Oh my. This is personal. I wrote this as Maine was about to vote on an assisted suicide referendum (we're famous for our referenda) in 2000.

Holding Hands at the Comma

I don't know where Mr. Attas gets the idea that "It is an act that is consistent with my own religious tradition and faith." Was there a vote on this issue at a previous General Convention? I have to say I respectfully disagree his belief.

Eric Sinkula

re: GC and euthanasia, resolutions are here. There was a theological study requested but have not seen anything recently. Too busy with same sex relationships I guess.

@E Sinkula:

Where does it say it REQUIRES a vote of GC, to say something is "consistent w/ my own tradition and faith"? Fr Attas believes it is, and that's enough for him.

****

I honestly don't know where "assisted suicide" begins, and "palliative care" ends (I'm honestly not sure it matters).

Within a few months (June 2005) of being diagnosed w/ ALS (aka "Lou Gehrig's Disease": sadly, STILL always fatal. People last hardly any longer w/ it than Lou Gehrig did 70 years ago!), my mom got very interested in assisted suicide (my dad was much against it, and I tended to agree w/ him).

Two years later, however, my mom "just knew" when it was time to stop fighting: stop eating, stop drinking, and just let go (on her own terms).

Certainly, on some level, all of us who stopped feeding and hydrating her "assisted" in her departure.

To me, however, I felt like she'd reached a decision consistent w/ her values, and her (Episcopal) faith.

I'll find out on Judgment Day, but I feel OK about her death (as good as she did anyway): it was time for her to move on...

JC Fisher

P.S. FWIW, please don't grieve for my mom (she lived to be 81). DO contribute to the ALS Foundation however. This awful disease takes too many way younger than my mom was...

If things were "natural", most of us would be dead before we were invalided -- but we dare to stand against the "natural" with our medicines and surgeries and medical paraphernalia.

Anyone who approves of these "artificial" means of prolonging life ought not to have any problems with an "artificial" means of concluding that life.

God surely did not create any human being to be a mindless vegetable on feeding tubes!

I claim the right - in the name of my Creator - to conclude this silly little life when I am no longer the kind of being I was created to be - when it is plain that in God's own hands (without technical medical interference), God would lovingly allow me to be dead.

Thanks to Rev. Dr. Attas for writing to this very difficult topic. Thanks also to Ann Fontaine for posting it here.

As a physician I have experienced no greater distress than when I cared for patients who were clearly dying and whose treatment plan was to "do everything," particularly when the gravity of their illness required intubation and invasive mechanical ventilation, and therefore deep sedation and analgesia to near unconsciousness, restraints, invasive intra-arterial monitoring, invasive central venous monitoring, medications to maintain blood pressure, artificial nutrition, bladder catheterization, rectal intubation.

It is one thing to work hard to get a patient over a tough patch, with all these interventions, toward healing. It is quite another to chase after a set of vital signs with not hope for recovery.

It is quite another to perform painful procedures and follow treatments that are at least uncomfortable, and that also diminish or practically extinguish a patient's independence, autonomy, awareness, memory, and even consciousness, on a patient who will not in any reasonable and experienced prognostication survive.

There is also a spectrum of issues that arise in the face of survival that is not intact.

In the face of serious, life-threatening or terminal illness, changing the goals of medical care from curative at-all-costs to treating easily reversible illness and actively pursuing congruent palliative care is humane, and can be deeply healing in a way that an ICU stay cannot be. One important opportunity that can and does arise especially if set out earlier rather than later is entering a process of life review and confronting issues of conscience, regret, contrition, forgiveness, reconciliation, acknowledgment, gratitude, conscious companionship, love, and otherwise deepening one's spirituality.

Along with Dr. Attas, I too believe that our religious tradition and faith are consistent with a person facing serious, life-threatening or terminal illness not pursuing curative treatment, invasive interventions and monitoring, actively easing suffering, and even in the case of certain, proximate death, increasing suffering, and decreasing quality of life to medically intervene to end such a patient's life according to their own express wishes. It is fraught with conjecture and hyperbole and is enormously dangerous per se. Yet there is great suffering that arises from categorically omitting this option.

Promising that a patient will not suffer at end-of-life is disingenuous. It is true, that there it is all-too commonplace a situation at the normal course of end-of-life for there to be limited, or diminishing efficacy of palliative symptom management. In other words, what we can promise is that we will do our best to anticipate and treat troubling symptoms at end-of-life. We unfortunately cannot guarantee that our interventions will work in terms of relieving their suffering.

We shall all die. In my experience and estimation, there are worse things than death. Our faith tradition and faith embrace both our life and our mortality.

Mr Fisher -

You ask Mr Sinkula, "Where does it say it REQUIRES a vote of GC, to say something is 'consistent w/ my own tradition and faith'? Fr Attas believes it is, and that's enough for him."

That's as may be, but it's not enough for me, and shouldn't be enough for you.

If Fr Attas says, "My opinion is that assisted suicide is consistent with my own tradition and faith," then he is making a statement about himself and his personal and professional experience of the Episcopal Church, and he is his own authority on himself and his experience.

But when he leaves out the first clause, as he does, and says, "assisted suicide is consistent with my own tradition and faith," then he is making a statement, not about himself, but about the Episcopal Church.

But he does not possess the authority to state that without an appeal to General Convention, which is the only entity adequately empowered by our tradition to make such a statement.

Which it appears not to have done.

JC,

I think DSE clarified my problem: the author of the article sounds as though it is consistent with the EPISCOPAL CHURCH as a whole, and within its traditions and faith, FOR assisted suicide.

Unless he meant to say HIS own personal faith and traditions HE believes in, which he does not say, he is making a bold statement that flat out is not true.

Eric Sinkula

I think that the challenge is to introduce the dynamic tension that exists between rules and the needs of actual people. I think issues of action taken along this tension form a large part of the Gospels.

Rules are fine until they fail real people in real situations, which are most often of human construction to begin with. Then our duty is to minister to the real people and revisit the rules, because they need revision.

It is fine to set about a well-intentioned process of rule-making that seeks to first do no harm, and do the greatest good. The caveat is that there is a long human tradition to self-congratulate for constructing rules cobbled together in safe, secure, abstracted settings far from the marginalized crisis. When cries for mercy go out the response is often "objective," juridical, from afar and can be deeply political.

I invite on-lookers to and stake-holders alike to consider the cries and protestations and rabble-rousing as evidence that rules are again failing real people in real situations. Please don't retreat to the rule book. Instead come and visit the sick, stay a while and watch. Come to hospices, stay a while and watch. Talk to chaplains and physicians and nurses and social workers and patients and family (present and bereaved). Don't judge from the safety of the armchair. Instead, come and minister, come and see the gap between human need, the situation and rules.

btw, I did not make clear above that there are measures in practice that can be explored (which are far short of active euthanasia), such as deep sedation when all attempts at analgesia fail. However, even these are controversial, and do in fact tread the tension of the "law of double" effect particularly when patients' organ systems begin failing, and where clinical evaluation and pharmacology collide with the natural course of end-of-life. So, as Dr. Attas suggests there is actually a continuum of good-death or euthanasia in practice that has arisen in response to "the Gap."

{Sigh}

When someone says "my own tradition and faith", I ASSUME it's "own personal faith and (interpretation of) tradition."

Frankly, I don't think there's any "faith and tradition" that ISN'T personal (i.e., subjective).

[Besides, Fr Attas said "consistent with": if that's not a personal, subjectivising clause, I don't know what is!]

If people go off on what one "medical humanities professor, and Episcopal priest" says, I can imagine the sort inquisitive microscopes that would be applied had this been said by +KJS or Bonnie Anderson! O_o

JC Fisher