Alleviating Suffering

Advocates of physician assisted suicide (PAS) and euthanasia express a strong desire to relieve suffering, even to avoid and eliminate it. No one should doubt that Christians have an equally strong desire to relieve suffering, despite their general historical and current opposition to PAS and euthanasia. In The Center for Bioethics and Human Dignity’s book The Changing Face of Health Care (Eerdmans, 1998), Nigel Cameron points out that: “The single most significant beneficial development in medicine in our generation has been hospice care, and the rise of palliative medicine as a central specialty. It is no coincidence that this was from the start a Christian project, devised by the remark able Dr. Cicely Saunders back in the 1960s.”

There is considerable evidence that hospice care deals so effectively with pain and suffering that few hospice patients ask about PAS and euthanasia, and those who had previously expressed a desire to die generally do not continue to seek to end their lives. Beyond the increasingly effective pain relief that hospice has pioneered, there is an important further dimension to hospice care that stems from its Christian roots. The alleviation of the kind of suffering that leads dying patients to desire that their deaths be deliberately hastened requires a good deal more than simply relief of physical pain. William Breitbart et al. recently studied terminally ill cancer patients—all of whom were receiving what the authors describe as “aggressive, inpatient palliative care”—and reported that a substantial 17% of the patients demonstrated clinical depression and desired that death be hastened. However, as Breitbart and his colleagues indicate in the December 13, 2000 issue of JAMA, there was no significant correlation between the desire for hastened death and the presence or intensity of physical pain. Although the authors recognized that this finding might reflect the quality of the pain management practiced in the study institution, they also viewed this result as a confirmation of “previous research that found little or no relationship between pain and desire for hastened death or interest in assisted suicide.” However, if patients were depressed, they were four times as likely to wish for hastened death as patients who were not depressed. The authors reported another significant reason for seeking a hastened death, namely, hopelessness. They characterized hopelessness as “a pessimistic cognitive style rather than an assessment of one’s poor progress.”

Given the above data and given that hospice patients very seldom persist in a desire to hasten death or in requests for PAS or euthanasia, one can confidently assert that hospice caregivers not only manage pain very well, but also greatly alleviate suffering due to depression and hopelessness. Treating these experiences of suffering is very much an explicit concern for Christian caregivers, and hospice has incorporated this concern into its care-giving model. This model emphasizes the importance of responding to suffering in a manner that seeks to prevent, remove, or change the kinds of experiences (like depression and hopelessness) that would otherwise fuel despair for one’s life or an explicit desire to end life or have it ended.

Comfort-only care (which does not seek to treat or cure a dying patient, but simply to make him or her as comfortable as possible) is not at all incompatible with finding meaning in the suffering that accompanies the dying process. Within the Christian tradition, some find meaning in the suffering that comes from facing one’s physical deterioration and inevitable death by identifying with the death of Jesus on the cross. However, the potential for such identification should not translate into a moral imperative to forego pain relief. Pope John Paul II, well aware that identification with Christ’s suffering on the cross continues to be an ideal for Christians, addressed this matter directly in the May 5, 1980 document, “Euthanasia: Declaration of the Sacred Congregation for the Doctrine of the Faith.” Having affirmed the notion that meaning is to be found in acceptance of one’s inevitable death and the dying process, he takes note of the teaching that suffering, especially in the final moments of life, shares in “the passion of Christ” and Christ’s “redemptive sacrifice.” Having also observed that some Christian patients use painkillers moderately so as to identify consciously with Christ’s suffering, he emphatically opposes any imposition of this practice. Furthermore, in this same declaration opposing euthanasia, Pope John Paul II strongly endorses com fort-only care and rejects curative attempts that carry significant risks or are excessively burdensome.

There is also within Christianity a more general expectation that life on earth entails suffering, and in distinct ways for Christians. Beyond the suffering that results from persecution, there is the suffering that results from compassionately taking on the burdens of others. One of the most dramatic instances in which followers of Jesus were called upon to suffer in this way occurred in the garden of Gethsemane just prior to Jesus’ arrest and crucifixion. Jesus had his disciples with him in the garden and, as recorded in the Gospel of Mark, he told Peter, James, and John: “My soul is overwhelmed with sorrow to the point of death…Stay here and keep watch” (14:34, NIV). Jesus asked these three disciples to “watch and pray,” but they failed miserably to do so (Mark 14:37-41).

The description of the enormous suffering Jesus experienced in anticipation of the torturous death to come contains an important moral imperative. Jesus expected His followers to be in prayer with Him and to be a companion to Him while He was suffering. In short, followers of Jesus owe compassion to those who suffer. What happened in the garden of Gethsemane contains a very urgent message for all who are attending the sick and the dying: Do not abandon the suffering; pray with them and for them; do not shun the suffering that will likely result from being present to those who are physically diminished and suffering in any way. Suffering in this manner is not an evil to be avoided. Rather, it is what inevitably will occur in a world in which physical deterioration, dying, and death are a reality; and everyone, Christians and non-Christians alike, has a moral responsibility to exhibit the kind of compassionate caregiving that will incur suffering for the caregiver. Indeed, as human beings we will suffer from such experiences, or at least be saddened even by thinking about or praying for people whose suffering is so great that we would rather not think about it at all.

Unless there are those who are willing to suffer with a person who is facing death, it will be extremely difficult for that individual alone to sustain a quest for meaning that will divert depression, hopelessness, and the sense of being a burden to others. Without others as companions in suffering, a dying person is likely either forced to be heroic or sorely tempted to find a means to hasten death. Comfort-only care requires comforters.

In his book Hippocrates in a World of Pagans and Christians (Johns Hopkins University Press, 1991), Owsei Temkin, a highly regarded historian, provides us with an extensive study of Hippocratic medicine and the ways in which it was embraced by both pagans and Christians in the first six centuries. The Hippocratic Oath forbade physicians to practice euthanasia or assist in a suicide. From the time Christians embraced the Hippocratic Oath, physicians, whether Christians or not, generally have not regarded assisting in suicide or administering euthanasia as expressions of compassion. Rather, truly compassionate care can be best described as providing a “suffering presence,” the very apt expression coined by Duke University Professor of Theological Ethics Stanley Hauerwas.

The commitment to be a dependable, com passionate presence to those who are suffering is, I have argued, a moral responsibility that Christian caregivers and family members share with the whole human community. When caregivers and family members are unwilling to tolerate or share in the suffering of their patients and loved ones, they are tempted to eliminate suffering by means of PAS and euthanasia— rather than to alleviate suffering by their comforting, empathetic presence and by any of the medical interventions that sup press physical causes of distress.

Christians have every reason to live in hope, not hopelessness, to the end of their days on earth. For suffering is at most temporary, and there is no divine mandate to suffer while ill or dying without employing morally acceptable means to manage pain and reduce suffering. Anyone who reads the gospels depicting the healing ministry of Jesus will find how consistently Jesus healed both body and spirit for those who sought His aid. He has indeed called us to follow His example in alleviating suffering due to pain, despair, and hopelessness. Human life is of incalculable worth to God and should be regarded as such by all humankind.