Harriet Goetz, a registered nurse at Elmhurst (Illinois) Memorial Hospital, has been in nursing for almost 40 years.
This article appeared in the Christian Century, June 21-28, 1989, p. 619. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
Physicians are asking if there should be one last act of care – to bring on death.
Back in the ‘50s I wrote an article for a nursing magazine to sort out my frustrations at the way terminal patients were treated There was then no "effective management of pain" or hospice care. Frequently patients were not even told that their days were numbered. Death was seen as a failure and embarrassment to the medical profession. I received some sympathetic letters from colleagues who were also troubled by the medical profession’s failure to approach dying in a decisive and positive manner.
Then in the ‘70s Elisabeth Kübler-Ross published her ideas concerning the stages through which the dying pass as they seek to reach a measure of peace and acceptance. This new openness was very liberating for medicine. Nurses no longer had to stand outside the sickroom of the dying, speaking in whispers. The hitherto forbidden subject could be faced and discussed. Predictably, however, the whole death and dying discourse began to develop into a sort of trendy psychobabble for nurses and chaplains and therapists who sat wringing their hands over someone stuck in stage three, saying things like, "If only he could move past it." A few patients even had the gall not to pass through the stages in the proper order.
Mercifully, professionals are much less likely to act and talk like that nowadays. And Kübler-Ross’s theories did lay the foundation for the hospice movement, greatly ease the mental and physical suffering of dying patients and inspire those who care for them.
In March the New England Journal of Medicine published a trailblazing article "The Physician’s Responsibility Toward Hopelessly Ill Patients." This article marked the first time that premier physicians used a prominent journal to discuss not only "pulling the plug," but whether physician-assisted suicide (performed by the patient) and euthanasia (performed by the physician) should be a part of the continuum of medical care. The article was picked up by the media, with experts from both sides presenting a preview of the debate that lies ahead. New occasions teach new duties. Thirty years ago we didn’t talk about death, 20 years ago that taboo was overturned, and now we are speaking the unspeakable. More than pulling the plug or stopping the tube feedings or writing do-not-resuscitate (DNR) orders, we now have the phrase "assisted death." An older, more direct term is mercy killing.
I have been a nurse for many years. I have been at the bedside of dying people, young and old, people who died with a dramatic intensity and others who died so slowly and quietly that it was hard to tell the exact moment of death. I do not think I could ever become callous. I think I still remember every one of those occasions. Maybe not the name anymore, but something about the experience: what the relatives said, what prayers the chaplain prayed, how the room smelled, who wept and who didn’t, who helped me wash the body. I have seen the medical profession make great strides in the management of pain and suffering. But there are some terminal patients whose suffering goes beyond anything the medical profession can alleviate. The physicians who wrote the journal article are asking if there should be one final act of care -- to bring on death. As a Christian and a caregiver, I find myself saying Amen.
R. D. Laing once wrote that we are more afraid to live and love than we are to die. I think he’s wrong. I think we’re pretty frightened of all three. Malcolm Muggeridge calls death the 20th century’s dirty little secret. Maybe we could keep it a secret a little longer by having all of our bodily organs transplanted, or eating health food from the cradle on or spending two hours a day reading self-help books. But, ironically, our very health technology is forcing us to confront death. The same great strides in medical technology that are saving and prolonging lives are in some cases prolonging unspeakable anguish and suffering. That’s the way it goes with technology. The doctors who wrote the New England Journal article have brought our dirty little secret out into the open. They dare to ask: Is there a time when it is appropriate, even obligatory, to assist death? They are appealing to people of faith to think about this matter and come to terms with their proposals.
How should Christians in general -- not just Christians in the health-care field -- respond to the, notion of physician-assisted death? A wealth of memories and experiences seem to be telling me one thing, yet "thou shalt nots" and "what ifs" pull me another way. It is hard to know what is both merciful and right. I am getting older, and I have to come to terms with this issue, both professionally and personally. All I can do is to set out some of the considerations and arguments and ask God to add his blessing.
Mercy killing is certainly killing. But which word do we emphasize? The "mercy" or the "killing"? There’s no way to make it sound acceptable. Killing sounds wrong and violent. ‘4Assist death" or "stop life" sound better, but euphemisms are dishonest evasions; the issue is killing. Why is it so difficult to bring oneself to kill a person? Often it isn’t that we want a person to live longer in a state of suffering; it’s just that we don’t want to be the one to end it: Yet why do we want to keep a person alive who has no hope of recovery, who is in dreadful agony and who is begging for death?
Killing people is one of the things we do best. We kill people who get too close to our border, we kill people to take their land, we kill people whose ideologies we despise or whose skin is a different color, we kill fetuses, we kill people by not sharing our resources, we execute prisoners. We kill all kinds of people who don’t ask to die, yet the poor bugger who’s begging for death we refuse in the name of humanity.
The newspaper recently carried a neat little chart of the various chemical and germ warfare agents now at our disposal; nerve gas, vomit gas, anthrax, dengue fever. This was just a little spot of routine news. We can look at this pocket-sized guide to killing off most of the world’s population and be so desensitized that we must struggle to call up righteous outrage. Nevertheless, for many Christians mercy killing touches a raw nerve. Certainly it seems closer to home. We ourselves may one day choose to be victims if euthanasia becomes an accepted way of dying.
One argument against euthanasia is that it brutalizes society. But which is more brutal: to insist that a person spend his or her last days in agony and suffering or to help that person die a more peaceful death? Christ transformed the universe and everything in it, our lives and our deaths. We hear a lot about new life in Christ, but we’re still holding on to the old death, the one with the sting. We don’t have the faintest inkling of what St. Francis calls "the kind and gentle death." Indeed, we have a sin that we don’t think much about: we are brutalizing death. We are giving death the status of a terrorist. When one of my colleagues who works on an adjacent unit came rushing over to borrow supplies, I asked her, "What’s going on over there?" "The patient has been dead for a half hour," she replied, "they’re just playing with the body." It was the second time that evening that the emergency team had resuscitated an 84-year-old woman. We are keeping the machines on long after life has gone. We are creating black markets for livers and kidneys. Perhaps we need to think more deeply about what is brutal and what is kind.
Another argument is that euthanasia is interfering with God’s role. But where do God’s rights begin and ours end? Is taking aspirin interference? Or having an appendectomy? How about an organ transplant or genetic surgery? Releasing a person from the last agonizing days of suffering doesn’t seem to be as much interference as installing a new heart or giving a total blood transfusion. Certainly it is not tampering with destiny as much as is providing a new heart. I guess God’s rights start where our technology runs out.
Perhaps with an eye to the martyrs, some insist that since Christ suffered, it should be our privilege to suffer as he did. Christ died to spare us, among other things, the superstitious view that brute suffering is God’s will. The cross and suffering he calls us to are the kind of self-sacrifice required to feed the hungry and help the oppressed. There is no way we can imitate what Christ did on the cross. Physical suffering for its own sake has always seemed to me to be morbidly out of phase with the Good News.
Some opponents of euthanasia espouse the domino theory: if we permit euthanasia, we’ll soon be killing retarded people, then the elderly, and then people whose ears are too large. This argument is often hauled out, but I’ve never found it convincing. Life and law in a pluralistic society such as ours do not move in a rigidly logical progression. I need only look at my own tensions of conscience. In most cases I do not condone abortion, but I am pro-euthanasia. I know people who are pro-choice and are peaceniks. I know hunters who are environmentalists. The domino theory has dramatic quasi-logical power, but life does not work that way.
I deeply admire those Christians who are attempting to live the seamless garment ethic -- to be utterly consistent in their pro-life values, allowing no wrinkles or tears in that holy garment. But as I look into a face distorted with pain, I would have to question whether I was more concerned with my seamless garment than another’s suffering. There is a line in a novel by Penelope Lively that makes this point: "Tell the man on the guillotine that the action lies elsewhere." Likewise, tell the man on his bed of pain that the action is really to be found in my system of ethics or in hospital procedure manuals or in the law of the land. The dying one might think otherwise. Paul Lehmann used to say that sometimes we have to forget our principles and do the right thing.
What about mental suffering? It’s sometimes even worse than physical anguish, but it is not in itself a terminal condition. Certainly I do not propose that anyone who is suffering apply to the mercy killing board for a euthanasia permit. The physicians who wrote the journal article are proposing alternatives for hopelessly physically ill patients. The sad truth is that many unhappy people do end their lives, and many of them would have had their lives made better with psychiatric treatment. Therefore, the suicide of the mentally ill, rather than be medically facilitated, ought to be medically interdicted no matter how they may ask to die. Strangely, it is not generally the hopelessly chronic, impoverished back-ward-type patients who kill themselves. It’s people like you and me.
What about family members? If euthanasia were legal, one would hope that the family could support the dying person’s last wish. Any family is under great stress at such a time, but more so families who have never given much thought to what they believe about death or who have unresolved conflicts with the dying member. When persons are comatose and terminally ill, the family has to make these difficult decisions. Thus, 93-year-olds are resuscitated and feeding tubes are forced down, mostly for legal reasons or because families want the consolation of being able to say, We did everything we could. Some of these procedures are terrible to see, and no one who has stood at the bedside has not wondered, Is this merciful? Is this right? When an aging desperate husband rushes into a nursing home and shoots his suffering wife and then goes to jail, we know something is terribly wrong. We need to give thanks for the hospital ethics committees, composed of doctors and nurses, pastors and counselors, who are doing fine work with families facing some burdensome decisions.
In the midst of these deliberations, we ask ourselves: What gives life its quality? Is it breathing? A heartbeat? Thought? Interrelatedness? Troubling questions indeed. It seems that we can’t really say what life is. Death, too, has several definitions: brain dead, biologically dead, legally dead. But it’s the dying we’re worried about. Many terminal patients wouldn’t want euthanasia because so much has been done to make their final days as comfortable as possible. It’s the other ones we’re concerned about. What is the only argument for euthanasia? That it is merciful. We assist birth; we try to make it as safe and painless and joyful as possible. Why can’t we assist death? Just that one word -- mercy -- seems a stronger argument for than all the arguments against.
My husband and I watched Babette ‘s Feast the other night. In this beautiful movie the old people go out into the night after dining on a sublime banquet -- a foretaste of the heavenly feast. "The stars come closer every night," one says, "and the candle burns lower." Yet they join hands and sing a joyful benediction. Clearly they are prepared for the heavenly banquet, and death is no dirty little secret.
I think, Dylan Thomas to the contrary, that I would prefer to go gentle into that dark night. Only I don’t believe it’s going to be a dark night. I think it’s going to be something like Frederick Buechner once wrote:
We are going, I believe, much further than at this point we can possibly see, and in everything we do or fail to do, much more is at stake, I believe, than we dream. In this life and in whatever life awaits us, he is the way; that is our faith. And the way he is, is the way of taking time enough to love our little piece of time without forgetting that we live also beyond time.
That’s what I want to do. I want to love my little piece of time like I love the little piece of ground on which my house sits. But when my piece of time is over, when the pain gets too bad, then I’d like to have the family and the pastor and the good doctors and nurses and friends surrounding me as I say farewell. I’d like to hear "Sheep May Safely Graze" once more, and I’d like to taste the Last Supper, knowing that they have saved the best wine till last. Maybe I will discover, like St. Francis, that it is possible to praise kind and gentle death.
Buechner also writes that death is not the final end -- it is the end of an act, not the end of the drama. If we really believe that then mercy killing is, to use a strange phrase, a profound technicality. The question for me is:
Can we knock on death’s door when the storm outside is unbearable, or ought it only to be opened from the other side? I believe that in his great mercy our faithful Savior will understand our attempts to be merciful to ourselves and others. Can anyone say Amen?