A version of this paper was originally presented at The Center for Bioethics and Human Dignity’s 30th annual summer conference, The Christian Stake in Bioethics Revisited: Crucial Issues of Yesterday, Today, and Tomorrow, June 23, 2023.
As revealed through statistical data and anecdotal stories, euthanasia and physician-assisted suicide (PAS) are highly practiced and strongly advocated for in some countries and states within the U.S. and are lurking at the legislative doorsteps of others. It is therefore incumbent upon those who study bioethics, particularly Christian bioethics, to honestly reflect upon the reasons why people choose euthanasia and PAS and provide an antidote to these reasons, highlighting the dignity and value of life, a task this paper attempts to breach. In sum, it will be evinced that suffering is the primary impetus as to why people choose PAS and euthanasia. Suffering that is endured for the sake of suffering itself is pointless; however, suffering united to the cross of Christ bears much fruit and can positively help someone see the value and beauty in their life, even amidst their illness.
Before commencing, it is important to define our terms. To cite Gail Van Norman, euthanasia is defined as “intentional termination of life by active administration of lethal means by a physician to a patient requesting it”; PAS is defined as “intentional medical aid by a physician [or other medical professional, depending on the jurisdiction] at the explicit request of the patient, to enable the patient to terminate his or her own life.”[1]
Our first goal is to analyze data from states and countries where PAS and/or euthanasia is legal and thereby articulate reasons why people choose these lethal acts. I will then articulate a compassionate response in favor of life.
To begin, consider Canada. The rate of euthanasia in Canada is expanding at a rapid pace. Canada legalized “medical assistance in dying” (MAiD) in 2016. Those who seek euthanasia need not be terminally ill, and as the Fourth Annual Report on Medical Assistance in Dying in Canada (published in 2023, the most recent report at the time of writing this article) states, “The annual growth rate in MAID provisions has been steady over the past six years, with an average growth rate of 31.1% from 2019 to 2022.”[2] In 2027, those who desire euthanasia due to mental illness alone will be able to access it.[3] Given the growing popularity of this act, the question must be asked, why do people desire euthanasia? According to the report mentioned above, people cite the “loss of ability to engage in meaningful life activities,” “loss of ability to perform ADL [activities of daily living],” “inadequate pain control (or concern),” “loss of dignity,” “inadequate control of symptoms other than pain (or concern),” and “perceived burden on family, friends or caregivers” as reasons for requesting euthanasia.[4]
Turning to the United States, consider Oregon, a state that recently removed their residency requirement and a state where patients have opted for assisted suicide due to many health issues, including a hernia and anorexia,[5] even though Oregon’s law requires that the disease be “terminal.”[6] In 1997, Oregon was the first state to legalize PAS; thus, the state has a significant amount of data to analyze in pursuit of answering our question of why people choose PAS. Participants cite the following reasons for choosing it: “losing autonomy,” “less able to engage in activities making life enjoyable,” “loss of dignity,” “losing control of bodily functions,” “burden on family, friends/caregivers,” “inadequate pain control, or concern about it,” and “financial implications of treatment.”[7] The State of Washington, which legalized PAS in 2008, provides the same reasons in nearly the same order of significance.[8] Other states that have legalized PAS—including Maine;[9]Hawaii;[10]Vermont;[11]New Jersey;[12] Colorado;[13] California;[14] and Washington, D.C.[15]—do not report reasons why people choose PAS.
Despite the lack of in-depth reporting and statistics about the use of euthanasia and PAS in some jurisdictions, the data that we do have can nevertheless be illuminating. Since Canada has such a high volume of citizens who choose euthanasia, their data remains significant.[16] Likewise, the similarities between Oregon and Washington’s data are noteworthy, as is their resemblance to the Canadian data. Through the available data, we more fully understand why people choose these deadly acts. In turn, we are poised to see some of the gaps and misunderstandings in the reasons provided, permitting us to offer rebuttals in defense of life.
As stated, one reason that people choose euthanasia or PAS is due to a supposed “loss of dignity.”[17] This supposed “loss of dignity” integrally relates to claims of “losing control of bodily functions”[18] and the “loss of [the] ability to perform ADL [activities of daily living],”[19] both of which could be viewed as threatening dignity. They might be life altering and excruciating, but they do not compromise one’s dignity. Although it is understandable that people feel that they have lost or are losing their dignity, this is simply impossible. It is possible that people may be humiliated due to their medical situation. However, dignity is rooted in being created in the image and likeness of God. Everyone—no matter their physical or mental state—is created in God’s image (Gen 1:26–27). Whether or not we live up to the demands of being created imago Dei is another topic; being created in God’s image is an undeniable reality, something that we can never lose. Thus, while we might experience a humiliating encounter or an undignified situation, we cannot lose dignity itself.[20]
Some cite “inadequate pain control, or concern about it”[21] as a reason to choose euthanasia or PAS. There certainly are instances where it can be difficult to manage pain, yet the reality is that pain can often be controlled.[22] Moreover, these reports highlight that people are “concern[ed] about” pain that they could potentially experience in the future; it is not certain that they will experience pain. The idea that one would desire to end their life based upon a potential, albeit uncertain, future probability is irrational.
Some cite the “perceived burden on family, friends or caregivers”[23] as a reason to end their life. We must never deny someone’s suffering, for feeling like a burden can be a real cross. However, as Paul states in 1 Corinthians 12:26, “If [one] part suffers, all the parts suffer with it; if one part is honored, all the parts share its joy” (NABRE). United in Christ, the faithful are intimately united to each other, and they are always called to enter into communion with each other; Christians ought not become solipsistic beings. As such, it is not a burden for members of the faithful to assist each other. As members of one Body, not only do we share in the suffering and joy of others, we are compelled and yearn to assist others. Taken out of the sphere of Christianity, the natural law teaches that it is written within man’s nature to be in communion with others; people often shirk from loneliness and seek camaraderie.[24] Desiring to assist others is a natural human desire.
Although we’ve considered a mere abbreviated reply to these arguments, taking a birds-eye view of the aforementioned reasons often cited in favor of PAS or euthanasia, one theme becomes eminently clear: people choose these deadly acts due to suffering. It is to this concept that we now turn.
Every reason listed in favor of these deadly acts in both international and domestic reports can be reframed as suffering. In annual reports from Canada,[25] Belgium,[26] and the Netherlands,[27] the term “suffering” is employed. However, this is not the case in the United States: most states never mention suffering in their statistics; including Oregon;[28] Washington;[29] Hawaii;[30] Maine;[31] Vermont;[32] Washington, D.C.;[33] New Jersey;[34] California;[35] and Colorado.[36] This is a discouraging and glaring omission, highlighting that the existential cause of euthanasia and PAS is often glossed over.
Nevertheless, further observation reveals that suffering is the primary cause of euthanasia and PAS. A supposed “loss of dignity”[37] is a form of suffering: feeling that one has lost their value and worth can fill people with grief and anguish and can be an immense source of moral suffering. One only need to think of nursing home residents who are often forgotten and may be unable to attend to their personal needs, relying on the assistance of others. Reducing this suffering can seem like an uphill task, but it is crucial that family and friends continue to visit their loved one so that they do not feel forgotten. Although it may sound simple, sitting with a loved one and listening to music, working on a jigsaw puzzle, or watching a sunset can be profound activities in the lives of those who otherwise feel forgotten. The ministry of presence should never be skirted, for it helps those who suffer recognize that they have dignity by who they are, not by what they do.
“Inadequate pain control, or concern about it”[38] is another form of suffering. Pain can definitely be debilitating, so the lack of pain control can be an agonizing form of physical suffering, and “concern about future pain” can be a form of anxiety and thus emotional suffering. Therefore, those who suffer from pain should be provided with the medical care necessary to treat their pain, as alluded to, and those who are fearful of the future should be offered clinical and pastoral counseling.
Being a “perceived burden on family, friends or caregivers”[39] strikes against our desire for self-reliance and can be the source of tremendous emotional suffering, as aforementioned. Hence, it is critical that family and friends of those who are suffering emphasize that they want to help the sufferer. Yes, accompanying someone who is suffering can be challenging, but numerous anecdotal stories highlight that loved ones genuinely want to help those in the throes of suffering, whether that be providing a loving presence, making a meal, sending them a card, etc.
“Losing control of bodily functions”[40] can likewise be a humiliating encounter, another experience of suffering. It is therefore imperative that those who care for the sufferer do so in the most respectable manner possible, offering them privacy, not belittling them, etc. The “loss of [the] ability to engage in meaningful life activities”[41] can be detrimental to one’s psychological and mental health, perhaps causing depression, despondency, or despair, types of emotional and spiritual suffering. Again, psychological and spiritual services should be offered to help the patient navigate through their suffering; loved ones of those who suffer should also be offered supportive services to help them navigate these often agonizing situations, for suffering not only impacts the patient but their loved ones as well.
The list could go on. Even if the word “suffering,” or variants thereof, are often absent in annual reports, and even if the term “unbearable suffering” is subjective,[42] it should be clear from this brief exposition that suffering is the fundamental reason why people choose these deadly acts. Pope John Paul II explains that there is
a cultural climate which fails to perceive any meaning or value in suffering, but rather considers suffering the epitome of evil, to be eliminated at all costs. This is especially the case in the absence of a religious outlook which could help to provide a positive understanding of the mystery of suffering.[43]
We will now turn to this “positive understanding of the mystery of suffering.”
If people choose PAS or euthanasia due to suffering, the question necessarily becomes: is there value in suffering? As we will see in this final section, suffering is not a worthless experience. The Christian tradition, namely, Jesus’ witness on the cross, teaches that there is tremendous value in suffering; in fact, suffering can bear much fruit, as Jesus’ resurrection proves.
While the horrific events on Calvary 2,000 years ago bore much fruit—our salvation—these events are not merely historical. Rather, the faithful are continuously called to hearken back to these events and unite themselves to them daily. Christ has given Christians a tremendous and awe-striking gift, allowing us to participate in his suffering. In Colossians 1:24, Paul writes: “Now I rejoice in my sufferings for your sake, and in my flesh I am filling up what is lacking in the afflictions of Christ on behalf of his body, which is the church.” Suffering in itself is an evil and should not be sought,[44] as this would be a form of masochism.[45] However, as Jason Eberl acknowledges, “when unavoidable suffering is forced on a person, he may accept this fact of his existence in the hope that it may serve as an instrumental good.”[46] It is from this perspective that we can better understand Colossians 1:24.
In Colossians 1:24, Paul is in no way diminishing Christ’s suffering; yet, he does reveal that Christ mysteriously allows the faithful to partake in his suffering. As Paul states earlier in Colossians 1:18, “[Christ] is the head of the body, the church.” Our suffering is not divorced from Christ. Christ is the Head, and we are the Body. Discussing Colossians 1:24, Orthodox theologian John Breck writes,
Very simply . . . [Paul] is speaking of the need for us to participate, to share in those afflictions as members of Christ’s Body, the Church. All is accomplished by Christ; yet our communion with him in his affliction “completes” or complements that suffering, insofar as we suffer as members of the universal Body of which he is the Head.[47]
Our union with Christ is fortified through our suffering, particularly when we actively unite our sufferings with his sufferings.
Saint Augustine would codify the reality of the union between the Head and the Body as the totus Christus, or the whole Christ—the Head (Christ) and the Body (the Church) are intimately united.[48] It is by virtue of being members of the whole Christ that we participate “in the afflictions of Christ on behalf of his body” (Col 1:24). Although certainly not equivalent to the sufferings of Christ on Calvary, our sufferings can be joined to Christ’s. Said another way, as a result of this intimate union, the sufferings that the faithful experience throughout their lives, whether that be the loss of a job, the death of a loved one, an illness—the list could go on—can be intimately united to Christ the Head, God himself. This should be the source of immense comfort for those who suffer, for it yields the realization that we are never alone in our suffering. Even if it seems that the world does not understand our suffering, Christ does. Not only can uniting one’s suffering to the suffering of Christ bring comfort and solace, it can also yield a profound experience of the Lord’s grace and love.
No matter how diligent one may be to make sense of suffering, it will always maintain an air of mystery. Discussing “the mystery of suffering,” Breck explains that “the term mystery in this context must be understood in its two quasi-contradictory senses. On the one hand, it signifies an enigma, a conundrum, an unfathomable paradox. Yet on the other, it is a true mysterion, a sacramental reality in human experience through which God conveys divine grace.”[49] Suffering will always remain somewhat incomprehensible, yet it can also be a beautiful gift if accepted as such, allowing the faithful to be more fully united to Christ.
While this paper is focused on the Christocentric understanding of suffering, it is worth briefly mentioning that even those who do not maintain a Christocentric worldview can also recognize the value of suffering, albeit this may be more challenging. There are countless stories of people encountering tragedy, illness, or injury which may then lead them closer to their friends and family, have a new appreciation on life, etc. In fact, as paradoxical as it sounds, suffering and our response to it can make us more virtuous, a claim that Christians and non-Christians alike can affirm.
Nevertheless, from the Christian view, it is recognized that in suffering, one is given the privileged opportunity to practice conformity, and eventually uniformity, with the will of God. The renowned Catholic bioethicist Father Tad Pacholczyk writes that on Calvary,
All he [Christ] could do was surrender his innermost being, embracing his Father’s designs as he thirsted for their realization. He could not so much as budge his limbs away from the wood. Hence the transformation from action to surrender, from outward activity in the world to inward activity of the soul, mystically accepting God’s unique designs, is among the most important transformative movements we can be party to during our life’s journey.[50]
In Hebrews 5:8–9, we read: “Son though he was, he [Christ] learned obedience from what he suffered; and when he was made perfect, he became the source of eternal salvation for all who obey him.” In the most horrific experience of suffering that any human being has ever, or will ever, experience, Christ surrendered his will to the Father: “Father, if you are willing, take this cup away from me; still, not my will but yours be done” (Luke 22:42). The faithful are called to practice this same renunciation of will. Declining one’s own will in favor of the Lord’s will allows the Christian to become more Christ-like, to actualize their identity as “a new creation” spoken of in 2 Corinthians 5:17.
Surrendering one’s will to the Father can be a sacrifice—one might have to fight nearly every ounce of their will to do this. Yet, it is in this sacrifice that blessings may abound. As 1 Peter affirms, the faithful are called to “offer spiritual sacrifices acceptable to God through Jesus Christ” (2:5). Enduring suffering in a Christ-like way and denying one’s will, especially in the face of suffering, in favor of the divine will classifies as a spiritual sacrifice. One author affirms: “It is the suffering caused by illness, by death, by the lack, that draws forth the spiritual riches of love—compassion, simple presence, self-gift, sacrifice—and the joy that accompanies it.”[51] One’s sacrifice will likely yield joy, the joy of remaining firmly grafted to Christ and acting as a true disciple in the Father’s vineyard.
In essence, when someone is suffering and desiring euthanasia or PAS, we must encourage them to look to the example of Christ. Christ’s example on the cross teaches us everything we need to know about the value that can be found in suffering. As members of his Body and thereby intimately united to Christ, the fecundity of suffering is a reality we can embrace if we suffer well and do not intentionally hasten our death or the death of another. If Christ took his own life, as those who desire euthanasia and PAS are tempted to do, we would not be saved. If someone intentionally hastens their own death, they deprive themselves of the opportunity to grow closer to the Lord and deny others the ability to witness the gift of a Christian life well-lived, especially during moments of extreme agony. Someone who desires euthanasia or PAS is certainly encouraged to receive the physical and psychological care necessary to reduce their undesirable symptoms in morally acceptable ways. They are simultaneously encouraged to offer their suffering to the Father as a spiritual sacrifice. This might include abnegation of their own will, such as foregoing euthanasia, but such abnegation is a positive acceptance of God’s will and permits one to become more like Christ. We are called “to share in the divine nature” as Peter says in 2 Peter 1:4; accepting and rejoicing in God’s will permits this reality to take root. The stakes could not be higher between extinguishing suffering in immoral ways or enduring suffering in union with God.
Finally, as Charles Camosy correctly argues, “fundamental human equality” is becoming increasingly jeopardized and compromised in many cases.[52] As we have seen from this brief study, we may argue that Camosy’s argument is notably true at the end of life, particularly when people are encouraged or tempted to choose euthanasia or PAS.
Given the mystery and perplexity in suffering, as well as the tremendous trials that suffering can bring, not only must we provide education on the gift of life and the often hidden gift of suffering, appropriate pastoral and spiritual care must be offered to those who suffer. One author rightly states, “As imitators of Christ, Christian caregivers . . . have an ongoing missional responsibility to be present to those who for any number of reasons are suffering, not excluding those wrestling with end-of-life issues.”[53] It is imperative that those who suffer, particularly Christians, be encouraged to recognize the value that can be found in their suffering. Christ teaches us that suffering is not worthless but is rather filled with tremendous value: “Our suffering is never pointless, unless we will it to be so, unless we refuse to relinquish it into God’s hands to serve his purpose.”[54]
[1] Gail A. Van Norman, “Physician Aid-in-Dying: Cautionary Words,” Current Opinion in Anesthesiology 27, no. 2 (2014): 178, https://doi.org/10.1097/aco.0000000000000046. Centuries ago, the term “euthanasia” carried a different connotation in Christianity than it carries today. For more, see: Jürgen-Burkhard Klautke, “Dying a ‘Good Death’ by Preparing for Eternity: Reclaiming the Forgotten Meaning of Euthanasia,” Dignitas 25, no. 3 (2018): 8–13, https://www.cbhd.org/dignitas-articles/dying-a-good-death-by-preparing-for-eternity-reclaiming-the-forgotten-meaning-of-euthanasia.
[2] Fourth Annual Report on Medical Assistance in Dying in Canada, 2022 (Health Canada, October 2023), 20, https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying/annual-report-2022/annual-report-2022.pdf.
[3] “Canada’s Medical Assistance in Dying (MAID) Law,” Government of Canada, last modified March 1, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html.
[4] Fourth Annual Report on Medical Assistance in Dying in Canada, 2022, 31.
[5] Public Health Division, Center for Health Statistics, Oregon Death with Dignity Act: 2021 Data Summary (Oregon Health Authority, February 28, 2022), 14n3, https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year24.pdf.
[6] “Oregon Revised Statute: Oregon’s Death with Dignity Act,” Oregon Health Authority, 2023, https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/ors.aspx.
[7] Oregon Health Authority, Public Health Division, Center for Health Statistics, Oregon Death with Dignity Act: 2023 Data Summary (Oregon Health Authority, March 20, 2024), 14, https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year26.pdf.
[8] Disease Control & Health Statistics and Center for Health Statistics, 2022 Death with Dignity (Washington State Department of Health, June 2, 2023), 7, https://doh.wa.gov/sites/default/files/2023-10/422-109-DeathWithDignityAct2022.pdf.
[9] Data, Research, and Vital Statistics; Maine Center for Disease Control and Prevention; and Department of Health and Human Services, The Maine Death with Dignity Act Annual Report (April 2024), https://www.mainedeathwithdignity.org/wp-content/uploads/2024/04/2023_MaineStateAnnualReport.pdf.
[10] Department of Health: Office of Planning, Policy, and Program Development, 2023 Our Care, Our Choice Act (OCOCA) Annual Report (Hawaii Department of Health, July 1, 2024), https://health.hawaii.gov/opppd/files/2024/07/2023-OCOCA-Annual-Report.pdf.
[11] Mark Levine. Report Concerning Patient Choice at the End of Life (Vermont Department of Health, January 15, 2024), https://legislature.vermont.gov/assets/Legislative-Reports/Patient-Choice-Legislative-Report-Final.pdf.
[12] The Office of the Chief State Medical Examiner, New Jersey Medical Aid in Dying for the Terminally Ill Act: 2022 Data Summary, https://www.nj.gov/health/advancedirective/documents/maid/MAidAnnualReport2022.pdf.
[13] Center for Health and Environmental Data; Colorado Department of Public Health and Environment, Colorado End-of-Life Options Act, 2023: 2023 Data Summary, with 2017-2023 Trends and Totals, https://drive.google.com/file/d/1_FIx4J0Xg3CKgYk4VI1p7xBmGUAJn6X3/view.
[14] California Department of Public Health, California End of Life Option Act: 2022 Data Report (July 2023), https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CDPH_End_of_Life%20_Option_Act_Report_2022_FINAL.pdf.
[15] DC Health, District of Columbia Death with Dignity Act: 2022 Data Summary, https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/2022%20Death%20with%20Dignity%20Annual%20Report.pdf.
[16] According to reported data, between 2016 and 2022 nearly 45,000 people died from euthanasia in Canada, and Health Canada reported that “MAID deaths accounted for 4.1% of all deaths in Canada in 2022, an increase from 3.3% in 2021, 2.5% in 2020 and 2.0% in 2019” (Fourth Annual Report on Medical Assistance in Dying in Canada, 5, 21.)
[17] Oregon Death with Dignity Act: 2023, 14; Fourth Annual Report on Medical Assistance in Dying in Canada, 31.
[18] Oregon Death with Dignity Act: 2023, 14.
[19] Fourth Annual Report on Medical Assistance in Dying in Canada, 31.
[20] As Eduardo Rodriguez explains, “human life has an intrinsic value.” “The Arguments for Euthanasia and Physician-Assisted Suicide: Catholic Response,” The Linacre Quarterly 70, no. 1 (2003): 62, https://doi.org/10.1080/20508549.2003.11877664.
[21] Oregon Death with Dignity Act: 2023, 14.
[22] See “Controlling Pain,” NHS inform, December 11, 2020, https://www.nhsinform.scot/care-support-and-rights/palliative-care/symptom-control/controlling-pain.
[23] Fourth Annual Report on Medical Assistance in Dying in Canada, 31.
[24] Humanity’s need for connectivity and communion is confirmed by a recent surgeon general’s report that describes an “epidemic of loneliness and isolation.” Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community (Office of the U.S. Surgeon General, 2023), https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf.
[25] Fourth Annual Report on Medical Assistance in Dying in Canada; “Communiqué de presse de la Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie—CFCEE,” February 27, 2024, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/cfcee-communiquepresse20240227-chiffreseuthanasie-2023.pdf.
[26] For statistical figures on the type of suffering (such as “physical suffering” or “psychological suffering”) that patients experienced who were euthanized in Belgium from 2002–2007, see Tinne Smets et al., “Legal Euthanasia in Belgium: Characteristics of All Reported Euthanasia Cases,” Medical Care 48, no. 2 (2010): 190, https://doi.org/10.1097/mlr.0b013e3181bd4dde.
[27] Regional Euthanasia Review Committees, Annual Report 2022 (April 2023), https://english.euthanasiecommissie.nl/the-committees/documents/publications/annual-reports/2002/annual-reports/annual-reports.
[28] Oregon Death with Dignity Act: 2023.
[29] Disease Control & Health Statistics and Center for Health Statistics, 2022 Death with Dignity.
[30] Department of Health: Office of Planning, Policy, and Program Development, 2023 Our Care, Our Choice Act (OCOCA) Annual Report.
[31] Data, Research, and Vital Statistics; Maine Center for Disease Control and Prevention; Department of Health and Human Services, The Maine Death with Dignity Act Annual Report.
[32] Mark Levine, Report Concerning Patient Choice at the End of Life.
[33] DC Health, District of Columbia Death with Dignity Act: 2022 Data Summary.
[34] The Office of the Chief State Medical Examiner, New Jersey Medical Aid in Dying for the Terminally Ill Act.
[35] California Department of Public Health, California End of Life Option Act.
[36] Center for Health and Environmental Data; Colorado Department of Public Health and Environment, Colorado End-of-Life Options Act, 2023.
[37] Oregon Death with Dignity Act: 2023, 14; Fourth Annual Report on Medical Assistance in Dying in Canada, 31.
[38] Oregon Death with Dignity Act: 2023, 14.
[39] Fourth Annual Report on Medical Assistance in Dying in Canada, 31.
[40] Oregon Death with Dignity Act: 2023, 14.
[41] Fourth Annual Report on Medical Assistance in Dying in Canada, 2022, 31.
[42] J. A. C. Rietjens et al., “Judgement of Suffering in the Case of a Euthanasia Request in the Netherlands,” Journal of Medical Ethics 35, no. 8 (2009): 502–7, https://doi.org/10.1136/jme.2008.028779. See also Bregje D. Onwuteaka-Philipsen et al., “The Last Phase of Life: Who Requests and Who Receives Euthanasia or Physician-Assisted Suicide?” Medical Care 48, no. 7 (2010): 601, https://www.jstor.org/stable/25701507; and H. R. W. Pasman et al., “Concept of Unbearable Suffering in Context of Ungranted Requests for Euthanasia: Qualitative Interviews with Patients and Physicians,” British Medical Journal 339, no. 7732 (November 28, 2009): 1235–37, https://doi.org/10.1136/bmj.b4362.
[43] Pope John Paul II, Evangelium Vitae (Rome: March 25, 1995), 15, https://www.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html.
[44] Jason T. Eberl, “Aquinas on Euthanasia, Suffering, and Palliative Care,” The National Catholic Bioethics Quarterly 3, no. 2 (2003): 339, https://doi.org/10.5840/ncbq20033257.
[45] We should also note that there is a difference between enduring an evil and inflicting an evil. See Daniel P. Sulmasy, “Physician-Assisted Suicide and Euthanasia: Theological and Ethical Responses,” Christian Bioethics: Non-Ecumenical Studies in Medical Morality 27, no. 3 (2021): 225, https://doi.org/10.1093/cb/cbab015.
[46] Jason T. Eberl, “Religious and Secular Perspectives on the Value of Suffering,” The National Catholic Bioethics Quarterly 12, no. 2 (2012): 256.
[47] John Breck, “Alternative to Euthanasia,” St. Vladimir’s Theological Quarterly 52, no. 3–4 (2008): 395.
[48] For more on Augustine’s articulation of the totus Christus, see Caitlyn Trader, “Imago Dei and Totus Christus: Providing an Identity for Members of the Baptismal Priesthood as Epitomized in the Blessed Virgin Mary,” (STD diss., University of Saint Mary of the Lake, 2022).
[49] Breck, “Alternative to Euthanasia,” 394.
[50] Tadeusz Pacholczyk, “Suffering in extremis and the Question of Palliative Sedation,” The National Catholic Bioethics Quarterly 16, no. 2 (2016): 224.
[51] Jane Dominic Laurel, “Suffering and the Narrative of Redemption,” The National Catholic Bioethics Quarterly 17, no. 3 (2017): 459.
[52] Charles C. Camosy, Losing Our Dignity: How Secularized Medicine Is Undermining Fundamental Human Equality (Hyde Park, NY: New City Press, 2021), 16.
[53] Gloria J. Woodland, “Ministry amid Competing Values: Pastoral Care and Medical Assistance in Dying,” Direction 47, no. 2 (2018): 145, https://directionjournal.org/47/2/ministry-amid-competing-values-pastoral.html.
[54] Breck, “Alternative to Euthanasia,” 396.
Caitlyn Trader, “Embracing Suffering: The Christian Antidote to Euthanasia and Physician-Assisted Suicide,” Dignitas 31, no. 1–2 (2024): 3–7, www.cbhd.org/dignitas-articles/embracing-suffering-the-christian-antidote-to-euthanasia-and-physician-assisted-suicide.