Dignity in Dying

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Clinicians in Intensive Care Unit
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The South African High Court recently passed a landmark ruling that would legally allow a doctor to help a terminally ill man to end his life. A high level summary of the case can be found here. This ruling is not new legislation and euthanasia remains illegal in South Africa. However this ruling opens the door for future cases which will be decided individually (until, perhaps, legislation is proposed, which would undoubted reference this ruling). In this article I would like to share my thoughts on this case.

"For everything there is a season, and a time for every purpose under heaven:
time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted;
time to kill, and a time to heal; a time to break down, and a time to build up;
time to weep, and a time to laugh; a time to mourn, and a time to dance;" — Ecclesiastes 3:1–4

Let me begin by saying that the topic of euthanasia is difficult and controversial. As a Christian, my default reaction is to oppose it (more on this later). However, there are many unknowns and I hope to use this article as a way of self-reflection.

I need to admit that, in my family and friendship circles, I have never had anyone suffer chronic pain to the point where they wanted to end their own life. Recently my parents' cat passed away. He had feline AIDS and was clearly suffering terribly from it. Shortly before his natural death, we decided as a family to have him put down because he was suffering so much. It may seem like a farce to most people to compare euthanising a pet and a human being (more on this later as well), but the reason why I bring up this story is twofold: the compassion I felt for a creature which was not even human and recognising its suffering, and how easy it was to recognise that having the cat put down would be the "humane" thing to do. For my opposition to (human) euthanasia, Scott Adams, the creator of the Dilbert comic, sincerely wishes me to die a slow and painful death. Adams is not a Christian, but I do respect him. And I believe he genuinely loved his father. So for a person to be driven to such an intense desire because of the suffering of a loved one, I can only imagine that there is an emotional dimension to the whole matter which I simply do not fully understand.

Personal Experiences

A few years ago my father nearly died. For a month he was unconscious in the ICU. I remember standing next to his hospital bed, watching him just lie there, looking unnaturally frail. The sound of the ventilator forcing air into his lungs was terrible. With each hiss, his body would convulse, as if accepting the air necessary to stay alive was like a child swallowing bad medicine. It really did seem mechanical; not human, not dignified. But perhaps the worst for me was seeing my mother, who visited every day, and stood by his side loyally: she was suffering as well. I did think that it would be easier if he did die. His condition would have led to a natural death, so there was never any question about assisted suicide. But he was a fighter and did not want to give up, despite the odds, and even parts of his own body, being against him.

Something else which happened in my life, which had a big impact on me, was the last time that I saw my grandfather. His health had been in decline, but he was not terminally ill and was still active. When I said goodbye to him for the last time after we had visited their home (which, at face value, should not have been different from any other time I had done so), I remember that he had a look in his eyes, one that chilled me: it was the look of being tired with life and ready to let go. He had had a long and good life and was not planning on sticking around unnecessarily—for anyone. A few months later he died naturally. That last time that I saw him was when I learned that the human desire to survive and to continue on at any and all cost, is not unquenchable.

The points that I am trying to make here is that I understand the impact that an illness can have on the rest of the family, and I do understand that some people reach a point where they are ready to die.

The Issue of Dignity

Turning back to the recent High Court case, there is one major theme running through everything that I have read about it: the man's dignity1. The lawyers argued that, suffering as he was, he was no longer dignified and would not be until his life ended. This was a powerful argument, because human dignity is protected by the Bill of Rights in the constitution. The opposition seems to have failed to argue that the man's dignity was not tarnished by his physical suffering.

Here is where I want to chime in.

As with the abortion debate or debates on moral issues in general, it is easy (when using secular arguments) to end up with relativism: our views on what is right is determined by what we believe to be fundamentally true. In such a debate, one can quickly reach an impasse where, given one's worldview, one has a solid—even superior—case for the argument. However, because the other person has a different worldview, the two end up in a debating stalemate.

"Dignity" is one of those fluffy concepts which becomes really difficult to define precisely and objectively when only considered from a secular point-of-view. Within the Christian context, however, it has a clear meaning. Humans have dignity because they are created in the image of God. This means that, of all things that exist, humans have a special place and standing before God—we are treasured. Theologically, this simple fact in and of itself explains why murder is wrong, why it is wrong to gossip, to slander, to abuse, to enslave etc. other human beings: you (the perpetrator) believe that your need or desire transcends the God-given worth and value of another person and will satisfy your need or desire by damaging the other person. This means that any offence against another person is dual: against the person, and against God whose image that person bears.

The dignity that we as humans have are inherently a part of us. From God's perspective, it is our being that gives us dignity. Our dignity is not taken away from us, for example, by physical nakedness, wearing particular clothes, being on the toilet, covered in filth, writhing in pain, and so on. In these case the world may perceive us as undignified, but that is because it only considers our outwardly and physical condition. There is no appreciation for being someone created in the image of God, being loved by Him and taken care of by Him. These inalienable qualities are what give us dignity.

Death damages (but does not destroy) our being. Death is unnatural (or, at least, unintended). When the physical body dies, it is the ultimate reminder that we are living under a curse and enjoying the fruit of sinful rebellion. Our sinful natures are not dignified. The consequences of sin on our bodies (whether death or illness) is not dignified. Eternal condemnation certainly is not dignified. Therefore Jesus Christ came into the world, was mocked, beaten, stripped naked and nailed to a wooden stake in public. There He gave up His life, and gave us the opportunity to be dignified before God again: by allowing us to approach the Father again and to seek to do His will, not our desires. His dignity was taken away from Him, so that we could once again regain our dignity.

Sadly, I doubt that this basic fundamental truth about dignity is what Dignity SA understands, and that it was not taken into account by the ruling judge, even though the constitution and our national anthem calls on God.

"You don't give people dignity: you affirm it." — Dr. John Perkins

A time to kill, and a time to heal

When I drew up my first will (from a template), I was confronted with the issue of a living will: the expressed desire to not be kept artificially alive when, according to the doctors' professional experience, there is no hope of recovery (at least not to any point of "desirable" quality of life). I did not know what to do and how to react. And from some cursory research it showed that there were no easy answers. I still do not really know what to make of all of this, whether for myself, or when I need to make a decision or plea for a loved one. Yes, miracles do happen and people who have been declared dead (whether brain dead or otherwise) can recover fully. Yes, once in a while cures are found for illnesses which previously were terminal2. But most of the time it does not work this way. People suffer, they cannot reasonably expect to recover and they want to die. We have been blessed with incredible recent medical advances to cure and keep alive what was unthinkable for the vast majority of human history. Perhaps we should not always overstretch: perhaps, if the body has suffered massive trauma, it should be allowed to shut down naturally. But I still think that there is merit in "doing no harm": to be proactive in alleviating pain, but reactive until the body starts shutting down. After all, the person lying before you bears the image of God, and deserves respect and care. And for the Christian, it is a homecoming.

  • 1. Adams also refers to his father's dignity in his blog post.
  • 2. I believe that there was a case some years ago when an advocate for assisted suicide—himself terminally ill—was cured by a medical breakthrough. I was unable to track down this story. If someone can source it for me I would be grateful, and will link to it.
  • . Photo credit: Calleamanecer, available under CC BY-SA 3.0 Unported.