The Logical Outcome

On the value, beauty, dignity of every human life. And on the ownership, stewardship, and eternal nature of every human life.

May 27, 2023

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A few years ago I was serving on the pastoral staff of a large church when a young woman walked in on a Sunday morning and wanted to talk to somebody. I happened to be standing right there and so we went into my office and she asked me about Christianity - specifically, how could she (or even could she) become one? I asked her about what brought her to that question and she told a story that started with a broken marriage. She had always believed that everyone should do whatever made them happy and she married a man who believed the same thing. The logical outcome of that philosophy as it worked out in his life ended their marriage. And this woman began to question what she had always believed. She thought perhaps doing good in the world was what life should be about. She began to investigate what doing good in the world looked like to her and that led her into a number of efforts to help the homeless, the poor, the addicted … and in every case, she found herself surrounded by Christians. She went online and found that our church had a number of such ministries, and so - there she was, asking me about Christianity.

We are often warned against what are called “slippery slope” arguments. That one bad (relatively minor) thing will lead, like sliding down a slippery slope, to more and more significant adverse outcomes. Of course, slippery slope arguments can be overdone. But what are often dismissively called slippery slope arguments are simply efforts to point out the logical outcome of an action or set of actions or philosophy. A man who believes that life is about doing whatever he wants will cause great damage in his marriage and in other relationships - and, eventually, even in his own estimation of his life. Of course he will. If there is no limiting principle, doing whatever you think will make you happy will justify almost anything - from adultery to murder to everything in between. It is absent a realistic anthropology which would help us see that I will want to do things that are destructive to me and to others. It is just the logical outcome. That view - do whatever makes you happy - is a branch of a larger philosophical tree, the fruit of which is present all around us. It goes something like: “as long as you aren’t hurting anyone … do what you want … it is your life … who can tell you to do something different (as long as you aren’t hurting anyone).”

Where is all this going? Sorry. It has taken me a couple of paragraphs to get to where I want to start. Here it is: Euthanasia is the sixth leading cause of death in Canada.

MAiD - or Medical Assistance in Dying - was made legal in Canada in 2016. And euthanasia is not simply a Canadian phenomenon, of course - a number of states in the US have legalized it in some form and it has been legal in Belgium and the Netherlands and in other countries for some time. It has become well enough established in parts of Europe that it has sometimes been called The European Way to Die.

Arguments that were characterized as “slippery slope” were present in abundance when the Canadian law was being debated - that this law, however carefully it began, contained the philosophical seeds that would lead to its expansion into areas not thought possible by proponents. And that is what has happened. What was initially intended to be a careful and compassionate solution to extreme suffering at the very end of life has become, in just a few short years, something far more common. Without identifying a limiting principle - “when is this not appropriate?” - MAiD has expanded far beyond a few terminal cases to include people for whom death is not foreseeable in the near term. The depressed, the poor, the homeless, the mentally ill need only find a doctor sympathetic to their situation to be euthanized. Further expansion to “mature minors” is also being considered. Where is the limiting principle?

When MAiD was first implemented, in 2016, a CBC article claimed that 90 percent of requests for assisted deaths were being refused in Toronto. But by 2021, only 4 percent of requests were deemed ineligible nationwide. “There isn’t a slippery slope,” said Timothy Stainton, a professor of social work at the University of British Columbia. “This is Mount Everest in a snowstorm.”

The daily death toll is staggering, even more so because it is unreported. Every day in Canada, in 2021, more than 27 people died by the hands of their physicians or nurses. It’s double the suicide rate, and there isn’t any sign of its stopping or slowing down. The world’s “euthanasia capital” is no longer Brussels or Amsterdam. It is now Ottawa. Canada euthanizes more people than any other country in the world — and its death toll is growing at a faster rate than that of any other voluntary system of euthanasia anywhere.

Canada’s Ministry of Death - National Review - 2/20/2023

For the last year that we have statistics (2021), over 10,000 people were euthanized in Canada. These deaths happen under a doctor’s care, typically in a hospital (distinguished from physician-assisted suicide, which typically occur in the home). In fact, roughly 6% of deaths in a Canadian hospital in 2021 came from a doctor administering lethal drugs. And this number is rising so sharply, that the numbers for 2022, when they are available, will almost surely be significantly higher. Of course they will.

Third annual report on Medical Assistance in Dying in Canada 2021 - Canada.ca

Some of the earliest and most consistent critics of MAiD in Canada are those in the disabled community, or those who work in this community and hope to reinforce to members of this community their worth and dignity as humans.

In sharp contrast to this gentle language that seeks to make death seem not so very terrible, proponents of MAID expansion use rather grimmer language to talk about the lives of the disabled and dying. They talk about experiences of dependence, diapers, or drooling as evidence of a life lacking in dignity – and thus a life that should be allowed to be ended by doctor-delivered death. It is not a stretch to see why disabled advocates have argued that the expansion of MAID sends the message that “simply having a disability is reason enough for us to want to die,” that life with a disability is necessarily a life unworthy of being lived. Their fears are already coming to pass.

Benjamin Crosby - Plough - 2/27/23

It should not be surprising, then, when MAiD begins to be mentioned in conversations with the homeless, the poor, or the mentally ill who struggle to gain the resources they need. A government that spends resources to prevent suicide, provides the resources to make MAiD free.

Some medical professionals even bring up euthanasia unprompted as an option for patients, including as a component of conversations about the costs of hospital stays, and there are regular reports of disabled people, given the insufficient state of disability benefits in Canada, considering MAID because of poverty. The implicit proffer of MAID as a solution to poverty and disability is a grievous betrayal of many of the values Canadians hold dear, of the laudable Canadian commitment to a kinder and gentler society which I have come to so admire as an immigrant here.

Crosby - Plough - 2/27/23

Disability experts say the story is not unique in Canada, which arguably has the world’s most permissive euthanasia rules — allowing people with serious disabilities to choose to be killed in the absence of any other medical issue.

Maria Cheng - Associated Press - August 11, 2022

It is easy to understand why one facing an excruciating period of time marked by dependence (or loss if independence), suffering, and fear would want to end that terminal phase early. I am sure I would want such a period for me to be as brief as possible. But hidden within that completely understandable sentiment lie huge questions about the purpose of life, about who’s life it is, and about the place of suffering and dependence for us. And if life is about more than independence, more than the experience of pleasure or the avoidance of pain, if I am a steward of my life and not the owner, if dependence can be good even if unpleasant - then my independent decision to preserve or avoid all of these things is surely out of place. It isn’t so much that it is the wrong decision - it is that it isn’t my decision to begin with. Much more than that, these questions have far more import for us with decades left to live (God willing) - because they are about the life we are supposed to be living now. If life is about having “good” feelings and avoiding “bad” ones, one might conceive of ending suffering early - but what a bleak life that is until then.

It is a tenderness which, long since cut off from the person of Christ, is wrapped in theory. When tenderness is detached from the source of tenderness, its logical outcome is terror.

Flannery O’Connor - Mystery and Manners (1957)

To be clear, I believe we can, and where appropriate should, do what people have done for thousands of years - to let the natural process of dying take its natural course. We are not obligated, nor advised, to pursue every possible treatment. That is far different from planning the date, time, and manner of our own death. Grasping at every possible treatment for as long as possible likely reveals a different sort of malady. But I am mostly here concerned not with death, but with life. What is it? Whose is it? How are we to live it? My concern with MAiD is multifaceted, but is largely related to how we conceive of life.

One of my first experiences with this issue came from preparing a briefing for a church leadership team a number of years ago. We watched selections from the documentary How to Die in Oregon. It is an excellent and very sympathetic telling of the story of a woman with cancer who chooses to die before the disease will take her. She says at one point, “this is not what I signed up for.” I sympathize. I am sure I have had the same sentiment at points in my life, but I was wrong, I believe. I don’t think this sentiment is really true in at least a couple of ways. What did we sign up for? That is a big question. What is this thing called life and what is it for? A bigger one, inherent in Christianity (though often ignored), is “who signed up for this?” Traditional Christian teaching (again, often ignored) is that I was signed up for this life. I didn’t sign anything. It is a gift, from Another. I am a steward of this life, not the owner. I am not free to do as I choose, even if I could construct a universe where no one else was hurt by my freedom (which I can’t). What I think I signed up for and what this life may really be about often diverge. As Flannery O’Connor wrote, even when I seek to act in tenderness, but when I am the one defining tenderness, what I believe to be tender may have terror as its logical outcome.

But what about my freedom? Isn’t freedom the quintessential American virtue? Didn’t the apostle Paul say “it is for freedom that Christ has set us free” (Galatians 5:1). Yes. But he had a pretty different conception of freedom - that I am free, empowered, transformed to do what I could not do before - to love my neighbor as I love myself (Galatians 5:14-15). I was recently asked about what is sometimes a point of confusion related to Christian freedom - that if God restores us and gives grace freely to us - aren’t we free to do whatever we want? I mean we can’t wear out God’s love, right? Part of my answer to this (theologically incoherent) logic was - “but what are we free for?” Freedom for what? Is the purpose of life to do whatever I want? Without wrestling with this question, we may be exercising our putative freedom in ways that move us toward despair, hopelessness, nihilism, and self-destruction. In our age of maximum freedom, we seem to be experiencing more of this darkness than ever before. By maximizing freedom, we are enslaving ourselves. In trying to extend our freedom into controlling the timing and manner of our death - we are missing the point of life. Who can look at what is happening in Canada and claim it as an advance for humanity? Forget what it says about death, what does it say about life?

The limiting principle of Medical Assistance in Dying or in Physician Assisted Suicide is the same limiting principle in all suicide, and in a thousand other decisions of moral import. It isn’t my life. It belongs to Him. One day I will be asked about it. I should, therefore, get busy.

Then Jesus said to his disciples, “Whoever wants to be my disciple must deny themselves and take up their cross and follow me. For whoever wants to save their life will lose it, but whoever loses their life for me will find it.”

(Matthew 16:24-25)

I am free to love those in despair, sickness, dependence, and poverty. I am free (whether I use this freedom or not) to count these lives as having equal value as those not (yet) afflicted. We find our lives precisely in not thinking about how to prioritize our comfort, pleasure, and security over the care of others. We also find it in being in community. This will mean taking care of others. But it will also mean being cared for, being honored in our need. I don’t want to need care or to be honored in my need - I don’t want to see my freedom slowly ebb into dependence. But, and this is easier to type than to live, it isn’t about what I want. I also know that this care doesn’t happen as often as it should. I know as well that all of this might be easy for me to say because I am not facing immediate suffering. But I am facing death, as are all of us. The question is who are we and how are we to live until then?