Doctor Assisted Suicide

Dr. Philip G. Ney

© 1992

Introduction: There are few questions in life as important as what is the right way and time to die.  Death is one of life's greatest challenges.  Until the Lord comes, it is something that every man and woman must face. All humankind is ambivalent about life and death, theirs and others.  There had to be from ancient times, social mores and legislative restraint to protect humanity from its own worst tendencies, ie. to kill themselves or to kill each other.

Death has always been seen as a fearful enemy.  Even if it cannot be overcome, it could be fought to a standstill.  Whenever humanity has embraced death there have been vast numbers of people who have died.  No one will forget Jonestown, and how the desire of some people to kill themselves became enforced death by cyanide for men, women, and unsuspecting children.

The basic questions regarding doctor-assisted suicide (DAS) are;

1.Does anybody benefit from this practice?  Are there tangible and measurable advantages?

2.If there is benefit, at what cost to individuals who perform the killing and those who observe from a distance?

3.What are the ongoing effects of DAS?

4.What are other alternatives to DAS?

It is contemplated that DAS is a function of a physician.  Therefore, it is a medical act presumably paid by medical dollars.  Historically, the burden of proof lies with those who perform or promote any medical act to show beyond reasonable doubt that it is; 1) therapeutic, 2) safe.  Therapeutic means that it benefits the patient more than no treatment.  Safe means relatively safe from side effects to the patient and the family ("First do no harm").  It has become increasingly apparent that family members of the poorly treated patient can also sue the physician.

It is not surprising that the Canadian Government is taking DAS so seriously.  Though the discussion often generates more heat than light, it indicates how deep the issues go, not only for legislators but for individuals.  Everybody who thinks about DAS at all realizes they cannot ignore it.  It will sooner or later become a personal question.

This is not a question of a right to die.  Everyone has that right and, saving the Lord's return, that right to die will be granted.  This issue is how, when, and in what manner people wish to die.  Those who desire DAS want to die in the time, place, and manner that they choose.  This is a selfish luxury.  The right to DAS becomes an enforceable obligation on some medical practitioner whose refusal may or may not be protected by his ethics.

Everyone has an ambivalent regard for life and death.  There is hardly anyone who, at some time, has not thought about wanting to escape the pain and confusion of living.  Virtually nobody who apparently wants to die doesn't also want to live, given a change in their condition or circumstance.  Thus life and death are a balance, a finely tuned ecological equilibrium.  With very little influence it can be tilted in the direction of death.  Thus it behoves humans to understand the balance and consider all those factors that may contribute to a fascination with death and a tendency to kill or to succumb to dying.  It appears that in humans, although no one really wants to die, there are a large number of people who are quite prepared to kill themselves and to kill others.

If man has an inherent ambivalence about life and an occasional desire to kill, what must be done to restrain him from expressing his own fatal aggression?  Will anything but an absolute prohibition work?  Humans are exceptionally good at rationalizing.  They can make all sorts of foul deeds look fine.  Humans have a tendency to dichotomize and to discriminate.  The advent of the computer has made it easier to digitalize and categorize.  Then there are few reasons not to decide which group is worthy of life.  That capacity, coupled with humanity's tendency to discriminate, can easily make one group appear to be worth all the efforts and the resources of concern compared to others which are not because of their inferior qualities.

All of life is on a continuum.  The qualities of each person and each group are on a continuum.  There is no obvious distinction between people.  The criteria by which people live and die can be easily shifted.  History notes that once it starts shifting toward death it is not easy to restrain the trend to killing.

Only the self-righteous and arrogant believe they can choose between right and wrong.  It is evident in this world we can only choose between good and evil, killing and curing.  There is nothing between.  We are known by the intentions of what we do, not by our political correctness.  Each choice we make influences the next.  The precedents we set result in both individual and legal trends.  

It is evident from history that civilizations wax and wane.  It appears that the waxing and waning of civilizations has less to do with a nation's Gross National Product, than with how well they care for those less deserving.  If a nation is to stay civilized, it must promote care for those apparently less deserving.  How then must it encourage it's citizens to participate individually and collectively? 

Courage and wisdom have always been the keys, not time and money.  Amazingly, resources seem to expand according to how concerned people are for their neighbours.  No one has yet demonstrated the world lacks the necessary resources to provide food, water and adequate medical care for every citizen of the earth.  The problem has always been distribution, which relates to people's selfishness.  Although there are elaborate, and sometimes forceful, justifications of those who have against those who have not, even a cursory scrutiny can detect the real issues.

If we do not learn from history it must repeat.  For the individual, family, or nation, conflicts generate chaos and result in entropy.  Unless we learn from the first tragic experience, we will continue re-enacting tragedy because we must learn.  We must learn or we will all die.  Unfortunately, it usually takes many repetitions of history before anybody is wise enough to detect the essential conflict.  Could DAS be one of those?

The different approaches to addressing this question must all agree, because there is only one truth.  We hope to show that there is pragmatic alternative to DAS, one which will show good morality, good law, good science, and good economic efficiency. 

We are all part of the bundle of life.  We live in a global village.  It is not possible to benefit at the expense of one's neighbour.  The Universal Ethic of Mutual Benefit that we hold states that only what is good for one's neighbour is good for oneself.  This restatement of The Law of Love has good moral and scientific support, so why isn't it more widely accepted?

If everyone is not welcome in this world, no one is safe.  Jesus Christ stated that if we welcome the littlest and most helpless person, a child, we welcome Him.  When we welcome Him we have His Father and thus all the resources of the universe.  It is not a question of having to throw somebody out of the lifeboat because there is no room or insufficient resources.  As far as we know, the universe and its resources are limitless.  The only thing that stops us from colonizing the stars is the enormous amount of money spent on death-dealing military budgets.  These budgets exemplify and are caused by the increasing amount of distrust.  Distrust is bound to increase when the very pillars of society, namely law, medicine, and religion, are shaken.  It is the obligation of both the professional associations and the public, to maintain the immutable ethics and integrity of these pillars.  Why would anyone want to make the pillars he leans on crumble into ruin?

Summary:

From legal, moral and scientific data, it appears that Doctor-Assisted Suicide does not work.  It has no heuristic value.  There is no evidence that anybody benefits.  There is no evidence that DAS is treatment, unless the only criteria of benefit is that there is no longer suffering.  Even if lack of suffering were the only criteria, it appears that there are far less harmful ways to end suffering than DAS.  There is more and better treatment.  It is possible to gain meaning in life even while dying.

If DAS provides no proven remedy, it is not treatment.  Modern medicine, of necessity, is increasingly evidence based.  If DAS is not treatment, then doctors should not perform or promote it, and no government should pay for it.  If the government is convinced by false data that there are too many people and too few resources, ie. the lifeboat is too small, then it should hire it's own executioners and not contaminate the medical profession.

From ancient times, medicine, law, and religion have been the pillars of society.  When these become shaky people are more likely to respond with, "who can you trust nowadays.  The law is now often stating it is alright to kill helpless people sometimes.  Religion too often supports various methods of killing.  Medicine obviously has mixed tendencies derived from mixed motives.  Some of these are to avoid inconvenience, the desire to gain public attentions, and the desire for money.  Without trustworthy pillars, society becomes increasingly distrustful.  Patient confidence declines, legal matters become more complicated, and the desire to know and worship God declines.  People become increasingly hedonistic and materialistic.  They tend to embrace death as a friend.

DAS is damaging to old people by;

1.increasing their fear.  This results in resistance to care-giving medicines, moves, etc.

2.diminishing their self-worth.  This results in an increasing sense of helplessness and a tendency to give up self-care to others.

3.their unfinished emotional business before death, lack of self mourning, etc.  Consequently, there is more likely to be more depression in old people and increasing need for medication, treatment, etc.

4.conditioning their helplessness.  When old people give up they become dependant and helpless.  Then they are progressively conditioned into increased helplessness because care givers attend to their weaknesses rather than their strengths.  Old people need the challenge to survive and mutual dependency.

5.they do not finish the business associated with the family: reconciliation, forgiveness, distribution of assets, etc.

6.they devalue themselves.  Society loses their wisdom and patience.

As society values people they value themselves and are valued by their family.  Because a family may realize society has an increasing interest in the early death of old people, and because of their own ambivalence about DAS, they will tend to avoid old people.  That avoidance will mean much more of the care has to be provided by the State, increasing costs of long term care.

Death always results in conflicts.  A DAS increases those conflicts between family members, some for and some against.  Through DAS, many people contribute to a person's death, actively or passively.  This greatly increases their psychological conflicts and prolongs mourning.  This results in depressions in other family members, and that removes them from the active work force while increasing the costs of medical care.

As the distrust of physicians increases, so the patient's ability to cooperate diminishes.  This increases the physician's time needed to persuade them to cooperate and increases the need for more records, fancy investigations, detailed lab tests, etc., all of which increase medical care.  It results in considerable conflict among physicians.  It increases the proliferation of false remedies.

The survivors of death always have difficult issues to deal with.  When children in the family realize that a loved one was accorded DAS, their normal conflicts following the death of a parent have added to them those of being a survivor.  Survivor guilt, shame, and fear increases the likelihood of anger or withdrawal in children and interferes with their school work and personal development.

We have proposed the UEMB is a practical alternative to euthanasia.  We will make every living person feel welcome.  This will increase everyone's self-esteem and self-worth.  As people value themselves, they will value others, care for their neighbours, and protect their environment.  Contrary to expectations, as the value of a person diminishes the value of people by considering some unworthy of life, so people devalue themselves, each other, and the world in which they live.  This results in increasing competition, discrimination, and selfishness.

The Universal Ethic of Mutual Benefit always applies in every situation of life and death.  What is good for one's neighbour is good for one's self.  As we treat others, we treat ourselves.  When we kill others we die inside.  When we disregard their helpless cry we become deaf to our own helplessness.  When we love our neighbour as ourselves we are loving ourselves.  To the extent that we meet their needs, ours are also filled.  The hallmark of civilization is respect for the apparently undeserving.  If our country is to have a place of honour among the nations and in history, it cannot allow doctor-assisted suicide.  There must be an absolute prohibition because none other works.

We must welcome everybody and love them as much as we love ourselves.

2.diminishing their self-worth.  This results in an increasing sense of helplessness and a tendency to give up self-care to others.

3.their unfinished emotional business before death, lack of self mourning, etc.  Consequently, there is more likely to be more depression in old people and increasing need for medication, treatment, etc.

4.conditioning their helplessness.  When old people give up they become dependant and helpless.  Then they are progressively conditioned into increased helplessness because care givers attend to their weaknesses rather than their strengths.  Old people need the challenge to survive and mutual dependency.

5.they do not finish the business associated with the family: reconciliation, forgiveness, distribution of assets, etc.

6.they devalue themselves.  Society loses their wisdom and patience.

As society values people they value themselves and are valued by their family.  Because a family may realize society has an increasing interest in the early death of old people, and because of their own ambivalence about DAS, they will tend to avoid old people.  That avoidance will mean much more of the care has to be provided by the State, increasing costs of long term care.

Death always results in conflicts.  A DAS increases those conflicts between family members, some for and some against.  Through DAS, many people contribute to a person's death, actively or passively.  This greatly increases their psychological conflicts and prolongs mourning.  This results in depressions in other family members, and that removes them from the active work force while increasing the costs of medical care.

As the distrust of physicians increases, so the patient's ability to cooperate diminishes.  This increases the physician's time needed to persuade them to cooperate and increases the need for more records, fancy investigations, detailed lab tests, etc., all of which increase medical care.  It results in considerable conflict among physicians.  It increases the proliferation of false remedies.

The survivors of death always have difficult issues to deal with.  When children in the family realize that a loved one was accorded DAS, their normal conflicts following the death of a parent have added to them those of being a survivor.  Survivor guilt, shame, and fear increases the likelihood of anger or withdrawal in children and interferes with their school work and personal development.

We have proposed the UEMB is a practical alternative to euthanasia.  We will make every living person feel welcome.  This will increase everyone's self-esteem and self-worth.  As people value themselves, they will value others, care for their neighbours, and protect their environment.  Contrary to expectations, as the value of a person diminishes the value of people by considering some unworthy of life, so people devalue themselves, each other, and the world in which they live.  This results in increasing competition, discrimination, and selfishness.

The Universal Ethic of Mutual Benefit always applies in every situation of life and death.  What is good for one's neighbour is good for one's self.  As we treat others, we treat ourselves.  When we kill others we die inside.  When we disregard their helpless cry we become deaf to our own helplessness.  When we love our neighbour as ourselves we are loving ourselves.  To the extent that we meet their needs, ours are also filled.  The hallmark of civilization is respect for the apparently undeserving.  If our country is to have a place of honour among the nations and in history, it cannot allow doctor-assisted suicide.  There must be an absolute prohibition because none other works.

We must welcome everybody and love them as much as we love ourselves.