5-15-2016 Bioethics Part 57

The speaker begins by praying and discussing the topic of physician-assisted suicide. They mention that a lack of healthcare coverage and limited pain management contribute to the appeal of this option for some individuals. The speaker emphasizes the importance of living in a way that supports and cares for others, regardless of the legality of physician-assisted suicide. They then introduce the topic of active euthanasia, explaining the difference between active and passive euthanasia. They discuss different categories of passive euthanasia, including voluntary and non-voluntary cases. The speaker also mentions the concept of pulling the plug on a person in a permanent vegetative state and the distinction between killing and letting die. All right, let's pray. God, we thank you for this morning, and for this time to be together, and pray that as we think hard through difficult issues, once again, that you would give us wisdom and insight in order that we might be not only better informed, but better enabled to help others live well and die well. In Jesus' name, amen. So for the past few weeks, we've been dealing with the rather controversial topic of physician-assisted suicide. We saw why it was so appealing to so many people, and we also saw how problems in our own society lead to physician-assisted suicide being such an attractive option to so many. Give me one example of those things in society that are current problems that lead to physician-assisted suicide being an attractive option for some, or for us as a society. That's right. So one of them is that while there are more Americans today than there were 30 years ago covered by health insurance, we still have a large percentage of the population, roughly 10%, that has no insurance coverage. Now, I made it very clear, I want to make it very clear again, that that is not a political statement, and I really don't care how people get covered. What is the problem, though? If 10% of the population is not covered, then how would that feed into physician-assisted suicide? Okay, it's cheaper to let them die. What else? What about the people themselves, those 10%? They feel like it's their only option, right, because if you go to the doctor and they say it's going to cost you $25,000 to get around a chemo, or you could end your life for $45, you'd be like, well, I don't have that kind of money. It's not even an option for me. I don't even know what I'm going to do. It's easy to kind of ride on the supposed benevolence of the people around you, but that's probably not going to work. There's also the thing that pain management isn't really a thing. Currently, in the United States, 50% of people who have cancer die without any pain management whatsoever. 50%! Because doctors are either not trained in it or they're focused on something else, which is curing the problem, the cancer itself, and so we're not actually worrying about that. We saw also that some people receive pain management. Very few receive what we would call suffering management because you can be fine, you can feel no pain on the outside, but on the inside, what's going on in your soul can be incredibly disruptive, and so people lose all hope, and while they feel well or feel no pain or limited amounts of pain, they're still incredibly discouraged and think, well, but I'm never going to get better. It's all terrible. It doesn't matter. I just want to die. All of these kinds of things lead to physician-assisted suicide being a more attractive option for people because they can't picture a world that's anything different. What we saw though at the very end of our time was that regardless of whether physician-assisted suicide ever becomes legal in the state of Tennessee, which it is currently not, but I can almost guarantee you will be within the next 20 years as it will be in the rest of the United States of America. It's currently legal in four states. That trend is just set to continue. Whether or not it's legalized does not shape or should not shape the way that we are as human beings. Whether it's legal or not, you and I ought to live in such a way that the people that are in our families or our neighborhoods or just around us should not even consider it to be an option because they're like, no, I'm going to be cared for by these people. There ought not to be, from anybody that we know, a sense of aloneness, which means that the way that you and I live today has implications on other people's lives and deaths because if people feel alone, abandoned, essentially if you are all jerks, right, which I know some of you have a harder time avoiding than others, but if you all live the American narcissistic get mine now dream, then other people, and I'm not kidding, other people will probably have an easier time killing themselves that you know because they'll be like, nobody cares about me, everybody around me just cares about themselves. And the time to care about somebody is not after they have attempted suicide or begin to talk about attempting suicide, right? That makes you seem like you don't really care or that you only care because somebody has said something. So the way that we live now matters for what happens in the future. This week, we're taking a step forward into territory that bioethicists are currently talking about and will likely become a reality in the US sometime in our lifetime. It's being practiced currently in other parts of the world, that being active euthanasia, and I'll define that term in a minute. Euthanasia means literally good death. This is commonly known, at least in the way that it's practiced today, as mercy killing, which is maybe a paradox or a contradiction in terms, but we'll get to that. Euthanasia differs from physician-assisted suicide in that there is someone actually actively taking the life of another person. In physician-assisted suicide, what takes place? No. Yes, they give you the resources to do it yourself. The kind of counseling, the drugs, or at least the prescription, they kind of lay it all out, but then you carry it out by yourself. So currently, the place in the world where this is most often, commonly, and famously done is Switzerland. In Switzerland, there is currently something called suicide tourism, which is a real thing because you do not have to be a citizen of Switzerland in order to legally kill yourself in Switzerland. So people go to Switzerland in order to die. There are very famous cases of this. A guy I absolutely love and hate at the same time, whose name is Hans Kuhn, who is a Roman Catholic who has his own love and hate relationship with the Catholic Church, is currently planning his trip to Switzerland to die. In that case, though, in Switzerland, they can literally hook you up to a machine, but they cannot push the button. You have to push the button legally. Now, interestingly, you cannot be prosecuted if you do push the button as a physician, but in that country, they can just give you some pills and say, okay, go into that other room and take it, or whatever, or they can hook you up. You still have to do it, though. That's still considered physician-assisted suicide. Euthanasia makes the step into the doctor or somebody else is actually taking your life. This definition needs to be defined. Somebody taking the life of another, right? Why would that definition have to be modified or clarified? Somebody taking the life of another. Murder, right? So, like, if you go out into the street, if you leave church today, you hate Chobee Sermon, and you go shoot somebody in the street, which, that would be something, then you would have committed murder. You would not have committed euthanasia. So, euthanasia is not just the taking of a life of another person. It's very hard to define this tightly. There are all kinds of disagreements, but roughly, here is an attempt at a definition. It's when someone, let's call them person A, takes the life of another person, this is person B, for their sake, person B's sake, in order to relieve unbearable pain and suffering. So, there's multiple categories of euthanasia. I hope you drink coffee or, you know, Diet Coke or Red Bull or whatever. It's about to get, to be, yes? So, we're going to talk about that right now, and these definitions of different ways. Okay? What we're going to start with is passive euthanasia. Okay? Passive euthanasia. Passive euthanasia. There's three categories in each of these, both passive euthanasia and then active euthanasia. We're going to think about these, and these are, you're going to start to see how complicated these divisions get, and how murky, but they're very important. So, there's, first of all, passive voluntary euthanasia. Now, I'm not saying that we ought to define all these things as euthanasia. I have some qualms with this, but still. So, passive voluntary, I should have made some slides, voluntary euthanasia. This would be me, myself, saying, I no longer desire to receive treatment. Let's say that I have brain cancer, and we're on, like, third round of chemo, and the doctors are like, it might work, and I say, I do not want to do that anymore. That's passive, right? I'm stopping something. Or, us going into round three, and me saying, I don't even want to take it. I'm done. Okay? So, passive, I'm just stopping something. Voluntary, I've made my own decision. Euthanasia, good death. Then, there's the next one, which is passive, non-voluntary euthanasia. So, non-voluntary, the third one's involuntary, because non-voluntary is kind of this gray, murky area. It's not against the person, but it's also not of their own volition. This is what we commonly would call pulling the plug on somebody. So, if I am in a permanent vegetative state, the doctors know that there is no stimulation possible on my body. I'm just not responding. Hooked up to all these machines that are currently keeping me alive. If I pull the plug, what happens to me? Or if somebody pulls the plug on me, what happens to me in the next instant? Anybody know? Nothing. That's right. Ordinarily, people do not die immediately. It takes anywhere from a few minutes to sometimes a few weeks for that person in a permanent vegetative state to die. Okay? So, in pulling the plug, are you killing the person? The answer is no. You are not. You are no longer sustaining their life, but you are not killing them. You are removing the things that are keeping them alive. And we're going to get to this distinction about killing and letting die as we go through this. This is a very important, massive distinction between those two things. So, in pulling the plug, this is non-voluntary because I am in a permanent vegetative state. Do I possess the capacity to say, yes, I want you to pull the plug? No. If I did have that capacity, then it wouldn't be non-voluntary. It would be voluntary. I would have made that decision. And then there's involuntary. Okay? So, what would you think this is? This is passive, still passive, involuntary euthanasia. Anybody have an idea of what that would look like? Wanting treatment but being denied. Okay? Yes. Or, you don't even have to want the treatment. It's just being denied treatment. Whether you know about it or not. So, let's say that I am a patient in a hospital and I have a condition. Let's say that it's really advanced lung cancer and the doctors know that there is a treatment available to me that might save my life, but it's incredibly expensive and the hospital administrator says, don't give it to them because it's not going to be covered by insurance. And they don't give it to me and as a result of that, I die. That's still passive because they're not doing anything against me, but it's involuntary. I didn't have the choice to turn it down. Passive involuntary euthanasia. Okay? Those are all those things. Of course, that third one is incredibly messed up and wrong. There's first two. They're super dicey. But we're talking this week about active euthanasia. Okay? We've got these three categories again. So, first category. Active, voluntary euthanasia. What would that look like? Please kill me. Right? And what? Not just that desire, but having a doctor do it. Does it have to be a doctor? No. You could also have somebody else do it. So, you could have, I could have my wife take my own life. Right? Doctor, let's say that we're in Switzerland or whatever. Doctor gets the medicine. The time comes down to the wire. And I say, Marge, I can't do this. Could you do this for me? And Marge goes, Yeah, of course. Let's do this. And then she administers the stuff. Even if it is completely voluntary. If she does it, there's a distinction between her doing it and me doing it myself. Now, you might think this is just semantics, but it's not. Or the doctor doing it or me doing it. If he gives me a clicker, if he clicks the button or I click the button, there's a difference there. Might be small, but it is something. Now, what would be active non-voluntary euthanasia? Let's go back to our example of passive non-voluntary, which would be pulling the plug on somebody in a permanent vegetative state. Now, what would be active in that same case of somebody who's in a permanent vegetative state? Giving them drugs that will stop their lives. So you do pull the plug, but you also administer drugs to them in order to end their lives quicker. People like Peter Singer are big advocates of stuff like this. And essentially the argument boils down to, you've already made the decision to take their life. You need to take their life quicker. And the whole thing is, do you actively take their life or do you let them die? And there is a lot of debate about that. And we'll get to the problems with, though it seems more merciful, let's just give them drugs to kill them quicker because they can last for a couple of days. And that's going to be miserable. Let's just kill them now. We've already made the decision that they no longer need to continue to live. Not easy stuff. Now, the most grotesque version of all this would be active, involuntary euthanasia. What would that look like? Yep. Okay. Yes. Yes. Yes. Right. So these are people who are going to be left alone. And as a result of them being left alone, some of this might have been non-voluntary. Like if there was somebody in a permanent vegetative state, that would have been non-voluntary. But there were other people who were active and awake and possibly senile or something like that but were who were administering drugs in order to take their lives as an act of mercy because nobody was going to be there to take care of them. Interestingly enough, right, in a case like that, that's a very clear case of people just being too stinking lazy or unwilling to give up their own lives for the sake of another or even just go through hardships. Like we're just going to take them out now because of course they're going to die. So let's actively pursue death against them. Rather terrible situation. There's not much talk these days about active involuntary euthanasia, something we should be incredibly thankful for. We're going to be spending most of our time talking about active voluntary euthanasia and then active non-voluntary euthanasia. Like that kind of gray area where the person themselves cannot or is not able to give consent. This is a good point to talk about. One point in our history as a human species on Earth, recent history at which or during which time active involuntary euthanasia was a big thing that was pursued by a particular society. Does anybody know at what point in our recent history there was a group of people, which group of people was, that pursued a large program of active involuntary euthanasia? The Nazis. Right. Jim Jones would also count, right? Well, no, it wouldn't count because they all agreed to it. But it was questionable in the case of children whether they understood what they were doing. But yes, the Nazis are the biggest case. It's important that we talk about this, or as we talk about this, we avoid comparing what we're going to be talking about. We avoid applying it too quickly to the Nazis. It's kind of an easy move. You hear it all the time today when people are talking about active voluntary euthanasia. That's what the Nazis did. Slow down. Maybe not. To put it simply, the Nazis counted the worth of an individual according to their social utility. How much somebody was worth, how much good they did to the society around them. So if you were an active contributing member to society, you had social worth. Some people had more social worth than others, but as long as you had some social worth, you contributed to the society in some way, then you were worthy. Now, if you had no social worth, the most kind of despicable term in active Nazi literature for these people were useless eaters. That's what you were. That's like people who were severely mentally retarded. Those people were useless eaters because they didn't have anything to contribute, supposedly, to society. And when food is short and resources are short, then those people become useless eaters. That is not the way that people who are currently talking about, yes, let's pursue euthanasia today. It's not the way they talk about human beings. Ethicists today would rather say that what's up for debate is what's best for the person who is experiencing pain and suffering. It's a person's own well-being that everybody is in search of. And so some see the ending of people's life as a solid option when they're in unbearable pain and suffering. Currently, today, active, voluntary euthanasia is permitted in four countries. The Netherlands, Belgium, Luxembourg, and, oddly enough, Colombia. However, many other countries are moving towards it extremely quickly. All four of those countries, while they've had really nebulous laws especially in the case of the Netherlands for quite a long time, they are definitely the leaders in this. Only in the last 15 years has this become absolutely stated in law legal. And it's, like I said, it's coming in more countries. All of the reasons that we've looked at for the acceptance of physician-assisted suicide are present when we're talking about active, voluntary euthanasia. So the cost benefit, the fact that people can do whatever they want with their own bodies because it's theirs. So I can choose when I want to die. You can't tell me when I have to die. I'm going to choose that. All of those things apply to this situation as well. The only distinction between physician-assisted suicide is taking that extra step and saying, now we're actually going to give you what you want instead of just giving you the resources to bring upon yourself that which you want. What I want to do for the remainder of our time is to talk about some of the real problems that have actually presented themselves in history with active, voluntary euthanasia and how they bear out on the possibility of the things to come in our own day. The goal is both to understand the kind of situation and then also see how easily mindsets about the worth of individual humans lead to things that would ordinarily seem despicable, how those things become common practice when we just shift the way that we think about human beings and when we consider the fact that we should just live our lives however the heck we want to, which is fundamentally unchristian. So, what are the problems? The current, modern day problems with euthanasia, these apply to different areas too, but this in particular. The first is informed consent. Is informed consent really possible in active, voluntary euthanasia? We raised the issue last week, I think Nicole raised it, The desire to take your own life, while understandable, is questionably rational. Right? You could say, like, I want to take my own life. It's questionable whether that's a rational thing or not. Some people would say yes and some people would say no. We do know this. Let me ask you the question. Just because you want something really bad, just because you want something worse than anything else on earth, does it make that thing okay? No. Right? Nobody thinks that. Nobody thinks that my level of desire of something permits that thing in modern day society. Okay? People who are suicide bombers, for example, are incredibly desirous of the thing that they are doing. But the vast majority of the world will look at that and say, I don't even know why that's totally wrong, but I know that that's wrong. So desire for something does not make that thing a good thing or a bad thing. Let's assume for the time being that the desire to take one's life is justified. At least in some instances, without taking the time to define what those instances might be. Just so we're clear, I do not believe that that is true, as I have stated in past weeks. The desire for you to take your own life is inherently irrational. It doesn't make sense. It's understandable, but it is not a good thing that we should pursue. But for the sake of argument, we're going to go down this path and just so I'm super clear, I do not believe that stopping treatment equals taking your own life. We're going to talk about that in weeks to come. So the question is, given the fact that it might be rational, even if we give that to somebody. Okay, fine. Maybe it's rational in some instances. The question is, can someone truly give informed consent to active, voluntary euthanasia? You say, okay, Jeremy, I would be able to answer that question positively if I knew what informed consent was. What is informed consent? Informed consent is by far one of, at least, the biggest issues in bioethics in the 20th century, especially what we call clinical ethics, or how you're supposed to interact in a clinical setting. This comes rather than Nuremberg codes. Anybody know when the Nuremberg codes were written? After World War II. Yes. After World War II, they came up with these things called Nuremberg codes. The Nuremberg code reads like this. The voluntary consent of the human subject is absolutely essential. Now, coming after World War II, why would this statement in the Nuremberg codes, again, the voluntary consent of human subjects is absolutely essential. Why would that be such a big thing? Okay, yeah, so there's that kind of general thing of like, it seems like there would be a wide open door to people just being able to freely take the lives of other people. That's the general thing. What would there be in specific after World War II? The Nazis experimented on Jews and also lots and lots of Germans who were deemed unfit to be part of society, such as those who were senile, those who were severely handicapped or mentally retarded. The Nazis did not just kill Jews, they killed all sorts of people that they deemed unworthy to live. And so the whole thing was, okay, we're not going to do that anymore. We've decided as a world and as a society that that is bad news. So we have to have voluntary consent from people. Now, what's the definition? It's this. Informed consent is shorthand for informed, voluntary, this is the tricky one, decisionally capacitated consent. Okay, so we'll just walk through all those. Informed, right? What does it mean to be informed? To know information, that's right. To know information, that's right. So I have received this information. It also has to be voluntary. Why does that play into this? Okay, and why is that so key? Okay, alright. Because if... So let's say that voluntary is out of it. If it's informed and decisionally capacitated intent, why is the voluntary part so key to it? Or how would that play into this? What if it just said it has to be informed and decisionally capacitated? I understand we haven't defined that word yet. Right, yeah. But we're saying like, so you are that though. You are that, you use that, and you've received this information. Okay, yeah, because we could say, I could say, like I could hold a gun to your head and say, listen, here's the thing, right, this happens in Sudan quite a bit, especially 15 years ago during the civil war. A group of Muslim raiders would come into a town. They would take everybody and line everybody up, hold a gun to your loved one's head and say, listen, this is very simple. This is informed and decisionally capacitated intent. You have two options. Option one is to accept Islam and all of its tenets. Option two is, I shoot your brother. Now, just so we're clear, this is your choice, and you are very clear on what your options are. And some people said, mm-mm. And the brother was shot, and they said, they made it very clear, you have decided to kill your brother. That was your decision, and it would go to your next family member. You have a decision. It would lay out the same thing again. Okay, now, just so we're clear, that is not what all Muslims do, and there is many Muslims, and there are still currently many Muslims, who repudiate what they did. However, that is a case of informed and decisionally capacitated intent, because decisionally capacitated just means that I have the capacity or the ability to make a decision. This is also important, because if it is informed voluntary consent, then what is the decisionally capacitated? Give me a case in which somebody could be informed and voluntarily receiving information, but not be capacitated to make a decision. A child, exactly. A child, we do not think, has the decisional capacity to make a rational informed consent decision, especially about something large, like taking my own life. Okay? So, or do something like, yes, you can remove my appendix, go for it. They don't have that decisional capacity. Neither would somebody, or it is at least severely questionable, whether somebody with advanced stages of dementia, whether they have that capacity. So, when it comes to something like euthanasia, the question is, does somebody actually have, in the moment, informed, voluntary, and decisionally capacitated intent to make that decision? And by the way, informed consent is so big and broad because it applies to everything. We could talk about informed consent for a long time, but we won't. The reason this is such a hot topic is, what qualifies as informed consent? Okay? Like, many of you are not doctors. Right? And many of you are not nurses. So, let's just go with the informed thing. Is there really ever a point at which you actually understand what the doctor is going to be doing to you? Because the doctor can come in and go, listen, here's the thing. Let's just take the appendix thing. We're going to go into here, we're just going to make a hole right here, we're going to go in, we're going to clip, here's a picture, we're going to clip this and clip this, and then take this out. And you know what? Sew it up, right? You're going to have a little scar like this. Great. That's what we're going to do. Are you actually informed about how that procedure is going to go down? That's a legitimate question. I'm not saying that you're not. But, for example, how much information do you have to have? Do you have to be informed to the level of like, well, I could do this procedure now. Now I'm informed. I wouldn't say that or else nobody could ever do it. But it is a question, what does informed even mean? Or, can you ever truly give consent? Do you actually understand what you are doing? Can I actually believe what you're saying? Or do I always have to be questioned or questionable like, ah, does he really understand what's going on here? Because both of those sides could become paternalistic very quickly. On the one hand, it could be like, I ask you your consent and you go, yes, and you go, all right, done. Thank you. And you leave the room because you don't care to give the actual answer from somebody. Or the other side is super paternalistic and going, do you understand what you're doing? Yeah. Now, are you sure? Right? Because this is what I'm telling you. I don't think you actually understand this. So both sides are tricky. And also, how long does informed consent last? What happens if you change your mind? If you give consent today, does it apply for tomorrow? If I give consent today, does it apply for a year from now? We can just keep asking questions for the rest of our time. So some of the examples of the difficulty of informed consent when it comes to the topic of active voluntary euthanasia will illustrate why this is such a big deal. Number one, in order to count as informed consent, a patient must be told what the possible outcomes will be of a procedure and what that will be like. Okay? Number two, appendicitis. Right? You come in, your appendix is bursting. This is a good example because it is a vestigial organ. Right? Which means that you don't actually need it in order to continue to survive. Okay? So doctors are going to come in and say, okay, listen, your appendix is about to blow up. Okay? We're going to go in and we're going to take your appendix out. Here are the possible complications of the surgery itself. Here are the possible complications of not having the appendix anymore. I'll give you a short list on both those cases because it's a super simple surgery. Right? I can perform it. It's not a joke. And, number two, you don't actually need your appendix very bad. If we go, you have a tumor in your brain, now the informed consent level goes through the roof. Here's all the possible complications of this. Here's how to do this thing. Here's the possible ramifications of what's going to come afterwards. Here's all the things that could happen to you. You need to know this before we do this procedure. Why is that reality for informed consent impossible when it comes to active voluntary euthanasia? I'll walk through it with you step by step. Number one, what are the possible outcomes of active voluntary euthanasia? Death. There we go. Right? So that part of it's simple. You're going to die. But in order to count, and it should count, in order to count, you have to say what the, not only what the possible outcomes are, but what that will be like. What are the possible outcomes going to be like of you ending your own life? No one knows. And you might go, well, I'm a Christian, so I know exactly what it's going to be like. But you have very little clue about what it is going to be like after you pass from this life. Right? Even if you are the most trained theologian on the face of the planet, you still have a ridiculously pathetic clue about what the new heavens, new earth, and hell is all going to be like. So, first of all, there'd be the very large question whether that's even medically appropriate to share that with a patient in a clinical setting. And second of all, even if it were appropriate, it's like, okay, so here's the thing, right? Like, you're probably going to go to hell. What's hell going to be like? Well, okay, so it's like a weeping and gnashing of teeth thing. It's probably not literal. It's probably like first century Judeo, you know, understanding of, what? Right? Even then, you're just like, you're giving people this murky idea. And there's also like what the Buddhists think about what's going to happen. There's this thing. So, could informed consent even be given? Because, could people even ever understand what the possible outcome of the quote-unquote treatment is? And the answer is, no. You might say, well, yeah, but German people really want it. You go, yeah, but if people don't understand what it's going to be like, and you can't explain that to them, then do you have the right to do that to somebody? And this, by the way, isn't even pulling into question, do you have the right to ever take the life of somebody else? This is assuming that you do have that right. It gets incredibly complicated, even if we have that right as a society. Next, people also have to understand what treatment options are in order to qualify as informed consent. All of us know, those of us who have children, those of us who are married, those of us who are dating, those of us who have a friend, those of us who work with other human beings, know that there is a dramatic difference in the world between two things. Between the act of being told something and the act of listening. Right? There's a fundamental difference between those two things. You're like, well, I said it. Yeah, but did you hear it? Right? Well, yeah, but I said it. No, I know that you said it, but did you hear it? Somebody who is hearing these things about the possible treatment options, the question is, do they actually understand what this is going to be like? Can we really assure that the person who is receiving this doesn't just understand all this stuff, but actually, or, understand what's happening. Did you hear it? Did you hear that, like, you're actually going to die, you're going to die, be dead, dead, all the way dead, never coming back from the dead, dead. The person goes, yeah, yeah, yeah, fine. You go, okay, alright. But do you actually understand what that means? The more profound the procedure, the more profound the understanding ought to be of the person receiving the procedure. So, removing a hangnail, limited amount of understanding. Dying, gigantic amount of understanding. Also, people need to understand all other alternative treatment options. And as we saw last week, somebody who is suffering from intense physical pain or spiritual, or we could at least say, you know, on a secular level, emotional pain, do they actually, are they actually even in a place to be able to receive the thing that there's other treatment options than you killing yourself? Because people who are in that position go, there is no other option. I'm just done. End it now. Take it away. And you go, well, you know, there are medications that would relieve your physical suffering. People go, nah, I don't even believe that. Because I've never experienced a pain this bad, therefore, I'm just getting it over with. And the idea to roll with somebody and go, okay, I guess I'm just going to believe you, and then treat them through the act of removing their lives is at least highly questionable. These are just some of the problems with active voluntary euthanasia in respect to informed consent. If we do not have people truly consenting in an informed way, then we have a wide open door to a serious amount of problems. And I could just keep going, by the way, with informed consent problems. We won't. This is where we'll end. The thing that keeps this stuff in balance, supposedly, is, yeah, yeah, yeah, but here's the thing, Jeremy. Or, yeah, yeah, yeah, but here's the thing, all you people who just want people to miserably suffer until they, quote unquote, naturally die. There's all kinds of checks and balances in place. We have rules and standards and stuff, and so that, all the stuff that you're preoccupied with, is not going to happen. Thankfully, we actually have historical proof of what happens, and we have a good understanding of human nature, which we'll get into next week. Though there are safeguards, safeguards are always only as good in every area of society as the people who are guarding the safeguards. And so, that's what we'll get into next week. Let's pray. I would thank you for this time. Thank you for... the ability to think deeply. God, that ability has often, and many times, in many ways, gotten us into deep and profound trouble. God, it is much easier to live in this world just focused on ourselves and our own desires, and to think that all of this stuff about people desiring to end their own lives, the desire of other people to end other people's lives, is just being in another world completely far away from us. But it is not. This is what our friends and our neighbors and our co-workers and our families struggle with. Things like this. And the longer that we continue to advance in medical technology and the idyllic notion that we are all supposed to live pain-free lives, the more this will be an issue. So we pray that we would continue to see this study as a matter of Christian discipleship and learning how to be, as citizens of heaven, the best possible citizens of earth as long as we remain here. We pray these things in Jesus' name. Amen.