Life is not always Black & White

Over the past week or so a couple of articles have cruised past the ol' browser window having to do with the topic of "Death with Dignity" or "Doctor Assisted Suicide", depending on your extremist position. Much of it has to do with laws that are coming to the fore attempting to regulate if and when it is possible for a patient to choose to die on their own terms, as well as the recent national story of Brittany Maynard, who became the poster child for this issue when she decided to end her life before succumbing to terminal cancer. I wrote about this around the time that she made her choice and while I was admittedly thinking things through and not necessarily taking a definitive stance on the issue, I think that most of what I wrote still stands.

The thing that bugs me about debates like this is that choices in life are rarely black and white. There is rarely an exact right and wrong, specifically in matters that are beyond the scope of what is addressed in Scripture, if by exact we mean universally right and wrong. Choices like this require us to think through not just the choice itself but the implications of attempting to draw any universal conclusions.

The opponent of Death with Dignity (DWD from here on out, which I use not because I'm attempting to take a position, but because I think it's less inflammatory than Doctor Assisted Suicide) will argue that life, by it's very essence, is black and white. With that I agree. You cannot be both dead and alive at the same time; it is, by it's very definition, a black or white issue. But the question is not really as simple as life or death, no matter how much we'd like to be able to simplify it. If that were the case, and we could reduce any difficult decision to life or death, we'd find that most of the time we would be remarkably inconsistent. Reduce war to life or death. Reduce medical intervention to life or death. Reduce criminal punishment to life or death. Reduce birth to life or death. Even if we were to answer consistently on the side of life–not to lean that direction, mind you, but unequivocally, without fail, in a black or white manner to choose life over death–we would inevitably find some examples that do not fit so neatly into our categories. What if childbirth will lead to the death of the mother, for example? What if refusing to go to war means that some other innocents will die at the hand that we could have stopped? What if our aging parent received a fatal diagnosis, and they could either live for two months pain free and then die in their sleep, or extend their life for two years, albeit in substantial discomfort?

I'm not suggesting that there is a right and a wrong answer to any of those questions, but that is precisely the point. What I am suggesting is that if you choose one over the other without at least wrestling with the question, I do not think you are giving the question it's just due. You do not feel the weight of the decision. And if you do wrestle with them, as you should, then you must at least admit that the choice is not purely a "life or death" decision. One answer may not be the correct answer in every single case. It's easy to say that you would never go to war under any circumstances, until your family lives in the country being attacked.

Such is the case with DWD. There are implications to our choices that go beyond whatever our extreme position is. For example, should hospital resources, already in somewhat tight supply, not ever be taken into consideration? What is the difference between "pulling the plug" on a family member who may be breathing on their own, but unable to feed themselves, and giving a bit of medication to speed up the process? Aren't we choosing death in both cases? And of course many difficulties exists on the side of the pro-DWD crowd: at what point does DWD just becomes suicide, as the opponents rightly question? Surely there is a line. Surely there will be people who want to take the pill and end it all as soon as they are given a terminal diagnosis, even if they appear to be in full health. Is that justifiable?

Inasmuch as I think that the question must be wrestled with and the decision given it's just weight, I do think it's possible is that you may come to a conclusion that is always right for you. You may decide that you will never, under any circumstances, have a doctor give you medication that will end your life short of how it may have ended. I think that you can come to that decision personally, without having to say that it's true for every person in every circumstance. In fact, to have wrestled with the decision personally and come to a conclusion is commendable; I'd argue that if you have done that, you would be unlikely to mandate that same conclusion for everyone else.

This is ultimately to say nothing about whether a law that regulates the practice is good or right, nor, perhaps more importantly, what should go into any such law that was passed. What seems reasonable is that if DWD becomes a legal practice, it ought to be regulated, and probably very tightly.

To say at the end of the day, however, that one decision is right over the other in all cases is to assume a level of knowledge that you do not and will not ever have. That doesn't mean that laws shouldn't still be passed or rejected–one way or the other, we are always responsible for our decisions–but it does mean that in considering the law, we ought to avoid platitudes that alienate more than clarify. Maybe let's commend those who are willing to be in the gray area with us; after all, that's where we all live.

Was Brittany Maynard Right?

If you follow the news, the name Brittany Maynard probably rings a bell. She was a 29-year-old woman who died last week in Oregon. She had inoperable brain cancer.

If that was all there was to the story, we'd have never heard of her. Her death certificate, like every other victim of brain cancer, listed a "brain tumor" as the cause of her death.

The difference between this victim of brain cancer and many others is that Mrs. Maynard decided that she wanted to end her life on her own terms, before the cancer inevitably got her. Before she was hooked up to machines. Before debilitating pain. Before she began to drain her families energy as they watched her die–perhaps quickly, perhaps slowly–but die in a hospital nonetheless.

So on November 1st, Brittany Maynard was given barbiturates, she fell asleep, and died.

Brittany's story went viral, and as a result, the conversation surrounding the practice of "medical suicide" or "death with dignity", depending your perspective, has once again come to the fore. (Growing up, the only time we ever talked about medically assisted suicide was when someone told a Dr. Kevorkian joke. The name was synonymous with the practice and more often than not was used to frighten a friend when they were headed off to a doctor's visit. "Going to see Dr. Kevorkian today?" we would ask, with little to no comprehension of what that actually meant.) 

The responses to Brittany's decision have been all over the map. Clearly, there are significant ethical implications to her decision. It raises a lot of questions–particularly for religious people–about the control that we have over our destiny or our own bodies or our own future. It raises a lot of questions–particularly for non-religious people–about the nature and meaning of life, but that is for a different post. Most people seem to dig in to their particular view point and really don't consider the full range of implications of sickness, health, medical intervention, what it actually means to be alive, and God's role in all of it.

So let me offer my perspective.

Keeping someone alive through medical intervention can be "playing God" just as much as ending someone's life through medical intervention.

One of the criticisms of the Death with Dignity movement is that we are playing God. We are deciding when to end our life.

As a Christian, I understand the sentiment behind that criticism. I believe that God is sovereign over the affairs of man and nothing happens that he does not either cause or allow. I believe that God knows my footsteps before I do. I believe that God created and loves all of his creation, and wants what's best for them. I believe that I ought to have a confidence in God that he has a plan for my future.

But when I get sick, I go to the doctor and get medication. Because I don't want to die.

It is not a contradiction to believe that God is both sovereign over my life, and he wants me to take care of business when I get sick. God's sovereignty doesn't lead me to inaction but to action. I trust that God has provided me with the rational capacities to make a wise decision. I trust that he has given the medical professionals the skills and knowledge to diagnose a sickness, offer me the right medication, perform surgery when necessary, and generally prolong our lives. And I also trust that, if I contract some sort of disease or start growing some sort of cancer, and I do nothing about it, and I die, that's not God's fault. It's mine.

Could God have stopped me from dying? Yes! But the purpose of God's miracles are never to protect me from being stupid. And it would be stupid to get sick, ignore the doctors, and die, because I assumed I'd be miraculously healed. (The purpose of God's miracles are to bring God glory.)

The medical advancements that we've made have allowed us to go on living longer and healthier lives, and make sure that diseases that used to kill us are now either totally eradicated or are no longer as deadly as they once were (In America, at least. The fact that many of these diseases and high mortality rates exist in other countries is a topic for another post.) A virus that might have popped you off at thirty just one hundred years ago is now no longer life threatening. Women don't die at child birth. More children make it to age 18. The average life expectancy has risen dramatically.

The point is that we're living longer, and it's in large part because we've figured out how to heal ourselves, how to deal with disease and sickness, and keep our hearts beating just a few years longer. Sometimes that means we keep it beating for a few years longer than we should.

The argument that we're "playing God" is usually based on the fact that it appears that we're not trusting God with the outcome; I'd argue that if this were truly the case, then we're also not "trusting God" by using any form of medical intervention that is ultimately for our well-being. If accelerating the process of dying is "playing God", then so is prolonging the process of life. We're intervening into the life and death process in a way that circumvents what would otherwise have happened naturally. 

That raises the question: if it's okay to prolong our life beyond what it would have otherwise been, why it is not okay to end our life somewhat shorter than it would have been?

Brittany Maynard had terminal cancer that was going to take her life. The final months (years?) of that cancer would have been debilitating and extremely painful. She would have lost all of her functional capacities as she neared death. It would have required her family to spend inordinate amounts of energy caring for her. Not the Brittany that they knew and loved, but a Brittany that was only a shell of the woman she once was, motivated to continue based only on an increasingly distant memory. Not to mention, the medical resources necessary to keep her alive and pain free.

This future was effectively guaranteed for her. As a result, Brittany decided that since she was certain to die anyway, and since that death would come with pain and suffering that only compounded her family's mourning, it was better to end her life quietly, in peace, before the cancer fully took over and killed her anyway.

You may not agree with the timing of it–should she have waited longer? Was it at a debilitating point? Did she have more "good days" left that were wasted by ending her life too soon?–but it's difficult to argue that her decision was based on a different set of standards than the other decision she could have made, which was to dope herself up with morphine or some other pain killer, avoiding the painful effects of cancer, until she eventually died anyway. In both cases, she avoided the painful effects of cancer, and in both cases, she died.

But what about a miracle?

This typically leads to a second objection: what if God wanted to work a miracle? Isn't she ruling it out by ending her life on her own terms?

To be sure, there is a tension between the "rational" part of our minds that understands and ought to examine how the physical world works and the part that believes that God can and does perform miracles that go against the physical and natural order. My Dad died of cancer in 2008, and up until the point that he died I continued to believe that God could work a miracle on his behalf and heal him of the cancer. I also believed that it was unlikely.

Does that indicate a lack of faith? Maybe. But I'd argue that God doesn't call us to blind faith or irrational faith. The faith that we see in the Scripture is not the "step off a cliff and hope things work out" kind of faith, but the kind of faith that is based on God's action in the past and promise of action in the future. (Even Jesus, when asked to step off the cliff because surely he had enough faith to do it, declined and opted for the slow, steady, plan of God.) Yes, the faith of a mustard seed is enough to make a mountain move, but that has a lot more to do with the power of God than the power of your faith.

Could God have healed Brittany Maynard? Again I say, absolutely. We know that God is powerful enough to do it, that he might do it for his own glory, and certainly that he does not wish that anyone should perish (physically or spiritually). That belief, however, doesn't mean we shut off our rational faculties and fail to deal with reality as it is.

There was a marked difference in my Dad's physical demeanor, spirit, and perseverance on the Friday morning before he died, and the Friday afternoon before he died. On Friday morning, there was a sliver of hope that there were options to treat the cancer. By Friday afternoon, the hope was gone. The doctors had done everything they could. All the knowledge that they had accumulated about cancer and about his cancer had been applied. All the surgeries and treatments they had at their disposal had been used. I'd add, all the prayers that could have been prayed to heal him of cancer and give him another five or ten or forty years had been prayed. But then the doctor came in and said, "there's nothing more we can do. We're sending you home with hospice care."

Two days later, Dad died. And it was pretty clear that on that Friday afternoon that he had already made up his mind: the end is near, I can let go now.

Dad didn't ask the doctor for a barbiturate, but he definitely decided when it was okay to die. I bet Dad could have willed a couple of extra days, maybe even a few more weeks. The doctor's even suggested that he could. In fact, in hindsight, Dad had probably already willed a few extra months. But then there were no more options. So Dad let go, and he died.

Our Hope is Not Yet Fulfilled

Here's the thing. Nowhere is it written that our hope is finally for this life. In fact, if our hope were for this life only, then Christians would be the most pitiful creatures on the planet! Only a fool would go on believing that he would never die of cancer, or of disease, or never get sick, or have all the money he wants or needs. Only a fool would believe it because the evidence says just the opposite.

The Christian doesn't hope that this life will be free of pain. The Christian hopes and believes that there is more than what this life has to offer; that there is hope on the other side; that even though in this life we live in brokenness, we also live in the glow of victory because of the cross. Yes, there is darkness. But the light has broken in. And someday, the darkness will be gone for good.

So was Brittany Maynard right to end her life? I don't know, but I'm definitely not willing to condemn her for her choice. Someday we'll never have to decide between a slow, painful death of cancer and the quick death of barbiturates. But that day isn't now. And I'm not sure that Brittany was wrong for deciding to avoid the pain that by all accounts was an inevitable reality, and deal head on with the consequences that were coming, no matter what.