End-of-Life Decision

Introduction

The case study involves George who is an attorney and in his mid-fifties. He began engaging physically by playing and coaching basketball for his son’s school team. He began experiencing muscle weakness and unresponsiveness and muscle coordination which prompted him to fall and injured his hip. During his treatment at the hospital, it was identified that he is suffering from amyotrophic lateral sclerosis (ALS). ALS is a degenerative disease that affects the nerve cells in the brain and the spinal cord. This disease is progressive and destroys the motor neuron gradually to the level of muscle control loss. The disease has no cure and any treatment only aims at managing the disorder. The life expectancy is considered to be three to five years but some few cases have extended to over ten years. The continued muscle atrophy finally causes inability or speaks, move, eat, and even breathe. The patient will be forced to finally rely on a wheelchair and a ventilator to support his life. George dreads the moment he will become a captive inside his own body and be reliant on others for completing simple basic tasks. This gives him the thought of a voluntary euthanasia. This paper will aim to capture the religious perspective with regard to end life decision. Specifically it will be based on Christian and Buddhist values on life and carry out a comparative ethical analysis of George’s scenario and the most appropriate decision from the views of the two religions. 

Religious interpretation malady and suffering

Christianity

The case of George’s suffering in form of physical malady through ALS leaves questions to why suffering exists. Christians always try to come up reasons for illness and other kinds of suffering. It evokes a question of whether God really loves us and if so, how could he allow sufferings to those He love. One major Christian perspective on the causes of suffering is because we live in a fallen world that through sinning welcome death.  According to the Christianity perspective, while we may never completely and exhaustively understand the reasons behind sufferings, the Bible shed lights on this topic.

It is observed that suffers helps create intimacy with God (Job 42: 5). This was brought out during the sufferings that Job underwent making him claim that his ears had only heard but with his eyes had actually received the relation. Christians, during the periods of sufferings, have an opportunity of deepening their relationship with God. In a way, suffering is seen a means of refining the Christian. The Book of Isaiah 48:10 attests to this by claiming the God brings test through furnace of affliction.

One concept that arises when the Christians try to answer the questions why suffering such as the one facing George occurs is theodicy. Theodicy represents the arguments brought out in defense of God during times of suffering. These perspectives are founded on the baseline of proving that God is still in control even in the times of pain and suffering. Different theodical arguments indicate that sufferings to be a way of God testing one’s faith or a way of inflicting punishment for wrong doing (Dein, Swinton & Abbas, 2013).

The Christians’ perspective further sufferings comes to give mankind valuable lessons such as humility, empathy, concerns for others, endurance and tolerance , being of good character and promoting righteousness (Hebrews 12:11, Romans 5:3-4, James 1:2-3).  Despite the suffering, Christian view holds that the Christians should still have hope in God. In the Book of 2 Corinthians 12:9, it describes that God’s grace is sufficient. God’s power is manifested in a perfect way through weakness. Therefore according to the Christians’ view George’s illness is not meant to bring suffering but to the glory of the name of God  (Strobel, 2001). 

Buddhism

Buddhism is a religion that believes that every occurrence has a cause and a consequence according to Ratanakul (2004). This is Karma, or the correlation between ones actions and the consequencies that come as a subsequent. Literally taken, it would mean that the outcome of George is bad because he was bad. Is this the case? Buddhists believe that life is a complex web that cannot be differentiated for an individual but the present life is part of a circular existence (Samsara) which goes back in ages. The existence of a single individual is thereby conditioned by the existences of others who preceeded the current life. Therefore borrowing this knowledge, I would advice George that his condition is not his own making, it can easily be the result of other people misdeeds manifesting in his life. In the Karmic law, George is expected to derive comfort by knowing that if he is confident that his life has been characterized by good sila (morals), samadhi (discipline) and panna (wisdom), he can attribute his suffering to the legacy of others in his circle that lived in the distant past. At the same time, as the Karmic law expects, George will be required to handle his body with utmost care since indulgence in alcohol and other substances that negatively affect our bodies will only act as catalysts to the suffering. 

Religious view of life of a person with a disorder such as ALS

Christianity

George’s analysis of his own life after being diagnosed with ALS seems unbearable. He cannot imagine himself losing his ability to move and speak. It is devastating that his life will have to fully depend on others for the simple daily functions. He is aware that continued degeneration would reach a point where he would be a captive within his own body. According to him, this would be torture as he would lose his dignity and position of powers. It is out of this reason that he considers taking voluntary euthanasia.

Christianity holds the perspective that life is a gift from God. God created human beings is His likeness, therefore destroying life would be against God’s will. By creating human beings in His own image, God accorded human life an intrinsic dignity and value. Human beings share the same image with God. The likeness to God gives human beings a special rational capacity to help differentiate between good and bad. Human life despite the quality or condition that is currently at is worth. This makes any argument based on the quality, such as the one made by George to be irrelevant. Christians therefore believe that no one has the right to ask for mercy killing for anyone or even their own life. The Christian views emphasize that all human being are equally valuable. By the virtue of being a human being created in the image and likeness of God, human life qualifies to be accorded with dignity and value. At no one point should the value of human life be measured by the means of mobility, intelligence, or success in life. 

Buddhism

Buddhism places very high value on every life and every suffering that might accompany such life is highly regretted. Buddhism starts with life and human existence is can be understood as a combination of the following five things: the physical being (rupa), emotions (vedana), ideas (sanna), mental dispositions (sankhara) and lastly consciousness (vinnana). Though nature is a combination of many forms of life ranging from plants to other animals, human life is viewed as a rare form of life that is often tasked with special responsibilities. The ability to make choices is what makes humans different. On this, George should view himself as a characteristically useful human being since he was able to choose his career, and to help other humans through teaching (active morality according to Matsuoka (2005)). He should not have doubts with his life, in the Buddhist view, he is immensely precious. 

Physical suffering (living with ALS for George) from a Buddhist point of view is a part of life that is inevitable. Age is bond to come along with some degree of suffering which in George’s life it has assumed the shape of ALS. What George can do is only managing the situation using drugs and modern technology which are also gifts from God. 

Values and considerations that each religion focuses on in deliberating about George’s decision on euthanasia

Christianity

Respect for autonomy

Autonomy is understood as the ability of being self-determined and able of making rational decisions. It is not all about having the rights to make a choice but rather the ability of making a duly, informed and rational decision (Moulton & King, 2015). One thing that is worth noting from the Christians perspective is being accountable for our decisions. Human beings being created by God is His own likeness are ultimately accountable to Him (Rutledge & Patrick, 1995). The Christian prohibit euthanasia even when requested explicitly by the patient. They consider the right to autonomy as not being relative. It is to accorded validity when it is used in light of other moral values concerned with respect of human life (Keown &Keown, 1995). It is also argue the state of sickness inhibits the ability of an individual to make rational decision.

Palliative care

George is resolving to euthanasia because he feels he will be unable to cater for his needs. The Christians hold that with the appropriate care, most of the suffering can be relieved. The Christians are prompted to carryout out acts of mercy, one of which is taking care of the sick. Using this idea, the Christianity will provide an option to offering support until the last minute as opposed to voluntary death (Dein, Swinton & Abbas, 2013).

God’s commandment 

According to the sixth commandment (Exodus 20: 13), it prohibits taking of human life. The Christians considers any form of mercy killing as murder which is a direct confrontation of the commandments given by God himself. It is from this commandment that the Christians peg their principle of sanctity of life from the point of conception until natural death.

Buddhism

Opting for euthanasia is a decision that George has to make to eliminate suffering especially in the long run phase of the disease. For the euthanasia to happen in the precincts of the Buddhist religion, various conditions need to be satisfied. It is however important to note that the religion does not advocate for euthanasia since life is priceless. The need for the procedure therefore needs to be justified on individual basis. To conduct euthanasia, three things are required as previously mentioned. First, is the aspect of compassion, the precept of not killing and wisdom which should all be observed? In the case of compassion, we should try and understand the feelings of the said patient. When the case is terminal and the level of pain involved is too much, we should allow the said person to cross over the bridge of life. The sole intent of euthanasia should not be driven by the intent to kill. For wisdom, for instance, when faced with a terminally ill patient, probably on life support and who needs many dollars each minute to survive, wisdom should be applied. Where the answer to such a scenario is definitely death, it would be wise to terminate the life of the said person. 

Moral justification

Christianity

George’s decision is being influenced by the possible deteriorating condition. While ALS poses the danger of doing serious damage George’s body, the intrinsic value of his life as a human being still remains the same. It would be thus ethically wrong to judge the worth of his life looking at his physical appearances.  From the Bible the Christians are assured that the battle is not a physical one but rather a spiritual one.

The Christian moral ethics hold that a good end does not justify a bad means of achieving it. In this perspective, they would be against the euthanasia. Just because the decision of voluntary euthanasia alienates George from suffering, it does not make the act of killing involved any lesser of a sin. The Christian morals hold that the morality of an action is not determined by the results of that action.

Buddhism

Under Buddhism, the only rational decision to make is to delay the euthanasia decision. First, George has just been diagnosed with the ASL disease and it is not apparently clear what the disease has in store for George. Second, according to Buddhism, physical feelings should be overridden by mental strength. To ensure that his mental strength is not swayed by the physical suffering, he can do what gives him both physical and mental satisfaction. This will be altering his karma. Be it charity, tourism or lecturing, he can do it so that he will be at peace with himself. He should also put his affairs in order by reconciling with those he was at odds with and ensuring that his property is in safe hands. 

Personal opinion

George should wait until he can bear it no more. He should not be embarrassed with the deteriorating state of his health but instead, he should be pleased with what he has managed to achieve as a human being. When the odds against him become hard to change, he can make or be assisted to make the decision that will bring to a halt his life. George cannot use autonomy for his decision as it should not be considered in isolation. Terminating his life based on the principle of beneficence is not absolutely acting in his own interest. Under the beneficence, the patient is supposed to follow the physician’s treatment choice which in this case, George has yet to consider.

References

Dein, S., Swinton, J., & Abbas, S. (2013). Theodicy and End-of-life Care. Journal of Social Work in End-of-Life and Palliative Care, 191-208.

Keown, D., & Keown, J. (1995). Killing, Karma and Caring: Euthanasia in Buddhism and Christianity. Journal of Medical Ethics, 265-269.

Moulton, B., & King, J. (2010). Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice. Journal of Law, Medicine & Ethics.

Matsuoka, M. (2005). The Buddhist Concept of the Human Being: From the Viewpoint of the Philosophy of the Soka Gakkai. Journal of Oriental Studies, Vol 15.

Rutledge, S., & Patrick, J. (1995). Euthanasia: Principles and Observations from a Christian Perspective.

Strobel, L. (2001). Why Does God Allow Suffering? Christian Research Journal, Volume 24, No 1.
Ratanakul, P. (2004). Buddhism, Health and Disease. Eubios Journal of Asian and International Bioethics, 162-164