–later in life nearly repudiates his faith and sound theology after the death of his wife, a process painfully detailed in his diaries, A Grief Observed. It is indeed unsettling to watch Lewis discard all of his carefully reasoned and theological understandings of pain and suffering in the brutal crucible of unbearable pain and loss. Nonetheless, he ultimately comes to terms with the paradox, and undergoes an embracing of this profound dilemma far deeper than the intellectual by means of his own trial of fire.

At the heart of this difficult issue lies the human heart. God undertook a vast and dangerous experiment when creating man: He wanted, not merely another animal — of which there were countless — but an animal capable of something He alone understood: love. He gave this exalted animal vast intellect — but this was not sufficient to engender love. He gave His creation powerful emotions, the capacity for both creation and destruction, which He alone had possessed — but this also was not sufficient. For love — the utter, uninhibited emptying of self for another — required that most dangerous license of all: free will. Having created us thus, designed with the capacity to love, we must of necessity be utterly free to choose — for choice is the very heart, the very essence of love.

It was, by all visible measures, an experiment gone wildly awry. Having given this creature the extraordinary capabilities required to love fully — intellect, emotion, passion, empathy, the ability to feel intense pleasure and pain both physically and spiritually — he set this creature free to love — first of all Himself, and then others of like kind. And the first choice of this masterpiece of creation was the decision to turn away: to replace the intended objects of love with the sterile altar of self. Thus was unleashed the monstrous liability of a truly free creature: the ability to hate, to cause pain, to kill, to destroy.

A world in which God eliminated evil would by necessity be emptied of all mankind.

If we are to be honest, much of the pain and suffering which comprise the evil of the world is due to nothing more than this: that man, having been given the ability to choose, chooses wrongly, and uses the gifts and abilities given for the purpose of love to instead elevate himself at the expense of others, often in ways stunningly malicious and utterly wicked. Look around you, at the world both near and far: pride, selfishness, greed, lust, rage, jealousy — all these things manifest themselves in our lives and those of others, causing great pain and endless suffering. The child abused; the wife abandoned; the drive-by shooting; the greedy CEO who bankrupts the company and rapes the stockholders; the serial killer and the rapist; genocide; wars of conquest; torture; senseless massacres: these are the actions of men and women putting self above others — and each of us does it, to a greater or lesser degree, though we minimize our own roles to justify our own actions. We all wish for a world where God would eliminate evil — but all assume that we ourselves would be the only ones left standing when His judgment is delivered. A world in which God eliminated evil would by necessity be emptied of all mankind.

Yet there also exists those evils which have been called, in days past, somewhat ironically, “acts of God” — those circumstances or events which cause pain and suffering, not directly engendered by human evil. Thus the child is born with a severe birth defect; hurricanes, earthquakes, and tornadoes cause death and destruction; chronic and devastating diseases fall upon those who seemingly deserve a far better fate. It is with this, this seemingly capricious evil, with which we struggle most earnestly, straining to understand, yet to no avail.

Judaism and Christianity both imply that some such evil may be consequential, the result of punishment or predictable consequences for the malfeasance of man. A more robust theology is less accusatory and thereby more coarsely granular — maintaining that such evil has entered the world because of the fall of man. Under such design our divine divorce has corrupted not only behavior, but our very natures, and all of creation. Yet such theology is of little comfort to those who are the objects of such seemingly random evil; we demand to know of God, “Why?” — and in particular, “Why me?” Yet there is no answer forthcoming, and we are left assuming a God either powerless to stop such evil or unwilling to do so.

Yet the problem of a good God, an omnipotent God, and an evil world of His creation is not entirely insoluble. Much lies in our projection of human frailty onto the nature of the Divine, and the impreciseness of our definitions of good and omnipotent. When we say God is good, we tend to mean that God is “nice” — that he would never do anything to cause us pain or suffering. Yet even in our limited experience, we must acknowledge that pain and suffering, while not inherently good, may be a means to goodness. We choose to have surgery or chemotherapy, though painful and debilitating, that our cancer may be cured. The halls of Alcoholics Anonymous are filled with men and women who, having faced both personal and relational destruction, have used their former liabilities as a gateway to a new, more fulfilling life — one which could not have taken place apart from their harrowing journey through alcoholism. To a misbehaving child, the discipline of a loving father is not perceived as good, but such correction is essential for the development of personal integrity, social integration, and responsibility.

Our inability to discern the potential for good in pain and suffering does not by necessity deny its presence; there are many who, when asked, will point to painful, difficult, and unbearable times in life which have brought about profound, often unexpected good in their lives, unforeseeable in the midst of their dark days. There surely is much suffering which defies our capacity to understand, even through we strive with every fiber of our being to find the goodness therein. But the fact that such inexplicable suffering exists, and that answers are often lacking, does not preclude the possibility that God is good, or that such suffering may ultimately lead to something greater and more noble than the pain endured.

We are … not merely imperfect creatures that need improvement: we are rebels that need lay down their arms

In our egocentricity we often neglect to look for the benefit in our suffering which comes not to us, but rather to others. Caring for someone suffering unbearably provides an opportunity to the caretaker to experience selfless love, compassion, tenderness, patience and endurance — character traits sadly lacking in our selfish world, which routinely turns its back on suffering to pursue an untroubled life of self-fulfillment and self-gratification. It is not inherently evil to be called to give beyond our means and ability — as caring for someone suffering always demands — for in the exhaustion and inadequacy thus revealed, we may discover unknown inner strengths, and come to a richer, and more fulfilling dependence on God. We are, as CS Lewis so accurately described, “not merely imperfect creatures that need improvement: we are rebels that need lay down their arms” — and finding how shallow are our reserves of love, compassion, and strength, we may through this brokenness seek to acquire them, humbly, from their Source.

But surely an omnipotent God has the power to stop suffering — is He not either impotent or evil when failing to use such power to remove our suffering? The omnipotence of God, like His goodness, is but dimly perceived. For the power of God is in perfect harmony with the purpose of God, and is thus used to advance these purposes for the greater good. Thus, the good deed of creating man with free will — and thereby capable of love — by its very nature restrains the omnipotence of God to violate that free will. The evil of the world exists in large part, if not wholly, because this free will has been abused. Yet the abuse of free will must be permitted, that the proper use of free will — the laying down of arms, the surrender to the sovereignty of a wholly good God — may take place, freely and unfettered as required by love. God must tolerate the existence of suffering and evil, that all may have the freedom to choose the good — though many will refuse to do so.

Yet he does not merely tolerate the presence of suffering, but provides for its very redemption: that suffering, though itself evil, may ultimately produce good. Thus pain, suffering, death, and evil need not triumph: they may provide the means that some may turn toward the good, or bring forth further good for themselves or others. This is redemption: to buy back that which is destructive, worthless, of no value, evil, and make it worthwhile, valuable, even priceless.

Christianity, throughout its history, has struggled with and largely resolved the problem of pain, within the confines of the mystery of God. Yet Christianity in its many doctrinal eddies has sometimes chosen the wrong path and the wrong answers to this challenge. Such errors generally fall into two broad categories: the concept of suffering as punishment or retribution from God, and the manipulation of God for man’s gratification. The first of these runs counter to the core doctrine of the cross: that God has chosen to provide in Christ a sacrificial lamb — that Christ, through his suffering, may bear the justice of God, so that we may see the mercy of God. Our suffering is not a punishment for sin, as such punishment negates the purpose of the cross. Correction, it may be; discipline, it often is; opportunity, it always is; punishment, it never is.

The countering position — that of God as divine opiate, ever present to kill our pain — is a variant of the faith which has become perniciously widespread, feeding on a culture of ease and self-gratification which creates God in its own image. Thus God becomes a font of wealth, of health, of prosperity, of a trouble-free materialistic lifestyle, a divine vending machine whose coinage is faith. Faith, however, in such a worldview is no longer a profound trust in a God who is beyond understanding and infinitely wise, but becomes instead a means of buying from God all which we demand. Hence, we may be wealthy, if we only have enough faith; we may be healed, if our faith is sufficient; we will not suffer if we will but strengthen and enlarge our faith. Our faith must be prefect, lest our pleas go unheard. The strength of faith matters more than its verity; we charge the gates of heaven with the bludgeon of self-will.

The perniciousness and destructiveness of this perversion of historical Christian faith lies in removing from the hands of God decisions of life and death, health and illness, wholeness and suffering, while burdening us with the hopeless demand that we steel our faith to impossible heights to coerce and manipulate the will of God. That such efforts are typically fruitless seems self-evident: God most surely is capable of healing — and does indeed do so often, even dramatically at times — but most surely does so in accordance with his divine wisdom and will. Should His wisdom dictate that suffering, poverty, brokenness, even death and despair would better serve the purposes of drawing men to Himself, what measure of human obstinacy and recalcitrance will change this will? When such “faith” proves futile, it destroys trust in God, and not infrequently leads to utter loss of belief, a bitter agnosticism born in false expectations and misplaced hope.

We demand of God that which we alone deem to be good, then blame Him when He pursues a greater good beyond our understanding

Hence, we demand of God that which we alone deem to be good, then blame Him when He pursues a greater good beyond our understanding. This is the struggle to which Kathleen is alluding, as she questions the goodness of God in failing to heal her husband, blaming her own “sins” for his untimely demise. To us, such a healing seems only good — in so far as it mitigates our pain and loss, as well as that of those we love — but like the surgeon’s knife, sometimes such pain must not be withheld that evil may be conquered by the good. Were he healed, and restored to full health, would he not then face death on yet another day? Our lives have both purpose and a proper time: we live for that purpose, and we die when that purpose is fulfilled. That those who are left behind cannot grasp that purpose — and appropriately suffer profound pain and loss at this separation — does not negate that purpose nor impede its culmination.

We live in a time when our expectations of health, of prosperity, of a pain-free life are increasingly met in the physical realm, while we progressively become sickly, impoverished, and empty in the realm of the spirit. Despite our longer lives, we live in dread of death; despite our greater health, we obsess about our ills; despite our comfortable lives, we ache from an aimlessness and purposelessness which eats at our souls and deadens our spirits. Though we have at our command the means to kill our pain–to a degree never before seen in the history of the world–yet we have bargained away our peace in pursuit of our pleasure. The problem of pain has never been an easy one; in our day, it has not been solved, but rather worsened, by our delusions of perpetual comfort and expectations of a trouble-free life.

Until we come to terms with suffering, we will not have comfort; until we embrace our pain, peace will never be ours.

Killing Mercy

The ethics of euthanasia, which as an issue generally stays just barely on our radar screens, given the host of contentious social issues taking up our political and cultural bandwidth, nevertheless may ultimately prove to be an enormous dilemma, with profound impact on both our lives as a society and as individuals. While the issue has only occasionally nosed into the political limelight–usually associated with some initiative regarding physician-assisted suicide–the underlying currents which keep this matter very much alive are powerful and unlikely to be resolved easily or painlessly.

There is broad appeal for the idea of euthanasia. It seems to fit perfectly into our Western democratic principles of the autonomy of the individual, rights and freedom, and the desire to control our own destinies. It seems as well an ideal solution to an out-of-control health care system, where technology and advances in life-sustaining capabilities seem to have taken on a life of their own, driving health care costs to extraordinary levels in the final years of our life, and seemingly removing much of the dignity we believe should be the inherent right of the dying. Patient’s families watch helplessly as their loved ones appear to be strung along in their dying days, tubes and wires exiting from every orifice, a relentless train of unknown physicians and ever-changing nurses breezing in and out of their rooms to tweak this medication or that machine. We all wish for something different for ourselves as well as our loved ones, but seem to be incapable of bringing that vision to fruition.

Euthanasia offers what appears to be an ideal solution to many of these difficulties. We love the idea that the individual may choose the time and place of their own demise; we see an easy and painless exit to prolonged suffering; we visualize a measure of mastery returning to a situation where are all seems out of control; we see a solution to pointless expenditures of vast sums of money on patients with little or no hope of recovery. It is for these reasons that initiatives to legalize this process are commonly called “death with dignity” or some similar euphemism reflecting these positive aspects–and when put forward, often find as a result a substantial degree of public approval.

This appeal grows ever stronger as our culture increasingly emphasizes personal autonomy and de-emphasizes social responsibility. We are, after all, the captains of our own ship, are we not? A culture which believes that individual behavior should be virtually without limit as long as “no one is harmed” can see little or no rational reason why such individual autonomy should not be extended to end-of-life decisions.

The reality, unfortunately, is that “no one is harmed” is a uniquely inadequate standard for human behavior, and our autonomy is far less than we would like to believe. It assumes that human behavior occurs in a vacuum. Thus we hear that sexual relations between consenting adults are entirely reasonable if “no one is harmed”–a standard commonly applied to relationships outside of marriage, for example, which often end up having a profound and destructive effect both on the spouse–and particularly on the children. “No one is harmed” serves as mere justification for autonomous behavior while denying or minimizing the inevitable adverse consequences of this behavior. When Joe has an affair with Susie at the office, and ends up in divorce court as a result, there can be little question that many are harmed: Joe’s children, not the least; his wife; perhaps the husband and children of the woman with whom he has had an affair. Yet in the heat of passion, “no one is harmed” is self-evident–believed even if false. And to mention these obvious ramifications of a supposedly “harmless” behavior is to be “judgmental” and therefore must be assiduously avoided.

But the consequences are real, and their ripple effect throughout society is profound: to cite one simple example, children from broken homes are far more prone to become involved in gangs or crime, to be abused sexually or physically; to initiate early sexual activity and become unwed mothers; to under-perform academically, and to have greater difficulty with relationships as teenagers and adults. These effects–particularly when magnified on a society-wide scale–have effects vastly broader than the personal lives of those who have made such autonomous choices.

Similarly, an argument is often used by libertarians (and others) for drug legalization using this same hold-harmless rationale. After all, who could argue with personal drug use in the privacy of your home, since “no one is harmed?” No one is harmed, of course–unless the residual, unrecognized effects of your drug use affects your reflexes while driving the next day, resulting in an accident; or impairs your judgment at work, costing your employer money or resulting in a workplace injury; or when, in the psychotic paranoia of PCP use, you decide your neighbor is trying to kill you, and beat him senseless with a baseball bat; or when the drug itself, in those so physiologically prone, leads to addictive behavior which proves destructive not merely to the individual, but to family, fellow workers, and society as a whole. Burning up every spare dollar of a family’s finances to support a drug habit, and stealing to support it–surely not an unusual scenario–can hardly be qualified as “no one is harmed.” To claim that there is no societal impact from such individual autonomous behavior is profoundly naive, and represents nothing more than wishful thinking.

But what about euthanasia? Surely it is reasonable to end the life of someone who is suffering unbearably, who is beyond the help of medical science, and who has no hope of survival, is it not? This, of course, is the scenario most commonly presented when legalization of euthanasia is promoted. It should be stated without equivocation that such cases do indeed exist, and represent perhaps the most difficult circumstances in which to argue against euthanasia. But it should also be said that such cases are becoming far less common as pain management techniques and physician training in terminal care improve: in my experience, and in the experience of many of my peers who care for the terminally ill, is a rare occurrence indeed that a patient cannot have even severe, intractable pain managed successfully.

But the core arguments used in support of euthanasia in such dire circumstances are easily extended to other terminal situations–or situations not so very terminal at all. Intractable terminal pain merges seamlessly into hopeless prognosis, regardless of time frame; then flows without interruption to chronic diseases such as multiple sclerosis or severe disabilities. Once the principle of death as compassion becomes the guiding rule, the Grim Reaper will undergo metamorphosis into an angel of light, ready to serve one and all who suffer needlessly.

To mitigate the risk of this so-called “slippery slope,” it has been suggested that safeguards against such mission creep be crafted. Such measures may invoke mandatory second opinions, waiting periods, or committee review, prior to approval of an act of euthanasia. That such measures are ultimately doomed to fail is self-evident: in effect, they impose a roadblock between patient autonomy and relief of suffering and its amelioration through euthanasia–and thus run counter to the core principle sustaining it. It is not difficult to foresee that such roadblocks will quickly be made less “burdensome,” if not rendered utterly impotent, by relentless pressures to prevent patients from needlessly suffering, regardless of their underlying disease.

Perhaps more importantly, the process of assessing and approving an act of euthanasia through second opinions or committee review is not some ethically neutral decision, such as vetting budget items or inventory purchases. Those who serve in such advisory or regulatory capacity must by necessity be open to–indeed supportive of–the idea of euthanasia, lest all reviewed cases be denied. As demand for euthanasia increases, such approvals will become rubber-stamped formalities, existing solely to provide defensive cover for unrestricted assisted termination.

But such arguments against euthanasia are in essence process-oriented, and miss the much larger picture of the effects of individual euthanasia on our collective attitudes about life and death, and our societal constitution. There can be little question that the practice of actively terminating ill or dying patients will have a profound effect on the physicians who engage in this practice. The first few patients euthanized may be done in a spirit of compassion and mercy–but repetition deadens the soul and habitualizes the process. This is routinely seen in many areas of health care training and practice: the first cut of a novice surgeon is frightening and intimidating; the thousandth incision occurs with nary a thought. One’s first autopsy is ghoulish; the hundredth merely objective fact-finding. Euthanasia, practiced regularly, becomes simply another tool: this can be readily seen in the statistics from the Netherlands, where even 15 years ago, a startling percentage of reported cases of euthanasia by physicians took place without explicit patient request — reflecting far more a utilitarian attitude toward euthanasia than some diabolical conspiracy to terminate the terminal. The detached clinicians, utterly desensitized to the act of taking a life, now utilize it as they would the initiation of parenteral nutrition or the decision to remove a diseased gallbladder.

Such false assumptions about the objective impartiality of the decision-making process leading to euthanasia can be seen as well when looking at the family dynamics of this process. We are presented with the picture of the sad but compassionate family, quietly and peacefully coming to the conclusion that Dad–with his full assent, of course–should mercifully have his suffering ended with a simple, painless injection. Lost in this idyllic fantasy is the reality of life in families. Anyone who has gone through the death of a parent and the settlement of an estate knows first-hand the fault lines such a life crisis can expose: old grievances brought back to life, old hot buttons pushed, greed and avarice bubbling to the surface like a toxic witch’s brew. Does brother John want Dad’s dignified death so he can cop the insurance cash for his gambling habit? Does sister Sue, who hates her father and hasn’t spoken to him in years, now suddenly want his prompt demise out of genuine concern for his comfort and dignity? Are the children–watching the estate get decimated by the costs of terminal care–really being objective about their desire for Mom’s peaceful assisted death? And does Mom, who knows she’s dying, feel pressured to ask for the needle so she won’t be a burden to her children? Bitter divisions will arise in families who favor euthanasia and those who oppose it–whether because of their relationship, good or bad, with the parent, or their moral and ethical convictions. To make euthanasia the solution to difficult problems of death and dying, as suggested by its proponents, will instead require the death of our spirits: a societal hardness of heart whose effects will reach far and wide throughout areas of life and culture far beyond the dying process. Mercy killing will kill our mercy; death with dignity so delivered will leave us not dignified but degraded.

The driving force behind legalized euthanasia and physician-assisted suicide is patient autonomy: the desire to maintain control over the dying process, by which, is it hoped, we will maintain our personal dignity. But the end result of legalized euthanasia will instead, in many cases, be loss of patient autonomy. When legalized, medical termination of life will by necessity be instituted with a host of safeguards to prevent its abuse. Such safeguards will include restricting the procedure to those in dire straights: intolerable suffering, a few months to live, and the like. Inherent in these safeguards are the seeds of the death of patient autonomy: such determinations must rely on medical judgments–and therefore will ultimately lie in the hands of physicians rather than patients. It will be physicians who will decide what is intractable pain; it is physicians who will judge how long you have to live; it is physicians who will have the last say on whether your life has hope or is no longer worth living. Such decisions may well be contested–but the legal system will defer to the judgment of the health care profession in these matters. Patient autonomy will quickly become physician autocracy. For those who request euthanasia, it will be easy; for those who do not wish it, but fit the criteria, it will also be far too easy.

This has been the legal and practical evolution of euthanasia in the Netherlands. The legal progression from patient autonomy with safeguards to virtual absence of restrictions on euthanasia is detailed in a superb paper from Brooklyn Law School’s Journal of International Law (available here as a PDF), in which this evolution is detailed:

Soon after the Alkmaar case was decided, the Royal Dutch Medical Association (KNMG) published a set of due care guidelines that purported to define the circumstances in which Dutch physicians could ethically perform euthanasia.

The KNMG guidelines stated that, in order for a physician to respond to a euthanasia request with due care,

  • The euthanasia request must be voluntary, persistent, and well-considered.
  • The patient must suffer from intolerable and incurable pain and a discernible, terminal illness.

Thereafter, Dutch courts adopted the KNMG guidelines as the legal prerequisites of due care in a series of cases between 1985 and 2001. Despite the integration of the KNMG’s due care provisions, courts remained confused regarding what clinical circumstances satisfied the requirements of due care. In 1985, a court acquitted an anesthesiologist who provided euthanasia to a woman suffering from multiple sclerosis. The court thereby eliminated the due care requirement that a patient must suffer from a terminal illness. By 1986, courts decided that a patient need not suffer from physical pain; mental anguish would also satisfy the intolerable pain due care requirement.

Similarly, all reported prosecutions of euthanasia prior to 1993 involved patients who suffered from either physical or mental pain. Then, in the 1993 Assen case, a district court acquitted a physician who had performed active voluntary euthanasia on an otherwise healthy, forty-three year old woman. The patient did not suffer from any diagnosable physical or mental condition, but had recently lost both of her sons and had divorced her husband. With the Assen case, Dutch courts seemed to abandon the requirement that a patient suffer from intolerable pain or, for that matter, from any discernible medical condition as a pre-condition for the noodtoestand [necessity] defense.

The requisite ambiguity of all such safeguards will invariably result in their legal dilution to the point of meaninglessness–a process which increasingly facilitates the expansion not only of voluntary, but also involuntary euthanasia. This is inevitable when one transitions from a fixed, inviolable principle (it is always wrong for a physician to kill a patient) to a relative standard (you may end their lives under certain circumstances). The “certain circumstances” are negotiable, and once established, will evolve, slowly but inexorably, toward little or no standards at all. When the goalposts are movable, we should not be surprised when they actually get moved.

Another effect rarely considered by those favoring euthanasia is its effect on the relationship between patients and their physicians. The physician-patient relationship at its core depends upon trust: the confidence which a patient has that their physician always has their best interests at heart. This is a critical component of the medical covenant–which may involve inflicting pain and hardship (such as surgery, chemotherapy, or other painful or risky treatments) on the patient for their ultimate benefit. Underlying this trust is the patient’s confidence that the physician will never deliberately do them harm.

Once physicians are empowered to terminate life, this trust will invariably erode. This erosion will occur, even were involuntary euthanasia never to occur–a highly unlikely scenario, given the Dutch experience. It will erode because the patient will now understand that the physician has been given the power to cause them great harm, to kill them–with the full legal and ethical sanction of the law. And the knowledge of this will engender fear: fear that the physician may abuse this power; fear that he or she may misinterpret your end-of-life wishes; fear that he may end your life for improper motives, yet justify it later as a legal and ethical act. The inevitable occurrence of involuntary euthanasia–which in an environment of legalized voluntary euthanasia will rarely if ever be prosecuted–will only augment this fear, especially among the elderly and the disabled. In the Netherlands, many seniors carry cards specifying that they do not wish to have their lives terminated–a reflection of a widespread concern that such an occurrence is not uncommon, and is feared.

Montana judge: man has right to assisted suicide

Effects on physicians:

Helen

Effects on Physicians

PHYSICIAN-ASSISTED SUICIDE IN OREGON:
A MEDICAL PERSPECTIVE

A Life Not Long

sunset

Recently, I’ve been ruminating on a topic which a frequent topic online and elsewhere: the endless pursuit of a longer, or eternal, life.

Here’s the question I’ve been pondering: is it an absolute good to be continually striving for a longer life span? Such a question may seem a bit odd coming from a physician, whose mission it is to restore and maintain health and prolong life. But a recent article describing the striking changes in health and longevity of our present age, seemingly presents this achievement as an absolute good, and thereby left me a tad uneasy — perhaps because I find myself increasingly ambivalent about this unceasing pursuit of longer life.

Of course, long life and good health have always been considered blessings, as indeed they are. But long life in particular seems to have become a goal unto itself — and from where I stand is most decidedly a mixed blessing.

Many of the most difficult health problems with which we battle, which drain our limited resources, are largely a function of our longer life spans. Pick a problem: cancer, heart disease, dementia, crippling arthritis, stroke — all of these increase significantly with age, and can result in profound physical and mental disability. In many cases, we are living longer, but doing so restricted by physical or mental limitations which make such a longer life burdensome, both to ourselves and to others. Is it a positive good to live to age 90, spending the last 10 or more years with dementia, not knowing who you are nor recognizing your own friends or family? Is it a positive good to be kept alive by aggressive medical therapy for heart failure or emphysema, yet barely able to function physically? Is it worthwhile undergoing highly toxic chemotherapy or disfiguring surgery to cure cancer, thereby sparing a life then severely impaired by the treatment which saved that life?

These questions, in some way, cut to the very heart of what it means to be human. Is our humanity enriched simply by living longer? Does longer life automatically imply more happiness–or are we simply adding years of pain, disability, unhappiness, burden? The breathlessness with which authors often speak of greater longevity, or the cure or solution to these intractable health problems, seems to imply a naive optimism, both from the standpoint of likely outcomes, and from the assumption that a vastly longer life will be a vastly better life. Ignored in such rosy projections are key elements of the human condition — those of moral fiber and spiritual health, those of character and spirit. For we who live longer in such an idyllic world may not live better: we may indeed live far worse. Should we somehow master these illnesses which cripple us in our old age, and thereby live beyond our years, will we then encounter new, even more frightening illnesses and disabilities? And what of the spirit? Will a man who lives longer thereby have a longer opportunity to do good, or rather to do evil? Will longevity increase our wisdom, or augment our depravity? Will we, like Dorian Gray, awake to find our ageless beauty but a shell for our monstrous souls?

Such ruminations bring to mind a friend, a good man who died young. Matt was a physician, a tall, lanky lad with sharp bony features and deep, intense eyes. He was possessed of a brilliant mind, a superb physician, but left his mark on life not solely through medicine nor merely by intellect. A convert to Christianity as a young adult, Matt embraced his new faith with a passion and province rarely seen. His medical practice became a mission field. His flame burned so brightly it was uncomfortable to draw near: he was as likely to diagnose your festering spiritual condition as your daunting medical illness — and had no compunction about drilling to the core of what he perceived to be the root of the problem. Such men make you uneasy, for they sweep away the veneer of polite correction and diplomatic encouragement which we physicians are trained to deliver. Like some gifted surgeon of the soul, he cast sharp shadows rather than soft blurs, brandishing his brilliant insight on your now-naked condition. The polished conventions of medicine were never his strength — a characteristic which endeared him not at all to many in his profession. But his patients — those who could endure his honesty and strength of character — were passionate in their devotion to him, personally and professionally. For he was a man of extraordinary compassion and generosity, seeing countless patients at no charge, giving generously of his time and finances far beyond the modest means earned from his always-struggling practice.

The call I received from another friend, a general surgeon, requesting an assist at his surgery, was an unsettling one: Matt had developed a growth in his left adrenal gland. His surgery went deftly, with much confidence that the lesion had been fully excised. The pathology proved otherwise: Matt had an extremely rare, highly aggressive form of adrenal cancer. Fewer than 100 cases had been reported worldwide, and there was no known successful treatment. Nevertheless, as much for his wife and two boys as for himself, he underwent highly toxic chemotherapy, which sapped his strength and left him enfeebled. In spite of this, the tumor grew rapidly, causing extreme pain and rapid deterioration, bulging like some loathsome demon seeking to burst forth from his frail body. I saw him regularly, although in retrospect not nearly often enough, and never heard him complain; his waning energies were spent with his family, and he never lost the intense flame of faith. Indeed, as his weakened body increasingly became no more than life support for his cancer, wasting him physically and leaving him pale and sallow, there grew in him a spirit so remarkable that one was drawn to him despite the natural repulsion of watching death’s demonic march.

Matt died at age 38, alert and joyful to the end. His funeral was a most remarkable event: at an age in life where most would be happy to have sufficient friends to bear one’s casket, his funeral service at a large church was filled to overflowing — thousands of friends, patients, and professional peers paying their respects in a ceremony far more celebration than mourning. There was an open time for testimony — and such a time it was, as one after another took to the lectern to speak through tears of how Matt had touched their lives; of services rendered, small and large, unknown before that day; of funny anecdotes and sad remembrances which left few eyes dry, and not one soul of that large crowd untouched or unmoved.

A journey such as his casts critical light on our mindless pursuit of life lived only to endure longer. In Matt’s short life he brought more good into the world, touched more people, changed more lives, than I could ever hope to do were I to live a century more. It boils down to purpose: mere years are no substitute for a life lived with passion, striving for some goal greater than self, with transcendent purpose multiplying and compounding each waking moment. This is a life well-lived, whether long or short, whether weakened or well.

Like all, I trust, I hope to live life long, and seek a journey lived in good health and sound mind. But even more — far more indeed — do I desire that those days yet remaining — be they long or short — be rich in purpose, wise in time spent, drenched in prayer, and graced by love for others and for God.

On Assisted Suicide


In a previous post on physician-assisted suicide, I had the following exchange with a commenter named Van:

Van: I take it you are are against assisted-suicide?

Let me ask you this – how can we say we live in a free nation if we cannot do what we wish to our own bodies, as long as we do not impact the life, liberty and safety of others?

I have mixed feelings on the subject, but I really have a hard time with others telling me what to do with my body.

Dr. Bob: Yes, very much against it.

You are, of course, perfectly free to end your own life, with or without such legislation. A handgun and a single bullet will do the job very nicely–along with a hundred other ways.

The issue with this public policy is that you are asking your physician to kill you — and therefore it is no longer just about what you do with your body, but very much involves other people–the doctor, the families, and society as a whole.

The problem with the “it’s my body” radical self-autonomy is that it focuses solely on the self, while conveniently ignoring the enormous consequences of such legalization on others and society as a whole.

Van: So your key issue is the doctor assisting in the suicide, thereby involving others?

Let’s say you have a 90 year old individual with no family, suffering from cancer, who has no meaningful impact on others. If they take their own life, you are OK with it?

Just trying to understand where you are coming from.

Van’s question is a valid one, to be addressed shortly, but in a digression, one should note what often passes for arguing from principles in our current culture: the argument from the exceptional. When promoting or defending some contentious social or moral issue, we seem always to find the most extreme example imaginable and argue from this specific instance, then applying our conclusions from the specific to the general.

So, for example, when arguing for government prescription health coverage, we must first find some old woman who has to eat cat food in order to pay for her prescriptions; when discussing gay adoption, we must find the idyllic gay couple, lifelong partners (or so we are told), ecstatically happy with nary a relational dispute, as parents; when arguing for assisted suicide, we must find the patient in unbearable pain with a loving husband passionate about ending her life “in dignity” by slipping her a deadly cocktail — or one who is dying utterly alone, with nary a friend or family member to share their suffering. That such argumentation almost invariably presents a false dichotomy is never considered: that far better alternatives might exist to solve the problem is never pondered; that applying the suggested solution based on emotion without consideration for its broad implications or ramifications may well prove disastrous — such complications are never considered as possibilities. We press for great social and policy changes with profound effects on culture and society using pop emotionalism and pulp fiction.

But I digress. So, to answer the question: I would not find suicide of such a sadly-abandoned individual justified, simply because no physician was involved. Suicide is the ultimate repudiation of life, of relationships, of hope, the product of the deep hopelessness and self-absorbed insanity of depression. My point was simply this: we all have free will. Each of us may choose, if we decide to do so, to end our own lives. There is a pernicious distortion of the idea of freedom which is a product of our radical individualism, to wit: I live in a free society, therefore by necessity I must be free to do whatsoever I please. Others must not only allow me to do so, but must bear the consequences of my actions, and must be actively engaged in enabling my behavior, because it is my right. Hence, I must be free to say anything I wish, without consequence, including any criticism of my speech; I must be free to terminate my pregnancy, without guilt or restriction, though my unborn child pays the ultimate price; I must be free to end my life when I wish, and my physician must be required to deliver the lethal potion — or at least must be coerced into finding another doctor who will, if his “values” (defined as mere subjective opinions) don’t agree with mine.

Many of the “rights” which are being promulgated and promoted by today’s secular culture are in reality straw men, fine-sounding proxies for demands and desires far less salutary than they sound. Thus, gay marriage is not about gays getting married (hence the lack of enthusiasm among gay rights advocates for civil unions which provide all the legal benefits of marriage), but is instead an effort to undermine traditional heterosexual marriage as normative in culture, thereby removing not merely legal but cultural restraints on all forms of sexual and relational heterodoxy. The high standard — heterosexual marriage, with its enormous advantages in the raising of children and establishment of societal self-restraint, morality, and relational stability — must be brought down to the lowest common denominator of any two (or more) people getting “married” — with the sole purpose of muting societal condemnation for self-gratifying, dysfunctional and heterodox partnerships. Unrestricted abortion, a.k.a. “freedom of choice” — or, “women’s health care”– is about the uncompromising (albeit delusional) demand for unconstrained sexual license without consequences — especially for women, but also for their sperm donors who want no responsibility for their casual hookups: dispose of the unplanned pregnancy, move on to your next “partner”, and you have achieved the perfect “zipless fuck.”

Likewise, physician-assisted suicide is not at all about “death with dignity”, but rather about actively enlisting the culture in support of radical individual autonomy. Not only must we exert full control over the time and manner of our death — which we have always been able to do, by simply killing ourselves — but we demand that society support, honor, and praise this decision, without the faintest whiff of criticism or condemnation. It is not sufficient that we be able to kill ourselves. Rather, it is necessary that we actively kill those societal sensibilities and strictures which condemn such a choice as morally misguided and potentially destructive to our human dignity and social fabric.

Were some silver-suited alien from Alpha Centuri to visit our noble globe, he would no doubt find our passion for self-extinction puzzling, to say the least. What manner of sentient being seeks to facilitate its own demise, only to perpetuate the illusion that they control their own lives? Has their existence no purpose but to be ended at their own discretion? Are their relationships so shallow that they choose death over life; has their suffering no meaning; will their precious time with life partners, friends, and offspring be traded for the dark comfort of a deadly cocktail? Who are these intelligent fools, our visitor would ask, who hand over the power of death to their doctors, oblivious to the evil which dwells in the hearts of men, waiting to be empowered by cold rationalism, scientific professionalism, self-justification, and sterile repetition?

Yet were our starship sojourner to examine the society which breeds such nihilism, he would, by turns, find his answer: we are, for all our technological advances and unbounded prosperity, a culture without meaning, a people without purpose. We have embraced unquestioningly the mantra of materialism: we have come from nothing, and to nothing shall return. Our relationships mean naught but what we may gain from them; our suffering gains us nothing but rage and resentment; our deaths are like our lives — without hope, without a future, joyless and empty. We desperately push the buttons and mix the potions which promise to make us happy and whole, yet find they only echo forlornly through our hollow souls, singing that siren song:

“I am my own master.”

Assisted Suicide: Coming to a State Near You

I hope to have more to say on the issue of euthanasia and assisted suicide in the near future. In the meantime, I highly recommend this article by Herbert Hendin, M.D. Dr. Hendin’s book, Seduced by Death: Doctors, Patients, and Assisted Suicide, is an excellent resource on the topic, the result of extensive research and multiple interviews taken while studying euthanasia practices in the Netherlands. This article provides a nice summary of his research and experience, which builds a solid case against euthanasia and physician-assisted suicide.

Washington has recently become the second state to pass an assisted suicide initiative, and, legislating from the bench, a Montana judge has ruled that man has right to assisted suicide.

This movement is on a roll, and you will want to be informed about why this is such a ghastly public policy trend.

A few highlights from the article:

Concern over charges of abuse led the Dutch government to undertake studies of the practice in 1990, 1995 and in 2001 in which physicians’ anonymity was protected and they were given immunity for anything they revealed. Violations of the guidelines then became evident. Half of Dutch doctors feel free to suggest euthanasia to their patients, which compromises the voluntariness of the process. Fifty percent of cases were not reported, which made regulation impossible. The most alarming concern has been the documentation of several thousand cases a year in which patients who have not given their consent have their lives ended by physicians. A quarter of physicians stated that they “terminated the lives of patients without an explicit request” from the patient. Another third of the physicians could conceive of doing so.

An illustration of a case presented to me as requiring euthanasia without consent involved a Dutch nun who was dying painfully of cancer. Her physician felt her religion prevented her from agreeing to euthanasia so he felt both justified and compassionate in ending her life without telling her he was doing so. Practicing assisted suicide and euthanasia appears to encourage physicians to think they know best who should live and who should die, an attitude that leads them to make such decisions without consulting patients–a practice that has no legal sanction in the Netherlands or anywhere else.

Assisted-suicide laws are always framed as being “compassionate” — appealing to the universal fear of dying a prolonged and painful death. Yet the unintended consequences of giving physicians the unrestricted power of life and death are often anything but:

Compassion is not always involved. In one documented case, a patient with disseminated breast cancer who had rejected the possibility of euthanasia had her life ended because, in the physician’s words: “It could have taken another week before she died. I just needed this bed.”

He also extensively studied Oregon’s experience with assisted suicide — the legislation which served as the model for Washington’s law — and found plenty of problems here as well:

Oregon physicians have been given authority without being in a position to exercise it responsibly. They are expected to inform patients that alternatives are possible without being required to be knowledgeable enough to present those alternatives in a meaningful way, or to consult with someone who is. They are expected to evaluate patient decision-making capacity and judgment without a requirement for psychiatric expertise or consultation. They are expected to make decisions about voluntariness without having to see those close to the patient who may be exerting a variety of pressures, from subtle to coercive. They are expected to do all of this without necessarily knowing the patient for longer than 15 days. Since physicians cannot be held responsible for wrongful deaths if they have acted in good faith, substandard medical practice is encouraged, physicians are protected from the con-sequences, and patients are left unprotected while believing they have acquired a new right.

The idea of assisted suicide has enormous allure in a culture of self-gratification and increasingly-shallow moral and ethical principles. Don’t be surprised when it comes your way — be prepared.

A Meditation on Life, from a Dying Man

Tony SnowTony Snow , a journalist and White House press secretary under George W. Bush, passed away on July 12, 2008 from colon cancer. This was a meditation he wrote in his last days:

Blessings arrive in unexpected packages, – in my case, cancer. Those of us with potentially fatal diseases – and there are millions in America today – find ourselves in the odd position of coping with our mortality while trying to fathom God’s will. Although it would be the height of presumption to declare with confidence ‘What It All Means,’ Scripture provides powerful hints and consolations.

The first is that we shouldn’t spend too much time trying to answer the ‘why’ questions: Why me? Why must people suffer? Why can’t someone else get sick? We can’t answer such things, and the questions themselves often are designed more to express our anguish than to solicit an answer.

I don’t know why I have cancer, and I don’t much care. It is what it is, a plain and indisputable fact. Yet even while staring into a mirror darkly, great and stunning truths begin to take shape. Our maladies define a central feature of our existence: We are fallen. We are imperfect. Our bodies give out.

But despite this, – or because of it, – God offers the possibility of salvation and grace. We don’t know how the narrative of our lives will end, but we get to choose how to use the interval between now and the moment we meet our Creator face-to-face.

Second, we need to get past the anxiety. The mere thought of dying can send adrenaline flooding through your system. A dizzy, unfocused panic seizes you. Your heart thumps; your head swims. You think of nothingness and swoon. You fear partings; you worry about the impact on family and friends. You fidget and get nowhere.

To regain footing, remember that we were born not into death, but into life,- and that the journey continues after we have finished our days on this earth. We accept this on faith, but that faith is nourished by a conviction that stirs even within many non-believing hearts… an intuition that the gift of life, once given, cannot be taken away. Those who have been stricken enjoy the special privilege of being able to fight with their might, main, and faith to live fully, richly, exuberantly – no matter how their days may be numbered.

Third, we can open our eyes and hearts. God relishes surprise. We want lives of simple, predictable ease,- smooth, even trails as far as the eye can see…. but God likes to go off-road. He provokes us with twists and turns. He places us in predicaments that seem to defy our endurance; and comprehension – and yet don’t. By His love and grace, we persevere. The challenges that make our hearts leap and stomachs churn invariably strengthen our faith and grant measures of wisdom and joy we would not experience otherwise.

‘You Have Been Called’. Picture yourself in a hospital bed. The fog of anesthesia has begun to wear away. A doctor stands at your feet, a loved one holds your hand at the side. ‘It’s cancer,’ the healer announces.

The natural reaction is to turn to God and ask him to serve as a cosmic Santa. ‘Dear God, make it all go away. Make everything simpler.’ But another voice whispers: ‘You have been called.’ Your quandary has drawn you closer to God, closer to those you love, closer to the issues that matter… and has dragged into insignificance the banal concerns that occupy our ‘normal time.’

There’s another kind of response, although usually short-lived an inexplicable shudder of excitement, as if a clarifying moment of calamity has swept away everything trivial and tiny, and placed before us the challenge of important questions.

The moment you enter the Valley of the Shadow of Death, things change. You discover that Christianity is not something doughy, passive, pious, and soft. Faith may be the substance of things hoped for, the evidence of things not seen. But it also draws you into a world shorn of fearful caution. The life of belief teems with thrills, boldness, danger, shocks, reversals, triumphs, and epiphanies. Think of Paul, traipsing through the known world and contemplating trips to what must have seemed the antipodes ( Spain ), shaking the dust from his sandals, worrying not about the morrow, but only about the moment.

There’s nothing wilder than a life of humble virtue, – for it is through selflessness and service that God wrings from our bodies and spirits the most we ever could give, the most we ever could offer, and the most we ever could do.

Finally, we can let love change everything. When Jesus was faced with the prospect of crucifixion, he grieved not for himself, but for us. He cried for Jerusalem before entering the holy city. From the Cross, he took on the cumulative burden of human sin and weakness, and begged for forgiveness on our behalf.

We get repeated chances to learn that life is not about us, that we acquire purpose and satisfaction by sharing in God’s love for others. Sickness gets us part way there. It reminds us of our limitations and dependence. But it also gives us a chance to serve the healthy. A minister friend of mine observes that people suffering grave afflictions often acquire the faith of two people, while loved ones accept the burden of two peoples’ worries and fears.

‘Learning How to Live’. Most of us have watched friends as they drifted toward God’s arms, not with resignation, but with peace and hope. In so doing, they have taught us not how to die, but how to live. They have emulated Christ by transmitting the power and authority of love.

I sat by my best friend’s bedside a few years ago as a wasting cancer took him away. He kept at his table a worn Bible and a 1928 edition of the Book of Common Prayer. A shattering grief disabled his family, many of his old friends, and at least one priest. Here was an humble and very good guy, someone who apologized when he winced with pain because he thought it made his guest uncomfortable. He retained his equanimity and good humor literally until his last conscious moment. ‘I’m going to try to beat [this cancer],’ he told me several months before he died ‘But if I don’t, I’ll see you on the other side.’

His gift was to remind everyone around him that even though God doesn’t promise us tomorrow, he does promise us eternity, – filled with life and love we cannot comprehend, – and that one can in the throes of sickness point the rest of us toward timeless truths that will help us weather future storms.

Through such trials, God bids us to choose: Do we believe, or do we not? Will we be bold enough to love, daring enough to serve, humble enough to submit, and strong enough to acknowledge our limitations? Can we surrender our concern in things that don’t matter so that we might devote our remaining days to things that do?

When our faith flags, he throws reminders in our way. Think of the prayer warriors in our midst. They change things, and those of us who have been on the receiving end of their petitions and intercessions know it. It is hard to describe, but there are times when suddenly the hairs on the back of your neck stand up, and you feel a surge of the Spirit. Somehow you just know: Others have chosen, when talking to the Author of all creation, to lift us up, – to speak of us!

This is love of a very special order. But so is the ability to sit back and appreciate the wonder of every created thing. The mere thought of death somehow makes every blessing vivid, every happiness more luminous and intense. We may not know how our contest with sickness will end, but we have felt the ineluctable touch of God.

What is man that Thou art mindful of him? We don’t know much, but we know this: No matter where we are, no matter what we do, no matter how bleak or frightening our prospects, each and every one of us who believe, each and every day, lies in the same safe and impregnable place, in the hollow of God’s hand.’

Tony Snow

Contrast this with the chatter of our age: the hollow arrogance of the neo-atheist; the mindless and irrational contradictions of the postmodern professor; the decadence devoid of dignity and grace in Hollywood’s finest; the flapping frivolity of the fawning and feckless media.

It is no small irony that the things of life grow clearest in the looming shadow of death; that for those who grasp these deeper things — glimpsed only in part, hoped for in faith rather than seen with the flesh — that the darkness of death casts sharp relief on the very essence and meaning of life.

Rest in peace, Tony. We will meet some day in the light, and our joy will be shared.