Assisted Suicide and the Illusion of Autonomy

[0:00] Thank you for coming to hear my thoughts on this very difficult subject. It's very much in the news right now. And I guess I entitled it Assisted Suicide and the Illusion of Autonomy because autonomy is a key concept.

[0:20] And I wanted to make sure that, because I know there are Christians who have not fully come to a conclusion about this, the issue of assisted suicide and euthanasia and mercy killing and all the euphemisms, all of the pretty ways that the concept has been dressed up like doctor-assisted suicide.

[0:42] Because there are Christians who are still confused about where they should stand on this, I wanted to help them to understand what the problems are with these concepts and what a uniquely Christian response might be to some of these ideas.

[0:56] First, a definition. Assisted suicide means actively facilitating, that is provoking, encouraging, in some way enabling, the self-inflicted death of a person who finds their life difficult, who sees no meaning in their life and has no hope for the future.

[1:13] In other words, a suicidally depressed person. Suicide itself, trying to kill yourself, used to be a criminal offense. Suicide was decriminalized in 1972, not because we had all decided that there was nothing wrong with suicide, but because it was seen that suicide was a mental health issue and could fit better inside a medical model, inside the medical system, than inside the justice system.

[1:39] But recently, Canada's Supreme Court, in what I see as the lowest point in its history, has changed our law to protect doctors who enable the suicide of a range of patients.

[1:56] The new law could apply to many patients, since the court chose not to specify that the patient would have to be actually dying. That's one of the most important concepts, I think, to get under our belt.

[2:09] This whole thing is not actually about people who have to be dying. This is something that is frequently misportrayed by those who are trying to promote assisted suicide euthanasia, as though we are doing nothing but shaving a few terribly arduous days off of the life of someone who is in their last moments.

[2:29] That is actually not what this issue is all about in reality. Since the court chose not to specify that the patient would have to be actually dying, it left open potential access to state-endorsed suicide for disabled people, children, and psychiatric patients.

[2:49] In fact, our court created an obligation for the medical system to supply lethal medication to selected suicidal people, or indeed for a doctor to kill some people directly, which in Belgium and the Netherlands has included disabled people, children, and psychiatric patients.

[3:09] Now, Quebec is aggressively adopting the Belgian model, and Quebec's plan is projected to go into action there in three months.

[3:21] Quebec's health minister is even threatening doctors and health care institutions who say that they do not wish to cooperate with euthanasia. We are in an era of twisted words and doublespeak.

[3:33] The government of the province of Quebec is now claiming that assisted dying is part of the continuum of health care. This is like saying that child abuse is part of the continuum of pediatrics, that female genital mutilation is part of the continuum of gynecology, that heroin addiction is part of the continuum of pharmacology, that a drink spiked with a poisonous drug is part of the continuum of hospitality.

[4:01] How could such an extreme position come to be the one favored by the legal and opinion elite of Canada? Canadians usually take a moderate middle road on things, which would mean no overtreatment, and yet also no medically engineered suicides.

[4:19] How did we get here? To say that this Supreme Court decision inflicts a festering wound on the constitutional heart of our country and eventually on our medical system would be an understatement.

[4:34] But we have to understand that our Supreme Court is simply reflecting bad ideas which have been brewing in the heart of Western culture for centuries. The court did not think these things up. The court's only role was to be obedient to opinion polls and to transfer the bad ideas of the crowd into our criminal code, to infect and contaminate the legal system with an unsafe and unhelpful pursuit of radical autonomy.

[5:01] To justify this, the court found that the right to life mentioned in our Charter of Rights and Freedoms actually guarantees a right to assisted suicide because, wait for this, you might lose years of life by killing yourself sooner rather than wait if you could be assisted in suicide by the state later.

[5:23] If this sounds crazy, read the court's judgment and decide for yourself. Google the Carter case, Supreme Court of Canada. It's easy to get the whole thing there and you can read their reasoning such as it is.

[5:38] It's hard to imagine that we live in a country where the judges so desperately wanted to predetermine the result of their case that they would twist the Charter of Rights and Freedoms, that they would torture the Charter of Rights and Freedoms on the rack of their own desires until they got the answer that they wanted.

[5:56] But that's what happened. Those who believe in a right to assisted suicide focus on individual autonomy. Autonomy is self-rule, literally.

[6:07] Independence. We all want to rule ourselves. Wise people, some of them Christians, have the advantage of knowing that we are never as free as we think we are, just as we are never as trapped or imprisoned as we fear we might be.

[6:24] Foolish modern people, some of them Christians, think that the ultimate autonomy is to be able to commandeer the prestige and authority and resources of the state to control the timing of our own deaths.

[6:38] Most of us are afraid of death and the details of the dying process. We are almost as afraid of becoming disabled. Indeed, some of us fear disability more than death. It makes sense that some people want assisted suicide as an escape hatch from such fears.

[6:55] Those who think this way invoke self-determination and autonomy as the ultimate overriding principle, which should trump other things in our laws.

[7:05] If we care about such people, we will try to help them question whether giving power to those around you to steer you to suicide or arrange your death is a sane way to achieve your goal of autonomy.

[7:22] The choices created by legalizing your assisted suicide may end up belonging to others, not to you. From a strictly worldly point of view, the first thing to understand is that assisted suicide and euthanasia are a public safety issue.

[7:40] You don't have to have any particular religious faith to learn that in those unfortunate places like Belgium, which have fallen into the use of assisted suicide and euthanasia, people who are not actually dying are throwing away years of life.

[7:56] Caregivers and relatives with an agenda are part of the environment that steers patients toward suicide or their doctors toward euthanasia. I urge you to note down for later Googling the words, Grim Complaint Against Kaiser Hospital, Victorino Noval.

[8:18] Victorino was a successful businessman in his 70s. He had a few minor problems, very early Parkinson's disease, but he was living his life, driving his car worth $60 million, making $3 million a year.

[8:30] He had the misfortune to develop a bad case of pneumonia. He was placed on a ventilator and was recovering when his daughters told the doctors that he wouldn't have wanted to live like this and that he should be taken off the ventilator and given escalating doses of morphine until he died, which the doctors unquestioningly did because the daughters claimed to hold the power of attorney.

[8:58] It turned out that the social worker who was coordinating this approach to the doctors was the boyfriend of one of the daughters, that the daughters were eager for their inheritance and that the son, who was kept in the dark about these machinations, who had been characterized by the daughters as a hopeless drug addict who shouldn't be consulted on these matters, arrived to find his father being killed by the doctors by escalating doses of morphine and launched a lawsuit, which you get to read all about.

[9:34] So that happened in California, where they will come dangerously close to legalizing assisted suicide in the next few weeks if they don't actually do it. A crucial vote was lost for our side, the side of keeping assisted suicide illegal in California a few days ago.

[9:56] Where euthanasia is practiced, palliative care, the care of the dying, has suffered. We've seen that in places like Holland. Suicide contagion has occurred where copycat behavior increases suicide rates.

[10:14] Early last December, a mother brought her young adult son to me and he was suicidal and I asked him if he had a plan and he said that he'd watched a video, a very slick video, a very well-produced video, featuring Brittany Maynard, who was an attractive, forceful, well-spoken California woman who traveled to Oregon when she learned that she had an inoperable brain tumor so that she could get a suicide drug which is legal in Oregon.

[10:50] She has become the poster case for the Hemlock Society which is now called by the more appealing Compassion and Choices title. I sent a letter to the assembly members of the Senate of California a few days ago who are on the committee who is deliberating assisted suicide and euthanasia and I can only hope that this warning which seems so clear will be heated.

[11:20] Oregon has seen, since it legalized assisted suicide and euthanasia, its suicide rate, not counting the doctor-assisted suicides, increase at a substantially higher rate than the rest of the country.

[11:38] Psychiatric patients are being killed as a solution to depression, even for anorexia in at least two outrageous cases. In fact, people have now been killed by Belgian doctors for autism, anorexia, borderline personality disorder, chronic fatigue syndrome, partial paralysis, deafness with worries about future blindness, and manic depression, bipolar illness.

[12:09] Get out your pencil and scribble down another Google. The death treatment, an article in the New Yorker just three months ago in June of this year.

[12:20] And that tells you all you need to know about the tragedy which befell Tom Mortier, the Belgian professor who was notified the day after his mother was euthanized for depression.

[12:35] He wasn't contacted, his sister wasn't contacted, they were just notified that their mother had been killed by one of the more active euthanasia proponents in Belgium.

[12:50] So, if we ignore all our human relations, relationships and responsibilities, self-determination and autonomy are all we have and all we have to answer to.

[13:04] After all, as one science author puts it, you are a tightly coordinated system consisting of billions of micromachines and nanomachines.

[13:16] He goes on to describe how your genome, proteome, metabolome, and microbiome, that is, the genes, the proteins, the chemicals, the bacteria that make up your body, will soon be able to be catalogued exhaustively and available to you in personalized form as your own repair manual.

[13:41] The same author concludes, we will leave behind the natural evolutionary forces that our ancestors endured and embark on a self-directed future.

[13:53] You can read about that in The Personalized Medicine Revolution by local author Peter Cullis, C-U-L-L-I-S.

[14:07] Now, this new science holds immense promise for medical care, but notice how it intensifies the focus on the individual's mechanical and biological functioning while having nothing to say about relationships and ultimate purposes of life.

[14:21] As people of faith, we have the privilege of trusting a sovereign God who wants the best for us. God made us intensely relational, both with him and with each other, and relationships need trust.

[14:36] This takes us to the parable of the talents which we read today. This is all about grace and trust. A rich, powerful man goes away and leaves three servants with various amounts of money to be used in his absence.

[14:49] Two of the servants take a risk with the money, use the money and business and multiply their gift by risking it in faith that things will work out, and they do. The third servant is the interesting one for the point of the parable.

[15:04] He buries the money in the ground, which is a rather dull and unimaginative thing to do, but hardly seems worthy of severe condemnation. Then he explains himself to his exasperated master who has returned by saying, Master, I knew you to be a hard man, reaping where you did not sow and gathering where you scattered no seed, so I was afraid and I went and hid your talent in the ground.

[15:29] We would be wise to see the worst part of ourselves in that servant. He refused to recognize that his master might have any love for him or want the best for him. He refused to venture out with trust that his master would accept his efforts.

[15:43] He makes a public claim that his master is a hard man who is interested only in himself. So it was in the Garden of Eden. The snake says to Eve, who had been told about the tree whose fruit would bring some kind of death, You will not certainly die, for God knows that when you eat from it, your eyes will be opened and you will be like God knowing good and evil.

[16:11] The snake is saying that God does not want the best for us or that God does not know what is the best for us, his own creation. Instead, the snake implies God has told a lie to Eve to manipulate her into being afraid to enjoy every possible sensation and experience and gain the knowledge to master the universe, at least in the matter of the knowledge of good and evil.

[16:38] We do not have to look far into our own lives to notice that when humans define good and evil for themselves, it does not always end well.

[16:50] The snake doesn't want Eve to reflect on that. The snake wants to position God outside a loving relationship with his creation and gives God an agenda with no necessary connection to the good of his creation.

[17:03] The serpent in the garden and the fearful man who buried his talent are saying the same thing. God cannot be trusted. If you buy into the petulant complaint of the talent-burying man or the insinuations of the snake, you are on your own.

[17:19] We all know or have heard about friends or family members who had a difficult final illness and death. There are two extreme positions available on the issue of death in our medical system. One extreme would insist on resuscitation and shocking the heart and all possible measures to delay an imminent death.

[17:36] The other extreme is to insist on the medical right to kill and the patient's right to be killed. The reasonable middle way careful symptom control until a natural death has suddenly become inadequate to our Supreme Court.

[17:55] Unsavory motives lurk behind the push to medically hastened death. A quick end delivers a larger inheritance to the waiting relatives. A quick end gives relief to those with a horror of other people's disabilities and those with horrified imaginings about their own future disability.

[18:15] A quick end satisfies onlookers who can't imagine any meaning in the life of a disabled person, whether the disability is physical, cognitive, or emotional. We can justify euthanasia by narcissistically projecting our own feelings.

[18:31] They must be unhappy being alive because I am unhappy watching them being alive. The question of meaning is a chasm splitting our society in two.

[18:44] Our post-Christian power elite sees no problem in assisted suicide because that elite has a naive faith that there is no real meaning to existence.

[18:55] Meaning suggests purpose, suggests purposeful creation, suggests a God. the post-Christian political position is that anything that the Christian church rejects is well worth promoting.

[19:09] During a debate about euthanasia, a Christian doctor friend once observed that there was no scientific proof that any of us are better off dead.

[19:20] Her opponents fell over each other rushing to condemn her for pushing religion. That is how silly the whole thing can get and has become. But as those whose hope is in Christ, we are given another perspective on the very human fear of that unknown called death.

[19:40] With the eyes of Christian faith, time is something given to us as a gift. Not just a math and physics concept, something that has to happen because things move.

[19:52] The world admires someone who can be described as self-possessed. We strive to belong to God. We accept the inescapable dependence we have on everyone else at every stage of our lives.

[20:06] This is not an aggravation to us, but an opportunity to be of service in return. Nietzsche rejected the idea of God and claimed to be a superman, able to stare into the abyss of meaninglessness without fear.

[20:23] Christians are grateful for the gift of hope in life beyond death. Which world do you want to live in? In the words given to us in Deuteronomy 30, verse 19, this day I call the heavens and the earth as witnesses against you that I have set before you life and death, blessings and curses.

[20:47] Now, choose life so that you and your children may live. I'm ending my formal talk here so that we'll have time to answer some questions because I think that it's too easy when talking to a relatively or predictably friendly crowd to cover material which may be uncontroversial to the audience and I would like to have the opportunity to answer some bothersome questions, some things that you find really troubling about this particular issue.

[21:23] Do we have anyone brave enough to ask such a question? John? Yes.

[21:35] Well, I'll repeat the question. John is saying that the Supreme Court has simply imitated, reflected the bad ideas which have been brewing in the middle of Western culture for centuries and these are essentially like many evils and exaggeration of the good.

[22:03] We saw a liberal enterprise to put more emphasis on the rights of the individual over the last few centuries. The extreme of this, of course, is to say that the right of an individual in any circumstance simply trumps all other considerations.

[22:25] To get away with that, you have to look at what John Stuart Mill was saying, which was that basically your rights should extend as far as it takes for them to start to interfere with other people, to harm other people, to interfere with other people's rights.

[22:42] And so, when you want to exaggerate a right out of all proportion, what you have to do is ignore the flip side of a right, which is the obligations which arise on the other side.

[22:56] So, when the Supreme Court declares a right to assisted suicide, that means that suddenly the society becomes obliged to provide the suicide. And that suddenly means in our rights-based environment that who gets this supposed desirable thing, this assisted suicide, it then becomes an exercise in power and in legal maneuvering.

[23:21] In our rights-based system, there is no conceivable self-declared suffering which should be less accommodated by the offer of assisted suicide than some other suffering.

[23:36] In other words, the Supreme Court left it open to the individual to decide whether their suffering was intolerable. They left it open to the individual to decide whether treatment of their particular condition was available.

[23:54] A condition is now called irremediable if you simply don't want the best available treatment and you prefer death to the best available treatment. So, this kind of verbal distortion has characterized the entire debate and certainly characterizes the Supreme Court's decision.

[24:14] The other way in which we have to ignore the question of whether rights impinge on others is to pretend that we are far more independent of each other than we really are.

[24:27] I mean, here I am speaking to you dependent on someone who developed the transistor in 1948. and someone who then developed the integrated circuit in the 60s.

[24:41] And someone who had all these manufactured in China or something so that the mic can pick up my voice. I mean, we're all so interdependent technologically on each other. And then we're dependent on each other socially.

[24:55] It's been shown that children who are raised without human touch and without people speaking to them have permanent neurological damage.

[25:08] It's built into our very beings that we need to be touched and related to from the time that we're born. So to ignore this kind of radical interdependence and to claim that autonomy is something which is under terrible threat and needs to be shored up by radical innovations like assisted suicide and euthanasia is an evil being created out of an attempt to do something good.

[25:40] What started as an attempt to do something good. That is, to ensure the recognition of the specialness and the rights of the individual. Yes?

[25:54] Right. Yes, I think maybe the most easily remembered and straightforward question you could ask is, well, if you're going to allow assisted suicide or direct doctor killing in one situation, who are you going to say no to?

[26:15] Just ask someone to think up a situation in which they think that the Supreme Court, with a clever lawyer in front of it, would still say no.

[26:26] because there's just no obvious way that the court could say no, or at least it could say no for very long. Because who's to say that my suffering is more than your suffering?

[26:40] Who's to say that psychological suffering is not as bad as physical suffering? suffering. In fact, when I look at my own practice, what I see is that there is actually more psychological suffering than there is physical suffering.

[26:52] In my average day, there are far more people who have a terrible pain in their mind and psychologically in their heart than there are people who have a terrible pain in their back.

[27:04] So when it starts to be your decision whether your situation is intolerable, then we start to see the terrible abuses that are happening elsewhere.

[27:17] The worship of radical autonomy can perhaps be best exemplified by the tragedy of Nancy Verhelst, who was a beautiful, young Belgian girl born into a family where her older brothers were favored and where she had a pathologically unloving mother who ignored her basically and kept telling her she wished that she had been a boy.

[27:49] So when Nancy got to the age of 12, her older brothers began to sexually abuse her. And by the time she'd gone through a few years of this, she said that she wanted to become a man so that her mother would love her.

[28:05] And so she went to some doctors who respected her autonomy and did mutilating surgery, to try to simulate maleness for her.

[28:19] But she was horrified by the outcome of the surgery. And she wanted to die. And so another doctor killed her. And so you'd have to look at Nancy, whose picture as perhaps an 11 or 12 year old you can easily see online.

[28:39] and you see this lovely child who had the misfortune to be born into an abusive family and then thanks to its worship of radical autonomy to be further abused by a medical system which then finally abused her by killing her.

[29:00] So this is the logical outcome of an unbalanced worship of autonomy over everything else. And I'd have to say that when you're speaking to a secular audience or if you're speaking to a friend with no faith on this issue, the fastest way you can lose their attention and lose the argument in their own minds is to show any disrespect for the concept of autonomy.

[29:30] autonomy. It's much wiser and accurate to remind your friend that we all want autonomy, we all want power over our own circumstances.

[29:41] It's just that assisted suicide and euthanasia laws on the very face of it are unlikely to reliably deliver that. It's already legal to commit suicide in order to enhance your chances of suicide, to promote suicide officially to you from the government health care system.

[30:00] The changes of the law have to go into protecting the system and protecting the doctors. And so you end up with a situation where you think you've gained an important new freedom and in reality you've simply lost important protections in the legal system.

[30:17] But there are certain losing arguments that I would warn you all off of. When you're speaking to someone with no faith and no access to the ideas of interdependence and our gratitude to God.

[30:34] To mention the sanctity of life is a dead issue because whose sanctity? Your sanctity, their sanctity? To mention dignity is a dead issue because their idea of dignity is taking a whole bunch of pills at a time of their own choosing.

[30:50] It's a minefield, but the simple fact life is a public safety issue. People need to be asked, where do you think this is going?

[31:03] Which story would you rather live inside? A story of meaning in life and of looking after each other, and that means looking after each other well when we are actually dying, and looking after each other well when we're depressed and unhappy with our circumstances?

[31:22] Or would you rather pretend to be Nietzsche's superman and stare into the meaninglessness of your existence and get your main sense of pride out of the idea that you can unflinchingly contemplate the idea that you are worthless and meaningless and that your life has no ultimate purpose?

[31:44] Which of those worlds would you rather live inside? And so I think that most people really would rather live in the world of love and relationship, but they're being sold a ticket about the necessity to assert yourself in a way that assisted suicide and euthanasia will supposedly deliver.

[32:09] So if we can simply raise that little red flag and still a little bit of doubt respectfully into people who after all are in their own minds have the highest of motives.

[32:21] They are proposing assisted suicide and euthanasia for reasons of altruism as they see it. Monja.

[32:37] Well, palliative care is not a place. Palliative care is a mindset. As we talk, I have a patient at home who's 57 years old and who is dying of metastatic cancer.

[32:55] She's unconscious today and her kids are doing a great job of being with her. She's had the palliative care nurse visit, but even in a place where there was no palliative care nurse, her treatment could be just as good as it is now.

[33:13] She's surrounded by love. She is receiving all the comfort care, all the symptom control that she requires. And so to say that we need to have a lethal overdose handy by because somebody in a smaller community might not have access to some kind of sophisticated thing called palliative care is just rhetoric.

[33:39] At the same time it must be said that most of the motivation of the people in these right to die movements, the people who celebrated when the Supreme Court did its nasty business of changing our law, most of those people are motivated because they've seen someone who was treated in a way that didn't look after their symptoms as they neared the end of their lives.

[34:05] So you see people being personally motivated by a bad situation and instead of saying why don't we make the situation better, they default to the idea of why don't we just provide death, why don't we just kill the patient.

[34:18] So we have to recognize that people are simply making a bad choice out of some obvious alternatives. At the very back.

[34:29] The question is, is there an increase in organ harvesting?

[34:40] No. That is on the way, though, because the ethics, you can always tell when there's trouble in the wind because obscure academics, philosophers, start to put out what sounds like really outrageous ideas in obscure journals and the ethics of not letting those good old organs go to waste have already started to be discussed.

[35:06] So you can tell that that sort of thing would be on the way. I think you have to give the people who are currently crusading for assisted suicide and euthanasia some credit. They're not a ghoulish bunch who are looking forward to harvesting organs.

[35:22] They really see this as an issue of personal control and they can't and they refuse to acknowledge that it's even suicide or euthanasia.

[35:35] Their classic line is, you know, calling doctor-assisted death, assisted suicide is like calling surgery a knife attack. So they've thought through their rhetoric very well.

[35:52] Another of the favorite lines is there is some pain that only death can cure. Which is one of those sort of fake deep things that dissolves when you stop and think about it because doesn't death actually stop all pain that we know of?

[36:10] I mean, it's just an empty but portentious sounding bit of rhetoric and it works really well. The other thing that they love to do is what I call the farmer behind the barn thing.

[36:20] which is that you know, there was this farmer and he had cancer and you know, because these people wouldn't give him assisted suicide, he went out behind the barn with a shotgun and how do you think his family felt cleaning that up?

[36:34] You know, so that's, again, all of the, that's a very dishonest argument. It's an argument which ignores all the obvious solutions to the problem short of the shotgun behind the barn.

[36:47] But boy, does it work. And when you've got a Supreme Court as apparently shallow in its analysis, as apparently preloaded with the itch to legalize these practices as ours was, then you get the result that we're living with today.

[37:08] So I think we're running low on time. One more question. One more question. One more question. I think that their valid concerns have all to do with the fact that the medical system has been slow to take advantage of the best knowledge of palliative care and of symptom control and that the medical system has showed a certain indifference to the patients in many situations.

[37:44] patients. And it's ironic, though, that recognizing the medical system to be as unresponsive and deficient as it is, that the proposed solution is to hand over even more power to that same defective system, and this time the power to actually kill you.

[38:04] people. So I would say that the best thing about those who are proposing assisted suicide and euthanasia is that they have at least raised the issues that we need to do better at caring.

[38:19] But we have to recognize that the radical core of the pro-euthanasia movement doesn't really care whether your symptoms are adequately controlled. They care only whether you are willing to carry on with your situation the way it is.

[38:34] If it is to you intolerable, they are 100% behind your right to be killed or to receive that suicide dose that you can take yourself. I'll be happy to take questions later.

[38:47] One more? You mean power of attorney? Representation?

[39:04] Well, yeah, I'd be happy to talk some more about that later. I think that the best thing you can have protecting yourself is a loving family who don't want your money.

[39:16] But I would be happy to talk to everyone after this. And in fact, I would urge any of you interested in getting connected into this euthanasia prevention coalition work that we're doing to simply email me at willjohnston at shah.ca.

[39:35] W-I-L-L-J-O-H-N-S-T-O-N at shah.ca. And thank you for listening.