Physician-assisted suicide is not new. I can still remember reading Derek Humphry’s “Final Exit” (1991) as a college student. I remember feeling great sorrow for those that suffer. Today, I still feel that pain as I work with oncology patients who face the end of life in the midst of pain and suffering.
Euthanasia advocates like Humphry remind us that the suffering of the dying is far more than pain. In “Final Exit,” Humphry reminds his readers that the dying often experience sleeplessness, fatigue, nausea, incontinence, thirst, bedsores, hunger, constipation, weight loss, itching, infections, dependence on others, hiccups and the loss of dignity.
Anyone who has ministered or stood at the bedside of a loved one knows the pain and suffering that occurs. Anyone who has stood by knows the feeling of helplessness experienced by the family. In the face of this horror, part of me wants to justify palliative physician-assisted suicide. But before I make such a leap, it would behoove us to listen to what the dying are saying.
On March 4, the Washington State Department of Health released its 2009 Death with Dignity Act report. From March 5 through Dec. 31, 2009, 63 terminally ill patients received lethal prescriptions from physicians. Of those 63 patients, at least 36 took the drugs and died. While the 2009 report is packed full of data about the process and demographics of those who received the drugs, the most striking part of the study is what concerned these terminally ill patients the most.
Fully 100 percent of those who died after requesting the lethal prescription noted that they were concerned about autonomy. Other notable issues are the inability to engage in activities that make life enjoyable (91 percent) and the loss of dignity (82 percent).
These numbers should be held in contrast with the minority concerns: pain control (25 percent), burden upon others (23 percent) and financial yoke (2 percent).
After reviewing these numbers, one might falsely assume that the emphasis on personal autonomy is associated with those who have neurodegenerative diseases like ALS or Alzheimer’s. To my amazement this was not the case. Only 9 percent of those who received the drugs had neurodegenerative-type diseases. The majority (79 percent) were oncology patients. One would have assumed that this group would be worried about the tremendous financial burden of cancer treatment or the horrific pain associated with these diseases.
The apparent contradiction of these numbers should force us to re-evaluate the right-to-die movement. For years the movement has argued for compassion and the relieving of suffering in patients who are dying. Often I have wondered if this were an emotional smoke screen to cover up arguments based on pure autonomy.
Regardless of the motivation of the arguments, the above numbers clearly illustrate that autonomy is the issue for patients. This phenomenon demands a response from Christian ethics. Over the last 30 years, patient autonomy has become the sacred cow of clinical ethics often to the exclusion of the other three pillars of bioethics: non-malfeasance, beneficence and justice.
I shudder, like most clinical ethicists, at the idea of limiting a patient’s right to choose, but we must acknowledge that patient autonomy is not an absolute virtue and must be weighed in the context of the other pillars of clinical ethics.
The overemphasis of autonomy in moral thinking takes its philosophical roots from liberal individualism, which holds personal autonomy as its highest value. In liberal individualism, the desires and volition of the individual are often in conflict with the desires and needs of the community. Liberal individualism comes into direct contradiction with social contract theory and natural law theory, which still hold personal autonomy in high esteem but do not consider it the supreme value.
For both, obligation to community must be balanced with personal autonomy. Often liberal individualism is mixed with one or more moral theories into a philosophical soup. The best example is the individual who argues for the expansion of Medicare while at the same time insisting that the state has no say in her medical care.
With this in mind, Christian ethicists need to take a step back and look at the role of personal autonomy in our discussion of euthanasia and physician-assisted suicide. If autonomy is the primary issue for individuals making these types of moral decisions, then Christian scholars are forced to evaluate the limits of personal autonomy.
Rarely in today’s moral marketplace is it fashionable to talk about individual moral obligations. While autonomy is important, it must not be viewed as the end results of ethics. Autonomy must be viewed in the context of our other moral obligations.
For Christian ethics, autonomy has limits because individuals have obligations to God and the community. While being sympathetic to the pain and suffering of those faced with terminal diseases, Christian ethics cannot overlook the interconnectedness of the individual and community.
While some see this as an attack on individual autonomy, the obligation works both ways. Christians are obligated to assist those in need, specifically those who are suffering in the face of a terminal illness.
Monty M. Self is the oncology chaplain for the Baptist Health Medical Center – Little Rock and an adjunct instructor of ethics at the University of Arkansas at Little Rock.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
