As states across the nation consider proposals to legalize doctor-assisted suicide, a longstanding but little known group of Christian medical professionals is doubling down in its opposition by taking proponents of the practice to court.
The Christian Medical and Dental Associations sued the Vermont Board of Medical Practice in federal court on July 19, alleging that physicians are being forced to violate their conscience and professional ethics through a government requirement that they either inform patients about end-of-life care or refer them to a doctor who will.
Dr. David Stevens, CEO of The Christian Medical & Dental Associations, recently told the Deseret News that his organization believes that doctor-assisted suicide is immoral as well as "dangerous for doctors, patients and family."
"As a Christian organization, it’s contrary to the Bible. Given life is sacred, we’re made in God’s image," Stevens said. "All the major religious traditions oppose it."
But beyond the moral implications, he believes that assisted suicide constitutes professional malfeasance, as the "foundation of the doctor-patient relationship is trust."
He questions how someone can fully trust a doctor who has the power to both cure and kill.
Inside the debate
His comments come as the doctor-assisted suicide debate has ramped up in recent years, specifically after the death of Brittany Maynard, a 29-year-old, cancer-striken woman who spent the final months of her life imploring the nation to embrace what she and other activists call "death with dignity."
After learning that she had terminal brain cancer, Maynard became an advocate for Compassion & Choices, a group that works to "protect and expand end-of-life options — and to ensure health care providers honor and enable patients' decisions about their care."
She appeared in interviews and commercials throughout 2014 to discuss her terminal diagnosis, and to openly advocate for physician-assisted suicide.
Her battle, including details about how she and her husband moved from California to Oregon, where physician-assisted suicide is legal, sparked heated debate about the moral implications of doctor involvement in the process.
It was in Oregon that Maynard eventually decided to take lethal drugs that were legally prescribed by a doctor. Just weeks before her November 2014 death, she told The Associated Press that her family no longer wished to see her in pain.
"I wanted a cure for my cancer. I still want a cure for my cancer. One does not exist, at least that I'm aware of," Maynard said. "When we all sat down and looked at the facts, there isn't a single person that loves me that wishes me more pain and more suffering."
California has since legalized doctor-assisted suicide; it is also legal in Vermont, Washington and Montana.
Maynard's decision to end her life brought to light an issue that, like many others, has profoundly changed in the eyes of the American public over time.
In 2016, Gallup found that 69 percent of Americans believe that doctors should be able to end the lives of terminal patients using painless means, compared to just 36 percent who believed that in 1950. Over the past decade, acceptance among Americans has ranged from 64 to 75 percent.
But the Christian Medical and Dental Associations are working fervently to turn back the tide of support for doctor-assisted suicide before more states legalize it.
The associations' history
The Christian Medical and Dental Associations has a long history, with Stevens quipping that the organization is "older than Penicillin."
Its foundations were set in 1931 when a medical student at Northwest Medical School noticed a Bible on a fellow pupil's desk. That sparked a discussion as well as the idea for the group's creation — and from there it blossomed.
"It began to spread on that campus and then to other campuses," Stevens explained. "We began to see a large movement into missions of Christian doctors across the country."
As it expanded in its size and scope, the organization started working in short-term missions in the 1960s, with its leaders starting to take official stances on public health issues a decade later.
"We really started having ethical positions in the ’70s after Roe v. Wade," he said, referencing the Supreme Court's landmark abortion decision. "We have over 50 ethical positions on our website."
These positions, which are not binding on membership, outline ethical viewpoints on a plethora of issues, including doctor-assisted suicide.
"We, as Christian physicians and dentists, believe that human life is a gift from God and is sacred because it bears God's image," reads the statement on assisted suicide. "Human life has worth because Christ died to redeem it, and it has meaning because God has an eternal purpose for it."
It continues, "We oppose active intervention with the intent to produce death for the relief of pain, suffering, or economic considerations, or for the convenience of patient, family, or society."
The organization first approved the language in 1992. It was around that time that the Christian Medical & Dental Associations also started diving a bit deeper into public policy.
The organization today has four main operational functions: working with students, medical missions, training doctors to do media and offering the public information about a litany of health issues.
"We’re on 270 plus campuses, where we have CMDA chapters really helping students to integrate their faith into the practice of medicine," Stevens said, noting that there are around 16,000 active members. "We have 800 members who are career missionaries around the world."
On the assisted suicide front, the Christian Medical & Dental Associations is now asking the courts to uphold conscience protections for doctors and other medical professionals.
The lawsuit filed against Vermont regulators in U.S. District Court in Vermont alleges that health care professionals are being forced to violate their oath "to do no harm."
"According to the agency, only physicians must refer patients to others who will counsel for assisted suicide," reads a statement from conservative legal firm Alliance Defending Freedom. "However, all of the health care professionals filing suit contend it is unethical for them to counsel for, refer for, or in any other way participate in suicide at the hands of medical personnel."
Bridget Asay, solicitor general at the Vermont Attorney General’s Office, told the Deseret News that the government plans to defend itself against the complaint, but declined to offer additional details on the matter.
Kevin Diaz, national director of legal advocacy for Compassion & Choices, though, said that his organization is considering filing a friend-of-the-court brief in support of the Vermont Board of Medical Practice.
"The federal judge should dismiss this case, because physicians should not impose their personal values on their patients by preventing them from receiving information about all of their end-of-life care options," Diaz said. "All terminally ill Vermonters should be able to make fully informed decisions about their end-of-life care that are consistent with their own values and faith, and most important, for them and for their families."
He said that Compassionate & Choices believes that a doctor who is unwilling to inform a patient about end-of-life care should "make a referral or otherwise arrange for the patient to receive all relevant information."
In addition to worries about upholding doctors' conscience rights, one of Stevens' primary concerns is that a widespread acceptance of doctor-assisted suicide could one day morph into a broader embrace of euthanasia.
For many, the two are conflated or synonymous, though Stevens cautioned against that notion. When it comes to physician-assisted suicide, doctors provide patients with information, or give a prescription for fatal sleeping pills.
Euthanasia, however, involves deeper involvement from doctors, and is defined as a situation in which "a lethal agent (is given) by another person to a patient for the purpose of relieving the patient’s intolerable and incurable suffering," according to the American Medical Association.
"It takes no great skill for a doctor to kill a patient," Stevens said. "What takes consummate skill is good end-of-life care."
The Christian Medical and Dental Associations is not alone in its opposition to assisted suicide and euthanasia either, as the American Medical Association — the nation's premiere medical association — also recently affirmed its opposition.
A recently published ethics document details the association's ethical stance. While it proclaims that it is understandable why terminal patients in extreme discomfort might seek death over continued life, the AMA believes that "permitting physicians to engage in assisted suicide would ultimately cause more harm than good."
The text continues, "Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks."
Stevens said that there are other concerns as well, including whether physician-assisted suicide would encourage the medical system to more regularly put an end to "burdensome patients," especially considering the high cost of health care.
"This whole premise is based on that there is a right not to suffer and an obligation to help people not to suffer," he said. "But how do you measure suffering? Suffering it totally subjective."
This argument becomes particularly pertinent when considering that mental illness has become a benchmark through which people in Belgium have been able to willingly end their lives; psychological disorders are covered under the assisted suicide law there.
It is that dynamic that has Stevens worried about what's to come in the U.S.
"Suicide’s not illegal. We’re not talking about giving people the right to die," Stevens said. "They can die now if they want to … suicide's not illegal (though) I don’t advise it."
He continued, "What you’re asking is to wrap the respectability of the medical profession around something that has been a thorn in society."