• indoubt Podcast
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  • May 6, 2024

Ep. 66: Is Medical Assistance in Death ETHICAL?? w/ Ewan Goligher

With Ewan Goligher, , , and Andrew Marcus

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MAID (Medical Assistance in Dying) continues to gain popularity. In fact, here in Canada, we are statistically leading the charge. People are traveling literally from around the world to go through the procedure of ending their life. Is this something that should be concerning as a Christian? Where should we stand when it comes to MAID? How do we, as believers, help those who are contemplating going this route? How do we grieve with hope if we’ve lost someone through MAID? As medical assistance in dying continues to gain popularity, we need to equip ourselves with a solid biblical foundation on the importance of life and how to navigate through these challenging discussions with grace.

View Transcription

Andrew Marcus:

Hey, this is Andrew Marcus. Welcome to THE INDOUBT SHOW. We’ve got a great program today, something that I’ve been looking forward to diving into and getting some wisdom and counsel and insight. We have Dr. Ewan Goligher, who is a physician in Toronto, and we’re going to be talking about MAID, medical assistance in dying. This is something that is growing so much specifically in our country, Canada. People are traveling all over the world to come here and partake in this. And so we need to be prepared and we need to be aware of how to respond Biblically. And so we hope you tune in and enjoy this week’s program. All right, awesome. Well, we have Dr. Ewan Goligher with us today, all the way in Toronto. How are you doing today?

Dr. Ewan Goligher:

I’m very well, how are you?

Andrew Marcus:

I’m doing great, man. Thank you so much. I know we’ve been planning this for a long time, and we wanted to wait because you have exciting news. You just released a new book a couple of weeks ago. And so maybe for those who are watching, we did an episode with you a few years ago with Daniel Markin, but for those who are maybe new to the program, tell us a little bit about who you are, what you’re doing, and then we’ll dive into your new book.

Dr. Ewan Goligher:

Well, thanks, Andrew. So I’m an intensive care physician and researcher based in Toronto. I’m at the University of Toronto. And I care for a lot of people in the ICU who are very sick, and sadly many of them don’t make it to survive outside the ICU. So we end up caring for a lot of patients at the end of their life. And sometimes those deaths are anticipated, sometimes they’re unanticipated, but because of the nature of the work in the ICU, we deal with a lot of ethical issues in end-of-life care. So when euthanasia was legalized in Canada about 10 years ago, I knew it would be another important issue for me to wrestle with.

And because many of my colleagues were actually quite supportive of the practice and I knew I was going to be in a minority of people who would be opposed, I really had to sit down and think hard about, “Okay, where do I stand on this? Why do I care? What is the view that accords with the true vision of human value and what is the view that accords with faithful discipleship and commitment to following Christ? And then how do I explain my views to other people?” So I had to spend a lot of time wrestling with all those things. And the result of that is this book, which I’m very excited to see out in print now.

Andrew Marcus:

Yeah, praise God, man. So let’s walk through, How Should We Then Die? A Christian Response to Physician Assisted Death. So tell us a little bit about your journey in writing this and your heart behind it.

Dr. Ewan Goligher:

Yeah, I wrote the book for other Christians, but in a way I wrote it for my friends at work and colleagues at work and people who see this issue very differently than I do. Because basically my goal in writing the book was to give Christians language so that they could explain to other people why we should oppose this. And in doing so, to persuade Christians everywhere that we should oppose this, that really the traditional Christian opposition to physician assisted death is the right position. And to work through that, it took me a long time to think through carefully what the root issues were. And to me, I see a number of core deep underlying issues that really inform one’s view about this, issues like how you understand the nature of human value, how you understand ethics. Is it just about personal autonomy and people making up their mind for themselves what’s right and wrong?

And what is the meaning of life? When somebody has grievous and irremediable suffering, which is the legal language that’s used to grant people the permission to end their life, what is the point of going on with that? What is the point of living with grievous and irremediable suffering, and how can we say that such a life is still worth living? So those are the core issues that I really felt like we had to wrestle with in the book. So in some ways the book is sort of occasioned by physician assisted death, but in a lot of ways really we’re wrestling with, what’s the nature of human value and what is the meaning of life in the face of suffering? Those are the big questions that the book has to wrestle with.

Andrew Marcus:

Such huge questions to ask and think about and discuss. And I feel like in your own experience, how has it progressed? So it was legalized 10 years ago, tell us about the progression. Because I hear from people saying that Canada is the leading force in this and people travel literally from all over the world to come to Canada to do MAID. And so maybe walk through what you’ve seen, even just some of the statistics of where we’re at now as a country.

Dr. Ewan Goligher:

Yeah, so assisted death has received widespread public acceptance very quickly in Canada. It was a quite dramatic moral sea change in a lot of ways. Just a couple of years before, 2014 when people really started talking about this, this was basically a taboo topic. And four years later it was a Supreme Court decision overturning it and new legislation officially legalizing it. So the change in public opinion was very rapid. And the consequence of that that we’re seeing is a very rapid growth in utilization of assisted death over time. So from about 1,000 people seeking assisted death in 2016, in 2022, which is the last year for which we have official numbers, there’s over 13,000 people who sought assisted death.

Andrew Marcus:

Wow.

Dr. Ewan Goligher:

And one of the big things that’s changed since it was first legalized is that the criteria or the kind of patients who are eligible for this has expanded. So originally the idea was that you had to have grievous and irremediable suffering and you had to be at or near the end of life. Death was reasonably foreseeable. But one of the things that happens when you embrace the idea that death is a effective remedy for suffering is that you start to look around and say, “Hey, there’s a lot of people for whom death is not reasonably foreseeable, but who are suffering in very significant ways.” And the logic becomes, “Well, why withhold death from them?” So in 2021 the legislation was changed to allow people with, say, severe chronic disability or even disability that they subjectively deemed to be severe and made their life not worth living as grounds for euthanasia.

And so we started to see in the media reports of people with health problems, serious health problems like environmental sensitivities, but basically the issue was, they couldn’t find adequate housing. And so they felt like they couldn’t live and go on with life because the social supports weren’t there, and they actually sought and obtained euthanasia.

Andrew Marcus:

Wow.

Dr. Ewan Goligher:

So situations where people clearly are just in despair and feeling hopeless, and as a consequence they see death as a way out. And so now it’s offered to them and available to them. Just in Quebec in the last week we heard about an unfortunate man who lay in the hospital bed at the emergency department for four days, developed this terrible sacral wound on his back, and ended up seeking assisted death after that. So you just have these tragic cases where people aren’t cared for the way that they deserve to be cared for and are seeing death as a way out, a kind of salvation from despair. And that’s the inevitable pattern of growth. This thing is going to expand inexorably once you embrace the idea that death is potentially a remedy for grievous and irremediable suffering.

So yeah, we’re seeing huge expansion and widespread acceptance and a lot of discussion about what other kinds of conditions assisted death might be appropriate for, say for example, mental illness or mature minors with serious suffering and so on. So this practice, the temptation to expand it will continue to be there.

Andrew Marcus:

Because they did talk about the mental illness and then they ended up going back and not approving it, but I’m sure that’s just a temporary, it’s going to come back to the conversation again and be accepted. Which is mind-blowing to me, because if someone’s depressed for a day or struggling over a weekend and decides in this moment of despair, “It’s going to be better for me,” that could change the number significantly.

Dr. Ewan Goligher:

That’s right. It’s going to be so difficult to adjudicate appropriate suicidality, which where they would offer MAID, and inappropriate suicidality, which where they would try to treat. And how do you differentiate that as a psychiatrist? I think there’s a lot of psychiatrists who are incredibly opposed to such expansion. There are others, of course, who are supportive of it. But it’s interesting that this, with mental illness, we reached a threshold where the Canadian public just seemed to say, “Wait a minute, we need to put a hold on this.” And it became a big political hot potato. And so the government wasn’t prepared to move forward, but as you say, the way that the legislation’s framed, it delays it for three years and then would automatically expand again in 2027.

So this is very much an ongoing issue, and those physicians I know who really embrace this see this as a genuine path to empower people. And so they see it as a genuinely good thing that ought to be widely available. Once death becomes therapy, then it’s a form of medical care that should be widely available. And so you really have two profoundly different ways of seeing people and seeing the world competing here.

Andrew Marcus:

Yeah. Walk us through some of, even just pick one of your core deep roots. We’re seeing the surface of what things are looking like and the decisions people are making, but maybe take us deeper and maybe highlight one of the sections in your book of like, “Okay, this is a core issue that we need to look at, instead of just the … Look at the root, not the fruit.” What would one of those be that stand out to you?

Dr. Ewan Goligher:

Yeah, so I would say one of the deep core issues is the question of, what do we mean exactly when we say that people matter? So both those who advocate for assisted death and those who oppose it will all agree that people matter, and both sides say they’re trying to respect persons and respect dignity. But the question is, if we unpack that a little bit, what do we really mean when we say that people matter? And in the book I explain the difference between seeing people as having extrinsic value, which is value that comes by virtue of what you can do and how useful you are, which is therefore necessarily conditional and contingent upon your abilities and your usefulness to yourself and society.

And I contrasted that idea with the idea of intrinsic value, which is value that you have just by virtue of who and what you are. That’s value that’s fixed, it’s unchanging. And there’s not many things actually in the world that have intrinsic value. Humans, I argue, are one of them, but you recognize that when you see that something’s priceless and irreplaceable, it’s a way of seeing, “Okay, that has intrinsic value. I can’t just trade that for something else.” And once we realize, when we say that people matter, that’s what we really mean, that people have intrinsic value, they’re priceless and irreplaceable. That’s why, for example, slavery is wrong, because slavery is just treating people if they have only extrinsic value.

And so once we see that, then we see, okay, people have intrinsic value, their value is fixed and unconditional. And once you realize that and you think about the fact that to say that something’s valuable means that it’s good that it exists, well, if people have unconditional value, then it means unconditionally good that they exist. It would always be a tragedy to lose them, to have their existence ended. And so what that entails is that deliberately causing the end of someone’s existence, causing their death, necessarily says that they don’t matter any more, that they’ve lost their value. And that requires a view of human value that says human value is just extrinsic rather than intrinsic.

So even when we say, “Oh, I’m just honoring someone’s autonomy by ending their life,” really what you’re saying is, “I’m allowing them to treat themselves as if they only have extrinsic value.” And so inevitably and necessarily a willingness to end someone devalues them. I like to put it this way, that you can’t call into question the value of a person’s existence without also calling into question the value of the person themselves. And once you grasp that connection, you see that this practice actually treats people as if they don’t really matter in a deep way. They only matter in a very superficial way.

And so given that we have such a deep intuition that people matter, and then coming from a Christian point of view where we see how people are made in God’s image, profound worth and value in his sight, such deep value that he would send his own Son to redeem them from the catastrophe that we find ourselves in because of sin, we see that this practice is just fundamentally opposed to the kind of value that people actually have. So that I think is just one example of these kind of core deep issues that we really need to wrestle with. And I would say that the widespread embrace of physician assisted death is a symptom of the fact that our society is forgetting just how much people matter. We’re increasingly viewing ourselves as if we only have extrinsic value and we forget actually that we have deep intrinsic value.

Andrew Marcus:

Such a good word. How would you, because you’re in this field, you’re in this world, how would you help a young person maybe who is getting into medicine or getting into the medical field, how did you navigate it yourself and how would you encourage a young person who’s maybe wrestling with being in that world and in that field when all this is, a lot of people are saying yes and amen?

Dr. Ewan Goligher:

Yeah, this is not the first big moral challenge that as a Christian we have faced with respect to being involved in the medical profession. Abortion was accepted and legalized in Canada a long time ago. And going through medical school, you would hear a lot of advocacy for abortion. And you have to be willing to recognize that in some senses you are in a moral minority as a Christian who’s committed to a pro-life position. But at the same time, there is immense good that medicine does. And I think the sad thing about these kinds of issues is that it obscures the fact that the medical profession is deeply aligned with Christian values, caring for the body, showing compassion, caring for the sick, etc. These are things that are deeply aligned with Christian values. And although these moral conflicts create some challenges for us, it’s a deeply good thing to engage in the practice of medicine.

And so what I would say to young people out there is, absolutely pursue this, be salt and light. And it’s hard to get in, but if God opens the door and is calling you to this, then it’s good work. And inevitably people will respect people who are excellent in their work, who are collegial and respectful. And I really tried in this book to write it with a tone that showed respect for the other side and not just criticizing them all as evil and morally blind. Because I think at least obviously we’re seeing a lot of disturbing things around this, but I also know that that people are genuinely grappling with, how do we address the problem of evil and suffering in our world? And that lack of spiritual resources that many people have outside the gospel means that they’re going to turn to other solutions that we’re going to find problematic. And so ultimately at the end of the day, we need to be present in order to be a faithful witness. And so I would encourage people to pursue the profession.

Andrew Marcus:

Yeah, that’s so good, man. That’s so good. And we talk about this often, even just my wife and I. We see that it’s happened in our family where someone decided to do this and we found out about it very last minute, like the day before, and it was very shocking to us. And it’s only a matter of time, as this continues to get more popular, that every family is going to be affected or knows someone. We’re all going to be touched by this reality. What would you say to someone who knows someone who’s tempted to go this route? How would you help them and give them wisdom on how to navigate those conversations?

Dr. Ewan Goligher:

Yeah, I think I would say two things. I think just the fact that we can anticipate this problem highlights the importance of talking about it before it becomes a personal issue. D.A. Carson, well-known Christian teacher, wrote a book on suffering called How Long, Lord? And in there he wrote something that always struck me, which is that the time to prepare to suffer, the time to build the kind of theological equipment that you need to suffer well, is way before you ever end up in the midst of some crucible of suffering. Because in the midst of the crucible emotions are high and it’s a genuine personal struggle, and you’re going to be able to respond to that and deal with it well if you’ve already worked through and thought about it. So I think that really extends, because the issue of physician assisted death is really ultimately a question of, how should we respond to the problem of suffering?

And I try to address that in one of the chapters in the book, because I think that’s one of the other core issues here, is, how do we respond to suffering? How do we make sense of it? So I would encourage people to really equip themselves well and to help their churches be well equipped, have Christians everywhere be well-discipled on these kinds of issues up front so that when the time comes, the right responses will be more intuitive and easier. But when we do encounter this, when we have friends or loved ones who are seeking assisted death, I think the first thing to do is just to bear in mind that we need to be deeply respectful. These are very personal issues, they’re very difficult. And at the end of the day, each one of us is responsible for our own choices. If I had a family member or a loved one or a friend who was thinking about this, the first thing and the foremost thing is I would just, through my words and my actions, try to remind them of just how much they matter, how much we value their presence.

And often that means spending time with people, being there for them. Because I think a big driver of this is this sense of being a burden, sense of loneliness, sense of isolation. And so we want to act proactively to address those things, to make sure people know that their presence is loved and valued, that we don’t see them as a burden. And that just means sacrificial love of many different kinds. And where the opportunity arises, you want to be prepared to explain to them why you can’t support that decision. But again, doing it in a way that’s very respectful and loving, and hopefully you can be a faithful witness to them both through your words and through your deeds in their time of need.

Andrew Marcus:

That’s so good. And I know we clearly see that it’s wrong and we don’t agree with it as far as a Christian perspective. Could you give us some of the point forms of what that conversation would look like when you have a moment to maybe address some of the concerns? What are some bullet points of words that you would give that might help a young person who’s watching this?

Dr. Ewan Goligher:

Mm-hmm. I think the big thing is first of all to say, “You know what? The reason why I can’t support this is because you matter too much. You’re sacred, you’re not disposable. You’re not the kind of thing that we can just dispose of when it’s not working properly. And because you matter so much, you’re untouchable. And I don’t think that anyone should lift their hand to end you, and that’s why I can’t support this.” That’s the first thing. You want them to see that you oppose it not because you don’t care about what they want, but rather because you have such a high view of how much they matter. They’re sacred and untouchable and holy, and so it’s because you value them so much that you can’t support it. And then I think the second thing is just to point them to the gospel and say the gospel teaches us that even when we suffer, life can be worth living, because what we ultimately need is not freedom from suffering. What we need is communion with God and love from one another.

And you can still faithfully worship God. You can still faithfully serve God as you go down the path of suffering. Of course, this is going to be compelling to someone who has faith or understands the gospel, but ultimately we have to help people see that their existence really matters, even whenever they have to suffer and things are difficult. And so to me, that inevitably involves helping them to understand that they’re made by God for a reason, that God loves them, he gave his Son for them, and ultimately they’re reconciled to him and they can serve him and worship him even in the face of difficulty. So their life still matters and their existence still has purpose. So those are the kind of things that I would want to go to talk about value and talk about purpose and meaning, and just remind them just how much they matter.

Andrew Marcus:

Yeah, that’s so good. I love that, and I love that you even mentioned earlier, as this continues to get more and popular, we need to be prepared now so that we’re trained and equipped for those conversations. So don’t wait for those situations. If you’re watching, don’t wait for those situations to come to your story, but be prepared. Be ready now. I always give the analogy of someone who’s swimming or learning to swim. You practice swimming in the shallow end so that when someone drops you in the deep end, you don’t sink. You’re prepared. So you’ve got to practice and be ready for when those moments come. It’s really interesting that you mentioned this, because you talk about how we don’t know how to suffer well. We just think, “You know what? I’m suffering. This is hard. I’m just going to end it.”

And I have chronic pain in my neck and my back, and I have a whole bunch of things that are going on that I’ve recently been aware of with an MRI, and knowing that the pain is permanent and the doctor and neurosurgeon saying that it’s never going to go away. “You can never do this again, you can never do that again.” I came home and I was actually pretty bummed out and depressed and had days of weeping over this new reality for my life. And I would never consider MAID, but I was aware of, “Man, this chronic pain is 24/7, I hate it. It’s terrible.” I can see why someone who is struggling every single day with something, it makes sense that it looks like ending it is the best result.

How could you encourage us to suffer well? Because we see through scripture, we see Jesus’s life, we see the cross, we see Paul and all these things that Paul went through. And then he talks about how it’s light and momentary affliction, and he gives a long list of all the things he’s been through. These guys weren’t … They all suffered. How do we suffer well, instead of just say, “You know what, I can’t take it any more”?

Dr. Ewan Goligher:

Mm-hmm. So yeah, towards the end of the book I address this very directly, and address it by recounting the story of Lazarus being raised from the dead. And in that story I see very clearly the ways in which Jesus invites us to cultivate the virtues of faith, hope, and love that we need to suffer well. We need the virtue of faith because really suffering is a test of faith. Can I trust God that his purposes are such that in the end I’ll be able to look back and say, “That was worth it”? Somehow in the face of that evil, like Joseph, the story of Joseph, he looks back on his life and his brothers are there apologizing to him and hoping that he doesn’t crush them. And he says, “You intended it for evil, but God intended it for good.” And the confidence that we need in the face of suffering is that somehow we’re going to be able to look back and say, “It was evil, but God intended it for good.”

And ultimately we’ll be able to say God got glory and we found joy and peace in the midst of this, and we know God better than we could have otherwise. And if knowing God is the highest good, then suffering could well prove to be worth it. But in the moment, we need the faith to trust God that he’s at work, that he has the power also to bring about those goods. So it’s a huge test of faith. So we need to cultivate the virtue of faith. The second thing I would say is cultivating the virtue of hope, the confidence that in this life we suffer and it’s difficult, and suffering has entered my life in pretty significant ways too. And the thing that fills me with hope is the hope of the bodily resurrection.

One day you will have a new, I’m not sure what the pathology is, but you’re going to have a new neck and a new body, and there’s going to be no pain, and it’s going to work perfectly. And setting your heart on that hope is what makes the gospel so powerful. Because if we don’t have that, if we’ve got nothing to look forward to, well then it’s easy to fall into despair, I think. And then finally, I would say the virtue of love, love to God and to others. Recognizing that ultimately the highest good is knowing God because he is the most valuable being there is. He is our highest good. And so what we really need is to grow closer to him, to know him and to be known by him. And often our suffering enables that in ways that would not otherwise be possible in this life. So those, I think cultivating those virtues of faith, hope, and love are what enable us to bear through when we’re called to suffer in difficult ways.

Andrew Marcus:

Yeah, that’s good. That’s a good word, man. Well, we really appreciate your time. We appreciate this resource that you have, and all the best to everything you’re doing in your life, in your family, and in your work.

Dr. Ewan Goligher:

Thank you, Andrew. Thanks for having me on. It was a pleasure.

Andrew Marcus:

Hey, thanks so much for joining us today. For more great content, check out THE INDOUBT SHOW on YouTube, Spotify, Apple Music, or wherever you stream your podcasts. We hope you enjoyed it today. Feel free to check out indoubt.ca, we have some great resources available to you. Have an awesome day. Hey, INDOUBT audio world, we’ve got something exciting happening June 8th, 7:30 PM. Winkler, Manitoba at Pathway Community Church, we are going to be doing THE INDOUBT SHOW live. It’s going to be amazing. We have Dr. John Neufeld with us from Back To the Bible Canada, and we’re talking about the Christianity and culture debate. How do we fit in? How do we stand out? How do we deal with politics? It’s a very timely conversation. It’s going to be an amazing night. You can go to indoubt.ca for more information.

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Is-Medical-Assistance-In-Dying-MAID-Ethical

Who's Our Guest?

Ewan Goligher

Ewan C. Goligher MD PhD is a physician and scientist at the University of Toronto. In the context of his practice of intensive care medicine, he often cares for patients at the end of their life. He attends Christ Church Toronto with his wife and four children.
Is-Medical-Assistance-In-Dying-MAID-Ethical

Who's Our Guest?

Ewan Goligher

Ewan C. Goligher MD PhD is a physician and scientist at the University of Toronto. In the context of his practice of intensive care medicine, he often cares for patients at the end of their life. He attends Christ Church Toronto with his wife and four children.