March 20, 2020

Be Our Guest / Elliott Bedford

Assisted suicide vs. palliative care: What’s the difference? Everything

Elliott BedfordRecently, our state legislature considered a bill to decriminalize the practice of physicians who might assist in their patient’s death by suicide. Thanks to efforts like those of our own Indiana Catholic Conference, the bill—the fourth attempt since 2017—failed to move forward. Yes, we get a reprieve, but recognize: these attempts will continue. Persistence is the strategy of this assisted suicide movement.

Another facet of their strategy is perverting language. You will see proponents obfuscate and use euphemisms like “death with dignity” or “aid-in-dying.” Most heinously, they will claim this is nothing more than palliative care. Nothing could be further from the truth.

Let’s start to draw the distinction by clarifying some key terms.

First, palliate means “to cloak.” The image should be familiar to us Catholics: when they are appointed, archbishops, for instance, receive from the bishop of Rome a vestige of a shepherd’s cloak (i.e., a pallium) as a sign of their office.

In a similar way, palliative care seeks to cloak the pain and symptoms of a medical condition or disease. The goal is to minimize suffering so you can live as well as possible amid the limitations that come from the condition. It’s a good means toward a good end. In this way, palliative care can be used alongside curative interventions, or by itself if comfort is the only goal of treatment. Palliative care is what allows us to say, “care always, even if there is no cure.”

Second, suicide means “willful self-killing.” That is, it is an action in which death is chosen for itself or as a means to something else. To be “assisted” means, in this case, a physician is administratively essential because they prescribe the death-inducing pharmacologic cocktail.

Advocates typically claim this option is necessary to help patients avoid a “death without dignity” due to excessive pain or loss of autonomy. The academic research shows that, in practice, patients often cite they want to avoid future pain or ‘being a burden” on their family or society.

The motives, concerns and fears of patients are certainly valid; the problem is the means by which they are trying to address those concerns. And it is these fears and concerns that the political agenda uses to advance its cause. This agenda will also claim that patients with terminal conditions who chose this course are not choosing suicide since they are already dying. But if that’s true, then no suicide should be problematic: we are all mortals, doomed to die.

Yet, we see clearly how deeply false this is: the death of actor Robin Williams, and the countless young men and women who suffer from this fate, is rightfully mourned as a tragedy. How can suicide be on the one hand, tragic and terrible (even considered a regrettable national epidemic) and, on the other, laudable and “dignified”? It can’t, plain and simple.

I would suggest that, from a spiritual and even pragmatic perspective, assisted suicide is a simple fix, a means to an end: it lets a patient and physician eliminate suffering by helping to eliminate the one who suffers.

True compassion, which means “suffering with” or “in solidarity,” is difficult and draining. It’s time consuming and, yes, involves suffering of our own. But that’s not all.

Consider a story told to me by a colleague. Her cousin was diagnosed with a glioblastoma, the same brain cancer that affected Brittany Manyard, who, with national media attention, moved to Oregon to end her life under its law. Instead, my friend’s cousin chose the palliative care route. He spent his remaining days receiving treatment for pain and symptoms, but he chose to forgo any aggressive curative radiation or surgery—they wouldn’t work anyway.

Most importantly, he also spent his time with his dad fishing and watching baseball games, preparing well for death. His dad was his caregiver the whole way. At the end, the father said to his son, “Thank you, for letting me be a father.”

When I told this story to then-Archbishop Joseph W. Tobin, when he was in Indianapolis, he paused and said reflectively, “What an opportunity for grace!” Indeed, grace for every one of them. And grace for us, to learn how to love.

Love doesn’t eliminate the one who suffers or help them eliminate themselves. Love doesn’t run away or abandon the suffering one. Love descends and enters into the suffering of the beloved. Love makes the suffering of the beloved its own. Love places, as it were, the suffering other on its shoulders—like a shepherd’s cloak—and carries the beloved home, to rest and be healed.

The political movement advocating assisted suicide will, indeed, continue. But the true antidote to this societal impulse toward assisted suicide is not to simply say “no.”

We need to lead with our “yes”: “yes” to palliative care, “yes” to the dignity of patients and clinicians, and “yes” to life—even amid its limitations and hardships.

We need to build our resources for palliative care—medical care that treats pain and symptoms in a holistic way to uphold the dignity of the patient no matter their condition or life expectancy.

Advocate for it, support it, ask for it, receive it, recommend it to your loved ones. Now is the time. Don’t miss your opportunity for grace.

(Elliott Bedford is the director of Ethics Integration for Ascension Indiana in Indianapolis and a member of the Hospice and Palliative Care Initiative, a collaborative initiative among the Archdiocese of Indianapolis, Ascension St. Vincent and Franciscan Health.)

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