Ought Euthanasia to be Allowed?

Paul Badham

What is Euthanasia?

Euthanasia literally means 'dying well" . It usually describes the view that doctors should be allowed to speed up the dying process by giving a fatal injection to a terminally ill and suffering patient. "Voluntary euthanasia" is when this happens at the repeated request of the patient themselves. "Involuntary euthanasia" is when it is done by doctors on their own initiative. Sometimes people use the term "euthanasia" to refer to cases when doctors switch of the life support systems of people who are so deeply unconscious that they have no awareness at all. They simply exist in a "persistent vegetative state" with blood and air being artifically pumped through their bodies. But switching off machines in such cases is not really helping people to "die well". It is recognising that they have really already died, and we are simply ending the ventilation of their corpses. Such cases don't raise moral issues in the way genuine euthanasia cases do. They are simply cases where lawyers and doctors need to agree about when life has for all practical purposes already ended.

Real euthanasia cases arise when a person who is terminally ill, conscious, and in pain, wants to die. Should the doctor help or not? Increasingly people say "yes". Support for euthanasia in Britain is growing from 51% in 1969 to 69% in 1976, 75% in 1989 and 82% in 1996. The reason most people give for backing euthanasia is that they don't want to suffer in the way they have seen their relatives suffer in the last stages of their final illness.

But do people have to suffer nowadays?

Some people, including most doctors, think it very surprising that support for euthanasia should still be growing because modern medicine is getting much better at fighting pain. If you look at the death announcements in your daily paper you will see that "peacefully" is the adjective most often used nowadays. A generation ago there were far more references to people dying "after much suffering, bravely borne". Such cases still exist and you could look in today's paper and see how many. But they will be far outnumbered by those dying peacefully. So why is pressure for euthanasia still mounting? The answer is that suffering does not just mean being in actual physical pain. It can mean being a total victim, unable to look after yourself, being uncomfortable, being unable to do anything, having to put up with all kinds of tubes in your mouth and nose, and having to put up with embarrassments like being doubly incontinent, or constantly vomiting. There is also the sense of futility which comes when one can't do anything and when one's mind is hazy with painkilling drugs so one can't think straight. In such cases it's not enough to know that actual pain can usually be controlled. If life has no real quality and you know it's simply going to get steadily worse then many people think it's better ended. Certainly recent research has shown that 28% of relatives believe that it would have been better if their loved one had died earlier than they actually did. That's why every year more and more people want the law changed.

Does the law need changing?

Some people think there's no need to change the law because sensitive doctors do help people out already. They do this by steadily increasing the dosage of pain killers even though they know that such doses will ultimately kill the patient. Most people see this as morally justified because of what is called "the doctrine of double effect". The purpose of giving the painkillers is the innocent one of fighting disease. The fact that raising the dosage will lead to death is a "foreseen", but legally "unintended" consequence. Consequently the police never prosecute a doctor who kills by giving an overdose of a recognised pain killer. But there are two problems with this as a solution. The first is that you can never be sure that you will get a doctor who will act in this way. The other is that all choice is taken away from the patient and the patient's relatives and is usually in the hands of a single doctor. While the current law exists they can't admit an "intention" to terminate life. This makes it difficult to discuss the situation with the patient, the family, the nursing staff or other doctors. It has to be a lonely decision which may or may not be what the patient actually.wants at that particular moment.

What would happen if the law actually was changed?

There is a great variety of opinion about what might happen if the law were changed. Those opposed to euthanasia often believe in what they call "the slippery slope" argument. This argument cites what happened in the case of Abortion law reform in 1967. This law was intended to permit abortion in exceptional cases, but what happened was that millions of abortions took place and we are close to a situation where we have abortion on demand. The worry is that the same might happen with euthanasia. Even some who in general are opposed to euthanasia recognise that there could be a few rare cases where it really would be in the best interests of everyone for the dying patients to be put our of their misery. But legislating for these exceptional cases rather than trusting in the good sense of the doctors could radically change the whole climate of opinion about death. The fear is that once the floodgates were opened we would quickly move to a situation where euthanasia became normal and where all elderly people would feel themselves under pressure to ask for it, or would even be at risk of having it imposed upon them without their consent.

What happens in Holland?

In the Netherlands voluntary euthanasia has been in practice allowed for many years. Opponents of euthanasia claim that it has already led to instances of involuntary euthanasia, that two thirds of elderly nursing home residents live in fear of their lives, and that consequently increasing numbers of Dutch people opt for nursing homes in Germany where they can feel safe from the threat of being "put down" against their will. Many "atrocity stories" of abuse of the Dutch euthanasia law have been reported in American and British newspapers and the example of the Netherlands is seen as a warning about what we could expect to happen here.

However according to the Royal Dutch Medical Association and the Dutch Society for Health Law, opponents of euthanasia have given a "very innaccurate and unreliable impression... about the extent and nature of the practice of voluntary euthanasia" in the Netherlands. To counter this bad publicity and to try to get at the truth the Dutch Government established a commission about Professor Remmelink, a supreme court judge. The data provided by this report showed that "voluntary euthanasia is in fact performed much less frequently than had been earlier thought". The primary effect of allowing euthanasia has been to give reassurance to terminally ill people that they will not be forced to suffer unendurable misery but will have control over the process of their dying. The Remmelink Commission showed that each year 25,000 ill Dutch people ask their doctors to agree to terminate their lives if ever they find their situation intolerable. Of these only 9000 repeat the request at a later stage, and then after discussion with their doctors fewer than a third of these are ultimately given euthanasia. Ironically one effect of legalising euthanasia is that fewer people may actually have their lives ended by their doctors. The point is that in Holland the patient's whole situation can be openly discussed when they are near death's door and the patient's true wishes at that moment in time can be ascertained. By contrast in Britain where euthanasia is forbidden, but overdosing with painkillers is permitted, the doctor may wrongly assess the real wishes of dying patients. The Remmelink Commission also established that although it might appear that 0.8% of deaths in Holland were caused by involuntary euthanasia this figure was misleading because at least half of these had given earlier notice of their wish for euthanasia when they became terminally ill, and in almost all the rest of the cases euthanasia had been performed when the patient was too ill to make his or her wishes known but where it was believed by both the doctors and the patients' families that euthanasia would have been the patient's wish if they had been able to ask for it.'

The relevance of religion to the Euthanasia debate

Almost all religions see euthanasia as wrong, either because it is an offence against God as in the theistic traditions, or because it is a source of bad karma in Eastern religions. In Christianity, God alone has authority over life and death so that to deliberately end a human life is to encroach on God's prerogative. From a Hindu perspective the patient endurance of the suffering of terminal illness offers the opportunity to create a good karmic inheritance which can improve one's lot in a future birth. On the other hand because it is characteristic of the world religions to see human life in a cosmic perspective, they do not advocate using extraordinary means simply to prolong life. There has been a long tradition of encouraging people to be ready to accept death peacefully and to see it as a natural part of an ongoing process of which this life is only the beginning. Christianity has always seen a willingness to face martyrdom as the supreme virtue and Christ taught that there can be no greater love than to lay down one's life for a friend.2 Similarly in the religions of the east there has been a long tradition of being willing to accept death, sometimes by refusing to eat in the final stages of illness or of willing oneself to die at a time chosen by oneself. However such cases are differentiated from any direct killing of oneself. Stoic philosophy in the ancient Graeco-Roman world and Shinto thought in Japan have been exceptional in actually advocating suicide.

Should Christians oppose Euthanasia?

All main Christian Churches strongly oppose Euthanasia. In Britain the Churches united to give evidence against it to a House of Lords Committee on Medical Ethics in 1994 and Pope John Paul II firmly condemned it in the latest Catholic catechism which says:

An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error ofjudgement into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.3

However it is interesting that opinion polls show that ordinary Christians do not follow their leaders in this matter since 80% of Anglicans and 73% of Roman Catholic laypeople would like to see Euthanasia legalised.4 We may be seeing here an analogy with that happened in the case of birth control which was originally opposed by all Christian leaders but which came to be so taken for granted by ordinary Christians (including Catholics) that gradually Church leaders (other than the Pope) came to accept it. The famous theologian Hans Kung has pointed out that very similar arguments are employed in the Papal Encyclical against euthanasia Evangelium Vitae as in the Papal Encyclical against birth control Humanae Vitae5 and that logically the two encyclicals stand or fall together. And just as almost all Christian leadership outside the Vatican has reluctantly come to terms with birth control so sooner or later Christian leadership will have to come to terms with death control.

What does the Bible say?

Euthanasia as we are thinking about it today is essentially an issue that has arisen out of the success of modern medicine in keeping death at bay. To this extent the Bible is not directly relevant. On the other hand most discussions of euthanasia assume that it is always wrong to take one's own life so it is worth noting that this is nowhere taught in the Bible. It was Shakespeare speaking through Hamlet who said that, "The Everlasting has... fixed his canon gainst self-slaughter!" And therefore the "calamity of so long a life" must be endured.6 The scriptures themselves do not say this, and biblical suicides (which always take place in extreme circumstances) are reported without condemnation. For example Samson is said to have been given strength by God to pull the house of Dagon down upon his own head so that he would die with his enemies.7 Saul committed suicide to avoid the humiliation of capture and his death was lamented by all Israel.8 Eleazur Avaran "gave his life to save his people and to win himself an everlasting name" by stabbing a war elephant from beneath so it fell on him and killed him as well as the enemies whom it carried.9 Razis "fell upon his own sword, preferring to die nobly than to fall into the hands of sinners and suffer outrages unworthy of his noble birth."10 In none of these cases is there any hint of disapproval. In the New Testament we are of course told that Judas Iscariot hanged himself, but this is simply reported without comment.11 The woe predicated on Judas was prior to the suicide, not consequential upon it.12 The overall picture of the Biblical suicides is that the kamikazi deeds of Samson and Eleazur were praiseworthy and the "death before dishonour" attitude of Saul and Razis was commendable.

For Christians the imitation of Christ is very important. Historically he died a cruel death at the hands of his enemies. Yet strangely the fourth Gospel says it was Jesus' own choice to lay down his life: "No one takes it from me, I lay it down of my own accord."13 Similarly St. Paul seems consciously to have chosen to go to Jerusalem even though he knew that such a decision would probably lead to his death.14 Yet he felt no concern at this: "I am on the point of being sacrificed; the time of my departure has come. I have fought a good fight. I have finished my course. I have kept the faith. Henceforth there is laid up for me a crown of righteousness."15

When we turn more explicitly to the question of whether euthanasia in terminal illness might be justified it is interesting to note how positively the Bible looks on death when it comes at the end of a long life. "O death how welcome is your sentence to one who is in need and is failing in strength, very old and distracted over everything; to one who is contrary, and has lost his patience!"16 And if the movement for voluntary euthanasia were looking for a text which summed up their whole perspective it might be Ecclesiasticus 30:17, "Death is better than a miserable life, and eternal rest than chronic sickness." My argument is that it is exactly this judgement that a modern Christian should be allowed to make and to act upon in the closing stages of life. From both a biblical perspective and from the perspective of the mainstream Christian tradition death is not something to be feared, but when it comes in the fulness of time it is to be welcomed. It is tragic that this dimension is so missing in contemporary Church life that modern hymnbooks asterisk for suggested omission the verse relating to death in St. Francis of Assisi's famous Canticle:

"And thou, most kind and gentle death, Waiting to hush our latest breath, O praise him, alleluia, Thou leadest home the child of God, And Christ our Lord the way has trod; O praise him, alleluia." 17

Much of the suffering associated with over-strenuous efforts to hold back the inevitable would be avoided if only such attitudes were once again common. From a Christian perspective death is believed to be the gateway to a new, richer and fuller life with God. If such beliefs are true then when death comes in the fullness of time it should be embraced and accepted.

The significance of the Golden Rule of Jesus

In Christian ethics one key principle is Jesus' "golden rule": "Always treat others as you would like them to treat you".18 Throughout life one's hope is that if one falls ill, one will be able to obtain medical help to be restored to life and vitality. Consequently on this principle doctors and nurses who minister to the sick are widely recognised by Christians as agents and embodiments of God's love. But equally following the golden rule might well lead a doctor to help a patient out of terminal and hopeless misery. The suicide rate for doctors is higher than for any other group. This is because they know the implications of terminal illness and have the means to release themselves from it. Moreover as Dr. Michael Irwin, former Medical Director of the United Nations made public, "Many physicians and nurses have private arrangements that they will hasten each other's deaths should they ever be unfortunate enough to resemble the condition of some of their patients."19 To legalise assisted suicide is to enable doctors to treat their patients in precisely the way they themselves wish to be treated. In this sense this exactly corresponds with the golden rule in Christian ethics.

For Further Reading
Paul Badham and Paul Ballard, Facing Death (University of Wales Press, Cardiff, 1996)
M. Otlowski, Voluntary Euthanasia and the Common Law (Clarendon, Oxford, 1997)
Robin Gill, Euthanasia and the Churches (Cassells, London, 1998)
Notes
1. M. Otlowski, Voluntary Euthanasia and the Common Law (Clarendon, Oxford, 1997) p.135, 136,436,451.
2. John 15:13.
3. Pope John Paul II, Catechism of the Catholic Church (Chapman, 1994), p.491.
4. 73% represents support for euthanasia among Roman Catholic laity and 80% is the Anglican figure. Both cited in M. Otlowski, Voluntary Euthanasia and the Common Law, p.259.
5. Hans Kung and Walter Jens, A Dignified Dying (SCM, London, 1995), p.119.
6. W. Shakespeare, Hamlet, Act I, Scene 2, line 129ff; Act III, Scene 1, line 56ff.
7. Judges 17:28-30
8. I Samuel 31: 3-6, 2 Samuel 1:11-27
9. I Maccabees 6:44
10. 2 Maccabees 14: 41-42
11. Matthew 27:5
12. Matthew 26:24
13. John 10:18
14. Acts 20: 16-38
15. I Timothy 4: 6-8
16. Ecciesiasticus 41:2
17. Hymns Ancient and Modern, William Clowes 1950, Hymn 172 verse 6.
18. Matthew 7:12
19. Sunday Times, 20th. July 1997.
Doctors demand the right to help patients die Now I can die with dignity Woman with terminal illness wins her battle for pain-killing drugs Dying woman wins right to end life in dignity Australia repeals world's first right-to-die law Doctor Death or Mercy Killing?