by Rev. Paul Bryant-Smith

As we consider end-of-life care for our loved ones and for ourselves, we are often struck by the difficulties that arise as a result of the improvements in medical technologies that have prolonged human life well beyond anything that could have been imagined even a few decades ago.

As we consider end-of-life care for our loved ones and for ourselves, we are often struck by the difficulties that arise as a result of the improvements in medical technologies that have prolonged human life well beyond anything that could have been imagined even a few decades ago.  Only a few generations ago, most people died at home of illnesses that could not be treated.  Today, most people die in hospitals or nursing homes after medical professionals have done everything within their power to extend the life of the dying person.  The ethical implications of the process of dying have become complicated as there seems to be no end to the ways of keeping the human body alive long after the quality of that life has ceased to be meaningful.  We are left to wrestle with the question of when the extension of life becomes, in reality, the extension of the processes of death.

For many years, terminally ill patients and their families have been able to exercise the right to refuse or discontinue treatment or to withhold or terminate life support such as respirators or artificial nutrition when they believed that the prolongation of life was no longer beneficial.  Indeed, it is the cases like Terry Schiavo’s that are the exceptions that prove the rule of how these practices have become accepted within the medical community and within our culture.  Beyond the passive means of hastening a person’s death, medical doctors also employ palliative sedation, sometimes called terminal sedation, which involves treating a terminally ill patient’s pain, even knowing that the treatment will hasten death.

In 1997, the Death with Dignity Act went into effect in the State of Oregon.  The act allows physicians to go beyond the hastening of death by passive means and allows for physicians to actively aid their patients in the dying process.  For some, the notion of a physician helping a patient to die conjures up images of Jack Kevorkian and his suicide machines while the use of terms like “physician assisted suicide” obscures the fact that the patient is already dying and falsely reinforces the image of the doctor committing euthanasia.  The reality of physician assistance in dying is quite different, as the patient retains full control over their dying process, with the doctor prescribing lethal amounts of barbiturate and the patient deciding when — or even if — they take the medication.  In Oregon, this patient-driven system is safeguarded by a multi-level process in which the patient who wishes to end their suffering must make multiple requests, both verbally and in writing, over a period of time.  The physician must deem the patient to be mentally competent before writing the prescription.  Finally, the patient must make their own choice to take the medication, a decision that a significant portion of the patients opt against because having the option to die gives them the courage and strength to live.

In November, voters in the state of Washington will vote on their own Death with Dignity Act.  Within my denomination, the United Church of Christ, two conferences have recently passed resolutions encouraging states to adopt such legislation.  To be sure, the resolutions passed by the Central Atlantic Conference and the Northern California-Nevada Conference generated much discussion around the issue.  Debate centering around the medical ethics of allowing physicians to prescribe medication for the purpose of ending a life, which many people view as contrary to notion that physicians should “above all, do no harm.”

Those who are opposed to legalizing physician aid in dying point to the preservation of life as the greatest good and make a strong distinction between allowing a patient to die via passive means as opposed to taking an active role in helping a dying person to end their own life.  Often, there is additional hesitation because of the potential for abuse and a fear that terminally ill patients might be coerced into ending their own lives by family members who no longer wished to care for them.  There is concern that people who are not mentally competent might choose to die rather than pursuing adequate medical treatment.  There is fear that members of racial minorities, people with disabilities, or those with limited finances might end up as a disproportionate number of those choosing to end their lives.

While the potential for abuse exists within any system, the actual numbers do not support the suggestion that the Death with Dignity Act provides a slippery slope down which society’s most vulnerable will slide.  According to the State of Oregon, since the Death with Dignity Act was passed in 1997, only 341 patients have died as a result of taking the prescribed medication.  The majority of them have been Caucasian, insured, well educated, and involved in hospice programs.  They were overwhelmingly cancer patients and cited loss of autonomy, intractable pain, loss of dignity, and decreased quality of life as their reasons for choosing to end their lives.

Over the years that I have been privileged to be a pastor, I have journeyed with many parishioners as they have faced their own deaths.  I remember one heroic man whose last request to me was that I send other terminally ill people to see him so that he could help them find peace in their journey.  I have known many that were able to die with dignity and peace with the assistance of well-run hospice programs.  I have known people who fought tooth and nail for every day of life, but I have also known some who would have gladly given up the fight, ended their pain, and gone on to be with God.

These people of deep faith, secure in their relationship with God and in their belief in eternal life, are the ones for whom I, too, wished a quick and peaceful death, free from the pain and indignity that their illnesses visited upon them.  Their lives and deaths remind me of our most basic adherence to the command “to do unto others as you would have them do unto you.”  As I think about my own desire to die a good death, I cannot find a reason to oppose others’ desire to die well.

As with many issues, people of faith will honestly disagree on the question of physician aid in dying.  For me, though, the center of the ethical question is an individual’s right to choose for themselves coupled with honoring the dignity of each person and having a system in place to make sure that the choice is truly their own.  As children of God, we each bear the divine image and, as St. Paul insists, there is nothing, not even death, that can separate us from the love of God.