October 2020 Pulse
The restrictions imposed due to the Covid-19 pandemic, including the paralysing lockdown mandated by countries around the world, have exponentially increased our dependence on technology. Board meetings, concerts, seminars, lectures, cooking and yoga classes are now conducted online using different platforms. Even churches and other religious communities have used digital technology to conduct their services and activities.
This massive move to take full advantage of modern technology has also changed the way in which medicine is practiced as doctors now consult patients remotely and virtually. ‘Tele-health’ or ‘telemedicine’ is showing great promise because it has widened the access to care and enabled doctors in the United States (for example) to work across state borders.
There is, however, a disturbing trend that has accompanied the obvious advantages of telemedicine.
For example, an article published in The Philadelphia Inquirer on 29 May describes how the coronavirus crisis has ironically helped abortion-rights advocates in America by expanding the scope of telemedicine. ‘The pandemic’, explains Marie McCullough, ‘is helping U.S. abortion-rights advocates to achieve a long-standing goal: Make it easier for women to use pills to end pregnancies up to 10 weeks.’
Assisting Suicide Online
The pandemic has also led some countries where physician-assisted suicide is legal to bend the rules and allow medically aided suicides to be conducted via tele-conferencing platforms such as Zoom. An example of this approach can be found in the ‘Telemedicine Policy Statement’ of the American Clinicians Academy on Medical Aid in Dying, published on 25 March, 2020.
According to its recommended guidelines, patients who wish to request the help of a physician to end their lives may do so by telemedicine. The first opinion is obtained through telecommunication via Zoom or Skype. But the second opinion can simply be done by phone.
The document also states that physicians can obtain sufficient information such as patients’ records and history of symptoms to assist in the termination of their lives through teleconferencing.
As Wesley Smith has rightly observed,
This means that assisted suicides will be facilitated by doctors who never actually treated patients for their underlying illness, who may be ignorant of their family situations and personal histories, and who have never met their patients in the flesh.
In addition, the document also states that adequate physical examination of the patient such as observation on his or her mental clarity, mobility, respiratory rate and discomfort, and, to a lesser extent, other symptoms such as jaundice or rashes can also be conducted virtually.
This is what it says about physical examination via telemedicine:
When possible, physical examinations are best performed in person. However, at the practitioner’s judgement and discretion, a telemedicine physical exam that includes the components noted above can be performed and is adequate if it establishes or confirms the diagnosis, prognosis and decision-making-capacity of the patient.
The liberalisation of assisted suicide through the use of digital technology should not come as a surprise. Studies have shown that in jurisdictions where euthanasia or physician assisted suicide are legal, there can be detected a gradual relaxation of official criteria and erosion of best practices.
In the Netherlands, euthanasia and physician-assisted suicide were legalised with cases like terminal cancer in mind. But the scope gradually widened to include other categories as well. A survey conducted in 2015 reports that 31% of GPs and 25% of elderly care physicians would grant assisted suicide for patients with advanced dementia.
The safeguards put in place in the state of Oregon to prevent abuses have often proved ineffective. Although physicians are not allowed to write lethal prescriptions if the appropriate conditions in the law are not met, patients can circumvent this by ‘doctor shopping’ – they will simply approach other physicians until they find one who will agree to prescribe the lethal drug.
In 2009, the International Task Force on Euthanasia and Assisted Suicide stated to the Montana Supreme Court that:
Many other patients seeking assisted suicide have … had to ask more than one physician for the lethal prescription. There is no way to know if physicians declined due to personal convictions, because they believed patients were not terminally ill or because they are determined that the patients had impaired judgement. During the first three years of legal assisted suicide in Oregon, reports indicate that, in 59 percent of cases, patients had to ask two or more physicians before receiving the lethal drugs. After the third year, official reports stopped including this category. Patients or their families can doctor shop until a willing physician is found. And, since non-prescribing physicians are not interviewed for official state reports, there is no way to know why they refused to lethally prescribe.
What is of concern here is that instead of imposing stricter controls, the criterion or requirement that was originally put in place to prevent abuse was simply abandoned.
The requirement that physicians participating in assisted suicide must have a thorough knowledge of the patient’s medical condition and mental state has already been set aside with the advent of suicide tourism in countries like the Netherlands and Switzerland. According to statistics from Dignitas, 221 people travelled to Switzerland in 2018 for this purpose – 87 were from Germany, 31 from France and 24 from the UK.
The use of online platforms like Skype in assisted suicide is also not entirely new.
Even though 57% of all assisted deaths in Oregon were attended by a physician, another health care provider or a volunteer, in the U.S. physicians are not required by the law to be present. Thus, even before Covid-19, physicians have therefore been using online platforms to assess and aid patients who wish to end their lives.
With the coronavirus outbreak, online assisted suicide will become more common, and, with the absence of the physician or volunteer, the family members of the patient will have to play a more active role in the process. They will have to administer the lethal drugs (in the U.S. doctors usually prescribe a compound of four drugs – digoxin, diazepam, morphine and amitriptyline – which are mixed with juice) to their loved ones.
This will no doubt prove to be a traumatic experience for family members. As Misha Ketchell reports: ‘Pre-pandemic, many families told me that preparing the lethal cocktail would make them feel like they were facilitating – and not just morally supporting – a loved one’s death. They were glad to outsource this delicate task. Now they don’t have a choice.’
Culture of Death
The easy access to abortion and assisted dying through the use of technology has helped to advance the culture of death.
Twenty-five years ago, Pope John Paul II issued an important encyclical letter entitled, ‘The Gospel of Life’ (Evangelium Vitae) where he refers to the ‘culture of death’ and warns that the legalisation of abortion and euthanasia may create a society that would trample on human dignity and revert to ‘a state of barbarism.’
In that encyclical – whose message needs to be heard with even greater urgency today – the late pontiff speaks about a kind of freedom that is in fact not genuine freedom at all. This is a freedom that is no longer concerned about the truth. It is a delusory freedom that has become enslaved by the falsehoods it has come to entertain.
‘Freedom negates and destroys itself, and becomes a factor leading to the destruction of others’, writes John Paul II, ‘when it no longer recognizes and respects its essential link with the truth’.
Having lost its moral compass, this freedom asserts itself relentlessly, showing little or no regard for the value and dignity of human life. In the words of John Paul II, this unprincipled freedom takes on ‘a perverse and evil significance: that of an absolute power over others and against others.’
The prevalence of this false freedom in modern medicine is seen in the elevation of autonomy and self-determination above everything else, including the principles of beneficence and non-maleficence. And it is precisely this corrupted idea of freedom that is valorised by the advocates of abortion, euthanasia and physician-assisted suicide and invoked in ethics review boards, journal articles and placards.
In an article published on the Catholic Education Resource Centre website, Robert George describes the societal forces that are fuelling the culture of death as the new paganism. Commenting specifically about American society and culture, George writes:
Remember: false gods always demand innocent blood. The evidence that a culture is descending into paganism is always manifest in the body count. A pagan culture is always, in the end, a culture of death. This was true in ancient Babylon and it is true in modern America.
Needless to say, Christians must oppose this culture of death with its cavalier attitude towards human life. And they must do so with persistence, consistency and courage, against the powerful currents – the zeitgeist – of contemporary culture.
In its stead, they must offer a counter-culture and be that catalyst in society that champions the culture of life, which regards every human life as sacred and valuable, worthy of respect and protection.
Dr Roland Chia is Chew Hock Hin Professor at Trinity Theological College (Singapore) and Theological and Research Advisor of the Ethos Institute for Public Christianity.