On Friday, January 18, University of Vermont bioethicist Dr. Robert Orr appealed to a crowd of 100 students, faculty, and community members to “draw boundaries” on end of life care and to choose palliative care over physician-assisted suicide. This Fifth Annual Faith and Bioethics Lecture to a full house in Moos Tower was co-sponsored by the Institute, Mars Hill Students, and the Christian Medical and Dental Association, with support from Dr. and Mrs. Ross Anderson.

Dr. Orr, who is on the national board of the Christian Medical and Dental Association and was a 2006 Scholar in Residence at C.S. Lewis’ former home in Oxford, England, suggested that there are four basic principles that guide much ethical thinking about end-of-life care: 1) non-maleficence; 2) beneficence; 3) autonomy; and 4) justice. Added to the bioethical decision-making matrix are judicial precedents, such as the right to refuse care.

Acknowledging that some treatments (such as CPR and the use of ventilators) can be limited in some cases, he indicated that the choice to limit care must be guided by the principle of double effect, first articulated nearly seven centuries ago by the great theologian Thomas Aquinas.

In calling for palliative care, which combines, in the words of the late Christian ethicist Paul Ramsey, “comfort and company” (as often found in hospice settings), Dr. Orr emphasized the importance of giving patients hope. Excellent end of life care, then, must concern not only physical symptoms, but also psychological, social, and spiritual realities faced by the dying patient. For those concerned especially about comfort, the Vermont bioethicist urged effective pain control, and emphasized that, because excessive pain tends to enhance respiration, graduated and increasing doses of morphine are often extremely helpful and are justified as long as the intent is not to produce death.

Dr. Orr’s ethical framework appeals to virtue, principles and consequences, which has its grounding in traditional Christian epistemologies that are guided by divine revelation, but also take account of reason and research on real-life outcomes. According to Orr, physician assisted suicide fails at the level of virtue and principles, especially the central notion that humans are created in God’s image (and thus far more than biochemical machines, which is the assumption behind much physician-assisted suicide).

In the end, said Orr, the choice of physician-assisted suicide vs. palliative care is the choice between emphasizing patient autonomy, where the physician becomes a technician, and compassion, where healers “suffer with” their patients.