Euthanasia and Economics: A Doctor's Formative Experience

She weighed, I supposed, about 65 pounds. All of her limbs were withered and fixed into what is commonly called a fetal position. She was only in her early sixties. As a hospital resident doctor I had been called down to the emergency department to see her. She had been referred in from a nearby nursing home where she had been a long-time resident. It seems that the catheter that drained her bladder had become caught somehow during the process of routine removal for changing. It was my duty to discover a way to remove it.

She was a victim of a rare, incurable disease that causes the brain gradually to deteriorate over a period of years, usually beginning in middle age and always fatal. The judgment and intellect diminish along with the personality and control over the body. She lost control of bladder and bowel. She had not uttered a word in several years. Nor moved much. Nor seemed to understand. Nor swallowed food. She had been fed by a plastic nasogastric tube. Even now it protruded from her nose with the capped end taped to her skin.

I will never forget her. It was one of those experiences that I regard as formative in my personal medical ethic. The Word of God should determine what is right and wrong. Yet experience serves to bring the issues to my attention and allows a focus on the Scripture. The Bible instructs my experience. I am in the world. The Bible helps me be not of the world.

I discussed her plight with a urologist. He recommended a procedure from freeing the stuck catheter. It was the least painful we could think of. But it was not without pain. As I carried out the procedure, I discovered that she could still understand pain. She could grimace. At least, that is how I interpreted the contorted expression on her hollow face behind the tube and tape.

Her life had intrinsic value because she was human. She was formed in the image of God. I knew that the image of God did not refer to her physical appearance, whether or not it was marred by the consequences of Adam's sin. Yet was she still alive because we valued her or because we value our pretended omnipotence in the world? The technology that had preserved her physical existence is all commonplace nursing skill today. Special air mattresses do not qualify as extraordinary care. Nor does the practice of turning and positioning her frequently to prevent bedsores. Nor do catheters, nor plastic nasogastric tubes.

Yet plastic itself is so new my father recalls it as a novelty in college chemistry. Balanced liquid nutritional formulas were new when I was a baby. I remember easily the development of several types of air mattresses. Because we can, we muss. Because it is not extraordinary, we do it. Because someone else can be made to pay for it, we aren't even forced to think about is Scripturally. Even then her care was costing $18,000 a year. Had she lived another generation, she would have died when she was no longer able to swallow. Would she have wanted it this way? I never knew. There were no living wills then. I wish there weren't now. No family member evidenced interest or awareness. Opposition was rising at that time to the horror of abortion and its close relative euthanasia. At last evangelical Christians were becoming vocal against these evils. With interest heightened by this index experience and bolstered by numerous like ones since then, I have read our journals, newsletters, and publications. There is a persistent blind side in the anti-euthanasia effort. On this blind side are two errors.

One error is a failure to consider money. We are acting as if we are omnipotent when we pretend that we have the resources to provide what has come to be considered ordinary care. Those who would actively kill a sufferer are sinfully "playing God." Also "playing God" are those who believe that even sacrificial giving will satisfy the technological idols we serve, hoping to receive from them a prolonged material existence. The other error is that we overlook simple kindness of the Golden Rule variety. Would I have wanted to be treated as this patient was, even if no one had to be extorted to pay for it? No. Despite the simplicity of a nasogastric tube, I see it as no kindness as all, as prolonging death. As a human being with intrinsic value, the image-bearer of God, she had a right to expect of us bread. We gave her instead a stone.


Originally published in The Presbyterian Journal, February 12, 1986

The Pottage of Psychology

The Church is exchanging its birthright of scriptural admonition and help and discipline for the pottage of psychology. We needn't imagine that Jacob's pottage was tasteless and not nourishing.... Unless psychology is SQUARELY based on scripture (or science, which is in turn based on scripture), the price includes accepting human wisdom where God's is available and different. The price includes waffling on the issue of sin. The price includes not allowing the body of Christ to grow and mature as it exercises its gifts in obedience to God's direction, relegating all the "hard" problems to "trained professionals."


Excerpt from a private letter

Death with Dignity

Discernment is needed by conservative Christians concerned about the value of human life lest we become like the experts in the law described in Luke 11:46.

Medical efforts are not neatly divisible into heroic vs. non-heroic. Hope is a statistical probability in medicine which is almost never a zero. Hope to a Christian is never a probability and always 100 percent.

The use of complex machines or dangerous surgery highlight the issue but simpler measures are often where we need discernment. On occasions I have seen a $3.00 plastic IV tube transformed into cruel punishment of the dying.

It is true that there is no such thing as a life not worthy to be lived. It is equally true that there are treatments not worthy to be inflicted.


Excerpt from a letter to The Presbyterian Journal, August 18, 1982