I had gone to visit Grandpa in Groningen, Holland, for the last time before coming to the United States to study in January 1996. He was in a nursing home because of a stroke six years earlier, but still excitedly played in a chess club, often went to concerts and wrote us newsy letters about what all our cousins were up to. He enthusiastically looked forward to the daily visits of Grandma and the rest of the family.
But on the day of my visit, something was clearly wrong. Inexplicably, he had declined dramatically. He clenched my hand, asking for a glass of water because he was terribly thirsty. I helped him drink with a straw. He told me he loved me and that I should enjoy my studies. He was very sleepy, so I gave him a hug and a kiss and he lifted his hand to wave me goodby.
I called my father, telling him I felt something wasn’t quite right. Everyone else in the family, too, wondered why Grandpa was declining so rapidly. On January 22, three days after my visit, my aunt was with Grandpa, giving him some water, when a nurse walked by and told her that she couldn’t do that as it was the doctor’s orders to withhold all food and water. My aunt, beside herself, ran crying down the halls, telling everybody what was happening, but nobody lifted a finger. The wider family tried to talk to the doctor, but he refused all consultation. I never saw my grandfather again. Five days after he wished me well in my studies, he was dead.
The awful truth about Grandpa’s decline eventually became maddingly clear. A week before his death my aunt had taken him for a biopsy. He had had slight problems with a bump on his gum. The biopsy had shown the presence of non-Hodgkin’s lymphoma in a virtually symptomless form. Given Grandpa’s age, it was not an immediate problem. In the presence of Grandma, he had asked the doctor at the nursing home for help because he had pain in his leg from deep venous thrombosis, not a life-threatening problem, and one that was improving. The pain was there because he’d had to stop taking his blood thinners for a few days in connection with the biopsy.
But the doctor claims that Grandpa’s request “for help” was really a plea for assistance in ending his own life. So, without discussing his plan with my grandfather, my grandmother or anyone in our family, the doctor, sworn to a profession that once lived by the credo “Do no harm,” this doctor prescribed a lethal dosage of morphine and wrote orders that my grandfather be starved to death. Of course, he didn’t write it that way.
Grandpa, gone! He had held my hand five days ago. How could it be? Impossible! Why?
By now, euthanasia estimates in the Netherlands range from 5,000 to 20,000 out of the 130,000 deaths recorded annually, according to Herbert Hendrin in his book, Seduced by Death: Doctors, Patients, and the Dutch Cure. The decision that was initially made to help those in intractable pain, has become a slippery slope that has gotten steeper and more slippery.
Hendrin insists that “virtually every guideline established by the Dutch to regulate euthanasia has been modified or violated with impunity…. The Dutch government’s own commissioned research has documented that in more than 1,000 cases a year, doctors actively cause or hasten death without the patient’s request.”
The death forced upon my grandfather is not a wild exception. In the two weeks after my grandfather’s death, there were 18 deaths in that one nursing home.
What gives us the right to determine it is time for someone to die? And who goes next? The patient the doctor is angry with? The one who is filling up bed space? The one who is a nuisance?
In the modern practice of euthanasia, also called “mercy killing,” it appears to me that we are chasing the 19th century ideal of the survival of the fittest: only the individual who is strong and fit ought to be allowed to live. Where is the mercy in that?
I was dumbfounded when I read Ellen Goodman’s column, “The Dutch Way on Assisted Death” (April 22, 1997; St. Louis Post Dispatch). The euthanasia disease appears to be spreading. Goodman describes euthanasia in Holland as “somewhere between forbidden and permitted… The ending of a life by a doctor remains illegal, but doctors who follow careful guidelines may grant their patients’ death wishes.”
She rather optimistically proposes: “If there is an American parallel to the Dutch way, it might be a state-by-state experiment, a testing of different rules and experiences with assisted suicide. The truth is that we, too, want to find a way of dying that is both merciful and careful.”
Is euthanasia really merciful and careful? Or in our must-fix mentality is it an expedient that allows us to pretend we’ve found a “cure” for the physical demise of the body which awaits us all?
I agree with Dr. D. J. Bakker, a surgeon at the Amsterdam Municipal Hospital, who wrote in 1992, “A medical science that is in need of euthanasia has to be changed as soon as possible to a medicine that cares beyond cure.”
A medicine that cares beyond cure is a medicine that teaches doctors how to take the scientific knowledge of God’s world we’ve gained and apply it with integrity and honesty in the alleviation of pain; how to walk through the very real human fear of death with the patient when it comes, without thinking it has to be somehow fixed; and perhaps, most of all, how to affirm the integrity of the life the patient has lived and, in fact, is still living. No one is served by doctors pretending to be little gods who will make the world a better place, and their own work easier, by hastening our death.
Grandpa, dead. How could it be?
Copyright © 1997 by Edith M. Reitsema. Used by permission of the author.
Edith M. Reitsema, a Dutch citizen who grew up in South Africa, did graduate work at Covenant Seminary in St. Louis, MO. A shorter version of “Grandpa is Dead” was published in the November 30, 1997 issue of the St. Louis Post-Dispatch.
Seduced by Death: Doctors, Patients, and Assisted Suicide
by Herbert Hendin (Norton; 1998) 304 pp.
Seduced by Death: Doctors, Patients, and the Dutch Cure by Herbert Hendin (Norton) 256 pp. Recommended by Edith Reitsema as the best book she found while researching the topic. Seduced by Death is written by a psychiatrist who specializes in the management of suicidal patients.
Seduced by Death: Doctors, Patients, and Assisted Suicide (pictured) can be ordered through Hearts and Minds bookstore. Simply call them at 717-246-3333 and they’ll take it from there. A portion of the proceeds will be donated to Ransom Fellowship. The second book is out of print, but we saw used copies for sale on amazon. Your local library may also have a copy.
The New Medicine: Life and Death after Hippocrates
by Nigel M. de S. Cameron (Wheaton, IL: Crossway Books; 1991) 182 pp. + bibliography + index.
Must reading for Christians concerned for life and ethics. Cameron argues that modern medicine was made possible when Hippocrates, against the norms of Greek culture, separated the roles of healer and killer. The modern acceptance of euthanasia, physician-assisted suicide, and abortion (all common in Hippocrates’ day) reverses that great achievement and (re)introduces a new—a pre-Hippocratic—medicine.
His argument, Dr. Cameron says, “is simple: that it is a fundamental misreading of the history and nature of medicine to regard it as capable of surviving the revolutionary value-changes which are now in progress. Only if medicine were narrowly conceived in terms of technique—a set of skills, a matter of expertise—could this be so. If, by contrast, medicine is actually constituted by its commitment to a set of values, then the dropping of those values marks the beginning of the end of medicine itself.”
This book is published by the Center for Bioethics & Human Dignity and can be ordered directly from them.
Dignity and Dying: A Christian Appraisal
edited by John F. Kilner, Arlene B. Miller, and Edmund D. Pellegrino (Grand Rapids, MI: William B. Eerdmans Publishing; 1996) 242 pp. + index.
This book consists of twenty papers presented at one of a series of superb conferences sponsored by The Center for Bioethics and Human Dignity. You can order this book and many other worthy volumes directly from them.
“The world in which we live,” writes Dr. Dennis Hollinger in his paper, “Congregational Ministry,” is simultaneously death denying and death desiring. It is death denying in that it cannot face with peace the reality that we are all appointed once to die and after that, judgment. Ironically, at the same time western society appears to be death desiring in its growing attempts to control the final exit and legally affirm the right to physician-assisted suicide. The contradictions stem from the fragmented world view that many now embrace in the postmodern world, a perception of reality that finds truth unwelcome and moral character to be subjectively defined. When coupled with increased social mobility which robs suffering and dying patients of a caring network, society will probably continue to exhibit the contradictions surrounding death and dying. The calls for voluntary euthanasia will only increase.
The church’s role in responding to the crisis is unique. As a community of proclamation and care it provides what no other community can: a life-shaping story to make sense of it all, hope, meaning, forgiveness, a Savior, and a caring group of brothers and sisters to send us off when it is time to go.
This book is published by the Center for Bioethics & Human Dignity and can be ordered directly from them.
Introduction: The Experience of Dying
“A Physician’s Experience” by David L. Schiedermayer, MD (Clinical Professor, Medical College of Wisconsin).
“A Nurse’s Experience” by Arlene B. Miller, RN, PhD (Associate Professor of Nursing, Messiah College).
“A Pastor’s Experience” by Gregory L. Waybright, MDiv, PhD (President, Trinity International University).
Part I: Guiding Vision
“Autonomy and the Right to Die” by Nigel M. de S. Cameron, BDiv, PhD (Senior Vice-President of Academic Planning, Trinity International University).
“Death and Dying” by John T. Dunlop, MD (Associate Professor, Cardiac Rehabilitation Program, Victory Memorial Hospital).
“Suffering” by Marsha D. M. Fowler, RN, MDiv, PhD (Professor, Schools of Nursing and Theology, Azusa Pacific University).
“Faithfulness in the Face of Death” by Allen D. Verhey, BD, PhD (Blekkink Professor of Religion, Hope College).
Part II: Pressing Challenges
“Forgoing Treatment” by John F. Kilmer, MDiv, PhD (Director, Center for Bioethics and Human Dignity).
“Medical Futility” by C. Christopher Hook, MD (Director of Ethics Education, Mayo Graduate School of Medicine).
“Definition of Death” by B. Holly Vautier, MDiv (Co-pastor, First Congregational Church, Clinton, MA).
“Euthanasia and Assisted Suicide” by Edmund D. Pellegrino, MD (Director, Center for Clinical Bioethics, Georgetown University Medical Center).
Part III: Particular Settings
“Nazi Germany’s Euphemisms” by C. Ben Mitchell, MDiv (Consultant, Southern Baptist Human Life Commission).
“Oregon’s Solution” by Jerome R. Wernow, PhD, RPh (Medical Ethics Fellow, University of Louvain).
“North American Law and Public Policy” by Arthur J. Dyke, PhD (Saltonstall Professor of Ethics, Harvard University).
“The Netherlands Experiment” by Henk Jochemsen, PhD (Director, Lindeboom Instituut).
Part IV: Constructive Alternatives
“Hospice Care” by Martha L. Twaddle, MD (Medical Director, Hospice of the North Shore).
“Long-Term Care” by James R. Thobaben, MPH, MDiv, PhD (Medical Ethicist, Mississippi Methodist Rehabilitation Center).
“Wise Advocacy” by James S. Reitman, MD (Director, Ethics Consultation Service, Wilford Hall Medical Center).
“Parish Nursing” by Norma R. Small, RN, PhD (President, Concerned Care Management).
“Congregational Ministry” by Dennis P. Hollinger, MDiv, PhD (Pastor, Washington Community Fellowship)
“Theological Foundations for Death and Dying Issues”
by Dennis Hollinger in Ethics & Medicine (Volume 12:3 1996) pp. 60-65.
A helpful, brief summary of some of the key issues in the biblical view of suffering, dying, and death by the pastor of Washington Community Fellowship in Washington, D.C.
“When we begin to construct a theology for the ethical issues of death and dying,” Dr. Hollinger writes,
one is struck by the paucity of theological engagement with death. If death is a topic in systematic theologies, it is usually very brief and lacking in the same depth that accompanies other theological topics. But the contemporary ethical issues that attend the end of life call for clear theological reflection. In particular they beckon us to theological analysis of the nature and meaning of death, the nature of suffering, and the role of human agency or stewardship in relationship to God’s providence and power.
In reflecting on these three theological issues it seems to me that they are best understood in creative tensions. That is, that in the Bible sometimes several tenets or understandings are held together and ought not to be severed from each other. As we work at ethical issues like treatment termination or euthanasia these theological tensions give us perspective and boundaries. Most of us don’t like tensions, whether in relationships or in thought. But when Holy Scripture holds together two theological verities, we should not sever them; we must uphold the tension. Specifically we will examine three theological tensions as guidelines and boundary markers for our work in ethical issues of death: death as friend and foe, suffering as challenge to persevere and opportunity to overcome, and divine providence in relation to human stewardship.
“A Case Against Dutch Euthanasia”
by Richard Fenigsen in Ethics & Medicine (Volume 6:1 1990) pp. 11-18.
The author is a Dutch cardiologist working at the Willem-Alexander Hospital in the Netherlands. In this eloquent article, after arguing in detail as to why euthanasia is an evil which must be rejected, Dr. Fenigsen includes a number of case studies from Holland which are clearly designed to wake us up to the deadly seriousness of the issue:
When at a departmental conference in a Rotterdam hospital an internist was asked why he attempted (involuntary active) euthanasia without knowing the diagnosis, on a patient who was not seriously ill, he explained that it is the calling of the doctor to perform euthanasia when the opportunity presents itself, regardless of the diagnosis, to spare people the illnesses and sufferings inherent to life. Lifesaving medical help has been denied to Downs syndrome children, the elderly, and single people without close family, on the grounds that society should not be burdened with keeping such people alive, and that it is in their own best interest to die as soon as possible. So much for my own observations; some of the cases published in the Dutch medical and popular press are equally distressing. A wife who no longer wished to care for her sick husband offered him a choice between euthanasia and admission to a home for the chronically ill; the man, afraid of being in unfamiliar surroundings and in the hands of strangers, chose to be killed. An elderly man coerced his healthy seventy-three-year-old wife to submit to euthanasia promising to make recourse to it himself in three days, only to go off to Austria. In both cases the doctors were aware of the coercion; nevertheless, they put these people to death. A general practitioner called to a patient’s home, and seeing her for the first time, immediately asked her to choose between hospitalization and euthanasia. When the stunned patient could not reply, he gave her one hour to think it over…
“Suicide is Not a Private Choice”
by David Novak in First Things (August/September 1997; Issue #75) pp. 31-34.
Rabbi Novak, who holds the J. Richard and Dorothy Shiff Chair of Jewish Studies at the University of Toronto, examines a modern claim in the light of history, law, and the Old Testament.
“It seems there are two overall ranges of relations,” Dr. Novak writes, “that are destructive of authentic human personhood (of which privacy is certainly an essential feature), that encourage spiritual dissolution. That is because in the case of one, there is too little privacy, and in the case of the other, there is too much privacy.
First, there is the totalitarian scheme that claims our total subservience and disposability for it alone. If any of us is better dead than alive for the state, it becomes our duty to be eliminated or to eliminate ourselves even before the state has to bother itself with the unpleasant necessity. Thus it was no accident that the suicide rate of German Jews beginning in 1933 dramatically increased—years before the actual ‘Final Solution’ of the death camps was implemented—when the society to which most of them believed themselves to be integrated members sent them the clear message that their presence was to be removed at any cost. Death became the last privacy to which they were consigned.
And second, there are the radically liberal regimes that send the message to their citizens that they are basically on their own, especially in situations when tempted with self-destruction. Here is where persons are the least self-sufficient, the most in need of help from others. In fact, is not our primary social need the need to be helped to control our own murderous tendencies? Thus in the Bible, the first city is founded by Cain, the first murderer, who, when left alone after killing his brother cries out (Genesis 4:13), ‘My crime is too great to bear!’ The city is to protect him both from being killed and from killing again.
When a society regards itself as being charged by a higher authority to care for each and every human life in its charge, is it not the prime responsibility of a society so charged to intervene, to break into our privacy, when there is a strong chance that death might otherwise occur? For if society is charged to defend all human lives from destruction, there is no longer a difference in kind between homicide and suicide.
“Always to Care, Never to Kill: A Declaration on Euthanasia”
in First Things (February 1992; Issue #20) pp. 45-47.
A concise and helpful statement signed by Protestant, Catholic, and Jewish leaders which argues against euthanasia on religious, moral, legal, and medical grounds.
“The well-organized campaign for legalized euthanasia,” the Declaration states, cruelly exploits the fear of suffering and the frustration felt when we cannot restore to health those whom we love. Such fear and frustration is genuine and deeply felt, especially with respect to the aging. But to deal with suffering by eliminating those who suffer is an evasion of moral duty and a great wrong. Deeply embedded in our moral and medical tradition is the distinction between allowing to die, on the one hand, and killing, on the other. That distinction is now under attack and must be defended with all the force available to us. It is permitted to refuse or withhold medical treatment in accepting death while we continue to care for the dying. It is never permitted, it is always prohibited, to take any action that is aimed at the death of ourselves or others.
“Would Dad be Better Off Dead?: the Problem of Physician-Assisted Suicide”
by David L. Stevens in Today’s Christian Doctor (Volume XXVII, Number 4; Fall 1996) pp. 4-7. A publication of Christian Medical & Dental Associations.
A medical doctor, former missionary, and executive director of the Christian Medical & Dental Society addresses the issue of physician-assisted suicide thoughtfully, and from first hand experience.
“As in the years leading up to the Roe v. Wade decision,” Dr. Stevens writes, “today the church and the medical profession are ill-prepared for the debate and in denial that physician-assisted suicide could happen here. Time is short if we are going to keep the dam from breaking.” Stevens argues that seven key points should be emphasized in educating the church and the wider public:
-legalizing physician-assisted suicide will destroy the trust relationship between doctors and their patients (and their patients’ families)
-physician-assisted suicide will open the floodgates of death
the slippery slope of physician-assisted suicide will be greased by the first commandment of medicine today: thou shalt lower costs
-physician-assisted suicide cannot be successfully regulated
-there is little if any true compassion in helping patients kill themselves
-we should not change the rules that have stood the test of time based on rare, sensational cases; and most importantly, legalizing physician-assisted suicide breaks the principles laid down in God’s Word
“‘Inevitable’ Assisted Suicide?: Don’t Bet Your Life”
by Wesley J. Smith in Human Life Review (Volume 23, Number 2; Spring 1997) pp. 61-74.
A California attorney discusses five key issues which are seldom mentioned but are crucial in the debate concerning physician-assisted suicide:
-assisted suicide would not be limited to the terminally ill
-legalized assisted suicide would be especially dangerous in the money-driven U.S. health care system
-protective guidelines do not work
-assisted suicide is a new form of oppression
-assisted suicide is unnecessary to alleviate suffering