Averi's+Letter

Dear Mr. Smith,

Hello, my name is Averi James and, as you know, I am a senior currently enrolled in Mr. Geib’s Bioethics class. The topic of death and dying, our mortality, is one I’m deeply involved with currently because in addition to discussing the moral implications of different modes of dying in Mr. Geib’s class, I am studying it from a different view as a hospice volunteer in training. I would like to thank you for being so generous with your time and energy in regards to your participation with myself and the rest of the class, and appreciate your perspective and accomplishments. However, I must admit that my opinion on the subject of euthanasia differs from yours.

Although I may be mistaken, it seems to me that much of your argument, or at least your ultimate opinion, on euthanasia is in accordance with the official view of the Catholic Church, or “Sacred Congregation for the Doctrine of Faith. It is the official belief of the Catholic Church that the act of euthanasia is fundamentally wrong. Viewing life as a “fundamental right” and a “gift of God’s love” it is believed (at least officially) by those of the Catholic faith that any act designed to shorten or end life is in all cases an act of murder, not mercy. While they have sanctioned the use of pain medication or even refusing medical treatment, they maintain the belief that suffering is an essential part of connecting with God, and suffering through even unavoidably painful processes of death is a “redeeming sacrifice” that humans are obligated to make. According to the Catholic Church, when it comes to euthanasia it’s not a question of relieving someone the burden of a degrading, painful existence, but “a question of the violation of the divine law, an offence against dignity of the human person, a crime against life, and an attack on humanity.” While I appreciate the Catholic Church’s consistency and compelling use of rhetoric, it seems to me that the reverence of suffering is as much an attack on humanity as anything else. Now it’s one thing if a person suffering finds meaning in that, if they feel it’s important because ultimately things are going to get better, but if a person suffering and dying in pain is having their soul crushed by a physical ailment, I simply can’t see the beauty in that. There is sometimes beauty in tragedy, mostly because we need to feel there is in order to withstand it, but how can any human being look into the face of another person who is suffering and hopeless and say, “God wants this”? What kind of benevolent god would allow such torture to plague someone supposedly created in his image?

I believe I revere life as much as anyone else, it is the only possession we enter the world with, but at what point does life transition into mere survival? In a few months, I’m going to be sitting next to someone who is terminal, someone who is facing death, and I’m scared. I’m incredibly frightened because I know that experience will change me, but I’m going to have to put that aside because in that moment, when I am there with a person who will soon leave this earth, I am going to need to be selfless. I will sit there with that person and if they are in pain, I will not feel like they are any more significant of a person because of it, I will simply want them to know that they are not alone, so that they can “live until they die”. I think it is selfish to impose on anyone one’s belief that their suffering makes them more sanctified. You know what I think makes people great, what makes them worthy of God or anyone else’s love? I think it is that we can impact others and make one another feel loved, not personally feel pain. I am in no way saying that I think euthanasia would be an appropriate solution for the patients I will work with, and I absolutely know that it is not a legal option, but in many of the cases we have evaluated it seems a more humane option. Once a person has come to terms with their death and the life they have lived prior to it, I don’t see why they should have to endure more. Frankly, if God really wants people to suffer, I don’t see what’s so great about him.

Of course it could be argued that legalizing euthanasia would make it more acceptable for people who aren’t terminal, or necessarily physically suffering, to choose this option. This is true of course because it would be at least legally recognized, but some fear that beyond making it an option, legalizing euthanasia would put pressure on the handicapped to seek euthanasia. Alison Davis, a woman who is severely disabled due to myelomeningocele spina bifida and is confined to a wheel chair because of this, finds even the suggestion that it be legal for the severely disabled to seek euthanasia outrageously offensive. She claims that “Legislation of the type proposed could well also lead to the //de facto// decriminalization of the act of killing a handicapped person of any age, just as it did in Hitler’s Germany.” Besides the fact that it seems like a pretty insulting comparison in terms of belittling the suffering of those killed in the Holocaust (after all, they weren’t seeking to be killed or tortured, and they were given no options), this comparison seems like a bit of a stretch. While I certainly understand her concern about placing less value on the lives of the handicapped than the able-bodied, the people who support euthanasia seem to be trying to allow the handicapped to decide the quality of their lives on their own and grant them the autonomy to do what they feel the most comfortable with in light of this evaluation. From this particular author’s perspective, I completely understand her belief that her life is as happy as any able-bodied person. However, it should be noted that she has always been disabled, that has always been normal for her. For someone who was paralyzed by some sudden injury, being disabled would not feel normal. It is absolutely possible for people who become paralyzed to, after some time and probably a fair deal of therapy, feel happy and adjust to a new normal and I have the utmost respect for these people, but not everyone is able to achieve that renewed sense of normalcy. Ramone San Pedro, for instance, was never satisfied with his life as a quadriplegic because for him that state of existence was not life. He lived for over a decade as a quadriplegic and didn't give up his pursuit to make euthanasia a legally viable option until he finally chose extra-legal ways to end his life. Giving people like Ramone San Pedro the authority seek and receive euthanasia does not in any way force people like Alison Davis, or any other handicapped person, to seek that same option. It just gives them a choice if they want it. While such a decision should not be taken lightly, and while I think disabled people not in the terminal phases of illness should wait at least one to two years and receive counseling and support before making such a decision, if someone’s life is no longer worth living, and never will be again, I have to say they deserve the right to choose to die. Alison Davis poses the question “Who could say I have ‘no worthwhile quality of life’?” and the answer is, only she could, but she doesn’t have to.

Chris Hill, unlike Alison Davis, would say that he didn’t have a worthwhile quality of life after his injury. Once a spirited, energetic man who during his life experienced great mental, emotional, and physical exultation, Chris Hill was transformed after he became a quadriplegic due to a hand-gliding accident. Hill felt that his true life ended with that accident. For him, the loss of physical ability also resulted in the loss of “dignity and self-respect.” He felt his post-injury state to be that of mere existence and torture. To him, “the legislature’s and medical profession’s attitude of life at any cost was an inhumane presumption that amounted to arrogance.” While, I suspect that the attitudes of the legislature and medical profession had more to do with a sense of duty to preserve life than they did arrogance, it can’t be denied that they viewed their position on the subject of euthanasia as more correct than Hill’s. Chris Hill’s frustration at the viewpoint of two able-bodied people is understandable. His injury deprived him of what he had found joy in pre-injury. He was incapacitated by his injury, denied movement, independence, sexual pleasure, and according him a reason to live. Although some are able to recover mentally from such physical incapacitation, Chris Hill had “always done what I (Chris Hill) wanted, had my own reasons for living” and once those reasons were no longer attainable goals he felt continuing to live to be a pointless endeavor. Prolonging his life seemed pointless to him because “It’s quality of life, not quantity that’s important.” It’s unfortunate, but it seems that the reality is some people will never recover their sense of self and purpose after a devastating injury, because they either don’t want to or don’t see a point in trying.

It is people like Chris Hill and Ramone San Pedro, people who feel their lives have ended and who cannot be persuaded otherwise, or who are terminally ill and simply don’t want to suffer anymore, who doctors in places such as the Dutch city of Delft may agree to euthanize. Doctor Pieter Admiraal is a specialist of palliative care, and a member of the “Terminal Care Team” at the hospital where he works. “As a member of the team, I also practice active voluntary euthanasia – openly and unashamedly.” In Denmark, euthanasia is not subject to the negative stigma it has in most other places. Euthanasia is viewed as a means to end suffering when nothing else can be done, and to help the patient achieve peace. Instead of supporting the idea that voluntary active euthanasia is somehow a crime against humanity, he believes in the literal translation of the word “euthanasia.” “‘Euthanasia’ means ‘a good death’ or ‘bringing about a good death,’” and Admiraal ends suffering with this. He believes the experience of life to be so subjective that ultimately, only the patient can know what he or she is feeling and what the best course of action is. “Suffering, loss of control, and physical decline are subjective experiences, and nobody but the patient herself is in a position to decide when enough is enough. It would be quite improper for doctors or other health care professionals to impose their values and their understanding of pain or suffering on the patient.” Of the opinions explored during this unit, this stance seems to me to be the most respectful of the patient’s autonomy, but it is important to note that while Admiraal respects the patient’s autonomy, he doesn’t do so without question. “To the extent that the properly counseled and supported patient takes a different view, it is the patient’s view which must ultimately be the determinative one.” In this way, autonomy is preserved without a high risk of abandonment contributing to the patient’s decision.

As for me, I agree the most with Dr. Admiraal’s view on euthanasia. I believe it is a choice that should not be taken lightly and that doctor’s have a responsibility to do all they can so that their patients don’t feel that euthanasia is the only solution to their predicament. However, ultimately I understand that in some cases euthanasia is the most humane option. Life is undeniably precious, but we cannot impose on other’s our view of their suffering. It isn’t ours and we can’t truly know a thing so subjective. Perhaps the best we can ever do is provide support and love and make life as livable as possible, but ultimately respect the choice of the individual. The philosophy of hospice , illustrated through the words of Dame Cicely Saunders, the founder of the first hospice, is that “You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die." If the only way to truly allow someone to live until death is to stop the suffering a bit early, I support it.

Respectfully, Averi James