When I started research for my book on physician-assisted death, I got down to answer the query Why not?
The query shouldn’t be theoretical. Even a decade ago, not long after I had finished my training as a physician specializing in intensive care medicine, serious conversations were starting about the potential of legalizing physician-assisted death. I noticed that “where causing death was once a vice, it was soon to be a virtue”—as I shared in a previous piece for CT.
Ever since my country, Canada, legalized MAID (Medical Assistance in Dying) in 2016, I even have tried to show to my colleagues and fellow residents—starting with, but going well beyond, my faith convictions as a Christian—that intentionally causing someone’s death contravenes and violates their incalculable value. So long as we’re committed to upholding the intrinsic value of individuals—as long as we insist that their value doesn’t merely derive from their usefulness to others or to themselves—it’s inappropriate and unethical for us to hunt or to supply physician-assisted death.
More than that, counting on our own sense-experience and human faculties, we cannot confidently claim to know what it’s wish to be dead. Therefore, it’s unwise and imprudent to hunt and (especially) to supply physician-assisted death. Both these reasons, I believe, count quite strongly, and appear to offer a excellent answer to the Why not? query.
Is the case then closed? Not quite, I believe.
For to reply effectively to this issue, we must not only address the Why not? query. We must also reply to the Why? query. We must address the deep, underlying motivation for looking for or offering physician-assisted death. We must face the suffering of the sufferer, and we will need to have something higher to supply than death.
When I met Michael, he was about 30 years old. I used to be a young medical student, learning the best way to take the patient’s history and to perform a physical examination. He was the patient, admitted to the hospital for a urinary tract infection—one in all many previous such admissions. Michael had primary progressive multiple sclerosis. He could barely move his legs and arms; they were stiff and contracted. He was blind.
I recall peering with my ophthalmoscope into his unseeing eyes, the white plaques of optical neuritis from multiple sclerosis effacing the surface of the retina. With the lack of some spinal cord functions, his bladder now not contracted. To prevent urinary retention, he had an indwelling urinary catheter, but this was also a conduit for repeated infection. These infections left him much weaker even than normal—prostrate in bed, nauseated, in pain, and profoundly unwell.
As a young medical student, seeing his condition made a striking impression of suffering and disability. To that time, I had not encountered many individuals with such severe chronic illness. My world had been walled off from people like him. I lived with my recent wife in our comfortable apartment; he lived in his nursing home. I used to be surrounded by family and friends; he was alone. I got here and went as I pleased; he was bed-bound.
My future was that of expanding skill and opportunity. His future held out progressively increasing discomfort and limitation. In that hospital room, our worlds collided. I used to be the doctor-in-training; he was the lesson. But we were also just two young men struggling to search out our way on the earth.
Michael was shrouded in despair. He was diagnosed with multiple sclerosis as an older teenager, and the disease had progressively taken away his abilities and liberties; it had stolen every little thing a young man dreams of in life. Now, a decade later, he was desperately alone and desperately sad. He was deeply lonely since his disease effectively cut him off from his relationships. It was not for lack of interest on his part, although friendships under such circumstances were undoubtedly difficult.
Perhaps it was too easy for others to ignore him; perhaps it was too uncomfortable to go to. After all, we frequently feel threatened after we see such suffering, for we’re tempted by a vague horror that the identical might occur to us. Only with the sort of repeated exposure to suffering and disease that medical professionals experience during their training can one develop the disciplined sense of invulnerability mandatory to manage (although this too will be profoundly unhealthy).
His loneliness was compounded by profound hopelessness. His was a progressive disease, unrelenting in its attack on his brain and spinal cord. His future held no hope for meaningful improvement, no possibility of freedom or relief. He spoke of the struggle to get through the day, feeling that there was little point in occurring.
What was the aim, the meaning, the purpose of such a life? It was gut-wrenching for me to take a seat and hearken to him. I felt the cruelty and injustice of the world. Why him? Why not me? I believed.
Our clinical encounter was soon finished. I left, profoundly moved by his suffering. For a moment, I had the privilege of seeing the world through his eyes. I could sense his struggle to maintain from coming apart and to retain his sense of personhood and dignity within the face of his disability and suffering. He was mourning a deep sense of loneliness, pointlessness, and hopelessness. His war for survival involved a relentless battle with despair.
This is how the will for physician-assisted death needs to be understood: It is a cry of despair that can not be ignored. To ignore that cry denies the value of the sufferer’s life—just as much as causing their death denies their value.
Imagine for a moment that you simply are walking near a cliff, and also you hear a cry of distress from below. Looking over the sting, you see a person clinging to a ledge, hanging precariously and desperately frightened of plunging to the rocks below.
Suppose a friend who’s with you offers him a high dose of fast-acting sleeping medicine to assist him go to sleep, so he now not experiences fear or distress. You might successfully persuade each your friend and the person whose life is in peril that it might be unhelpful, unwise, and inappropriate to supply or ingest the sleeping medicine. But the issue stays: How do you help the person in his moment of peril?
Likewise, even when we now have successfully shown that physician-assisted death is an inappropriate and unwise strategy to reply to suffering, our task shouldn’t be complete. We have failed to really look after our patients if we hear their cries of despair, particularly of their requests for death, and easily throw our hands as much as say, “Sorry, it’s unsuitable for me to finish you, so I can’t enable you to.”
Rather, we must probe the explanations behind such a request; we must understand the fears and the pain that result in such a cry. And we must discover a strategy to come to their aid. It stays as much as us to supply a greater way for our fellow humans who find themselves within the crucible of suffering.
In some ways, an efficient response to the Why? query would nullify the Why not? query. If we are able to show that physician-assisted death is unnecessary in the primary place—if we are able to show the best way to bear the unbearable—then we’d go a really long strategy to resolving the problem. Answering Why not? is secondary to finding a deep solution for Why?
Ultimately, when there appears to be no escape to an individual’s despair, the one solution is for us to learn the best way to bear their suffering because the body of Christ.
Ewan C. Goligher is assistant professor of drugs and physiology on the University of Toronto.
The following excerpt is customized with permission from Ewan C. Goligher, How Should We then Die? A Christian Response to Physician-Assisted Death (Lexham Press, 2024).
Update (January 25, 2024): An earlier version of this text misstated why the creator began his book research. We regret the error.
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