Ep. 294: A Christian Perspective on Assisted Suicide

Daniel Markin:

Hey, this is Daniel Markin, and welcome to indoubt. On this episode, I’m joined by Ewan Goligher. He’s a physician in Toronto, also at the University of Toronto. And he works in end-of-life care. And what we’re talking about today is medical-assisted suicide, medical end-of-life care, the fact that in our country right now, you can have euthanasia, where a person can elect on their deathbed to be killed, and we call it mercifully, to end their suffering. And so this brings up a lot of controversy in our culture, and as we think about this as Christians. And so we wanted to do this episode, though, so that you could think critically about it and be able to think biblically about what this means for us as believers. So I hope you find this episode helpful.

Daniel Markin:

Hey, welcome to indoubt. This is Daniel Markin, and I’m joined today by you Ewan Goligher. Ewan, how you doing today, my friend?

Ewan Goligher:

I’m very well. Thank you.

Daniel Markin:

Hey, listen, we got a really interesting and controversial topic that we’re going to be talking about today something that if many of our listeners have been listening to the news or paying attention to our culture, in Canada specifically, over the last number of years, we’re talking about assisted suicide, but there’s a correct name for that. And so this is something that we want to discuss, because it’s super painful for many people. I think we don’t have a good grasp on even what it is, and then the implications of that. And so Ewan, if you would please just explain who you are, what you do, and then begin to walk us through, what is assisted suicide or MAID, as it’s now being called?

Ewan Goligher:

Sure. Thank you, Daniel. So I am an assistant professor of medicine at the University of Toronto. I’m an intensive care doctor. And I’m also a research scientist. I study sort of ways to improve life support and mechanical ventilation. So that’s what I do as my day job. But in the ICU, I’m often involved in caring for patients at the end of life. And when MAID, or medical aid in dying, was legalized several years ago, it really became something that those of us who look after patients at or near the end of life, had to come to grips with in terms of what we thought about it, in terms of the ethics. And then for me in particular, as a Christian, what my spiritual and religious moral obligations were with respect to this sea change in medical ethics. So medical aid in dying has a number of different labels. It’s sometimes called physician-assisted death. Traditionally, it was called assisted suicide or euthanasia. So assisted suicide was the term used for when the patient ingests a lethal prescription themselves. And then euthanasia was the term used to describe the act of the doctor or nurse administering the lethal medication by injection. But just for ease of language throughout the interview, I’ll just discuss it as euthanasia, which basically, I think encapsulates the notion, this is an act where you’re deliberately and intentionally causing the patient’s death. And that’s really what makes this different from anything else we do in medicine, where we otherwise would never intentionally aim to cause the patient’s death.

Daniel Markin:

Right, because I feel like the irony here is, and correct me if I’m wrong, but as a doctor, you took an oath to try and care for people and try and keep them alive. And that’s your goal here. And all of a sudden this comes along, it’s passed through legislation. Now it’s approved. And this is seen as a solution, which is going completely against your oath. And I imagine that’s been a little bit of a conflict of interest, or how has that been with some of your colleagues? How do you guys wrestle with that?

Ewan Goligher:

For one thing, it reflects a gradual progressive evolution in the basic understanding of what medicine is and what it’s for. Traditionally, it was seen as something that was aimed at preserving and promoting the bodily health of the patient. And increasingly, it seemed as a means of promoting personal autonomy and personal wellbeing, so something distinct from and different from the idea of bodily health per se. What was so strange about it when it was first being legalized, was that for those of us who objected to being involved at all, who felt that it was unethical, we suddenly found ourselves in the position of being almost seen as lacking in compassion or being the bad doctor, so to speak, the doctor who doesn’t care about the patient. So whereas traditionally, an unwillingness to cause a patient’s death was seen as a virtue, now in the popular imagination, it becomes a vice. So it was just a 180 degree turn in the way that our traditional medical ethics worked. So it was upsetting and challenging to navigate and to discuss with colleagues and with patients, and so on. So it’s been a challenging season for many physicians across the country.

Daniel Markin:

No kidding. Was it a majority shift, or were you in the minority of this, or were there most doctors were maybe feeling that way, but then were being quiet about it? Because obviously, your license depends on that.

Ewan Goligher:

Yeah. So I would say that the majority support the legalization of euthanasia. And what’s interesting is that even though many are supportive of it, very, very few are actually willing to do it. It’s actually difficult to find enough doctors to meet the level of demand for euthanasia across the country. That’s an ongoing challenge. And one of the reasons why referral became mandatory was that that was the way in which the regulators wanted to make sure that patients could get access. And so the rules are that you have to refer, you don’t have to actually perform euthanasia, but you do have to refer for it. At least in Ontario and a couple of other provinces, those are the rules. But you’ll find that although most doctors are supportive of the idea, they’re completely unwilling to do it themselves, even though it’s the simplest thing possible.

Daniel Markin:

And the basis for this, and you just touched on that, but I’ve heard it also called mercy killing, right? And the idea is, “Well, it’s more merciful for them to be killed like this, or to choose to die now, than it is for them to actually suffer and die.” And so in your view, how did we arrive there as a society, where we actually began to see that as merciful? Because I think you could make the case that you’re showing mercy in what you’re doing, in actually caring for someone in their end of life. We have palliative care where literally, we have doctors and nurses committed to making people’s last days as comfortable, as painless as possible, as they spend that time with their families, as they reflect on their life and they find what becomes most important with them. I hear of a lot of people who, in those last days, actually might return back to the faith they once had. And so in your estimation, how did this creep in to our society?

Ewan Goligher:

Yeah, that’s a really great question, and it’s a huge topic. I would say, very briefly, that it reflects a big shift in our society’s values towards a generally secular way of seeing the world. So in a secular way of seeing the world, there’s no God, or at least God’s not particularly relevant. We decide for ourselves what’s right and wrong. And we make decisions based on our experience of this present reality. And nothing beyond it sort of counts into the decision-making. So for one thing, the rightness or wrongness of killing someone or of ending someone’s life depends on the person’s preference for life. If they want to be dead and if they decide that they’re better off dead, well, that becomes true for them. And then you are expected to act accordingly. So it’s a big shift in the way that we understand how you decide what’s right and wrong, what’s true and false. One of the really interesting things to me is the way in which this act of euthanasia completely takes for granted that you have some idea of what it’s like to be dead. It’s actually a profoundly faith-based act, because it assumes that you know that you’re better off dead than alive, and that assumes that you know what it’s like to be dead. So it reflects a sea change in the sort of general assumptions that we’re willing to make about reality and about how we decide what’s right and wrong. It really reflects moral relativism, or the idea that people can all decide for themselves what’s right and wrong. And it reflects secularism, and this idea that you don’t need to consider that there is anything beyond this life.

Daniel Markin:

I’ve heard you … and you wrote this in your article for Gospel Coalition, but you use the terms intrinsic value and extrinsic value. Could you discuss those a little bit? Because I think that’s an important piece of this, as you can consider maybe the imago dei and what we see in Genesis.

Ewan Goligher:

Yeah. So it comes back to this fundamental question of, what makes it wrong to cause somebody’s death? And that in turn raises the question, well, what makes them matter or be significant in the first place? So when we’re talking about human value and what makes people matter, we can talk about two kinds of value. There is intrinsic value and there’s extrinsic value. And extrinsic value is value that comes from your usefulness, what you can do, what you bring to the table, so to speak; whereas intrinsic value comes from just from who you are. It’s value that you have just by virtue of what and who you are. And one way to think about it is that things that have extrinsic value are generally things that we’re willing to buy and sell, whereas things that have intrinsic value are things that are priceless. And an analogy that I like to point to, although I don’t think it’s a perfect analogy, is something like the Mona Lisa, which is sort of priceless. And you almost couldn’t put a price tag on buying the Mona Lisa from the Louvre, because it’s just such a precious artifact. It almost has intrinsic value. Well, even more extreme value than that are the kinds of value that people have. Understanding this kind of value is important because to have extrinsic value means that your value is conditional, whereas to have intrinsic value means that your value is unconditional. So if we say that people have absolute rights and that they absolutely ought to be treated with respect in certain ways, well, that relies on a notion that you have intrinsic value. And I think ultimately, everyone wants to believe that humans have intrinsic value. The problem is that it’s very difficult to understand where that kind of value, that sort of value by virtue of who you are could come from. And this is the beauty and power of the Christian faith, is that it helps us to make sense out of and understand why people matter so much, because they’re made in the image of God. This is something I think we know deeply, intuitively. And once we recognize that people have intrinsic value and that therefore it’s absolutely good that they exist, we start to realize, “Wow, we really shouldn’t be deliberately ending people’s existence, because we’re destroying something that’s priceless.”

Daniel Markin:

Yeah. And on that too, it’s so interesting that in our culture, too, we’ve shifted, like with the extrinsic value, that’s all that matters. Yet in matters of animals and caring for … I walk around downtown here in Vancouver. And you’ll always see people showing the video of animals being killed, slaughtered, like the pigs or meat, the chicken industry, whatever. They’ll talk about the fact that these animals are being slaughtered and they have intrinsic value. And yet, our world turns around and says that humans are based on extrinsic value, based on what you can do. But all of a sudden these animals, not made in the image of God, right … And not that we shouldn’t care for nature. That’s definitely in the Bible, too. We’re to have dominion over the garden, to care for it. That’s something we see. But our world is in many places shifting away and saying that these animals have more value than humans, which when you begin to hear that, I mean, that’s when I know an idea is not from the kingdom of God. Right? But I’m like, “That’s an idea of the enemy. That’s an idea of Satan.” As soon as it flips upside down and makes complete and utter nonsense, that’s when I’m like, “This is not something that is of God.” It’s crazy that our world is in this place. And now, here we have doctors like you being pressured into this very thing.

Ewan Goligher:

Yeah. One of the interesting arguments that was made in support of euthanasia was animal euthanasia. People said, “Oh, if my dog was suffering this way, I wouldn’t force them to go through it. I would go to the vet and have them put down. So if people matter at least as much or more than animals, then why are we unwilling to relieve their suffering by causing their death?” And so you could see the way in which that argument relies on the idea that humans aren’t really fundamentally different in the nature of their value from animals, that there’s no real difference. And if we treat animals with respect in a certain way, we have to treat humans with respect in the same way. And I think one of the ways in which our world is deeply broken is the way in which we so easily forget just how much we matter. And over the last few years as I’ve been reflecting on these things and trying to find language to describe the true depth of human value, and I think this idea of intrinsic value, value by virtue of who you are, becomes so powerful because it helps us to understand why, even though people become disabled, they still matter so deeply. And even if people are suffering chronically and limited in certain ways, they still matter so deeply. And I think one of the tasks that we have as a Christian community is to remind ourselves of this, to remind those who are suffering of their value, and to live that out as communities that display servant-hearted love. People in our communities should be continually reminded just how much they matter, just how deeply valuable they are. And I think that kind of memory, of the depth of human value, becomes a powerful witness to the world of the beauty and power of the gospel to change people’s lives.

Daniel Markin:

Yeah. And that is a truth, the fact that … it’s not something that it’s wishful thinking that like, “Oh, if you believe in the gospel, you now have value.” No, we actually believe this is a reality, written into the fabric of our world, into the fabric of creation, the fabric of the human story. And that’s what’s being taken away. And we’ve exchanged that for a fraudulent story. And I think that returning back to the other story, I mean, you talk about even 2020 and the implications, teasing that out, of mental health and all those issues with people, a lot of it, we’re discussing their intrinsic value. It’s hard to be isolated, but even when you’re thinking about these things, you have value, you matter, you are made in the image of God. And that’s something, I agree with you, we all wish that were true. And it’s sad when people actually can’t accept that is true because they don’t know God, and everything that they are hearing is being said the other way. As you operate as a physician in this area, what’s the most frustrating thing?

Ewan Goligher:

I would say the thing that frustrates me the most is the way in which many of my colleagues don’t see how a willingness to cause people’s death devalues them. Some of the stories that have been in the media recently about people with extreme chemical sensitivities, unable to find new places to live, and therefore finding that they can’t go on with life, and then finding a doctor who’s willing to cause their death, it frustrates me that those physicians or nurse practitioners or whoever’s offering it to them, don’t see that they’re sort of acknowledging the pointlessness of that person’s existence, and just how much it devalues them. So instead of our profession turning around saying, “No, these people really matter and we need to find a way to help them,” rather the response is, “Yeah, you’re right. There’s no point in going on. And we’re happy to end your existence.” That’s a tragedy. I think it’s really going to undermine and erode public trust and respect for the profession over time. And I think that’s bad for patients more generally. So that’s a more abstract or general frustration. And I would say that’s the biggest thing that frustrates me. When people are thinking about end-of-life decision-making, these are truly weighty issues. And we need to be so gentle and so patient and respectful of how people are going through these things. It is tremendously difficult to endure chronic suffering. And I would never want to play that down at all by opposing euthanasia. I’d want to honor the courage of those who are enduring chronic suffering. But I think in that moment, what we want to be, we want to be people who are there to say, “You matter so much that I’m willing to go through this journey of suffering with you. I’m willing to come alongside and endure these difficulties.” And I think for many people, just knowing that people will be there with them, that they won’t be alone, that they’ll be loved and valued and treasured, that they’re not perceived as a burden, to be reminded of those truths, will make all the difference in their decision-making about whether or not to seek euthanasia.

Daniel Markin:

I’ve heard it said as well that most people, when you’re in a lot of pain, you’re in chronic, chronic pain, you want it to end. And a lot of times, the instincts take over, you just want to be taken out of that pain. And I think that drives a lot of the decision. My understanding is that for the majority of people, if you can manage that pain like you do in end-of-life care, if you can give them enough, I don’t know, morphine or hydromorphone, whatever, to dull their pain, most of the time, they’re okay with that. They would rather see the end of their life naturally. And it just feels like this is just a cheap way out to just be like, “Well, just end it quickly and more efficiently.” And then to spin it and say, “Then you’re not a burden to your family or to society.” And we’ve lost what it means to actually die well. As I think about it, it reminds me of when Paul’s talking in Colossians about filling up in the afflictions lacking in Christ. And you tease that out. And it’s not that Christ’s afflictions are lacking, but it’s that Christ came, suffered, rose again, returned to heaven. And now we are here to carry on the gospel. And one of the ways that the gospel is actually proclaimed most mightily is through our suffering, that people see how we suffer different, and they actually can take note of that: “Look how that person’s suffering, and unwaveringly, their faith has not changed. They’re still hopeful. What is it that they believe that they live like that?” That is something that’s so powerful. And I think that’s being robbed, taken away, and it’s painful to see.

Ewan Goligher:

Yeah, these are great points. I mean, I would say two things. I would say, first of all, you’re absolutely right, that palliative care and moderate palliative medicine is incredibly effective at controlling symptoms and relieving pain, relieving discomfort, and helping people to live well through the dying process. And I have colleagues who are immensely skilled at helping people through that. In the ICU, we see some of the more extreme cases of physical suffering at the end of life. And we absolutely can control it. And I’ve personally sometimes sedated people as needed, in order to make sure they’re comfortable as they go through the dying process. We have the tools at our disposal to relieve the vast majority of physical suffering. But it’s interesting, if you read the literature, the reason people are seeking euthanasia is not physical suffering. That’s very rarely the reason people seek it out. It’s because of a sense of a loss of autonomy, a feeling that there’s no point in going on with life because you’re progressively becoming more limited, losing control. And actually, what’s powerful and attractive to people about euthanasia is the ability to regain some control over the end of life. So it’s very much actually an intervention for spiritual or existential suffering rather than for physical suffering, despite how it’s sometimes advertised. So this is why we’re seeing people with mental illness and disability being offered euthanasia, because it’s really not about controlling physical symptoms. It’s about the challenge to make meaning out of life when you’re suffering. And if life feels utterly meaningless, then that’s a form of existential suffering that medicine can’t fix, can’t address. So the second point I would make, and to your point about filling up what’s lacking in Christ’s afflictions, I think this is part of the message that, as Christians, we need to remind one another of, and then we need to speak to the world, is that life is profoundly meaningful. And we have purpose and significance unconditionally, no matter what circumstances or difficulties we find ourselves in, that our life matters, that our existence matters. And that there’s a reason that we’re here and there’s a reason we’re going through things. There’s a wonderful book by Viktor Frankl. He was a Jewish psychiatrist who survived Auschwitz. And I remember a quote from that book. He quotes Friedrich Nietzsche, actually. And Nietzsche was saying this ironically, but Frankl was affirming it as true, that he who has a why to live can bear almost any how. And I think this is the challenge that our society is facing, that we are seeing with MAID, is actually, what is our why to live? And if we lose that, then it becomes much harder to bear the suffering that might come our way.

Daniel Markin:

You mentioned two things there. One, I was not aware that this could be offered to someone who had declining mental health. That’s crazy to me, that that would-

Ewan Goligher:

Well, I should clarify that that’s the legislative change that’s being actively discussed at the moment.

Daniel Markin:

Oh, wow.

Ewan Goligher:

And I think there’s very strong support from it, from the Trudeau government. So it almost certainly will go through. They have a track record of continually easing restrictions and barriers to accessing euthanasia. So I think they’ll probably continue on in that vein with this new legislation.

Daniel Markin:

We’re coming in for a landing here, for this program. But it’s been, obviously, a very heavy episode. Can you send us off with some hope, the hope of the gospel, and how the gospel plays into this?

Ewan Goligher:

Yeah, absolutely. I mean, I think, like I said before, the crux of this whole issue is the question of whether it’s possible for our suffering to really matter. And if I would say there’s anything significant about the story of Jesus’ life, I would say if there’s anything important and significant about the gospel and bringing it to bear on this whole question of euthanasia, it’s the idea that Jesus’ life, death and resurrection shows us that suffering really does matter, that God uses suffering to accomplish his ends in this broken world. And that’s not to say that suffering is somehow intrinsically good or that we shouldn’t protest or lament pain and suffering. These are real evils. But it’s the power of the gospel, that God can take what’s broken and tragic and turn it for good. And I would encourage those Christians who are listening to reflect on the fact that when God calls you to suffer in life, that it’s an opportunity to prove the true depth of your worship and love for him, because it’s easy to worship God when everything’s going well and you’re getting everything you want in this life. But until you’re like Job, who can say, “Though he slay me, yet I will trust him,” that’s when you’re really worshiping. That’s when you’re given the privilege of really showing the world just how valuable and glorious God is, that he can satisfy you in the midst of that. So I think we have a message and a philosophy of life as Christians that absolutely meets the needs of those who are afraid of suffering and facing the journey towards death. And so, I’m so thankful to have that. And I’m hopeful that God will use us to faithfully spread that message of meaning and purpose and value to a culture that’s struggling to find its way through these very difficult issues.

Daniel Markin:

Amen. Well, Ewan, thank you for your time. Thank you for jumping on this program with us. And Lord be with you in your continued work as a physician. It’s tricky times, but I believe he’s called you to that. And I’m sure you wouldn’t be doing it unless you felt the calling to it, as well. And so, serve the Lord in that, and looking forward to speaking again.

Ewan Goligher:

Thank you very much, Daniel. It was a pleasure to chat.