Need help navigating life with diabetes? You can always Ask D'Mine! Welcome again to  our weekly Q&A column, hosted by veteran type 1 and diabetes author Wil Dubois.

This week's question brings to mind the fact that it's nearly Lent, the time when many Christians give up something (usually a vice) as a way of reaffirming their religious beliefs. This daughter of a T2 mom who takes insulin has a serious related concern...

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Josie, type 3 from New Jersey, writes:We are pretty devout Catholics. My mother, who is now 70, is a type 2 diabetic and has taken insulin for about 15 years. She wants to stop, but her doctor says there are no alternatives, and that she’ll die without it. To me, that makes stopping insulin suicide, and that’s a sin, right?

Wil@Ask D’Mine answers: Holy Cow. Oh. Bad choice of words on my part. This is probably a call-the-Pope kinda of question, but as always with reader questions, I will fearlessly take a stab at it for you. Still, you might want to get a second opinion.

From a priest.

Now I think I’m safe in saying to all my readers that if your religion says that suicide is a sin, and if you are a believer and a follower of that religion, then it is a sin. Where do the world’s major religions come down on the subject? Your religion, Josie—along with most other flavors of Christianity, Judaism, and Islam (suicide bombers notwithstanding), together with Buddhism and Hinduism—takes a dim view of ending your life by your own hands.

In fact, as “sin” goes, killing yourself is one of the biggies. Why is that? From a religious perspective it seems to come down to questioning God’s plan for you, which I guess makes suicide a form of blasphemy, and that’s one of those things that historically and mythologically pisses deities off.

So that’s pretty simple, for most religious folks in most religions, suicide is some sort of sin. The real question, then, is this: Is stopping your medication a form of suicide? And to answer that, we need to talk a little more about suicide.

I’m sure that most folks, religious or otherwise, would agree that putting a gun to your temple and pulling the trigger would count as a suicide. As would hanging yourself, jumping in front of a train, setting yourself on fire, downing a full bottle of sleeping pills or even pulling a gun on a police officer.

Anyone disagree with that analysis? Even if you aren’t religious, I’m sure you would agree with that list of actions being classified as suicide, even if you personally may not regard suicide as a sin. 

Now, let’s talk more about that bottle of sleeping pills. What, really, is the difference between taking too much medicine to kill yourself versus not taking enough medicine, knowing that will kill you? Ah ha! Got you there, didn’t I? Interestingly, although these two actions are the opposite sides of the same coin, with the same result, a great many people view one as suicide and the other as not suicide. 

What’s up with that? 

Personally, this always leaves me scratching my head, but the alleged logic when I dig into it is that taking an overdose is an overt action, whereas doing nothing is passive and “letting nature take its course.” That’s all good and fine, until you get God back into the picture. Is medicine part of God’s plan? Most mainstream religions, including the Catholic church, say “yes.”

Specifically for you, Josie, the National Catholic Bioethics Center has written extensively on the subject, and their take is that Catholics are 100% free to refuse “extraordinary” measures and experimental treatments, especially in an end-of-life sphere, but that taking run-of-the-mill proven medicines—like insulin—is classified by the church as “morally obligatory.” And the Catechism backs that up, spelling out (in a discussion of euthanasia) that acts of omission count just as strongly as acts of commission, if death is the result, and are therefore sins.

All of that said, I live in a very Catholic part of the world, and I’m impressed with the ability of the local Catholics to find ways to justify ignoring the dictates of the church hierarchy. So even if the church says it’s a sin, your mother would need to accept that, which I suspect she currently doesn’t.

So where does that leave us?

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Image source: Jim West / Science Photo Library

Well, is your mother’s doctor correct that there are no alternatives to insulin for her? That’s a 100% maybe. Here’s the thing: We know that, historically, in the normal course of type 2 diabetes, the burgeoning insulin resistance will ultimately burnout the ability of the body to produce meaningful amounts of insulin, hence our terminology of “insulin-dependent” when describing advanced type 2 diabetes. The fact that insulin will be required during a lifetime of T2 is a punch that should never be pulled. The concept should be introduced at diagnosis.

But you’ll note that I said “meaningful.”

There might still be a trickle of insulin being produced. So could that trickle be enhanced with a slew of modern pills? I’m beginning to think that’s possible, especially when linked to a reduced carbohydrate diet, but to me the impact on quality of life would be more burdensome than insulin, and the side effect risks higher. But still, perhaps in this case, it’s an option to be evaluated.

It might be the lesser of evils for your family.

What do I personally believe? Keeping my own Episcopal religion out of this, here’s my humanistic take on suicide: I don’t like suicide. In my time working in healthcare, the only wounds I saw that never healed were the wounds left on the souls of the loved ones of people who killed themselves. In general, we humans have an amazing ability to recover from the most horrific of experiences. We are strong. But something about the suicide of a loved one short-circuits the healing processes of heart, mind, and soul. Suicide of a loved one leaves behind a wound that remains fresh and raw, decade after decade. Survivors carry these wounds to their own graves. So from what I’ve seen, committing suicide is the ultimate cruelty to your loved ones. 

I guess if that’s not a sin, I don’t know what is.

So do I believe that not taking medicine is a form of suicide? Yeah, I do. I see no difference between picking up a bottle of unnecessary pills to kill yourself and setting a needed bottle down. Not taking medication that can easily keep you alive is making a choice to die, and that, by any definition, is committing suicide.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. Bottom Line: You still need the guidance and care of a licensed medical professional.