Grace and Truth in the Shadowlands: How to Talk to Someone Considering Euthanasia
This article first appeared in the August 2023 issue of FOCUS.
Because of the tender mercy of our God, the dawn from on high will break upon us, to shine upon those who sit in darkness and in the shadow of death, to guide our feet into the way of peace.” (Luke 1:78-79 NRSVUE)
Although spoken two thousand years ago, Zechariah’s words accurately describe our world today. We definitely “sit in darkness and the shadow of death,” and desperately need Jesus, the dawn from on high, to break upon us and to guide our feet into the way of peace.
The legalization of MAiD (medical assistance in dying) in Canada is a particularly tragic illustration of our plight. This change in our criminal code marks a watershed moment for our society and continues to damage our communal life in countless ways. MAiD’s foundations and implications must be examined with rigour, especially by Christians. Two aspects of MAiD should be addressed. The first is the broader philosophical and spiritual foundations and implications for society. Then some practical ideas are needed to guide our interactions with those contemplating or planning MAiD for themselves. Help for those whose families and communities are affected by MAiD will also need to be considered.
As Christians, the Ten Commandments form the bedrock of our moral code. Jesus underlined this truth and provided a summary in Matthew 22:36-40 (ESV):
“Teacher, which is the great commandment in the Law?” And he said to him, “You shall love the Lord your God with all your heart and with all your soul and with all your mind. This is the great and first commandment. And a second is like it: You shall love your neighbor as yourself. On these two commandments depend all the Law and the Prophets.”
In Exodus 20:13 the sixth commandment is, “You shall not murder.” (ESV)
Despite the manipulation of the language and the romantic treatment MAiD has had in the media and in public discourse, the stark reality is that Canadian tax dollars are used to pay healthcare workers to kill members of our human family. It is noteworthy that before MAiD could be legal in Canada, the criminal code had to be amended to allow a physician or nurse practitioner to prescribe lethal medications or to end a life by lethal injection without being guilty of murder. MAiD is not an extension of palliative care or “just another treatment option.” MAiD is a permanent, life-ending, elective procedure. In Canada, over 99% of these deaths are by lethal injection: one member of the human family deliberately and directly ends the life of another. I often choose to refer to this not as its euphemism, MAiD, but as “medical termination”, the description used by the (more honest) citizens of the Netherlands. While euthanasia generally does mean giving a lethal injection, its direct translation from the original Greek is “good death.” Using medical termination clearly shows the reality of what is actually being done.
One of the often-held, serious misconceptions that is fostered by the media and many levels of government, is that medical termination is only for those at the end of life who are experiencing severe and intractable physical pain and suffering. Although this presumption generates the compassion that would be appropriate to such situations, the premise is completely false. As the chart below demonstrates, the common denominator for most medical termination requests is the desire for control.
The Supreme Court of Canada tacitly acknowledged this in the 2015 Carter decision, by approving medical termination for those who were experiencing a “grievous, irremediable condition or disability” that resulted in suffering that was intolerable for that person and not amenable to a treatment that was acceptable to that person. These parameters are entirely subjective. It is not surprising that medical termination continues to expand toward its logical end: its normalization for almost any situation. However, this subjective feeling that one’s life is not worth living is not an individual issue, but a community responsibility. Since every single one of us is made in the image of God, dignity is inherent in each member of the human family. If an individual is not feeling dignified, the onus is on the rest of us in the human family to come alongside that person to reaffirm our love, concern, and commitment to caring.
Medical termination is not just for the “end of life”, but takes aim at all suffering, not by alleviating the suffering, but by eliminating the sufferer. Suffering is universal. No one is exempt. We experience it in its myriad forms from the moment of our birth until the moment of our death. The total elimination of suffering is incompatible with living. Jesus, the Suffering Servant of Isaiah 53, shows us that not all suffering is meaningless and without purpose. It is right and good to work diligently to eliminate needless suffering, especially for those who are vulnerable, ill, or unable to speak for themselves. But it is wrong and evil to take the lives of those who are suffering under the false pretext of “mercy.”
When we observe the most common reasons people seek medical termination, we gain valuable insights into how we can address the existential suffering and fear at the core of their requests. Our society places its highest value on independence, control, and power. But Christians are called to follow Christ’s example of interdependence, submission, humility, and powerlessness. Christ in the garden of Gethsemane said, “Not my will but Thine” and Mary replied to Gabriel at the annunciation, “I am the Lord’s servant. […] May your word to me be fulfilled.” (Luke 1:38) If the Lord is to be able to “guide our feet into the way of peace,” we must come to a place of deep understanding and acceptance that if something is forbidden or prohibited in the Lord’s Word, doing that thing will never bring shalom — peace with order, well-being — to ourselves, our loved ones, or our world. It is easy to underestimate the extent to which our thoughts, opinions, and actions are influenced by the culture in which we live. The wrong action or thought, the disobedience — may seem to be more convenient or more private or even more loving or more considerate of others, but those are lies, just like the first lie recorded in the Bible, “Did God really say…” (Genesis 3:1 NIV). This is the life-giving truth: only what the Lord approves will bring long-term, eternal peace (shalom) and joy. Our journey may be very hard, but we can trust Him to sustain and enable us as we choose to “be the Lord’s servant” even when it is challenging. This is an especially powerful way to demonstrate that we “have no other gods” before the Lord — gods like autonomy, utility, security, a good reputation, and perfection.
We must come to a place of deep understanding and acceptance that if something is forbidden or prohibited in the Lord’s Word, doing that thing will never bring shalom — peace with order, well-being — to ourselves, our loved ones or our world.
Answering Life and Death Questions
But what about our friend or family member who is considering medical termination? Some of the following ideas may also be helpful to healthcare professionals, and all conversations, especially those in work settings, must be patient-led and not coercive. However, when we have a relationship with an individual or a family and can speak from a place of trust, others are often extremely grateful for our help in times of distress.
If possible, wait for an invitation to be involved. It is good to remember that Job’s friends were a great comfort to him while they sat with him in silence and commiserated for an entire week. It was only after they tried to explain the situation that their presence became harmful and distressing. Listen first. Ask the person to share his or her complete story with you in whatever detail he or she desires. State clearly that you are ready to listen without judgment and that you will only interrupt if you need clarification. Then truly listen. It is important to thank the person for sharing and for trusting you with the story and its details before you move on to commiserate. If you can comment in an empathetic way about specific aspects of the story you have just heard, it will show that you were paying attention and thus be more meaningful. Give the person time to respond to your words and thoughts and to add other thoughts as needed. Trite platitudes and easy answers are simply irritating. Just be yourself and pray moment by moment for the Holy Spirit to guide your thoughts and words.
There may be apprehension and misunderstanding about the dying process itself. A person may desire to have more control himself if he has had a negative experience with death. Perhaps a friend or relative died with symptoms that were not well-controlled, or the patient was treated disrespectfully, or her wishes were not honoured. It may even be that the person has only heard about such deaths and never experienced death first-hand. Reassurance and a firm commitment to good care and faithful accompaniment can go a long way to alleviating such fears and may reduce the desire for a hastened death. It may also help to know that most deaths — from whatever underlying cause — tend to be quiet and peaceful, not painful, and violent as shown on TV and in the movies. Most people with a terminal illness from cancer, organ failure, frailty, or other causes, tend to drift, usually gradually, toward more fatigue and then into sleeping more and finally into sleeping all the time, then to being in a coma, and then at some point, they simply take their last breath. This is in no way less “dignified” than dying by a lethal injection. There is a beauty in allowing the Lord to determine one’s days: “…all the days ordained for me were written in your book before one of them came to be.” (Psalm 139:16)
A major goal of palliative care teams is to help patients and their loved ones to “reframe hope.” Although life may now be very different, it can still be very good. In addition, what we now think we would want later often turns out to have been wrong. Yes, there are losses to mourn and griefs to bear, but it is possible to adjust to our changed circumstances.
And as Christians, we affirm that even as we continue to “overflow with hope,” lament can be an appropriate and therapeutic response to these difficult times in our lives. “How long O Lord?” is actually a cry of faith, not of unbelief.
With a death that is foreseeable, many can embrace the potential to “put things right” and to seek reconciliation and shalom in every area of their lives. I find my “magic question” is very powerful and effective: “What is the worst part of this for you?” I have been stunned by the diversity of the responses given over the years. Sometimes the “worst part” is not anything that was even on our radar screen as a palliative care team. Maybe it is an estrangement from a loved one, or a child given up for adoption many years ago who has never been reconnected, or an adult child living with a disability who will need care, or even worry about a beloved pet. It may be possible to address this “worst part” in ways that bring deep healing. Some of our patients have remarked that they are now able to “die healed.”
The medical literature confirms that much of the desire for hastened death is prompted by fear. If you have a stable and trusting relationship with the person, it may be helpful to ask about the role that fear could be playing in the person’s desire for hastened death. Using the “third person” in the discussion can reduce the intrusiveness of the enquiry. For example, “Sometimes people who are facing serious situations like yours find that they have significant fears and concerns that may be hard to express. If you are having similar thoughts, it might help to talk about them, and I/we would consider it a privilege to be part of that discussion.” Christians, especially, may need to be reminded, as Dr. John Scott noted in the Dying with Christ – Living with Hope series, that fear itself is not a lack of faith. Some fear is healthy and may even save our lives as it helps to prevent us from doing things that are not wise. And the fear of death is universal, partially because it is a fear of the unknown. As the passage from Luke 1 implies, as we sit “in darkness and the shadow of death”, we experience a type of bondage to that fear. The good news is that those bonds are broken and our feet are guided into the way of peace through Christ’s death and resurrection. Jesus, our “dawn from on high,” repeatedly says, “Fear not!”
Are not five sparrows sold for two pennies? And not one of them is forgotten before God. Why, even the hairs of your head are all numbered. Fear not; you are of more value than many sparrows. (Luke 12:6-7 ESV)
We also have a significant opportunity to leave a faithful legacy for those who come after us. We understand that we have a responsibility to be trustworthy stewards of our world’s physical environment, but we also can be wise stewards of the metaphysical, philosophical, and spiritual environment of our world as well. For example, if grandparents choose to die when they face challenging situations, what message does that send to children and grandchildren when they encounter difficulties of their own? Avoiding hastened death does provide some protection against suicide in our loved ones and also serves as an example of our commitment to obeying Scripture.
Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us, fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God. Consider him who endured such opposition from sinners, so that you will not grow weary and lose heart.
What a tremendous impact we could have on our world if we as individuals and communities reset our minds and hearts to choose to lean into these experiences and to show that these last chapters in our lives can be a much greater and more fulfilling adventure than hastening death! Can we learn to appreciate that it is a priceless gift to others to allow ourselves to be cared for?
It shows that we trust that our care will be good.
It shows that we trust that our caregivers will be able to care well.
It shows that we trust the Lord to fill this experience with His grace in all its messiness and sorrow.
It shows that we trust Him to “perfect” both us and our caregivers, to make us more like Jesus, and that this will bring glory to His name.
And it shows that we truly believe that He will never leave us or forsake us — no matter what!
We began by remembering Zechariah’s words about sitting in fear in darkness and the shadow of death. Let us end by rejoicing in the fullness — at least the fullness that we can experience this side of heaven! — of the brilliance of that “dawn from on high” — a true light, the light of all mankind, shining in the darkness which has not overcome it. This dawn, our Jesus, is full of grace and truth. May He endow us too with a full measure of his grace and truth as we journey through the shadowlands with our patients, our loved ones, and our world.
In the beginning was the Word, and the Word was with God, and the Word was God. He was with God in the beginning. Through him all things were made; without him nothing was made that has been made. In him was life, and that life was the light of all mankind. The light shines in the darkness, and the darkness has not overcome it. […] The Word became flesh and made his dwelling among us. We have seen his glory, the glory of the one and only Son, who came from the Father, full of grace and truth. (John 1:1-5,14)