A case study of AIDS and the end of life
I. Introduction
Fatal diseases are dropping in numbers with modern medical technology, but mankind has yet to find a cure for AIDS. We have medicines that can slow the advancement of the viral disease, but none that can halt it altogether. This leaves the unfortunate persons infected with not only the disease, but also the knowledge that it will eventually lead to a difficult death. As such, many desire the ability to put an end to their suffering before it takes them too far down that road of agony. Many places have even legalized a patient’s right to die, but it often puts doctors in a morally difficult place: is ridding a patient of terrible pain more important than their life?
II. Definitions
It is key to define terms before we delve into the rest of the issue. First term to define is euthanasia. Euthanasia, also known as “mercy killing,” is the intentional and direct efforts of a physician or medical professional to help a dying patient die. [1] This typically entails the injection or administering of some sort of lethal dose of drugs by the medical professional with the intention of ending the patient’s life.
This is slightly different from physician-assisted suicide, in which the medical professional does not directly cause the death. That said, they are still participating in the death of the patient by providing and instructing the patient with the means to end their own life. While not directly responsible, the medical professional still remains culpable, even with only indirect causality; however, this is not seen as such under most right to die laws, since the final decision rests upon the patient in this circumstance.
III. AIDS Data
In this instance, it is important to know what this disease is and why it is fatal. Acquired immunodeficiency syndrome (AIDS), is caused by the human immunodeficiency virus (HIV). This virus is especially dangerous due to its abilities to not only avoid detection from the immune cells (specifically the T-cells), but because it uses that stealth to attack the immune system itself. The virus sneaks in and incapacitates the immune defenses of the body by taking over the functionality of its target cell. As a retrovirus, it contains RNA as its genetic carrier, but once the RNA is in the target cell, specialized enzymes translate that RNA into DNA, and other enzymes splice that new DNA strand into the host cell’s genome, officially taking over its functionality by forcing it to slowly build new viruses.
Once infected, the number of immune cells in the patient will slowly but inevitably decline in number. This leaves the person vulnerable, like a castle with no defenders. Normally weak pathogens like common fungi, weaker viruses, and even parasites find no resistance to their entry and begin infection their unresponsive host, spreading in the absence of strong immune response. When the immune cell’s defenders drop to a specific level, namely one sixth that of a healthy person’s level, that person is diagnosed with AIDS.
It is no wonder that many AIDS patients ask for physicians to provide life-ending treatment when their body becomes too overrun to recover. The fear of this painful end must be constantly on the minds of those infected. The psychological and emotional strain that builds up as time goes on could become debilitating, even just in dreaded anticipation of their fate. To many doctors, such life-ending treatment is deemed merciful, while others see it as a breach of medical ethics. Who is right?
IV. Ethical Issues
Key to this discussion is the morality of suicide. Is it morally acceptable for someone to decide to end his or her own life? From a naturalistic evolutionary perspective, death is an inevitable conclusion to every life. Not only that, the fundamental goal of all living things is to avoid death. That said, a naturalistic evolutionary origin does not give a person an actual reason to live in the first place. If we are here during life, but are gone when we die, then there is no reason to fight through pain. Suicide is very commonly used as an escape because of this.
Without a belief in a higher power, it is nearly impossible to formulate a strong case against suicide. Even with time invested in searching, as this author has done, does not reveal any strong secular arguments against suicide. Some argue that suicide and euthanasia are a slippery slope, or that suicide effects others around the one that dies, yet even these have no real strength behind them if there is no ultimate meaning to life besides enjoying it while you can before you cease to exist.
Of course, is this the only view on suicide? Of course not! Human exceptionalism can also stem back to worldviews such as the Judeo-Christian stance that mankind was created in the image of the creator. As such, our value does not stem from ourselves, but from our relationship to God who made us. As one could likely imagine, being made in the image of the perfect Creator instills an immeasurable value into each human life. To end it flippantly is in a way blaspheming against the maker himself.
V. Pain as a virtue
One argument against life ending treatments is that pain produces endurance. While not all pain can or should be seen as a chance to grow by “toughing it out,” trials like injury and disease can indeed build character in tremendous ways. This author’s own experience with a badly broken leg, followed by surgery and years of therapy were not something ever desired, yet it was tremendous in shaping the character from that point on.
As some may say, suicide is the “easy way out.” Instead of facing the pain and holding on to hope even in dark times, suicide is an escape. It is not even surrender to the disease; rather, it is giving up before the disease even runs its course. It is not difficult to see why such a course is so easily longed for by those inflicted with a fatal diagnosis, but to give up is to profess that life is not worth living. From a naturalistic view, it would not be worth living, yet from the view of those in the faith, every second is a gift from God and we are given our times for a purpose. From the view of a believer, such trials test our faith and refine us, like fire purifies gold.
VI. Alternatives
When disease and despair set in, suicide is not the only answer. Current medical technologies may not be able to cure diseases like AIDS as of yet, but our pain management capabilities are getting much better. Our knowledge on what pain is and how to block such neurological signals has improved, allowing us to keep people comfortable even as death approaches.
Of course, death itself may be the real terror, not the pain. Instead of waiting for death to come naturally, the inflicted person often suffers psychologically from the anticipation and fear of what is to come. In such instances, a trained counselor can help the person to find peace and hope. Even in such dire situations, hope can lead to opportunities to serve and be served even in those last days.
VII. Ultimate Consequences
All of this deliberation leads up to a fork in the road. To one side, the patient is lead to their death at the hands of the physician, be it directly or simply through facilitation of the act; on the other side we see the glimmer of hope. On the side of self-inflicted death, we see despair and lack of hope at what remains of their lives. Often this stems from an atheistic or agnostic worldview where life after death is seen as little more than fantasy and wishful thinking. Death is the end to such a person, where they simply cease to exist; however, the other path holds out that hope for something greater.
If we are indeed created by a loving God and what he has made known to us is true, then we are given much reason to hope for the future after our physical death. After that, we shall shed all pain and disease. When one sees such a future, the present darkness is but a shadow to be destroyed by the brilliant light coming on the other side. Truly, hope is a powerful thing. In some cases, hope was all that helped people survive. Despair easily leads to a person giving up, while hope gives them strength.
If the first worldview is true, then both people of faith and those without it will cease to exist. The problem comes if the creator is real and his words are true, for then only those that find hope in him will find peace. Those that rejected him in life would find no solace in death. It is that fate that could give a physician pause in proceeding with life-ending treatments.
VIII. Conclusion
In this case of an AIDS patient requesting life-ending treatment once the time comes, this author, in the shoes of the physician would have to decline. When one’s soul is on the line, ending their life before their natural time has come puts their eternity at risk. Legal or not, physician-assisted suicide, when seen in the light of the Christian faith, is wrong. We do the patient no good by hastening their death and robbing them of their last chances at eternity. Pain management and recommendations of good counselors would be advised, but as the physician, assisting in suicide simply cannot be acceptable. They Hippocratic oath should have held all physicians away from dealing in death, but when we cannot see the ultimate end of things, it seems merciful to put an end to a person’s sufferings. Mankind is not like an injured horse, however. We are created in the image of God, and as such, we should never have the right to take away what God has given.
[1] Rae, Scott B. Moral Choices: An Introduction to Ethics. 3rd ed. Grand Rapids, MI: Zondervan, 2018.
Science & Religion 