Choosing to live

Excerpted from "The Courageously Mundane Faithfulness Of Kara Tippetts," Breakpoint commentary by John Stonestreet, November 7, 2014 - A young Oregon woman with a brain tumor recently made the choice to die. But a Colorado woman facing a terminal disease is choosing to live. What can we learn from their stories?

Oregon allows physician-assisted suicide; California doesn’t. Brittany Maynard chose November 1 as the day she would end her own life, with the help of a doctor. And I’m sad to say she carried through with her plans—despite the enormous outpouring of love and prayers from people across the country who urged her to change her mind.

One of those people was Kara Tippetts, a 38-year-old married mother of four who knows well the fear and pain of a stage 4 cancer diagnosis. Her approach to illness has been to rest on the grace of God and to find power in living faithfully moment by moment, squeezing the goodness out of each day, and exhibiting, no matter what the prognosis, “mundane faithfulness,” which is the name of her blog.

Kara tells a story of mundane faithfulness in her new book, The Hardest Peace.

Kara has used her voice to reach out to Brittany Maynard, asking her to reconsider, gently telling her that there’s more to life than good physical health and the avoidance of suffering. “Suffering is not the absence of goodness,” Kara says in an open letter to Brittany, “it is not the absence of beauty, but perhaps it can be the place where true beauty can be known. ...That last kiss, that last warm touch, that last breath, matters—but it was never intended for us to decide when that last breath is breathed.”

Kara has been learning that lesson on her own journey. Go to her blog and you’ll see that Kara is not throwing around a lot of cheap Christian clichés. Here’s an entry from October 18:

“How do you love when you are at the bottom of yourself? The last gulp of a drink you feel tentative to swallow? How do you swallow that last gulp of life and fight to live it well? I’m struggling today,” she writes, “and I knew it would be a hard one. Chemo brings a low that I struggle with words to describe.”

And then on October 20: “...The hand held, the time spent reading together, the little loves that when faced with death have become the giant important moments in my life. The time praying together, laughing together, cooking together and crying together. They add up to a life well lived. [They] are simply the best of life.”

Friends, let's pray for Kara and for all those facing terminal illness—as well as for their families. And let’s also pray for our culture, that we learn that life is always a gift, without exception.

Commentary

CMA VP for Government Relations Jonathan Imbody: "Even if moving stories like those of Brittany Maynard prompt some to think we need to legalize assisted suicide, it's crucial to remember that such laws affect many more people and have many more consequences than originally imagined. The elderly, the handicapped and the depressed all become much more vulnerable under assisted suicide laws. You as a health professional know that much can go on behind the curtain that will never show up on a chart or in court. What appears on a document as a voluntary decision may in truth be coerced or otherwise improperly influenced--by an unduly negative presentation of a prognosis, or by family members who want an easy way out for themselves.

"Laws teach principles, and assisted suicide laws teach that suicide is not only good but a right. The right to die too easily becomes the duty to die. How many elderly patients already consider themselves a burden? How many heirs already wish their benefactor would die? What is a severely depressed teen supposed to think when society legalizes suicide?

"I know from conducting on-site research in the Netherlands what happens when the medical community and society make medical killing normal. I spoke to a son whose father, who had chosen euthanasia out of fear and a lack of his wife's support to choose life-extending surgery, told the doctor he didn't want to die after the doctor had administered the first shot to put him to sleep. The doctor ignored his statement and quickly administered the lethal injection. A grandfather asked for help with a painful thrombosis and instead died at the hands of a physician who interpreted his request as one for euthanasia.

"When doctors gain the power to kill, no patient remains safe. Hippocrates helped transform medicine with a proscription against assisting suicide--a measure that for the first time protected patients. Do all in your power to see that your state does not turn the clock back to the days when patients had to fear their physicians."

Action
State Legislative Issues - Physician-Assisted Suicide

Resources
Jonathan Imbody Senate Testimony on Euthanasia
Kara Tippetts, blog
"Small wonders" - Kara Tippetts - World magazine
CDD STAT Interview with Kara Tippetts
Euthanizing Medicine, a presentation on the implications of legalizing physician-assisted suicide
Top Reasons Why Physician-Assisted Suicide Should Not Be Legal

Terminally ill patient ends her life

Excerpted from “Brittany Maynard, right-to-die advocate, ends her life,” USA Today. November 3, 2014 — Brittany Maynard, the 29-year-old face of the controversial right-to-death movement, has died. She captivated millions via social media with her public decision to end her life.

Sean Crowley, spokesman for the non-profit organization Compassion & Choices, confirmed Maynard's death Sunday evening. "She died peacefully on Saturday, Nov. 1 in her Portland home, surrounded by family and friends," according to a statement from Compassion & Choices. The statement said Maynard suffered "increasingly frequent and longer seizures, severe head and neck pain, and stroke-like symptoms." She chose to take the "aid-in-dying medication she received months ago."

Her death brings a new element to the movement in the age of social media because the conversation has included younger people. "She's changed the debate by changing the audience of the debate," Abraham Schwab, an associate professor of philosophy at Indiana University-Purdue University Fort Wayne, told the Associated Press earlier.

Maynard was diagnosed with a stage 4 malignant brain tumor. She moved with her family from California to Oregon, where she could legally die with medication prescribed under the Oregon Death With Dignity Act.

"I understand she may be in great pain, and her treatment options are limited and have their own devastating side effects, but I believe Brittany is missing a critical factor in her formula for death: God," said Joni Eareckson Tada last month in an article for Religion News Service.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’m deeply saddened by Brittany Maynard’s suicide. As far as we know, she had no hope—despite Joni Erickson Tada, Kara Tippets (who is dying with Stage 4 breast cancer) and others pointing her toward God, our real source of hope. I’m saddened because Compassion and Choices used and possibly abused her as their ‘poster child’ for legalizing physician-assisted suicide in a slick media campaign that drew millions of Facebook and YouTube hits, as well as enormous favorable media attention. I can’t help but wonder why she announced she was going to postpone her suicide, only to take her life two days later? Did she feel pressured or obligated to do it?

“I’m even more saddened that many more patients are likely to die because Ms. Maynard glorified suicide as the answer to suffering, and it won’t just be highly controlling, terminally ill patients like her. In the short term, it will be vulnerable teens and the depressed. In the long run, it will be handicapped newborns, Alzheimer’s patients, the chronically sick and the mentally ill, as we have already seen in Europe. It’s inevitable, despite all the so-called safeguards. Who can deny ‘this right to death with dignity’ to anyone who is suffering or is even afraid they may suffer in the future? And if the patient is incompetent, should the physician, exhausted caregiver or the son or daughter set to inherit the estate decide ‘on their behalf?’ Ultimately, it will kill the ethos of healthcare as doctor-patient trust is destroyed.

“It is too late for Brittany, but not for you and me to speak the truth in love to alter the predictable future. I’m heading to New Jersey next week to meet with legislators to urge them to say ‘No’ on an expected physician-assisted suicide vote scheduled for Thursday, November 13. I’m then traveling from one end of Montana to the other, speaking out against physician-assisted suicide in every major city and doing media interviews along the way to hopefully halt their march off the physician-assisted suicide cliff.

“What are you going to do to alter the future—before it is too late?”

Resources

CDD STAT Interview with Kara Tippetts, a stage-four cancer patient
Euthanizing Medicine, a presentation on the implications of legalizing physician-assisted suicide
Top Reasons Why Physician-Assisted Suicide Should Not Be Legal

Action

Physician-assisted suicide legislation is now being attempted in California, Connecticut, Massachusetts, Nevada, New Jersey, New Mexico and Pennsylvania. If you’d like to get involved in the fight against this dangerous legislation, please contact communications@cmda.org.

Will doctors be forced to kill?

Excerpted from "Will doctors be forced to kill?" commentary by Wesley J. Smith, First Things, July 25, 2014 - The wailing and gnashing of teeth in some quarters over the modest Hobby Lobby decision has me worried. Apparently, many on the political port side of the country believe that once a favored public policy has been enacted, it immediately becomes a "right" that can never be altered or denied. More, once such a "right" is established for the individual, others should have the duty to ensure access—even at the cost of violating their own religious consciences.

If such thinking prevails, medical professionals could be forced to participate in the taking of human life, for example in abortion, assisted suicide, and (given the research trends in regenerative medicine) providing treatments derived from the intentional destruction of human embryos or fetuses.

That certainly seems to be the direction in which the ACLU wishes to take the country. Recently, the ACLU of Washington State began trolling for potential clients to sue medical professionals or facilities that refused to participate in certain legal procedures or transactions based on religious objection:

"Have you or members of your family been denied reproductive health care or end-of-life services by a religiously based medical facility? The ACLU believes that everyone in Washington has the right to receive health care that is not restricted by the religious beliefs of others."

The solicitation listed specific procedures—some of which involve the taking of human life—that presumably a patient should have a right to receive. They include:

• Abortion
• Information about Washington’s Death with Dignity Act [the law permitting doctor-assisted suicide for the terminally ill];
• Referral to support organizations or cooperating providers to assist a patient in using Washington’s Death with Dignity Act;
• Medical providers permitted to participate in Washington’s Death with Dignity Act;
• Palliative care/nursing support for patients who choose to stop eating and drinking to allow natural death (e.g., participation in suicide by starvation, not a natural death)
• Pharmacy dispensary (e.g., forced dispensing of drugs used in assisted suicide, RU 486 abortions, etc.)

Moreover, the American medical establishment already opposes conscience exemptions for abortion and the dispensing of contraception. For example, the American College of Obstetricians and Gynecologists (ACOG) published an ethics-committee opinion denying its members the right of conscience against abortion.

Such denial of medical conscience is not yet embedded in American law. But if the anti-religious liberties lobby gets its way, it will be. Indeed, in coming years, medical professionals who believe in the Hippocratic Oath’s prohibition against killing could well be driven out of medicine.

Commentary

Jonathan Imbody, CMA VP for Govt. Relations: – The US Senate recently highlighted this battle over conscience and autonomy by voting on a bill (the Women’s Health Protection Act, S. 1696) that would, in the words of the National Right to Life Committee, "invalidate nearly all existing state limitations on abortion ... [including] laws allowing medical professionals to opt out of providing abortions, laws limiting the performance of abortions to licensed physicians, bans on elective abortion after 20 weeks, meaningful limits on abortion after viability, and bans on the use of abortion as a method of sex selection." Thankfully, the Senate bill failed, on a largely party-line cloture vote.

The bill reflects the escalating conflict between two camps in American society that hold irreconcilable worldviews: those who follow objective moral and ethical standards outside themselves (such as the Bible and the Hippocratic oath) and those whose only ethic is autonomy, which boils down to "whatever I want." The scary part is that many authorities in the medical community, which used to lead the way in promoting and following objective ethical standards, have all but abandoned the Hippocratic oath and increasingly promote autonomy as the ethic that trumps all else.

As appealing as autonomy may sound and even though it has its place in some cases, it is not the kind of standard that protects others well at all, like the Bible and the Hippocratic oath do. That's because one person's autonomy in one direction inevitably runs smack into another person's autonomy headed in the opposite direction. What happens then? Whoever is strongest wins.

If a patient gains the power in the name of autonomy to demand and receive whatever he or she wants, the healthcare professional becomes a mere "provider" and loses the essence of professionalism--professing to follow an objective standard. Similarly, if a mother insists on fulfilling her autonomy through an abortion, the baby loses her life.

Autonomy brooks no competition. So autonomy is less a reliable ethic and more a prescription for conflict, an enemy of tolerance and diversity.

In the First Amendment's establishment clause ("Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof"), America's founders carefully balanced conscience freedoms with community interests, minority rights with majority rule, individual liberty with governmental function. We must shore up that understanding of freedom every chance we get--in the culture, in Congress and in the courts--or we will lose the ability to live out our faith in our professions and in the public square.

Action

1. Urge your U.S. senators to support (or thank your senator for already co-sponsoring) the Health Care Conscience Rights Act - S. 1204 , to protect religious liberty and preserve patient access by providing conscience protections for health care professionals. (Note: You will be provided with editable text based on your senator's sponsorship or non-sponsorship of this bill.)
2. Urge your U.S. Representative to support (or thank your Rep. for already co-sponsoring) the Health Care Conscience Rights Act - H.R. 940.

Resources
CMDA's Freedom2Care website: Freedom of faith, conscience and speech
CMDA's Freedom2Care commentaries in national newspapers
CMDA Freedom of Faith and Conscience resources
"U.S. Senate Democrats launch push for “the most radical pro-abortion bill ever" - National Right to Life

Assisted suicide advocates make their case in JAMA

Editor's note: Under JAMA's Conflict of Interest Disclosures, each of the authors of this excerpted article "report consulting for Compassion and Choices," an assisted suicide advocacy organization formerly known as the Hemlock Society.

Excerpted from "The Changing Legal Climate for Physician Aid in Dying," JAMA, April 14, 2014 - Voters in Oregon and Washington have legalized aid in dying by public referendum, legislators in Vermont have done so by statutory enactment, and courts in Montana and New Mexico have done so by judicial rulings. Support for aid in dying is increasing, and it would not be surprising to see voters, legislators, or courts in other states approve the practice.

At one time, it was not clear whether patients could hasten death by refusing life-sustaining medical treatment. Recognition of the right to refuse life-sustaining care reflected a societal consensus that people should be able to decline treatment when they are suffering greatly from irreversible and severe illness. Although a right to refuse treatment did not go too far in allowing death-causing actions, many people felt it did not go far enough. For instance, some patients are seriously ill and suffering greatly from widely metastatic cancer or other advanced diseases, but are not dependent on life-sustaining treatment. For those patients, aid in dying can be an important option.

However, there are real risks if patients are allowed to receive a prescription for a lethal dose of medication. Not all patients who would ask for a prescription would be suffering from an irreversible and severe illness. Some might have become tired of life, depressed, or feel that that their life has insufficient meaning. Accordingly, a right to aid in dying could be recognized only with assurances that access would be limited to patients who are truly seriously ill. In addition, as with the withdrawal of treatment, the government could not impose limits by making quality-of-life judgments.

The terminal illness requirement provides the right kind of limit for aid in dying. It does not empower the government to make quality-of-life judgments, and it restricts the practice to patients who are suffering from irreversible and severe disease.

This is not just a matter of theory. Oregon has had more than 15 years of experience with aid in dying limited to the terminally ill, and the state’s experience has been reassuring. Vulnerable patients are not succumbing to aid in dying. It is not surprising that once Oregon’s experience with aid in dying was reassuring, other states were willing to consider authorizing aid in dying.

By restricting aid in dying to competent and terminally ill adults, the law can ease the dying process for patients, and their families, and avoid the potential for the mistreatment of patients.

Commentary

CMA VP for Government Relations Jonathan Imbody – “These assisted suicide advocates cleverly employ several techniques to break down barriers to their radical position, which is that we should obviate over two millennia of Hippocratic medicine and empower doctors to help their patients kill themselves.

• Employing euphemisms: The authors insist that the euphemistic term ‘aid in dying’ replace the clear and accurate term ‘assisted suicide.’ The group they support changed its name from the Hemlock Society to Compassion and Choices.
• Linking a radical idea to an accepted idea: We're supposed to think that just as our society once hesitated to allow patients to refuse life support but now accepts that notion, we likewise should see the light and embrace assisted suicide. As if there is no difference between letting someone die naturally and killing them with secobarbital.
• Stressing meaningless safeguards: The authors try to position themselves as the concerned, conservative protectors of patients and ethics, emphasizing that ‘a right to aid in dying could be recognized only with assurances that access would be limited to patients who are truly seriously ill.’ But since ‘the government could not impose limits by making quality-of-life judgments,’ who determines what ‘seriously ill’ means? You guessed it--physicians like the authors, whose bias toward assisted suicide will doubtless expand the definition beyond meaning.
• Citing misleading statistics: ‘Figures don't lie, but liars figure.’ Crafty assisted suicide advocates wrote into Oregon's assisted suicide measure the following secrecy clause: ‘...the information collected shall not be a public record and may not be made available for inspection by the public.’ That clause prohibits anyone-- relatives, media, watchdog groups, medical associations--from investigating the details of any of the reported assisted suicide cases. State bureaucrats, who, of course, maintain a vested interest in covering up any problems or abuses that might reflect negatively on the state, annually trot out their own bland, general statistics without detail or the possibility of review. Year after year, assisted suicide advocates point to these meaningless, whitewashed, non-verifiable numbers as proof that the system is working wonderfully.

“For secular audiences, some effective arguments against assisted suicide include:

• highlighting the lack of safeguards in most assisted suicide measures, including inadequate diagnosis and treatment of depression, the absence of requirements to notify family members and the dangers of storing lethal medications at home;
• explaining how assisted suicide perverts the safe nature of the patient-physician relationship, removing the vital assurance that the physician will always ‘do no harm;’ and
• emphasizing that healthcare payers including insurers, the government and even heirs have a tempting financial incentive that leans heavily toward your premature death.”

Resources

CMDA Resources on Assisted Suicide

Action

Write a response to JAMA

Advocate in your own specialty college for hospice and palliative care and against assisted suicide and euthanasia.

Quebec election may speed euthanasia legalization; doctors protest

Excerpted from "Doctors don't want euthanasia bill revived post-election," CTV Montreal, March 17, 2014) - The provincial election has put the provincial government's euthanasia bill on the back burner, but a group of doctors wants to remind the public about what it believes are the risks of Bill 52.

Doctors for Social Justice was joined by former state of New Hampshire representative Nancy Elliott to speak about why legislators in her state recently rejected its own assisted suicide bill. Dr. Paul Saba, head of Doctors of Social Justice, said if the government were to pass the bill physicians would leave Quebec.

"Some doctors will say no, we cannot be accomplices to this; we will not practice under those conditions," said Dr. Saba. Last year, the World Medical Association adopted a motion saying physician-assisted suicide is unethical and must be condemned by the medical profession.

Commentary

CMDA President Richard E. Johnson, MD – “I have spoken with Dr. Saba, and Larry Worthen, the executive director of CMDS Canada. Both are very concerned about the upcoming election in Quebec. If legislators with a pro-physician-assisted suicide leaning are elected, they fear that it will be very difficult to prevent Bill 52 (legalizing physician-assisted suicide) from passing. The language of this bill is quite broad and will make it very difficult for physicians who oppose it to maintain their freedom of conscience.”

Action

Pray for Dr. Paul Saba and those who are working to prevent the legalization of physician-assisted suicide. Pray for our colleagues in CMDS Canada. Pray for Larry Worthen, who desires to “speak the truth in love” while engaged in the battle. Pray that the public will vote for legislators who value life and keep physician-assisted suicide from becoming law.

Resources

Quebec Bill 52 to legalize euthanasia
World Medical Association opposition to euthanasia resolution
CMDA Euthanasia/Assisted Suicide Resources

Blind Twins Euthanized

Excerpted from "Deaf twins who discovered they were going blind and would never see each other again are euthanized in Belgian hospital," Daily Mail, by James Rush and Damien Gayle. January 14, 2013--A pair of identical twins, who were born deaf, have been killed by Belgian doctors after seeking euthanasia when they found out they would also soon go blind. In a unique case under the country's euthanasia laws, the 45-year-old brothers, from Antwerp, chose death as they were unable to bear the thought of never seeing one another again. They were euthanized by doctors at Brussels University Hospital, in Jette, on December 14 by lethal injection after spending their entire lives together.

Euthanasia is legal under Belgian law if those making the decision can make their wishes clear and are suffering unbearable pain, according to a doctor's judgment. In Belgium, some 1,133 cases of euthanasia - mostly for terminal cancer - were recorded in 2011, about one percent of all deaths in the country, according to official figures. But this case was unusual as neither twin was suffering extreme physical pain or was terminally ill. David Dufour, the doctor who presided over the euthanasia, told RTL television news the twins had taken the decision in 'full conscience'.

Belgium was the second country in the world after the Netherlands to legalize euthanasia in 2002 but it currently applies only to people over the age of 18. Other jurisdictions where it is permitted include Luxembourg and the U.S. state of Oregon. Just days after the twins were killed Belgium's ruling Socialists tabled a legal amendment which would allow the euthanasia of children and Alzheimer's sufferers. The draft legislation calls for 'the law to be extended to minors if they are capable of discernment or affected by an incurable illness or suffering that we cannot alleviate.' The proposed changes are likely to be approved by other parties, although no date has yet been put forward for a parliamentary debate. Full story can be found here.

Commentary

CMDA Member, Moral Revolution Board member and “Ask the Doc” blogger Andre' Van Mol, MD: “Physicians at Brussels University Hospital euthanized these adult brothers due to impending blindness, not terminal cancer or unbearable pain. They were described as 'very happy' and with '‘relief’ to see the end of their suffering' when they were not suffering, but living as they had for decades. This is where disabled rights groups correctly see trouble ahead, when common disabilities are relabeled as needless and easily terminated suffering – lives not worth living.

 

"In his 1949 paper 'Medical Science Under Dictatorship,'¹ Boston psychiatrist Leo Alexander wrote, '. . . Medical science in Nazi Germany collaborated . . . It started with the acceptance of the attitude basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. . .' He called this 'the infinitely small wedge-in lever' which got this mindset rolling, 'the attitude towards the nonrehabilitable sick.' Even without dictators, soon the right to die to becomes the expected duty to do so in the name of the common good and fiscal bottom line.

"The swath of people targeted for euthanasia (or 'aid in dying,' its recent and benign-sounding label)² is ever expanding. The article claims 1 percent of all deaths in Belgium are now by euthanasia. Dutch palliative care physician Dr. Ben Zylicz warned the British House of Lords, 'If you accept euthanasia as a solution to difficult and unresolved problems in palliative care, you will never learn anything.'³
"A grand benefit of the end of life is the opportunity to make relationships right – with God and people. It is precisely the realization of mortal life’s impending end that can lead people to softened hearts, opened minds and receptive spirits. Euthanasia kills the last chance for the new birth in Christ.

"There is a conflict of interests between palliative care and euthanasia, aka aid in dying: doctors cannot be both patient advocates and executioners. Compassion means coming alongside and suffering with, not offing people for defects. Terminal patients need pain control, companionship and often anti-depressants, but not doctors deeming them better off dead."
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1. NEJM, 241:39-47, July 14, 1949.
2. Van Mol, A. “Premature Termination of Life Is Not Palliative Care.” CHEST. 2013;143(1):279a-279. doi:10.1378/chest.12-2187 http://tinyurl.com/ajh3xfj
2. “Better palliative care could cut euthanasia” Hugh Matthews, BMJ 1998;317:1613 (12 December) News.