As Loved Ones Die (3)

In the preceding column I raised questions about the terribly difficult issue of euthanasia, and specifically, whether in an Orthodox Christian perspective there could ever be a morally acceptable way to hasten the death of a dying person, when that person is consumed by uncontrollable pain and suffering. Fortunately, such cases today are rare. Palliative care and medications for pain management have been developed to the point that “terminal anguish” can usually be mitigated to an acceptable degree. But not always.

The question arose because at the time my aged and infirm mother was dying. Her final days were marked by organ failure and acute respiratory distress. The hospice team did all it could to provide her relief and facilitate her struggle. But her struggle continued, and we had no doubt that her suffering was real. Now she has passed on, and we are still grieving: both her loss and the fact that for days she was consumed with the physiological process of having her life painfully ebb away. We knew that for months she had longed to die. Seeing her lying on her death bed, gasping for breath and in obvious distress, I couldn’t keep from mulling over what I had always taken to be a forbidden, even unthinkable question. Is it ever appropriate—that is, in conformity with the will of God—to intervene in the dying process in such a way as to facilitate the passage from a life that is no longer a life, into the blessedness of life beyond?

Is our reluctance to talk about euthanasia—or, when the patient is conscious and able to make choices, physician assisted suicide—due to some cosmic law against deliberately ending a human life? Is it due to the conviction—or the fear—that God will condemn us for the sin of Cain if we even raise the issue? Yet the commandment “Thou shalt not kill” refers not to cases of terminal illness but to murder—the unlawful taking of a human life against the best interests and wishes of the victim—within the Israelite community. (And even there, under certain conditions, capital punishment was authorized and prescribed.) Is our real objection to euthanasia in fact just fear of the “slippery slope” that might lead to the wholesale slaughter of genetically “defective” newborns, the handicapped, the marginalized, the burdensome members of society? But what does that have to do with this person in these immediate circumstances: a dying loved one who longs for nothing more than “the peaceful separation of soul and body”?

We rightly hold that God determines the when and the how of our conception—which gametes will produce the zygote that becomes “me”—and we declare that therefore (a non sequitur?) He alone must determine the way and the time we die. Yet there is a synergy involved in both. God brings a zygote into existence with the cooperation (conscious or not) of the parents. Is it not possible that God might expect and act through such a synergy at the time of our death? Can He not move or inspire us to make a decision concerning the diagnosis and prognosis of a terminally ill person that would lead us to extend medical care to the point of ending, peacefully and lovingly, this life that is no longer a life, but merely an existence void of substance, aim and meaning? Particularly when that existence is consumed by unmanageable pain and suffering? Is it morally wrong to take such “quality of life” issues into consideration when the dying person’s only prognosis is an imminent and painful death? Could not a gesture to foreshorten that agony be the most appropriate and compassionate way to achieve what we pray for each day: “a painless, blameless and peaceful ending” to our earthly existence?

There are some questions we Orthodox refuse to allow ourselves. “Euthanasia” and the circumstances that might warrant it is one of the most obvious. “There are better ways,” we insist. And on the whole this is certainly true. Hospice care can work wonders, as can proper pain management and palliative care in general. And the slippery slope does present a very real and present danger. Proper care, when a cure is not possible, is the most appropriate response we can make, the most precious gift we can offer, when a person becomes irreversibly “terminal,” when death is imminent.

A question we Orthodox need to address, though, is whether under certain very specific circumstances that caring can include medical intervention to relieve—and even, if deemed beneficial to the patient, accelerate—the dying process and thereby alleviate the person’s otherwise unmanageable suffering. (There is no moral or spiritual obligation to bear anguish until the bitter end, as if suffering were punishment for our sins or a precondition for our redemption. It is neither. God does not inflict punishment as a penalty; and Christ alone has wrought our redemption through His own suffering on the Cross.)

It is no secret that a tacit pact is often made between patients and their doctors, which leads the latter to make decisions regarding terminal care that border on euthanasia or physician assisted suicide. To be sure, we cannot and must not “license doctors to kill” (that language, however, stacks the deck). On the other hand, may we—insofar as we follow the patient’s competent request or advance directives—encourage clergy, family and the medical team to reach a mutually acceptable decision concerning terminal care that under tightly controlled, well-monitored circumstances might allow a doctor, with both legal and moral sanction, to intervene medically so as to hasten the dying process, once the patient has irreversibly entered it? Will we forever condemn such an action as “murder,” or will we one day come to regard it as an aspect of appropriate—that is loving and compassionate—medical care?

There may indeed be “a better way.” But as my mother’s breathing became ever more belabored and her distress ever more evident, as her body continued to waste away, and as we persisted in our ardent supplications that God at last release her from this final agony, I felt compelled to raise the question. I have raised it because for too long—with the exception of a very few Orthodox medical professionals who specialize in terminal palliative care—we have considered it to be “unthinkable,” and therefore a non-issue. We have been far too reluctant to deal with it directly and prayerfully, keeping in mind the best interests of the patient who struggles, often in pain and anguish, to complete the Paschal journey and enter into eternal rest.

Some readers of these reflections will, of course, condemn them and me for heresy or insensitivity or wanton neglect of dying patients. They may feel that they only advance the perverse aims of the “euthanasia movement,” and therefore it is “unorthodox” even to voice (or to think) them. But if any of those readers have found themselves raising similar questions as they watched a loved one die in pain and distress, yet as Orthodox Christians they felt compelled to keep such questions to themselves, then perhaps it is worthwhile discussing this issue publicly. Perhaps by openly confronting difficult and even offensive questions—especially those we dare not raise out of the misguided fear that they are forbidden or definitively resolved—we might allow and even encourage our faithful to voice the cares and concerns they have about their own lives and personal experiences. We might convey the important message that life is made up of difficult questions and hard choices, and that we have not only the moral right but the pastoral obligation to address those questions and make those choices as faithfully as we can.

In the final analysis, we are asking not “what is morally acceptable?” or “what course of action is licit?” We are asking rather, “What is God calling us to do in this particular situation, given these particular circumstances, in order to fulfill His will and remain faithful to His ultimate purpose?”