Choosing to End a Life
Taken from the Evangelical Fellowship of Canada
AS OUR COURTS AGAIN CONSIDER CALLS TO ALLOW ASSISTED SUICIDE,A NEW APPROACH TO THE PUBLIC IS AS FOLLOWS:
When Physicians discovered in November that Scott Routley, the 39-year-old London, Ont., man who has been in a “persistent vegetative state” for 12 years, could communicate with them, the news was rightly seen as a medical and scientific breakthrough. Significantly, Routley was able to reassure the doctors he feels no pain.
And when 15-year-old Amanda Todd took her own life after years of what she felt was unbearbale bullying, her tragic death caused an outpouring of compassion and increased talk of the importance of suicide prevention for teens. No 15-year-old should have to endure such severe emotional and mental anguish.
But when Gloria Taylor, a B.C. woman with ALS (lou Gehrig’s disease), lobbied for her right to have a physician assist in her death, she was seen by many as a courageous leader and advocate of an individual’s right to die when and how she chooses. Taylor died naturally of an infection in October, but her cause remains in the legal arena.
The media has treated these events as seperate issues. But all of them have something in common. They have brought into sharper focus – and greater confusion – the issues surrounding the end of life and whose decision it is to determine it.
Canadians benefit from medical advances that prolong life and alleviate physical pain, but ironically there is a parallel push in society to end life sooner because of psychological and social suffering, or what many health professionals now refer to as “existential suffering.”
Contrary to popular assumptions, most dying patients do not experience intolerable pain, says Vancouver palliative care physician Dr. Margaret Cottle. For example, “ALS patients tend to die a more peaceful death. They don’t suffocate, they don’t choke to death.”
What terminal patients experience is fear: fear of abandonment, fear of being a burder to their loved ones, fear of losing control over their bodies, fear of the possibility of pain at the end.
Our confusion around these issues is compounded because “We’ve medicalized suffering,” says Sister Nuala kenny, a Halifax pediatrician and bioethicist at Dalhousie University.
It helps to consider emotional and physical pain seperately. One person may be “dying and have no suffering,” while another may “have very little physical pain and have huge suffering.”
“If you have chest pain,” Kenny explains, “I’ve got stuff I can do for you. If you have heartache because your son is on the street prostituting himself for drugs in Vancouver, I should recognize the pain in your heart. But I have no prescription for that.”
Kenny’s research found “psychological distress and care needs” are by far the greatest factors for patients requesting assisted death.
NEW EFC REPORT
That research highlights a fundamental question – “Why do people request assisted suicide?” – notes Faye Sonier, legal counsel at The Evangelical Fellowship of Canada (EFC) and its Centre for Faith and Public Life in Ottawa. Recently she supervised research for a new EFC discussion paper called Palliative Care and End of Life Therapies (free at www.theEFC.ca/ResourcesOnEuthanasia.)
The EFC paper suggests if something can be done to meet the underlying needs and fears of a patient, there will be fewer requests to end life prematurely.
WE’VE MEDICALIZED SUFFERING.
While patient autonomy is touted as one of the reasons for choosing the time and method of death, autonomy is difficult to measure, says Larry Worthen, a lawyer in Dartmouth, N.S., who is now executive director of the Christian Medical and Dental Society. Patients are always influenced by others such as hospital staff, family members and physicians. In the past we believed the viruous thing was not to hasten death. “Do we want to have a society where it becomes virtuous to end your life?”
Euthanasia and other forms of physician-assisted death (PAD) are illegal in Canada. Bill C-384, a private member’s bill to legalize euthanasia and assisted suicide, was defeated 228-59 in April 2010. But in June 2012 a British Columbia Supreme Court judge ruled in the Carter case Canada’s law against assisted suicide was unconstitutional, and granted Gloria Taylor an exemption. In August the federal government launched appeal, to be heard in march. The EFC will participate as an intervener (details at www.theEFC.ca/carter).
While proponents of PAD insist there is no “slippery slope,” and there are enough safeguards available to prevent abuse, years ago, notes Cottle (the Vancouver physician), people were being kept alive longer than was natural. Heroic measures were being taken to prolong life. “I actually feel it’s the other way around now, especially with older people,” she says. “We’re giving up on people sooner than we did, and sooner than we should.””It’s a recipe for elder abuse,” she adds. “There’s a big problem with elder abuse, and it’s growing.”
Alex Schadenberg of London, Ont., executive director of the Euthanasia Prevention Coalition, agrees. He recently authored a publication called Exposing Vulnerable People to Euthanasia and Assisted Suicide (available at www.epcc.ca) in whice he cites numerous European, Canadian and American studies that show phyicians don’t always follow guidelines in settings where assisted suicide is legal (Belgium and the Netherlands, as well as in Washington and Oregon). Among his findings:
-Patients are being euthanized without having made an explicit request. (A study from the Flanders region of Belgium shows one-third of euthanasia deaths are without explicit request.)
-Nurses are illegally administering lethal drugs.
– Between 2003 and 2011 the number of euthanasia deaths in the Netherlands doubled.
-In one Belgian study half the Euthanasia deaths went unreported.
-Older people were more likely to be victims of unreported euthanasia deaths.
The unreported cases were determined by an anonymous questionnaire sent to several thousand physicians, Schadenberg explains.
Cottle has seen research, and is alarmed how “the guidelines are just being completely discarded.” What’s more, she says, “There have been some screw-ups in Washington and Oregon.” People have lived for several days after a lethal injection, or vomited the pills they have swallowed. Death does not always come quickly.
WHOSE LIFE IS IT?
Twenty years ago Sue Rodriguez asked the memrable question, “Whose life is it, anyway?” Rodriguez was the British Columbia woman who requested assisted suicide before the symptoms of ALS got too difficult for her to bear. Her quest was for autonomy, for controlling your own destiny, has only gotten stronger in society today.
(The EFC intervened in the Rodriguez case, and its arguments formed a key part of the court’s decision in recognizing the value Canadians place on the “sanctity of life” in understanding the “right to life” mentioned in section seven of the Charter of Rights and Freedoms.)
But Rodriguez was wrong in assuring her life was her own, says Cottle. “The Christian knows it’s God’s life.”
Responding to the issues requires some careful approaches for Christian professionals. “Faith-based arguments are dismissed” in the public square, says Kenny, who moves in both the secular and religious worlds. The ethics and health policy advisor to the Catholic Health Alliance of Canada has always worked in secular rather than Catholic institutions. “We need to make these arguments more generally accessible,” she says.
Cottle agrees. “We have to learn how to speak into our own culture in ways that they can understand. If we just say, ‘The Bible says not to kill,’ they don’t really care.”
One way is to point out the discrepancies in our society. Kenny and Cottle both mention capital punishment as an example. “We do not allow the death penalty in this country, and we’re proud of this fact,” says Kenny, a naturalized Canadian who came here from the United States, “partly because of the ethical underpinnings of the Canadian system.”
Why then, if “we don’t even allow killing of people who are hardened criminals,” asks Kenny, would we want people to die because they experience emotional and psychological suffering?
“We have a very intricately balanced ecosystem of compassion and caring for one another,” says Cottle. If a patient wants a physician-assisted death, that ecosystem is disrupted. A doctor has to make the death happen,” and we all have to participate in it – which is why we voted out capital punishment.”
On a practical level, several things are being done to engage Canadian society in the battle against euthanasia. Larry Worth-en of the Christian Medical and Dental Society is busy making presentations to educate medical students, Kenny continues to present her findings that most requests for physician-assisted deaths are due to psychological and emotional reasons rather than physical pain. Alongside the EFC’s intervention in the appeal of the Carter case, the Euthanasia Prevention Coalition and the Christian Legal Fellowship are also set to intervene.
Dr. John Patrick, a retired Ottawa physician and educator, is calling for medical students and physicians to take the Hippocratic Oath seriously once again. Society is in danger of having physicians with moral integrity, he says, and there needs to be provision for those who wish to follow the Hippocratic principles of doing no harm.
“Our society has lost its moral consensus and cannot therefore agree on the kind of medical care to provide, or the ethical basis of medical care,” he says. So Patrick set up www.hippocraticregistry.com, and he encourages physicians to join. Further, he suggests forming groups of physicians and medical students who will take the Hippocratic Oath, a practice already followed by some medical practitioners.
But while the battle is being waged in the public sphere, there are still things Christians can do to ensure no one has to feel abandoned at death.
“The biggest thing we need to do in churches is get the theology of suffering figured out,” says Margaret Cottle. “We live in a fallen world. Suffering is something that is going to come to us.” Sometimes, she says, all we can do is follow what Mary did at the foot of Jesus’ cross. “All she did was stand there and bear witness.”
“The Christian community has to realize that there’s an importance of being with the ‘other,'” adds Alex Schadenberg. Visiting those who are sick, especially if they are alone is an important ministry. “If there are people who actually care about you, you are fairly more likely to say that my life does have value,” he notes.
The EFC’s discussion paper confirms that. “The will to live in inextricably linked with maintaining a sense of meaning and connection to one’s world,” it says.
However difficult it might be for Christian medical professionals as well as lay-people to navigate the dark waters of euthanasia and physician-assisted death, it is imperative they do, says Cottle. Otherwise, “As the culture gets darker, are we really shining more, or are we being swallowed up?” FT
The Pathophysiology of Tobacco Use, Addiction, and Cessation
In the past six seconds someone died from tobacco use. The World Health Organization estimates that tobacco will kill 6 million people this year (2013) In the United States, Tobacco is the leading cause of preventable death, responsible for 1 in every 5 deaths.
How does tobacco kill? I will examine the adverse effects of tobacco kill? I will examine the adverse effects of tobacco on the pulmonary, cardiovascular, and neurological systems. Tobacco affects three of the most important organs of our body: the lungs, the heart and the brain.
When a person breathes, the elastic fibers in the lungs stretch; when he exhales, the fibers return to their original size. Healthy lungs efficiently deliver oxygen and remove carbon dioxide from the bloodstream.
Smoking exposes the delicate lungs. The resulting scar tissue is less resilient than the original healthy cells. When the elastic fibers are damaged, the lungs lose elasticity. The fibers still stretch to expand but not return to their original size which leaves old air in the lungs and less room for fresh air. This is diagnosed as Chronic Obstructive Pulmonary Disease (COPD).
Chemicals in cigarette smoke such as arsenic, formaldehyde and nitro amines can cause mutations in the cells’ DNA which makes the cells reproduce uncontrollably. This action produces cancer of the lung. Tobacco use is responsible for 80-90% of lung cancer deaths in the US. (I don’t have the Canadian statistics)
Smoking cigarettes increases thrombosis or blood clotting. As the blood travels through already narrowed arteries, the platelets are more likely to stick together. When platelets coagulate in an artery, they form a blood clot which stops the flow of blood. That prevents the heart tissue from receiving necessary nutrients and it dies. This is called a heart attack. After 15 years of non-smoking, a former smoker’s risk of heart disease is statistically the same as someone who never smoked.
Tobacco contains the addictive organic chemical, nicotine. When tobacco smoke is inhaled, nicotine is absorbed in the blood stream. Receptors in the brain respond to nicotine and trigger the release of dopamine which gives feeling of pleasure and creates a physiological dependence on nicotine. Its use can suppress appetitite and calm nerves. A smoker will associate smoking with certain routines, activities and people. The associations trigger a strong desire to smoke.
Besides unwanted health issues, tobacco is a financial drain. Second-hand smoke exposes children and other family members to the same toxic and carcinogenic chemicals that create health problems for the smoker. Tobacco use is linked to other negative behaviours in youth, such as “high-risk sexual behavior, alchohol use and drug use.
Don’t light up for the first time and save yourself a world of future heartache and health problems. If you currently smoke, options are available to help you stop; nicotine patches, drugs that suppress cravings, antidepressant therapies, and behavioral counseling. Take to your doctor.
Smoking cessation is difficult, but it is possible. Say NO to tobacco!
(Taken from the Union Signal, winter 2014)