Christians and Physician Assisted Suicide

In my experience working with terminally ill patients over the past seven years, I have often seen people of the Christian faith go all out in the ICU, wanting “everything done” for a terminally ill loved one. In these circumstances, when I speak with family members of the patient, they tell me they will continue to pray for a miracle to happen. As a person of faith, I respect their faith and their right to exercise it. When appropriate, I gently remind them that ultimately we all die and that, in the case the miracle does not happen, it is good to have an end-of-life plan in place.

This experience came to mind when I read a recent article in www.time.com by Corinne Johns-Treat, a cancer patient who has decided that she wants “death with dignity.” The article stands out because she explains how she came to that decision in the context of her faith: “…[T]he more I learned about the safeguards and autonomy in the law, and the more I prayed about it, having seen people suffer so much at the very end of their lives, I came to believe in that it fit into my faith. I found comfort in this law” (California’s ‘End of Life Option Act’).

As I read her thoughtful article, several familiar themes arose: autonomy, personal suffering, and the painful experiences of others. These, of course, are used by others defending PAS who do not necessarily have a particular faith commitment. To place her decision within the framework of her Christian faith, Johns-Treat adds this thought: “If God grants us the intelligence to enable doctors to offer treatments that prolong life—that have prolonged my life—wouldn’t that same logic apply to those of us nearing the end of our life? When science can’t offer life-sustaining treatments anymore, then the role of medicine should be to relieve suffering.”

I don’t know anyone in the medical field who would disagree with the goal of “relieving suffering.” The question is how to define it. Cannot palliative care offer more to the dying patient than PAS? My work in hospice showed me that death does not need to be anguish for patient and family alike during the final hours of life. Palliative care physicians and their teams do tremendous work every day to relieve the terminally ill of their suffering. As the field of palliative care continues to deepen and grow, and as people become more aware of their mortality, I hope that PAS does not become the default method of “relieving suffering.”

Christians – and members of other faith groups – will undoubtedly continue to wrestle with these issues in the coming days. This is important because they are indeed matters of life and death.

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Jon Holmlund
Jon Holmlund
4 years ago

I agree, and think this is one of the critical points against PAS/EAS: that it distracts from a proper emphasis on excellent palliative care.

Michael Knower, MD, HMDC
Michael Knower, MD, HMDC
4 years ago

Dr. Skjoldal, I have been a hospice physician in Oregon since December 1988. Although we are certainly more adept at symptom management than we were a quarter century ago, you and I need to admit that we cannot always control terminal delirium, pain, dyspnea, and other symptoms as well as we would like.
Having said that, we need to ask, “How deep is our faith?” Specifically, can we trust God with the timing and circumstances of the end of our lives? God is capable of performing miracles without endotracheal intubation and mechanical ventilation. He is also capable of bringing our days to a tranquil end without relying on three grams of Secobarbital.
We have allowed a hijacking of the language. We as a society are told that dignity depends on the mode of death, rather than on the quality of the preceding life. “Compassion” originally meant “to suffer with,” an often time-consuming, discomforting process, rather than inducing a quick and predictable demise as advocated by Compassion and Choices. The ultimate act of personal autonomy is now portrayed as bringing to an end the person and his ability to make any further choices or exercise any future autonomy.
As for the vaunted safeguards under the Oregon Death with Dignity Act and its heirs: there is no requirement for psychiatric consultation to assure the patient is not depressed; the two-week waiting period is shorter than the time to steady state for most antidepressants; some prescribers take the hospice physician’s certification as the “second opinion” without bothering to contact the hospice physician; by not classifying the ingestion as a suicide the death certificate data are questionable. You and I know that even in the most experienced hands prognosis is an art fraught with uncertainty. I have had patients discharged from hospice for improvement to greater than six months’ prognosis turn around and say, “Well, in that case I’ll use the Death with Dignity Act.”
Not all those prescribed the drugs for assisted suicide use them. However, if you read the Oregon Health Division’s annual reports, the numbers are steadily increasing. In 2014, the number of Oregon deaths reported under the Death with Dignity Act was half again that of deaths ascribed to diabetes. In the Netherlands reported deaths from active euthanasia and assisted suicide now exceed those from bronchogenic carcinoma.
It is disturbing to consider the similarities between the Oregon Death with Dignity Act, the California End of Life Option Act, and the Sterbhilfe laws under the Weimar Republic. We are sending a strong message that there are lives no longer worth living, and Oregon’s rising suicide rate over the past twenty years attests to the fact that our general population is listening.

Neil Skjoldal
Neil Skjoldal
4 years ago

Dr Knower,

Thank you for your post. The experience from Oregon needs to be told. It is hard to escape the conclusion you have drawn re: the general population’s acquiescence. This is indeed troubling.