A Mental Health Perspective on Physician Assisted Suicide

Deborah Sturm
April 1, 2017
Reproduced with Permission

"Those who have a 'why' to live, can bear with almost any 'how'." - Viktor E. Frankl , Man's Search for Meaning

"Where there is life, there is hope." -Terri Schiavo

The 2016 film, Hacksaw Ridge , directed by Mel Gibson, focuses on the military service of Private Desmond Doss, a combat medic and conscientious objector, who saved the lives of at least seventy-five men in one night, eventually earning him the Congressional Medal of Honor. Doss's passion was obviously fueled by his Christian faith and a tremendous regard for human life, as he was willing to save the lives of men who others would have left behind. For example, in one scene, he compassionately responds to a fellow soldier, Ralph Morgan - played by actual Afghanistan war hero Damian Thomlinson - whose legs had been badly mangled and who begged to be saved, as he pleaded with Doss, "Please don't leave me. I got kids!"

I can't help but wonder how many modern-day men - although soldiers are exceptional because they often volunteer to go into harm's way in defense of their country - would bother to plead for their lives in a similar situation. Would many view themselves today as having a "poor quality of life" after such a debilitating injury, compelling them instead to refuse medical assistance?

The Spreading of Physician Assisted Suicide in the United States

At midnight on February 18, 2017, Washington, DC became the seventh jurisdiction in the United States to legalize physician assisted suicide (PAS). PAS proponent Jessica Grennan, national director for political affairs and advocacy for Compassion & Choices - formerly the Hemlock Society - considers this a great and necessary victory. In a statement, she said, "The advocacy of D.C. residents and local officials is what won this victory . . . Democracy conquered the personal mindsets of paternalistic politicians whose opinions should not get in the way of people getting the medical relief they want and need." 1 No doubt, she sees this as a victory for the "autonomy" for which the advocates of PAS have been clamoring for the past few decades. 2

So what does it mean for Americans now that Washington, DC, our capitol, which is the heart of the nation, has legalized physician assisted suicide? I must admit that I personally do not feel optimistic that this monstrosity can easily be stopped, at least not any time soon. According to the New York Times, we have arrived at a "remarkable moment" in the United States: "Close to 20 percent of Americans now live in jurisdictions where adults can legally end their lives if they are terminally ill and meet eligibility requirements." 3 Furthermore, according to a 2015 Gallup poll, nearly 70 percent of Americans now believe doctors should be permitted to assist terminally ill patients in committing suicide and that using the term "suicide" does not seem to temper support. 4 And my biggest concern is that PAS will be imposed on persons with disabilities and the frail elderly, people who are not even terminal - perhaps even our wounded veterans - through emotional manipulation and coercion. This is darkly illustrated in the award-winning short video, "The Mother Situation." 5 Although director Matt Day says he is not opposed to euthanasia, the film "casts doubt on the effectiveness of 'safeguards' concerning euthanasia." 6

The Enormity of the Culture of Death

After Terri Schiavo was executed on March 31, 2005, through court-sanctioned starvation and dehydration, her brother Bobby Schindler, commenting on the public support his family had from high-profile people such as Mel Gibson and James Caviezel, came to the following conclusion:

"An innocent, disabled woman was being unjustly starved to death. And when you have people of their stature, and the pope and the president, and the governor and senators and congressmen on Terri's side, and they are unsuccessful, you understand how powerful the death movement is in our nation." 7

On the day Terri Schiavo died, Rush Limbaugh candidly and accurately responded, "Today, America hit rock bottom." 8 And from reading derogatory comments about the Schindler family in book reviews on Amazon, I have come to the conclusion that people like me - and perhaps those who read this article - are perceived by many people in this country as belonging to a lunatic fringe that needs to "get with the program."

Personally, I have not been permitted to forget the barbaric imposed death of Terri Schiavo, as my late father died exactly three years later on March 31, 2008. And the biggest irony of all is that my husband Mike, on December 23, 2005 - several months after Terri died - was diagnosed with a rare appendiceal cancer which ravaged his abdominal cavity, leading him to become "short-gutted" from surgeries. I watched him go from a healthy 175 pounds to around 85 pounds at the time of his death. It was a slow starvation that spanned nearly seven years. But at least his body was afforded time to adjust to the chronic deficit of nutrition and hydration. Terri Schiavo, on the other hand, was subjected to acute and barbaric starvation and dehydration, something that could only have been a grueling experience and heart-wrenching to witness. Furthermore, the fact that it took thirteen days for her to die after the removal of nutrition and hydration is an attestation that she was not dying in the first place. Instead, this time span clearly indicated she was healthy and strong. To get a glimpse of how Terri Schiavo appeared on the day she died, Bobby Schindler, on the tenth anniversary of Terri's death, provided the public with a graphic sketch. 9 This is contrary to the statement of George Felos, Michael Schiavo's attorney, that she "looked beautiful" and peaceful. There is no lie that the Culture of Death is not willing to tell.

How Did America Get to this Point?

Several years ago, my nursing colleague Nancy Valko, RN, ALNC, spokesperson for the National Association of Pro-Life Nurses, in an interview, said, "Evil is a ravenous, expansive creature. Once you decide to tolerate a little bit of evil . . . it expands of its own accord. It knows no limits." And to better understand how many people in our country have gotten to the point of accepting physician assisted suicide and euthanasia, please read Valko's article, "Then and Now: the Descent of Ethics," in which she includes a brief history of the tireless work of the insidious Culture of Death. 10 I also recommend exploring Valko's website, https://nancyvalko.com/ to get a comprehensive look at "A Nurse's Perspective on Life, Healthcare and Ethics." Valko explains that we have gotten to this point incrementally. The proponents of the Culture of Death knew exactly what they were doing to get America to accept physician assisted suicide and euthanasia as alternatives to natural death. Furthermore, one of their means and ends was to get many people to sign "living wills," which are dangerous as they have a general presumption for refusal of life-saving treatment and, therefore, a presumption for death. 11

The Modus Operandi of the Culture of Death: "Catastrophic Thinking"

The Culture of Death operates by exploiting people's fear of suffering, lack of understanding about death and dying, and society's narcissistic quest to stay young and fit. Furthermore, many people no longer believe in Hell, so they are not concerned about the consequences of their actions. It is truly a "what if" mentality that is based on "catastrophic thinking" and unrealistic expectations. (More on this later.) Look no further than the well-publicized case of Brittany Maynard, who is now the "poster child" of physician assisted suicide. Maynard was a 29-year-old woman from California who was married a little over a year when she was diagnosed with an aggressive brain cancer. In an article published posthumously by CNN on November 2, 2014, one day after her death, Maynard explains why she opted for physician assisted suicide - prompting her family to move from California to Oregon - as opposed to cancer treatment and hospice care. 12 The "catastrophic thoughts" and unrealistic expectations are italicized. She writes:

"Because my tumor is so large, doctors prescribed full brain radiation. I read about the side effects: The hair on my scalp would have been singed off. My scalp would be left covered with first-degree burns. My quality of life, as I knew it, would be gone . . . I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind . . . Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that." 13

By the way, it is doubtful that she would have suffered "for weeks or even months" in hospice care, as anecdotal evidence suggests that some hospice organizations are willing to actively terminate patients' lives, no doubt, because it is cost-effective. 14

Maynard is engaging in self-inflicted emotional manipulation - and she is also manipulating the public - something that we think only happens to victims of abuse at the hands of abusers. I recently spoke to a friend in South Carolina who told me a story of someone who experienced a catastrophic accident. A doctor attempted to persuade this person to refuse treatment: "You will never get better;" "Your insurance will run out;" "You will burden your family;" "You will lose your home," and on and on.

I cannot imagine doing this to a patient, and I believe it is abusive and manipulative. This is projecting "catastrophic thinking" onto patients, and in turn, getting them to think "catastrophically." 15 This "catastrophic thinking" is at the root of psychopathology. When I was working as a psychiatric nurse, I used to employ "cognitive therapy" - developed by Dr. Aaron Beck and considered a milestone in psychology - with my patients to help them understand their emotions - e.g., sadness, fear, and anger - and mental states - e.g., anxiety and depression.

Briefly, our feelings and mental states don't simply happen. Instead, they occur as a result of entertaining certain dysfunctional thoughts which are actually interpretations of life's events. These thoughts, e.g., can be errors in judgment or unrealistic expectations. Maynard's unrealistic expectations are as follows: "I should always be healthy;" "I should always look attractive;" "I should always feel good;" "I should never be sick," and so on. This is called "shoulding" on oneself. This is at the root of depression, although Maynard insisted this was not the case.

When patients become aware that their feelings don't simply happen, and that they are indeed a product of their thoughts, they can learn to manage their feelings through re-interpretation of the events of their lives, even those that are the most challenging. Even a child can implement "cognitive therapy."

When I was about ten years of age - and over a space of two to three years - I suffered from anxiety attacks during the night. I would wake up shaking uncontrollably, and this would prevent me from sleeping for the rest of the night. I specifically remember thinking that I must be physically sick. I also recall that the shaking ceased as soon as the sun came up. Eventually, I began to think through why this was happening and taking note that the shaking was happening only when it was dark. I came to the conclusion that I could not be physically sick if I was shaking only when it was dark. Immediately upon "putting the pieces together" and coming to this conclusion, I stopped shaking, and the anxiety attacks completely ceased.

I believe this illustrates the mental resiliency of the human mind, and that we all possess the potential within us to re-orient the thoughts that cause us emotional and physical distress. Consider the barbaric circumstances of the late Dr. Viktor Frankl, a Jewish psychiatrist and neurologist who survived the harsh conditions of the Nazi concentration camps. Frankl believed that his survival was rooted in finding a meaning to his life - which involved thinking about the love he shared with his wife, from whom he was separated as a result of the Holocaust.

And indeed, the problem with modernity, as evidenced by rampant addiction , is society's failure to find meaning in life. And this collective failure - propelled by rejection of the Divine and instead embracing nihilistic escapism - is playing into the acceptance of physician assisted suicide and euthanasia. For what is it that a person must do to overcome addiction , but to acknowledge and re-connect with God and to surrender oneself to His care?

Yet the Culture of Death insists that we instead indulge in the very thing from which mental health professionals have been trying to steer us. "Indulge, indulge, indulge in catastrophic thinking," says the Culture of Death. And the American Psychological Association (APA) is trying to maintain a position of neutrality regarding physician assisted suicide, stating that it "take[s] a position that neither endorses nor opposes assisted suicide at this time." 16 However, the Oregon Medical Association took a "neutral" stance on physician assisted suicide, which helped to usher in the "Death with Dignity Act" in 1996. Moral neutrality really does not exist, as Jesus reminded us that whoever was not with Him was against Him. (cf Matthew 12:30) I believe that the APA's current position is partly based on cowardice and political correctness rooted in fear of "offending" the proponents of physician assisted suicide. And it also betrays their own trepidation about being inconvenienced by illness. Could this not limit its members' ability to help anyone if their public policy position is based on fear?

Projection: Another Tool of the Culture of Death

I cannot count the number of times people have told me that they "would not want to live like Terri Schiavo," or, "I don't want to be hooked up to machines and tubes," or, "If I have an accident and cannot have my previous state of function, just let me go." Again, all of this is based on "catastrophic thinking," as well as unrealistic expectations, as each of us are losing our previous states of functionality with each passing day. But there is another phenomenon occurring - projection. I believe that when a person speculates that they will be miserable in a state that they have never experienced, they are projecting their own existential restlessness and emptiness into a prospective situation. What made Michael Schiavo believe that his wife Terri was miserable? Was he ever in her condition? By all accounts, Terri was most happy when she was simply in the presence of her mother Mary Schindler, as evidenced by Terri's brightened demeanor shown in video recordings. Perhaps, then, it was Michael Schiavo who was miserable. Plenty of people testified in affidavits that he engaged in bullying, controlling behaviors, and intimidation tactics to get what he wanted. These are not characteristics of personal happiness, but instead of emptiness and narcissism.

A Breakthrough in Measuring the Emotions of Persons who are "Locked In"

The Terri Schiavo Life & Hope Network recently reported on an article published by The Telegraph regarding experiments done on four patients who are "locked in" as a result of neurological damage from Lou Gehrig's Disease. Researchers at the Wyss Center for Bio and Neuroengineering in Geneva, Switzerland, have found that the patients are able to communicate through a "brain computer interface which deciphers their thoughts." 17 They discovered that these patients reported that they are "happy most of the time" despite their debilitating conditions and their need for round the clock care for their basic needs." 18 According to Professor Niels Birbaumer, the researchers were surprised at the patients' positive responses regarding their "quality of life," as each required - and had accepted - mechanical ventilation. What primarily contributed to their happiness was simply having "satisfactory care." 19

Perhaps the results of these experiments help to show that human fulfillment, indeed, is not based on our functional level, which is the assertion of the Culture of Death, and that, instead, adversity - as pointed out by Dr. Frankl and experienced by these patients - can strip away the illusion that our modern day distractions and conveniences - our computers, our ipods, Facebook, and our smart phones - can ever make us truly happy. Adversity can put us in touch with that "still small voice of God" within us and the sanctity of life ethic consistent with a Culture of Life that asserts our value and dignity lies in the simplicity and serenity of the ontological reality of merely being human.

Can We Become Like Private Desmond Doss?

If our lives are going to contradict the Culture of Death, we must approach the difficulties of life as did Private Desmond Doss, who did not "catastrophize" in his situation. Just as a recovering addict learns to deal with his life "one day at a time," Doss faced the daunting tasks in front of him - saving the lives of his fellow soldiers - by rescuing one man at a time, pleading with God, "Help me get one more." Isn't this exactly how Mother Teresa of Calcutta dealt with the poor and the dying, treating each person one at a time as though they were the only one in the world? And as an addict must break out of denial in order to heal, our culture cannot heal unless we also break out of denial and face the fact that we are indeed in a spiritual battlefield, a culture war, where the casualties are not merely bodies, but souls as well. In the long run, we will win, but the cost is the blood of Jesus Christ and the martyrdom that goes along with it. As Peter Kreeft writes, "The blood that saved the world two thousand years ago still flows and accomplishes the same work. Insofar as we let ourselves be Christ's blood bank, we will save our society and our world." 20


1  Bradford Richardson. February 18, 1017. "D.C. physician-assisted suicide law goes into effect." Washington Times . Available at: http://www.washingtontimes.com/news/2017/feb/18/dc-physician-assisted-suicide-law-goes-effect/ . Accessed on March 12, 2017. [ Back ]

2  The mainstay of the modern bioethics movement relies on the "Georgetown Mantra," and consists of four principles: autonomy, beneficience, nonmaleficence, and justice. These principles came into being as the sanctity of life ethic, which asserts that all human beings are of equal value and dignity, was eroding. See http://www.catholiceducation.org/en/science/ethical-issues/harsh-medicine-chapter-one-from-culture-of-death.html . Accessed on March 13, 2017. [ Back ]

3  Paula Span. January 16, 2017. "Physician Aid in Dying Gains Acceptance in the U.S." Available at: https://www.nytimes.com/2017/01/16/health/physician-aid-in-dying.html?_r=0 . Accessed on March 31, 2017. [ Back ]

4  Andrew Dugan. May 27, 2015. "In U.S., Support Up for Doctor Assisted Suicide." Available at: http://www.gallup.com/poll/183425/support-doctor-assisted-suicide.aspx . Accessed on March 31, 2017. [ Back ]

5  Alex Schadenberg. March 17, 2017. "The Mother Situation: Award-Winning Short Film about the Dangers of Euthanasia Wins at Film Festival." LifeNews . Available at: http://www.lifenews.com/2017/03/07/the-mother-situation-award-winning-short-film-about-the-dangers-of-euthanasia-is-a-hit/ . Accessed on March 18, 2017. [ Back ]

6  Ibid. [ Back ]

7  Mary and Robert Schindler with Suzanne Schindler Vitadamo and Bobby Schindler. (2006). A Life that Matters: the Legacy of Terri Schiavo - A Lesson for Us All . New York, Boston: Warner Books, p. 188-89. [ Back ]

8  Ibid, p. 305. [ Back ]

9  Bobby Schindler. March 30, 2015. "I Will Never Forget the Look of Horror on My Sister Terri Schiavo's Face the Day She Died." Life News . Available at: http://www.lifenews.com/2015/03/30/i-will-never-forget-the-look-of-horror-on-my-sister-terri-schiavos-face-the-day-she-died/ . Accessed on March 18, 2017. [ Back ]

10  Nancy Valko. Pentecost 2012. "Then and Now: the Descent of Ethics." Women for Faith and Family. Voices Online Edition . Available at: http://archive.wf-f.org/12-2-Valko.html . Accessed on March 12, 2017. [ Back ]

11  Deborah Sturm. November 11, 2005. "Why Catholics Should Avoid Secular Wills." ZENIT . Available at: https://zenit.org/articles/why-catholics-should-avoid-secular-living-wills/ . Accessed on March 18, 2017. [ Back ]

12  Brittany Maynard. November 2, 2014. "My right to death with dignity at 29." CNN . Available at: http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/ . Accessed on March 18, 2017. [ Back ]

13  Ibid. [ Back ]

14  See http://www.hospicepatients.org/articles-from-heart-of-ron-panzer.html#audiointerviews . [ Back ]

15  Norman Cotterell, Ph.D. May 9, 2016. "Catastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders." Foundation for Cognitive Therapy . Available at: https://www.beckinstitute.org/catastrophic-thinking-transdiagnostic-process-across-psychiatric-disorders/ . Accessed on March 18, 2017. [ Back ]

16  APA Resolution on Physican Assisted Suicide. Available at: http://www.apa.org/about/policy/assisted-suicide.aspx . Accessed on March 18, 2017. [ Back ]

17  Terri Schiavo Life & Hope Network. February 2, 2017. "Locked-In Patients Tell Doctors They Are 'Happy' After Computer Reads Thoughts. The Telegraph . Available at: http://www.lifeandhope.com/locked_in_patients_tell_doctors_they_are_happy_after_computer_reads_thoughts . Accessed on March 31, 2017. [ Back ]

18  Ibid. [ Back ]

19  Ibid. [ Back ]

20  Peter Kreeft. (2002). How to Win the Culture War: A Christian Battle Plan for a Society in Crisis . Downers Grove, IL: Intervarsity Press. 119. [ Back ]