Saturday, January 21, 2006

Episcopal Thoughts on Suffering and Dying

This week the Supreme Court ruled on the case of Gonzales vs. Oregon. This was the case related to the Oregon Death with Dignity Act, and the issue of physician-assisted suicide.

The issue in the case was whether Federal drug control legislation supercedes the rights of the state of Oregon to regulate medical practice. Under the previous Attorney General of the United States, John Ashcroft, federal policy was established that prescribing a predictably fatal dose of medication to enable a patient to commit suicide was a medically inappropriate use of a controlled substance for which doctors could lose their DEA license, and perhaps be prosecuted. The state of Oregon sued, claiming that regulation of physician practice was a prerogative of the states, one that federal law could not overrule. The Supreme Court agreed with Oregon.

It’s noteworthy that this is in fact a very narrow ruling. For example, it apparently doesn’t affect another recent ruling by the Court against medical marijuana. More important, it doesn’t really address whether a person, even in search of palliation of suffering, has the right to commit suicide.

As one who works with people who are suffering, I take this issue seriously. We wrestle, many of us, with the appropriate response to people in pain, people in severe disability, people who find their current experience unbearable. When we ask patients to consider health care treatment directives and living wills, those instructions on care in extreme circumstances, we do not use the language of life and death, but of quality of life and experience of dying. When is life not worth keeping? When is death better than the process of dying?

I will have several comments to make to this. For this post I want to point out that the Episcopal Church has spoken to this. When our people say the Church does not speak to contemporary issues, it is largely because they do not know that the General Convention and the various diocesan conventions do speak to these issues. They do not know, I believe, because we as clergy do not tell them. Before we let anyone complain – before we ourselves complain – that the Church says nothing, we need to look to General Convention. Very often in fact General Convention has spoken.

In this case, General Convention spoke as far back as 1991. It first spoke in Resolution 1991-A093, “A Resolution to Establish Principles With Regard to the Prolongation of Life.” This resolution was then amended in 1994 in resolution 1994-A056. (You can begin a search to find these and other resolutions of General Conventions back to 1976 at http://www.episcopalchurch.org/13299_502_ENG_HTM.htm?menu=menu5393.) Let me share some parts of the resolution as amended that I think are worth note and discussion.

“1. Although human life is sacred, death is a part of the earthly cycle of life.”
“2. Despite this hope [of resurrection in Christ] it is morally wrong and unacceptable to take a human life in order to relieve the suffering caused by incurable illness…. Palliative treatment to relieve the pain of persons with progressive incurable illnesses, even if done with the knowledge that a hastened death may result, is consistent with theological tenets regarding the sanctity of life.”
“3. However, there is no moral obligation to prolong the act of dying by extraordinary means and at all costs if such dying person is ill and has no reasonable expectation of recovery.”


These are from the first three paragraphs of an eight-paragraph resolution, and there is much to discuss even in these passages, much less the entire resolution. I am struck most powerfully by the recognition that physician-assisted suicide is presented in no small part in the belief that there are some conditions for which no other adequate palliation exists. At the same time, much has changed in palliative care since the Church first spoke in 1991, or the Oregon Death With Dignity Act was passed in 1994. If the current generals are always fighting the last war, as the proverb goes, is the current Supreme Court arguing a problem out of date?

But, no, I don’t think we can accept that. Suffering continues. Patients continue to experience intractable pain, and need all the palliative care we can morally provide. We need to continue to reflect on what is appropriate in easing that suffering, in taking the fear out of the process of dying. And as we reflect, we as Episcopalians need to be aware that the Church has not been silent. We may not feel compelled by acts of General Convention (and that also may be the topic of another reflection), but we should not ignore them, if we are to maintain our integrity as Episcopalians. And if it shows little integrity to ignore them, it shows less integrity to remain ignorant of them.

(One further reference I can recommend: "Faithful Living, Faithful Dying" from Morehouse Press. This book, prepared by the End of Life Task Force of the Standing Commission on National Concerns, was received at the 2000 General Convention. It addresses these and other issues of care at the end of life.)

2 comments:

Peter Menkin said...

Regarding your post, "...Thoughts on Suffering and Dying." I read your comments on death with interest, especially in light of the Supreme Court decision. I was happy to see that the Episcopal Church through General Convention does not endorse aided suicide for the ill. Usually, people are at a loss as to what to do about so large a subject, and guidance along with discussion of the issues is a help. Thank you for your thoughtful postings on your blog. I have been blog-surfing and came across your blog.

In my parish volunteer work, what we in our parish call our lay ministry, I visit the elderly and the dying. Often I read to those who cannot read because of weakness or fading life, and often visit those who have no family. The most difficult visits, for me, are those with the dying who are on artificial life support. There is something spiritually difficult about pulling the machinery that keeps someone alive artificially, and for my side being a journeying friend.

In my experience, and for my own and what I think of others wellbeing regarding suffering and death, a natural resolution is better. The person who is dying is at peace, there is less struggle, and what I perceive as discomfort. Everyone does not hold my opinion, and stance, as I have learned. There are many who wish life to be prolonged as long as possible.

To the issue of aiding death, it is an irrevocable act and to me reprehensible to do the things it takes to aid death in shortening life. I perceive there is a balancing act, a kind of contradiction that we live with in this kind of discussion. I seek the peace of mind and spirit that you suggest in your outline of mercy and reliance on God.

P.S. I have a new blog myself:
http://journals.aol.com/novatopete/Poemsandreflectionsspiritualreli/

Marshall said...

Peter, thanks for commenting. And, I will certainly look at your blog.

In clinical ethics we often say that any intervention that can be refused can also be attempted and then withdrawn. I won't go into the arguments. Our point when we get to the bedside is to offer some option to family members who feel overwhelmed by the issues that confront them. At the same time, I know well that sometimes it's harder to stop an intervention than it is to not start in the first place. We try not to direct family members to the decision we would prefer; but we do have opinions, and it can also be hard to keep our discussions neutral.

I will say that I am wary of discussing "dying naturally" or "letting nature take its course." If we were to pursue that position, it's too late when you get to the hospital. We have already intervened with antibiotics, pain medicines, and other interventions. All too frequently, by the time the phrase "natural death" comes up, we are long past what is "natural."