[00:00:08] Speaker A: You're listening to faith in healthcare, the cmda matters podcast. Here's your host, Dr. Mike chubb.
[00:00:19] Speaker B: Welcome, friends, to Faith in Healthcare, where we continue to explore the issues that matter most to Christian healthcare professionals. So whether you're in healthcare, married or otherwise connected to someone who is, or you're simply interested in how God is working through Christ followers in patient care.
[00:00:39] Speaker C: And beyond, we're so glad that you're here.
[00:00:42] Speaker B: Around the world, and especially just across our northern border, in a little over a decade, we have seen a dramatic shift in how society thinks about suffering, autonomy, and the role of health care professionals.
Since legalizing assisted suicide in 2016, Canada has recorded more than 100,000 assisted deaths, now making up roughly 5% of all their deaths. For Christian healthcare professionals, this certainly raises urgent questions. What does it mean to say that people made in the image of God always matter?
And what is medicine for? And how do we distinguish good end of life care from physician caused death?
Well, to help us think through these issues, I've invited our Vice President of advocacy and bioethics, Dr. Brick Lance, to join me today. Brick works closely with our ethics committee at CMDA and helps our members navigate the growing pressures around the issue of assisted death.
Together, we're joined by Dr. Ewan Golliger, who is Associate professor of Medicine and Physiology at the University of Toronto and a critical care physician in the University Health Network.
His research in acute lung failure has actually been published in the New England Journal of Medicine and in Lancet and in JAMA and other leading journals. In the icu, he regularly walks patients and their families through life and death decisions and speaks widely on the ethics of end of Life Care.
Dr. Gallagher is author of the book How Should We Then A Christian Response to Physician Assisted Death. He's also written a book on death and a catechism for Christians. Both of these books are from the last couple of years.
Well, in this episode, he helps us examine why human beings have intrinsic value, how expressive individualism shapes modern ethics, why euphemistic language matters, and what's really behind most requests for assisted death.
He also offers us a clear ethical framework for distinguishing euthanasia from palliative care or the withdrawing of life support.
It's actually a very sobering and deeply needed conversation today, so let's dive in.
[00:03:26] Speaker C: Well, today on faith and healthcare, I have invited to be with me in the studio today our Vice President of advocacy and bioethics, Dr. Brick Lance, who has just recently been honored by finishing his degree in bioethics from Trinity International University. So welcome to the program, Brick.
[00:03:45] Speaker D: Thank you, Mike. That was a labor of love the past two years.
[00:03:48] Speaker C: Wow. But you had to write a lot of papers.
[00:03:49] Speaker D: Well, yes, actually, it was extremely valuable. One to learn how to write, learn how to speak, learn how to research. I mean, it was valuable from many perspectives, but enjoyable at the same time.
[00:03:59] Speaker C: Well, I'd like to ask you to introduce our guest today, because you and the chair of our bioethics committee and a former chair who's now on the board of trustees, within a space of five minutes, texted me after hearing our guest today speak at a bioethics conference, and I'm like, I have never had this kind of endorsement ever for a future plenary speaker. So why don't you go ahead and introduce our guest?
[00:04:20] Speaker D: Oh, yeah, it's my pleasure. And I'm sure our listeners, Mike, have the same concern as you and I do of what's happening in Canada. And just, you know, briefly, there's now over 100,000 people that have been killed since 2016 legalizing assisted suicide. It accounts for 5% of their deaths now. But we were at the CBHD, that's the center for Bioethics Human Dignity summer conference and course.
So I got to meet Dr. Gallagher, and he was one of our plenary speakers. And I will just say outright that God has gifted this man with the ability to speak truth well, but also speak it for the Lord. And that's why I came to you and said we need to have this gentleman on the podcast.
[00:04:59] Speaker C: Well, welcome, Dr. Ewan Gallagher to Faith and Healthcare. It's a CMDA Matters podcast, so you come highly endorsed. So let's start off with some basics. Just could you tell us basically your faith story, how you came to claim Christ as your savior?
[00:05:15] Speaker E: Yeah. Well, thank you very much, Mike, for having me on. It's an honor to. To. To be here.
I grew up in a Christian home. You know, the Lord's grace was at work from the beginning of my life. I grew up hearing the gospel. My father was a pastor, and, you know, I, I. I don't ever remember a day where I didn't know who Christ was and what he done for me. And, you know, gradually growing up and increasingly embracing that and making it my own faith, you know, grateful for the way the Lord's been at work. I was baptized when I was 16, and by God's grace, he's preserved my faith since that time, through university and medical school and professional life and so on.
[00:05:58] Speaker C: So, yeah, never challenged to deconstruct that faith along that process, I guess. Or maybe you were challenged along the way.
[00:06:04] Speaker E: I mean, challenge for sure. I never felt the need to engage in a deep deconstruction, to be honest with you. Christianity has always just made a lot of sense to me.
But of course, that involves taking the time to think hard, to understand the arguments for the faith once received, you know, that have been made down through the centuries. But as Christians, we have a tremendous tradition that we draw on, of reflection through the ages about the kind of fundamental problems, the problem of evil, all the kinds of things that sort of challenge our faith along the way. But secularism never seemed particularly attractive or compelling to me. And, you know, that's obviously ultimately the grace of God, but. So no major deconstruction process, but for sure, wrestling and facing all the usual challenges.
[00:06:50] Speaker C: Well, Brick, Dr. Gallagher's written a book, and why don't you tell our listeners about the book and let's get into this and start talking about assisted suicide.
[00:06:59] Speaker D: Well, the book does have a great title, very catchy title, But How Should We Then Die? A Christian Response to. To Physician Assisted Death. And so that will be our topic today. And Dr. Gallagher, on page 25 of your book, How Should We Then Die, you state, quote, everyone agrees that people matter. End quote. Now, when I teach students, which I have the opportunity to do, I ask the question, are human beings intrinsically valuable, or does their worth depend on their ability to contribute to society? Now, it's interesting. I do get a mixed response, but I would still say in the United States, the majority of students, no matter what their faith or non faith is, they do agree that human beings have some intrinsic worth. So my question for you.
Did this idea of human worth come from Christianity or somewhere else? And do. Does really everyone agree with that in today's culture?
[00:07:49] Speaker E: Yeah, this is a really important question because it kind of has to do with how we approach conversations about ethics in the public square.
I had to really wrestle with this when I first started grappling with the issue of assisted death, when it sort of really entered the public conversation in Canada around 2013, 2014.
Up until that point, you know, going through med school residency, critical care training, you know, the kinds of major ethical dilemmas that Christians face in the practice of medicine. Issues like abortion, for example, just hadn't really touched on my professional life. And so I'd never really had to engage with ethics. But all of a sudden, there's this huge sea change going on around me where everybody's changing their mind about this issue and they're saying, well, you know, this is the new patient centered thing to do.
How do you say no to being involved, not supporting? How do you defend conscientious objection. And so I think it's a really important issue where I've landed, and I think you'll see a bit of difference among Christians about this, is that ultimately the knowledge about the fact that we matter is built into human nature of creation, that it's something actually that because we're made in the image of God, because we're rational beings, because we have the capacity to understand and appreciate value and to see the beauty in other people, I think we know by nature that people matter. And so we can use that as a premise, a starting point. Now, ultimately, of course, Christianity helps us to understand why people matter. Christianity helps us to understand the human story, the fact that we're made in the image of God. We're creatures beloved by God and made and created in a special way so that we can make sense of the fact that we matter. But I don't think you need to be a Christian to know that people matter. And this gives us a tremendous point of leverage, a starting point. And I think one of the challenges that we have is that people kind of know that people matter, but they don't. They haven't actually thought about in what way do they matter. So even you, when you use the language of intrinsic value, I don't think that kind of language is sort of what's in a lot of people's heads. They just have this sense that people matter, and you have to sort of help them work it out in some detail. So that's really what I tried to do in that particular chapter in the book, is to say, okay, well, what do we mean when we say that people matter? And then what kind of implications does that have for the rightness and wrongness of killing, for example?
[00:10:13] Speaker C: Well, Dr. Gallagher, another thing that matters that Brick and I have been talking about a lot this week as we've been around here at the headquarters, is language.
And I shared with Brick that there's a lot of language out there that we do not appreciate. And it seems to me, maybe it's my bias, but that as Christians, we succumb so quickly to accepting the party line as healthcare professionals especially, and there's a lot of terminology here in this arena of assisted suicide, and you subtitle your book is physician assisted death. And while that's not the same as medical assistance in dying, it still.
It still is. Like, wait a second, aren't we all assisting Patients through their deaths, no matter whether you, before Canada passed your laws and here in the states.
And the other issue is that we're pushing here at CMDA is we're not gender affirmation carry another one of those things. We just accept that instead of saying, no, no, no, no, that's bad stuff. So talk to us about the language and why you settled on physician assisted death.
[00:11:18] Speaker E: Yeah, I totally agree with you. And to be honest with you, I'm. This is something I'm. I feel like I personally am growing in wisdom about just the significance of language because it's easy to blow words off as games and say, well, it doesn't matter what you call it, it's clearly bad. But the truth is that language becomes a very powerful means of making something acceptable that otherwise might not be. And I think you're absolutely right. There's a reason why they don't call this physician hastened death or physician induced death, or, you know, Dr.
Mercy Killing, you know, was even a term that used to be used.
[00:11:55] Speaker D: Right.
[00:11:55] Speaker E: Because they just recognize those things have negative connotations. And, you know, those who are on the other side of these issues are masters of leveraging language. They are to advance their ends. And I think that we can learn from them and be strategic, for sure.
So, in fact, throughout the book, I try to use the term euthanasia as much as I can, but. And because I like the way that term at least sort of is associated with this idea of intentional ending of life.
But one of the complexities is that there's physician assisted suicide and there's euthanasia. Practically, they're somewhat different practices, although I think morally and ethically they're equivalent.
And so in order to try and capture that those two together, I found the term assisted death a reasonable way of doing that. Is it potentially, is there a better, a more, stronger term to be used? Well, possibly. But I think the other thing is that, you know, if, if the culture settled on particular language, then we, we kind of need to sort of use the language that's being used so that people know what we're referring to. That being said, I will not use medical aid in dying. I, I never call it that. I never try not to let other people call it that because that's really misleading, I think.
[00:13:14] Speaker C: Right.
[00:13:14] Speaker E: Whereas physician assisted death, you know, is clear enough that the doctor is assisting the death, they're bringing about the death. And so to me, I was able to live with that term. But none of these terms are perfect really. It should be physician homicide.
And then the question becomes whether it's a morally acceptable homicide or not. But I think if the other side would never. Would never accept that term. And that's so interesting, Right, because it just means that deep down in their bones, they know this is wrong. Right. If we call it what it really is, and they can't live with that, then they know that it's wrong. And so I think you're right. We need to be very wise about the language that we use and stand our ground on it. So, yeah, I continue to grow in wisdom in that area. Thank you for bringing that up.
[00:13:58] Speaker D: Yeah, yeah, thanks for that response, Dr. Gallagher, and thank you for your discussion on that, because we're discussing that all issues of ethics and bioethics within our culture. And that's just one.
Now, I want to ask you a question about where our culture is at today, and particularly from a historical perspective, and this idea of autonomy. So Carl Truman states that our culture values expressive individualism, and he actually borrowed that term from someone else. I like that term. Our Supreme Court justice in the United states stated in 1992 in the Casey decision, at the heart of liberty is the right to define one's own existence, of meaning of the universe and the mystery of human life. And that's the end of the quote. So if autonomy is the primary virtue of our culture, then how do we decide what is right and wrong?
[00:14:44] Speaker E: I first began to wonder that question myself when I tried to engage colleagues about the issue of assisted death in conversation before it was legalized in Canada.
So just a few years earlier, you know, nobody would have ever admitted that they would accept the idea of killing a patient. It was taboo. It was utterly taboo. When I was in medical school, you know, people brought it up, but it was sort of a abstract, theoretical, ivory tower kind of concept. Nobody would say they would actually go do that.
And then 2013, 2014, it's just like this moral. It's like this tide sweeps in and everybody's changed their mind about this. And you sort of say, well, you know, what do you thinking? Why do you think this is good? How do you respond to my arguments? And what I really found is that people actually lack the intellectual equipment to think through right and wrong at a rational level.
You know, in addition to the idea of expressive individualism that you referred to, the philosopher Alasdair MacIntyre, in his kind of seminal work on ethics or, you know, critique of the modern west and ethics, you know, identifies this idea of emotivism that, at bottom, people think of right and Wrong as sort of just how you feel personally about an issue, it sort of reduces to the level of a feeling or gut. And that means, you know, if you, if you say, I think this is right or I think this is wrong, that's basically a conversation stopper rather than a conversation starter, because people don't know how to, you know, think about right and wrong beyond just how they personally feel about it. Not, of course, makes it very challenging to be a conscientious objector, because people just think that you're being difficult and have no good reasons for your position.
And that seriously undercuts respect for conscience. So, yeah, autonomy is a kind of guiding moral principle in our culture. It's really become, in terms of the four classic principles of the Georgetown mantra, it's really become the primary and fundamental one. But I think it speaks to the fact that at the end of the day, people can do better with ethics than you do you. And what our part of our task then is not just to give an argument for why assisted death is bad, but to give them a whole. To help them understand morality fundamentally to begin with. And that's, of course, a massive challenge, but I think it's part of the church's witness to the culture today is to call them to the truth about right and wrong. And that's what makes our work difficult, but also fundamentally important.
[00:17:16] Speaker C: Dr. Gallagher, throughout your book, you point out that a secular viewpoint or worldview really is a religious viewpoint.
And while I'm guessing that not all of your secular colleagues are familiar, that you talk with, interact with, are familiar with worldview and that terminology, how does that go over when you share with a secular group or a mixed group that, that really, it's at the level of a religious belief, people have a.
[00:17:44] Speaker E: Really hard time computing that they have a, you know, this is sort of like, you know, where the psychiatrists use the term insight.
People have no insight about this. They cannot see the way that they're grounding their kind of moral beliefs and practices and certain assumptions about the nature of reality. And it's really, really hard for them to think, to see that that's sort of a religious kind of way of seeing the world because, you know, for them, religion is God and tradition and dogma and so on, and they think that they've forsaken all those things. So, you know, it's. That this is the irony of secularism is that secularists lack insight about their own metaphysical situation. So, yeah, it's hard to. But. But I think once you, I, you know, One of the interesting things I would say is that argument that you're right, where I try to bring that out and show that essentially when people say that assisted death is a good thing for somebody, they're making assumptions about what it's like to be dead.
Many secular colleagues have told me that that's actually the best argument they've heard from me, that they don't feel like they can answer that, really.
But for them, the idea that you could be as or worse off when you're dead is just sort of utterly unthinkable. And they're willing to, to leap off that cliff without looking, so to speak. And so, yeah, it's a profound blind act of faith, like I call it in the book. And it's so striking because once you see that, then it just becomes so obvious just how profoundly religious this practice really is.
[00:19:18] Speaker D: So I have a question, being from Oregon, and I've been there since 1989, but during the 1990s, of course, we were the first place in the world to legalize what then was called physician assisted suicide.
And the reason back in the 90s was this idea of pain and that uncontrollable pain. But in Oregon, keeping the statistics, pain or the fear of pain has never been in the top five reasons for someone to ask their physician to kill themselves. And so I guess my question is this process of legalizing assisted suicide, it comes up every year in multiple states. In our union, we only have 10 or 11 states that now legalize it, but it comes up every year in legislative sessions. So what is our counter argument about this?
[00:20:04] Speaker E: Well, I think people need to be reassured fundamentally that we can control physical pain and suffering. I think it's very, very important that we begin with that message, that simply because we're opposed to euthanasia doesn't mean that we're condemning people to go through the dying process in agony.
And I think that the palliative care movement has made a lot of headway even since the 90s. And at least in medicine, we have a concept of how dying, the pain and symptoms that patients suffer through the dying process can be generally very well managed. But of course, the public doesn't necessarily know about that always. And secondly, the delivery of palliative care is not as nearly as good as it should be. And so I think that fear of pain and suffering is a big issue that we need to effectively address in our conversations about this. But, but, you know, as, as you, as, you know, the vast majority of people seeking assisted death, and this is, well, documented in Canada as well as the United States.
They're not seeking it because of uncontrolled pain and suffering. They're seeking it because of, you might call existential suffering, the fear of being a bird in the sense that there's no point in going on in life, progressive loss of autonomy. And that's real suffering, that's profound suffering that needs to be addressed. But it's not really a medical problem. It's actually a spiritual problem.
And so really what you're seeing is assisted death is a medical solution to a spiritual problem and therefore not really the right remedy. And so I think our counter argument has to be, A, that we can help people flourish even through the dying process, and B, understand that the data shows that that's not actually why people want assisted death. They want assisted death because life has become absurd to them.
[00:22:01] Speaker C: Dr. Gallagher, you use a number of descriptors to talk about the age that we currently live in, and a number of words like helplessness, hopelessness, purposelessness, loneliness. And the New York Times religion editor, whose name is currently escaping me, about five or six years ago, wrote a column, the Age of American. And I think we could make that North American despair, the age of American despair. Do you remember who that. I don't remember the author, but very profound. And you know, death from despair, all time high.
Suicide, alcoholism, drugs, you name it.
So what can we as Christians do in the midst, especially those of us physicians and other healthcare professionals, what can we do proactively in the midst of this crisis?
[00:22:49] Speaker E: I think it's really important that people appreciate that in many ways, the rise of euthanasia and assisted suicide is a symptom.
It's a problem that we as healthcare professionals have to grapple with in a profound way.
But it's really a symptom of that deeper cultural malaise, that despair, that sense of meaninglessness. And you can sort of tolerate life and enjoy it to the best of your ability until real suffering comes along and you're going to lose. You're losing your autonomy, you're losing your abilities, you're losing your independence, and the things that you enjoy in life are progressively being taken away from you. And maybe you don't have great social supports and there's nobody there to show you how much you matter.
It easy for us to slip into despair. We are profoundly fragile creatures. And so this is a real problem. And in many ways assisted suicide, euthanasia are symptoms of that despair. So I really think that at the end of the day, it's not until our Culture regains a vision for what the point of being alive and being human is. And ultimately that that concept can only be appreciated in light of the fact that we are made by God for the glory of God and to enjoy him and to enjoy one another.
And having cut ourselves off from God, we're destined to wither and we cannot ultimately flourish socially. So the answer to these things at the deepest level is the gospel.
Ultimately, the task of proclaiming the gospel lies with the church. And so I think from a very practical way that we can all work towards addressing this problem is by supporting our churches, supporting the work of the gospel, and by ensuring that within our churches we cultivate the kind of community where everybody can see how much they matter. So that this assisted suicide and euthanasia doesn't appeal to anyone. But I think in many ways, the church is the real solution. The growth of the church and the kingdom through it.
But in our practice, I think two things. First of all, by refusing to participate, we bear profound witness to the value of life. Like, if we're willing to make sacrifices professionally because we are so committed to the idea that people matter too much for us to lift our hand to end them, that's a way of bearing witness to the world about the true nature of human value and the glory of God in the human.
And secondly, I think, of course, where opportunities arise, where we have appropriate relationships with patients, where patients open up the opportunity to talk about the deep questions of life, we want to be ready to share the gospel in a clear and respectful manner that accounts for the power dynamics within the physician patient relationship.
To me, that really is the solution. Like I said before, this is a symptom of a deep spiritual problem more than of a medical problem.
So the remedy lies at the spiritual level.
I think a big part of it, of course, too, is restoring the ethos of medicine as something that doesn't merely exist to fulfill desires and empower preferences, but as something that has a genuine good to offer people in terms of their bodily flourishing. And I think we've lost sight of that. We're very focused on caring for what we might call the psychological self and actually forgetting the body. This is another really important cultural Critique by Alasdair MacIntyre. Medicine is guilty of forgetting the body, which is incredibly ironic. So here we are destroying bodies in order to free psychological cells from suffering, which is really the opposite of what medicine is for.
[00:26:42] Speaker A: Before we continue with this week's episode, here's a special announcement for you.
Mark your calendar for the 2026 CMDA National Convention April 23 through 26 in Loveland, Colorado. A time to renew your spirit, recharge your faith and connect with fellow believers in health care.
We're thrilled to welcome John Stonestreet, President of the Colson center and co host of breakpoint Radio, a nationally recognized voice on faith, culture, theology and Christian worldview.
Convenient lodging is available at the Embassy Suites by the Hilton Loveland Conference center and Spring Hill Suites by Marriott with special CMDA room rates reserved for attendees.
Learn more or register for either
[email protected] events CMDA is here to support and equip you at every stage of your journey as the nation's largest faith based professional healthcare organization.
Membership connects you with a community of like minded colleagues, resources and opportunities to live out your faith and practice, learn more and get
[email protected] let's jump right back into this week's episode.
[00:28:08] Speaker D: Yeah, I appreciate that and I could not agree more. And I think the church needs to help the healthcare professional, but I think the healthcare professional needs to help the church. I think this is a symbiotic relationship together because it is a battle and I think it will be. My personal feeling is it can be a battle until Christ returns.
So kind of on this idea of the vulnerable population and I want to talk a little bit about the slippery slope. It appears that the, you know, people will say the slippery slope doesn't exist. But if you look at Canada, of course the numbers rise every year. You try to expand it, you're trying to expand it now to children. You've expanded to those that have disabled either mentally or physically without any end of life in the near future.
So it seems like the slippery slope is real. My question on that is the nature of vulnerability. You talk about that in your book Independency.
I'm under the impression that dependency is healthy because God created us to be dependent. We're dependent on each other, we're dependent on creation, we're dependent on God. That's built into our human nature and this idea of vulnerability.
We're all vulnerable.
But how are those that are asking for their physician to help them take their life, how are they particularly vulnerable?
[00:29:21] Speaker E: I think that often when we talk about vulnerability, we, we apply a socioeconomic lens to, to that. We think that you're vulnerable if you're, if your bank account doesn't have many dollars in it, you're vulnerable if you're sort of disconnected from family, if you belong to a marginalized community, immigrant community or others, and there are genuine Vulnerabilities to all those things for sure.
But I think that's an incomplete conception of vulnerability because there's not only socioeconomic vulnerability, there's spiritual vulnerability.
And I really see this going on whenever people make the argument that in Canada, the vast majority of people seeking assisted death are white, wealthy, middle class or upper middle class people who, you know, they would say are, you know, are not the vulnerable type of, who, you know, are empowered and they're simply getting what they want.
And what I would say is that, well, that to me reveals a profound vulnerability in white, wealthy, non religious, upper middle class people because clearly they, they can't cope with suffering. They have a vulnerability to suffering such that when life gets difficult, it becomes pointless for them. They don't have the spiritual and existential resources to respond to it.
And so there's a different kind of vulnerability at play. And it's not correct to say that simply because most people who get this are wealthy, for example, that that doesn't mean that there's not a vulnerability at play. And so arguments based on appeals to economic data, for example, really can't resolve the rightness or wrongness of this practice one way or another.
And we have to be very direct to try and undercut those arguments to show the assumptions that they're making about the nature of vulnerability.
You know, once you embrace the idea that death is therapy, then the what the so called logical slippery slope is inevitable because there are lots of people who are suffering out there who are not terminally ill. And you mentioned people living with disabilities, you mentioned children.
In Canada, there's a raging debate about euthanasia for people with mental illness.
There's a lot of talk about expanding this to advanced directives for those who are, you know, in the early stages of dementia.
You know, once you believe that death is a kind of therapy for untreatable illness, well then, you know, a lot of people are eligible for death and it's, it's inevitable. So the slippery slope is very disturbing for those of us who see the wrongness of this, and it's great news for those who, who believe wholeheartedly that death can be good for you.
So at the end of the day, the fundamental root issue has to be, is this a practice that honors and respects human value and human dignity?
And those who say yes will be quick to seek to expand it. And those like us who see that it clearly violates human value and human dignity will do everything we can to stop that expansion. But that's really how it plays out.
And the logic is sort of unavoidable.
[00:32:37] Speaker D: Well, that leads to the next question about hope.
And in your book, you state that many believe that death is nothingness, that you end up in nothingness. And I had a very close friend that passed away with vsed. And for our listeners, that's volunteer stopping eating and drinking, which is done in all 50 states in the United States. And he believed that as well. You know, I shared the gospel many times, and I don't know what he believed on his deathbed. But why do people believe in this nothingness? And then the question is, how do we convey hope? Is hope related to the terms that you use in your book of intrinsic versus extrinsic value and of creating meaning versus discovery meaning? If you could clarify those terms and tie the idea of hope behind those.
[00:33:19] Speaker E: Sure, that's a big question.
So, you know, I think why do so many people assume that death is nothingness?
Well, I think they've been raised believing that metaphysical naturalism, or, you know, basically a kind of atheistic, scientistic, as opposed to scientific worldview is the only is the rational default option. And any beliefs about the nature of reality beyond, you know, this physical existence, things that we can talk about, touch, taste, hear, see and smell anything beyond that is sort of ultimately a pleasant fiction, something that many people believe in but don't really have good grounds for believing in.
So the assumption that death is nothingness is just seen as kind of the rational default. Of course, on careful scrutiny, it doesn't make sense, but perhaps we won't get into that just now. So, you know, how do, how do we respond to it?
A. I think the fact that death is nothingness sort of making taking your own life rational just shows that at the end of the day, what we expect in this life and beyond this life is fundamental to our ability to cope with suffering. If you're living with suffering, and the truth is that medicine cannot make all suffering go away, we all no. 1 appreciate that in many ways our task is to journey with our patients, to help them manage as best they can.
But ultimately, what helps you to overcome and transcend that suffering is this idea of hope, of hope for something better than the present moment, that life won't get worse, but rather will get better.
And I think that's what really we offer people in the gospel. Not always necessarily hope for. For this life, not always a cure in this life, but the promise that because Jesus has died and risen from the dead, we too will be raised bodily to perfect glorified bodies and all of the ailments and weakness and pain and difficulty that troubles us here and now will be gone forever. And one day will feel like a distant dream that seems so unreal. And it's that kind of hope that empowers you to go on life, to persevere in suffering. And also the hope that the Lord is with you, that he'll never leave you nor forsake you. And the hope that even in the midst of your pain, by patiently enduring it, you can glorify him and honor him and enjoy him and still be a blessing to the people around you. All of those things, I think, fuel hope that enables perseverance. So what does that have to do with extrinsic versus intrinsic value and with discovered versus created meaning?
Well, essentially, once we understand that we matter by virtue of what we are and not because of what we do, that means our existence is significant no matter what.
And it means that we're here for a reason, because that value has to come from somewhere. We're not inventing our own value then, nor are we inventing our own meaning. We have to come from somewhere if we have that kind of value. And that means our lives, lives have purpose. And that task we have is to discover that purpose. And again, it's the gospel that reveals to us that purpose that nobody and no circumstance can take away from us, such that we're able to transcend the suffering that we find ourselves in. So that would be a try to brief answer to try and encompass all the points you raised there.
[00:36:50] Speaker C: Wow. I don't know if you're aware, Dr. Gallagher, certainly Dr. Lance, is that our vision statement at CMDA is bringing the hope and healing of Christ to the world through Christian healthcare professionals. So you've so eloquently.
I wish I could repeat back multiple times in all the venues where I go exactly what you just shared and living with hope. And if we don't bring our faith to work, are we really bringing hope, true hope, to our professions?
This is a basic question, but I think it important, important one. Maybe we should have started with this, but can you distinguish between the terms palliative care, terminal sedation and withholding and withdrawing life support?
[00:37:33] Speaker B: Because I think those are really important.
[00:37:35] Speaker C: Here for this discussion.
[00:37:36] Speaker E: Yeah. So one of the things that we really need to, as healthcare professionals, we can appreciate in a way that our patients and our friends and family outside of medicine will have a little harder time is the sort of bright line between physician assisted death practices like assisted suicide, euthanasia, versus all of the practices you just mentioned the critical bright line really has to do with the fact that the question of whether or not you're deliberately trying to bring about death, are you seeking to intentionally cause death or not?
In palliative care, where we try to control and alleviate pain and symptoms as people journey towards death, at no point are we acting in a way that tries to bring about the death of the patient. We're seeking the health of the patient, trying to help their body work as well as it can, even while it's in the dying process.
Terminal sedation is a more challenging area where the issue of intention really becomes sharpened a lot because there are times where patients are in such uncontrolled distress or agony that the only way to really ultimately effectively control that suffering is through sedating the patient and keeping them continuously sedated. I've had to do that a number of times in the icu, but again, at no point am I doing that in order to try to cause the death of the patient. And the dosing and the effusion rates of the sedation are not calibrated to accelerate death or calibrated to relieve that distress.
And again, even with withholding or withdrawing life sustaining measures, we're not doing that because we're trying to bring about the patient's death. We are doing that because we're recognizing that those would be futile and ineffective therapies. If their purpose is to restore physical function or to maintain homeostasis while we await healing. And they don't actually offer that possibility of healing, well then, then they're futile and it doesn't make sense to continue, continue them. Many people find withdrawing life support sort of a really thorny issue.
They feel like it. They, you know, and a lot of my ICU colleagues would say, for example, well, we're already taking people off of life support. We're already essentially killing them. So what's the difference? And maybe I'll get into the details here a little bit more because we have a healthcare audience. And the thing that I would point out is that for a patient to die when they're on life support, taking them off of life support is a necessary but insufficient condition for them to die.
They don't die just because you take them off of life support. They die because they have an underlying fatal illness that takes their life, whether advanced respiratory failure, et cetera, et cetera. Whereas when you perform euthanasia, that injection is the sufficient cause of the patient's death.
And so we can really get into the moral, philosophical nuances here, but That's a critical point, is that taking people off life support is not a sufficient condition for death. And that's why it doesn't necessarily entail intentionally trying to cause the patient's death. I've taken people off of life support many, many times after extensive discussions with their family, and at no point have I ever been doing that deliberately in order to render the patient dead. And, you know, once in a blue moon, the patient actually survives and is transferred out of the icu.
And we don't call that a failure of discontinuation of life sustaining measures. So we really have to think carefully and critically. And this is where really thoughtful Christian ethicists become really valuable in helping us to sharpen our concepts. But that's generally how I try to walk people through these issues so that they understand that's very helpful. Able to maintain that bright line that's.
[00:41:24] Speaker D: I like that term, the sufficient cause. So that's.
[00:41:27] Speaker C: And I wonder if that's not the answer, at least it could be an answer to the terminology.
[00:41:31] Speaker D: Right.
[00:41:31] Speaker C: I've not thought about it before, but physician caused death, physician caused dying among others, or advanced dying as being. Because that's. I mean, it truly is what it is. And hopefully that's not offensive. So offensive. The other side, they would never use it.
[00:41:45] Speaker E: Yeah, Well, I can tell you for sure they'll never use it.
[00:41:48] Speaker C: They'll never.
I defer. I defer to your experience. Experience for sure.
[00:41:53] Speaker E: I mean, I know the palliative care community.
There are many palliative care physicians early on in Canada who were very opposed to assisted death because they really didn't want to get palliative care and euthanasia mixed together in Canada. And sadly, that's sort of evolved that way. But one of the things that they tried to do was to say everyone should call this physician hastened death, because that speaks to that causation.
But, you know, there was a lot of pushback on using that because again, you know, the semantics actually become really important. Yeah.
[00:42:24] Speaker C: And we succumb, as I said. Well, let me finish up with this question and then, Brick, I'd like you to be thinking about resources that we have available at cmda.
[00:42:32] Speaker D: I have one more question after yours.
[00:42:34] Speaker C: Okay. All right. Well, we Christians live with paradox. And then Brick and I have one more shot at you. We live with paradox. And the Apostle Paul stated that today die is gain. So, boy, probably a half an hour answer to this question. But you're going to have to be brief. Is there a way to die?
[00:42:51] Speaker E: Well, yeah. Isn't that a wonderful reality or irony that as Christians we have so much to look forward to in dying, and yet we refuse to take our hands to lift our lives? I just. I think it's just one way in which our faith is so interesting and rich.
And it really just has to do with the fact like that Paul goes on to say, you know, to depart and be with the Lord is far better. But I remain here because it's needful.
And we understand that our. We have discovered meaning. We have real meaning, objective meaning and purpose. And it's needful for us to be here as long as we're here. And ultimately it's the Lord who decides when our existence is no longer needful and our life is in his hands. And so we joyfully persevere in suffering because it's good for others that we remain and because it's needful for us to be here. And so we have such profound, meaningful existence even in this life, that although the next one offers us such eternal rewards, we patiently wait for it because it's needful for us to be here.
[00:43:53] Speaker D: So my next question, I think, is a very practical question here in the United States. And I said, some states have legalized physician assisted suicide, physician causation of death. How about that versus those states that do not?
And you're in critical care practice, so you swim in this world, you deal with death on a very regular basis.
But you and I, we both practice in a medical community, we practice with our colleagues. And so my question is, is the doctor patient relationship, is it being altered or changed, particularly over this past decade in Canada with this legalization of physician causing death?
[00:44:32] Speaker E: Yeah, I appreciate the opportunity to reflect on this. One thing I would say, first of all, is that although I'm on a very different place on this issue than my colleagues, it's so interesting that still I can see, and we might call this common grace or the, you know, the measure of good by nature. But I would be happy for them to care for my family, my parents, because there is real grace and a real appreciation for human value in their life. And they're really struggling. I think in many ways the issue of assistant death, you see that people are sort of struggling with how to respond to the problem of suffering. And this seems to be a way to respond to that. And I think the other thing that physicians are all struggling with is the.
The way in which medicine is being pushed towards a provider service model.
Yeah, this is an example of that, you know, euthanasia, basically, the patient decides whether or not it's good for them to be dead. The doctor has no authority.
The criteria for dying are written by lawyers, not doctors.
So, you know, all the doctor does is say, well, do you meet these criteria that are written in the law? I can't tell you whether being dead is good for you or not. So it's a practice that undermines the dignity of the profession in that it reduces the physician to a technician. And that's part of a broader trend that I think all physicians are grappling with, which is this idea of the provider service model where it reduces the physician to a technician and undermines the real moral dignity of the profession, which actually derives from the intrinsic moral value of the patient.
For sure, we've all seen that progress in health care over the last 10 years. And has assisted death contributed to that?
Undoubtedly. Although even if it hadn't been legalized, I think this remains a major larger problem, this issue of how we conceptualize what medicine is for.
And so I think part of pushing back on this is reminding people fundamentally what the purpose of medicine is and that really is rooted in the nature.
[00:46:44] Speaker D: Of human dignity and re establishing that trust which is essential to that relationship with your patient.
[00:46:50] Speaker C: And it makes me think immediately of our friend Farr Kurland's book the Way of Medicine and the contrast to provider of service model versus the way of medicine. Brick, there are a lot of resources we have at cmda, including a resource you worked really hard on called Bridging the Gap to help our members and ministry partners go to their churches.
[00:47:10] Speaker D: Yeah. And there's some real practical questions and answers in that module, including making out your statement, you know, of what you want at the end of life and discussing that with your family. And anyway, there's some very practical tools in that, but also does address this.
[00:47:26] Speaker C: Issue as well, and position statement on this very topic.
[00:47:28] Speaker D: Yes.
[00:47:29] Speaker C: That was produced by our ethics committee with a number of bioethicists, and you're on that committee. So they can find that by going to CMDA.org closing words and appreciation for our guest today.
[00:47:43] Speaker D: No, I think this is valuable for all our listeners, actually, for everybody in cmda. We all deal with death. Every physician deals with death, no matter what your practice is. And how can we then help that patient die? Well, and there's a way to do that, and that is respecting the patient, honoring the patient, telling them that they're valuable, tell them they're wanted, tell them they have a purpose.
This is extremely valuable.
[00:48:05] Speaker C: Great. Well, Dr. Gallagher, thanks for being with us today.
And God bless you and I hope that you'll be on all kinds of platforms sharing this message and we will certainly make your book available and a link for that. I'm sure it's available on Amazon, all kinds of other platforms for folks to.
[00:48:24] Speaker D: Find and I will just tell the audience you ought to get this book and read it. It's not a Super long book.
Dr. Gallagher, very good writer if I may say so. It's an easy read. I don't mean easy detrimentally, but easy that you can just follow his thoughts.
[00:48:39] Speaker C: Including for non medical people.
[00:48:40] Speaker D: Yeah, even non medical you can follow his thoughts very clearly the way he elucidates it.
[00:48:43] Speaker C: Yeah, yeah. Any concluding words, Dr. Geller before we say goodbye?
[00:48:47] Speaker E: Well, thank you both for your ministry and grateful to CMDA and their advocacy and the fellowship that we have together and serving Christ. It's a great privilege to serve Christ in the practice of medicine.
[00:49:00] Speaker C: Amen.
[00:49:01] Speaker D: Thank you.
[00:49:07] Speaker B: Many thanks again to Dr. Ewan Gallagher for joining us today and to our Vice President of advocacy and bioethics, Dr. Brick Lance for co hosting our conversation.
As we've heard, physician assisted death is not just another medical procedure.
It emerges from a deeper cultural story about autonomy and suffering and what it means for a life to have value.
Once a society begins to view death as a form of therapy, the so called slippery slope isn't a scare tactic. It actually becomes the logical next step.
Dr. Gallagher reminded us that every single person bears the image of our God and has intrinsic worth that doesn't depend upon independence or their productivity. He helped us see how secularism often functions like a competing religion, how euphemistic language can mask physician cause death, and how most requests for euthanasia actually arise less from physical pain and more from spiritual and existence existential vulnerability, an age of loneliness and despair and fear of being a burden.
He also drew for us a crucial ethical line between good end of life care and the intentional act of ending a patient's life, calling us as Christian healthcare professionals to bear faithful witness in a culture marked by despair.
Well, if this episode encouraged you or helped you think more deeply about these issues, please share it with a colleague, a student, or a friend. And be sure to follow Faith in Healthcare on your favorite podcast platform and on social media so that you can stay connected.
If you're not yet part of this growing community, we'd love to welcome you to cmda. We're here to help you walk faithfully and to equip you in your training years, your years of practice, and even beyond. You can visit CMDA.org join and become part of a movement of Christ followers who are transforming healthcare through the love.
[00:51:27] Speaker C: Of our great physician.
[00:51:30] Speaker B: Next week I'll be joined by Dr. Bill Griffin and we're gonna speak with Dr. Andre Mickle. He's a tenured endodontics professor at Case Western Reserve University who sees his academic clinic as his own Mission Field. Dr. Mickle shares how God brings residents from around the world to Cleveland, Ohio, and how he turns anxious dental moments into opportunities for prayer, and how servant leadership reflects Christ's love.
He's also going to explain to us how seminary and a doctor of ministry shaped his own ministry to students, especially those from unreached places, and how bold as well as compassionate faith can thrive even in a secular university setting. Whether you're in medicine or dentistry or any Corner of Healthcare, Dr. Mickle's story, I think it's going to encourage you to see your workplace as a place of gospel influence as well as kingdom impact thanks so much for listening to Faith in Health Care, the weekly podcast from the Christian Medical and Dental Associations where our desire is to always keep the main thing the main thing, and that's bringing the hope and healing of Christ to the world through committed Christ followers in healthcare. That's what matters to us at cmd.
Friends, may you recognize this week that the Lord is with you and that he is for you to do his good work.
Thank you for listening and we'll see you next time, Lord willing, on faith in health care.
[00:53:12] Speaker A: Thanks for listening to Faith in Healthcare. The CMDA Matters Podcast if you would like to suggest a future guest or share a comment with us, please email cmdamattersmda.org and if you like the podcast, be sure to give us a five star rating and share it on your favorite social media platform.
This podcast has been a production of Christian Medical and Dental Associations.
The opinions expressed by guests on this podcast are not necessarily endorsed by Christian medical and Dental Associations.
CMDA is a nonpartisan organization that does not endorse political parties or candidates for public office.
The views expressed on this podcast reflect judgments regarding principles and values held by CMDA and its members and are not intended to imply endorsement of any political party or candidate.
