Wednesday, June 14, 2017

Surprising Research Result: Fear of Loss of Autonomy is the Primary Motivation for Euthanasia; Is that fear a sin?

Whenever I read a research article about euthanasia, A.K.A. Physician Assisted Dying (PAD) or Physician Assisted Suicide (PAS), I get the feeling that I am reading a report from Dr. Mengele. Canadian researchers recently reported their experience with what they call "Medical Assistance in Dying" (MAID) which is legal in Canada. The movement in the U.S. to have similar laws passed by individual states has been gaining momentum, and my worry is that Medicare, the U.S. version of government-run healthcare, will start paying for euthanasia in the states in which it is legal and the system will eventually be forced to extend the "right" to euthanasia to everyone. The Canadian report, "Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada" in the May 25, 2017 issue of the New England Journal of Medicine, is chillingly cold and clinical, including a flow chart outlining the process in order that other hospitals might replicate the program. The report is available only by subscription so I cannot provide a link, but the important conclusion they reached was this,
“Those who received MAID tended to be white and relatively affluent and indicated that loss of autonomy was the primary reason for their request,” the report states. “Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms.”
This was unexpected since most of the campaigns for euthanasia, PAD, or PAS that I have seen emphasize the relief of uncontrolled pain and suffering as their primary goals. I have yet to hear a pro-euthanasia proposal that puts autonomy at the top of the list of factors as to why people should support legalization of these procedures.

Autonomy (per Wikipedia) is derived from the ancient Greek word: αὐτονομία autonomia from αὐτόνομος autonomos from αὐτο- auto- "self" and νόμος nomos, "law", and means "one who gives oneself one's own law". I believe it originally used to refer to the autonomous rule of the city-states of ancient Greece.

"Autonomy" to the modern Canadian and American probably means something similar to "one who gives oneself one's own law".  It is somewhat akin to social relativism and moral relativism in that each individual makes his or her own rules and the rest of us are supposed to be supportive no matter what the end result might be. In practice, it means that "I am in control of every part of my life including my death even if it means you (the doctor or nurse) must insert the needle and/or prescribe the drugs". Autonomy has become a modern virtue, and the loss of it is felt by those seeking euthanasia to be a fate worse than death.

As Christians, autonomy may mean something completely different. We have accepted Jesus as Lord, and we recognize that we are no longer in control,
"Or do you not know that your body is a temple of the Holy Spirit within you, which you have from God, and that you are not your own?" 1 Corinthians 6:19 (NRSV)
See also,
"and it is no longer I who live, but it is Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me." Galatians 2:20 (NRSV)
Why do people fear a "loss of autonomy"? Maybe it is a just primitive instinct that they are unable to overcome, maybe they are agnostic or atheistic and have been operating under the delusion that they have some sort of control over their lives, or maybe they are Christians but have not fully given things over to God and have never completely accepted that God is the one who is in control, and that is not a place Christians should want to be. 

Bill Muehlenberg  in his commentary, The Grievous Sin of Autonomy (Apr 10, 2014) wrote that such autonomy is a horrendous sin,
"But in the biblical and spiritual sense, autonomy means something quite different: it is not a virtue at all, but a horrendous sin. The biblical worldview posits a God who is there, who has created all things, and expects of his moral creatures a loyalty, dependency, and obedience at all times.
The essence of the Fall, and of all sin, is personal autonomy – the idea that we do not need God, that we can pretend we can live a life totally apart from God, and that we in fact are the centre of the universe. That rejection of reliance upon and complete dependency on God is the height of what sin means – a radical independence of God and his standards."
It would have been helpful if the Canadian researchers had included a spiritual assessment in their study so that we could see if there was any association between religious affiliation, church attendance, or faith in God and the fear of loss of autonomy.

The growing acceptance of euthanasia (no matter what the euphemistic acronym) is evidence that the world is in desperate need of the Good News that God is always with us, and He is in control, not us.

And yes, we will die, but we have nothing to fear as long as we have given our hearts, our minds, our bodies, and our souls to Him. 


  1. It shouldn't be a big surprise. After all, self-identification is the modern replacement for the Gospel. Individuals, according to this view, should be able to determine everything about themselves, without regard to biological facts and without regard for other people.

    On a personal note, I can understand people's fear of landing, helpless, in an institution where survival depends entirely upon other people. Causing them to stain their souls by contributing to the patient's death is not an appropriate answer to that fear.

  2. Maybe it's the sense that someone is choosing to die rather than the drip drip drip loss of dignity. In a hospital, when your wristband is a bar code, scanned at 3am in the morning it's hard not to feel that you are only an inventory item. It's not the loss of autonomy but the loss of personhood.

    1. That is why inpatient hospice houses were developed.

  3. FYI: Chasing the ever changing language used in this debate I see that after the Hemlock Society died we now have the more euphemistically named "Compassion and Choices" organization rising from the ashes.