A HASTENED DEATH
By
Kenneth W. Phifer
October 20, 2004
For presentation on November 14, 2004
By Lawrence Egbert at Final Exit Network Conference

In the first year of my ministry, an older woman confided in me that she wanted to die. She was weary of pain and helplessness. She felt diminished by being a care-receiver rather than a care-giver. Life had no pleasure or purpose for her other than pain relief. She was without hope. She wanted the release of death and was not even able to help herself accomplish this. It took eight years of misery for her yearning to become reality. My efforts to comfort her were futile, even, as I look back now, cruel.

Some twenty years after that I was involved with a woman in a different congregation I was serving, Merian Frederick, who sought out the services of Dr. Jack Kevorkian. On October 22, 1993, in the presence other son and daughter-in-law and myself and with the assistance of Dr. Kevorkian, Merian ended her life. Her choice to do so was made after a struggle of several years with ALS (Lou Gehrig's disease) and with the awareness that she would soon lose her only means of communicating with the world, the strength in her fingers to write her thoughts on a yellow pad or tap out a message on her computer.

I had known Merian for twelve years, worked with her in many capacities in the church, and counseled with her and her family on many personal issues. We had often discussed hastened death before she first experienced the symptoms of ALS. Within a few days of her being diagnosed, that conversation became very practical and very personal. As her spiritual counselor, I worked with her to be sure that every possible option was considered and then considered again. Her family was intimately involved in this conversation and in the eventual decision that Merian made.

Had there been a better way for Merian to be relieved of what she viewed as pure hell-a good mind soon to be unable to communicate because of the ruined body in which it was housed-she would have chosen it. Having made her choice she spent the last days of her life more happily and more purposefully than at any time since learning the name and nature of her disease.

If I have learned no other lesson from more than thirty years of ministry, I have certainly learned that sometimes life is not worth living.

If we reach that point of suffering and choose to hasten our death, we should have the best available help to make the terminal point of life truly good and gentle for us. This may call for professionals in health care, like doctors or nurses or pharmacists. It is likely to involve family members and/or close friends. Spiritual counseling is also sometimes needed. For some people all of these will be important.

If loved ones and professionals are able and willing to cooperate with us, the moment of our death can truly be full of love.

I support the right of competent individuals to choose a hastened death when the measure of their suffering goes beyond their capacity to endure it. Five religious/spiritual principles inform my support of hastened death.

First, mere existence is not an absolute value.

That which exists changes, grows, deteriorates, becomes something quite different. Value is found more in the process than in the simple existence of any form of life. Conscious and articulate life, human life, sometimes can choose its changes, grounding that choice in values and meanings derived from its own life experiences. Sometimes the change that we choose is death, an end to this existence being preferable to a continuation of it.

Every one of the religions and philosophies that has had a major influence on our society argues this way.

Socrates believed that death was better than violating the law of the city of Athens, to which he had sworn fealty.

Jews perished at Masada rather than be enslaved.

Christians martyred themselves rather than betray their god by bowing to a Roman deity.

There are ideals, values, principles, and persons for which and for whom we would give up our lives if called upon to do so. What parent would not sacrifice his/her own life to save the life of their child? There are people who risk their lives, and sometimes lose them, in rescuing a stranger.

By making such a choice as this, we are at least implicitly saying that our death helps someone who is left behind. In certain circumstances, we may regard that way of helping another as being of higher value than our own existence.

To choose death sooner rather than later can be an act of high moral stature. Mere existence is not an absolute value.

The second principle is that we should respect life.

We should rejoice in life and be glad that we are alive. We should not give up life cheaply or quickly, our own or others. We should live as fully as we can for as long as we can. But there are different ways of doing this.

My friend Pansy respected life by defying her doctors when they declared that her ninety-six-year-old kidneys had shut down and were not going to function again. Three months after this diagnosis, she went home. She went back to her purposeful work of calling people who were house-bound or in nursing homes and hospitals to cheer them up. She kept this up until her energies gave out a year later and she died.

The Pitney VanDusens also respected life. They loved each other over many years. They made a pact as part of that love that they would die together. When both were of advanced age, and one of them was in very poor health, one day they simply lay down on their marital bed and he took her life and then his own. They made it clear that they did not wish to live under conditions in which they could not give but only take, conditions in which they would only be a burden to others, conditions in which they could only suffer. It was time for them to move on. They respected life by ending it and making room for someone else to enjoy life.

Sometimes choosing to die is as much a sign of respecting life as choosing to live.

A third principle is that suffering in and of itself has no moral worth.

Those who argue that the deity gives us pain in order to help us grow spiritually or to chastise us for our sinfulness are missing the moral mark. How could anyone have confidence in a deity who would cause the kind of suffering that one can see daily in hospitals, nursing homes, and emergency rooms? Are we to believe that a deity brought to two mothers the anguish of losing their sons to murderers who tortured them, forced them to have sex with each other, and then killed them? Just so the mothers could grow spiritually? What of those young men and the terror and humiliation of their last hours-was that because of their sinfulness? Such views are morally monstrous.

My experience as a chaplain at the Massachusetts Hospital School for Handicapped Children revealed to me the enormous suffering through which some children must go. The various ailments of these youngsters were not the consequence of their moral failings. They were simply damnable bad luck. I could not imagine a divine figure who would bring such anguish to these gutsy boys and girls and their families. That they redeemed their suffering with courage and humor and hard work did not make me or them grateful for their pain and disability. It only made me and others more appreciative of their endurance and their achievements.

Suffering that we have not chosen does not in and of itself have any moral value. Disease, accident, decline, great age do not themselves have moral worth. How we face them does. One ethical -way of doing that is by choosing not to let that suffering continue when it is of such magnitude that nothing else in life matters and there is no hope of relief save in death.

Suffering is not itself moral. Only our response to it can be moral.

The next principle is that the autonomy of each individual must be respected.

Within the constraints of time and place and ability, each of us can choose how to live and each of us should be allowed to choose how we die. It is not so much that we have a right to die, as it is that, if death does not surprise us, we have a right to choose the moment of our letting go.

Autonomy is essential in moral action. Autonomy means that we are informed about the conditions in which we find ourselves and that we have legitimate options among which to choose. Autonomy does not mean that we are coerced subtly or overtly into one decision or another. It means that we freely make the choice we deem best.

There is no principle in modern medical practice more important than this one. The idea of informed consent- required for treatment and for research involving human beings-is grounded in the notion of autonomy. The individual whose life or health is at stake should decide what should and should not be done to her, not the doctor or the nurse or the family. Their role is to inform and support the individual in his or her free choice. From the Nuremberg Code onward, this value of respecting the autonomy of each person by obtaining informed consent before initiating a medical or experimental procedure has been recognized as a fundamental value.

No less should this be true in making decisions that will hasten death: not starting treatment, stopping treatment, treating pain even if the consequence is a more rapid death, actively helping to bring about death.

Autonomy is necessary if we are to have meaning as moral creatures. It must be as applicable in our waning days and hours as it is when we are in full strength.

The fifth principle is that our individual lives are imbedded in community.

It is in the connections that we make to others that the deepest layers of meaning in our lives are revealed. We make these connections with families, friends, colleagues, neighbors, people who share our religious or political outlook or who enjoy the same sport or hobby. We also make connections with people who are different from us and who in their difference call upon us to enlarge our vision of the human collective.

In all the major decisions of our living, thinking about and sharing with a wider network of associations is important for understanding the larger meaning of what we are choosing to do.

This is especially true when it comes to a decision about ending our lives. It is of great importance that we begin now to talk with those we care about regarding our feelings about death and dying. How long do we wish to live when our condition is terminal and our suffering great? Such talk helps us to know the impact of our decisions about how we want to die on those "who survive us. In loving relationships, this knowledge may sometimes, and rightly, influence the choices we make.

Preparing an Advance Medical Directive and a Medical Durable Power of Attorney helps to clarify our views at this moment. Such documents announce to loved ones and strangers how we wish to confront our ending. Together with conversation, these papers help others to understand, even if they do not agree with us, why we have made the decision we have made.

Death and dying are in one sense the most individual and isolating events of our lives. But in another sense these moments are communal. The dying and death of any person we love touches us, changes us, alters the wav life is for us. The presence at memorial services of physicians, nurses, and other health care workers and care-givers testifies to the fact that those who are with us professionally in our last days are also part of our community.

No one is an island. The death of any of us affects all who know that person. How that death occurs is often as significant as the fact of death.

We live and die in community.

These five principles are the basis of my support for hastened death.

Hastened death has always been a part of human societies. It is a more urgent issue today because of medical knowledge and technology. Where pain can be relieved, it should be. Where healing can occur, we can all be glad.

But the truth is that not all pain can be managed. What right has any one of us, much less society at large, to force people to endure grievous pain that cannot be relieved short of total unconsciousness with no hope that this can be changed? If a person in such a condition pleads for death, as some of us might do, by what moral standard do we continue to refuse to give them the help they are begging for?

A kind system of health care would recognize that different people will make different choices in these agonizing circumstances. A kind system of health care would make provision for all possible choices: risky experimental procedures, hospice care, adequate pain management, and aid in dying for those who choose it.

Furthermore, doctors cannot always be healers. Each of us will come to a point in life when no medical treatment will help us, save perhaps to relieve our pain. At that point, when our condition is terminal, what we need more than anything else is intelligent compassion. We need people who understand the pain in our bodies and the suffering in our souls. Compassion may well be to give us drugs and apply therapies to make our bodies feel better. But for some of us, compassion may well be to help ease us into death.

Doctors already do this, and do it legally and with the support of most religious communities. What they do is act under the principle of the double effect. The double effect is the principle by which doctors prescribe for pain even though they know that the level of medication prescribed will kill the patient. No less an opponent of active hastened death than Pope John Paul II has put his seal of moral approval on the double effect. "It is licit," he writes in The Gospel of Life. "…to relieve pain by narcotics, even when the result is decreased consciousness and a shortening of life."

This is a kindness for those whose bodies are racked with pain, whose spirits are sore with despair, who have no realistic hope this side of the grave, and who want relief from their suffering. They want out of life. It is a kindness for the families who suffer watching helplessly as their loved ones writhe in agony.

Ultimately the question of how we die is a spiritual issue, not a medical or legal one. Religious leaders and other counselors can help people to think clearly about the options available. We can give full emotional, moral, and spiritual support to whatever decision the person before us makes. Our responsibility is to be with people, not tell them what they must do or judge them because their decisions do not agree with ours.

The ultimate goal is to enable every person not carried away by sudden death to make informed choices about what happens to them in the last stages of life. We will not all choose the same way. There must be room for those who choose to live even in the face of frightful pain and suffering and for those who choose a hastened death. In this way it becomes possible for each of us to find that even death can be meaningful.

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