“I don’t want to be a burden.”
This phrase is, all too often, the motto of suffering people in our society. I hear it frequently in my work as an Emergency Physician, especially from those with chronic diseases or life-limiting diagnoses. I read it frequently in news articles and ethics journals, particularly those discussing issues related to end-of-life care, dependence, and disability. A fear of burdensomeness is often cited as a contributing reason for those who seek to end their own lives through the intervention of a doctor—a practice that, in Canada, is misleadingly called ‘medical assistance in dying’ or ‘MAiD.’
But why do many people feel like they become burdens as soon as they are meaningfully dependent on others? The answer is straightforward, from my perspective.
“A fear of burdensomeness is often cited as a contributing reason for those who seek to end their own lives through the intervention of a doctor…”
Our society often believes in an anthropology—a view of the human person—that equates our value to our independence. You matter only insofar as you are a self-possessed individual who is not meaningfully dependent on others. The way this worldview has affected the space of bioethics is perhaps best exhibited in a major essay by American ethicist Ruth Macklin titled, “Dignity is a useless concept: It means no more than respect for persons or their autonomy.” [1] For Macklin and many others, the dignity of the person means no more than their capacity for self-rule, self-assertion, and self-determination. Such a worldview necessarily implies that those who are meaningfully dependent on others, who are not fully autonomous, have lesser dignity and lesser value. It is no wonder that such persons may feel as if they are, in themselves, burdens.
Such a worldview is necessarily ableist: failing to show adequate care and respect to persons with disabilities. If dignity means no more than autonomy, then those who are dependent on the care of others have less dignity, less value, than those who do not. The well-meaning attempts of many people in our communities to make public spaces more accessible and welcoming to disabled persons are undercut by this ableist anthropology that is ubiquitous in present medical, bioethical, and popular conversations.
“Such a worldview is necessarily ableist: failing to show adequate care and respect to persons with disabilities.”
Furthermore, we must clearly see that such a worldview is ultimately demeaning to all human persons. None of us are fully independent, fully autonomous. All of us are deeply dependent on other human beings and on the natural world. Some people, particularly if they are wealthy, can sustain, for a few short decades, the illusion that we can exist without meaningful dependence. The consequences of such attempts are often disastrous: loneliness, boredom, purposelessness, and despair. Success in such a project is a prison in and of itself. No one is successful for long: everyone is ultimately dependent, and as such, a worldview that equates value to autonomy is, in the end, degrading for everyone.
The Christian response to such a situation must begin with a clear assertion—in word and witness—of an anthropology that is simply and radically different. Paul tells the Galatians, “Carry each other’s burdens.” This shift in language changes everything. For the Christian, a person is never a burden. A person is always a gift. Every member of the human family is beloved by God and so should compel our respect and even our reverence. Persons who suffer often carry heavy burdens, but the person themselves is not the burden. The response of the Church, when we see a neighbor (especially someone who is very different from ourselves) who is deeply dependent, is to rush to them to practice creative compassion: a term which most directly means ‘co-suffering.’ Our clear witness to dependent and disabled others must be this: “You are never a burden here.”
“It is good for persons with disabilities: affirming their inviolable dignity and opening space for the development of rich friendships and other mutual relationships.”
Responding in such a way has incredible redemptive and healing potential for individuals and communities. It is good for people with life-limiting diagnoses: affirming their inherent dignity and demonstrating how they might still give and receive blessings, even as they walk through the shadow of death. It is good for persons with disabilities: affirming their inviolable dignity and opening space for the development of rich friendships and other mutual relationships. It is good for everyone: for all of us are deeply dependent.
And, when we acknowledge our dependence, we are closest to grace: the grace of others and, ultimately, the endless grace of God.
About the Author:
About the Author:
Dr. Quentin Genuis is an Emergency Physician at St. Paul’s Hospital in Vancouver, and the Physician Ethicist for Providence Health Care. He holds a Master of Letters in Theology from the University of St. Andrews. He teaches in academic, clinical, professional, and lay settings on a variety of issues related to bioethics, compassion, addiction, and theological anthropology. He enjoys drinking Scottish whiskey, reading Dostoevsky, and slacklining. He loves his wife, Kalyn, and their four children: Lila, Rowan, Elias, and Junia.
Dr. Quentin Genuis is an Emergency Physician at St. Paul’s Hospital in Vancouver, and the Physician Ethicist for Providence Health Care. He holds a Master of Letters in Theology from the University of St. Andrews. He teaches in academic, clinical, professional, and lay settings on a variety of issues related to bioethics, compassion, addiction, and theological anthropology. He enjoys drinking Scottish whiskey, reading Dostoevsky, and slacklining. He loves his wife, Kalyn, and their four children: Lila, Rowan, Elias, and Junia.
