In the debate over physician-assisted suicide, there are two clear arguments.
One is: Life is sacred, and the divine timing of death should not be tampered with.
The other is: Life is sacred, and the decision of how to spend one’s final moments is personal.
The debate would have been unthinkable for past generations, whose doctors could do little to stave off life’s final certainty.
Now, modern medicine is powerful enough to stretch life’s last moments into days, weeks, even months or years. But when should someone say, “Enough”?
When is it OK to die?
Voters will decide this week whether to legalize physician-assisted suicide for terminally ill people who have been given less than six months to live. If voters approve Initiative 1000, Washington would become the second state in the country, after Oregon, to allow people facing imminent death to request lethal drugs and end their own lives.
It’s a debate that has polarized families and especially churches, where the question of how to die has become a spiritual dilemma. The Roman Catholic Church has driven the fight against assisted suicide, but advocates of the initiative say the issue isn’t faith, but individual rights.
“It’s your right to make your own decision about your body,” said Anne Martens, spokeswoman for Yes on I-1000. “It is a spiritual issue, but no one faith should dictate for an entire state.”
Bruce Davis eased people through their final days for 30 years as a geriatric physician. At first, some of his oldest patients knew about death more intimately than most people do today. Before doctors were added to speed-dials, before aspirin became part of a normal daily diet, death happened at home. It was more accepted, and it wasn’t feared as much as it is today, he said.
Many Americans so embrace devices and treatments that prolong life because of that fear.
“We don’t know what death is,” he said.
When Davis retired from his medical practice, he went back to school and became a minister with the Unitarian Universalist Fellowship, the only major religious organization to formally support physician-assisted suicide.
Since then, Davis’ role at the bedside of the dying hasn’t changed much. His goal is that their final moments are peaceful, that they’re not pressured into treatment that unnecessarily prolongs life, and that they know it’s OK to simply pass away.
“If that’s a high-quality, family-connected, comfortable experience, and not at the Nth degree of suffering, that is the capping moment of life,” Davis said.
A peaceful death may be overrated, said the Rev. Bryan Hersey, priest at Our Lady of Perpetual Help and at Immaculate Conception, two churches in Everett.
“Obviously suffering should be avoided, but when it’s unavoidable, then it becomes redemptive,” Hersey said.
If a terminally ill person thinks suffering has no value, it would be logical to request lethal medication, Hersey said. But death — and the suffering that comes with it — is part of the divine plan God set out for mankind, he said. To opt out of the pain of death could mean missing a chance to identify with the suffering of Christ.
“We can say, ‘OK, God, I don’t know how it’s going to work, but I’ll trust that even this has value,’” he said. “That’s the mystery, that’s the tough part. But there’s that leap of faith we encourage people to take.”
It’s not fair to assume that people who attend certain types of churches will lean one way or another on the issue of physician-assisted suicide, said Gary Laderman, a religion professor at Emory University in Georgia.
Opponents argue that life should always be preserved, but the same people honor death in other ways, Laderman said. They or their children may fight in war, and are honored if they die in battle. In historic times, some were encouraged to commit suicide rather than be forced to convert to another religion.
It’s different when someone is facing death because of illness, but those other scenarios offer clues that issues of death aren’t clear-cut, Laderman said.
“Your scripture may not provide you with absolute certainty of what the right choice would be,” he said.
Ancient Jewish texts offer clues that even then there was debate over whether to prolong life or end it, said Rabbi Marna Sapsowitz of Temple Beth Or in Everett. She hasn’t taken a public stand on the issue, but knows the opinions among her congregation vary.
“Certainly we turn to our tradition and to our sacred texts to inform us and guide us, but sometimes we end up in different places,” Sapsowitz said.
In Buddhism, the last moments of this life are directly linked to the first moments of the next, said Donald Castro, a teacher at the Seattle Buddhist Temple. If a person’s intention is to escape this life, that’s not a dignified death, he said. But if the intention is to end life in a peaceful way, there could be a spiritual benefit in the next life, he said.
The Episcopal church so struggled with the question of physician-assisted suicide that church leaders created a national committee to examine the issue. After much debate, the committee concluded that the denomination should focus on providing better end-of-life care, not “killing people,” said committee chairwoman Cynthia Cohen, a medical ethicist at Georgetown University.
Historically, some Episcopalians have supported assisted suicide and even euthanasia, the practice of a doctor or other care provider taking action that kills someone who is terminally ill or at the end of their life.
“They lived in a time when there was no palliative care, no hospice, few medications and drugs that could be used to address issues related to pain near the end of life,” she said.
Spiritually, someone may have been justified in turning to assisted suicide in that case, Cohen said. The Episcopal church doesn’t issue a blanket condemnation for everyone who chooses assisted suicide, she said. And at least one diocese — in Newark — supports the practice.
But there’s little reason for considering assisted suicide today, Cohen said. Doctors in past decades were more likely to try to keep people alive at any cost, but now they don’t necessarily consider someone’s death to be a personal medical failure, she said.
“It’s acknowledged now that you’re not going to be able to keep a patient going, and that you do want to do palliative care,” Cohen said. “Doctors are much more willing to stop if it seems useless.”
They may be more willing to stop, but medical technology is so advanced today that they can keep terminally ill people alive for extended periods of time — perhaps beyond their divinely appointed time to die, Laderman said.
“There’s a big fear that the doctor becomes God,” he said.
Many people who oppose assisted suicide don’t want to acknowledge that some end-of-life care and pain management achieves the same result, said Davis, Universalist minister and former physician.
Some pain caused by terminal illness is so severe that the medication necessary to control it is strong enough to slow or even arrest a person’s respiratory drive, he said.
“Any honest physician will tell you that our help against a person’s suffering may hasten their time of passing,” he said.
Some pain medicine can be so strong that a patient is “snowed,” a term doctors use to describe someone who lives in a haze, Davis said.
“They’re not in pain, but that is not what I would consider a quality end of life,” he said.
Hersey, the Catholic priest, agrees that while people today view death as a clinical experience, “at some point we are going to die. We need to acknowledge that and decide, if we are going to experience death, how are we going to do it?”
Reporter Krista J. Kapralos: 425-339-3422 or kkapralos@heraldnet.com.
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