32November 2007

Fire in the BellyFrom time to time we will

publish articles from members who have strong convictions

about issues of the day. Here is one such...

Euthanasia: the issue

Euthanasia is the intentional killing by act or omission, of a person whose life is thought not to be worth living (Myers, 2000:9). It can be voluntary (i.e. at the

explicit request of the patient) or involuntary. (Wyatt, 1998:172). Euthanasia must not be confused with two other aspects of medical care: withdrawing medical treatment which is burdensome or futile; giving symptom relieving treatment which has the unintended side effect of shortening life (Wyatt, 1998:173) In this essay I shall address the issue of both Euthanasia and Physician Assisted Suicide (PAS), as they are philosophically identical. The medico-legal difference is that PAS does not require the doctor to perform the final act that leads to death, however the doctor provides the means and instruction. For example, the doctor gives the patient lethal medication with instructions on its use, but does not actually administer it. Some argue that PAS is not Euthanasia, however the intent and outcome are the same, I shall not distinguish between the two. Some believe that there are times when Euthanasia/PAS is the best option for individuals and society, and want it legislated. Others say that there are no times when they should be allowed.

Arguments in support of Euthanasia

i) Euthanasia is thought to be an acceptable option for the following reasons (Wyatt, 1998): Personal autonomy, including the belief that a person has sovereignty over their own life. It is argued that there is no harm inflicted on others, therefore others should not interfere with the choices made by an individual regarding their own life.

ii) Aging population leading to rise in chronic disability including neurodegenerative problems (e.g. dementia).

iii) Inability of Healthcare resources to meet the demand – euthanasia is cheaper than keeping the chronically ill alive. The shortage of organs for transplant is also a problem and legalizing Euthanasia could be a solution: organs would be plentiful and useable.

iv) Patients’ fears – of pain, indignity and dependence. Reasons given by patients who died via euthanasia in 2003 – 2004 in Oregon, USA, are revealing:

• 22% said their pain control was inadequate• 35% feared being a burden• 85% feared losing their autonomy (Fergusson, 2005:7).

Biblical and Theological Principles:

To understand Euthanasia from a Christian perspective we need to go back to creation. Genesis 1:27 “So God created man in his own image, in the image of God he created him; male and female he created them”. Imago Dei is one of the foundational principles of Christian anthropology. Following on from this is the understanding that God regards human life as precious: Gen 9:6 “Whoever sheds the blood of man by man shall his blood be shed; for in the image of God has God made man”. Genesis 1:28 reveals that mankind has been given vast amounts of freedom and responsibility on earth, however this God given mandate comes with limitations, revealed in the next chapter: Genesis 2:17: “…but you must not eat from the tree of the knowledge of good and evil, for when you eat of it you will surely die.” Adam and Eve’s disobedience of this commandment testifies to their desire to be more like the Creator than the Created. Although we have been created with freedom to chose, there is a moral order which limits those choices (Stott, 1999:381).

Desiring to be in complete control of every aspect of life, even to the point of how and when to end it, also reflects Adam’s original sin. Life and death should be under God’s control alone: Deut 32:39 “there is no God besides me. I put to death and I bring to life” and 1 Samuel 2:6 “The Lord brings death and makes alive; He brings down to the grave and raises up”.

1. Being a created being means that we are also dependent. Dependence is an integral aspect of our humanity, it is not an evil or inhuman state. Dependence is the opposite of autonomy; we depend on God for our physical existence, as well as our salvation. Jeremiah 17:5 “This is what the Lord says: ‘Cursed is the one who trusts in man, who depends on flesh for his strength and whose heart turns away from the Lord’.” Thinking that we can sustain and save ourselves is the essence of sin not of maturity (Stott, 1999:380).

2. The Bible teaches protection of the weakest not survival of the fittest. James 1:27 “Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress…”

EuthanasiaCase study:

Mrs P, an 89 year old lady, has inoperable cancer, and has been told that she has three months to live. She watched her husband die a slow, painful death last year and does not want to face the same herself. Nor does she want to put her family through the trauma again. She approached me asking to be given something to help speed up the inevitable, and spare her the indignity of a protracted and painful death.

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When God physically raised Jesus, He proclaimed the approval/acceptance of the human body: this body is fit to be transformed to a new humanity. When we assist in killing another human, however compassionate and rational our motives, we damage our own humanity (Wyatt, 1998:194). A Christian appraisal of these philosophies shows that they are all fundamentally flawed.

1. Autonomy in death denies the sovereignty of God, an over-reaching of our abilities as His creatures. The use of the phrase ‘Right to Die’ distorts the Biblical understanding of Life itself: the right to live is a matter of nature and not of will (Charles, 1995:266). It is interesting to note that in our modern times the idea of sudden death is welcomed, while protracted death is feared. Most previous generations saw sudden death as horrible judgment from God, leaving no time for preparation, repentance and goodbyes. (Wyatt, 1998:178)

2. Utilitarianism is the logical conclusion of believing in the ‘survival of the fittest’. However it is contradictory to the Christian understanding of our mandate to protect the vulnerable. The frightening side of utilitarianism can be seen when discussion turns to distribution of resources in an overburdened healthcare system: those who are viewed as a drain (elderly, infirm, disabled) can become an asset – for example, their organs can be harvested to assist those whose lives are considered more worthwhile. Disturbingly, Nazi Germany demonstrated that such concepts are not fanciful but could become a reality if society does not resist them.

In fact, one of the concerning realities of Euthanasia is the development of the concept of a ‘duty to die’. In Oregon, USA, Euthanasia was legalized under the Death with Dignity Act in 1994. Studies show that of those who died from assisted suicide:12% in 1998, 26% in 1999, 63% in 2000 stated that they felt themselves to be burdensome. (Ganzini, 2000:342) i.e. the longer the legislation is in place, the greater the proportion of people who choose Euthanasia out of duty. Legalizing Euthanasia not only puts pressure on the patient, it places unfair pressure physicians. There needs to be a clear distinction between deciding which treatments are futile and which human lives are futile. A physician should learn to discern the former but should never be able to decide the latter. (Wyatt, 1998:199)

3. Individualism mistakenly assumes that dependence is an evil. It also denies the reality of what occurs in practice. “A clinical situation is one of dependence. When another person is depending on you, the best thing you can do is be trustworthy and not abandon them to their own autonomy” (Gillett, 2004:13) Furthermore, once a person decides they want to die, individualism asserts that no-one else has the right to stop them. However, rights are meaningful only in a social context, therefore every ‘right’ imposes on others some form of obligation. (Charles, 1995:266)

4. Avoidance of suffering is a relatively modern obsession in the Western world. Suffering, from a Humanist worldview, is senseless and has no ultimate meaning. Hence the elimination of suffering has become one of the primary goals of medicine (Wyatt, 1998:195). However, while the Bible condones the intervention of humans to relieve each other’s suffering, it does not give permission to remove the sufferer. The story of Job teaches us that suffering often has an eternal, transcendent significance which we do not understand. Suffering is not a question which demands an answer, it’s not a problem which demands a solution, it is a mystery which demands a presence. (Wyatt, 1998:67)

Other concerns

1. As in many ethical debates, language has been hijacked to change societal attitudes towards Euthanasia. Euthanasia rhetoric depends on euphemisms such as ‘exit preference’, ‘death with dignity’ and ‘right to die’. (Charles, 1995:271) These words conjure strong sentiment by use of images and symbols, however they fail to truly represent what Euthanasia is (and isn’t). For example, ‘Death with Dignity’ assumes that it is not possible to die with dignity in any other way except through Euthanasia. It also ignores the reality that assisted suicide is not always dignified – in fact, in Holland, 15% of deaths by Euthanasia were reported to involve distressing difficulties such as vomiting, extreme gasping, muscle spasms and reawakening. (Horton, 2001: 357)

2. Making Doctors into killers breaks trust. Patients should have the total assurance that their doctor will only ever be their healer and comforter. If there is a possibility that their doctor could also be their killer, uncertainty and insecurity enters the relationship. Hippocratic medicine, although not Christian in origin, has been the foundation of accepted clinical practice for

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thousands of years. It is clearly distinct from non-Hippocratic medicine, seen in the form of Witch Doctors/traditional healers, where there is no oath of allegiance made to the patient. In non-Hippocratic medicine the patient can never be completely sure that the doctor has not been paid more by someone else to give them poison rather than medicine. (Wyatt, 1998:216-217)

3. A person who is suicidal is by definition mentally unwell and needs help. Medicine that decides to assist a person to commit suicide is betraying the mandate to help rather than harm. Rather than throwing a lifebuoy to a drowning person, it is throwing a lead weight.

4. There are aspects of the dying process that remain mysterious and important. Dying is an opportunity for growth – emotionally and relationally. It is a chance for healing, reconciliation and forgiveness. Priorities are re-ordered, dreams articulated, and it is the final opportunity to ensure the eternal destiny is securely in Christ (Wyatt, 1998:204). Interfering with this process has unknowable implications, and therefore should be avoided.

Implications of the issue for the Christian community

A Christian response to Euthanasia should be both individual and corporate.

Individual Christians should be aware of the real (not euphemistic) issues underlying the call for changes in euthanasia laws, and should be prepared to challenge the underlying cultural values, as already outlined. Individual doctors must understand the historical approach of physicians to death and dying, where the doctor saw it as their duty to stay with a patient particularly in those final hours (Rutecki, 1995:280). They must also wrestle with their own limitations as humans and practitioners within a fallible occupation: good medicine knows its limits, and does not make decisions based on fear, inexperience or simply because an intervention is possible. Technical fixes do not ultimately eliminate suffering and death, they often simply make the physician feel better (Wyatt, 1998:198) A corporate response is imperative. According to Daryl Charles (1995:273) the task of the church is threefold: i) theological ii) apologetic iii) ethical

Theologically the church must reassert human dignity, the understanding of Imago Dei and the understanding of depravity. The Church must counter culture when culture strays from its God-given mandate of stewardship.

Apologetically the church must understand the times we live in, discerning the philosophies that are ruling our society, and countering them with a Christian worldview (Colossians 2:8). Engaging the culture without compromising is a difficult but necessary activity. One of the key ways to ensure

that we are being faithful to the Word of God is to be clear about the meaning of the words we use. Truth must be clearly communicated.

Ethically the church must not only be actively involved in shaping the debates as they occur, it must also be able to offer alternative social remedies. For example, speaking against legislation to legalize Euthanasia, but also developing hospice and palliative care. I believe there is also a fourth task, that of practical activity, as the Bible clearly teaches that God brings comfort through other people (2 Cor 1:3ff, 7:6; Mt 25:31-46). As the apostle Paul approached his own death, his words were very revealing. In 2 Tim: 1-14 and 4:6-13 he clearly believes that he is close to death. His requests centre his desire to be with others – Paul needs intimate friendship in his last days.

The Church should offer practical teaching about the process of death – for example, how to walk someone through their final stages of dying, how to comfort effectively, how to grieve well. Of all people, Christians should be leading the way in helping people to truly die with dignity. A leader in the former Soviet Union was once asked why active persecution was never able to repress Christianity. He responded ‘because Christians never let anyone die alone!’ (Rutecki, 1995:288) It is our duty as Christians to care for the dying with compassion, skill, empathy and faithfulness: to care but never to kill.

Conclusion

Mrs P’s request for me to ‘help’ her die is ostensibly reasonable. However, once we understand the personal and cultural drives towards making Euthanasia acceptable, we can see that it is incompatible with Christian teaching of God and humanity. Our response should be both individual and corporate. We must choose the more challenging, Biblical route, that of caring for a dying or demented person with Christ-like compassion, respect and dignity. It is ultimately God who comforts the suffering, sick and dying through the presence of His people, and decides the final hour of death.

Bibliography

Charles, D ‘The ‘Right to Die’ in the Light of Contemporary Rights-Rhetoric’ In Bioethics and the future of medicine: a Christian appraisal Ed: Kilner, J.F., Cameron, N.M., and Schiedermayer, D.L. (U.K., Paternoster Press:1995)263 – 278

Fergusson, A. ‘Going West?’ In Triple Helix (Christian Medical Fellowship, U.K. Summer 2005):6-7

Ganzini L. ‘Physicians experiences with the Oregon Death with Dignity Act’ New England Medical Journal (2000): 342

Gillett, G ‘How we should live as Christian Doctors’ in Lukes Journal (Christian Medical and Dental Fellowship Australia, Vic June 2004): 10 - 14

Horton, R “Euthanasia and assisted suicide: what does the Dutch vote mean?” Lancet (2001);357

Myers, K, Physician Assisted Suicide (U.K.: CMF file, 2000)

Rutecki, G.W. ‘Until Death Shall Be No More: Christian Care for the Dying’ In Bioethics and the future of medicine: a Christian appraisal Ed: Kilner, J.F., Cameron, N.M., and Schiedermayer, D.L. (U.K., Paternoster Press:1995) 279 - 289

Saunders, P. ‘The Euthanasia Bandwagon’ in Triple Helix (Christian Medical Fellowship, U.K. Winter 2005):3

Wyatt, J. Matters of Life and Death: Today’s healthcare dilemmas in the light of Christian Faith (Leicester, U.K.: Intervarsity Press, 1998).

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