This Catholicism 101 special feature is part one of a debate between the editorial staff of The Torch.
To see the rebuttals from each side, please click here.
In order to talk about the spiritual ramifications of physician aid in dying, I think the first important step is to define the terms. My knowledge of this comes entirely from the recent bill passed in the state of California, called the End of Life Options Act (ELOA), of which a description is attached below. I became interested in the ethics of ELOA because my mother works for a non-profit hospice organization called Mission Hospice and Homecare, which serves the San Francisco Bay Area, and thus the passage of this bill has affected her company greatly. Several patients have already chosen to use ELOA since it became legal last June.
For nearly as long as my mom has worked at Mission, she has instilled in me the conviction that death is just another part of life. It is not to be dreaded or to be considered evil, because just like any part of life, there is sacredness in it.
I spoke with Martha Kay (MK) Nelson, one of the chaplains at Mission, about her experiences with ELOA. She has seen a sacredness in this way of dying, just as much as in the non-ELOA deaths she has seen. MK told me the story of a patient named Lynn, who chose ELOA, and I think her story is evidence that indeed God’s presence can be found in patient’s choice to die with dignity.
Lynn suffered from ALS, and was reaching the point in her sickness where she was deteriorating very quickly and would soon lose much of her quality of life. She had been through bouts of depression earlier in her illness, but when she started considering ELOA, she was doing it out of a place of peace with her impending death and readiness to accept it. She was no longer depressed, and wasn’t seeking an easy way out of her suffering.
Rather, MK describes one particular meeting they had, when Lynn was sitting by the window talking about ELOA, and she gestured gently towards the sun, streaming in from outside. MK said “it was almost like she was being called by God, like she heard the dinner bell and was called home”. MK didn’t mean to insinuate that Lynn’s choice to speed up her dying process was lighthearted, like being called to dinner, but rather that there was an authenticity to Lynn’s decision that was clearly not uncertain at all. She knew it was what she was meant to do.
MK said, “Lynn entered into this really interesting radiant peace. It was clear to me that she was articulating from her deepest or highest self. [The decision] really entered into her spiritual life.”
She described the actual day that Lynn decided to take the drug, for which MK was able to be present. She recalled how one of Lynn’s family members had been put so much at peace by Lynn’s own demeanor that day, saying, “we see how joyful Lynn is” and how “they really saw the best of her” that day. MK described the process of intentionally creating of a space for a holy act to take place, surrounded by people who had supported Lynn on her life’s journey and in her illness journey. She recalled how there were several minutes after Lynn had taken the medicine, when she was still there, looking around, smiling at everyone.
“How could that moment not be sacred?” MK said.
For me, that question is really the heart of why I believe ELOA is an important option for people to have. Yes, it’s an incredibly complicated decision, but ultimately for some people it is the right decision. For someone like Lynn, ELOA provides an opportunity to draw closer to God and to come to peace with their own dying process. They have the chance to open their ears and hearts to God, and then exercise their own free will based on where their spirit is led.
MK told me that with all of her experiences with patients, “in the two weeks it takes [between required verbal requests], you can’t not be prompted to think more deeply about it.” And thus, in a way the accessibility of ELOA causes a profound spiritual reflection in its own way. That is absolutely not to say that it is a more holy way to die than any other way, however it is to say that ELOA deaths are also sacred.
I also spoke with Don Mulford, another chaplain at Mission, and a Presbyterian pastor by training. Don explained the way he sees ELOA: “anytime you have to make a tough decision, it is an opportunity for your relationship with God to grow, because you are stretched.” He stressed the importance of recalling that God gave us free will, and the fact that to be human is to “partner with God in making decisions about our lives.”
Some people are deeply convicted that hastening their dying process is what’s right for themselves and their families, and ELOA simply gives them the chance to act upon conviction. Each person’s dying process is incredibly unique, and no person has the right to judge another’s choice, if they have made it prayerfully and intentionally.
Neither chaplain I spoke with seemed to believe that ELOA is always the best choice for patients in the dying process, and I don’t believe that either. Rather, ELOA is one way of dying with dignity, that has proven to be a good option for many patients. These patients are people with spiritual lives, who may not always be Christian, but nonetheless have been touched by the Holy Spirit and led in God’s wisdom. Through prayerful contemplation, they can experience a death that is profoundly holy and full of dignity.
What ELOA is:
ELOA is not suicide, because the patient is not killing themselves. They are already going to die within six months, usually less. Sometimes it is called “euthanasia”, but the term “euthanasia” typically implies someone else administering an injection or medication to another person in order to end the patient’s life. ELOA is entirely self-requested and self-administered, so it is also not that. Like refusal of possible treatments (a perfectly legal option for many patients) ELOA allows people to hasten their dying process once no other options are available.
ELOA allows for patients in California to request a high-dose lethal drug, on the conditions that they have an incurable and irreversible disease that leaves them with less than six months to live. Patients must be in good psychological condition as assessed by a physician. They must request the prescription verbally twice, a minimum of fifteen days apart. They also must fill out a written request, and receive a consult from a second physician confirming their terminal prognosis. Once they have received the drug, it has to be mixed with water, and they must be able to administer, drink, and swallow it themselves. Nobody else can assist them in taking the drug.
The rhetoric used when discussing euthanasia often focuses on the person suffering and whether the method used is quick and painless or “humane.” However, this misses the point of the opposition. Euthanasia in particular and suicide in general is wrong simply because it is an offense against one’s own person. Murder—the killing of an innocent person—is never justifiable, and this applies to others and one’s self equally. Thus, just as it is wrong to murder other people, it is wrong to take one’s own life, regardless of circumstances.
The third clause of the Hippocratic Oath reveals: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.” In fact, much of the Oath emphasizes the point of using one’s skills for healing and not the opposite. Though it forms the backbone of the Western medical tradition, rejection of the oath has become close to a matter of fact in many medical schools, not least due to this and similar issues.
The Greeks considered medicine to be an art. ‘Art’—in this sense—refers to a set of skills practiced for a purpose. Thus, the purpose of the medical art was to cure disease and foster health. Euthanasia, on the other hand, has the opposite aim as its goal. Any proponent of euthanasia must explain why it is that if a doctor should work to bring about health in the patient, the same should, in this one case, work against the purpose of his art.
For Christians, there is a still-graver reason for why euthanasia is wrong: Christians believe in a God who not only created the Universe, but who actively sustains it in this very moment and who actively guides history. St. Paul says, “And we know that God causes all things to work together for good to those who love God, to those who are called according to His purpose” (Rom. 8:28). Further, God spoke through Isaiah, saying, “Can a woman forget her nursing child and have no compassion on the son of her womb? Even these may forget, but I will not forget you” (Isa. 49:15). His power and love, then, work concordantly for our benefit, “for assuredly He does not give help to angels, but He gives help to the descendant of Abraham” (Heb. 2:16).
We can see that euthanasia amounts to the rejection of the belief in His providence and goodwill toward us. Underneath support for euthanasia seems to be the belief that somehow, He did not foresee that anyone could undergo this kind of suffering, that anyone could be in this much pain, and—more importantly—that His grace cannot help one to bear this heavy cross with dignity and honor. Of course, God's plan is often perplexing, but that does not mean it does not exist. Job questions God on precisely this point. God does not give him a rational explanation, perhaps because we cannot understand it. “My thoughts are not your thoughts, nor are your ways My ways,” He declares in Isaiah (Isa. 55:8). Instead, He declares to Job that He created the heavens and the earth and is Lord over history. The choice before Job and us is whether we trust that He has our best interest in mind, that He will not abandon us, and that He neither makes mistakes nor permits wanton suffering.
I have been honored to see someone who made the choice to trust God: my grandmother, Marieta Evangjeli. She spent most of her life with two broken knees, her husband was killed by the communists, her only son emigrated to the US and, finally, she was diagnosed with liver cancer. In the last few months she was in pain, horrendous pain. I know this from what the doctors said, not because she ever complained. Her smile never died from her face, neither did her zeal for the Lord.
She died calling for my father, who arrived two days later. Her pain was made worse by not being able to see her son for the last years of her life. I do not know why God permitted this woman who suffered so much to pass in such a painful way. I do not know why He did not permit her to see her son one last time. But I trust in Him, not least because she trusted in Him. Taking her own life was not something that even entered my grandmother’s mind. She was thankful for everything in her life, the good and the bad. The good because she found joy in each moment and the bad because it allowed her to grow in virtue. The term “death with dignity” is often thrown around in this discussion. Let the wise judge who has the better claim to that title.