The Dying Society

More and more jurisdictions across North America are embracing the latest nihilistic trend in medical decision making - euthanasia.  Multiple states, led by Oregon, have legalized it under specific circumstances and last year the Canadian Supreme Court struck down the federal law prohibiting physician-assisted suicide after deciding that it violated the Canadian Charter of Rights and Freedoms.  

As the situation currently stands, the old law remains in place for another month or so.  The current government has asked the Court for an extension so it can craft a new law before the old one expires.  If the extension is not granted, or even if it is but the government can't pass a satisfactory new law, Canada will be without any law prohibiting physician-assisted suicide, much like it has lacked any law regulating abortion since the old one was struck down by the Supreme Court back in the 1980's.

The results of this development are either enlightening or frightening, depending on which side of the debate you sit.  For those who hold that God gives life and only He can take it away, this is a tragedy and another step towards civilized barbarism as Western society sinks into cultural decay.  For those who see nothing sacred in life this is a great step forward.  For decades we've been able to kill unborn babies without consequences (at least none that we're allowed to talk about).  Now we can proudly add the terminally ill to the list.

But will the list end there?  Already in Europe, the pioneering area in euthanasia, physician-assisted suicide has expanded to include children with disabilities, people with prolonged but not necessarily terminal illnesses and even the very depressed in some places.  In the absence of a law in Canada, will the initial "Only for the terminally ill and those with intractable pain" quickly expand to other indications?

Consider how the definition of death changed in Western society in the late 20th century and you'll see a reason to shudder.  The former definition was a strict one, quite close to one of the mainstream positions in Jewish law in requiring cessation of cardiorespiratory function.  Faced with a need for organ transplants and a lack of organs due to this definition, ethicists in the 1970's and 80's changed it to one requiring brain death only, not brain stem death or cessation of cardiac function.  This had the beneficial effect of allowing doctors to pronounce people dead even thought they would have previously been considered to be alive and thus increased the availability of organs for transplant.  

Currently Western society considers it a sign of mental illness to desire suicide.  We hospitalize people against their will when they try (and fail, of course).  Well, what happens when we change the definition?  Let me present the following one for your perusal: Suicide is wrong when attempted by a person with no physical or mental illness that might reasonably encourage him to want to kill himself.

Imagine that definition going into play.  It sounds nice in that it creates a category of people for whom suicide would be considered wrong but the minute someone tries to kill themselves it becomes evident that they have a mental illness that encourages them to want to kill themselves.  

Part of this drive takes place in the shadow of Western society's growing aversion to any kind of suffering.  We want to live without pain, without illness, without disability and see any of those three things as intolerable affronts to our pursuit of personal fulfillment.  A life not free of these things is not a life worth living, according to this popular way of thinking.

In typical decadent Western fashion, it won't be the patients ending their lives themselves.  No, they'll get their physicians to do it for them.  They don't want to suffer and they don't want to lift the syringe either.  They want to sit back and passively exit life without even taking the final responsibility for the moment it happens.  

And where are the red lines?  If people will end-stage cancer and ALS can request that their doctors kill them, why can't people with dementia, severe depression or just good old fashioned loneliness?  Any red lines would be arbitrary and ultimately moved to accommodate societal desires.

As an Orthodox physician I tremble at the thought of this coming to pass.  Engaged as we are in a low level culture war between religious and secular liberal forces, this will play out for me on a personal level.  Halacha is very clear on this issue: I am forbidden to participate in any way in physician-assisted suicide (even of socialists and communists, nebich).  That means that I cannot even refer a patient to  physician willing to kill them if I won't do it myself.  On the other hand, the political correct regulatory authority that issues my licence to practice medicine has, over vociferous protests and objections, announced that it expected physicians either to kill their patients on request or to make arranged to find a doctor who will.  Refusal to help kill patients would result in disciplinary action and possible loss of right to practice medicine.  What's a God fearing Jew to do?

Well the answer to that is evident, isn't it.  But it's the bigger picture here that should scare us all: a society that has no interest in living with adversity will eventually lose its will to live at all.