As a doctor I don’t believe “assisted dying” is dignified

A Party to Death

We have become innovative in our ability to engineer the beginning of life but seem quite helpless when it comes to stopping death. Unable to avoid our ultimate fate, we defiantly finesse the inevitable and die on our own terms. We believe that since we have constructed some creative life on-ramps, we should also be able to exit life’s highway before we come to the end of the road. We take things into our own hands, grab the Grim Reaper’s sickle, and announce that we are now in control. Mr. Reaper, a bit startled, shuffles back to Gehenna for a smoke and mumbles, “that was easy.” 

Our rocky relationship with the Grim reaper has once again made its way into couple’s therapy in the form of a debate over a new UK bill designed to legalize assisted dying for the terminally ill (the bill will be debated in the UK Parliament’s House of Lords on 22 October). Unbelievable? has given us the opportunity to be flies on the wall for one of these sessions with distinguished counsellors Rabbi Jonathan Romain of the Religious Alliance for Dignity in Dying and Dr. Mark Pickering of the Christian Medical Fellowship. Romain believes that strictly defined physician assisted death should be legalized while Pickering feels that it is antithetical to faith and will result in an ethical slippery slope.

Plotting a Vector

There are two guarantees in life – birth and death – which form what, the former abortionist turned pro-life advocate, Dr. Bernard Nathanson described as a vector of life beginning in the fertilized egg, proceeding through gestation, childhood, old age, and ultimately terminating at death. As we have become technologically more sophisticated, we have been emboldened to  fiddle with this vector by conceiving life in a test tube, prolonging it with medications, and now prematurely ending it through physician assisted suicide. Sadly, humans have an unfortunate tendency to wade into the scientific waters without contemplating the ethical depths. 

A vector has both direction and magnitude. Science can teach us the natural direction of our human vector but it is incapable of revealing the magnitude of the points along the way. Humans know the direction because we are a mist that appears for a little time and then vanishes but God knows the magnitude since He knit us together in our mother’s wombs, counts every hair on our heads, sets eternity in our hearts, and determines the allotted times of our existence and the boundaries of our dwelling places, therefore we need to be very careful when we actively remove a point on the line because it may just skew our trajectory. We need to ask ourselves if prematurely terminating a vector will tragically eliminate important points on our life graph?

Death with Dignity

Romain is a member of the Religious Alliance for Dignity in Dying. Dignity is a powerful word but what does it actually mean in the context of assisted death? Death certainly doesn’t care whether you die dignified or not because either way it gets the last word. It appears that this catch phrase is only important to the living and boils down to an obsession with looking as life-like as possible before one dies. While it may seem noble to avoid becoming a burden to others, or sparing friends and family from seeing us at our most physically frail, aren’t we really just indulging the last vestiges of human vanity? We may want to rewrite the rules of death, but in the end, our clever wording will be nothing more than a poetic act of acquiescence.

When we view life as a ledger sheet, the bottom line becomes the tenuous balance between pleasure and pain. Our culture then becomes a Quality (of Life) Assurance Department that raises a red flag every time somebody’s accounts payable column overflows with suffering. Sadly, secular accounting practices are incapable of balancing the books and their only option is to recommend the client file for bankruptcy. The Good News is that the accounting firm of God and Son is licensed in Afterlife Annuities and has been transforming suffering into gain for more than two thousand years. In fact, with every deposit of faith they guarantee a secure heavenly treasure that pays eternal dividends.

Sanctity of Suffering

Romain, a Jewish rabbi surprisingly stated that, “There’s nothing sacred about suffering, there’s nothing holy about agony.” I think he may face some push back from a people who were in captivity, wandered in the wilderness, were exiled, persecuted, had their Temple destroyed, and yet who remarkably remain God’s Chosen. 

Suffering does have a purpose. My father died of the cruel progressive suffocation of pulmonary fibrosis yet his time of emotional and physical suffering was a time of healing and transformation for our family that would not have been possible had he ended his life prematurely. If we don’t explore the value of suffering then we have done a disservice to the spiritual and emotional growth of the terminally ill. 

I would argue that some of the holiest persons we will ever encounter are those who have suffered. A holy person does not avoid the slings and arrows of life but rather oozes a peaceful countenance every time they are pierced by the world. A holy person is one whose life has been turned inside out by the refiner’s fire of tribulation only to reveal a soul of pure gold. While the thought of turning a human being inside out conjures up painful images, I would suggest that holiness always comes at a price. Our bodies are supposed to be temples where the Lord dwells, but how can others know He has taken up residence unless we are turned inside out and our sanctuaries made suitable for public viewing. When we accept Jesus Christ as Lord and Savior we will undergo painful temple restoration, but we must also be willing to take the next step and allow our renovated sanctuaries to be open houses for those who do not know the Lord.

Human Shields

Nobody is stopping people from committing suicide so the question is not one of personal autonomy but rather whether we should allow governmental, legal and medical institutions to implement it. Assisted suicide isn’t done in isolation but makes others party to a death. Should personal autonomy be overseen by the governance of institutions that are willing to sacrifice the individual for the corporate good? 

I fear that “personal autonomy” will not only become fuel for organizational power but will also serve as a human shield when they are accused of overstepping their bounds. I think the disarray brought about by the response of scientists, physicians and governments to the COVID pandemic has made people acutely aware of the problem of entrusting personal autonomy to the care of large institutions.

Turn of a Phrase

Romain stated that the current bill is written with tighter language than previous bills to ensure that it doesn’t become a slippery slope, but the problem is that in a postmodern culture, words, even when carefully crafted, will inevitably be redefined and re-appropriated to expand the mandate. Pickering pointed to the Canadian experience where the wording of the assisted dying law has, in a short period of time, morphed from  “terminally ill” to “disabled or chronically ill” and “assisted death” has become “medical aid in dying.” 

It won’t take long before terminally ill is redefined as “life inconvenienced,” mental competence as being in touch with one’s feelings, and personal desire as group identity. We have already seen this happen with the transformation of abortion into “reproductive health.” How long before assisted dying will become “thanatotic health?” I think Romain has too much confidence in the ability of well-constructed language to resist deconstruction and underestimates postmodernity’s ability to turn a phrase.

In the Trenches

I find it odd that those who are the strongest advocates for physician-assisted suicide are often not the ones suffering? They are naturally very uncomfortable seeing others suffer, but instead of setting aside their anxiety and offering comfort they opt for the out-of-sight out-of-mind strategy. As a neonatologist, I saw far too many families avoid spending time with their critically ill babies because they were uncomfortable with pain and suffering even though those were the moments their babies needed them the most. The medical treatment indicated at those difficult times wasn’t a prescription for death but a healthy dose of human touch. 

It is those in the trenches who know what war is truly like, therefore, we need to take our guidance from those most intimately acquainted with death and dying. Pickering noted that physicians involved in care of the dying are generally strongly opposed to assisted death, “The closer you get to death, and working with death, and the concept of assisted suicide and euthanasia, the more you tend to recoil from it.” 

Prescribing Death 

We need to remember that assisted dying is not just about the rights of those who wish to prematurely end their lives but is also about those who are commissioned with carrying it out. Strict boundaries need to be established because physicians tasked with preserving life should not be put in the position of dispensing death. I suspect that most physicians who are in favor of assisted death don’t want to be the ones who actually write the prescription. Pickering quoted the late Rabbi Jonathan Sacks in this regard. 

“It is the physician’s responsibility to heal not harm even if the patient requests it. Despite Judaism’s strong emphasis on human choice, free will and personal responsibility, we believe there are certain things we may not do even out of great compassion.” (Rabbi Jonathan Sacks)

The Hospice movement has largely neutralized the arguments put forward by those in favor of assisted dying by implementing cutting edge medical measures to control pain while simultaneously making the dying process a time of emotional and spiritual healing for both the patients and their families. 

The Final Act of Defiance

We may want to be a rebel and give Death “the finger” by ending life on our own terms but all we will have done is give the Grim Reaper the day off.  If we really want to be death dissidents then we need to join the Resurrection Rebellion and defiantly chant with the great cloud of witnesses, “O death where is your victory? O death, where is your sting?” Since we cannot prevent this final state of biological affairs, people of faith need to ask themselves whether they should celebrate the life that remains or become a party to death?

Jesus’ death on the cross was not the quick, relatively painless death of a sacrificial animal. Jesus’ death was accompanied by hefty doses of pain and anguish, which means that His suffering must have been just as important as His death for our salvation. And while this may make some of us uncomfortable, we have had martyrs from every generation who have considered, “sharing in His suffering and death,” a way to share in His eternal life. 

We should never trivialize the suffering of our fellow humans and must make every effort to comfort them as they approach the end of their lives but helping them build a bypass over the via dolorosa may prevent them from viewing some of the most glorious redemptive sights along the way. St. Paul made the case that death was the last enemy. If it is true that there are no atheists in foxholes then we deny the terminally ill the opportunity to meet a suffering savior every time we hand them over to the enemy.

But whatever gain I had, I counted as loss for the sake of Christ. Indeed, I count everything as loss because of the surpassing worth of knowing Christ Jesus my Lord. For his sake I have suffered the loss of all things and count them as rubbish, in order that I may gain Christ and be found in him, not having a righteousness of my own that comes from the law, but that which comes through faith in Christ, the righteousness from God that depends on faith— that I may know him and the power of his resurrection, and may share his sufferings, becoming like him in his death, that by any means possible I may attain the resurrection from the dead. (Philippians 3: 7-11)

Erik Strandness is a physician and Christian apologist who has practiced neonatal medicine for more than 20 years.

Watch the episode: Should people of faith support assisted dying?

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