In 1988, as young man of thirty, I was sick with a strain of meningitis that robbed me, for awhile, of my ability to communicate. I was able neither to talk or write, and yet my mind was fully alert. I was conscious every minute of intense pain. In my weakness I prayed to die, not because I could not communicate, but because my head hurt far worse than I had believed possible. For a great many days I was assured that I had two possibilities ahead of me: Death, or blindness. Finally, after I could speak again, physicians at Johns Hopkins offered me the chance to be a Guinea Pig for a new use of medicine, which brought me to an eventual recovery. As a result of that experience my perspective on suffering and on being completely helpless is not merely theoretical.
At what point, and on what grounds, is it in keeping with Christian faith to decide that we have the right to die in order to avoid suffering or a feeling of humiliation? Having been in enough pain to think of death as relief, I can understand the difficulty of the question, and appreciate the problem. Speaking as a pastor, and in light of what I have already experienced of pain and suffering, I would advise that submission to the will of God requires us to accept suffering, seeking to avoid it only by legitimate means. Medicine and treatments have long been regarded as perfectly legitimate. Suicide, assisted or otherwise, does not have the approval of any sound Christian teaching.
Of course, when the preservation of physical life is maintained completely by “heroic” or extra-ordinary technological means to the point where nothing is preserved except the functions of the body, is it really a Christian view that death should be put off beyond a reasonable time? This question is valid, because medical technology could advance to a point where bodies are maintained as a resource to be harvested in a dystopian scenario as gruesome as any science fiction writer has ever imagined. At what point could this kind of preservation be just as much a matter of playing God as the practice of euthanasia?
But, when the question is about the alleged right to die, what rights can a Christian claim to have? I am speaking here about moral, not legal, rights. The spokesmen for the Libertarian Party always begin by telling us that their basic philosophical view is rooted in the notion that everyone owns himself. “I own myself, you own yourself” is the way Walter Williams customarily begins his explanation of Libertarianism. Perhaps so, in terms of legal and constitutional reasoning. However, in terms of moral theology, and ethical philosophy, Saint Paul tells us that we are not our own, and that we were bought with a price. The Christian belongs to God, first by God’s right of creation, and then by His right of redemption, having bought us back from sin and death with the blood of His Son.
Having been faced with a prognosis of death or blindness, and living with unendurable pain, I was faced with this problem at a relatively young age. By what right do we choose either life or death for ourselves? What is there for us other than the will of the Living God? How do we know His will except by His Word, in light of how the Church understands it? Whether we live or die, does not Saint Paul tell us that we are the Lord’s? Unless death is handed to us as the will of God by a call to heroic sacrifice in the dutiful service of charity or martyrdom, what right do we have to choose other than to live? We are forbidden to dance with Ernest Hemingway’s “mistress” and blow our brains out.
And, since the issue has been brought before the whole nation by very tragic events, we should consider that to have a Living Will which would not permit a feeding tube to be inserted is suicide. For the use of nutrition is a natural and proper thing for the body, and to choose thirst and starvation is a choice to be killed, no less so than to choose a lethal injection. Otherwise, we would have to define nutrition and hydration as extra-ordinary, a legal and moral nightmare of the first order.
This is not the same as the “heroic” and extra-ordinary measures I have mentioned. Certainly the Christian view of life is incompatible with a mad attempt to avoid death altogether. The idea of a cryogenic freezer has been dreamed up simply for those who have a fear of death- and a lot of money to waste. Medicine is rightly used to give us a long life in this world. But, is it consistent with faith to try to find a scientific way to avoid death altogether? Natural immortality most likely would never be achieved; and it has never been revealed to be the will of God for fallen man. Our hope is in the pattern of Christ’s resurrection, the only final perfection and eternal life.
Faith means that we trust God. Suffering may be in our future, but if so, it fails in comparison with the glory which shall be revealed in the children of God. Even in light of the intense pain I suffered all those years ago, I know what is required of me, should it again come to such a pass. The perfection of character, the completed work of the Holy Spirit to bring forth the fruit of faith, hope and charity that please God and edify others, are to be embraced. To cut short the work of God by a legal instrument is a right we do not have.
I have never been as sick as Fr Hart has just described. I also live in a typical modern, developed society where death and dying are generally hidden away, so I have had little experience of it. Nevertheless, being about as old as Fr Hart, I've been sick and sore enough, and had sufficient experience of terminal illness in others, to be able to conclude that nobody should expect that dying is going to be any fun. In fact, it is likely to be painful, distressing ('that masterful negation and collapse of all that makes me man'), and characterised by long periods of dependence on the care of others. We need to prepare ourselves for dying as much as for death, and learn to maintain dignity in outwardly undignified circumstances.
What an experience! You certainly managed to profit from such a dreadful thing, as may we all. This is a wonderfully thoughtful and God-centered article, and I hate to quibble, but I must.
I am entirely unconvinced that the insertion of a feeding tube or the agreement to accept such an insertion is a moral imperative. Yes, nutrition and hydration are aspects of the ordinary process of life, but I would contend that we are no longer talking of feeding, but of extraordinary measures to bypass what may indeed be an intended part of the cessation of bodily fuunctions. From time immemorial it has been far from uncommon for physical death to be accompanied by, and perhaps partly occasioned by, the cessation of the desire for eating, and thus of nutrition itself. Is what has been called the "last fast" necessarily suicidal? I haven't yet prepared a "living will", but, if I am to do so, it will not be permissive of such an artificial feeding arrangement -- not indeed out of a desire to hasten death, but out of a sincere desire to let nature take its course. The line between this procedure and other 'heroic' measures is an extremely fine one -- so fine that I find myself unable to see it at all.
Fr. Hart wrote, "a Living Will which would not permit a feeding tube to be inserted is suicide. For the use of nutrition is a natural and proper thing for the body, and to choose thirst and starvation is a choice to be killed, no less so than to choose a lethal injection. Otherwise, we would have to define nutrition and hydration as extra-ordinary...."
I must respectfully disagree. Nutrition and hydration, by themselves, are ordinary and natural, but the ordinary and natural means of receiving them is by mouth. Feeding tubes, being artifacts, are by definition not natural and, because comparatively few of us use them, and then only under extraordinary circumstances, they are scarcely ordinary, either.
This may be analogized to the use of a respirator: breathing by itself is natural and ordinary; breathing that can be accomplished only by the use of an external machine is not.
Because the feeding tube and the respirator are "means", not ends, it is appropriate to ask oneself what the end is for which one or the other (or both) are being used in a particular case. Where the patient has some hope of recovery, and these implements are being used to support bodily functions until the time of such recovery, then their use makes sense. But, by the same token, when there is no reasonable prospect of recovery, when the body has so completely worn out or broken down that it will not function on its own, their use for pure maintenance, against the will of the patient, is more debatable.
Thus I think it is defensible for someone who has thought through these issues to reject this extraordinary means of supplying the necessities of life. What is a means of cure in one case may, in another, be merely a means of unnecessary prolongation.
I saw this in the case of my own mother. The child of two physicians, she had literally grown up with issues of life and death and, long before her 80th year, had decided that when, as she considered it, her time had come, the appropriate response was to accept gracefully God's Will for her. After a stroke that left her conscious but unable to speak or swallow and with one side of her body paralyzed, the hospital staff inserted a feeding tube.
With her one usable arm, she withdrew that tube, after which her three children instructed the staff to cease making similar interventions. We knew that she felt that once she could not swallow naturally, and when there was no reasonable prospect that she would recover that faculty, then the time had come when she was meant to die, and she meant to do so with as much dignity and peace as she could manage.
I, too, have confronted death "up close and personal" a time or two already and am not sure I did so with as much grace as she did. While future circumstances may compel me to endure dependency, in which case I hope I would do so as Fr. Hart suggests, I cannot see artificially created dependency, without more -- such as some hope of improvement, -- as a virtue or a benefit.
John A. Hollister+
Many of the people who use feeding tubes are not in the condition called "terminal." Furthermore, some people who are not able to defend themselves are removed from feeding tubes only to suffer the unspeakable agonies of death by dehydration, with all of it stages (including the blindness that certain dishonest scum bags, after the autopsy, tried to misrepresent as pre-existing, in the Terri Schaivo case). Others, not thinking, are put through this horror by a careless kind of Living Will. Then, as with Terri Schaivo, some are forced to die when they were not in a terminal state.
My own thoughts about the Schiavo case were not so much regarding the content of the decision, so much as who was making it. It appeared that Mr Schiavo had already made 'other arrangements' regarding his personal life, but as he was Mrs Schiavo's husband, he was legally responsible for decisions regarding her medical care. If the decision had been made by her parents, it would have been the opposite one. What seemed to be playing itself out (from my distant vantage point) was not so much an ethical debate as to what was appropriate treatment for a patient in Mrs Schiavo's condition, but a tug of love between a husband who'd sort of 'moved on' and parents who believed that they still knew what was best for their child.
I was avoiding mentioning the Schiavo case, but, since it has been brought up, I found that at the time, it raised more questions in my mind about such procedures than were considered in the media, by the massive pressure groups on both sides, by the Congress, and in the courts. It still does present me with the same questions. Though I haven't yet made a Living Will, it has become definite that, when (and if) I finally get around to it, it will not include permission for feeding tubes and respirators on anything other than a very temporary basis. I think I'd prefer that neither be used at all. This is especially true of the feeding tube -- if I can no longer eat, I can pretty well assume that God has called me to my final fast.
A serious question arises as to how obligated we can be to do every scientific procedure that we have figured out how to do. Where do we find the line between God's will for our life-span and our ability, as a result of free will, to go beyond His will? Must we jam a tube down a person's throat and thus cause great discomfort, just because we can? Are we thereby preserving them in a tortured living state that God intends to lead them out of? Is it not true that this physical life is temporary at best, and, for a Christian at least, far inferior to what is to come? Is all of this perhaps evidence of an ultimately non-Christian fear of death?
The practice of euthanasia is wrong primarily because it is an example of man playing God -- could that not be said of a wrongful extension of physical life by what is called 'heroic measures'? We've developed morally questionable ways of killing, and, I contend, also morally questionable ways of extending life.
I was far more incensed by the huge furor raised over the Schiavo case and the attempt to use the full power of the strongest governement in the world to decide what is a very sensitive, very personal, and very private kind of moral question, and by its assumption that the issues are, of course, black and white. I believe they can be unscrambled only by intense quiet prayer.
I'm afraid, Fr. Hart, that this is a question on which we will continue to have extremely strong disagreement.
The Schaivo case was a case of legal murder. She was not terminal, she did not have a "Living Will," and the courts actually broke the law rather than enforcing it. The judge made himself the advocate of the "defendant," and therefore every decision that followed was illegal (the true basis for every appeal, which was ignored willfully and stubbornly). If she was even partially conscious (which the evidence strongly indicated), then her death by dehydration was inhumane. Without a true concern for her possible (likely) suffering, her husband managed to walk away with a fortune that had been raised for medical care.
What the case showed was how powerful the culture of death has become in our society. She was not terminal, but rather, disabled and inconvenient.
We must hold to the sanctity of life as the highest priority, not the quality of life. Otherwise, every case of dependence becomes the grounds for court ordered death.
I'm not going to argue the details of a specific case. On this one I've examined both sides rather closely and can only come to the conclusion that it is not as clearcut as either side claims. I'll rest it there.
However, you will have a very difficult time convincing me that it is respect for sanctity of life to use extraordinary measures that can arguably be considered as torture in and of themselves, merely in order to prolong the suffering. That sounds more like blasphemy against life to me. Ceasing to use such measures is not the same thing as taking action to cause death, but seems more akin to determining not to cause more anguish.
Feeding tubes don't go down the throat or up the nose. You have probably been given the same exact thing to deliver fluid if you were ever in a hospital overnight, only not for nutrition. It's a simple IV. At what point does nature take its course? Modern medicine gives us a new norm, as does modern sanitation, air conditioning and heating. The case we have mentioned was not a case of torture until the dehydration began. In this case the issue was not her feeding tube, but her disability. Our society rejects disabled people, and this was at the heart of the case, not respect for a standard of life.
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