The first nursing home I entered reeked of stale urine and cigarette smoke. Residents softly moaning in pain sat unattended in the hallways and foyer. Chronically understaffed, nurses and aides hurriedly attended to the bare minimum medical needs of residents, and had little time for anything else. As I began to minister in this facility, I quickly realized that most of these residents never received a single visitor, abandoned by church and family alike.
It is these residents that will be most affected by the litany of assisted suicide laws being passed in states throughout the country. Around the world, countries have slowly made it easier for individuals to kill themselves, and have widened the legally acceptable reasons that one is allowed to commit self-murder. The most infamous suicide regime is just over the border in Canada, whose Medical Assistance in Dying program has made it easy for those with questionable medical issues to commit suicide, and has enabled serpent tongued caretakers to push the unwanted to take their own lives. Several American states have enacted euthanasia bills, with New York’s recent legislation (if signed by the Governor) soon to become the most permissive in the union. New York’s atrocious Medical Assistance in Dying Act should alert American Christians to one of the most pressing moral battles of our time, one that requires mobilization of churches, individuals, and nonprofits to fight on a number of different fronts.
The front lines of the current and future euthanasia fight are nursing homes, as these are places filled with suffering and isolated individuals who are most at risk of committing suicide. A majority of nursing homes in the United States are underfunded and understaffed, with only 25% meeting the minimum number of recommended nursing staffing hours. Cost cuttings, closures, and corporate takeovers are common, all of which lead to diminished care for residents. A recent alleged scheme by United Healthcare, in which nursing homes were incentivized to cut medical services in exchange for bonuses from the insurance company, exemplifies how cost cutting measures often come at the expense of nursing home residents.
MAID legislation grants to nursing homes and insurance companies a new and effective tool in their drive to cut costs. The most time consuming, costly, and difficult patients can now be encouraged to commit suicide, freeing up beds for less demanding (and more profitable) residents. While all of the various suicide enabling bills include some form of safeguards, which outlaw the most egregious forms of coercion, there will always be more subtle ways that facilities can nudge residents to commit suicide. For instance, a resident can be given information pamphlets about suicide, or a staffer could encourage self-murder with an occasional whisper, reminding a resident that “they don’t have to suffer like this if they don’t want to.”
Beyond these explicit forms of persuasion, MAID laws create an environment where the pressure to commit suicide is implicit. For example, let’s take a resident named Linda. Linda requires three times the usual help to get out of bed in the morning, and has a chronic illness that requires an outsized portion of nursing hours to manage. On top of that, Linda complains often about the other residents, the staff, and the facility. Linda has the stigma of a “difficult” resident. The staff know this, and more importantly, Linda knows it as well. She knows she is occupying a bed that could be used by someone who is less of a burden to the facility. When suicide is introduced into her facility as a legally viable option, it will inevitably become the elephant in the room, an ever-present option that the staff and residents are aware of, even if it is never overtly discussed. The implicit pressure is there and irreversible once suicide is legalized.
We have all felt this kind of implicit pressure before. When my kid is screaming on an airplane, I frantically try to quiet them down, even if no one complains. If there is a long line behind me at the register and I can’t find my wallet, I feel the pressure to hurry up even if no one yells “move it” from the back of the line. Residents in nursing homes will feel this same kind of implicit pressure, a demonic voice in their head saying “hurry up and die, stop being a burden” even if it is never audibly whispered in their ear.
Insurance companies and management will find it difficult to resist the urge to implicitly or explicitly promote a culture of self-murder in nursing homes, since suicide is an incredibly effective cost cutting tool with few negative financial drawbacks. Half of nursing home residents never receive a visitor, so there are few friends and relatives around to complain when explicit forms of coercion occur. Residents who are coerced into committing suicide won’t leave negative feedback or call an abuse hotline, since they are dead. If a facility cuts costs by reducing the quality of food, they will be met with a litany of complaints by residents. But convincing a few costly residents to kill themselves will receive little blowback.
Christians can and should vigorously oppose the passing of further statewide MAID laws. There is already significant public outcry from Christians about these laws, and I hope that this outcry will translate into cogent and sustained political action to prevent their spread. A concerted effort to find out where every state and federal congressman stands on euthanasia would be a good start. But Christians must also learn to combat the effects of MAID nationally and particularly in the states where suicide is legal. While Christians should work to eliminate the supply of suicide, they must also work to eliminate the demand for it.
The latter is a more difficult, less concrete task, as it requires that Christians begin to care about the millions of lonely, elderly, and infirm hiding in plain sight. I have spent years mobilizing churches to start worship services in nursing homes and assisted living facilities, and I am continually amazed at how few Christians understand the immense care deficit that exists in these places. Estimates are that 50% of nursing home residents never receive a visitor, and my experience in nursing homes certainly validates such an estimate. I have also found that number to be accurate even for the more well-off assisted living facilities. The only people who care about these residents are those who are paid to care. At best, a nurse or CNA shows them a modicum of compassion. At worst, staff are too busy or too hardened to do even that.
Christians have a Biblical obligation to care for these residents. The fifth commandment to honor father and mother applies as much to the care of elder parents as it does younger ones. The New Testament church expanded this commandment to include care for widows. Essentially, Christians are called to treat faithful widows as well as they treat their own parents and grandparents, with the familial bonds extending and intermingling with the spiritual bonds of the body of Christ. But it has been my experience that few Christians make any effort to care beyond blood bonds, and fewer still envision the body of Christ as one that extends beyond the church walls and into the nursing home. My fear is that a chasm is developing between word and deed, that a groundswell of protest against MAID is not being accompanied by a concerted effort to care for those who are targeted by these laws. I have helped to start worship services across the country, and in every single locale, I have found numerous nursing homes, rehab hospitals, and assisted living facilities that are utterly absent of any Christian presence. The church’s absence from these places makes it easier for MAID laws to be passed and easier for efforts to euthanize the vulnerable to go unnoticed.
Christians should learn from the recent history of the pro-life movement, which combined organized political action with ground level compassionate care for those who are most likely to be tempted to abort their children. The establishment of Pregnancy Resource Centers across the country provide social, economic, and spiritual support for women who are often in dire situations. Today, thousands of children have been born and nurtured as a result of these centers. The compassionate dedication of Pregnancy Resource Center volunteers have provided a profound witness to the intrinsic worth of all human life, and have silenced the voices of those who claim that the pro-life movement does not care for individual lives of pregnant women.
In a similar way, Christians need to combine an organized opposition to MAID with a number of small, large, formal, and informal movements that engage those most at risk of choosing to end their lives. Such movements need not be complicated. At the heart of such efforts must be a ministry of presence and attentiveness. What is needed is for Christians, prompted by the love of Christ and obedient to the command to love widows, to befriend and be present to the isolated and infirmed. Presence and attentiveness communicate to the infirmed that another human delights in the sheer fact of their existence, and reminds them that they are beings created in the image of God.
In nursing homes and assisted living facilities, a ministry of presence and attentiveness is quite radical. Residents almost exclusively interact with people who are paid to care for them. They are objects in an economy, with every human interaction an expense on a spreadsheet, to be scrutinized and weighed for the sake of efficiency. A ministry of presence stands in stark contrast to this economy. It communicates to residents that they have intrinsic worth, and that there are those who are not burdened by their infirmities.
Those whose infirmities are great, who know that they are a burden on those who are paid to care for them, are often the ones at greatest risk of suicide. When Christians dare to befriend these individuals, they remind them that they are subjects and not objects, that their lives are precious. In turn suffering individuals discover something to live for, that their existence is cherished by another who would mourn their premature loss. Within nursing homes and assisted living facilities, the consistent friendship of non-medical personnel also has the added effect of reminding doctors and administrators that residents are not defined by their medical expenses, and that attempts to diminish their care and hasten their deaths will not go unnoticed. The isolated are no longer isolated, and the vulnerable now have an advocate.
I want to live in a country where every assisted suicide law is rescinded. But I would be content to live in a country where these laws exist, but no one avails themselves of the opportunity to end their life. The path to end and prevent MAID laws is long, difficult, and murky. It requires Christians to pay attention to state and local politics, to question their elected officials, and organize grass roots efforts to put pressure on these officials. Over time, I pray that such efforts reduce supply-side opportunities for self-murder in hospitals, nursing homes, and care facilities.
The path to end the demand for suicide is longer, but straighter. There are millions of elderly and infirmed in America who have no one who knows them, and no one who cares for their soul (Psalm 124). Many of these individuals are concentrated in care facilities hiding in plain sight. What these individuals need the most is a friend who will care for them without strings attached, who will share with them the Gospel if they don’t know Christ, and remind those who do know Christ that their life is deeply cherished by their Lord and Savior. All it takes is for individuals from the outside to take the first step of friendship. I run a simple organization, Heritage Mission, that helps churches start worship services in facilities, which enable these kinds of bonds to be formed. There are other similar organizations that equip volunteers to reach residents. Even without such organizations, individuals can always call up facilities and ask to volunteer in some capacity. Since so many facilities are understaffed, they are quite open to having volunteers run activities or help with meals.
I am convinced that if every infirm individual had a close Christian friend, the demand for MAID would evaporate. There are millions of individuals who feel like objects yet desire so deeply to be treated as subjects. All that is needed is for Christians to take the first step.