Answer

Case Study: End of Life Decisions

Healthcare has been defined in terms of two fundamental components of medicine and surgery. However, in recent times, patients and healthcare providers have begun to appreciate the influence of personal values, “faith, hope and compassion” in healthcare services (De la Porte, 2016). Consequently, drawing from 1200 studies and some 400 literature surveys, a study by De la Porte (2016) argued that the “health behaviours”, religion, and disease control interventions positively relate to desired health outcomes. Indeed, the findings have since been validated through cross-sectional studies by Musa, Pevalin and Shahin (2016) which associated the “significant outcomes” for patients who have benefited from religious and spiritual support during illness. This provides an ethical analysis of an ALS (amyotrophic lateral sclerosis) patient hereafter referred to as “George” through survey of literature, case study, literature on the Christian worldview to determine his interpretations of suffering in light of Christian narrative. Consequently, this confirms consensus in literatures that delineate interpretations from the Christian worldview on suffering as critical antecedents for achieving positive health outcomes and end of life decisions.

Amyotrophic lateral sclerosis (ALS), commonly referred to as motor neuron disease, is a progressive disease headlined by deterioration of motor neurons leading to muscle
weakness and ultimate paralysis (Hardiman et al., 2017). In anticipation of potential debilitation and suffering from ALS, interpretations of suffering from Christian literature on the fallenness of man have gained prominence in healthcare. Indeed, these writings have focused on the notion of suffering under inspiration from antique works on evil and tradition. One of such writings by Čiočytė (2018) scrutinizes suffering in the Book of Job in the Bible and attributes it to the debased state of humanity. Specifically, the findings have raised important questions on the frailty of man, though concerns with sufferings of seemingly pious men endure. In the Book of Job, the fallenness of man is aptly amplified with the words, “Naked I came from my mother’s womb, and naked I will depart. The LORD gave and the LORD has taken away; may the name of the LORD be praised.” (Job 1:21 KJV). Similarly, the Book of Judges attempts to decipher the underpinnings of the problem of suffering through Gideon by stating, “If the Lord is with us, why then has all this befallen us?” (Čiočytė, 2018). In the same way, minor prophet Habakkuk protests God’s apparent silence in the face of violence: “Thou who art of purer eyes than to behold evil and canst not look on wrong, why dost thou look on faithless men and art silent when the wicked swallows up the man more righteous than he?” (Habakkuk 1:13). Yet, there is a commonality in these narratives which entrench suffering as integral to what it means to be human. However, from the outset, Christian literature presents suffering as a recurrent theme, culminating in the suffering of the Lord Jesus Christ and eventual victory on the cross. Despite there being a unified understanding of suffering from majority of Christian literature, there are noticeable variations approaches on the issue. For instance, Immanuel Kant, and 18^th century philosopher perceives evil as personal responsibility. Accordingly, he opines that the problem of evil and attendant suffering should be perceived through faith, as a medium of interaction with intangible things. Inferentially, it calls for patients battling incurable diseases such as George to invest in a belief system so as to mitigate adverse effects of disease (Čiočytė, 2018). In the Christian faith, answers to the preceding questions seem to be embedded in the doctrinal puzzle surrounding “incarnation and resurrection” form which Jesus Christ features prominently. The latter are also Jesus Christ’s prescriptions to the problems of suffering, evil and death. While the deeply personal impacts of suffering have led many to perceive suffering as an instrument by which God exerts vengeance on those who do evil, others such as Saint Thomas Aquinas dispels this notion by stating that “human suffering is not God’s punishment (Čiočytė (2018). On the contrary, “paradise lost” is considered as the predictable result of human acts of disobedience and fallenness. However, the solution to suffering is hidden in Christ. Aquinas further states that “Our Lord took upon Himself the total pain of that separation” from Aden, and through the cross, engendered everlasting fellowship through death on the cross. In other words, St Aquinas offers an archetypal account that presents a personal response to the problem of evil through “incarnation, death and salvation of humanity” (Čiočytė, 2018).  On the whole, suffering presents as an adverse outcome of the fallenness of man, and Jesus Christ offers hope out of eternal condemnation. This hope transcends death, through the hope of eternal life.

Interpretation of suffering with a focus on the hope of resurrection has been idealized in diverse literature as essential for improving health of terminally ill patients. In the current case study, having realized that his condition cannot be cured, it is recommended from Christian narrative that George should confront the hopelessness brought about by the certainty of death from ALS with the Holy Scriptures. Qualitative studies by Lewis Hall (2016) perceive suffering as a result of the fall from Edenic privilege and subsequent entry of sin into the world. This narrative also presents death as the culmination of suffering. However, in acknowledging the feebleness of man under the weight of suffering and death, the authors see solutions as embedded in the Almighty God. Particularly, the scriptures also infer that the solution to suffering can only be found in God’s offer of “redemption through the death and resurrection of Jesus”.  This view conforms to the scriptural depiction of Christ as one familiar with suffering, and well able to sympathize with us; he is as such, a classical example of “how to suffer” (Lewis Hall, 2016). In addition, Jesus’ example gives hope to others who would suffer, as the redeemed can learn lifelong lessons on the way God’s long-term plans for humanity are achieved. In this sense Christianity acts as an antithesis to secular doctrine which advocate for avoidance of pain at all costs. One such example is the Buddhist doctrine which suggests that human should overcome pain. Rather, suffering individuals should seize the prospect of change through the gracious remediation of Christ into something grander; attainment of the resurrection from the dead. This point is aptly captured in the assertion of the Apostle Paul: “In all things God works for the good of those who love him,” (Rom. 8:28). Lewis Hall (2016) offers 3 interpretations of suffering from the life of Jesus Christ from which George’s can derive strength. First, the suffering should be interpreted as an opportunity to present woes to God through petition and lamentation.  Lamentation, a symbol of desperate dependence on God has been idealized in scripture and is the subject of the Book of Lamentation, a cry for respite from Babylonian captivity. The second interpretation perceives suffering as an antecedent of patience, the attribute of the fruit of the Spirit (Gal. 5:22). Suffering, or long-suffering as referenced in other writings, is recommended as a requirement for seizing opportunities to practice compassion, conformity to scripture, peacefulness, and diligence. Finally, George should interpret his suffering through cultivation of hope, a firm belief that “puts present suffering in perspective”. These are exemplified in the words of Apostle Paul with the affirmation: “I consider that our present sufferings are not worth comparing with the glory that will be revealed in us” (Rom. 8:18; Lewis Hall, 2016).

A number of cross-sequential studies have juxtaposed the “suffering of the just” with the value that God attaches on human life. For instance, ecclesiastical studies by Kutarňová (2019) on the Book of Job perceives the latter as a type of Christ, as his suffering evokes concern from the laity as to why a just God would permit suffering. In both Biblical accounts of the sufferings of Jesus and Job, Satan, occupies a vital position as the instigator of temptation. Job is hailed for resisting the prompting of his wife to curse God and die, pretty much the same way Satan tempted Jesus, the incarnation of the Word of God, to prostrate himself before him in worship (Kutarňová, 2019). It can be inferred from teleological research that suffering in patience somehow elevates one to some measure of the fullness of Christ. In addition, both personalities highlight God’s high regard for human life through the sacrificial death of Jesus to restore to bequeath fallen man the hope of resurrection. Jesus too demonstrated his value for human life by resisting temptation to subvert God’s plan for eternal salvation. Principally, he resisted the allure of worldly opulence by refusing Satan’s desire for worship.  He overcame temptation from a trusted ally, who had previously confessed him as the Christ. Third, he stood his ground in the face of a chronic fear in Gethsemane where he was tempted “to prefer His own will to the will of His Father”, to vacate his role of seeking and saving the lost. Finally, God’s love for mankind was manifested through Jesus’ refusal to save himself from the cross even though he was tempted to do so (Matthew 27:40; Kutarňová, 2019). As he contemplates euthanasia, George should consider the Christian view that God‘s love or him remains and will never change regardless of his medical condition.

Discourse on whether or not to legitimize medically assisted suicide and euthanasia has significantly increased in the past decade. In the Christian orthodoxy, ethical considerations have played a crucial role in the portrayal of euthanasia as a product of popular culture, and an affront to God’s law. From scripture, it is apparent from the Christian narrative that sanctity of human life is the prevailing standard upon which end of life decisions are based. This includes all decisions whether medically assisted or not. However, there is no evidence from scripture that expressly forbid euthanasia and medically assisted suicide. The result is that even Christians have to make determination on this subject at a personal level (De Villiers, 2016).  However, in word and in spirit, the Bible firmly and absolutely prohibits all forms of killing including mercy killing.  Available evidence shows the Christian basis of the rejection of medically assisted suicide as the sixth commandment which expressly forbids killing in all forms. Inferentially, this view acknowledges God as the ultimate authority over life and death.

Analysis of the sixth commandment by De Villiers (2020) have reveals a “very specific” and restricted use of the verb murder to the killing of an Israelite by a fellow Israelite as an act of revenge. This criterion effectively precludes killing for other reasons ass may result from war or extreme penalty. As a result, much of the Old Testament scholarships contend that the sixth commandment should be the focus of fresh translation. For instance, some have argued that the Old Testament approves of the death penalty for myriad misdemeanors and crimes committed by enemies of Israel. Apparently, all the instances of suicide recorded in the Tanakh were not construed as “illegitimate killing”, as such acts did not elicit strong sentiments against them. For instance, many Christians perceive the “suicide of Samson as an act of heroism” (De Villiers, 2020). Other Christian beliefs have anchored their rejection of “medically assisted suicide and voluntary euthanasia” on the belief that only God Almighty wields power over life and death. However, there is consensus among biblical scholars that the preceding position presents some ambiguity. Specifically, it could be interpreted that only God has the power to permit the killing of a person or “control over the life and death of a human being” (De Villiers, 2020). Moreover, recent developments on medically assisted killings through “safe abortion” have dovetailed with ongoing clamour for euthanasia to exert pressure on Christians to climb down from their anti-euthanasia positions. Modern Christian “ethicists” concur that in special circumstances, when individuals are encumbered with moral dilemma, particularly surround the overriding objective to save lives, then it may be allowable from a Christian ethical perspective to permit medically assisted killing.

Conclusively, it is apparent from the foregoing discussion, end of life decisions, and sufferings associated with them can be handled by crystalizing expert knowledge and the Christian narrative to yield positive outcomes for patients. Specifically, as a starting point, it is essential that patients facing potential end of life decisions should seek interpretations on their suffering from the Holy Bible on matters concerning the fallenness of man, the hope of resurrection, God’s value for human life, and perspectives on medically assisted suicide. If I was to be in a similar situation as George’s, I would draw strength from daily reading of scripture, with incessant petitions and lamentations with the hope that God will reverse my situation. What I will not contemplate, however, is medically assisted suicide.