5-8-2016 Bioethics Part 56

The speaker begins by saying a prayer and then introduces the topic of physician-assisted suicide (PAS). They clarify that PAS refers to giving medicine or advice to someone to end their own life, not actively killing them. They discuss reasons why PAS might seem attractive, such as relieving pain and being a cheaper option. They mention the importance of trust in healthcare and how the dual commitments of sustaining life and relieving suffering conflict with PAS. They also mention the need for adequate healthcare and the debate surrounding who should pay for it. They highlight that 10% of the American population is uninsured, which may lead to people choosing PAS due to its lower cost compared to expensive treatments. They discuss how legislators may find PAS attractive as a way to reduce spending on healthcare for the uninsured. They conclude by emphasizing the need to address patients' needs in order to prevent PAS from becoming a more viable option. Let's pray. God be with us this morning as we think or seek to think hard about difficult issues before us and give us wisdom and insight and compassion as we study these things in Jesus' name. Amen. Last week we began looking at the rather difficult issue of physician-assisted suicide. When I'm talking about physician-assisted suicide, what am I talking about? I'm trying to remember, like, not exactly word-for-word the definition, but more or less what I'm talking about. There you go. Yes. Right. So it's the giving of the medicine or the advice, the opinion that one ought to kill themselves, facilitating it. It is not the active offing of people. That is what we will think about, Lord willing, next week. This week we're going to continue thinking about just the idea of doctors being enabled and emboldened to encourage people and help people end their own lives. Why is it that that might seem like, in talking to people over the last few weeks, it's been interesting, how many people are like, who would ever think of such a thing? How could that even be a possible thing? Well, we came up with a large number of reasons last week why such a thing is attractive, at least hypothetically. What are some of the reasons that physician-assisted suicide is attractive? Yes, it can seem merciful to people who are in a great deal of pain. It's cheap. There we go. There's the economic model. We talked about top-down, which is kind of government-legislated, which is possible, at least. Or bottom-up, which people are just taking the easy route out. Okay, what else? There you go. You're going to have a death party. It's a real thing. People are like, if it's scheduled, if you know it's coming, then it comes as less of a shock. It's just kind of, you just embrace death, and it's a great way to go out. Also, there's a very simple kind of thing that people have the objective right to die whenever they want to, because they own their bodies, therefore they can die when they want. And if I can die when I want, because I own my body, then I can pick exactly when I want to die. I could die right now if I wanted to. I should have that right, and I should have the right to receive aid from physicians around me. These are all kinds of reasons that people come up with. The problem, though, that we saw last week is there is a very real core of the medical profession, which is twin commitments of sustaining life and relieving suffering. Sustaining life and relieving suffering, kind of summed up under that idea of do no harm. And while there are some who would argue that physician-assisted suicide falls under that, really what we're doing is we're trading one, which is relieving suffering, for the first one, which is sustaining life. We also saw that trust is fundamental in health care, that you have to be able to trust the person that you are going to go see. We saw examples of when that doesn't happen, like in Nicaragua in general, where nobody goes to a hospital because people die in hospitals, because people don't go to hospitals until they're almost dying, or almost dead. So it's just this repeated cycle. Or in Zimbabwe, the example that we learned from Jerry, where people will not get lumbar punctures in order to check if they have meningitis, because when they get lumbar punctures and they find out they have meningitis, they assume that the meningitis came from the lumbar punctures. Trust is fundamental in medicine. If doctors are sometimes the providers of life and sometimes the agents of death, then there will be a lack of health care. If you are sick or assume that you're sick, then you will pause at least for a brief moment before you go and see a doctor, thinking maybe he's going to encourage me or she is going to encourage me to end my own life. The reality is, and this is where we'll start this morning, is that patients' needs do need to be met. And when patients' needs are not met, then physician-assisted suicide becomes a more viable and kind of desirable option. There's two bioethicists by the name of Kilner and Mitchell that give a series of needs that need to be met, and as I think through these needs together, these needs aren't being met well today in America in the 21st century, and as a result, physician-assisted suicide is becoming more and more of an attractive option. Again, there's four states currently that have legalized physician-assisted suicide, Washington, Oregon, California, and Montana, with for sure more to come. So, problem number one, or just the situation, is that patients need adequate health care. Patients need adequate health care. Humans need adequate health care. That, by the way, is not a public policy statement in a year burdened with election and all kinds of politicized statements. There is absolutely no qualms on any side whatsoever, Republican, Democrat, Independent, Socialist, pot-smoking party, the guy who just wants electric cars and that's all he's running on. Nobody disagrees that people need adequate health care. What is the debate about? Who should pay for it? Who should regulate it? How we should get it to people? But nobody's like, screw human beings, nobody needs health care. Nobody thinks that. The debate is all on how. We're not going to talk about how this morning. About 30 million Americans in the United States today are uninsured. This is down substantially from before what we commonly refer to as Obamacare went into effect. Whether you love it or hate it, I don't really care. Still 30 million people, which is about 10% of the American population, are not covered under health care. You go, well, I mean, so what? Who cares? What might be a result of 10% of our population not being covered in health care when it comes to physician-assisted suicide? It's cheaper so they choose it. Right, it's cheaper as opposed to what? Chemotherapy, right? That would be a specific example of just kind of treatment, right? Like if I am faced with the reality of the American health care system and I'm thinking I'm going to go in for an initial consultation and the doctor goes, you have cancer. You have lung cancer. As a result of having lung cancer, we can treat that lung cancer with chemotherapy. You don't have insurance and you're also not under Medicare. You just fall into that weird kind of place of being part of this 10% that's not covered. It's going to cost you $50,000. You go, how about no? It's not like, oh man, I'm going to really have to dig into my retirement account. It's just for a lot of these people, they just don't have anything. And so, remember, there's two ways. We'll go with the little economic route. So we've got this little economic route that's for $45, you can end your own life. You can do it when you want, you can do it how you want. The doctor is not going to actively kill you. The doctor is going to prescribe you the medication. It's not going to happen on the initial consult, this doesn't happen. But just think about the weight and the force of this. You're sitting in that doctor's office and the doctor says, we live in a state where let's say that physician-assisted suicide is legal. And you go, doc, I can't pay for that. And the doc goes, well, I know. And there's no way it's going to get paid for, right? I mean, you could like crowdfund the thing. It's probably not going to happen. You're probably not going to be one of those like 10 people that get like a million dollars because your story is super sad. Not going to happen. You're going to die. So what ends up starting to happen is that you begin to get kind of counseling, technically that's what they would call it, about how to end your own life. At least the possibility, viability. Because you're going to die and you're going to die suffering. So essentially the idea is that they would prescribe you the medication after you go through a series of checks and balances. And then you just get the meds and they sit on your bedside table and you take them whenever you want. They're just there, right? A set of pills, you take them in order, done. That would seem rather attractive for somebody facing a lot of suffering coming down the line. It looks pretty good when you can't get well. It's also super attractive for legislators, isn't it? Think about it. I'm not talking about a particular party. I'm talking about legislators in general who deal with more stuff than you could possibly imagine. Legislators are not solely in charge of what we would commonly consider to be health care. Health care is one part of a very large number of responsibilities that legislators have. Now, imagine that you are all legislators. Scary thought, I know. And as legislators, let's say that I am in charge of the legislature and I come before you and say, folks, here's the thing. We have a rather large deficit that we need to make up. Here is where we've got all our spending going on. You see how much money we're spending on uninsured people and providing them health care? And they're just, you know, they're taking, we could put that into schools. Now imagine that for a second. Let's put it in the terms it would usually come across as. Poor, undereducated, colored people are dying and using a large amount of our public resources to do it. We've got potholes to fix. We've got schools that need to be built. Wouldn't it be better if these people were alleviated of their suffering? Notice, there's nothing in that language about let's exterminate poor people. It's just let's help them. It's all about this idea of helping. And you're a legislator. You've got to get elected again. If this is a viable option in the state in which we live, if we were all legislators of Tennessee, then it would seem like a viable option to us, especially if we were running deficits and spending a lot of money on health care, which we are. I bring this up at this point simply to show you. We could have done this at kind of any point along the way. That when you crack the door to something, you are actually opening the possibility of worlds that didn't exist before. Physician-assisted suicide is currently not a viable option in the state of Tennessee. We are not allowed to do that. You can take your own life, although it might be against the law. It's against the law in a good number of states to take your own life. There's reasons for that which we won't get into this morning. But physician-assisted is not currently an option. So when the state legislators look at the budget, they can't go, well, let's just cut this by encouraging people to die sooner, relieving their suffering earlier. We can't do that. If we did have that option, we could. Every decision that you and I make as individuals and every decision that we make as a society affects many other areas of our lives. We talked about this a few weeks ago, especially when it came to just committing suicide. If I commit suicide, then I am going to affect a number of people. How many people? I can't be totally sure. It might be different than the number of people you would affect if you killed yourself. It might be lesser or greater. And it might have, in those people, let's say that I affected 10 people. Would I affect all 10 people in exactly the same way? No. Some people would be affected very deeply, let's say my wife. And some people would be affected not so much, like, I don't know, the mail lady who I give peppers and tomatoes to, even though she does not like to deliver my mail. She might be just kind of like, oh, that's sad, right? Or Marge would be rather more dramatic, at least I would hope so. Marge would be much more affected by that. Same thing happens when we make all kinds of other decisions. Other people are affected. If we as a society open the door to something like physician-assisted suicide, then it will not lead to all-out chaos where doctors are going around killing people left and right. However, it will affect doctors, it will affect legislators, and it will affect each and every one of us. Because we'll go, maybe I should just go out, maybe I should just take this route. All of this stems from a basic reality that a good number of people today do not have access to health care. It would be one thing if nobody had access to health care. Let's go back to the Middle Ages. The most advanced form of health care is essentially bleeding people and putting leeches on them. If that's all health care was, then we would all kind of be in the same boat and we're all screwed. But if medical technology exists, and we've seen this from the very beginning of our study up until now, if medical technology exists, then the question immediately becomes, with each new technology, who gets it? So think about like when we were talking about gene therapy. So either switch off cancer, which would be a very kind of easy yes, we should do that, or to make you more intelligent. That gets much more questionable. But even the question becomes at that point, does everybody get it? Does everybody have access to it? Or only does some people have access to it? And is that fair? Is that just? In the same way, if we have a number of people that do not have access to health care, again, not trying to get into public policy arguments of how they should get it, then we have people who see a very open door to just ending their own lives. It should be something that you're concerned about. Now, you could be concerned about it in a number of different ways. You could be concerned about it and say, I'm going to become a legislator myself. You could be concerned about it and say the way forward is X, or someone sitting right next to you could say, forget that garbage. The way forward is Y. Doesn't mean we're all going to come to the same page on all this stuff. But it should bother you that there are people who see killing themselves as a viable option in your society. That should not just be like, well, screw those people. They should just have faith or something like that. What that is saying is that you are not even attempting to walk even a couple feet in those people's shoes, trying to understand the weight of somebody who sees no other option in life except killing themselves. One reason out of very many is because they don't have access to health care. Number two, let's talk about the 90% of people who do have access to health care. The second point is that once patients have adequate health care in general, it is essential that they have adequate pain management in particular. Tragically, in a recent study of the United States health care system, half of the people dying of cancer in the U.S. did not receive any pain management, half. So people are dying, 50%, are dying from cancer without any pain management whatsoever. The reasons for this are many. Here are two important ones. Number one, old school doctors for whom pain management just wasn't on the radar, just wasn't something that they took into consideration. They were dying of bone cancer. Well, bummer. It's not to say that they used to be jerks, but rather that we have seen one of the real positive advancements in recent years in medicine is to understand something we should kind of all understand, that humans are rather complex creatures. I think most of us get that intuitively, but we now know that on a more kind of scientific level. And when this is not taken into account and little effort is put into relieving somebody's pain, we just go, you've just got to bear with the pain. You've just got to suck it up and deal with it. Now, is there a time and place to just tell somebody, you've just got to suck it up and deal with your pain? There you go, scratch the knee. Yes, there is a time and place where it's perfectly appropriate, especially when it comes to children or something like that, or human adults that are acting like children, just stop whining, right? I'll use a personal example from my own life. When I stub my toe, the world has ended, right? Now, I could cut my toe off and I would be perfectly fine. But when that stupid nail cracks and breaks and bleeds, oh my gosh, okay, I've got to think of something else. Then my world has come to an end, okay? It's perfectly appropriate for Mars to go, Jeremy, you just need to quit being a baby and man up, okay? But that doesn't apply in every case. If I was just in Washington and I was across the street from the house that I fell off of and completely shattered my collarbone, right? It looked like a green twig splayed open. It just shattered the thing, right? I passed out. It would have been wrong for Mars to have come up to me in that point, kicked me in the shoulder and said, Get up, you big baby. You're just being a wuss. You just need to walk it off. Just scale it up, right? If I have cancer and I feel like my bones are on fire 24-7, it is wrong and not loving, kind, generous or anything else to just tell people you just need to suck it up, right? Pain management has to be on the radar for people. And when that's not taken into account, then that affects what's going on inside and will have a deleterious effect on me as a human being. And this is also, this whole idea of no pain management comes from the second thing, which is doctors are often focused on something else than managing the pain. What would a doctor be focused on? What would you want your doctor, to some degree, to be focused on? Cure. Make you better. Now, why is that a good thing? They're determined. That's right. You do not want a doctor who comes in and says, All right, so here's the deal. You have cancer. So, sorry about that. I'm going to, like, try something. Probably not going to work. But, you know, the whole thing, try, don't succeed, try, try again. We're not going to go with that. We're going to try one thing. If it doesn't work, I'm just going to go play golf. You don't want that person. This is the paradox of medicine. Because if the doctor comes in and says, You know what, here's the thing, Tim, you've got brain cancer. We could fix it. Here's the thing. We're just going to manage your pain. Right? What would that doctor be? Yeah, yeah, that's wrong. You're not supposed to kill people. But, so, but that would be, that would be, you would think that he was, you'd go get a second opinion. Right? For sure. We're talking about managing my pain. I want to be cured. And the paradox of medicine is there is a very delicate balance between dealing with people's pain and being rigorously in the pursuit of curing people. And as technology gets better and better, though we do learn more and more about pain management and the need for it and the way to balance it without ruining people, there is a continual tension because people are more rigorously in pursuit of curing and they are less willing to give up and yet we understand more and more that we can't fix everything. And so all these things are just constantly going on in a doctor's brain and he has a whole large number of patients. If there is unbearable pain and the doctor doesn't care or seem to care, then, of course, death is going to look pretty good. Right? And why would I continue to live? The doctor doesn't care if my pain is not fixed. I can't do anything about it. This leads us to point number three. Suffering management is often ignored. What the heck is this? Here is where we very much move from the external to the internal of a human being. People are complicated. Those people who are suffering don't just need adequate pain management. They also need to be helped with the conflict that's going on inside of them. We've seen for a while in bioethics that what happens on the outside, right, which is my physical body, oftentimes affects what's happening in my soul. So if you break something, you're not just like, well, I'll just figure it out. I'll just wait until it's mended. Not a problem. There will almost always be, to some degree, emotional consequences for a physical disruption of normal service. This could come in very small ways, like my stubbed toe and me being mortally terrified to put on socks or do something simple like get into bed, which is a real thing. Pray for me. It could also, my wife's laughing. She knows it's true. But it could also get scaled up, right, to the point where let's say that I really enjoy playing disc golf because it's one of the greatest sports ever invented, and I tear something in my shoulder. And now I can't, it's not like, oh, it's going to hurt to play. It's like I can't play. That's going to be upsetting. It will be upsetting for like a whole season. Or imagine going into the doctor and them telling you, oh, you have bone cancer in your leg. We can take your leg off. You just so happen to be a marathon runner. You think you're just going to be like, that's all right. I'm just going to spend the next five years getting a very advanced prosthetic and spending hundreds of thousands of dollars on this. It's going to be totally fine. Or then you ratchet it up and you're going to lose everything. You're probably going to die from this. There's a large amount of suffering internally that will come as a result of just a physical problem. This is one of the things that bears witness to the fact that you're just not a body, that you actually have a soul. Because whether you believe in God or not, the shocking thing is that when you find out you have cancer, you don't go, all right. Everybody, to whatever degree they believe in a god or multiple gods or no god at all, everybody has the same reaction, which is an emotional response, which comes from somewhere. It's not just a clump of atoms doing something. People who are dealing with these kinds of things do not need just a doctor to manage their pain and a doctor that they can actually see. They also need a village of care. If I have cancer, then when it comes to my suffering management, what do I need? Anybody? First and foremost, let's just think about what I need on the curing side. I need a doctor. There we go. Way to kick it off. I need a doctor. What else do I need? That's right. I need a hospital. I need a team of nurses. I need some medication. What else do I need? Think about the suffering side of it. I don't just need that side. What else do I need? Support. Where's that support going to come from? Family, friends, right? Hopefully there's some kind of spiritual support there. All this kind of stuff is needed by the person who is suffering. Now, watch. This person is in the United States and they are receiving the best care humanly imaginable. They are at Johns Hopkins, right? And they are just getting the Cadillac treatment. And they are sitting alone in a room and receiving treatment for that brain cancer, that rare form of brain cancer that kills 90% of people. But there are signs that they're going to make it. And they're all alone in a room. Does that person have what they need? No. Not at all. See, the thing is that people can get well on the outside just fine. But people can be completely destroyed on the inside and nobody sees it on the emotional and spiritual level. Think about this. You get cancer. Right? They catch it early. It doesn't ruin your life. It slows it down for a little bit. But then it goes away. They quote-unquote cure it, which is never actually the case. Are you just fine then on an emotional and spiritual level from then on out? Why not? Okay, because you still have cancer in you. What does that do? Huh? It could come back at any point. So what would that do to you emotionally? Fear. You worry about it, right? Exactly. So then it would go from fear, right, being terrified of the future, to then shift to the polar opposite, which would be apathetic. Should I even do anything? I'm just going to die. And it would just fluctuate back and forth and back and forth. 30% of you will get cancer. Not just you. This isn't like some prophecy or something. Humans today, 30% of people get cancer. And when it goes away, you can no longer say, I'm going to be part of the 70%, which is those who don't get cancer. I'm going to be part of those people. You're now part of the 30%. I have had cancer, and cancer is always looming. So those people who are even cured of cancer are not inherently fine emotionally. They will need, just like the rest of us, ongoing care on an emotional and spiritual level. And what should not surprise us is that those who do receive, both on a religious and secular level, some kind of care emotionally, that their desire to end their own lives goes down dramatically. Makes sense, right? But if you and I, and we've got nurses and stuff up in here, but I'm not talking to a group of doctors, but if you and I do not have ongoing concern for people who are suffering around us, then those people will continue to suffer, and for some, ending their own lives will seem like an attractive option, because either from the worry or the apathy about tomorrow, they'll think, I should just end it now. It's going to come back. Or even if it doesn't come back, it doesn't matter. It's over for me. I should just end this now. Thankfully, by helping people deal with stuff on an emotional level, this does go down. And though the desire to treat these profound underlying issues might continue, to some degree, if physician-assisted suicide is legalized, it will definitely go down. You are not allowed to receive aid from a physician in dying if you are substantially depressed in the states where it's legal today. You can't just walk in and be like, Doc, I want to kill myself. And the doctor goes, Alright, here's the pills. Have a nice day. You have to prove that you are in a kind of rational place. What's the only problem? There's lots of problems with that. What's one problem with that? Who makes the decision? There we go. What else? Wanting to die is not rational. Good. Yeah, if you only have a few months to live, what rational mental state does that put you in anyways? Anybody in here who's ever been depressed knows that depression, when you're in it, and you're in it deep, is not, even then, at that point, always the same every single day. Some days are still better than others. Now, every day is miserable, but some days are better than others. And if you've got to go see a clinician three times, and it's the clinician's decision, you don't have to be bright and cheery and think the world is great. Scale of 1 to 10, how depressed is this person? That person's circle is under 5. Check. Circle is over 5? Okay, well, this time doesn't count. But all you've got to do is hit the right days in the right order with the right people, and here's your pills. And the next time apathy hits, or the next time overwhelming worry hits, you're done. Now, does that mean that everybody who suffers from depression and physician-assisted suicide will kill themselves? The question is, why do we open the door to such a thing knowing that people who are in such a state make decisions that are not rational themselves, which is, Nicole hit it on the head, the desire to kill yourself is not rational in any state, however happy and joyful about it you are. Number 4. Close with this. When patients are dying, they need assurance that they are in control of their health care decisions that are having such an impact on their lives. This is especially true when people lose the ability to make decisions for themselves, that they need to know that their decisions, how they desire to be treated, are going to be followed up on. This reality is what gave rise to advanced directives, which we covered a few months ago, either the power of attorney for health care or the advanced directives. Kind of laying out what I would like to see happen in case of an accident where I am not able to give my consent to something, I am either going to empower somebody to make that decision for me or I'm going to empower somebody to make that decision for me and here are some of the things that I don't want done. These are kind of the limits. That's what those things are. There are just two difficulties with advanced directives. I still encourage every single one of you to get one, but there are limits to it. Number one, as we talked about during the advanced directives, it doesn't cover everything. You cannot micromanage your future as much as you would desire to. The second one is the much more discouraging one, which is in a disturbingly large number of cases, nobody follows the advanced directive. You cannot be held legally liable currently under U.S. jurisprudence for not following an advanced directive. If the doctor decides to do something against the advanced directive, he or she can do that. Or you can just simply ignore the advanced directive and ask the people standing right in front of you or the family members at the time, what do you want us to do? If those people say something, you go, they said it. I'm just doing what they asked me to do. In a moment where making that decision is not exactly easy. Seinfeld is one of the greatest shows ever written. Interesting segue, I know. In one of the greatest clips in Seinfeld, it brings up the point that there is a massive difference between taking a reservation for a car rental and holding the reservation. And the same thing goes for advanced directives. There is one thing to having an advanced directive. There is another thing to having confidence that that advanced directive is going to be followed up on. And while I would like to say that advanced directives are ironclad and every doctor follows them, I simply can't. And this creates a culture of helplessness. That's where we live today, by the way. One of the reasons why we worship medicine is because we're terrified of it. It's beyond us. It's like your cars, right? You're terrified of your car because you don't know how to fix it. We're terrified of our bodies, interestingly enough, because some people seem to know more about them than ever before. And so we deify doctors and those in the medical profession thinking they can solve everything because they know more than we do, but we'll do whatever they say. And if we have something like advanced directives and we know that they don't get followed all the time, then, well, we're back to the case where suffering and helpless people see physician-assisted suicide as an attractive option. So hopefully we can see that there are a good number of reasons why physician-assisted suicide is attractive to people. And like many other practices, Christians ought to oppose this one. But do it carefully. It is one thing to oppose a practice, right? It's one thing to say. We'll use a different example that's kind of the same level of hot-topicness in our society. It's one thing to oppose abortion, right? Kudos. Go for it. It is another thing to know why you are opposing it and suggest something else in its place. Will abortion go away if it is made illegal in the United States of America? No. Will physician-assisted suicide keep people from killing themselves? No. So, really, while we ought to be concerned to some degree whether these things are legalized or not, the reality is that you and I ought to be about two things, which are care and prayer, right? I know they rhyme. It's not my goal. One is prayer. Very few of you have the direct ability to influence whether or not physician-assisted suicide is going to be something. You're not doctors who are forced with making that decision of whether I should suggest this or not. You're not working in the medical profession. Very few of you are there. And very few of you are legislators who are going to make this legal. And you ought to pray. And your first reaction to whether or not prayer is a good idea says a whole lot about what you think about God and what you think about the world you live in because I can almost guarantee you that most of our default reactions are, what's that going to do? We should pray. The second thing is actually care for people who are suffering. If this is true, if the reason why physician-assisted suicide is attractive is not just because it's legal but because of all these kinds of circumstantial things that are around us and are only going to grow going forward, then you and I ought to be part of that massive humanity that has the ability to care for other human beings. What is ideal is that we create a society particularly within the church but even hopefully in our neighborhoods where whether or not physician-assisted suicide is legal or not, people around us don't even consider it. Same thing with abortion. Whether it's legal or not, we should create such a society where people don't even consider it. Of course I'm not going to do that because I will be taken care of by the people that I'm surrounded by. That is what the power of the gospel does to human beings. It shapes them in such a way that we don't just work on the legislature or something like that. We don't just berate people who make decisions that we're opposed to but that we act in certain ways that are completely unthinkable because of course I'm going to be taken care of because I'm surrounded by these people. Each and every one of us, whether we're a garbage man or the world's greatest surgeon, has a role to play when it comes to stuff like physician-assisted suicide. Let's pray. We thank you for this time and for the ability to think about these topics. We pray that you would help us to be caring and compassionate people knowing that it will require much from us, that it is difficult, that it is much easier to just get upset about the way the world is and hope somebody else changes it without thinking about what kinds of people we ought to be. God, I pray that you would give us good hope and good courage to be the kinds of Christians that you desire us to be in order that tragic options like physician-assisted suicide are not even thinkable for the people that we are in contact with. I pray these things in Jesus' name. Amen.