EUTHANASIA RECONSIDERED
Philip G. Ney, MD FRCP(C)
Pioneer Publishing 12/11/09
In the urgent, heated debate regarding euthanasia
there are some aspects that are ignored. I believe if
people, politicians and physicians considered these they
might think differently.
Everybody is ambivalent about most things almost all the
time. This is true especially about living and dying.
It doesn't take much to sway their thinking from one to
the other. Sometimes two words are enough to make people
despair. A reversal in finances or love may precipitate
a stated desire to die. At that point, somebody to help
them do it, (assisted suicide) is enough to make it happen.
I have treated thousands of people who ostensibly wanted
to commit suicide. Their mind is usually clear. Their
desire is apparently well thought out. They are suffering
intensely and from their point of view there is no reasonable
future. Yet with a sense of being understood, a realistic
hope and some loving person's renewed commitment to keep
supporting and looking for a way out of the trap, they
find hope and life. None of those people I know are sorry
they didn't die, (PTL).
Most people like to believe that when they die there will
be a peaceful transition to unconsciousness and oblivion.
Not so. The almost universal reaction of those who have
had a near death experience is that you wake up when you
die. Suddenly you become very aware. That experience is
seldom forgotten and is usually life changing.
Most people would like to believe that with the appropriate
medication and supportive family you could have a calm,
nearly painless death, (euthanasia). Not so. A study on
the effectiveness of various palliative medications examined
the level of catecholamines (adrenalin like hormones)
at autopsy. They found there were elevated levels regardless
of the drug used. So it seemed that at the moment of death
there was one final desperate struggle or that the person
was facing some horror or some wonder that produced terror
or excitement, depending on where they were headed. Another
study found that there was no particular connection of
post mortem catecholamine levels to the cause of death
but that those levels "may reflect the magnitude
of physical stress responses during the process of death…"(1)
You cannot benefit at the expense of another. If it isn't
good for them it won't be good for you. If people, by
whatever terms it may be disguised, kill someone or agree
to let them die, a part of them also dies. They lose part
of their essential humanity. Soldiers are toughened. Doctors
become less empathetic. Do patients want their doctors
to lose some of their capacity to understand and make
a correct diagnosis?
Since Hippocrates, trust in the medical profession has
gradually grown, mainly because doctors swore never to
poison, abort or take advantage of any patient. When that
trust diminishes, the cost of medical care rises. Patients
are more willing to sue. Doctors are more likely to practice
defensive medicine to avoid making any mistake that will
result in expensive litigation. Patients will be more
dubious about taking meds, more often seek 2nd opinions
and be less cooperative with investigations. By any measure,
defensive medicine is much more expensive.
Most creatures stay healthier and live longer when they
have a reasonable amount of struggle and when they assist
each other. This is a lesson learned from zoos. Even the
best homes for the elderly inadvertently reinforce progressively
dependent behavior by being too helpful. There is far
too much medication given to the elderly who appear to
be depressed but are grieving the loss of themselves,
their hopes and their family who visit less frequently
because "they always seem in a daze" That psychotropic
medication obstructs the painful but necessary process
of mourning.
Dying is one of the most important events in one's life.
There are at least 10 critical tasks to perform before
a person can say, "I am done:"(2). Reconciliation
with Creator, family, friends and foes is the finest legacy
a person can leave but it is not easy and needs time.
Until this and other vitally important tasks are completed
people will naturally feel they are dying too soon and
hang on desperately.
Although with bravado some people will say, "So I
will cease to exist, so what", very few really believe
they were born to die. Death feels so unnatural. Instinctively
the body and mind fight death. There is grudging acceptance
that life is over, usually because of pain, confusion,
disintegration and despair. Yet given a chance to live
a little longer with even 20% improvement, people will
generally go for it.
Christians believe that a human body becomes a live person
when his/her spirit enters, which is,as far as we know,
when fertilization takes place. Therefore that person's
dies when their spirit leaves the body. There is no other
definitive end point. Yet those who do not know what to
look for may not so easily discern it. Palliative care
staff note, "The light goes from their eyes".
Family say," he was no longer with us". It will
take more careful observation and research to be confident
in knowing more precisely when, but that will be the time
to terminate life support. Until we confidently know when
a person's spirit leaves their body, we must err on the
side of life and continue to support and treat.
As Christ demonstrated, (3) it is possible to dismiss
one's spirit in the final throes of dying and in that
way avoid the excruciating wrench and terror of the last
phases of death. The Centurion at the cross, although
he had seen many die in agony, fear and hatred, he had
never seen anyone dismiss their spirit. It was so remarkable
that He beat his chest and said, "Surely this was
a son of God". Christ came to show what life in God
can be like for those who trust Him. I believe it is the
privilege of Christians, when dying, to commend themselves
to God and dismiss their spirit. Then God will decide
when to act upon that request. Because He is merciful
and kind and takes no delight in suffering, He will take
our spirits sooner than most.
God promises He will never leave His own. Therefore we
can confidently say, there is no suffering or frustration
or despair when He is not inside and beside a child of
His. There is no suffering that is greater than the joy
and peace of being in Him and He in us. To Christ on the
cross, it felt like God had abandoned Him, and that drove
Him to despair. God never left His son but turned away
long enough to give Him an experience of hell. Now Christ
can surely understand all types of human suffering and
readily respond when they cry to Him. After all God dearly
loves all He created (4). He wants nothing more than all
turn to Him for forgiveness and life.
Suffering and dying is partly the painful process of peeling
the skin off the spirit. It is more difficult and prolonged
for those whose body was their prime possession. It can
be the best time for people to become more spiritually
minded and get ready to meet their Creator. Since there
is no close correlation between the age and maturity of
a person's spirit and that of their body and mind, we
often see that those with intellectual or physical handicap
are wiser than we might expect. Likewise, the spirit can
go on maturing in wisdom and grace as the body deteriorates
and dies.
Grief complicated by guilt often becomes pathological
grief, which may become a difficult to treat depression.
Whether in fact or in fantasy, we contribute the death
of someone near and/or dear there is a biologically based
guilt. Since it is not possible to apologize or make amends
or be forgiven, this biologically based guilt is persistent.
Those who have agreed to the recommended plan to stop
food and water, may then with each visit watch the mother
who nurtured them when she herself had to go without,
slowly and painfully die. They often suffer regrets, recriminations,
fear, sorrow and guilt which becomes a difficult treat
"affective disorder"
Doctor assisted death of all kinds harms a noble profession,
which has not always been noble. "In 1941 the psychiatric
hospital Hadamar, celebrated the cremation of the ten
thousandth mental patient in a special celebration. Psychiatrists,
nurses, attendants and secretaries all participated. Everybody
received a bottle of beer for the occasion" (5).
What began with, what people could be persuaded to believe,
were good intentions turned into a holocaust that nobody
should forget lest they allow it to happen again. (6)
Of course there is a slippery slope. Civilizations slide
and collapse. Morality, without constant vigilance, rapidly
decays. If nothing else surely we have learned this from
ancient and modern history. It has always taken a courageous
few to buck the popular trend, does it not, Socrates,
M L King, J C Messiah? Are there any among our present
politicians?
Until these 16 issues are considered and discussed, the
debate about euthanasia is incomplete.
1) Zhu et al Postmortem serum catecholamine
levels in relation to cause of death. Forensic Sci Int.2007,
173: 122-9.
2) Christian Principles of Palliative Care. Philip G.
Ney. Victoria, Pioneer Publishing, 2007.
3) Matthew 27:50, Mark 15:39, Luke 23:46-47.
4) Psalm, 145:9
5) Wertham F. A Sign of Cain: an exploration of human
violence. New York MacMillan, 1966
6) Ney PG Ethical Dilemmas in Medicine. Annals of Royal
College of Physicians and Surgeons, Canada. 17: 465-466,
1984.
Yours sincerely Philip G. Ney MD FRCP(C)
pgney@telus.net 250 478 6388
PS. Please circulate this to your prolife colleagues and
friends.
