A Pro-Life Position on Euthanasia
Philip G. Ney, MD, FRCP (C)
May 29, 2005
Originally published in CMQ February 1994; 29-33

EDITORIAL SUMMARY:

There are twelve real issues behind a person’s wanting to die by the hand of a physician, and they are treatable without assisted suicide. Professor Ney presents a principle named “The Universal Ethic of Mutual Benefit” based on the truth that, as we are all bound together in the bundle of life, one can never truly benefit at another’s expense. To allow or promote assisted suicide is not only harmful to the patient, it is detrimental to the physician. But the Dutch experience summarised as “It seems that social acceptance of euthanasia is resulting in physicians acquiring more power over the life and death of their patients” shows there is rapidly becoming no effective protection for patients against being killed without request. It must be remembered that all governments are alarmed by the rising cost of medicine and are tempted to use euthanasia as a quick and easy health cost-reducing device.

Suddenly it has become popular to talk openly of those whose low quality of life precludes further efforts to heal them and those who, anticipating an undignified and/or painful demise, choose to have a physician kill them. Having worked through the issue of suicide with several thousand people, I can say with some confidence that I have met very few people, if any, who really wanted to go through the process of dying or desired to be non-existent. The real issues are as follows:

1. Not to be entirely free of pain, but to have relief from unremitting physical and psychological suffering (for which medicine now has a large repertoire of chemicals and techniques).
   
   
2. Not to be dead, but to have a reason to be alive. Dying time is not wasted time. It creates a crisis when one must grapple with existential questions more easily avoided when you are healthy. These are about whether life is temporary or eternal. If eternal, to whom and for what do I report? Have I righted wrongs and been reconciled to family, friends or enemies who hurt or have been hurt? Am I leaving a blessing or a curse on those from whom I must now depart? etc. These questions and many others can make the difference in a life, hut they all take time.
   
   
3. Not to have false expectations about health, but to have a real hope that things will improve temporarily, at least. It is only temporary relief any of us have. To have a secure hope for eternity.
   
   
4. Not to be abandoned to die alone, but to have a firm commitment from physicians and caregivers that they will stay with the patient to the end.
   
   
5. Not to be alienated from friends and family, but surrounded by those who love and who in turn are supported by people with wisdom about dying.
   
   
6. Not to lose dignity (which is basically pride), but to be without fear of death by knowing the Prince of Peace.
   
   
7. Not to be angry with the loss and unfairness of dying so soon, but to acknowledge the privilege of having been alive.
   
   
8. Not to be sorrowing, but relish the small, momentary joys of living.
   
   
9. Not to be helpless, shrinking in size and pitiable, but to transcend the loss of physical and mental control with a growing awareness of one’s eternal and magnificent spirit.
   
   
10. Not to be worthless, but to be acknowledged as always contributing, even with dependency. Our being unworthy of love and care teaches the hard lessons of loving to others. The more difficult it is for them, the more they can learn about love and about themselves.
    
    
11. Not to feel unwanted, but to assert one’s right to exist. If all people are not always welcome by those near and dear, then no one’s life is secure.
    
    
12. Not to be a burden, but to understand that one’s dependency is a heavy responsibility that makes others mature.

These are the twelve real issues behind a person’s wanting to die by the hand of a physician; they are treatable. Most ethicists offer no real answers to these vital questions. Often their negative assumptions negate each one more than they realize. They are not just permitting dying, they are promoting death.

The Lord of Life is also the Great Physician. He can heal anyone at any time and in any manner He chooses. On many occasions He allows the healing professions to assist Him, for then we all learn the power of death, we grow in wisdom and patience and we rely more upon Him. Yet we must all transit the painful passage of birth into the next world. If our spirits have already been regenerated, both the joys of life and the pain in passing are meaningful. When all of life has its purpose, the anxiety of dying is not terror and loss but a stimulus better to know the Prince of Peace and gain the personal knowledge of Him, forever.

A major error that many ethicists have is in ignoring a principle which I suggest be called “The Universal Ethic of Mutual Benefit’. Because we are all bound together in the bundle of life, one can never truly benefit at another’s expense. We only benefit when what we do for ourselves is also good for our neighbour. Thus, what is good for woman must also be good for man. What is good for black must be good for white. What is good for a dying patient must also be good for the physician. To allow or promote physician-assisted suicide is not only harmful to the patient, it is detrimental to the physician. When a physician kills a patient, part of him also dies.

In British Columbia, the president of the Right-To-Die Society, on behalf of a woman (Ms. R.) suffering from Amyotrophic Lateral Sclerosis (Motor Neurone Disease), filed a court petition for physician-assisted suicide. In the vituperative rhetoric that ensued, some vital arguments got lost. [1] Yet it is clear from the lower court judge’s decision that any right to physician assisted suicide can legally be interpreted as an enforceable demand that some physician must do the killing.

Although there are some quantitative differences, it appears that the case of Ms. R. is essentially the same as that of the many suicidal adolescents that I see. These adolescents are suffering acute mental anguish, sufficient to make them wish they could be dead. Their desire to end their lives stems from unremitting turmoil, a sense of helplessness, persistent fears, considerable anger and a feeling of alienation. Many suicidal adolescents are fully aware that they arc handicapped because of child abuse and neglect, or must face long years of depression or schizophrenia, or arc struggling with a slow and agonizing death through substance abuse or AIDS as a result of promiscuity, or with quadriplegia after a traffic accident. They choose a quick and “dignified death” by suicide as the only logical alternative. They resent the interference of professionals who seek to treat them. Some people, after considering their very difficult circumstances and suspecting their inevitable downward course, would see their decision to kill themselves as rational. In my experience, the basic reasons to be suicidal, i.e. hopelessness, alienation, pain, helplessness, fear, anger, etc. are all treatable. Thus all suicidal patients are treatable even when they protest, “just let me die.”

Dying time is not wasted time. It is the time when people settle their affairs, mourn their losses and prepare to meet their Maker. Approaching death creates a crisis, and only then do many people deal with old misunderstandings, resolve many old hurts, air pseudo secrets, seek forgiveness of friends and work on reconciliation with injured family members. Once personal and interpersonal issues are settled, they commit their spirit into the hands of the Great Spirit, their dying appears to be easier and more rapid.

When physicians kill some patients it undermines all patients’ trust in the medical profession. As a result, it becomes more difficult to gain a patient’s co-operation. Lf a patient won’t undress because they mistrust that the physician’s only intent is to treat them, maybe they will co-operate because they like their doctor. Physicians must then rely more heavily upon their patient’s fondness for them. To be more popular with patients, physicians will have to adopt current public opinion. Public attitudes to moral issues are ostensibly reflected in opinion polls or the media. Rather than public morality being influenced by enduring medical ethics, physicians have become increasingly concerned about their public image.

Physicians arc always being asked to kill out of compassion. This is accentuated by pressure exerted by some misguided media. Not to kill patients was one of the basic tenets of the Hippocratic Oath which over twenty-three centuries built a modicum of patient confidence into the medical profession. When this is eroded by euthanasia, there is an inevitable increase in distrust between physicians and patients. This results in more defensive and thus more expensive medicine. The only logical and truly economic ethic for physicians is always to treat every patient, regardless of who they are, to the best of their ability and to the limitation of the resources available. When they are restrained by legislation, physicians are better able to withstand private pleas and public pressure to kill those with a “lower quality of life” because it is a “kindness”.

Margaret Meade, commenting on the remarkable change in the attitude of physicians as embodied in the Hippocratic Oath, states:

“Throughout the primitive world the doctor and sorcerer tended to be the same person. He who had the power to cure would necessarily also be able to kill. For the first time in our tradition there was a complete separation between killing and curing… One profession, the followers of Asclepias, were to be dedicated completely to life under all circumstances regardless of rank, age or intellect, the life of the slave, the life of the emperor, the life of a foreign man, the life of a defective child ... This is a priceless possession which we cannot afford to tarnish. But society is always attempting to make the physician into a killer, to kill the defective child at birth, to leave sleeping pills beside the bed of the cancer patient. It is the duty of society to protect the physician from such requests.” [2]

The pro-life position is not to “let die” but always to fight death. The pro-life physician does not kill, hasten, suggest death, or let anyone just die. They always treat everyone to the limits of their abilities and resources. They also acknowledge some harsh realities:

1. Everyone is dying, some faster and some more painfully than others, and all must some day leave their body.
   
   
2. There is keen competition for finite medical resources. When faced with tough decisions about who and how much to treat, the pro-life physician’s first response is to do whatever they can to improve their skills, develop new technologies, expand basic science and demand more resources. But when every effort is exhausted, they must triage, i.e. first treat the person who is most likely to benefit, regardless of age, sex, race, religion, or apparent importance.
   
   
3. If one is to love one’s neighbour as oneself, then there must be an even distribution of prevention and treatment opportunities. There is little reason for expensive procedures to prolong the life of a few, while many others lack basic vitamins, immunization, antibiotics, clean water and proper hygiene.

Pro-life physicians know the best way to fight death is always to promote life. When it is impossible to improve their patient’s physical condition, there is always a possibility of helping them improve their mental outlook, and if that is not possible, there is the need to promote spiritual awareness and growth. Essentially no one really wants to die, but they do want suffering to stop. Physicians must always be encouraged to treat, and discouraged from terminating the lives of suffering patients. If not, no one is safe, for some day each one of us will also be a patient.

Pro-life physicians do not believe in letting people just die. Otherwise why would they fight for the life of the premature infant, the suicidal teenager, the bed-ridden grandmother, or the apparently brain dead traffic victim? The pro-life mandate is to follow the example of the Great Physician and respond most ardently to the needs of the smallest and most helpless. In doing so they remind society that everyone is equal, and that those apparently least worthy deserve the best a physician can give them. To “let die” is passive euthanasia. Neither judges nor philosophers see any practical distinction between active and passive euthanasia.

In November 1991, the Dutch cabinet decided euthanasia will remain a penal act but its extension by a physician will provide a legal foundation making that life termination not punishable. [3] In the same year the government reported that 42% of all who died in Holland that year, died from an “active” or “passive” act of a physician; a large percentage without their permission.

Table 1: Death In the Netherlands (1990)

Source: The main quantitative data from the report of the committee Onderzock Medische proktijk inzake euthansaie (Investigation of medical practice with regard to euthanasia), Van Der Mass, et al. “Euthanasia and other medical decisions concerning the end of life” Lancet 1991 Sep 14; 338(8768): 669-74.
(#) figure calculated by author.

Although physician-assisted suicide is supposed to enhance patient autonomy, ten Have and Welie [4] state, “it seems that social acceptance of euthanasia is resulting in physicians acquiring even more power over the life and death of their patients. As the Remmelink Report [3] shows, in most cases of ending human life, it is the physician who decides that it is appropriate to hasten death.” The Dutch government reported that 40% of euthanasias in the past ten years were done without the knowledge of the patients’ families, and that 45% were executed on the basis of the physician’s decision alone. The research shows there is no effective protection for patients against being killed without request. It must be remembered that all governments are alarmed by the rising cost of medicine and are tempted to see euthanasia as a quick and easy health cost reducing device.

Humans were not designed to die. Death is an interloper, an enemy, huge and horrible. Life and death arc always in conflict. A pro-lifer is always lighting disease, distress, destruction and death. Those who promote death in any guise are enemies of life.
Maybe it is time we recognized the utility of an immutable oath-backed ethic always to treat and never take advantage of patients regardless of personal desires or public pressures. Having thought about the various dilemmas I have faced I wrote this ethic* which now hangs in my office. Now whether prospective patients agree or not, they know where I stand on life and death issues.[5] It is not easy to display one’s ethics. Once people know what you believe you arc expected to live by those tenets.

Although it is right to sympathize with Ms. R., who is suffering acutely from a devastating illness, it is apparent that she is essentially not different from that of other dying patients or other suicidal people. Any court decision made regarding assisted suicide for her will establish not only a legal, but moral and ethical precedent that will tend to lessen the patient’s determination to live and the doctor’s determination to treat.

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