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Physician Assisted Suicide - why is it wrong?

1. Introduction


I have been trying to write something on Assisted Dying for some time, and have found it difficult. Discussing end of life issues, especially when we are concerned about the suffering of those we love, is not easy and I am sensitive to those who have struggled (and are struggling) with this issue. However, I want to offer a contribution on this subject as the States of Jersey prepare to discuss and vote on a proposition to make Physician Assisted Suicide legal in Jersey. I may offer further comment on the proposition itself at a future time.


I should add that this piece will probably leave out some arguments that are important for you so I have put a number of links at the end for you to find out more.


A doctor friend recently said to me that this is the most important subject in his lifetime. Indeed, this is such an important subject for us all. Whether you are a person of faith or not it matters.


2. The Christian View


The Christian position traditionally sees Assisted Dying as wrong for a number of reasons. The Bible teaches us that life is a gift from God, a very precious gift. Into each human being the Almighty has breathed life (e.g. Job 33:4); each one of us is made in His image (Genesis 1:27); each one of us is precious to Him.


In the Old Testament even before the Old Testament Law came to be, God instructed Noah and his family very clearly:


‘Whoever sheds human blood, by humans shall their blood be shed; for in the image of God has God made mankind.’ (Genesis 9:6)


And in the subsequent Law given by Almighty God to Moses on Mount Sinai it makes clear that life is so very precious and not to be wilfully taken: it is protected in one of the 10 commandments – “You Shall Not Murder” (Ex. 20:13). And elsewhere in the law it states if someone does end the life of another the penalty is that their life is also ended: a life for a life (e.g. Ex. 21:12ff).


Jesus even equated anger with murder in Matthew 5 – clearly recognising that importance of the original commandment.


From an orthodox Christian position, life is the gift of God; life is very precious; each person, each life, is made in the image of God; every life matters; and for another to deliberately end that life is wrong.


At the heart of Assisted Dying debate is the problem that if you take one life you don’t simply diminish that one life – you diminish all human life.


3. Non-Religious Reasons For Opposing Assisted Dying


Having argued that ending a life prematurely is wrong in God’s eyes, I want to offer some non-religious arguments as to why, even in the most extreme cases when suffering seems unendurable, asking a doctor to deliberately and directly end that life is wrong.


Assisted Dying (also called Medical Assistance in Dying [MAiD] in Canada and the USA) is legally permitted in places as far apart as Oregon in the USA, Canada, the Netherlands and Belgium. You can read more about the impact on these communities elsewhere, but the impact has included children being euthanized, people who are depressed having their lives ended and in Belgium a recent scientific report from Ghent found that people who have everyday conditions as a consequence of being old accounted for over 17 per cent of all reported euthanasia and assisted suicide cases in 2019, and a 47 per cent of all “nonterminal” eutha­nasia cases.


So what are some of the “non-religious reasons” for opposing assisted dying?

3a. Arguments from CARE against Assisted Suicide

CARE (Christian, Action, Research & Education) on their website[1] give the following arguments against assisted suicide:

1. Alternative treatments are available, such as palliative care and hospices. We do not have to kill the patient to kill the symptoms. Nearly all pain can be relieved.

2. There is no ‘right’ to be killed and there are real dangers of ‘slippery slopes’. Opening the doors to voluntary euthanasia and assisted suicide could lead to non-voluntary and involuntary euthanasia, by giving doctors the power to decide when a patient’s life is not worth living. In the Netherlands in 1990 around 1,000 patients were killed without their request.

a. This argument is very strong. Almost everywhere it has been passed the laws have been made more and more liberal. In Belgium, for example, having started with restrictions on age and competency, it is now, as of 2014, permissible for even young children to be euthanized if they wish it.[2]

3. We could never truly control it. Reports from the Netherlands, where euthanasia and physician-assisted suicide are legal, reveal that doctors do not always report it.

4. The assumption that patients should have a right to die would impose on doctors a duty to kill, thus restricting the autonomy of the doctor. Also, a ‘right to die’ for some people might well become a ‘duty to die’ by others, particularly those who are vulnerable or dependent upon others.


3b. Other Arguments against Assisted Suicide

There are some other arguments against it from the way it has worked out in practice:

1. End of Life Timing. One of the arguments for assisted dying is to limit it to those who are terminally ill and nearing the end of their lives, perhaps with 3 or 6 months to live. The difficulty is that, as doctors will tell you, no doctor can accurately gauge how long each patient will live. Some die in a shorter period than expected and others die after a much longer period (one doctor told me someone who was given a few days or weeks lived for 3 more years and not long ago I spoke to someone who had hours or possibly days to live and a few months later was chatting to them as they went down King Street…).

2. The Vagaries of the treatment. It is suggested that all you need to do is ask the doctor to prescribe what is needed to end your life, follow the legal procedures, receive what is prescribed, you take it and that is the end. In Oregon in 2019 & 2020 from taking what was prescribed to unconsciousness was in the range 1-90 minutes and to death was in the range of 1 minute to 47 hours[3]. 25% took over an hour to die and 7.6% to over 6 hours. Not just an isolated case. And some even regained consciousness[4]. Of those who regained consciousness, none tried again to terminate their lives. (And this data is collected from about half of those who have had their lives terminated by MAiD that they don’t have data on nearly halfof the cases in Oregon) I dread to think of the suffering, for both the individual and loved ones in that window when it didn’t “work” immediately. Ironically they call their act the “Oregon Death with Dignity Act”. I am not sure how much dignity there was for many of those patients.

3. Difficulties in the Definition of Unbearable Suffering. Another argument is that it alleviates unbearable suffering. Aside from the difficulty of how we describe unbearable suffering (is it simply physical pain? What about severe mental anguish? Or torment of the soul? Or extreme despondency or depression? All of these to the sufferer can seem like unbearable suffering), there is no formal definition of unbearable suffering, so if we legislate on the basis of unbearable suffering there is no way of determining if something was within the law or not – it is currently an entirely subjective measure, which the courts couldn’t hope to deal with. On the issue of physical pain, it can be controlled in almost all cases, and in the tiny number of cases where it cannot be directly controlled there is sedation to prevent unnecessary suffering.

4. Those With Disability Become Vulnerable. Many in the community of those with some form of disability are also vocally against assisted dying. Baroness Tanni Grey-Thompson, the wheel chair user and former Para-Olympian, has been a cross-bench peer for 10 years and is now a specialist in areas including disability rights and controlling and coercive behaviour. She made a very powerful presentation to the Jersey Jury[5]. Describing herself as somewhere between an agnostic and atheist, she acknowledges what a difficult issue this is. Having said that, she states she is against assisted dying and supportive of palliative care.

In countries with some form of assisted dying unbearable pain is very low down of the list of reasons why people actually take their own lives – not wanting to be a burden is high and she is very concerned about coercive behaviour – especially towards people with disability.

Lionel Roosemont, a Belgian father of a 20- year old disabled daughter, explained[6] what he and his family have had to put up with from fellow Belgians while out in public.

" We were walking with our child in a wheelchair and we would have people that we did not know, come towards us and they would ask us, ‘ Why don’t you have that child euthanised?’”

“…. If today you go through Belgium you will not see many children that have a handicap because they have not been allowed to live.”

5. The Pressure on the Most Vulnerable. The final argument I will make in this paper is simply this: if assisted suicide or dying is legalised the most vulnerable people in our midst (not only those with disability) may feel pressurised either by societal pressure or the desire not to be a burden into going through with it. Last year in Oregon 53.1% of those who chose this path said they did so to avoid being a burden on family, friends or care-givers[7].


4. The Important Place of Palliative Care


Some have argued that the proposals bring dignity to dying. This is simply not accurate. Dignity in dying is not a new thing. The Palliative Care movement has been ensuring dignity for all its patients over many decades as they come to the end of their natural lives. As Dr. Carol Davis says[8], “palliative care is about living as well as you can until you die.”


Jersey and Britain have excellent Palliative Care compared to many countries ensuring good end of life care. In many of the countries with assisted suicide the investment to ensure the best end of life care is lacking investment and a number of hospices, for example, have closed.


Dame Cicely Saunders, the founder of the modern hospice movement, is quoted as saying:

“You matter because you’re you, and you matter to the end of your life. We will do all we can not only to help you to die peacefully, but also to live until you die.” Good palliative care ensures all those who need it receive it.


As I have written, the Christian position is that the deliberate taking of another’s life is wrong. However, relieving pain at the end of life is an important tool in palliative care, even if it may bring forward the timing of their death. It is also important to note that doctors honour someone’s decision to no longer eat or drink – ethicists on all sides agree forced feeding of a dying person is not right if they do not wish it; it is also important to honour someone’s decision to reject medical intervention of any kind. These last two are about allowing the body to follow it’s own course. Medical practitioners, carers and loved ones will of course be on hand if someone changes their mind in a palliative care setting.


The point is this: our community already provides care and dignity at the end of life so that people may die well. Our palliative care is outstanding and is what needs to be supported wholeheartedly, not potentially undermined by approving assisted dying.


5. Conclusion


Christians have always stood for the value of every human life. Assisted Suicide in which the life of one of us is deliberately ended prematurely is contrary to Christian teaching and natural law. If we open this door a crack, it will inevitably be opened wider and wider, as it has everywhere else in the world where it has been permitted.


Please do contact your elected representatives – Senators, Deputies and Constables to share with them your view. If people who care about life do not speak up the potential is that it becomes a slippery slope, such that we become like Belgium, where in 2016 24 babies under 1 year old were administered lethal injections in Flanders[9], even though it was illegal. No authority has taken any action about this. Life is cheaper than it used to be – may that not happen here.



Rev. Paul Brooks

October 2021


Books


“Death by Appointment” by Ilora Finlay and Robert Preston (published by Cambridge Scholars Publishing, 2020)


“Matters of Life & Death” by John Wyatt, foreword by John Stott (published by IVP, 2009)


Online articles and resources:


Article in Christian Today:

https://www.christiantoday.com/article/the.church.should.be.at.the.forefront.of.a.passionate.opposition.to.assisted.suicide/137491


Article on pain as justification:

https://unherd.com/thepost/pain-is-not-a-justification-for-assisted-dying/?mccid=ed7d10b362&mceid=044ee407c4 by Henry George, A freelance writer and researcher


CARE website resources:

https://care.org.uk/cause/assisted-suicide/whats-wrong-with-the-assisted-dying-bill?utmsource=CARE&utmcampaign=cf7c66165e-Impact16JulyCOPY01&utmmedium=email&utmterm=08cc8d9cafe-cf7c66165e-459058337&mccid=cf7c66165e&mceid=83e79ae61d

Presentation by Tanni Grey-Thompson: https://www.youtube.com/watch?v=2FNJTfUICjE&list=PL4aZ9DqBy0lc3pFcc50jwRRfMS5GvEI15&index=22


Presentation by Dr. Carol Davis, Lead Consultant Palliative Medicine and senior lecturer at the University Hospital Southampton and Visiting Consultant in Palliative Medicine Jersey Hospice Care, and previously worked at the Royal Marsden Hospital as honorary consultant in palliative care:

https://www.youtube.com/watch?v=Suvrq5yIr3Y&list=PL4aZ9DqBy0lc3pFcc50jwRRfMS5GvEI15&index=28


Christian Institute Article: Assisted Dying makes death a treatment for the vulnerable:

https://www.christian.org.uk/news/assisted-suicide-bill-makes-death-a-treatment-for-the-vulnerable/?e011021


Websites


Care Not Killing promoting good palliative care:

https://www.carenotkilling.org.uk


https://care.org.uk/cause/assisted-suicide (has several links to excellent materials and articles)


https://www.christian.org.uk/resource/assisted-suicide/



Footnote: Jersey Citizen’s Jury on Assisted Dying


Jersey’s government recently established a citizen’s jury to consider whether assisted dying should be permitted in Jersey. The report (which can be found on the government website) was produced following online sessions looking at the arguments for and against assisted dying by 23 members of the island community and the outcome was a report in which 78% of the panel agreed assisted dying should be permitted in Jersey.


There are inevitably questions about how representative of the island community the panel actually was and whether their conclusion was a reasonable one. The problem is that many believe that their view is the Island’s view.


The panel was picked, apparently carefully, from those who responded and were willing to be a part of the panel. They had to be both willing and able to function online for the 5 Saturdays of their taking evidence. It immediately excludes the elderly or those who do not enjoy too much online activity.


I understand that even before the evidence started a majority of the panel were in favour of Assisted Dying. Indeed the report says that of the panel 52.2% were in favour before they began and another 30.4 % said they thought it should probably be allowed – they based this on the view that these were the prevailing views of the people of Jersey: but no official poll has been taken as far as I know. So it is no surprise that at the end 78% were in favour. I would argue that they were not a group that genuinely reflected the Island community – I do not think over 80% of the people in Jersey support this law change.


Even if the panel members were all entirely neutral on the subject before they received their evidence, that evidence was inevitably limited by the time available to them – while each of the early speakers had about 9 minutes to make their case from their perspective, the latter speakers only had 5 minutes. So, for example, they had one palliative care consultant in favour of assisted dying and one against – so as a panellist you would think the views were 50-50 on the issue. In fact the Association for Palliative Medicine Palliative, an association of 1200 doctors working or interested in Palliative medicine working in hospices, hospitals and the community, surveyed their members and 85% were against it – an overwhelming proportion – yet by giving the two doctors equal input it seems it is evenly spread.


From the faith community a local pastor spoke against the proposals, but no local faith leader could be found who supported Assisted Dying so they found someone from the Unitarian church, which is not a Christian church (they reject all Christian Creeds and that Jesus was the son of God, for example). The Church of England has about 600,000 as an average Sunday attendance and a membership of nearly 900,000 at the last count with over 2,000,000 attending a Christmas Service in a C of E church. The Unitarians have a total UK membership (i.e. not just England and the Channel Isles!) of about 7,000. But still, each position had the same time giving the view that it was an equally held view.


In my view, the flaws in the Government of Jersey’s Assisted Dying Citizens’ Jury’s report’s methodology and make up are significant and prevent it being a helpful document in this debate.





[1] https://care.org.uk/cause/assisted-suicide#s:primer [2] https://www.patientsrightscouncil.org/site/belgium/ [3]https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year23.pdfp. 13 [4]https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year23.pdfp. 16 [5] https://www.youtube.com/watch?v=2FNJTfUICjE&list=PL4aZ9DqBy0lc3pFcc50jwRRfMS5GvEI15&index=23 [6] https://www.youtube.com/watch?v=YAVq1pFJbHc [7]https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year23.pdfp.12 [8]https://www.gov.je/SiteCollectionDocuments/Caring%20and%20support/ID%20Dr%20Carol%20Davis%20presentation%20slides.pdf [9] https://www.ieb-eib.org/en/news/end-of-life/euthanasia-and-assisted-suicide/belgium-euthanasia-of-new-borns-practiced-outside-the-law-2041.html

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