Medical Aid In Dying - Opinion

When the Soul Seeks Relief: A Chaplain's Case for Medical Aid in Dying

Despite the carefully conceived conditions and safeguards attached to legislative measures regarding the human right to medical aid in dying (MAID), the decision to end one's life by choice is a profound and weighty one for all involved. The Senate of my state, Illinois, is slated to decide the fate of the MAID bill recently approved by the House sometime this fall.

Faith leaders, with their diverse perspectives, weigh in on both sides of the MAID debate. Some defend their flat objections to a measure advocating our right to choose the day of our dying based upon the belief—their certainty—that only God rightfully controls the beginnings and endings of human life.

As a chaplain well-acquainted with incidents related to accidents, murder, gunshots, fragility, weakness, suffering, and death, self-inflicted and not, I have formed an opinion based on decades of deep contemplation upon the nature, not only of God by any name, but also, and very specifically, of the soul.

I'm in favor of MAID for those souls seeking relief under the bill's prescribed conditions. I further believe that, despite living in a nation founded upon strong religious influences, we've consistently avoided serious consideration of the nature of our souls at a deep level, and that this failure fuels a trend to impose inhumane conditions and consequences upon others, especially those without money or power.

One of our most significant problems in the MAID argument is our fundamental alienation from the soul, however we conceive it. The word itself is embedded within our culture. Pilots and sea captains still refer to "souls on board." The soul is mentioned often within traditional religious institutions. Still, the lived convictions surrounding the soul seem vague, despite conceptual familiarity. What is the nature of the soul, then? How does it relate to life as we know it and live it?

Convictions matter in addressing the encompassing topic of life and death, so here's my working definition of the soul upfront:

I perceive it as a spirit-based, animating, and motivating force that moves within us and with us as we make our all-too-human way through this violent and suffering world. It's the vital, grappling core of what we call the self. It can transcend; it can languish; it can rejoice and suffer. It seeks our attention, and its choices are an aspect of our unique, sacred journeys. "Soul" won't readily explain itself and can be hard to interpret, especially if it belongs to somebody else.

First Encounters with the Culture and Language of the Soul

In the nineties, I volunteered at the Holocaust Memorial Foundation of Illinois, helping survivors record their stories and driving them to speaking appointments. I was helping in association with the Spielberg Project to produce archival records while Holocaust survivors and camp liberators were still available to offer their accounts. Throughout, I balanced the exhilaration of encountering the strength of human beings against the crushing weight of the horrors they had endured.

What challenged me to the core happened off-camera and led me to consider the possibility that souls speak in voices perceptible at levels beyond obvious "hearing." Beyond the simple acts of asking and listening, I felt myself shifting into an indeterminate state of being during survivors' emotionally unguarded moments. As if, for brief moments, I became the other. Absorbed within those moments of anguished recollection, I was witness to the inconceivable and unsayable, albeit decades removed; it felt that real.

I had a mentor at the Foundation, an emotionally strong survivor named Karla, who lovingly made herself available to help me process these experiences. I could not, by myself, put together the fragments of the horrific scenes I held within, images pointing to a world that somehow existed at the same time average U.S. citizens, with dreams of winning wars, enjoyed the golden age of movies. In theaters, fast-framed images offered distraction and hinted at a hopeful future. Far away in real time, humans explored their "patriotic" capacity to scale the furthest reaches of evil. I struggled to comprehend.

Karla did her soul work, helping me through it until the realization finally arrived that, through this volunteering, I'd been privileged to experience life as it was beyond my limited perceptions. Life: haunting in its bloated ugliness, yet at the same time, as small and fragile as a life-giving seed waiting to be sown. It was as horrid as the most searing photograph in the hidden archives, as beautiful as the warmth of Karla holding me, helping me come to grips with an excruciatingly honest account of what it meant to be alive.

Karla died many years ago, but she's here with me.

Related to MAID

This legislative measure acknowledges the exhausted soul seeking to abandon the mortal world, to exit in peaceful dignity. It offers safeguards to prevent misuse and misappropriation under extreme circumstances, as it affords access to a challenging journey, a journey that is deeply personal and individual.

Bodies in pain can be evaluated and treated, and to an extent, so can our thinking minds. We have drugs that can erase our animated, feeling selves and still leave a breathing body, alive in a manner of speaking. But the soul – who can question or assess it except our own contemplative, curious, courageous selves? As Scottish author and minister George MacDonald said more than a century ago, "You don't have a soul. You are a Soul. You have a body." And a review of Judeo-Christian scriptural sources, upon which our nation was founded, would appear to support that assumption.

About This Soul We Speak Of, Yet Often Do Not Know

Initial concepts about the soul have been passed down to us directly through family traditions and the folkways of our shared culture. More challenging to grasp is what we might know of its depths, its darkness, its needs as distinct from the ego or the physical body.

Psychoanalyst James Hillman wrote Suicide and the Soul, published in 1964, to challenge conventional attitudes about suicide. Focusing upon the soul and its autonomous expressions and needs, his ideas contribute to discussions and decisions surrounding MAID today.

In his view, the soul cannot be defined by genetic inheritance or chromosomal arrangement. Hillman, a Jungian analyst, does not rely on religion, philosophy, or psychiatry to make his points, although practitioners within those areas may still draw on some of his observations. His central point is simple, the implications profound: The soul is autonomous and capable of suffering. A soul's suffering may override every other priority within the scope of a single person's lifetime, including the decision to continue existing in the world.

The field of psychology has not paid enough attention to death, according to Hillman. The same applies to expository teachings about the soul. Here's where Hillman takes up the challenge, writing, "Maybe your body and its life [are] in your own hands, but your soul participates in the world. You may be the sole executioner, but may you also be the only judge?" He goes on to explain the dynamic, contributive aspect of the soul: [I]f we do not give back to the soul of the world [emphasis mine] some of what it gives us, will it not wither from neglect, the world becoming ever more soulless, and our urge to suicide ever stronger?"

Applying this to MAID decisions in a world veering toward soullessness: When the body has been ravaged, its mind exhausted, the will to live depleted, it's the soul's suffering that becomes paramount. In a world showing signs of "withering from neglect," becoming ever more soulless in its treatment of vulnerable others, what is the point of living in an afflicted state of mortal being? Thus, Hillman rejects the narrow view of a chosen death as solely pathological or driven by ego. He posits that within the purview of the soul lies its own "necessity," its urge toward a release from an unbearable situation it can no longer inhabit meaningfully. MAID, in this context, can be seen as a response to the soul's desperate need, facilitated consciously and respectfully, rather than as a violent rupture or passage from mortal life.

Our culture broadly invests its energies in thoughts, prayers, and well-meaning platitudes that encourage battling, staying strong, fighting on, and pushing toward hope. Hillman sees these blanket, socially approved responses as again stemming from our dissociation with the soul's reality. Fleeing toward distraction, medical fixes, or moral condemnation helps us avoid confronting our mortality. Who teaches us to engage with the prospect of our own death? A few have tried.

Writing While Dying

CW Huntington Jr, a professor and scholar of Asian religions, died peacefully in 2019, half a year after receiving a pancreatic cancer diagnosis. During the six months before his death, he kept note of his thoughts on mortality, found in his posthumously published book, What I Don't Know About Death. Leora Batnitzky, Professor of Jewish Studies at Princeton, called his book a "deep meditation on what it means to both wake up to and let go of life," begging the inquiry, what wakes up, and what is let go in dying?

Here, Huntington examines the process of dying in a medicalized age through the lens of his daily experiences as an actively dying man. He awakens to and illuminates how modern medicine, focused on cure and prolongation, often fails to acknowledge the existential and spiritual dimensions of dying. As medical interventions begin to fail, death becomes a technical failure, not a natural transition or a potential release.

He's not dismissive of life-extending treatments. He does convey that our remarkable, often admirable, ability to prolong biological life collides violently with the soul's cry for release when that prolonged life means unabated suffering. In these cases, technology outstrips wisdom. We can "keep the body going" long after the soul has declared its existence within that body unbearable.

The Price of Soul-Blindness

These days, we aren't just keeping up with the neighbors. We are trying to keep up with everything, everywhere, all at once: image, narrative, lifestyle, news that robs many of any semblance of peace. There is little rest in a world of busy bodies in motion striving to meet goals. That much-desired sense of inner peace is also elusive. So why must a peaceful, dignified medically assisted death remain out of reach for those who desire it?

Chaplain Jeff Mulac, reviewing Huntington's book, makes deep and difficult observations that ring true. We take up "our lifelong projects" as people, embarked on an "endlessly subtle project of self-achievement…" and that "[this] obsession to save oneself, to make new plans and realize dreams of accomplishment is the greatest stumbling block to authentic realization."

Authentic realization encompasses the acceptance of the eventual ending of this life as we know it.

All material signs of life, its components, moments, and treasures, undoubtedly matter. Huntington, drawing on the wisdom of Asian and other wisdom traditions, urges us to consider that not all we try to save – including our life under protracted, painful conditions – is worth saving because it isn't real. It's founded on our false beliefs about who, what, and how we need to be, how everything must remain. But nothing stays the same.

The soul has a wisdom that is part of us, belonging to the world, just as it is. A note written by a student at the University where I taught expressed these feelings following the death of his dearly loved grandfather: "There's a piece of my grandfather's soul in the banister he built on the stairway to our basement, still more in the presence of my grandmother and my father. As such, it's not difficult to tally the value of a person's soul."

Letting the Soul Have Its Say

We need new words and ways to reflect upon the deep calling of our souls. Soul connects us to the mortal self, and through our being, to this world in alignment with our decisions about how we choose to live. Even as we must grieve our endings, there is good to be found within life, if only we are attuned to it. As I've learned from many, including the Holocaust survivors and my friend Karla's tender care of me: The soul's instinctive wisdom, and all it might convey to us, would astonish us.

I agree with James Hillman when it comes to the chosen life endings of those we know and love. The soul we knew, the soul we are, deserves our due consideration, including the respect inherent in honoring its choice for a peaceful release when suffering becomes unbearable.

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