5-22-2016 Bioethics Part 58

The speaker begins with a prayer, expressing gratitude and asking for clarity on the topic of euthanasia. They define active voluntary euthanasia as requesting someone to end your life to alleviate suffering. They share an example of a woman in the Netherlands who was allowed to die due to going blind and extreme OCD. The speaker discusses the difference between the Nazis' view of euthanasia as eliminating "useless eaters" and the intention behind voluntary euthanasia. They explore the concept of informed consent and its challenges in euthanasia cases. They question the rationality of the desire to die and the ability to give consent while suffering from extreme pain. The speaker highlights the importance of well-considered and stable decision-making in euthanasia cases. They discuss the difficulties in tracking euthanasia cases in the Netherlands and criticism of the lack of transparency. The speaker shares statistics showing short periods of desire for euthanasia and lack of written Okay Good morning, let's start with a word of prayer Thank you for everything we have received And thank you for the time that you've given us this morning God we pray that as we talk about death one more week that you would give us both an appreciation for the lives that we have and Clear thinking and reasoning about the end of our lives in Jesus name. Amen So last week we started talking about Active voluntary euthanasia, what the heck is that? Everybody know Tell someone to kill you For what purpose? Because it needs to be a little tighter because if I just tell somebody to kill me then that's just like wishing for death Yes to end suffering Usually tied to both pain and suffering Because suffering can be defined as all kinds of interesting things that might not necessarily count for example Not too long ago there was a woman in the Netherlands who Received permission from the government to end to have her life ended for her because she was going blind and also had extreme OCD and As a result of going blind she despaired of life Because she wasn't going to be able to clean Or she was going to be able to clean to a certain degree and was always going to be afraid that she had not cleaned Enough and the government said yeah fine. She's now dead I Could go on with stories for like a long time That is kind of what? We are facing. That's not every case by any stretch of the imagination, but we'll see that that is Not a one-off story We saw from the very beginning of our time that to compare Assisted Euthanasia or voluntary euthanasia to the Nazis kind of offhand is Irresponsible not exactly correct. Why was that? What is the difference between the Nazis what we were talking about? Okay, a voluntary and involuntary good what else How did the Nazis see these people Useless eaters, that's right. That was the Sickening but one of the terms that they used for people who were for example, severely mentally retarded now They were seen as useless So that's not what we're talking about today. We're really talking about how to kind of help people Who are in? Trouble, but as we'll see that's not exactly Helpful we talked a lot late last week about this idea of informed consent It applies to kind of everything that's ever done in medicine. But what is informed consent more or less Okay, so that would form part of it a person has to be told about the possible outcomes of the procedure Whether that is, you know removing the splinter from your hand or removing a tumor from your brain and Why is that problematic when it comes to euthanasia? That's right, you can tell people what's going to happen as a result of the procedure you're going to die What the side effects of that thing are is impossible to determine even if you were to give out You know the quote-unquote the Christian answer. It's still pretty nebulous exactly what's going to happen Good what else is informed consent imply? Yeah, we did that complication so the side effects you're going to suffer something Possibly we don't know what that thing's going to be exactly so You agree to it. That's right. So you you consent to the thing and it's a voluntary Consent you're like, yeah, absolutely do this thing and we talked about is the desire to die even rational Now there's debate about that. But as long as there's debate we should probably severely question whether somebody has the ability to Give consent in that way Okay, good Also We talked about it really truly being voluntary if I am suffering from extreme amounts of pain Am I in the right kind of place to make a big life choice? Most likely not whether that be to sell a car or go to college or drop out of college or something Or in my own life. I am NOT in a very good place to make that kind of decision There's a difference as we saw between hearing what a treatment might be and then Understanding what a treatment might be So these are some of the problems that we saw with Active voluntary euthanasia People don't aren't truly giving their consent or might not be giving their consent then The practice is questionable Everybody agrees at that point but people say Well, that's why there's all these safeguards in place Encouraging sound Encouraging sound These safeguards are in place in order to make sure that people don't die in the wrong kind of way But this is where we'll start this morning the safeguards are only as good as the people guarding them And it's here that we're actually going to move to an historical example We don't have to guess it about what this possible future might be we actually have one Netherlands is a test case about how Voluntary consent is such a fragile concept The first problem when it comes to the issue with the Netherlands and studying it because they've had it for over 30 years the first problem is Figuring out how many people have died by euthanasia Now you would think that that's a simple process of counting up numbers because you would assume that if people were being Killed by doctors that there would be some record of it. However The same is as insane as it might sound people get classified in the Netherlands as a by what they actually died from according to quote-unquote natural causes, so Somebody who was euthanized very well might have their death certificate read respiratory failure Is that true in a certain sense if you are pumped full of something like morphine Yes, absolutely true. You stopped breathing and as a result of not being able to breathe anymore You died. What would be another form of respiratory failure? Huh? Your lung collapsed? Good. Or like somebody making an action against another person though You're smothered. That's right. Good old pillow technique. Just and you still be well, they I mean Here's the thing they died by not being able to breathe anymore So it's complicated because even the reporting techniques Don't show who's actually been euthanized and who's not there's nothing. There's no box to check or anything like that And this is just said here to point out the difficulties That come with kind of figuring out what euthanasia even looks like in a society it's hard to determine when you don't even have a regulated form of counting it which Goes to show the critics of euthanasia in the Netherlands go this kind of shows that doctors are scared to say what they're actually doing Which means it's probably wrong Right, people are not talking about it. It's probably you got some guilty consciences up in there, but There's a big massive report done in 1991 few decades after this was legalized or at least not prosecuted in the Netherlands and The government wanted to see how the practice was going. They kind of want to catch up on it In about 6,000 cases per year people were found to have not given their consent to their own deaths 6,000 that's just the people that they were recorded like they found out no consent was given on their part In the same year a medical examiner looked at the data and the guidelines that the government had set up There's these interesting guidelines. We won't go through them this morning But the important one for this morning is that and this sounds good and ought to be there People have to make the decision to end their lives from a well-considered and Stable desire well considered and stable. Okay. Why would those two things be so key? Well considered I what would be the opposite of that? Huh? Throw the moment done. I want to kill myself good. And then what is the stable part? Okay, yeah, you have to be clear-minded and it probably has to go over a period of time You have to continue in that same path. You can't be wobbling like well, I wanted to kill myself for 20 years All right. Well, how much how much of those 20 years you want to kill yourself? Well, like I wanted to myself 20 years ago and I want to today So like there's a gap of like 19 years and some change where I didn't want to think but that's not really that stable It has to be considered. Well, it has to be well considered and stable How long do you think a well-considered and stable Period would have to be in place in order for you to get permission from the government to kill yourself any guesses One year great. So we might be questioning any other guesses All right, that sounds pretty good, right? Let's say for the moment that we agree that yes killing yourself is permissible under some very few and limited Circumstances and if you have a well-considered and stable opinion over a year, then maybe that would be appropriate At least it's hypothetically possible well in this Observation of how long it took people because that does have to be recorded In 17% of the cases people had this desire for two weeks in 35% of these cases people had this desire for a week and in 13% of the cases these people had this desire for one day and that was considered stable and well considered Crazier than that In two-thirds of the cases there was only oral evidence. There was nothing ever written down. So the doctor just said Yeah, this person has been talking to me for two weeks done There's nothing they didn't have to sign anything saying yes I am a well-considered and stable mind and desired in my own life day one. All right, maybe Week one week two week. There's nothing like that It's just like yes, he did and it goes on the doctor's oral kind of testimony and it's over And again, this does not take into account the people whose cases are completely unclear Now this should not surprise us but the people who are critical of the Dutch program in the Netherlands are very much at least disliked if not despised a Number of people have observed that dissent is not welcome or tolerated But dissent is I think we would all agree necessary in Any professional field anywhere? You have to have some people who are kind of going against the flow of opinion Who are kind of going against the flow and saying whoa slow down this is stupid Even if it is something relatively Small i'll give you an example a pertinent example from my own life of something that is small I'm, not necessarily alone in this. However at costco if you're about milk from costco The milk at costco comes in a rectangular Cube it is the dumbest form of storing milk on the face of the planet earth there are reasons that this is Why this is formed shaped in this way? It can go through a conveyor humans don't have to do it You can't do it when you have the kind of thing at the top You also can't stack those kinds of regular cartons. You can stack these square ones So there's all kinds of like environmental benefits to it. There's only one problem and that's that you can't pour milk out of the container Now everybody can say like this is genius. We have to do this, but some people have to say We do need to like save the environment or whatever. I'm totally down with that But can't we get there we have smart people we can cure diseases We surely can come up with a better design that can pour milk out of one of these things That's a small example, but the same thing has to have even everybody's like no whatever This is the best milk carton container on the face of the planet, which everybody said that would be insane if we live in a society where everybody says uh You know the speed limit being 55 is the greatest thing on earth. Somebody has to be like well, we should question that notion Same thing when it comes to something like voluntary euthanasia But in the netherlands what we're seeing is that dissent is not tolerated In this country dissent Oftentimes is being less tolerated than it used to be Uh just in like, you know the political sphere or whatever people who have dissenting ideas are not Respected or listened to they're just blown off hand It doesn't mean that the dissenting people are always right. Lots of dissenting people are crazy but every once in a while they're not and in somewhere like the netherlands the people who are dissenting to something like euthanasia are very much Despised because what they are painted as is against people's Rights and liberties because The kind of notion is you're telling other people what they can and can't do with their bodies. You're a terrible human being when the reality is Maybe not everything people want to do with their bodies is totally appropriate Same thing with you know, if people wanted to go Use their bodies to blow up other bodies Then we would say well, I understand that that's a strongly held conviction But even if everybody in this society thinks that's a good idea I might dissent from that And maybe have a good reason for it. Thankfully, there still are advocates in the netherlands that are fighting for either stricter controls or the abolishment of this thing because it hasn't gone real well, but It's not easy for them In a situation like this, it seems like the only valid option in the world is to be on board To either do the killing or to do the dying It's just kind of this thing that everybody has given into A major problem With the dutch system shows how easy it is to slide from Active voluntary euthanasia to at least active non-voluntary euthanasia Remember that non-voluntary is this place where we don't necessarily have consent So you go, I mean, I think That this person would have wanted this and had they been Did had they the capacity to say anything? So somebody who's born severely mentally handicapped They never had the capacity They never had the capacity, right? Who would have the who would have had the capacity but doesn't in the moment What group of people would that be? Coma, who else? Huh? Yeah, somebody with alzheimer's might also count Because even if they are even if you qualify them as a different person It's like what would the original person have wanted because that's what really matters and on that basis people go We're going to put you down Now this sounds like you know 1984 Or brave new world or something like that. This isn't a conspiracy or something stupid. These are smart people Who are trying to help individuals but help them through dying The status of euthanasia is questionable at best And there have been in the last couple decades improvements in the System in the netherlands. Here's the only problem improvements are good when it comes to like repairing roadways right nashville Has and will continue to have in the next five years should the projections continue a pretty ridiculous traffic problem, right? It is good That people are thinking about how to improve the traffic situation in nashville, and it will hopefully get better over time But we're not talking about Transportation says we're trying to talk about taking in people's lives This is not something we should just look for improvement in it's kind of something We should put it into until we can be really sure that we get this thing, right? Because while you might not care if your enemy gets off or that, you know person down the street that you don't know If it's your grandpa, you better believe that you're going to care And so we should care how people live their lives Now this isn't a problem with dutch people. This is not against the dutch The dutch do many things that are amazing They do the little wooden shoe things, right? They have some great tasting cheese they have uh from all that I can gather a beautiful architecture and lots of bike riding in their country Tulips, there we go. Thank you. Lots of tulips and the pointy hats They do those things too. So there's lots of things that the dutch do. They're just fine The problem is not with the dutch. What is the problem? Vanity, there you go. Yes Once again to say because here's the thing we can easily look at the dutch program. This is what some people do Advocates for active volunteering from the united states go. Yes. Yes. Yes. That's the dutch but we are americans We Are better at figuring this kind of stuff out, which is totally not true historically, but still We can figure this out and the problem is we are not really any different than they are The problem isn't that the dutch are so insanely corrupt The problem is the dutch are human beings and human beings have a tendency to act like a bunch of morons We all love to play god. Don't we you love to play god. You struggle to not play god on a regular basis Uh, and if you go, how do I do that? Jeremy every time you worry you are playing god, right? Or every time you i'm gonna figure this out i'm gonna And you get frustrated you get angry the whole world you are playing god Humility is incredibly hard to come by Humble humans always will live in radical skepticism of innate goodness Because you're not that good And you probably think that you're better than almost everybody in this room At least a little bit better at least you're on par with everybody And you are on par at being a pretty miserable person, right? Because this is something we all struggle with we are all fighting with sin always And so when you put a whole bunch of people together, they don't get better They remain all kind of jumbled up and messed up And it can be wonderful sometimes but ordinarily it's a mess Which is why we should never expect politics to be easy or pretty And this leads me to the third problem of active voluntary euthanasia, which is this Nazism was an ideology that grew nothing ever evil comes fully formed from the outset There is a uh, two very infamous and hilarious laws that exist in argumentation The first law is something called godwin's law This was developed like back in the 90s when internet chat rooms were a huge phenomenon Kind of everybody in the world was on them And this guy who's both a lawyer and uh a writer named I don't remember what his first name is, but godwin So the last thing he came up with this thing called godwin's law, which is the longer that a discussion goes on in an internet chat room the more the probabilities of somebody mentioning nazis or the hitler or hitler approaches one or absolutely sure right, so 17 lines Whatever probably not going to get there 17,000 lines you better believe somebody's going to get to your hitler or that's that's a nazi response or something There's also something in argumentation called and this is totally kind of tongue in cheek But the reductio ad hitlerium argument Which is kind of once you mention hitler the argument is over right or the nazis you go Okay, I can't say anything against that Because they just go well you're being hitler and you go. Why what are you going to say? Nuh-uh, like it's just kind of over There's a problem though with both of these Kinds of things it is true I mentioned from the beginning and want to be very clear that to simply say if we have active voluntary euthanasia We will be the same as the nazis. No, we will not not even remotely. However the problem with these things that are very real they're funny because they're real is because Nazism didn't come from nowhere And hitler didn't grow out of hitler did not come out of his mother's womb Fully formed as a tyrant and an insane megalomaniac There is a major distinction Between the way that we speak today and the way the nazis spoke between social utility on the nazis part And individual well-being on our part but Individual well-being talk often comes down to very similar language of burden This burden term is oftentimes thrown around in the nazi thing. It was a burden on society so Mentally retarded people are a burden on our society Our society is going through a war fighting for the kind of cause of the arian nation and to bring about The greatness of the third reich as a result of that These useless eaters are getting in our way and we must exterminate them because of the burden that they are on society and Should god forbid though he does not exist Should we let these people procreate then they will further on this kind of problems in society So we need to get rid of them now burden on society. That's how it goes Today we use the language of burden all the time So if somebody is terminally ill Who is that a burden for? Family your family. That's right. Who else is it burdened for? Huh, why would it be a burden on doctors? More patients that's right The longer these people stay alive the more I am having to continue their care and other people are not receiving care So in fact in order to let this person who's going to die live I am burdening. I myself am burdened and therefore all these other patients are also burdened That sounds appealing doesn't it? That's right eventually this burden argument Which starts which usually starts with the individual the person suffering is burdened with this illness Okay, not only that but their spouse is burdened and their family is burdened by watching them melt away into the ether Then it kind of gets broadened and their family is burdened Their neighborhoods are burdened by somebody who is suffering and kind of just dying from this cancer that is eating them from the inside out And it's incurable and we cannot take this away and then The doctors are burdened and the nurses are burdened first of all personally by having to suffer alongside of this person And give care to this person continually and as a result of that then the care they give to others is burdened We are working towards national health care. You might think that that's god's gift to the world or satan's tool I do not care and your opinion is probably rash but If you if we go there This is not argument for it or against it But the arguments today are Whether it's a good thing or bad thing you are taking from us You receiving care Is taking from me even a private insurance policy If it's an hmo and you are cooperating with other people then you are taking health care dollars So you are a burden on me And guess what It comes in prettier language and it comes in kind of More interesting packaging and we avoid the Nazi thing to the nth degree because of course we're not going to call them useless eaters. We're just saying let us help you I want to write back to we should get rid of these people because they're a burden on society Whether that society be extremely small or that society being all of us Every culture wrestles with prejudices Each Society is unique in some way in its prejudices, but we all have Something our prejudices are usually against old people And against those who are incurably ill It Is the way we think about people that matters when it comes to active voluntary euthanasia once we start thinking about people as different than us as something other than we are And put ourselves above those people Then those people become of course automatically less than us For a long time people saw Those who are let's use severely mentally retarded those people have existed Since the very beginning, okay, it's not like some new phenomenon What's the only difference between today and let's say the 1600s More of them survive, okay Because of our advanced medical technology which interestingly creates more and interesting problems for us today But regardless both in the 1600s and up until Relatively recently the vast majority at least saw these people as being truly The humblest in society which they are but what did that mean about them when it came to our How we approach those people They are the humblest weakest members of our society And what does that mean? And how those of us who are not in their position? How do we approach them? They need us right so and and so we ought to do what? Help and care for them. It was a thing of like the weaker you are in society the more Deserving you are and in need of the care of those around you Today they're a burden That doesn't come in all cases and instances. It's not like we've completely flipped the script But this is the way that we often think and talk about those who are in these kinds of situations The weakest essentially get run out Once we start thinking about them in this way Once we start thinking about them in this way, then it becomes very easy to start talking about active Non-voluntary euthanasia. We've talked before about wrongful life suits People are currently suing people in the United States court systems On the basis of being wrongfully alive People are suing their parents doctors and nurses as a result of breathing Because they believe it is their right to not be alive anymore And they are sick and tired of their parents having brought them into this world That's a real thing and that's only going to continue Living in a society such as that will make Active non-voluntary euthanasia if not active involuntary euthanasia much more prevalent or at least possible Because we'll say of course these kinds of people don't want to live and once you start moving down that hill And once you start moving down that hill once you start moving down the hill of everybody who has this level of severe mental retardation Of course would never want the life they live then. What's the problem? Huh you make decisions for them and who's the them? Yeah, all of them it's not like this person or these three people it's anybody who kind of hits this criteria They fall into this camp. It's the yeah, we get rid of these people And we couch it in because it's like kind of love towards them because of course they wouldn't want to live It sounds crazy, but it all comes down to the fact that we think that we have this ability to Play god And of course the critics of this would say not at all. We're just trying to help people but helping people Is hard to define when it's taking their lives And once you start down this kind of slippery slope or if you want to call it an open door Then the door doesn't get shut anymore This is what we've seen in other parts of the world It is at least going to be likely impossible that we don't come back from this as one writer has put it It may well prove convenient and all too easy To move from recognition of an individual's right to die to a climate enforcing a social obligatory Duty to die preferably quickly and cheaply This is what we this is your like kind of like last act of citizenship So moving from right to obligation is not that far of move Instead of killing we should focus on care in order in closing today. I want to read you something The doctor wrote about the death of his father Says this This is what it should look like As I start writing this My father-in-law is three feet away lying in bed in a coma in the last hours of his life He's 81 years old and has widespread cancer He is now passing on right in front of my eyes His spirit and self are in the process of leaving the house That his earthly body soon to inherit a heavenly body Unencumbered by poor lungs oxygen tubes morphine Pump and foley catheter. I am honored to be part of his passing and delivery into eternal life Rarely do family members get to experience death with their loved ones these days Many are afraid many can't let go many do not know they can Or how rich and good a deep and deep an experience it can be the example of my father-in-law is in The example of my father-in-law Is in peaceful contrast to the tyranny of life's urgencies His death in our house will not acknowledge beyond a small circle was a celebration of relationship He was aided by a few friends family members medical professionals and a hospice personnel With pain struggle and success it all fit together When the hour of his death came we were rewarded rather than shattered Jacob's ladder seemed to descend from the heavens as the veil between the material and the spiritual worlds parted in our presence We were all in a holy place and we knew it My father-in-law's eyes gradually closed and his breathing slowly stopped as he quote-unquote walked home He was gone from here the shell of his body clearly no longer housed him We all sobbed gently in sadness and relief for him and in celebration of his life One of our close friends looked over at me And and through bright sparkling wet eyes and tear-washed cheeks whispered. Look what Kevorkian is still stealing from people We all had experienced something more Than we had ever experienced before We all had experienced something more Than we could have ever planned for yet. We knew it was not unique his death Awfully wonderful was a foreshadowing that all humans could experience The elements that helped make this death such a deeply fulfilling human experience are available to everyone faith Forgiveness family friends and the help of professionals, especially hospice These things didn't take away the real daily details of pain fear loneliness blocked bowels sleepless nights yelling out bedpans crying fits fighting kids medication side effects or exhaustion But they did help make them manageable and meaningful And they did have the potential to make death a blessing rather than a curse We had all experienced that blessing This is the way it was meant to be Now there might be minor quibbles with what this doctor has to say It always will be a curse no matter how peaceful it is in the end But the reality is is essentially that the struggle is worth it and in order to Bring about that kind of Euthanasia, which is good death Then what we must do is care for those who are dying Which is going to require an extraordinary amount of work on our part And I just want to close saying this Each and every one of you is currently dying Some of you more rapidly than others. Some of you know it more than others However, as we have seen from the beginning of this study until the end the time to start caring for dying people Is not when they are on their deathbed And if you do not prepare to take care of people on their deathbed while they are still alive Then when you go to their deathbed, you will be seen as somebody who's just taking advantage of a dying person Maybe for your own needs or maybe for their needs or maybe for the needs of other people Somebody does not want you in their deathbed or near their deathbed If you do not know them Or at least it would be a rarity if that were the case Therefore What behooves all of us is to take care of each other now who are dying And light is the fact that some of us will be dying in a more evident and visible way in the future As the doctor put it in this it's not going to make it all easy One of the reasons for active voluntary euthanasia is that pain medication suffering care And the work of hospice does not alleviate. It's not a panacea. It doesn't just take all this away You're right Everybody's right that says that it doesn't but it does make it manageable and meaningful which is why we should work so hard at it Let's pray Now we thank you for this time and pray that as we continue to think about What? this very difficult subject Looks like and means for us here that you would give us confidence and hope In being the kinds of people we ought to be today In light of the fact that all of us are dying and in light of the fact that we do Get incredibly scared when it comes to things like death I'm just nervous and weirded out and we pray that you would help us to long suffer with each other And for each other in christ's name we pray amen