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.

Can Vets Help Physicians Consider Euthanasia?

I had no plans to write on the issues of human versus animal euthanasia, since it seems like I’ve spent more than enough words on the topic previously. Then I began to tackle the mail, journals and newsletters in my mailbox and came across a submission that made me want to re-open the whole issue. In the July issue of “Veterinary Practice News,” Dr. Alice Villalobos, a well-respected palliative-care veterinary oncologist and previous president of the Society for Veterinary Medical Ethics, submitted a “ViewPoint” piece that asked, “Can vets help physicians consider euthanasia?”

First of all, I have great respect for Dr. Villalobos as a veterinarian who has made a great contribution to the welfare of animals by the development of a “quality of life” scale that helps assess, in a more tangible way than to attempt a determination of “suffering,” when an animal patient should continue to receive treatment, including palliative or hospice care, or when euthanasia should be considered the most humane option. The article that includes this information, by the way, is found at the ”Pawspice” (rhymes with “hospice”) website. You may find it a fascinating read.

Her piece starts solidly, with the reflection that the veterinary standard for hospice care, including euthanasia, is spilling into human hospice, in some states at least: “…there is no way to deny that there is a societal trend for crossover to the way veterinarians assist animals at the end of life.” Indeed. Ask the legislatures in Vermont, Oregon, Washington, and Montana. And she further reflects that it goes the other way as well: some veterinarians adopt a vitalist model that would place enough guilt to convince someone into spending resources, financial and emotional, on an end-stage renal failure patient to try “’…one more day to keep her going,’” ultimately ending in a pet that dies in the hospital and away from human family members. Some veterinarians increasingly imitate some of their human medical colleagues that wish to extend life at all costs.

I find it appropriate to condemn this kind of practice—it is paternalistic and unkind to human and animal alike. The patient, of course, has no voice, and a veterinarian can effectively bully a client into doing extensive and futile procedures or face the shame of “killing” their pet. Where Dr. Villalobos goes off the rails is in the next section of her piece. Here she makes her argument for human euthanasia:

“Many seriously sick, old and frail people receive brilliant medicine and supportive care as hospital patients. Then they get transferred into a facility where they become humiliated persons whose bodies are being warehoused until they die.

“Baby boomers fear that they will get futile medicine or live too long in chronic pain, past their desired time, languishing year after year in tomorrow’s thriving extended care industry.”

Okay, perhaps this is just genuine emotion, and not an ad hominem attack on the human medical field. There is plenty to criticize in the way we treat human beings at the end of life. But she goes on:

“What about the horrendous emotional suffering of people whose bodies and/ or minds have withered into vegetative tissue barely resembling their original self? The distraught families of warehoused persons feel guilty and hopeless because they are barely recognized or not acknowledged at all during visits.”

Several critiques here: how does one who is in a vegetative state (curiously defined as “bodies and/ or minds”—I am curious what a “vegetative body” resembles) have the wherewithal to suffer so horrendously? I thought their minds had already withered to an unrecognizable degree. Must we resemble our “original self” to maintain human dignity? A visit to a fifty-year high school reunion will challenge that view. And how did we shift the focus to the guilt and hopelessness of family members, not the patient? Ought these, then, be the predominant foci of our ethical decisions?

But my greatest criticism is the ethical leap Dr. Villalobos makes here: A decision to forego burdensome medical treatment that would extend life necessitates euthanasia. She infers (at a minimum) that a decision to forego treatment is the same as the decision to have a physician actively end life, perhaps even absent the patient’s will. They are certainly not, and effective palliative medicine in human medicine has shown this. Allowing a patient to die as a result of the underlying disease is not euthanasia. While this is not generally practical or advisable in veterinary medicine, humans can “die with dignity,” to use that wretchedly-abused term, without being euthanized. Yes, it is different.

Euthanasia is a big part of how I, and other veterinarians, can fulfill our mission to relieve animal pain when they become moribund or face intractable pain. It has always been ethically sound for us to do so. We recognize that an extension of the process of dying offers little of value to our patients. The same cannot be said of human beings, where interpersonal relationships are more complicated—and the risks of hastening the end of life are far more complex. To make this jump is ethically unsound and, frankly, rather sloppy.

We must ultimately decide if ethical principles must apply to humans and animals identically or if human beings are a different sort of being, based on our innate “human-ness.” And we must realize that, as our technology develops further and can extend life longer, popular sentiment and cultural ethics will equate the decision to cease or withhold treatment with euthanasia. Maybe we have our work cut out for us, even if it means revisiting the issue a few more times than we think we have to do.