When I began researching my book on medical assistance in dying, I decided to answer the question Why not?— which, at the time, was not theoretical. As a doctor specializing in intensive care medicine, I regularly received requests from patients for help in ending their lives.
In 2014, shortly after completing my training, serious discussions began about the possibility of legalizing medical assistance in dying, and I realized that “where causing death was once a vice, it was soon to be a virtue” – as I shared. in a previous piece for CT.
But since my country, Canada, legalized MAID (medical assistance in dying) in 2016, I have tried to demonstrate to my colleagues and fellow citizens – starting with, but going well beyond, my religious beliefs as a Christian.
Intentionally causing the death of a person contravenes and violates their incalculable worth. As long as we are committed to defending the intrinsic value of people – as long as we insist that their value does not derive simply from their usefulness to others or to themselves – it is inappropriate and unethical for us to part of seeking or offering medical assistance services. the death.
Moreover, relying on our own sensory experience and human faculties, we cannot confidently claim to know what it means to be dead. It is therefore unwise and imprudent to seek and (especially) offer medical assistance in dying. These two reasons, I think, are very important and seem to provide a very good answer to the question Why not? question.
Is the case then closed? Not quite, I think.
Because to respond effectively to this problem, we must not only tackle Why not? question. We must also respond to For what? question. We must address the deeper, underlying motivations for requesting or offering medical assistance in dying. We must face the suffering of the sufferer and have something better to offer than death.
When I met Michael, he was around 30 years old. I was a young medical student learning how to take a patient history and perform a physical exam. This was the patient admitted to hospital with a urinary tract infection – one of many previous such admissions. Michael suffered from primary progressive multiple sclerosis. He could barely move his arms and legs; they were stiff and contracted. He was blind.
I remember looking through my ophthalmoscope into his blind eyes, the white patches of optic neuritis caused by multiple sclerosis erasing the surface of the retina. With the loss of some spinal cord functions, his bladder no longer contracted. To prevent urinary retention, he had an indwelling urinary catheter, but it was also a channel for repeated infection. These infections left him much weaker than usual – prostrate in bed, nauseous, in pain and profoundly ill.
As a young medical student, seeing his condition gave him a vivid sense of suffering and disability. Until then, I had not met many people with such a serious chronic illness. My world had been isolated from people like him. I lived with my new wife in our comfortable apartment; he lived in his retirement home. I was surrounded by friends and family; he was alone. I came and went as I pleased; he was bedridden.
My future was one of developing skills and opportunities. His future awaited him, with more and more discomfort and limitations. In that hospital room, our worlds collided. I was the doctor in training; he was the lesson. But we were also just two young men struggling to find our way in the world.
Michael was in despair. He was diagnosed with multiple sclerosis when he was an older teenager, and the disease gradually took away his abilities and freedoms; he had stolen everything a young man dreams of in life. Now, a decade later, he was desperately alone and desperately sad. He felt deeply alone since his illness effectively cut him off from his relationships. It wasn’t for lack of interest on his part, although friendships in such circumstances were undoubtedly difficult.
Perhaps it was too easy for others to forget him; perhaps it was too uncomfortable to visit. After all, we often feel threatened when we witness such suffering, because we are tempted by a vague horror that the same thing could happen to us. Only with the kind of repeated exposure to suffering and illness that medical professionals undergo during their training can one develop the disciplined sense of invulnerability necessary to cope with it ( although it can also be deeply unhealthy).
Added to his loneliness was a deep despair. It was a progressive disease, relentlessly attacking his brain and spinal cord. His future offered no hope of significant improvement, no possibility of freedom or relief. He spoke of the struggle to get through the day, feeling there was no point in continuing.
What was the purpose, the meaning, the purpose of such a life? It was heartbreaking for me to sit and listen to it. I felt the cruelty and injustice of the world. Why him? Why not me? I thought.
Our clinical meeting was soon over. I left, deeply moved by his suffering. For a moment, I had the privilege of seeing the world through his eyes. I could feel her struggle not to separate and to maintain her sense of identity and dignity in the face of her disability and suffering. He grieved a deep feeling of loneliness, uselessness and despair. His war for survival involved a fierce struggle against despair.
This is how we must understand the desire for medical assistance in dying: it is a cry of despair that cannot be ignored. Ignoring this cry denies the value of the patient’s life – just as causing his death denies its value.
Imagine for a moment that you are walking near a cliff and you hear a cry of distress coming from below. Looking over the edge, you see a man clinging to a ledge, hanging precariously and desperately afraid of plunging into the rocks below.
Suppose a friend who is with you offers him a high dose of fast-acting sleeping pills to help him fall asleep, so that he no longer feels fear or distress. You may be able to convince both your friend and the man whose life is in danger that it would be unnecessary, unwise and inappropriate to offer or ingest a sleeping pill. But the problem remains: how to help man in his moment of peril?
Likewise, even if we have succeeded in demonstrating that medical assistance in dying is an inappropriate and reckless way to respond to suffering, our task is not finished. We have failed to truly care for our patients if we hear their cries of despair, especially in their pleas for death, and simply raise our hands to say, “Sorry, that’s not right of me.” part of ending you, then I can’t help myself. You.”
Rather, we must investigate the reasons for such a request; we must understand the fears and pain that lead to such a cry. And we must find a way to help them. It remains for us to offer a better path to our fellow human beings who find themselves in the crucible of suffering.
In many ways, an effective response to the For what? question would cancel the Why not? question. If we can demonstrate that medical assistance in dying is not necessary – if we can show how to bear the unbearable – then we could do a lot to solve the problem. Answer Why not? is secondary to finding a deep solution to For what?
Ultimately, when it seems impossible to escape a person’s despair, the only solution is for us to learn to endure their suffering as the body of Christ.
Ewan C. Goligher is an assistant professor of medicine and physiology at the University of Toronto.
The following excerpt is adapted with permission from Ewan C. Goligher, How then should we die? A Christian response to medical assistance in dying (Lexham Press, 2024).
If you or someone you know needs help, call Suicide & Crisis Lifeline at 988 or text a crisis counselor at the Crisis Text Line to 741741. In Canada, call Talk Suicide Canada at 1-833 -456-4566.
