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Exit Ramp
William P. Cheshire, MD
If lost in County Rockingham, A North Carolina mystery Distorts one northbound exit ramp Which enters highway two-twenty. Don't lessen your pressure on your brake Or leave your car unoccupied, For gravity reversed may make Your unattended auto slide - Uphill - defying Newton's law! Bewildered witnesses to this Will ask, by what strange twist or flaw Do opposite directions switch? From slip to creep, from roll to rush, The car let loose will plummet thus On slopes too steep for eyes to trust. Without true bearings, fall we must. Which way is up? Which way is best? Confusion frames experience. Whilst heavens rotate East to West, Surrounding landscape orients. Our sense of vertical depends On how the mountains shape this scene; An optical illusion bends Perspectives once erect to lean. When looming mountains lift our view To north horizon upward nudged, Inclining frames of reference skew; A level path we cannot judge. So how much more should we, therefore, Rely on valid moral points Of reference when we first explore Requests oddly for death by choice? The road that medicine could take Toward doctor-assisted suicide Would be a terrible mistake Against which now we must decide. The Dutch have demonstrated well The slippery slope along which we Proceed once doctors cannot tell A lethal dose from therapy. Hippocrates would question how The Dutch with systematic ease Give euthanasia and allow Not only treatment of disease, But also ending lives of pain And suffering that will not relent. 'Tis death they offer as "humane," At times without informed consent. Kevorkian and Humphrey claim, That aiding suicide is kind. It eases economic drain And puts the sick outside our mind. If suicide is good, they say, For present suffering's relief, Then why not offer it today To those anticipating grief? And if a noble benefit Is gained by choking respiration Then why withhold from those unfit To voice their fatal last petition? Such killing fast degenerates, Despite concern for patients' best, Into a plot that terminates Without explicit prerequest. And exercise of "right to die," If done with regularity, Would drive the expectation high That suicide is onešs duty. The notion of a right to die In reason finds approval nil, From such a harsh judicial lie Would obligate doctors to kill. Authority once granted makes The next step that much easier still. Removal of restrictions takes Us further down a murderous hill. As ethical constraints give way, Down go the lowly euthanists. Headlong they plunge, their morals stray Into a bleak, black, deep abyss - Yet they insist - that up the slope Of progress marches suicide Unleashed. Through fallacy's false hope And pride they claim compassionšs side. Here, too, the opposite is true; "Compassion" means "to suffer with," And not abandon patients to Asphyxiation, harm, or death. The long disorienting climb To suicide's elusive crest Has ended at no peak sublime, But in the depths of wickedness. No shadows tip topography On slopes of medical demise, But rather flawed theology Leads to unsavory compromise. The one firm reference point of truth, Is where God's precious blood was poured: Grand vertical straight azimuth, The cross of Jesus Christ the Lord. His cross establishes the sign That orients the soul to see, His outstretched arms the level line Of horizontal certainty. In weakness Jesus came into This hurtling world like us to live. Intense heart-rending pain He knew, The God who suffers and forgives. His Words, the Bible, testify That in due time death will arrive. Believe in Him, although you die, And He will raise you up alive! He is the truth, the life, the way, His counsel light that guides our feet. To follow Him from day to day, Keeps our path smooth, our peace complete. Trust in the Lord, in Him abide, And He will keep you in His grip; Steep slopes make seem to make you slide, But He will never let you slip. His Sermon on the Mount reveals A slippery slope one should beware, For anger multiplies in zeal: The root of murder thus laid bare. One cannot capture dignity By sheer autonomy's command, But mercy and humility Through Christians lending hand, Will love the sick and suffering As God so loved the world - that He Did give His only Son to bring Salvation overflowingly. Now crouching at our doorstep waits The gospel that claims death as well, And it desires nor hesitates To send hospitals straight to progress.
Commentary Life's mysteries often emerge in ordinary places and must be discerned from a particular perspective. One lonely rural highway access ramp in North Carolina is such a place. On this exit ramp, a car left in neutral gear will roll apparently uphill. The optical illusion results from the way the surrounding foothills slope gently upward toward the north, so that onešs orientation to the true horizontal, perpendicular to gravity, shifts slightly. Few vertical clues such as buildings or tall trees are available. A mile to the north, Cedar Mountain enhances the deceptive sloping effect by seeming to lift the horizon. One's overall sense of levelness thus slants by approximately one degree, which is enough to make one feel off balance when turning while walking. Although the highway access ramp also leans uphill to the north, its true slope is only one-half of a degree. The dominant slope of the surrounding landscape overwhelms one's judgment of the position of the ramp, making it appear to slope one-half degree in the opposite direction. To an observer standing anywhere on the hill, the car that seems to be rolling uphill is, in fact, rolling downhill. If one's orientation through the senses can be so easily deceived by geography, then one's ethics can surely suffer disorientation by failing to heed valid moral reference points and instead setting one's compass by surrounding cultural slants. This analogy is relevant to the issue of physician-assisted suicide, because opponents invoke slippery slope arguments of progressively broader applications and abuses. The Dutch, for example, who do not prosecute physicians for performing assisted suicide or euthanasia, have begun to accept such "treatment" as appropriate for some suffering individuals who simply anticipate the future symptoms expected from illness,1 and in some cases even for those who are not physically ill.2 A 1991 Dutch government study documented 14,691 cases in a single year in which medical actions were taken or omitted with the intent of ending patients' lives without their expressed permission. Of those deaths, 1000 were subjected to outright euthanasia, 4941 received morphine in doses in excess of what was needed to control pain with an intent to end life, and life-prolonging treatment was removed or withheld in 8750 with the intent to end life. Chillingly, a significant proportion of the patients receiving "involuntary euthanasia" had complete mental capability yet were not consulted in decisions resulting in their deaths.3 Dutch physician Van der Maas, sidestepping the term "involuntary euthanasia," speaks of "life terminated without explicit request."4 Americans have witnessed media coverage of the controversial "mercy" killing pathologist Dr. Jack Kevorkian, who is now serving a prison term for homicide. American bookstores have sold millions of copies of Derek Humphrey's suicide instruction manual, Final Exit.5 In "Exit Ramp," highway slopes and assisted suicide converge. The poem argues that not only does assisted suicide falter along a logical slippery slope, but also that some of its proponents are proceeding along that slope in a direction opposite to what they think. What may seem good according to an ethical frame of reference slated by mortal wisdom can, in fact, be evil as measured by God's just and absolute standard. Ethicists disagree as to where we are along the moral slope and in what direction we are headed. Kenneth Cauthen argues, in the Ethics of Assisted Death: I think that the analogy of the slippery slope is basically wrong. We are not at the top of a hill so that the slightest nudge of the boulder will start it downward into an abyss. It feels more like we are near the bottom of a steep incline trying to push a boulder upward a few inches.6 The cross of Christ marks the true vertical, and his outstretched arms the true horizontal. Christ's life, death and resurrection are the guideposts that orient us along the slopes of life as we journey toward eternity. The Christian response to requests for suicide should not be abandonment to death, but assistance in life. This includes treating pain and depression and compassionately responding to emotional and spiritual needs. This includes affirming the value of the suffering individual and seeking meaning in the midst of suffering.- E&M
References 1. The Royal Dutch Medical Association's Commission on the Acceptability of Medical Behavior that Shortens Life has recently decided that "voluntary euthanasia or physician-assisted suicide can in some cases be justified" for the patient in the earliest stage of dementia "because of the inescapable future perspective of loss of human dignity." Berghmans RLP, "Ethics of End-of-Life Decisions in Cases of Dementia: View of the Royal Dutch Medical Assocation with Some Critical Comments", Alz Dis Assoc Discord 13 (1999): 91-95. 2. In 1993 a physician was acquitted for assisting in the suicide of his depressed patient, a 50-year-old woman going through bereavement and divorce. H. Hendin, 'Assisted Suicide and Euthanasia: the Dutch Experience', in MM Uhlmann, ed., Last Rights: Assisted Suicide and Euthanasia Debated, (Grand Rapids: Eerdmans, 1998), pp. 367-86. 3. R. Feingsen, 'The Report of the Dutch Governmental Committee on Euthanasia,' Issues in Law and Medicine 7 (1991): 339-344. Cited in Kilner JF, Life on the Line: Ethics, Aging, Ending Patientsš Lives and Allocating Vital Resources. (Grand Rapids: Eerdmans, 1992, pp.77-78, 262n). 4. Hendin, 1998, p. 375 5. Derek Humphrey, Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, (Denver: Hemlock Society, 1991). 6. Kenneth Cauthen, The Ethics of Assisted Death: When Life Becomes a Burden Too Hard to Bear, (Lima, Ohio: CSS Publishing Co., 1999) p. 71.
William P. Cheshire, MD, is Assistant Professor in the Department of Neurology at the Mayo Clinic in Jacksonville, Florida, USA.
This article appeared in Volume 17:2 of Ethics & Medicine.