The doorbell rang. Twice.
As she reached for the doorknob she felt his hand touch her behind her ear and pull back her hair. He put his hands on her shoulders and kissed her neck. She instinctively reached back and patted his hand.
“Chemo kicked my ass,” he said, “I need to go to bed. Can you be the fairy god-mother tonight?”
“Sure,” she said, “go on…”
She turned to kiss him and he was staring at her. His eyes shimmered, not from pain but something she’d never seen in them before. Her head tilted involuntarily as she looked at him.
“I love you, Annie,” he said, and turned away.
Her breath stopped. The doorbell rang again. She turned to reach for the door then back again as his hand slid down her arm. He touched her fingertips as he pulled away.
“Ben?…”
He was shuffling toward their bedroom down the hallway, one hand on the wall. She knew he would make it.
“TRICK OR TREAT!” a choir of voices called from the porch. She opened the door.
“OHHH!!! Who do we have here… Oh! Harry Potter, a scary skeleton and a bumble bee!!” For the next couple hours she doubled up on the candy and when it ran out she turned off the porch light. She turned out the living room lights and pulled the curtains to discourage late Trick or Treaters.
She locked the door, put the empty candy bowl on the dining room table and looked down the hallway.
Their bedroom door was almost closed, outlined by a faint halo of light.
She quietly pushed the door open. Ben was in bed, the blanket was neatly folded down across his chest and under his arms. One arm lay across his chest, the other off the edge of the bed. His mouth hung open, there was a raspy gurgle of breath.
It was not right. Ben didn’t sleep like that.
She rushed to the side of the bed and put her hand on his arm and shook him. “Ben? BEN?” He did not move.
She pulled the chain on his nightstand light. There were two white prescription bottles, the lids beside them. It was his oxycodone. She called 911.
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They had to borrow some folding chairs and table for Thanksgiving dinner. It had been years since the entire family was together and now there were six grand children.
The kids knew Dad had a serious cancer. They knew he was declining in spite of his dismissive bravado about the effects of his surgery and chemo and his “Happy Pappy” Facetime sessions with the grand kids. His suicide attempt was shocking because their Dad was not a “quitter”. They began to discuss among themselves who would be able to help Mom, nursing homes, moving their parents out of their lifelong home. It was all complicated and expensive and daunting. When he sent them all a generous check and a note, “Let’s all be together for Thanksgiving this year”, they all concurred that it had to happen. For Dad, for Mom. For themselves.
Ben sat at the head of the table and Annie at the right corner as always. Before the cancer the seating was just family tradition, now it was so she could cut up his food and help him navigate feeding himself with some sense of dignity.
The tide of the dinner flowed from hilarity to sobriety. They played the “remember that time when…” family game. “Remember that time when we left Jeff at the water park and didn’t realize it until we got home?” “Remember that time when Mom tried smoking pot with us and she couldn’t stop laughing at the dog humping her leg?” They remembered their childhood broken bones, dead pets and lost friends; they revealed high school sneaky shenanigans and relationship regrets; they talked about their job dramas; they talked about their current careers and dream goals. But it seemed obligatory to each of them to circle around and at least mention Dad and Mom and how each of them was grateful for the family their parents had imperfectly tried to create had guided and shaped them. It seemed a pre-emptive celebration of life.
The silences between sentences grew longer.
“WELL…” Ben set his fork down at a long impasse. “I want you all to know this has been the best Thanksgiving I think we’ve ever had. I’m proud of all of you. You’ve all made a good life for yourselves and your children. I wish we all lived closer now that everyone gets along better (chuckles), but it’s kind of late for that. I don’t want to be morbid, but we all know why we’re all together for once. I wish something like this could have happened when we were taking care of your grandparents, but we couldn’t afford to get all of us together before they died. So, while you’re all here, I want you all to know Mom and I have talked to an estate lawyer and we’ve set all of our affairs in order so you won’t have to deal with any medical, legal or financial issues when we die.”
“Dad, we don’t care about your money…”
“Oh, I know that. But I do, and I care about you and my grandchildren. I want to take as much of the burdens for our end of life issues from you all as possible. We had to make some horrible decisions for your grandparents. I don’t want you to have to go through that. Anyway, it’s all in our wills and family trust. I’m just letting you know. SO, what’s for dessert?”
Annie cleared dishes from the table and the parents served up pumpkin pie and vanilla ice cream to the kids. Ben stood up and surveyed the family chaos, smiled, and shuffled down the hallway.
Annie brought a plate of pie and set it down at Ben’s empty place. She looked around.
There was a loud POP! like a thick book hitting the floor. Everyone froze.
Annie started toward the hall, then began to run. She pushed the bedroom door open and there was a sweet, smokey odor. The master bathroom door was closed, a piece of paper hung akimbo by a Band-aid. The children looked over her shoulder.
It was Ben’s shaky handwriting.
“Please do not open the door. Just call 911. I know this is hard, but I’m sparing you all from something much harder. I love you all. Dad. John 15:13”
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The above is fiction but it is an amalgamation of stories I have been told in private correspondences and that I have read about people with terminal illnesses. (All details of my sources have been obscured, any similarities to any real incident is purely coincidental.)
Over the past couple years I have been writing about the personal realities of care giving my dying parents and my personal bout with cancer. Because of my experiences I’ve begun to think about end of life decisions, the theology, church history, and ethics of MAiD (Medical Aid in Dying), also known as “Assisted Suicide”. (The term MAiD is currently preferred to “Assisted Suicide” because of the traditional religious stigma attached to the term “suicide”.) For those who are reading this and have not been following this series, at the end of this post I will link all the previous relevant blog posts so you can see my full research and line of thought.
This blog post/chapter is specifically about theologically examining some of the motives for requesting MAiD. To be sure some motives for taking one’s life are, as many Christian and non-Christian theologians, “worldly” philosophers, and secular psychologists have said, selfish, manipulative, cowardly, escapist, morally weak, and from a place of a faithless existential despondency or despair. Everyone suffers but suicide is generally regarded as a sinful response to pain, whether physical, spiritual or emotional (with pastoral caveats). The question is, how are we to endure suffering in a spiritual, existentially strong, or for the Christian, a “Christlike manner”. Historically we extol uncomplaining acceptance of suffering (whether voluntary or involuntary) as Christlike: we strive to be silent sheep before the shearing of our bodies and souls with physical and existential pain. “He was oppressed and He was afflicted, yet He did not open His mouth.” (Isaiah 53:7).
However, in most popular Christian thought it is not enough just to accept suffering, we must “learn from it” because all suffering is a tool in the hands of God “for our salvation”. The avoidance of, or premature ending of, terminal suffering is historically understood to be “playing God” who sovereignly ordains the time and manner of our death (and possibly how much pain you will go through to learn your lessons). In a sense this theodicy, when pressed, becomes “God knows when every sparrow falls because He strikes it down out of the sky (or at least ordains who does it for Him and when and with what)”. But, to be fair, all theodicies end up in cul de sacs eventually. That said, our theology of the sacredness of life essentially says that, even in the case of terminal illness, by ending our own or someone else’s pain by human agency prior to a “natural death” we are thwarting some divine plan or avoiding some divine lesson that can only be learned through suffering because of our sinfulness. (The issue of “why then seek or give pain relief for non-fatal conditions if suffering is instructive” is another whole issue in the theology of suffering… But that’s another rabbit trail.)
As difficult and as great a sacrifice as it is, the greatest love is not in enduring prolonged suffering for the sake of others. It is not just in Christ’s earthly, Holy Week sufferings that the world is redeemed. It is ultimately redeemed by His death and resurrection. But it is not His “involuntary death by a conspiratorial political assassination” but by His “voluntary death” at the hands of His creation. Over and over the hymns of the Church tell us Christ CHOSE His death voluntarily and as God had every power to avoid His suffering and death on the Cross, but because it was freely chosen, it saved us from the consequences of sin:
“Knowing that Thy power is infinite and Thy crucifixion voluntary, the hosts of angels were amazed.” (Sessional Hymn, Tone 3, Wednesday. Lenten Triodion p. 677)
“By Thine own free choice, O compassionate Christ, Thou hast endured a shameful death upon the cross…” (Stavrotheotokion of Friday, Tone 3, Lenten Triodion p. 679)
“O Savior, by Thine own free choice Thou hast endured the Cross and set men free from corruption.” Sessional Hymn, Tone 5, Wednesday. Lenten Triodion p. 685)
“…Thou the joy of all, wast nailed upon (the Cross) willingly, and hast delivered from the curse those that dwell on earth.” (Sessional Hymn, Tone 5, Friday. Lenten Triodion p.687)
“When Thy Mother beheld Thee, O Christ, hanging by Thine own free choice upon the Cross between two thieves…she cried out… It is because in Thy surpassing love Thou willest to restore mankind to life.” (Stavrotheotokion, Tone 5, Friday. Lenten Triodion p. 687)
These are but a small sampling of dozens of hymns throughout the Church year. The important thing our hymnography points out is this: Christ’s suffering and death were not private events. It was a communal experience: In His death all humanity was set free, delivered. All suffering and death is experienced personally, but not privately. It is not just the sufferer who is burdened and is released from sorrow, pain and grief by death, it is also those who are related to the one suffering. Love makes death a redemptive communal event. It was His acceptance of death in His human flesh in love that overcame all that separates and grieves and burdens us all. The ultimate definition of what is sin and what is not sin is The Cross of Christ. There is a motive for the voluntary, willful, rational giving up of one’s life in a manner other than natural causes (a definition of “suicide”) that is affirmed by Christ Himself as redemptive and sacred rather than damning sin because it is an imitation of the love of Christ Himself: “Greater love hath no man than to give up his life for his friends.” (John 15:13)
The Church calls death “the blessed curse”. The salvation of the entire human race comes through death. Death itself is destroyed by death. Ultimately the re-ordering of the entire cosmos cannot be accomplished apart from it. Because of the Fall creation is disordered, imperfect and it both nurtures us and kills us. Not before its final immolation and dissolution can the sons of God be freed from its futility and corruption (Romans 8:18ff). Nothing is exempt from the “circle of life”: For there to be life, things must die, and often we must make the decision who and what dies for the sake of preserving life and a semblance of goodness in a futile order. This is the “divine economy” until the Second Coming. Everything must die at some point or place in divine and human history for the sake of both temporal and eternal goodness: Plants, animals, people, the earth, the cosmos, and yes, even God.
How does this relate to MAiD, the voluntary, willful taking/giving up of one’s life? There are many motives for requesting MAiD. I am sure most or all of them are mixed. How can they not be when one is facing the unique mystery of personal extinction that will only end after a prolonged, agonizing, unpredictable time of suffering? But mixed motives are mixed, not only because of existential fear and the wish to be freed from our personal pain. They are mixed because our suffering, like Christ’s, is not private: it is communal. We don’t suffer alone and our suffering affects those we love.
One of the motives for MAiD is to die voluntarily in order to willingly bear the fullness of the inevitable end of suffering so that others will not have to suffer. It is to bear in death the emotional, financial, and sometimes impossible burden of care giving. It is bearing in our self through our death the burdens of the guilt, shame and the prolonged grief of our community because of our illness and pain. By our stripes they are healed, our death is communally redemptive. In our death they will be freed from (at least some of) the consequences of the futility of the fallen order.
For some MAiD is not only about avoiding pain (though that is a very real motive and one that can be addressed with palliative care/pain management), it is coming to peace with and accepting the reality of death: Death is inevitable and there is no longer any denial. The community WILL grieve death, eventually. The community WILL be freed from the emotional and financial and relational responsibility of care giving the dying, eventually (and at what costs). The issue theologically and pragmatically is timing, agency and what death means to both the dying and to the community. The core theology of death and the Cross is the issue of freedom: Of course the dying one is freed from the constraints of the fallen creation by death, every funeral sermon points that out. But the Cross show us that death is also the FREEING of the ones held in bondage to sin and death, a freeing from the consequences of the Fall. When a terminally ill person dies the community is freed from dealing with the futility and consequences of the fallen order in themselves and in the dying one. When a terminally ill person CHOOSES to die for the sake of his/her community, it is the bearing of THEIR grief by the acceptance of the ultimate outcome of the grievous condition, a healing of THEIR stripes by the bearing of the ultimate end of pain, a healing of THEIR diseases (the breaking and ruination of family, their guilt, their shame, perhaps even their unspoken, broken desire for a quick, early death) by the ending of the disease for them on their behalf.
A major objection raised by the traditional theological attitude toward MAiD/assisted suicide is “we shouldn’t let family (or society) off the hook of taking care of the dying”. The sanctity of life means it is their God ordained responsibility to preserve life at all costs and to endure the suffering of care giving. We have no “right” to remove others’ responsibilities (and their suffering) by choosing our own death. However, that flies in the face of our Gospel hymnography of Christ’s “voluntary passion” for the sake of assuming of all that destroys our humanity. He willingly assumed in Himself all the cosmic dissolution, fear, suffering and death in His purposeful and willful acceptance of death. Choosing death is a fulfilling of the Gospel: “Greater love hath no man than to lay down his life for his friends.” It is through voluntary death that we are saved, our griefs are comforted, our wounds healed, our relationships restored, our sins forgiven because ultimately death is communal. We do, by virtue of the Cross, have the free choice to die for the sake of those we love.
The problem we have when discussing MAiD is our minds are quick to default to condemning ALL voluntary death through un-nuanced versions of Augustinian definitions of suicide. But it is clear that even Augustine admitted there were some problems theologizing around his own definitions and historically the Church has functionally and pastorally rejected and re-defined some of of his ideas. As I have explicated in previous blog posts (which will be linked at the end of this post) all “voluntary death” is not “damning suicide”. In short, the Church canonizes those who avoid sin and escape the loss of physical and spiritual purity by voluntarily accepting death. It lauds sacrificial self-destruction for the sake of one’s community in war and civil service. Self-sacrifice is admirable, hymned and extolled in the Church and even by pagan philosophies. Why? Because voluntary death in some circumstances reflects the fullness of the image of Christ: the image is not just in enduring suffering, an imitation of the silent bearing of the torture and pain. A noble voluntary death for the sake of others is ultimately the fulfillment of the bearing of the cross: death for the sake of the healing of mankind and to free those held in bondage to sin, dissolution, futility, grief, sorrow, and death.
The Church’s theology holds in tension the sanctity of life and the necessity of death in the economy of the fallen world. Under the rubric of the universal affirmation of the sanctity of life, war and capital punishment are debated as having a legitimate function in keeping peace, protecting life, and insuring the peaceful good order of societies. The argument for the restraint of the evildoer by interventional individual killing, war, and capital punishment is that death removes the threat of greater suffering and death in the community by afflicting death on an individual or a corrupt nation. One can debate these issues and privately hold opposing opinions within the Church because the Church faces the realities of corrupted human nature and the regretful reality that sometimes the taking of a life is necessary in the fallen order. So, one can be a pacifist, a civil servant, or a soldier and still be a saint. There is no “dogmatic statement” that damns one for participating in the utilitarian, corporate or private application of death which has a “benefit for the good order of society”. Killing in war, or in defense of the innocent or self is regarded pastorally as a grievous event which harms the individuals who kill and are killed, but ultimately is not regarded in the same way eternally as a passionate or premeditated selfish murder.
The question then is, is there room under the umbrella of “pro-life” to also debate the legitimacy of MAiD as a regretful economia in the fallen order? At what point does pro-life become “pro-suffering” for the sake of merely preserving all life at all costs including the tragic effects on those in the community? Is it possible for “biological life” to become an idol upon which everything must be sacrificed including the lives and limited resources of the community that could be used to serve and nurture others? “Economia” is the Church making pastoral exceptions in recognition of the limitations of the fallen world to meet the standards of spiritual perfection. “Economics” is the pragmatism of justly distributing finite resources to an infinite need. Wisdom (both within the Church and in the world) is knowing how and when to do something less than ideal to accomplish a greater good FOR a fallen individual in a fallen circumstance. It is also knowing how and when to do something less than ideal TO a fallen individual in fallen circumstances for the greater good of the community.
Can we regretfully, legitimately TAKE a life and under what circumstances is the debate of war and crime and punishment because the world is fallen. The Church has entertained this debate for 2000 years.
Can we OFFER our life by our free will, in love as a regretful, rational, sacrificial act in a fallen world for the greater good of our community? Perhaps it is time to revisit the topic through the lens of the Cross and the pastoral mind of the Church rather than Augustinian colored glasses.
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Previous posts on the pragmatics and theology of end of life directives, suicide, and MAiD/assisted suicide. Click the titles to read the posts.
The Will to Live, the Choice to Die My parents had end of life directives. What happened when they are not followed. She had dementia and could not legally speak for herself regarding her wishes any longer.
Love is as Strong as Death I had to decide whether I wanted to live or die when I was diagnosed with cancer. My Dad was depressed and Mom was declining. I began reading about “murder/suicide” in the elderly and hid his guns when he was at Walmart. The issues and the options regarding end of life decisions and assisted suicide.
Death Unplugged: Euthanasia The bio-ethical and theological definitions of euthanasia, suicide, and the issues surrounding end of life directives and MAiD.
The Longest Day The day my Dad died he asked me to help him “get it over with”. I did not help him, but not for theological or legal reasons. An exploration of the theology and definitions of suicide, voluntary martyrdom, and saints in the Augustinian “canon” that has been the foundation of Church theology for centuries.
I Hurt Care giving my Mom who wished to die but didn’t. A brief history of the theology of suffering, suicide and damnation over the centuries.
A Hard Mercy An exploration of mercy killing (euthanasia), the theology of suffering in animals and human beings, and the issues of where God is in pain.
Loved to Death The saint who murdered her daughters and committed suicide. The messiness of the theology of suicide and actual Church practice.
NEXT: Pastoral issues and recommendations regarding suicide, MAiD, care giving, end of life issues and advance directives.