The Euthanasia Issue
By the Rev. Dr Ian Mavor, OAM
The topic of euthanasia is of interest to many in modern society, and researchers suggest strong support for people being allowed to choose when to die. While this depends on how the research questions are framed, the usual scenario is of older people with incurable illness and in great pain.
Just as many of the supporters of euthanasia have been influenced by an experience of witnessing a painful death, my experience is of a different kind and has led me to a different view on this issue. After training as a Physical Education teacher, I have been a minister for 50 years, and for 16 years have been involved with the founding and ongoing work of Hopewell Hospice Services on the Gold Coast.
In the context of Hopewell’s home-style residential care, I have seen hundreds of people with terminal illnesses given the necessary physical, emotional, social and spiritual care to enable them to have a positive experience for their final days and a peaceful death. I believe that holistic palliative care is preferable to assisted suicide, often euphemistically called “euthanasia,” i.e. a “good death.”
Another influence for me was serving as Principal Education Officer (Health & Personal Development) with responsibility for aspects of the school curriculum that had a focus on the students as persons, rather than the focus on head knowledge found in most academic disciplines. Linked to my Phys Ed training, this reinforced my awareness that the whole person includes body as well as mind.
While serving at Lifeline Gold Coast, I was trained in Suicide Intervention, which gave another perspective. The Applied Suicide Intervention Skills Training (ASIST) provides valuable awareness of the mindset of those at risk of suicide and ways of responding. Even when a person has a focus on wanting to die, there can be another part of them that wants to live. The Intervention involves respecting and listening to both parts.
In other words, the resources for a desire to live are also present in the person, even if overwhelmed for a time by the pain that they are going through. That ambivalence can also be found in the person’s body, and when it is also ready to die, that will happen peacefully if the mind cooperates.
Many “baby boomers” express the wish to get the final stage of life over quickly. This is often linked to a fear of loss of control and of being a “nuisance” to loved ones. I have been interested in the shift in recent years from people being afraid of what might happen after death to a situation where the greater concern is with what might happen before death.
While many people say that their preferred option is a quick death, I have heard one family after another express thanks for the gift of their final times together.
With support, family members can find enrichment in walking this final journey with their loved ones. I have also provided grief counselling for others who were deeply suffering because they had been robbed of this opportunity by a sudden death. Where that death was through suicide the pain was even greater. Fear of a painful death gives stimulus to the push for legalisation of assisted suicide.
In contrast, my experience at Hopewell Hospice has been of people finding the end stage a precious experience, when there is good management of pain – including physical, social, emotional and spiritual factors.
When people speak of their “right to die,” I wonder who is stopping them from dying.
This is not about people on life support. That is a different discussion. It is about people whose mind has decided that this life, for whatever reason, (and at whatever age) is not worth living and who want to die.
In practical terms, all that is stopping them is a body that refuses to co-operate, i.e. a heart that keeps beating and cells that keep regenerating.
To say that it is their choice to die and that they should be assisted in doing so, means ignoring the fact that part of them, i.e. their body, is not involved in that choice. While part of them wants to die, another part is not yet ready.
In this view, the problem is not “the government” or “God”. The issue is much more at the personal level as a mind-body split. Unfortunately, modern medicine tends to encourage this split by treating the body as a “machine” to be manipulated. This fits the assumption that the body can be destroyed when it fails to perform as the mind wishes.
There are times when the body is moving into death and the mind is fighting against what is happening. This situation is usually applauded in the obituaries as “fighting courageously against cancer (or whatever) up to the last.” Alternatively, the mind has decided that death is the best option although the body is not yet ready. The mind may then seek external help to destroy the body through assisted suicide.
Historically, mindsets have moved from pre-modern, to modern to post-modern. In the first of these, there was a reference to an external authority, such as God, to decide when death should happen.
In contrast, the modernist perspective tends to focus on the mind and cognitive functions as the essence of human nature, so that what the mind wants is all that matters. The post-modern emphasis is on individual choice and that further reinforces the argument for a “right to choose”.
There is also, however, a movement to a post-postmodernism, with a greater awareness of our links to the natural world and of the harm that humans have done through the rampant dominance of rational thought and of individualism. It is this more holistic and integral perspective that calls for a recognition of the whole person and recognition of body, mind and spirit in taking account of the fullness of our humanity.
It seems strange to me that some politicians who emphasise care for the environment regress into the denigration of the body when it comes to supporting assisted suicide.
In this, of course, I write from the perspective of working with people who had the necessary support through counselling and good hospice and palliative care, and this is all too often not the case.
In his book “Gesundheit”, Dr Patch Adams has written of the benefits of good end-of-life care and a natural death that does not depend on speeding up the dying process:
We are here to help patients live the highest quality of life and, when that is no longer possible, to facilitate the highest quality of death… In no way am I trying to ignore the tragic loss of the deceased to the family and the world. We must all experience that loss, and grieve in our own style…
I believe that with conscious effort and advance planning, dying can be an anticipated and beautiful event shared with one’s family and friends – a final celebration of being together… Let’s stop fearing death and transform it into an experience that could bring us closer together as a family.
The Separation of Mind and Body
Rather than denying the power of the argument about freedom of choice, the aim here is to promote a more holistic perspective on the nature of that individual decision making process. Part of the progress of the modernist era was the differentiation of the mind from the body. This has been linked to the work of 17th century French philosopher René Descartes, who gave a rational basis for surgery on the body by separating it from the concept of the soul.
The problem has been when that differentiation becomes a dissociation of the parts, rather than a higher-level integration that respects both mind and body, and sees them as part of a greater whole.
Recent research into the interworking of the nervous, immune, endocrine and other systems of the body shows up the inadequacy of this reductionist way of thinking about our human functioning.
A cartoon by Jules Feiffer summed up the nature of the mind-body dissociation particularly well:
This is my head. It thinks. It talks. It charms. It worries. It laughs. It hurts. It has a hundred wonderful tricks. I am proud of it.
This is my body. It is funny looking. It malfunctions. It looks best in winter clothes. I have as little to do with it as is humanly possible. Lucky for my body that I need it to chauffeur my head around. Otherwise, out it would go.
Process Work and Mind-Body Awareness
Arnold Mindell, the founder of the therapeutic approach known as Process Oriented Psychology or Process Work, gave a particular emphasis to becoming aware of the whole range of channels through which information becomes available to a person. Of these, four basic channels are visualisation, hearing, body feeling (proprioception) and the sense of body movement (kinaesthesis).
In general, “mind” usually refers to seeing and hearing, while “body” is usually a composition of feeling and movement. In Western culture, people tend to be more aware of data coming through channels of seeing and hearing (mind) than through channels of feeling and movement (body).
In Mindell’s analysis, energies in those channels that are out of awareness tend to be experienced and interpreted as external forces happening to the person and, as such, are not part of their primary identity. This can be the case particularly with strong feelings and body symptoms.
From this point of view, the healing of the mind-body split can involve activities that heighten awareness of the whole range of available communication channels, particularly feelings and movements within the body.
It may also involve the development of a greater acceptance of the messages that are seeking to come through those channels, some of which will come from what Jung called the shadow or disowned parts of the person. In Mindell’s model, these will often find expression in body symptoms associated with illness.
Meditation, in its various forms, is another valuable way of nurturing mind-body links. Attention to the breath, which can function both consciously and automatically, can help this mind-body connection.
With senses and mind constantly controlled through meditation, united with the Self within, an aspirant attains nirvana, the state of abiding joy and peace in me. – Bhagavad Gita
In my view, a “good death” is one in which the mind and body are in reasonable harmony, and both are ready to go at the same time.