Introduction
Physician-assisted suicide (PAS) has been around for many years and has always been hotly debated. As a Christian-based hospice organization, we have vowed to treat each patient with love, care, and dignity. Our staff all have the same beliefs and feel that “life is a gift from God and is to be regarded as a sacred trust. God is the owner of life. God gives life, and only God can take it” (Tuten, p.61, 2001). Currently, we have a patient in residence, M.J. who with the guidance of his brother, an activist in the euthanasia movement, has decided that he wants to and has a right to die in a manner of his own choosing. M.J. states that the hospice can neither ethically deny him that right nor discharge him. After discussing the issue with my staff, they have all refused to participate in PAS and have indicated that they will all quit their jobs if the hospice participates in M.J.’s PAS. As a Healthcare Administrator, it is my job to make the final decision on this issue that is dividing the organization and the community. The American Civil Liberties Union, ACLU, has threatened to boycott and sue the organization if we do not assist M.J., and the Board of Directors has left it in my hands to come to a resolution that reflects our Christian ethics and values.
History of Physician-Assisted Suicide
Suicide has been around for many years in various forms and in some cultures has been considered socially acceptable. The practice of hara-kiri, in Japan, is “morally linked the person to his fellows and to the emperor. It was an ultimate affirmation of loyalty and moral responsibility” (McCord, 1992). Pre-modern Eskimos have practiced that the elderly and sick have ended their lives gracefully as a way of preserving the community against threats of a harsh environment (McCord, 1992). If other cultures have been performing selective euthanasia for centuries, then why would it be such an issue in the world today? Our moral compass, as Christians, remind us that “life is in itself something holy or sacred, transcendent, set apart – like God himself… something before which we stand (or should stand) with reverence awe and grave respect – because it is beyond us and unfathomable” (Tuten, p.61, 2001). We look upon suicide as a sin, because God created it and the Bible tells us that our dates are written in the Book of Life, already predetermined, so we as Christians, should not go against that to end lives before our time.
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Ethical Issues
“Ethical issues about death, dying and a person’s right to make end-of-life decisions have become one of the most legally complex and culturally sensitive areas to emerge in our time” (Ports, Johnson, Warren, p.85, 2005). Porter, et al, go on to say that “sensitive issues associated with a terminally ill patient's right to make end-of-life decisions and the disposition of those who are unable to make such decisions for themselves will keep health care professionals, medical ethicists, counselors, families, lawyers, judges, and legislators busy for years to come” (p. 85). Jack Kevorkian has knowingly assisted in at least three physician-assisted suicides. Two with the aid of his notorious “death machine.” Kevorkian feels that PAS is a means for science to benefit from death. “After a person is rendered permanently unconscious, various procedures can be performed on the living human body, organs can be removed for transplantation, mysteries of dying can be explored, after which death can be brought about with a lethal dose of barbiturates” (Winslade and Markides, 1992). Does that sound dignified in any way to the patient? It seems to me the patient who wanted to control their death in a dignified manner did not expect to give their body away to scientific exploration.
Life and Death
“Death is defined as the irreversible cessation of the vital functions of respiration, circulation, and pulsation” (Porter, et al, p.85, 2005). Our Founding Fathers recognized life as an inalienable right. The founder of the modern hospice movement, Cicely Saunders, MD states, “You matter because you are you. You matter to the last moment of your life and we do all we can not only to help you die peacefully but also to live until you die” (Tuten, p.60. 2001). Our society today has devalued life to the extent that life really means nothing. Kids are going out and killing people with no worries or concerns. Genesis 2:7 says, Then the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature” (ESV). God created us and breathed His breath into us. He does not want us to give up and kill ourselves, the lives He created, before He has determined to call us home. James 1:12 says, “Blessed is the man who remains steadfast under trial, for when he has stood the rest, he will receive the crown of life, which God has promised to those who love Him” (ESV). We go through these trials, even health-related ones, in life so we can rely on God to get us through them. He wants us to lean on Him and His Word. He does not want to give up or to help others give up. Helping someone end their life is going against God’s word. “if life is sacred, either from the psychological perspective, religious to philosophical perspective, then the desire to take or the act of taking one’s life is wrong, either by virtue of mental illness, spiritual sin, or ethical error. The desire, request, or act of ending one’s life may call for counseling, forgiveness, or understanding but never approval and never assistance” (Tuten, p.61, 2001).
Legality
In 1991 Washington legislation was put to a vote regarding Physician Assisted Suicide. Initiative 119 “required that adults could request aid-in-dying only after two physicians certified that they were mentally competent, terminally ill, and had less than six months to live; two independent witnesses had to certify the patient’s condition” (McCord, 1992). Former Surgeon General C. Everett Koop proclaimed that the medical profession cannot be society's healer and killer at the same time. Patients look to their physicians as being the one person on earth who can help them, they trust them to do everything in their power to heal them and make them better. What happens when that trust is broken? How can a physician who takes an oath to do everything within his or her power to help patients then they provide the medications needed to help someone end their life? The argument is that even if physician aid in dying is morally permissible situations, sound, and prudent public policy and law still should not permit it because of the dangers of either an “erosion” or “slippery slope” phenomenon” (Tauten, p.62, 2001). Tuten goes on to explain that the erosion argument asserts that reverence for life gradually will wear away and society eventually will consider it normal to use death to relieve pain and suffering (p.62). Whereas the slippery slope argument, Tuten explains, that allowing euthanasia in even a small number of morally-defensible situations will begin a slide down which euthanasia will be permitted in many other cases that are not morally justified (p.62).
Medical Futility and Euthanasia/Suicide
The American Heritage Dictionary defines euthanasia as “the action of inducing the painless death of a person for reasons assumed to be merciful” (1970). Where the Shorter Oxford Dictionary defines it as “the action of inducing a quiet and easy death” (1973). However, Webster’s Third New International Dictionary defines it as “the act or practice of painlessly putting to death a person’s suffering from incurable conditions or diseases” (1976). Suicide, on the other hand, is often “considered the errant and tragic preference of death over the correct and appropriate choice of life. When the option of life has been removed from the repertoire of choices and the selection becomes death now or die a little later, the concept of suicide becomes less clear and the use of the term becomes more contested” (Tuten, p.60, 2001). One can argue that even when death is imminent or inevitable the action of one taking his or her own life is suicide. To me these two are no different because one chooses to be euthanized therefore, they are choosing suicide. Suicide is against the biblical worldview because we are supposed to treat our bodies as a temple because we were created in the image of God. Porter, et al, explains futile treatment as that that cannot, within a reasonable possibility, cure, ameliorate, improve the patient’s condition, or restore a quality of life that would be satisfactory to the patient. Is this a reason to give up and kill oneself?
Conclusion
While there will probably always be arguments for and against PAS, this organization will continue to not offer or allow PAS to be performed on the premises. While some states like Washington and Oregon have passed Right to Die laws and legislation, the state of Georgia has not passed any such law so allowing M.J. to be euthanized on our premises would put our organization and our staff at legal odds. As an administrator, I can not allow that to happen to my staff or myself. We will continue to give M.J. the respectful and nurturing care we offer all our residents and be sure he retains all his dignity if possible. We will serve as Jesus served and love as God loves us, but we will not compromise our beliefs and the ethics of our organization for the whims of one patient nor will we back down from an outside organization who wants to stir up trouble. Since PAS is illegal here the ACLU has no legal leg to stand on and all courts will back us. So, this issue is closed for now, when Georgia decides to pass legislature on the subject, we will then revisit this issue.
References
- McCord, William, (1992); Dignity, Choice, and Care; Society July/August 1992 Transaction Publishers
- Porter, Theresa, BSN; Punporn Johnson, BSN; Nancy A. Warren, Ph.D., RN, (2005) Bioethical Issues Concerning Death: Death, Dying and End-of-Life Rights; Critical Care Nursing Quarterly, Vol. 28, No 1, pp 85-92, Lippincott Williams and Wilkins, Inc
- Tuten, Mavis, RN, OCN, (2001) A Death with Dignity in Oregon; ONF Vol 28, No1, pp 58-65 2001
- Winslade, William J. and Kyriakos S. Markides; (1992) Assisted Suicide and Professional Responsibilities; Society July/August 1992, Transaction Publishers
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