#660: MAiD and the Moral Imagination

Why people are susceptible to euthanasia.

I spent a little time this weekend thinking about why “medical aid in dying” has gained traction in Canada. After rather forcefully denouncing the practice in a talk at a church in Toronto, I spent some time chatting with some Christians involved in long-term care who thought I was too strident and stringent in my opposition. For my part, I was shocked by their willingness to entertain the practice: while they were by no means supporters of the kinds of extreme uses that have made their way into the headlines, they also were strongly opposed to any kind of absolute prohibition on the practice. All this gave me occasion to wonder how intelligent (evangelical) Christians working on the “front lines,” so to speak, of death and dying end up adopting a stance toward killing that I think is morally repugnant. To that end, a few hypotheses.

1. Efforts to extend life as long as possible sometimes lead to the slower, but sometimes more agonizing, loss of faculties. This slow decay can increase the burdens of aging and dying for the person undergoing it in ways that previous generations would never have encountered. In this couple’s experience, doctors have sometimes extended life-sustaining hydration and nutrition in ways that have actually burdened patients rather than benefited them. One possible source for the impetus to preserve life regardless is deep moral convictions by families or doctors—but I think a more plausible source is doctors’ fear that they are going to be sued or dragged into a political maelstrom if they fail to offer such life-extending care, and families’ anxieties that they will be “killing” their loved ones if they opt to not take it. As the medical system burdens the dying in these ways, “medical aid” in dying becomes more attractive.

2. Medicine’s astonishing improvements in prolonging life (which we can rightly give thanks for) has meant that decisions about how we will live the end of our lives are unremittingly medicalized—which makes medicalizing our death seem intuitively plausible. “Medical aid” in dying is extraordinary branding, as it simply extends how we already think about bodies into how we think about their death.

3. “Medical aid in dying” is an easy practice to justify philosophically—as is “extend life as long as possible.” The former makes a blunt appeal to harm and patient autonomy, while the latter depends upon a brute assertion of life as an absolute value. The distinctions needed to help patients die without killing them are subtle, though, and difficult to communicate. While it is reasonable to expect doctors (and many nurses) to understand what is and is not permitted, the likelihood of mistakes and misunderstandings (that will cause real harm) goes up as the scope of people involved in caring for the very elderly and terminally ill goes up. This is especially true as the number of optionsincreases: once MAiD became a possibility, it revealed what kind of moral formation caregivers actually had: do they genuinely understand the reasons why MAiD is wrong, or were they simply inculterated into a set of default practices that they did not need to critically understand? Earnest, godly people involved in long-term care need a level of moral and intellectual formation in a society where MAiD is on the table that they would not need otherwise.

4. The professionalization of dying through the advent of long-term care facilities and hospice centers makes it more plausible for people to accept the professionalization of death itself. While such centers alleviate many of the burdens on families, it also removes family’s opportunity to participate in the care for their loved one. I wonder whether this lack of proximity actually makes families more susceptible to supporting MAiD, as they have already made the decision to turn the authority over the bodies of their loved ones to the medical establishment and deprived themselves of the experience of goodnessthat comes from being bound together with another human being in their most difficult moments.

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I was going to wrap this up by suggesting that none of this gets at the real heart of the problem, which I take to be a kind of nihilism that has long pervaded our society. The “boastful pride of life” is the drug that fuels both Canada and America; MAiD is only one pernicious expression of it. Karl Barth’s contention that post-war Europe needed to regain a little more “confidence in life” is true of us, as well.

But I thought I would leave the final word to my friend Ben Parviz, whose assessment is both elegant and astute:

Death and dying are mysteries and not problems. One cannot contemplate the nature of death or the experience of death apart from contemplating one’s own existence. We contemplate death and dying by experiencing it—the deaths of our loved ones, our family members, our neighbors—and by recollecting those experiences. We participate in the dying and death of our loved ones by being present with them, fully attentive to them, and giving ourselves wholly over to them throughout the process of their dying and being laid to rest. Participation in the mystery of death is relinquishing control, recognizing that we are subject to a mystery that holds power over us, and journeying with the dying on their final pilgrimage in life.

This journeying may involve gently dropping water onto a parched tongue or wiping spittle from the dying loved one’s mouth, keeping watch late into the early morning hours while listening to and feeling dying moans, speaking prayers and singing hymns, stumbling through words that do not quite form full thoughts, washing the body of your dead loved one. Paradoxically, loving participation in the dying and death of our loved ones helps us to feel ourselves as alive.

The one who will die is denied the opportunity to be the recipient of attention, care, and love, and those who would have given it are denied the opportunity to do so. With assisted suicide, death is a problem that can be solved effectively, efficiently, cleanly, at the time and in the location of one’s choosing, and with the approval and facilitation of the medical and state apparatuses. Loved ones may be around or involved, but even this is under the control of the one who will die. Most regrettably, assisted suicide reinforces the tendency of degrading mystery to problem, which denies us the possibility of availability, of participation in being, of love, and of hope.

Ours is a society of people who need to feel themselves alive. It is a society in need of mystery. Increasingly, citizens struggle to find a reason to live, preferring non-existence and capitulating to desires for self-destruction and death. A complete analysis of the social and cultural causes of this epidemic of despair is necessary, but it would be complex and would need to have a wider gaze than mere economic and material causes. A society that is attuned strictly to problems and not at all to mystery is ill-equipped to understand despair, or to find hope through participation in being.

Until next time, then.