How Should We Then Die?: A Christian Response to Physician-Assisted Death
By Ewan C. Goligher, MD.
Lexham Press, 2024.
Paperback, 160 pages, $ 18.99.
Reviewed by Robert Grant Price.
Why not let patients determine whether to die at the hand of a physician?
Ewan Goligher, a medical doctor who teaches at the University of Toronto, has received this question from a summer research student. The future doctor’s inability to consider the complexities of the question drove Goligher to write How Should We Then Die?, a book-length response to one of the most pressing questions in medicine today. Goligher treats the divisive moral issue with the gravity and tenderness it demands and delivers readers an argument against doctor-assisted death built on the twin foundations of logic and faith.
As an entry into the canon of books about doctor-assisted death, How Should We Then Die? might seem like an offering that has arrived a decade too late. In Canada, doctor assisted suicide, now called Medical Aid in Dying (MAID), has for many become an accepted treatment for terminal and not so terminal illnesses. MAID accounted for upwards of 15,000 deaths in 2023, and reports emerge regularly of patients who have been offered death as a cure for their pain, including a woman with spastic cerebral palsy who had to endure a nurse’s suggestion that she take MAID because her condition had debilitated her to the point where she was “not living.” The faithful woman rebuked the nurse. Her life, she said, wasn’t hers to destroy.
Despite the victory of MAID over Canadian public opinion (Do the revolutionaries chant “Give me MAID or give me death!”?), How Should We Then Die? remains a timely book. While doctor-assisted death might have become one of those “rights” that lawmakers will be loath to restrict, MAID is, for now at least, a choice patients must make individually. A book like Goligher’s has the potential to persuade individual readers about why previous generations have seen MAID as anathema to medicine (and why this generation is an aberration from the norm) and why individual lives, even lives filled with suffering, bring good into the world.
To help make sense of suffering, Goligher turns to religion. The subtitle of the book, A Christian Response to Physician-Assisted Death, informs readers at the outset that they will be treated to a Christian view of life and death. So does the prayer that prefaces the book. Goligher’s Christianity delivers much to the discussion around end-of-care medicine, largely by building a case that Christianity offers an alternative to the religion that currently dominates healthcare. That religion is secular atheism.
As Goligher argues, the pretension atheists make that they are not religious tend to fall apart under scrutiny. They have a view of the divine, a perspective on the meaning of life, an understanding of what death is, and more. Both the Christian and the atheist view of life are built on a faith in what cannot be known. The atheist has faith in what he knows about the soul and about what comes after death, and none of these beliefs can be proven. It’s the same with Christianity. “Assisted death is an act of secular faith,” Goligher writes. Opposing assisted death is an act of Christian faith.
Throughout the book, Goligher returns to his most persuasive argument: that human life has intrinsic value. This perspective is one of those values buried so deep in the social firmament that a person might forget the value is Christian. Goligher sets this Christian view against the secular view now reigning in healthcare: that humans have extrinsic value. To treat humans as creatures with extrinsic value—meaning they have value only for what they can do, not for what they are—is to treat humans as things that produce value as opposed to persons who are valuable in and of themselves.
Goligher documents how widespread this secular view of life has become. Patients end their lives with the help of the medical establishment because they cannot work, they cannot care for themselves, they cannot think, ergo they have no value to anybody, including themselves. Goligher’s reasoning culminates in difficult conclusions for the secularist. For if a life can be terminated when it is deemed to have no value, then surely lives can be valued differently according to how much productivity and utility they possess. As Goligher argues, the secularist who treats life as a commodity—and that’s what an extrinsic appraisal of value does—cleaves to the same view of human life as does the slave trader.
Despair features prominently in How Should We Then Die? “Physician-assisted death is held up as a solution to the problem of suffering,” Goligher writes, but “at bottom, it is really an act of despair.” Goligher does not gloss over the despair that accompanies death. As an end-of-life physician, he has seen suffering, and he shares examples from his professional life of the desolation that awaits the dying. In a chapter dedicated to addressing despair, Goligher espouses a Christian existentialism that he argues offers consolation to the dying. The value of life must be intrinsic if the meaning of life is to withstand the obliteration of death. This is a point Goligher makes in this chapter, and across the entire work, in language subversive in its simplicity and filled with pathos for those suffering through the worst moments of their lives.
The final section of the book provides a neat summary of Goligher’s argument. This chapter would make a fine pamphlet for anti-MAID missionaries to hand out to troubled souls.
The main proponents of MAID are rich, white, godless people who have colonized healthcare with their ennui. These people profess to have no intrinsic value and don’t see it in others. They, perhaps more than anybody else, despair at death. Whether they are open-minded enough to read How Should We Then Die? remains to be seen, but if they do read with open ears, they might find in Goligher’s gentle language and common-sense logic a reason not to kill themselves—and each other.
Robert Grant Price is a university teacher and communications consultant.
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