Drs. Margaret Cottle and William Toffler explain why physician-assisted suicide laws are dangerous to society and urge Colorado listeners to oppose currently proposed physician-assisted suicide legislation coming up for vote in the state.
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Dr. Margaret Cottle: We have this illusion that somehow we can control every aspect of our lives and somehow, if we can't control death, that we're all going to have to die, that well, maybe we can control the manner and the timing of it and somehow we get death before death gets us. And I think it's very important for us as Christians to stop and think about that for a minute. Who really is in control?
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John Fuller: That's a profound question about life and death issues from a faith perspective and you'll hear more today on "Focus on the Family" as we look at these issues related to the controversial and at times, confusing topic of physician-assisted suicide. Thanks for joining us. I'm John Fuller and your host is Focus president and author, Jim Daly.
Jim Daly: John, this is a difficult topic to address, especially in families where a loved one is facing a terminal diagnosis like cancer or maybe the doctors have simply said, "There nothing more we can do." And at that point, you may be wondering what's next? Tragically, there are voices in our culture today who will tell you that death is the answer and they say, "Why not end it all?" And [they] use terms that make suicide sound like a good and wise decision.
In fact, such advocates believe suicide should be your legal right and they want doctors and your state government to help you do it. Admittedly, this is a complex issue. There's a lot of emotion and intense feelings surrounding that and I realize it, even some confusion about the terminology and the way people make it sound. But what often gets lost in all the well-meaning arguments is the value and worth of human life and that is the bottom line.
God created us in His image and all of our days on this earth are numbered by Him and that's why we're going to offer a different perspective about physician-assisted suicide today, because this is becoming a legal battle in the United States and in other countries around the world. And now there's a legislative effort in this state about physician-assisted suicide and we want to give you the facts today so you know how to respond to your elected officials and how to talk to your friends and neighbors about it and be informed.
John: Well, the Colorado House of Representatives could vote this week on a bill to legalize physician-assisted suicide here in the state, so please go to www.focusonthefamily.com/takeaction. Do that right away and make your voice heard or call 800-232-6459; 800, the letter A and the word FAMILY to learn more.
Jim: Our guests today are two members of Focus on the Family's Physician Resource Council and this is a team of doctors who help us review medical issues and bioethical issues and provide resources. And it was my privilege to talk with Dr. Margaret Cottle and Dr. William Toffler, who are experts in this field of end-of-life care and treatment and here's how our conversation began.
Jim: You know, the Christian tradition is one of life. I think right from the 1st, 2nd centuries, our forefathers and "foremothers" in the Christian faith fought for life. I can remember the wonderful story of I think it was Telemachus jumping into the Coliseum, demanding that the gladiators not treat each other the way they were treating each other, which is to kill each other. And he was stoned that day, but from the legend of that story, that was the last day they hosted gladiator events. That's a powerful illustration of Christians standing in public squares, saying, you're made in the image of God. This is not the right thing to do.
It may not be a direct correlation, but as you look at it, let me just start both being physicians, let me start with that question. From where you sit, what is that grand plan? How should we look at the end of life from a godly perspective?
Dr. William Toffler (Bill): You know, the end of life is one of the most special times that we could experience if we allow ourselves to experience that. Much like childbirth, it's got pain and it's got suffering, but there's also great joy in it. And as you know, Jim, I lost my wife almost 18 months ago and I wouldn't trade any of those times that we had together. There was great suffering, but there was also our family experiencing unbelievable joy because we knew how special those times were. The reality is, that we did things together in a way that hadn't happened in the first 35 years of our marriage, those last five years.
Jim: What would be an example of that?
Bill: Well, I think the conversations we had, the times, special moments together. She at times in the last stages of life, required oxygen. Being able to minister to her like she had to our children, to me even, as wives, my wife in particular, would be supportive of me through my career, through thick and thin, would defend me when I really didn't deserve it.
The reality is, that she loved me as agape love many times and this was an opportunity for me to do things that weren't easy, just that in many cases, I'm suffering sometimes emotionally as much as she's suffering physically. And yet, that's a bond that comes like two people in foxhole, where you both experience adversity and live and work together with that. There's no experience like that. Even our childbirth, we have seven children. We were blessed with an abundance. We are expecting our 13th and 14th grandchildren in a little while. This is her legacy, but that suffering together is really the greatest bond we can have. And I think in terms of Christ-life terms, I think of the image of Christ going to Golgotha, suffering for the very people persecuting Him and the meaning of that is timeless. And that's the model for us for how we should be with one another. And unfortunately, in our utilitarian world today, that is not the case.
Jim: Margaret, let me ask you this question because some people don't have the worldview that we have and for them, it is to Bill's point, a utilitarian decision and one that you shouldn't be tellin' me what to do. I mean, if my loved one or if we don't want to suffer in Alzheimer's or some other disease that's very debilitating at the end, why should you prevent me from doing what I think is best? I don't believe in the God you believe in.
Dr. Margaret Cottle: That's an excellent question and it's certainly one that is asked many, many times. And I think the way that the question is asked and who is asking the question should direct how we respond.
People who are people of faith, of many different faiths, can have an understanding about the sacredness of sharing in suffering together. But often out in the secular world that's not a message that will connect with people. And I think we have to be very careful how we approach this.
And I think what I do when I talk about this with folks who don't have faith, is I talk about the richness of the human experience and how important it is that we are the only creatures that get to do this, to come alongside one another when we're in a dark time, that we can come alongside and we can say, "You matter to me." We can say, "We will help you. We will be there." And not only is that good for the person who's needing the help, it's good for us.
And why would you not do that? It's such a lonely thing to say to the person, "Well, you think your life isn't worth living. Fine, we'll help you die. We agree with you; it's not worth living." You know, "We'll make it possible." We'll either, if it's a place where euthanasia is legal, we'll actually cause your death or we'll give you a means if it's assisted suicide. So, this idea that somehow this is a compassionate thing, to me is where the problem lies, because it's not compassionate to just leave someone alone in that. The compassion comes, the true compassion comes in coming alongside people and caring for them.
Jim: And walking through that dark time with them.
Jim: Let me kind of lay the landscape or ask you to do that. When we talk about physician-assisted suicide, there's a lot of terminology that the lay person, we may not understand. So, as doctors, I wanted to ask you that question. Can you help us, you know, through "death with dignity" and "euthanasia" and some of these other terms that are applied to that situation?
Jim: Just talk about that and help us better understand it.
Margaret: I think the easiest way from laymen's terms is that euthanasia is pushing the syringe and physician-assisted suicide is prescribing the pill. So, that's a simplification, but euthanasia is when the person who is actually carrying out the act, makes certain that the person is dead on the spot. Whereas, assisted suicide, there will be a prescription written or other means given to the individual, who may or may not decide at a later date to follow through with that.
Bill: And the danger with what Margaret just said is, when you give a prescription to someone, a lethal overdose of sleeping pills essentially is what's tried or a sedative. It's not pain medicine. It's important that people understand. This is not overdoses of pain medicines. But when they give it, it's not clear who gives it, who takes it or how it's given. In fact, because of the unavailability of some of the sedatives, they're actually using orally sometimes a drug that can be given intravenously in the vein through a syringe.
So, we really don't know after it leaves the pharmacy who's giving it to whom. That's one of the clear dangers of this. In Oregon, where we've had assisted suicide legal ever since it was officially put in place in 1997, so we're talking roughly 17, 18 years—
Bill: --we've had people who said they couldn't swallow, so a brother-in-law had to help a man with ALS to swallow a pill. Well, how do you help somebody to swallow? And when asked that question, he wouldn't say how he helped him to die. Was it a pillow? Did he force it down the gullet? I mean, how do you do that?
So, the language is important. You actually used the correct term, "physician-assisted suicide." You killing yourself with something given to you by a physician and that's supposed to be the boundary. Already in Oregon, we know some nurses have done this. We know that it's gone outside that supposedly narrowly crafted model law that's working so well.
And when you talk about the other terms that you use, the so-called "death with dignity," the so-called "aid in dying," the so-called "choice in dying," why do I say "so-called?" Because I believe in aiding the dying. That's what Margaret and I do, but I don't believe in killing my patients. The solution to suffering is not to end the life of the sufferer and that unfortunately is what those euphemisms are covering up.
Jim: You know, I think of Joni Eareckson Tada, who at 17 or 18, as a teenager, she dove into a lake in shallow water and broke her neck. She talks in her testimony about a time where she contemplated suicide, because she was so depressed. And depression is often part of the experience there. But looking back now, she would, I think say if she were sitting here, what a horrible mistake that would've been, given how God has used her to reach people, to help people with special needs. And that's the slippery slope issue. Talk about that and where physicians, if it's passed, if it's nationalized, if we say, physician-assisted suicide is now the law of the land—
Bill: Well, it happens--
Jim: --how does it make it easier for physicians to treat a 17-, 18-year-old quadriplegic who doesn't want to live?
Bill: --well, your point is very well-taken and I can think of no better example than my colleague and again, he's one of the co-founders of Physicians for Compassionate Care, where we're trying to maintain a consistent medical ethic and never participate, refer or promote assisted suicide.
So, Dr. Ken Stevens had a patient come to him in Oregon who'd just been diagnosed with colon cancer. This is an overwhelming [diagnosis], being told you have cancer. It's not operable and so, she says to him, he's a radiation oncologist, the chair of the department at Oregon Health & Science University, and he asked her about her request. He said, "I don't want any chemotherapy. I don't want surgery, since it won't work. I just want the pills."
And she had son that was gonna graduate from the police academy. She wanted to see him get married and just simply reflected back, "Don't you want to try to live for those things and I can perhaps help you with the radiation" that he's a specialist in. Indeed, she over the weekend, over the next week, changes her mind. He gives her the therapy and the tumor melted away. She's telling this story on tape. People can go to YouTube and look for Jeanette Hall and Ken Stevens and in her own voice, she talks about, "I would've done this if it hadn't been for Dr. Stevens. He saved my life."
Bill: In fact, it's an important point, 'cause all states should be aware that in my state that's had it for 17 or 18 years, they actually were pushing to move it to 12 months, not six months. And oddly enough, those sides didn't want to go forward. Obviously, I don't' believe in expanding the law. It's misguided. It's an inherent conflict of interest for doctors. But the promoters of assisted suicide didn't want it because it would expose that there is a slippery slope.
Bill: This is simply doctors acting more like, forgive the term, but vending machines if a person wants this, rather than recognizing the process behind their request, something deeper. When people say, "I might as well be dead," maybe what they're really saying is, "No one cares about me." When people say, "You know, I don't think I can go on," maybe I'm afraid I don't have the strength and they need encouragement, coaching.
Jim: Well, and some of that is training and of course, when doctors are being trained, if they're trained to respect the request of the patient without digging deeper, that's your point, and really knowing the person better, you may be making the wrong call.
Jim: Margaret, let me ask you this. There are sympathetic situations where the disease is a difficult disease, where terminal illness is imminent, that you know it will come. And for those families and again, I'm right with you both. I mean, I am pro-life right to the core, but I'm trying to represent a position that you can address, even within the Christian community. When that anticipation is, it is getting close and there might be a bit of suffering, I guess my question would be, how good is pain control and pain management today to help an Alzheimer's victim or another disease, Lou Gehrig's disease, where it is a dreadful death? How do you respond to that family member who's saying, we'd rather try to time this so they don't have to go through that kind of suffering? Is that compassionate? Or is that misguided?
Margaret: Well, there is a lot of questions that you've asked--
Jim: I'm sorry.
Margaret:--all at the same time, there. But first of all, I would like to say that we've been talking a lot about suffering in our broadcast here. And to be honest, physical suffering is not the reason why people ask for assisted suicide or euthanasia. This is very clear in the medical literature.They reasons that people ask for this are lack of autonomy, lack of being able to do the things that always gave them pleasure before, fear of being a burden on their families. These are by far the most important reasons why people ask for assisted suicide or euthanasia.
There is a fear of suffering in the future and the other thing that the literature shows is that people are far more likely to ask about having that option available to them farther on down the road, then they are at the very end of life when they reach that point, so that it's almost this idea that, well, will you still be there for me, doctor, if it gets to be too much for me?
And I've been able to say to my patients, I can't go that final step and I wouldn't go there even if it were legal. However, I'm never going to desert you. I'm going to be with you. I'm going to keep taking care of you. We're going to get your symptoms under control. And I think the word "control" is really important. We are very much control freaks in our culture in the Western world. As one of my colleagues has said, "There are not too many people who are subsistence farming in sub-Saharan Africa who are asking for physician-assisted suicide.
Margaret: It's a Western issue, because we have this illusion that somehow we can control every aspect of our lives and somehow if we can't control death, that we're all going to have to die, that well, maybe we can control the manner and the timing of it and somehow we get death before death gets us. And I think it's very important for us as Christians to stop and think about that for a minute. Who really is in control?
John: Some really good questions to consider on today's "Focus on the Family" with Jim Daly and this topic is very important this week, because the Colorado House of Representatives could vote to legalize physician-assisted suicide perhaps in the next few days. So, let me urge you to follow up, learn more. You can do that at www.focusonthefamily.com/takeaction. Don't let this come to Colorado. Let your voice for life be heard and again, go to www.focusonthefamily.com/takeaction or call us to learn more, 800-A-FAMILY.
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Jim: Let me ask both of you, how is "physician-assisted suicide" fundamentally different from a patient's right to withhold treatment or life support? What's the distinction between the two?
Margaret: That is a very excellent question because these things tend to be conflated in the media all the time, and people get very confused about this issue. You already have the right to refuse any treatment, no matter how life-saving it might be and no matter how deleterious to your health or to your life it might be for you to discontinue that. So, stopping treatment that is no longer working or is causing you more pain, or that you just simply don't want is already your right as a competent adult individual.
There are some nuances when people are no longer able to speak for themselves, but there's a big difference between assisted suicide and euthanasia where the intention is for the person to be dead, versus a withdrawal of treatment or stopping treatment when the intention is to stop something that is no longer working.
Bill: In fact, I think the healthcare system, if you think about it, a profit-driven system, is all too eager to hear that kind of statement. In fact, one of the dark sides of some of these check box forms is that people are given these forms even when they have years to live and you're supposed to make a decision in advance when you don't know what the circumstances are.
And what's worse, some of these documents don't even require the patient's signature. They're literally called "physician order for life-sustaining treatment." In other words, it's the order from the doctor, so this so-called choice is handing over your choices. So, this whole notion and the confusion, the conflation that Margaret talks about is real. It's happening and I fight for accessing services for my patients. I never have to fight if they don't want things done. That's no fight at all. We've learned. We're not back 40 years ago.
Margaret: Yep. Rita Marker has said, do we trust our governments and our healthcare systems to do the right thing or do the cheap thing?
Bill: Elder abuse lawyers, when I was testifying against assisted suicide in Washington, D.C., an elder abuse lawyer talked about, this is the perfect crime. You have an overdose at home, if it's assisted suicide. No one asks questions in the state of Oregon. It's never investigated. So, once you have an overdose, you would be fair game. No one asks questions about what secondary gain is there to the so-called loved one who's making the decision.
Jim: Life insurance, whatever.
Bill: Well, exactly.
Margaret: Actually your heir can help sign you up for it, too.
Bill: There is no questioning about a potential conflict of interest and this is clear. And people who, even from the most secular point of view with no reference to the theology behind this act, good or bad, will say, this is horrible for society. The choice is an illusion. You're losing your choice. Ending your life is all too easy. In the United States, 43,000 people end their lives every year and most of us, I have to say "most," because there literally are people who really don't care about that, but I care about it. I believe it's a tragedy that we squander someone's life because they weren't identified. They didn't reach out for help or we failed to provide help in the right way.
That's the Christian way. That's the human way. You don't have to even invoke our faith background of what do we do? Who was the Good Samaritan, is the point? And that's what we should be doing with suffering, not accepting the carnage. It's more suicides in the United States right now than deaths on the highway and that's not assisted suicide. That's people feeling despondent, not having someone in their life. Feeling abandoned, lonely, jobless, hungry or just simply depressed from a genetic point of view. It's sad; it's tragic and I think we've now imposed that callousness on the disabled, the sick and the dying.
Jim: It's a tragic moment.
Margaret: Our friends who are in the disability rights movements, most of them are very much opposed to assisted suicide and euthanasia because what they see is this double standard in suicide prevention. If you are a non-disabled person, we want to do everything we can to prevent you from committing suicide. We want to come alongside you. We want to say, this is a tragedy. We want to help you. But if you are disabled or if you are newly disabled because of your illness or because of cancer or because of another illness, then well, maybe your life isn't worth living and maybe we should help you die. So, it's a complete double standard between people who are non-disabled. We want to prevent their suicide and people who are disabled and we see that as rational.
John: Some really challenging, good perspectives from our guests, Dr. Margaret Cottle and Dr. William Toffler on today's "Focus on the Family" with Jim Daly. I'm John Fuller and Jim, this conversation has been so helpful in unpacking and understanding what's at stake when people argue for physician-assisted suicide.
Jim: Well, I couldn't agree more, John and I hope everyone listening will prayerfully consider the information we've shared today and what your response should be to the efforts to legalize physician-assisted suicide in your state. You know, it's easy to dismiss issues like this as just politics, because if it doesn't directly affect you, why bother? But as a fellow pro-life Christian, let me challenge you on that and like I said at the beginning, we believe God created human life and infused it with value, intrinsic value, whether it's the preborn child or those who are approaching those final days and hours of life. God sees every day that we have on this earth as precious.
Today we heard about the grave dangers that physician-assisted suicide poses. As responsible citizens, we need to stand up for what's right in our culture and speak against those ideas and beliefs that will cause irreparable harm to our culture as a whole. And we do it respectfully, always.
So, let me urge you to get involved, to be informed about this issue and to stand with Focus on the Family in helping prevent any effort to legalize doctor prescribed death in your state.
John: Yeah, Jim, in fact, the Colorado House of Representatives could take this matter up this week and so, we urge you to contact your state leaders to let them know what you think of this dangerous bill.
As Jim said, we want to be respectful. We want to be good witnesses for Jesus Christ as we do this and we've made it easy for you to learn more, to kinda walk through the process of communicating well. Visit www.focusonthefamily.com/takeaction to see a sample letter than you can copy and paste into e-mail right away, along with further details and talking points about the matter.
And then please, pass this info along to your friends and neighbors. We've got to be better informed on this. At the website I mentioned, we'll link back to this program so others can hear what we've shared today or get a CD or download a copy of the program and pass that along. You can also suggest they grab the Focus on the Family smartphone app, so they can listen on the go.
Again, stop by www.focusonthefamily.com/takeaction for more or call 800, the letter A and the word FAMILY; 800-232-6459.
And finally, let me remind you that Focus on the Family is listener supported. We're able to give valuable information like this because of the generosity of friends like you, so please consider a gift to support this family ministry today.
Our program was provided by Focus on the Family and on behalf of Jim Daly and the entire team, thanks for listening in. I'm John Fuller, inviting you back tomorrow, when Greg Smalley joins us to describe a simple way to transform your marriage through appreciation.
Dr. Greg Smalley: What do I really love? What do I like? What do I appreciate about my marriage relationship? [There's a] great verse that says, "Where your treasure is," so what you value, "there will your heart be also." So, a great way to strengthen your relationship is to begin to think about, you know, what do I love about our relationship?
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John: That's next time, as we once again, help your family thrive.
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Find out how you can take action against physician-assistant suicide legislation in Colorado.Read more
Physician-assisted suicide is positioned by some as a caring response to the challenge of dying. But is it?Read more
More information about the end of life.Read more
Dr. William Toffler's seen firsthand the unfortunate ways in which physician-assisted suicide has played out – in a state where it's been legal for some time now.Read more
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Margaret CottleView Bio
Dr. Margaret Cottle is an author, speaker and palliative care physician in Vancouver, BC., where she has been caring for terminally ill patients for over 20 years. She is also a clinical instructor at her alma mater, UBC Medical School. Dr. Cottle is VP of the board for the Euthanasia Prevention Coalition of Canada and serves on the Christian Advocacy Society of Greater Vancouver. She and her husband Robin, an ophthalmologist, have two children.
William TofflerView Bio
Dr. William Toffler is a family physician and professor at Oregon Health Sciences University. He received his medical degree from the Medical College of Virginia in 1976 and completed his residency in family medicine at the Medical University of South Carolina in 1979. Dr. Toffler is a medical activist with strong interests in medical controversies and ethics issues. He serves as the national director for Physicians for Compassionate Care – a nonprofit organization that promotes care for severely ill patients without sanctioning or assisting their suicide.