Randomly euthanized.

Random Wednesdays, April …..the problems of medically assisted suicide, euthanasia and end of life ethics.

Warning to readers ; this isn’t going to be a cheerful post but we all get to die and some of us get to do it badly, in pain, fear and distress while others make the terrible decision to take the end of their life into their own hands, often with the assistance of a medical professional.

So, this is a serious post and in fact this version is my third attempt at writing the same post because I started the first two with events from history and then recent events in Europe and notably Canada that seem as though they are a progression towards the mandated taking of life. Starting there, with for example the euthanasia programme instituted by Adolf Hitler in 1939 as ‘Aktion T4’ killed some 300.00 physically and mentally handicapped individuals for Hitler’s purpose of ‘racial hygiene’ is nothing like the more modern progressive approach to initially allowing requested medically assisted death in only certain specific problems and then slowly extending it seemingly just for the purpose of cost and convenience.

The mistake I made in my first two attempts at writing this post is I ended up making a comparison between Hitler’s Aktion T4 of 1939 and recent changes in the law that make assisted suicide still illegal in the UK for instance while allowing it several European countries : the Netherlands, Belgium and Switzerland for example. In this post I mainly want to talk about the situation in Switzerland and the Netherlands because the latter is , in a way, culturally closer to the UK – there are a couple of things I want to add about the USA and particularly Canada where there have been some egregious examples of assisted suicide offered as ‘solutions’ to simple social problems.

I want to start off though by avoiding the comparison between 1930’s Nazi Germany and progressive 2023 – I happen to think that some people’s view that we are in another version of pre-war Germany is a poor understanding of history : if you will I prefer to make a comparison between the 15th and 16th century and the modern age when a crisis of information and knowledge being disseminated via the Gutenberg press is more like the problem we have today with the control of the internet and ‘misinformation’ on social media ….at least in the eyes of the establishment and mainstream media.

My main point in this post isn’t so much the fact of medically assisted dying now being accepted in more countries and states within countries but it is more a critique on the attitude taken towards those people choosing to end their own lives by a bishop in the Roman Catholic church and, as far as I can tell, expressing a canonical judgement on the issue. What I am taking issue here with here is this Youtube video below in which Brendan Vogt is discussing the issue of medically assisted suicide with Bishop Robert Barron. For those that don’t know either then Brendan Vogt works for the Catholic publishing house ‘Word on Fire’ and Robert Barron is a diocesan Bishop in the USA who is a major communicator of Roman Catholic issues on the internet.

For the purpose of understanding my own post and critique I feel that it is vitally important to know what is being discussed here.

Having a ‘dog in the game’.

For those less familiar with colloquial English to ‘have a dog in the game‘ is to have a personal interest or involvement in some problem or other : in my case it came from having a father who owned and bred racing greyhounds so having a dog in the game (or race) meant that we were involved than mere spectators. With regard to this issue I have both a personal and professional dog in the game so here goes with both.

The first is that I think that my late mother died badly, in unnecessary pain while in a ‘care’ home at the end of her life and her suffering I feel was of no benefit to anyone in the sense that Bishop Barron talks about it. Secondly, my professional interest comes from having been a specialist nurse who often had to deal with the practical end of life issues in a British hospital which included advising on the use of the LCP or ‘Liverpool Care Pathway’ , communicating with relatives and then performing a procedure known as verification of expected death. Given the huge number of elderly patients who die in British hospitals and who’s immediate end of life events can be distressing to them, their relatives and the care staff then relief of suffering was regularly what we tried to achieve.

Once again, for those unfamiliar with English end of life care the LCP is a pre-worked out methodology of dealing with the known problems of the end of life in elderly patients – the three main problems being pain, agitation and respiratory distress due to (often) pulmonary oedema caused by heart failure. I don’t have the time to deal with the arguments for and against the LCP except to say that there was a campaign in the press to suppress it’s use and the main argument being used was that the LCP was being used to hasten death whereas the actual intention of using it is to relieve the actually occurring distress of patients in the final hours of their lives.

End of life in English law.

Under English law actual suicide is no longer a criminal act but I guess it would be somewhat difficult to bring a case against the deceased, it is however illegal for a 3rd party to assist in any way although a potential prosecution can only be brought by the director of public prosecutions. Although brought before the English parliament as a private members bill and argued in the house of lords medically assisted death (euthanasia) remains illegal in the UK. In practice what this has meant that those people seeking to deliberately end their own lives in a medically assisted manner have had to travel abroad and usually to the only country that allows non residents to do so….that being Switzerland.

Vogt vs Campbell.

My great internet communicator hero for the whole of the Covid 19 pandemic period is fellow English nurse (Dr) John Campbell. My main reason is that he is the only qualified commentator who seems to have read and reported on the actual research and when he does so he does his critique with us, the viewer, quite literally looking over his shoulder at the paper he is reading. It sometimes feels like a particularly critical teacher marking one’s homework line by line but he was a medical and nursing educator so I guess that is par for the course for him.

So, my frustration with Brendan Vogt is that in the embedded video he refers to a ‘report’ about euthanasia frequently without either providing a link in the video description or in any way giving us, the viewers, a chance to see directly and comment on the report that he is quoting from. Now, I like to think of Vogt as an honest player so I take it that the report he quotes from does actually exist but I wonder about it’s source and provenance ; my concern is that it could be a cherry-picked shock horror piece generated by a Catholic/Conservative source which is using the data to lead us to an obvious political conclusion. In this case that conclusion could be something along the lines of ‘conservatives good-liberal progressives all bad’……after all US politics does seem deeply divided along those lines.

My opinion for what it’s worth – that is simply not good enough work as a communicator to quote from any source and not give us any link to the actual report.

Bishop Barron – for and against.

I start my critique of Bishop Barron’s comments on euthanasia by looking at one of his other lectures which I benefited from – the link will be below. In that lecture Barron quickly covers the four main philosophers that seem to have the greatest impact on 21st century life and thinking, the four being : Nietzsche, Marx, Sartre and Foucault. I already knew some of Nietzsche’s work because he is the only one I have read thoroughly and in previous posts I happily admit to having been a Nietzsche’an nihilist. I knew enough about Karl Marx but then almost nothing about Jean Paul Sartre and only peripherally about what other commentators have said about Michel Foucault – our man Dr Jordan Peterson for example ; but I never realized to what huge extent my own life has been described by Sartre….and it’s not pretty !

Bishop Barron’s take on Sartre is that our generation (the boomers) have become fiercely individualistic to the point of selfishness where our main and perhaps only concern is how we live our lives. I think now that there has been a ‘progressive’ drift in each subsequent generation to the extent that what we see and hear now is near entire generations insisting on their ‘rights’ their happiness and their fulfillment being paramount – I wonder even if this is also seen in the drift to claiming that we can be anything we want to be , even to the extent of being an actually different sex.

Lets run with that idea for a moment…..I think about the current ‘me’ generation a lot, an entire generation , it seems, that feels that it is entitled to have and to do whatever it wants to with no consequence and it always demands ‘respect’, affirmation and being right. Another way of understanding the ‘me’ generation is to think of it as trying to be and wanting to be it’s own master to the point of wanting to live it’s own way and even to die in it’s own way – something I have heard in my own generation is the thought that the only thing we truly own is our own life and that we feel that our life and death is ours to decide and choose, and nobody else’s. For anyone who knows anything about Catholic Christianity this is the polar opposite of the line taken by many Catholics including Bishop Barron ; for them life is something given by God and in a way is not really their’s to mess with and ultimately to end in a deliberate act.

Given that this single point is something that people are going to argue about I would first like to summarize both the liberal view and the conservative Catholic view.

Liberal view….that ‘my life’ is my own and it is entirely up to me as to how I live it and ultimately, should I make this choice, in how I end it. If you like your philosophy then this is mostly the Sartre’an , existential standpoint that also seems to say that this existence is the only one we have, that suffering is both real and likely and that by pushing that out a bit we should say that we have the gift of intelligence and compassion to do something about that.

Catholic view…..that life is a gift from God and we have no right to end it at our own choice however unpleasant that end might be. To go one step further , and this is where I begin to take serious issue with Vogt and Barron, that suffering is seen as positive and should be willingly accepted. In response to that I would say that if that is both a ‘Christian’ view and doctrinally a Catholic one then I can see why more and more people would turn their back their back on the opinion of the established church.

End of life suffering : my ‘dog in the game’.

This is where I come in throwing punches a bit both personally and professionally because I do feel that many people fear and/or experience end of life suffering, both physically and mentally, and as a former specialist nurse that really makes me angry because it’s so unnecessary…..in fact and i’ll be blunt here….it really pisses me off !

So, obviously, I have spent most of my adult life as a nurse and one of the basic principles under which we trained and then by which we worked is that we did for people what they needed but maybe couldn’t do for themselves because of sickness, infirmity or lack of knowledge. At the extreme end of that I spent most of my working life in an intensive care unit doing everything for people while most of the time they were unconscious. The other main principle we worked with was that all life has a natural span and it ends…..often with a difficult, painful and distressing end…..and we take it as our job to reduce and relieve that distress and suffering as much as we can. There is a huge grey area of course because there is for example one view that says that relieving severe pain at the end of life with opiates for example actually shortens life/causes death and is therefore wrong, in fact in the Catholic view that may well be a sin.

There is a better argument within nursing that a person in the last stages of life deserves not to die in pain and distress and given the choice then a slightly shortened life not in pain, or not in as much, is far better than an extended one in severe pain. Bluntly put, we could say that the person is already dying and is soon actually going to die so why should they die a horrible death when we can intervene and make it , not a better death, but a less worse one. Another side of that is that both intelligence and compassion are traits that we find valuable in anyone who practices healthcare and it is caring about a situation (compassion) and having the smarts (Intelligence) to do something effective about it that makes for a better nurse or doctor.

Now, I know that all of that is mostly about a better argument for effective palliative care at the end of life rather than an argument for the deliberate ending of life as simply another medical technique but this argument, and my anger, is more directed at Barron’s glib and unthinking comments about medically assisted suicide so I figure that it’s best if I get that off my chest first….

Where the evidence has been collected and studied – notably in the Netherlands, it does seem that suicide and notably medically assisted suicide has increased (report below) and while I also can’t refer to an actual report there is at least anecdotal evidence to say that the level of suicide and suicide attempts have increased during the recent pandemic ; having read through all of the reports on this I haven’t found any convincing evidence to support this. Again, anecdotally it does also seem that there has been a huge increase in depression, especially among women, in the so called ‘liberal’ countries…..where there is also an increased suicide rate. Given that depression is known to be a factor in suicide and/or suicidal thoughts I think that we should also look at why that is the case.

Having both worked in the end of life situation and having dealt with attempted suicide and self harm in the acute care setting….also having known several people who have taken their own life (or at lest expressed the wish to do so) I feel that I do have a ‘dog in the game’ although, unlike Bishop Barron I chose not to hide behind dogma and canon law but instead take the view that we have to take the subject seriously and also this…….that the reasons and causes that seem to lead people to chose to take their own lives or request assistance with the same, are not well covered by rigid Catholic dogma and they aren’t even covered well in the original scriptural material. I would suggest that life (and death) has changed out of all recognition since ‘Biblical’ times and maybe it is only the most basic and fundamental values expressed within it that could be applied today.

It is merely my opinion but to hide comfortably behind dogma and canon law is fundamentally un-Christian where for example Christ is recorded as commanding his followers to heal the sick and give help to those who are poor in spirit , and so on and so forth….in other words to have and act in a spirit of understanding and compassion rather than hiding behind ‘the law’. I would have far more respect for the established church if it did have a dog in the game and rather than sanctimonious finger wagging it actually engaged seriously and compassionately with those who are suffering physically or mentally to the extend that they are considering suicide.

Links.

UK parliament document on assisted suicide : https://www.parliament.uk/business/publications/research/key-issues-parliament-2015/social-change/debating-assisted-suicide/

Netherlands report on suicide statistics. https://www.cbs.nl/en-gb/news/2022/17/1-859-suicide-deaths-in-2021-36-more-than-in-2020

US suicide statistics : https://www.cdc.gov/suicide/suicide-data-statistics.html

Wikipedia page on suicide in the USA. : https://en.wikipedia.org/wiki/Suicide_in_the_United_States

Bmj paper on Covid 19 and suicide rates : https://www.bmj.com/content/371/bmj.m4352

Forbes article on assisted suicide and euthanasia : https://www.forbes.com/sites/katharinabuchholz/2022/08/12/where-most-people-die-by-assisted-suicide-infographic/?sh=5e96650549a3