Euthanasia Reconsidered

Posted by on Dec 11, 2009 in Medical Discoveries and Medical Ethics

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) 250 478 6388
PS. Please circulate this to your prolife colleagues and friends.