Physician-assisted suicide: Can the culture of life and love prevail?

The daunting specter of physician-assisted suicide (PAS) continues to loom in our country and throughout the world.¹ At times it appears as though the culture of death will prevail in the minds of our people and in our laws. In November of 2008, Washington state joined Oregon as one of the two states that has legalized PAS by ballot initiatives, protecting physicians who prescribe a lethal dose of drugs to a patient seeking to kill himself. With the backing of millions of dollars, the initiative was passed with nearly a 6:4 margin. Since 1991, there have been six ballot initiatives seeking to legalize PAS in five states. (Washington voters had initially voted against PAS in 1999 at a 4:6 margin.) From January 1994 through June 2009 there have been 113 legislative proposals in twenty-four states. Thankfully, for various reasons, none have passed. However, in Montana (Baxter v. Montana), a district court legislated from the bench and determined that doctors may assist in suicides and be protected from liability. In December 2009, the Montana state supreme court upheld the ruling.

Since 1997, when the “Death with Dignity Act” took effect in Oregon, 629 lethal prescriptions have been written, with 407 individuals taking their own lives. The year 2008 saw a record number of individuals committing suicide by prescription overdose. On May 22, 2009, Linda Fleming became the first to kill herself under the new law in Washington. Sadly, more will soon follow. And, in Europe (which provided the model for the Oregon law), as of April 1, 2009, four countries offer protections to those who assist in suicides: the Netherlands, Belgium, Luxembourg and Switzerland. Efforts are underway in many countries to join their ranks, while thousands of Europeans have already taken their own lives. Finally, countless thousands upon thousands have been negatively influenced and convinced that PAS is a morally acceptable exercise of freedom and choice.

This is a disappointing, sobering and urgent situation. Pope John Paul II described euthanasia and PAS as “one of the more alarming symptoms of the ‘culture of death,’ which is advancing above all in prosperous societies,” is “senseless and inhumane” and “an injustice which can never be excused.”² With faith and hope in Jesus and a firm resolve, it is not inevitable that PAS and euthanasia proponents will win the day. However, given the urgency of the situation, we as pastors, educators and pastoral ministers must act decisively and consistently. I believe that we can win the day if we seek to educate our people in three key areas. First, we must foster awareness of the root mentalities and characteristics of the culture of death. Knowing the mentalities of the culture of death will allow us to eradicate them from our own minds and hearts, equip us to root them out of our families, and influence society as a whole. Second, our flocks should be aware of the corrosive and underhanded tactics of the proponents of PAS and euthanasia. I suggest that it is these tactics which have brought about the victories to date. Third, we must consistently preach and teach an authentic Catholic understanding of suffering and death, compassion and love, hope, and the true dignity and inviolability of each person. If we do these three things faithfully, the culture of life and love can prevail. If we do not, it is my firm conviction that our society (including many Catholics) will surely succumb to the culture of death. My hope is that this article will offer a brief and necessarily incomplete primer on these key issues.

Mentalities and characteristics of a culture of death

In Evangelium Vitae, John Paul II identifies a number of the characteristics of the culture of death that foster the pro-euthanasia and pro-PAS movement. The first characteristic John Paul II identifies is a lack of relationship with God, which he describes as “the deepest root of modern man’s confusion.” When we “deny or neglect our fundamental relationship with God,” lose faith and hope, and lose a sense of mystery, we become more susceptible to a pro-death mentality. Without the relationship of faith and hope in God, there is no ultimate meaning to this life. Without the light of Christ, all is dark; what man endures seems senseless, and man’s very existence seems meaningless. Archbishop Ignazio Sanna emphasized this to the Pontifical Academy for Life when he said, “only those who have a lofty concept of God have a lofty concept of man.”³ Without God, suicide seems rational in the face of suffering, because if this is all there is, there is no reason to suffer through it. Without God, the meaning of everything becomes distorted and disfigured, especially the mysteries of suffering and death. As Pope Benedict XVI states in his encyclical Spe Salvi, “Let us put it very simply: man needs God, otherwise he remains without hope.” In recent decades, there has been an increasing tendency to replace hope in God with a hope in man, his technology and the progress that he can attain himself. The exaltation of progress without God as our sure compass has led to various evils that denigrate the true good of man. “Progress in the wrong hands…becomes a terrifying progress in evil.”⁴  Genuine progress is only attained through conformity to God, the moral law and “by corresponding progress in man’s ethical formation”; otherwise, “it is not progress at all, but a threat for man and for the world.”⁵

Due in no small part to modern man’s lack of faith and hope, John Paul II identifies a fear of suffering as a second characteristic of the culture of death. The repulsion of suffering leads man to think he must avoid it at all costs. Suffering is “rejected as useless, indeed opposed as an evil, always and in every way to be avoided.”⁶ This second mentality has gained prominence as provocateurs like “Doctor Death,” Jack Kevorkian, state that man has “a right not to have to suffer.” However, there is no conceivable right to not suffer, and we must recognize that suffering is a part of human existence which cannot be entirely avoided. While we may seek to diminish or avoid suffering as long as it does not involve doing something immoral, it is a grave error to think that when one suffers, his life is somehow less valuable. The proponents of PAS suggest that the worth of a human life is based upon health or the pleasure one is able to enjoy. However, each person, regardless of physical or mental state, bears a great dignity and worth that is never diminished by suffering.

Third, John Paul II identifies a utilitarian ethic as a mentality of the culture of death and as a root-cause of this pro-death movement. Utilitarianism views the human person as possessing worth only if he is able to provide some good to society and contribute to its flourishing. In a society “marked by an attitude of excessive preoccupation with efficiency,” it often treats the individual as though he ought to live only if he or she is useful to society.⁷ Man is merely a cog in a machine, and when he is no longer useful, he is a burden. Such a view is a terrible misunderstanding of the human person, and it devalues the young, the old and those who are impaired or disabled, perceiving them as “intolerable and too burdensome.”⁸ Unfortunately, the assumptions of utilitarianism are widespread in our culture, particularly within the media, political sphere and health care system.

A fourth characteristic is a fear of life being unduly prolonged by burdensome and overzealous medical treatment. Hoping to avoid such burdensome treatment, suicide is often promoted as a legitimate medical and truly human solution to avoiding unnecessary hardship and pain as one faces the end of life. Catholics are no different from others who often do not want to undergo every possible procedure or medical treatment to indefinitely prolong life. And this inclination is correct…we have no moral obligation to pursue every possible treatment. One is only obliged to undergo treatments that keep the “real situation of the patient” in mind and which offer reasonable hope of benefits that are greater than the burdens that may be incurred.⁹ “Aggressive medical treatment[s]” that are “disproportionate to any expected results,” as well as excessively burdensome treatments, are not morally obligatory though, in principle, normal comfort care should always be provided.¹⁰ Neither euthanasia nor suicide are ever a necessary or morally acceptable solution at the end of life. One may never intentionally cause death by taking an action or omitting a life-saving procedure in order to end suffering. One need not pursue suicide in order to avoid burdensome treatment or severe pain at the end of life. Through appropriate palliative care, in keeping with the moral law, pain may be alleviated. Balancing the principles governing the end of life and avoiding over/under treatment is not always an easy task, but with sound moral guidance and prudential discernment, extremes may be avoided.¹¹

A fifth root mentality of the culture of death “lies in a notion of freedom which exalts the isolated individual in an absolute way.”¹² The view that man has absolute autonomy and serves as his “own rule and measure” is a particularly evident characteristic of the culture of death.¹³ Our society tends to have a view of freedom that exalts the will of the individual to such an extreme that freedom is understood as license to do whatever is desired, except unlawfully encroach upon the autonomy of another. The colloquial expression is, “I can do whatever I want…as long as I am not hurting anyone.” This view raises the individual over and above God and declares him as the standard and arbiter for what is morally acceptable. In his October 1995 homily in Baltimore, John Paul II said, “Every generation of Americans needs to know that freedom consists not in doing what we like, but in having the right to do what we ought.” When man believes that there is no such thing as acts which we ought not ever do, and that each individual alone can determine what is “right for me,” he will likely fall into the trap of accepting suicide. Here, within the modern world, we see an imprint of the fall of man in the Garden of Eden. Encouraged by the culture of death, man, especially in the West, ignores God’s will, declares his autonomy and arbitrarily decides when his life is of value. The culture of death depends on an obsessive preoccupation with this exaggerated sense of the individual, and so at the end of life seeks “to take control of death,” and in the name of autonomy names this evil act of suicide as good. Rather than possessing absolute autonomy, we ought to see ourselves as caretakers of life who possess freedom so that we may pursue good and avoid evil.

The culture of death and the mentalities that characterize it are prevalent in our society. It is vital that we remain vigilant and aware of the mentalities that will lead humanity toward death and destruction and value every human person as God does—as very good and precious in his sight.

Tactics of the pro-suicide movement

Having identified the root characteristics of the culture of death, we turn to the tactics of those groups whose expressed purpose is to push the pro-suicide agenda and thus promote that culture. Most influential within the United States is Compassion and Choices (C&C), formerly known as the Hemlock Society. Such groups actively promote suicide to individuals through various methods, including direct-to-consumer marketing, “how-to” manuals, a “storytelling” contest, and Compassion and Choices magazine, which has 45,000 subscribers. They do so in government through a variety of methods, including lobbying well-connected and well-heeled politicians and filing lawsuits. In my mind, this promotion reinforces the need to bring these issues to the people before it is too late. We are in the middle of a very real political and cultural war that will shape the way we and our loved ones view end-of-life issues for centuries to come.

So what are the tactics and strategies of proponents of euthanasia and PAS? First, they intentionally manipulate and engineer language so that suicide and euthanasia appear more palatable. One needs to look no further than the name “Compassion and Choices.” After all, who could be against compassion and choice? Playing on the culture of death’s exaggerated sense of individual autonomy, the most obvious example of this verbal engineering is to speak of a “right to death,” as though there were such a right. One of the mottos of C&C is “My Life. My Death. My Choice” because they claim suicide to be “a fundamental right protected by [the] state.”¹⁴ If there were such a right to die, there would be a corresponding obligation and duty to help fulfill this right with every request. This would certainly be frightening! Another example is the hijacking of the phrase “Death with dignity.” All would agree that dying with dignity is a good thing, but PAS proponents have hijacked the phrase to refer to euthanasia and suicide, while simultaneously presenting the pro-life position as though it is against death with dignity. Of course, death with dignity is not achieved by killing oneself, but rather through virtuous relationships with God and others.

Pro-suicide groups refer to PAS and euthanasia in such sterile terms as “self-termination” and “self-deliverance,” and in laudable terms such as “an act of compassion or mercy,” a “choice for freedom from suffering” or “aid in dying.” They obscure the meaning of words so as to shroud what is truly happening in a false veil of credibility and professionalism. This tactic has been taken so far that C&C has convinced the state of Oregon to no longer use the word “suicide,” but rather “physician-assisted death,” “physician aid in dying” or “hastening death.”¹⁵ In the same C&C article cited above, C&C claims that it is essential to recognize the difference between “aid in dying and suicide.” The claim is that “the choice of a mentally competent, terminally ill patient for a peaceful death via self-administering medications prescribed for this purpose” is not suicide. They redefine suicide as “the act of a person who is not dying, who may be suffering from impaired judgment or mental illness, to precipitate death.” This novel definition of suicide is creative to be sure, but ultimately it is completely fabricated rhetoric with the sole purpose of garnering public support. Suicide is any action that involves the deliberate taking of one’s own life. Whether medication was prescribed or whether the person is mentally ill does not alter whether the action chosen is suicide. In short, proponents deliberately change the meaning of words and use terms that sound innocent, laudable or professional in order to shift the opinions of society.

Why do they do this? “Polls show that people are more likely to approve legalizing the practice when the word suicide is not used in describing it.”¹⁶ They are trying to create new social norms, and verbal engineering usually precedes societal and cultural engineering. If you win the “word game” and define the terms to be used in debate, you win the game. This despicable tactic is proudly acknowledged by the founder of Compassion and Choices, Derek Humphry, who said “The euphemisms won,” when public opinion turned to support PAS in Oregon. PAS and euthanasia pervert the true meaning of compassion, mercy, choice and medicine. As Catholics, we ought be on guard for this tactic, and make sure that our language actually describes what is happening.

A second common tactic is to dramatize end-of-life cases. This is promoted by C&C and encountered in various forms of media, likely because it increases viewership and the bottom line. Perhaps this dramatization is not always a deliberate ideological push, but this becomes increasingly difficult to believe in light of movies like Seven Pounds and Million Dollar Baby and the recently announced filming of a movie on Jack Kevorkian which includes a cast of A-list actors and screenwriters. The producer of this movie describes Dr. Kevorkian as “a man who walks in the footsteps of Martin Luther King and Nelson Mandela.”¹⁷ This, about a man who murdered or assisted the suicide of seventy people suffering from depression, including five who were not even sick? With a misconstrued understanding of compassion, the media seems to relish the story of men or women who suffer from difficult diseases and glorify those “pioneers” who help them approach a peaceful end. The narrative is put forward in such a way that it appears as though the only truly human solution is to kill the person. PAS is presented as a necessary response to suffering and a medical treatment to which one has a right. C&C and the mainstream media purposely work the emotions and feelings and ignore other solutions, including palliative care and hospice, which address pain and tend to the genuine needs of the person. As a recent article in USA Today titled “Dr. Death Served Us All With Time In Prison” stated, “They cry out that physician-assisted suicide is the only humane and compassionate thing left in the spectrum of treatment at the end of life” (emphasis added). Is suicide really a treatment? Caring? Humane? Imagine the implications for medicine if suicide is considered a treatment. In Oregon there have already been at least two patients who were denied life-saving treatments by their insurers, who instead offered to pay for drugs to commit suicide.¹⁸ Nonetheless, an article in the Seattle Post-Intelligencer insists that if we do not pursue “aid in dying,” then individuals will be left to the “whims” of the uncaring medical resident who will “ravage” the person, causing “ungodly suffering.”¹⁹

When encountering these words, it is very clear that the goal is to generate fear and lead people to believe that the only choice is suicide in order to avoid “ungodly suffering.” However, the debilitated and vulnerable are in need of and can be offered effective pain management, comfort care, and “the look of love which they so desperately need.”²⁰ The temptation to turn to suicide in the face of suffering is ultimately “a request for companionship, sympathy and support in the time of trial.”²¹ This is the role of families, medical staff and medicine as a whole—to cure when possible and to care always. We cannot allow ourselves to be swayed by the ideological commitments and dramatization of the media and C&C.

Third, advocates of PAS present the pro-death mentality as culturally superior, while deriding the pro-life mentality as ridiculous. One example is a May 2006 column in the Seattle Post-Intelligencer titled “Medieval Thinking No Help to Dying.” The author refers to the pro-life position in terms of “unfounded fears,” “old taboos,” “backward” and “obsolete notions.” Here, and in countless forms of media, those who support PAS are presented as progressive, more advanced and truly ethical, while those who believe life always has dignity are caricaturized as uncaring and behind the times. PAS proponents are the elite, well-educated and progressive, who seek to rescue the unenlightened simpleton who stubbornly sticks to his obsolete and backward medieval taboos and refuses to acknowledge the compassion and mercy of the pro-suicide crowd simply because someone in authority told him PAS was bad.

Unfortunately, these and other efforts of Compassion and Choices have met with much success, and the tide of public opinion has been seen to shift toward the pro-death crowd. I contend that this is largely due to these coercive strategies. The good news is that this is not the end of the story. The more we are aware of the pro-death mentality around us, and the more we are aware of the strategies of those who promote the culture of death, the more effectively we can respond and bring about change. With this in mind, we turn to the Bride of Christ, the Church, who in her wisdom helps us to understand the mystery of life and suffering and offers us a beautiful theology of compassion and hope.

Theology of suffering and death

In these pages I have written about Jillian, one of the homeless, severely disabled and dying women I met in Kingston, Jamaica.²² Her strength and approach to life were a powerful witness to the beauty of our lives, and a strong testimony to me about the dignity of persons as they approach death. Her countenance and words reminded me of the appropriateness of Christ’s words, “Be not afraid.” Though enduring much hardship as she neared her final days, her faith was as strong as ever. Jillian recognized that Christ’s call, “Come and follow me,” included following him even into suffering and death. And by sharing in the suffering he endured, she would also share in life with our Father in heaven. “For as we share abundantly in Christ’s sufferings, so through Christ we share abundantly in comfort, too” (Rom. 5:3).

The proponents of PAS and euthanasia believe that suffering diminishes the dignity of the human person and the value of life, and therefore, in situations like Jillian’s, suffering should be avoided by any means necessary. However, Jillian is a strong reminder that each person is made in God’s image and likeness, has been redeemed by Christ, and is made to share eternal life with him. Every person is the high point of God’s creation, and is precious in his sight. We are made in his image, and this is in no way diminished by suffering. Rather, the true dignity of the person is revealed through his or her response to suffering. A person’s dignity is not reduced as his “quality of life” declines and suffering increases. Clear examples of this can be found throughout Scripture, particularly within the story of Job, who endured losing all he had, yet retained his dignity because he refused to reject God. Psalm 116 offers a similar reminder that each of us is called to trust in God even when “I am greatly afflicted,” because “precious in the eyes of the Lord is the death of his faithful ones.” With faith and hope, Christians recognize that afflictions, suffering and death are not absurd, but rather serve as a means to embrace and bring about redemption. Cardinal Lozano Barragan reminds us that “when Jesus speaks of his glory, he speaks of his cross. That is when he draws all to him.”²³ Like Job, we are called to patiently endure the crosses we bear and to recognize that God knows well the plans he has for us. They are plans of fullness, not of harm (Jeremiah 29). We are called to “die in the Lord” (Rom. 14:7), which means we humbly face suffering and “meet death at the ‘hour’ willed and chosen by him.”²⁴

In Spe Salvi, Pope Benedict XVI emphasizes that “it is not by sidestepping or fleeing from suffering that we are healed, but rather by our capacity for accepting it, maturing through it, and finding meaning through union with Christ, who suffered with infinite love.” The person of faith ought to approach suffering as a means to pursue union with Christ through conversion of mind and heart. Suffering can bring about good in our lives by serving as an opportunity to enter into the glory and mystery of Christ’s cross. When we recognize this, perhaps we can echo the faith-filled and loving words of St. Thérèse, who was no stranger to suffering in her life. “For is there a greater joy than that of suffering out of love for you?” Faith and hope in Christ and his plans for us allow us to see the mystery of suffering and death as an opportunity to become one with Christ, who suffered for our sake and for our salvation.

The proponents of PAS and euthanasia argue that in order to have “death with dignity,” one must not suffer, and must be able to choose the means and time of death. Jillian recognized this simply is not true. She told me she was ready to die, and she even prayed that God would take her into his arms. She also said she knew God had a plan for her. To live according to that plan and allow natural death to occur is the only way she could approach death with dignity. In this, the Blessed Mother is a good model—“Let it be done unto me according to your will” (Luke 1:38). Or consider the words of Christ during the agony he endured at Gethsemane: “Father, if it be possible, let this cup pass from me; nevertheless, not as I will, but as you will” (Matt. 26:39). As Archbishop Jose Gomez has emphasized, “A death is only dignified when it respects the essential dignity of the person as someone created by God.”²⁵ Death is not dignified when it is grasped for by suicide or euthanasia, because “true dignity and excellence in men resides in moral living, that is, in virtue.”²⁶ Each person is the steward of his life and is entrusted with safeguarding it. The Catechism of the Catholic Church, 2280 states, “Everyone is responsible for his life before God…but [God] remains the sovereign master of life…we are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.”

Since man is made to be in right relationships, the person who dies with dignity has dignity insofar as he is in right relationship with God, others and self. Suicide is self-murder, and directly and deliberately attacks and harms these relationships founded in love and trust. We can approach suffering and death with great dignity when we embrace the Christian understanding that death can lead to life eternal with the Father. “The Gospel contains a fundamental paradox: to find life, one must love life; to be born, one must die; to save oneself, one must take up the cross. This is the essential truth of the Gospel, which always and everywhere is bound to meet with man’s protest.”²⁷ It is when death is faced with faith in Christ and hope in his promises that we can proclaim, “Where, O death, is your victory; where, O death, is your sting?” (1 Cor. 15:15).

Those, like Jillian, who suffer as they approach death, demand a response from us. The response is one of love and compassion. True compassion involves suffering with the sufferer, not ending his life or giving him the means by which to end his own life. Assisting in suicide is no loving act. We are called to sustain and love the sufferer, not exterminate him.  In 1 Corinthians 13, St. Paul recognizes that “love is patient…it does not rejoice at wrong…love bears all things, believes all things, hopes all things, endures all things.” Truly loving and respecting a person’s dignity means caring enough to foster his relationship with God—not encouraging him to view his life as worthless. Consider the beautiful words of Popes Benedict XVI and John Paul II. In Spe Salvi Pope Benedict writes

The true measure of humanity is essentially determined in relationship to suffering and to the sufferer. This holds true both for the individual and for society. A society unable to accept its suffering members and incapable of helping to share their suffering and to bear it inwardly through “compassion” is a cruel and inhuman society. Yet society cannot accept its suffering members and support them in their trials unless individuals are capable of doing so themselves; moreover, the individual cannot accept another’s suffering unless he personally is able to find meaning in suffering, a path of purification and growth in maturity, a journey of hope. Indeed, to accept the “other” who suffers, means that I take up his suffering in such a way that it becomes mine also…. To suffer with the other and for others; to suffer for the sake of truth and justice; to suffer out of love and in order to become a person who truly loves—these are fundamental elements of humanity, and to abandon them would destroy man himself.

In Salvifici Doloris John Paul II writes, “suffering is present in the world in order to release love, in order to give birth to works of love towards neighbor, in order to transform the whole of human civilization into a “civilization of love.”

Suffering and death are a mystery. At times, Christ calls us to suffer, and as Christians we are drawn to unite our suffering with him on the cross. Rather than viewing our suffering as an absurd evil that should be avoided at all costs, our faith unfailingly calls us to use it for personal conversion. When we suffer, we are called to embrace Christ more fully and thus become more like him. We may confidently proclaim with St. Paul “that suffering produces endurance, and endurance produces character, and character produces hope” (Rom. 5:3-4). The specter of PAS is a striking reminder that we must be vigilant in fostering the culture of life. PAS and euthanasia are so dangerous because they accomplish exactly the opposite of what proponents of PAS claim. They leave us without hope, have no room for true compassion, destroy all ability to choose, and ultimately are irrational and inhuman responses to the difficulties of life. May we endeavor to encourage the faithful to place hope in Christ, whose “victory over death embraces every man” and seek to suffer with the sufferer.²⁸ May we endure our own sufferings in union with Christ, who embraced his own passion and death out of compassion and love for us. In the face of suffering and death, may Christians vigorously respond to Christ, who says, “Be not afraid to come and follow me. Seek me with all your heart, and I will be found by you, and give you rest.”