The Moral Deliberations of 15 Clergy on Suicide and Assisted Death: A Qualitative Study

Abstract

Given the relationship between moral objections to suicide, physician-assisted suicide (PAS), and euthanasia and religion, it is important to understand under what conditions clergy have moral objections to suicide, ending futile medical treatment, PAS, and euthanasia. This study used thematic analysis to explore the moral deliberations of 15 clergy and the right- and wrong-making properties of nine death and dying scenarios. Fifteen Catholic, Jewish, and Protestant clergy completed semi-structured interviews. Data analysis generated eight themes: sanctity of life, preservation of the natural course of life, pastoral care, support of the faith community, referral to professional services, end-of-life decision in community, consultation with medical professionals, and a shift to a hopeful narrative. Respondents consistently endorsed the priority of pastoral care, demonstrating a deep concern for the well-being of suffering congregants. In conclusion, respondents were consistent in the application of eight themes to end-of-life scenarios but differed in their approach to the removal of a feeding tube and being present for a PAS death. Every respondent objected to suicide.

Appendices

Appendix 1

Nine scenarios

• 1. Amy is a healthy 15-year-old whose boyfriend just broke up with her when he found out that she is pregnant. She told her friend Denise that she was too nervous to tell her parents and then swallowed five of Denise’s mother’s anti-anxiety pills. Denise called 911. When you meet with Amy in the hospital, she says she is disappointed. She wanted to die and wants to try again. She asks for your advice. (Case developed by Mason)

• 2. Jon is a healthy, 31-year-old veteran who returns to the United States from the war. He wants to resume life where he left off with his wife and 2-year-old daughter. But he starts to have nightmares and flashbacks. He begins to drink to put himself to sleep and finds it harder and harder to get out of bed in the morning. He begins to miss work sometimes. His manager at work is not so sure that he is cut out for his job anymore and had a frank talk with him on Friday. Jon is worried about his memories of the war and about his need for a job so he can take care of his family. He feels panic and hopelessness at the same time. He comes to you to get advice. He seems agitated and depressed and keeps wringing his hands without making eye contact. You ask if he has suicidal thoughts, and he says that he has been thinking about suicide every day. He asks for your advice. (Case developed by Mason)

• 3. Jacob has been a successful businessman. He recently retired at the age of 72 at the urging of his wife and because he sensed that he was no longer able to function as well as he once had. He gets around his neighborhood, but he has trouble finding his way around unfamiliar places. He’s been on an antidepressant for a year. He says he’s depressed by the loss of his capabilities and by the “mollycoddling” of his wife. He says he’s tired of being treated “like a child.” She nags him constantly about doing his exercises. She even answers questions for him. He knows that all this will just keep getting worse. He tells you that he is preoccupied with suicide. He asks your advice about killing himself. (Based on a case described by Hendin 1997, p. 192)

• 4. Noah is a 47 year-old, HIV-positive White male. He was just discharged from the hospital for pneumonia, where he required a respirator for breathing. While he was hospitalized, doctors also found an AIDS-related bacterial infection, a low platelet count, and an AIDS-related cystic lung infection. Also while in the hospital, Noah had two episodes of blood infections with a drop in blood pressure lasting about 2 h. He recovered and was removed from the respirator but developed painful inflammatory deterioration of the nerves in his arms and legs. Noah complains angrily of pain in his hands and feet. He also raises the issue of suicide. He does not want to live this way. He’s terrified of dying alone, especially when his partner is at work. He also feels trapped in his wheelchair and is afraid he will be in pain with no access to transportation. He asks for your advice. (Based on a case of Dr. Carlos Gomez as described by Hendin 1997, pp. 206–208.)

• 5. Deborah is the daughter of a 71-year-old woman, Olivia, who is now in a persistent vegetative state. She is thought to neither see, hear, nor feel. Olivia is being kept alive by life support systems at the insistence of Deborah, who is following her mother’s wishes. Olivia was in poor health when she entered the hospital for diabetes-related problems and a fractured hip. A few days after admission, Olivia began having seizures that could not be immediately controlled with anticonvulsant medication, leaving her brain-damaged and in a coma. Several weeks later, the doctors feel that continuing treatment is futile. Deborah asks for your advice. (Based on a case described by Hendin 1997, p. 186.)

• 6. Ezra, 19 years old, was caught in the crush resulting from a collapsed stadium. He survived but lost consciousness as a result of two punctured lungs, which caused an interruption in the supply of oxygen to his brain. He is left in a coma, in a persistent vegetative state. When awake, he is thought to neither see, hear, nor feel. Medical experts who examined Ezra agreed that he will never regain consciousness. He is not on life support; he breathes naturally, without any assistance. He also digests normally. Because he cannot feed himself, he is fed through a tube to his stomach. His parents and the doctor want to stop the tube-feeding. Ezra’s parents ask your advice. (Based on the case of Tony Bland as described by Keown 2002, pp. 12–15, 217–238).

• 7. Abby is a 54-year-old woman with amyotrophic lateral sclerosis (ALS) and some fronto-temporal dementia. She has talked to her doctor and you about suicide periodically during her 3 years of illness. Her doctor recently told her that she has a few more months to live. Abby restates her desire to die. The doctor prescribes Abby lethal drugs that Abby can take and tells Abby’s sister that if Abby wants suicide, she may soon lose the will to follow through. Abby calls you. She is getting weaker and is in a more and more debilitated condition; she wants to end her life while she still can. She says she would like you to be present when she takes the drugs. She says she is ready but not quite—she needs about a week to be with her sister. Her sister tells her gently that the doctor is concerned that unless she acts this weekend, she may not be able to take the drugs. Abby looks terrified. She says she feels pressured and needs more time. She does not act over the weekend. However, the following Monday Abby says she’s ready and would like for you to be present. What is your response to Abby? (Based on a case described by Hendin 1997, p. 35)

• 8. Naomi is a healthy, but grief-stricken, 43-year-old social worker mourning the death of her younger son from a car accident two months earlier. Her oldest daughter died by suicide several years ago. Naomi grew up with a domineering and disapproving father, and her husband beat her when he was drunk. Naomi says that she began to live the moment her oldest child was born; she then became someone other than the object of her father’s criticism or her husband’s blame. She tried to leave her husband a few times but returned to take care of her children. She considered suicide but could not leave her children with their father. She wonders if her oldest daughter would have killed herself if she had left. Her husband blames Naomi for the suicide death of their oldest daughter. Naomi met with a doctor for about 30 h; the doctor agreed to help her die by administering a lethal injection. The doctor has consulted with some experts. Some experts believe that Naomi could recover, and others believe that therapy won’t help. Her sister and brother-in-law agreed to be with Naomi at the end but later changed their minds. Her sister said they do not want to be there because their children would then ask for details. However, Naomi’s friend has agreed to be there. She asks for your advice. (Based on a case described by Hendin 1997, pp. 23, 61–65.)

• 9. David is a 66-year-old man with Parkinson’s disease. He speaks with some effort and gets stuck on certain ideas but has not experienced any dementia. He recently had a fall due to his motor problems. His wife has cared for him for 5 years but now says she’s “worn out.” She no longer wants to care for him. She has given him a choice between euthanasia and admission to a home for people with degenerative illnesses. David, afraid of being left to the mercy of strangers in an unfamiliar place, agrees to be killed. The doctor, although aware of the coercion, is open to ending David’s life. David asks for your advice. (Based on a case described by Hendin 1997, p. 93.)

Appendix 2

Interview definitions

• Suicide is a death caused by self-inflicted fatal injuries with some intent to die.

• In physician-assisted suicide, the doctor assists the patient to take his or her own life (Keown 2002, p. 31).

• Euthanasia is the active, intentional termination of a patient’s life by a doctor who thinks that death is a benefit to that patient. It includes either acts of commission (lethally injecting a patient) or of omission (withdrawing tube feeding) (Keown 2002, p. 10).

  • In voluntary active euthanasia, it is the doctor who terminates the patient’s life at the request of the patient (Keown 2002, p. 9, 31).

  • Non-voluntary active euthanasia is euthanasia performed on those who do not have the mental ability to request euthanasia (such as babies or adults with advanced dementia) or those who, though competent, are not given the opportunity to consent to it (Keown 2002, p. 9).

  • Involuntary euthanasia is euthanasia against the wishes of a competent patient (Keown 2002, p. 9).

• Palliative care is the care for relief of symptoms when a cure is no longer possible, practicable, or desired.

• Futile medical care or treatment is the continued provision of medical care or treatment to a patient when there is no reasonable hope of a cure or benefit.