Euthanasia- coursework on Christian belief, ethical philosophers and that of the medical establishment.
Hannah Hawker
Religious Studies
Euthanasia- coursework on Christian belief, ethical philosophers and that of the medical establishment.
'An acceptance of the practice of euthanasia is incompatible with Christian beliefs in the sanctity of life and, but not with the attitudes of ethical philosophers or some medical establishment'
Before I can begin to discuss the statement there are issues that need to be illustrated; that there are no black and white answers. For example, a Christian doctor who has pledged hypocrites oath and believes whole heartedly in the bible may also believe in the human rights of an individual, i.e., the right to death without suffering (remembering that in this country a vet is allowed to put animals out of misery and suffering and provide them with a merciful death, a right under British legislation). Basically there cannot be a simple straightforward answer. There are issues that can only be truly relevant and appropriate to somebody actually going through pain and suffering. How can one claim to know what is right or wrong without experience? I am sure that many would change their outlook on euthanasia if confronted with a long painful death. Hence, one can be sympathetic but not empathic.
Euthanasia translates as 'good death' or 'dying well' but what is a 'good' death? One could describe it as a peaceful, painless, lucid with loved ones present.
In order that the question of euthanasia can be properly dealt with, it is first necessary to define the words used. Etymologically speaking, in ancient times euthanasia meant an easy death without severe suffering. Today, one no longer thinks of this as the original meaning of the word, but rather some intervention of medicine whereby the suffering of sickness of the final agony are reduced, sometimes also with the danger of suppressing life prematurely. Ultimately, the word euthanasia is used in a more particular sense to mean "mercy killing", for the purpose of putting an end to extreme suffering or an end to an incurably sick patient from the prolongation, perhaps for many years, of a miserable life, which could impose too heavy a burden on their families or society. It is therefore, necessary to state clearly in what sense the word is used in the present essay; by euthanasia is understood an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. Euthanasia's terms of reference are to be found in the intention of the will and in the methods used; therefore, a Christian understanding of euthanasia is that nothing and no one can in any way permit the killing of an innocent person, (although one must bare in mind that different denominations may hold a slightly different view on aspects) whether it be a foetus or an embryo, an infant or an adult, an old person or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for herself or himself or for another person entrusted in his or her care, nor can person consent to it, either implicitly or explicitly. There is a widespread agreement that omissions as well as actions can constitute euthanasia. The Roman Catholic Church, in its Declaration on Euthanasia, for example, defines euthanasia as 'an action or omission of itself or intention causes death'. Nor can authority legitimately recommend or permit such an action. For it is a question of the violation of he divine law, an offence against the dignity of a human person, a crime against life, and an attack on humanity.
It may happen that, by reason of prolonged and barely tolerable pain, for deeply personal or other reasons, people may be led to believe that they can legitimately ask for death or to obtain it for others. Although in these cases the guilt of the individual may be reduced or completely absent, nethertheless the error of judgement into which the conscience falls, perhaps in good faith, does not change the nature of this act of killing, which will always be in itself something to be rejected. The pleas of gravely ill people who sometime ask for death are not to be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care is love, human and supernatural warmth with which the sick person can and ought to be surrounded by all those close to him or her, parents children, docors and nurses.
There are different types of euthanasia and before looking more closely at the arguments it will be necessary to draw some distinctions. Euthanasia can take three forms, voluntary, non-voluntary an involuntary.
Euthanasia can be voluntary even if the person is no longer competent to assert his or her wish to die when his or her life is ended. You may wish to have your life ended, should you ever find yourself in a situation where, whilst suffering from a distressing an incurable condition, illness or accident has robbed you of all your rational facilities, and you are no longer able to decide between life and death. If, while still competent, you express the considered wish to die when in a situation such as this, then the person who ends your life in the appropriate circumstances acts upon your request and performs an act of voluntary euthanasia.
Euthanasia is non-voluntary when the person whose life is ended cannot chose between life and death. For example, because the person is hopelessly ill or a handicapped newborn infant, or because illness or accident have rendered a formally competent person prematurely incompetent, without the person previously indicating whether he or she actually would have chosen euthanasia in certain circumstances.
Euthanasia is involuntary when it is preformed on a person who would have been able to give or withhold consent to her own death, but has not given consent- either because he/she was not asked, or because he/she was asked but withheld consent, wanting to go on living. Whilst clear cases of involuntary euthanasia would be relatively rare it has been argued that some widely excepted medical practices (such as the administration of increasingly large doses of painkillers that will eventually cause the patients death or the unconsented to withholding of life sustaining treatment) amount to involuntary euthanasia.
Euthanasia is not compatable with most Christian mostly from the sanctity of life perspective. Sanctity means sacred 'given by God'. Built into that definition is the idea that we human beings do not have the right to terminate life. Contrary to popular belief, this is not in fact a biblical expression but is a biblical concept derived from the understanding of these four main points:
* Human life being made in the image of God Genesis 1:27. In Genesis 9:6 was instructive for our forbearers and should be for us as well, "Whoever sheds man's blood, by ...
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Euthanasia is not compatable with most Christian mostly from the sanctity of life perspective. Sanctity means sacred 'given by God'. Built into that definition is the idea that we human beings do not have the right to terminate life. Contrary to popular belief, this is not in fact a biblical expression but is a biblical concept derived from the understanding of these four main points:
* Human life being made in the image of God Genesis 1:27. In Genesis 9:6 was instructive for our forbearers and should be for us as well, "Whoever sheds man's blood, by man his blood shall be shed, for in the image of God He has made man". This scripture is more than a prohibitation on the taking of innocent life. Being created by God, we are stewards of our lives rather than owners. Created to be like God, our lives have an eternal purpose; set apart for, and owned by God. Since we are created in the image of God, our lives have intrinsic and immeasurable value. This is the source of the 'sanctity of life' concept. Because we are created in Gods image, people have an incoherent and God given dignity.
* Gods commandment, 'thou shall not kill' Exodus 20:13
* The fact that just as we value by something by what we are prepared to pay for it, 'God so loved the world that he gave his only son, so that whoever believes in him shall not perish, but shall have eternal life' John 3:16
* The belief that God has ultimate right over our bodies; 'you are not your own; you were brought at a price. Therefore honour God with your body' Corinthians 6:19-20
Thus Christian teaching is such that one must 'maintain the deepest respect for individual human life from beginning to end'- but Christians do recognise that human life in the physical sense has a natural end. A goal of medicine is to recognise that natural end. Christian belief sees that there is no requirement to give all possible treatment to all possible patients in all possible situations, just because those treatments exist. In other words, while believing that it is always morally wrong and always unnecessary to intentionally kill patients Christian belief is such that they also recognise that a time may come when an interventionalist treatment need not to be started or continued and the patient should be allowed to die with all appropriate care given. Jean Paul, Pope, states that 'this is not euthanasia but good medical practice.'
In February 2001 the Pope John Paul issued one of his strongest condemnations of euthanasia; saying that they were tantamount to legalised crime, corrupting society. He said that laws permitting euthanasia should not be seen as inevitable social necessities,
"...These (laws) are a seed of corruption in society and its foundations. Civil and conscience cannot except this false inevitability, just as it cannot accept the idea that wars or inter-ethnic extermination are inevitable," he said.
Looking at different denominations of Christian perspective of euthanasia provides one with a better understanding of their basic beliefs. Here, there are a few statements from different churches. The Evangelical Lutheran church made a statement in 1992 on matters regarding euthanasia. The Evangelical Lutheran church said they support passive euthanasia:
"Health care professionals are not required to use all available medical treatment in all circumstances. Medical treatment may be limited in some instances, and death allowed to occur."
They oppose active euthanasia,
"...deliberately destroying life given in the image of God is contrary to our Christian conscience."
However, they do acknowledge that physicians struggle to choose lesser evil in some situations, eg, when pain is so severe "that life is indistinguable from torture." Surprisingly, although physician-assisted euthanasia is a hotly debated subject, they do to comment on it.
The Orthodox Church states,
"The Orthodox church opposes murder, whether it be suicide, euthanasia or whatever, and regardless if it is cloaked in terms like 'death with dignity'. A person contemplating ending it all because of despondency instead should turn to God for strength and support. The Book of Job serves as a prime example of how someone overcomes extreme suffering by staying focused on God."
Roman Catholic Church states-
" Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obligated to accept life gratefully and preserve it for His honour and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of."
And finally the Salvation Army-
" The Salvation Army believes that people do not have the right to death by their own decision ...only God is the sovereign over all life and death...the grace of God can sustain through any ordeal or adversity."
As Christians hold the bible to be the revealed word of God, this is helpful in my approach to Christian view of euthanasia. Euthanasia translates as a 'good death' or 'dying well'. According to Christian belief life is a gift from God. From this I want to address the value of life, the responsibility to honour and respect life (remembering that this is from a Christian perspective). I will do so in three main points.
* In the Gospel of John, Jesus presents himself as the door (John 10:8) and he warns us of those who will come to do us harm...to teach us falsely...to distract us from the truth. In John 10:10 he warns us of those who promise life but in the end bring death and suffering.
* Jesus was one who was rejected by those who promoted themselves spiritual leaders. He demonstrated this determination...to value all life. He detested heresy. He said, "I am the good Shepard! I know my sheep and my sheep know me, and I lay down my life for the sheep". John 10:14.
* There is an elderly women story in the Bible with the 'issue of blood' in Luke 8:43-48. A woman touched His garment and was healed. She came to Him trembling, this shows the He saw the value/sanctity of life even in the aged, it brought comfort and hope,
"In relation to human life, to acknowledge that God is the creator and sustainers and the Lord of all life"
Some people believe that life is sacred and that no one has the right to purposely take a life. Many religious people follow this principle, so do not agree with suicide and assisted dying. However, there are many religious people who do support voluntary euthanasia, such as our late vice-president Lord Soper, an important Methodist minister. In the Netherlands, Catholic or Dutch Reformed clergymen may be present at assisted deaths. It must also be remembered that religious arguments cannot, and should not, apply to anyone who does not share that belief.
This argument states that once we have made voluntary euthanasia legal, society will soon allow involuntary euthanasia. This is based on the idea that if we change the law to allow a person to help somebody to die, we will not be able to control it. This is misleading and inaccurate - voluntary euthanasia is based on the right to choose for yourself. It is totally different from murder. There is no evidence to suggest that strictly controlled voluntary euthanasia would inevitably lead to the killing of the sick or elderly against their will. As Ronald Dworkin, professor of Law at Oxford and New York
University, said in 1994:
"Of course doctors know the moral difference between helping people who beg to die and killing those who want to live. If anything, ignoring the pain of terminally ill patients pleading for death rather than trying to help them seems more likely to chill a doctor's
human instincts."
People who do not agree with voluntary euthanasia often refer to the 1967 Abortion Act. They argue that the numbers of abortions which now take place every year show that the safeguards set out in the Abortion Act have been ignored. They argue that this example should be taken as a warning of what could happen if helping people who are terminally ill to die is made legal. They believe that the law would not be able to control a huge amount of euthanasia cases, many of which would be involuntary. However, abortion is a very different issue to assisted dying. It is also important to remember that people choose to have abortions, they are not forced on people. There is no evidence to suggest that assisted dying will be forced on anyone either.
Some people who do not agree with voluntary euthanasia argue that if it was legalised, it would damage the moral and social foundation of society by removing the traditional principle that man should not kill, and reduce the respect for human life. However, the idea that we should not kill is not absolute, even for those with religious beliefs - killing in war or self-defence is justified by most. We already let people die because they are allowed to refuse treatment which could save their life, and this has not damaged anyone's respect for the worth of human life.
Christians hold the Bible to be the revealed word of God and I find this lucid information in my approach to euthanasia, and how Christian belief is not compatible with it. I find that from scripture that the biblical concept of justice is balanced by the biblical concept of mercy and I hope that my own resolution of this balance is clear.
There are two points offered by Christians and those of other faiths that advise against an individual seeking euthanasia;
* Life is a gift from God. Thus, only God can start a life and only God should be allowed to end one. An individual committing euthanasia is committing a sin.
* God does not send us any experience we cannot handle. God supports people in suffering. To actively seek an end to ones life would represent a lack of trust in Gods promise.
Of course, there is a significant and growing percentage of Agnostics, Atheists, Humanists, secularists; ethical philosophers and some medical establishment that do not accept these theologically based arguments. They might argue;
* Each person has autonomy over his or her own life. People who are in severe pain with a terminally ill disease, or whose quality of life is non-existent should be allowed the right to seek assistance if necessary.
* Sometimes a terminal illness is so painful that it causes life to be an unbearable burden; death can represent a relief of intolerable pain.
An active question for the medical establishment is whether individuals should be allowed to choose euthanasia, or whether they should be forced to follow the theological beliefs of the dominant religion that still has a great effect on society. An argument from the medical establishment shows that:
* A survey in 1994 showed that over 10 per cent of doctors already help patients to die, despite the risk of prosecution.
* Nearly half of all doctors would be willing to help someone die, if it were legal.
* 79 per cent of British people think that this should be a legal choice.
* Medical advances mean that people are living longer but dying of incurable diseases.
* Not everyone dies well. About 5 per cent of terminal pain is still incontrollable, even in hospices.
* Everyone should have the choice of a dignified and peaceful death.
A critical issue arises at this point. Secular humanism claims that every life has a "quality" attached to it. This means that circumstances, abilities (or disabilities), suffering or other factors render a life better or worse, because the person has a greater or lesser degree of contentment or happiness. With contentment or happiness as the standard some lives are deemed to have such a low quality that it is reasonable to prefer death. As with euthanasia, some people are in so much pain and suffering that their quality of life is poor, that they prefer death. This is the antithesis of the "sanctity of life" ethic, which maintains that every life, created in the image of God has intrinsic God-given value that is not reduced by circumstances. Paul teaches, "I have learned the secret of being content in any and every situation" (Phil 4:12).
It is sometimes said that euthanasia is not tolerable merely because God forbids it. A Christian claims to know that because of the authority of either scripture or Church tradition. Some have argued over the true meaning of the 6th Commandment; it does not say literally 'Thou shalt not kill'- that is a bad
Translation. A better translation is ' Thou shalt not murder'
In our society the battle of euthanasia is being fought on three main fronts, the Christian standpoint and that of medical establishment and ethical philosophers.
"Not only must it be addressed by the government, but given our times it requires the mobilization of all the forces of Christian charity and human solidarity."
(The Pope, John Paul). Having looked at the Christian perspective, I am following on to the outlook of some ethical philosophies.
Looking at arguments from a different perspective, a came across an argument in support of euthanasia. It is an argument called 'the argument from mercy'. It is a remarkably coherent argument (in its main idea). Terminal patients often suffer pain so terrible that those who have not actually experienced it can hardly comprehend it. Even I, who has a terminally ill Mother and sees her in a lot of pain, and has, in the past seen her in immense amounts of pain, cannot comprehend what she goes through. Their sufferings can be so terrible that we do not even like to think about it. The argument from mercy says that euthanasia is justifiable because it puts an end to the terrible suffering.
The basic idea of the argument of mercy is lucid enough. Among many philosophers, the utilitarians attempt to take this argument and develop it into a more meticulous one. The basis of Utilitarian philosophy is the 'greatest happiness for the greatest number'. They hold that actions should be judged right or wrong according to whether they cause happiness or misery. They argue that when judged by this standard, euthanasia turns out to be morally acceptable. The most common utilitarian version of the argument may be elaborated like this:
. Any action is morally right if it serves to increase the amount of happiness in the world or to decrease the amount of misery. Hence, the action is morally wrong if it serves to decrease happiness or increase misery.
2. Killing a hopelessly ill patient, who is suffering great pain, at his own request, would decrease the amount of misery in the world.
3. Therefore, such an action would be morally right.
The first premise of this argument is the principle of utility. Bentham (a 20th century utilitarian philosopher 1748-1832) said that it is pleasure and pain alone 'to point out what we ought to do, as well as determined what we shall do'.
Many philosophers think that this is unacceptable, the promotion of pleasure and pain are not the only morally important things. For example, people might be happier if there was no freedom of religion, because if everyone adhered to the same religion there would be a greater harmony between people. The religious element in Northern Ireland would be removed. There would be no unhappiness if a Jewish woman wanted to marry a catholic man. If people were brainwashed enough then happiness might be increased, but the argument continues that even if happiness could be increased in this way, it would be wrong to do so because people should be allow freedom of choice. Therefore the argument concludes that the principle of utility is unacceptable.
There is an associated intricacy for utilitarianism, which connects more directly with euthanasia. Suppose, for example, a person is leading an unhappy life, and is more unhappy than happy, but does not want to die. Or is in a lot of pain, but still prefers to live (maybe they have a family). This person thinks a miserable life is better than dying. Now we would agree that this person should not be killed, yet it would decrease the amount of misery in the world if he were killed. So therefore it is hard to see how, on strictly utilitarian grounds it would be wrong. So the principle of utility deems inadequate once again, yet contemporary utilitarians have an easy answer. In the first place, as far as euthanasia is concerned, the basis of the utilitarian argument has reasonable force, even though it may be faulty. Because, although promotion of happiness and the absence of misery are not the only morally important things, they are in effect very important things. So, when an action would decrease misery, it is a very strong reason in favour.
There is increasing medical interest and support in the UK for legalising voluntary euthanasia. In 1990, a working party from Institute of Medical ethics said:
"A doctor, acting in good conscience, is ethically justified in assisting death if the need to relieve intense and increasing pain or distress caused by incurable disease greatly outweighs the benefit to the patient of further prolong life"
At the moment, the British Medical Association (BMA) is against legalising voluntary euthanasia. At their 1997 conference they voted against any immediate change in the law on assisted dying. However, they do support living wills and a patient's right to refuse treatment. In 1999 the BMA said:
"A valid advance refusal of treatment has the same legal authority as a contemporaneous refusal and legal action could be taken against a doctor who provides treatment in the face of a valid refusal."
In July 1995, The Lancet, one of the main medical journals in the world, dealt positively with voluntary euthanasia. The article was called The Final Autonomy, and the final sentence read:
"All we ask is that Medicine moves towards non-medical opinion by admitting euthanasia openly (and more honestly) into all its future discussions of end-of-life decisions affecting competent adults."
However, many doctors support a change in the law. In the September 1996 issue of the BMA News Review, the results of a survey of over 750 GPs and hospital doctors showed that doctors were divided over legalising voluntary euthanasia. The results were as follows:
* 46% of doctors supported a change in the law to allow them to carry out the request of a terminally ill patient for voluntary euthanasia.
* 44% were against euthanasia and supported the present law
* 37% said they would be willing to actively help end the life of a terminally ill patient who had asked for euthanasia, if the law allowed it.
Twenty-two doctors actually confessed to having broken the law and helped someone to die. Following this survey, Dr Stuart Horner, who was then the chairman of the BMA's medical ethics committee, said:
"...if we genuinely believe that all the efforts of medicine have been exhausted it may well be that in a particular case euthanasia has to be considered. That is a matter for the doctor concerned and I would be the last person to say they had
done the wrong thing."
Nurses would also like to see a change in the law. In 1995, a survey carried out by the Nursing Times found that 68% of nurses believed that if people ask for help to end their life, it should be given in some circumstances. 69% of nurses had personal experience of a patient asking for voluntary euthanasia.
In 1935 The Voluntary Euthanasia Society was set up, containing doctors, lawyers and churchmen. Their aim was to make voluntary euthanasia, for a competent adult, who is suffering from an incurable illness, to receive medical help to die at their own considered and persisted request.
The society believes that everybody has a right to choose how they want to live and die. They believe that each person has value and is worthy of respect, has basic rights and freedom and the power to control their own destiny.
At the moment, doctors can legally practice 'passive' euthanasia- that is, taking away or withholding treatment even if the person will die. But, doctors cannot directly help a person to die. The Voluntary Euthanasia Society believes that in situations where a competent terminally ill patient is asking for help to die, passive euthanasia has the same morality as a doctor giving their patient a lethal injection.
The Voluntary Euthanasia Society argues that doctors should not be practicing euthanasia behind closed doors; doctors should be helping their patients to die legally and with dignity. Assisted dying should be openly discussed to make sure that both patients and doctors are protected. Euthanasia already goes on, even if the law forbids it. In 1994 a survey published in the British Medical Journal showed that some doctors already help patients to die.
Here is a table of results from a questionnaire carried out by the Sunday Times in 1998-
Question
Yes
No
Have you ever been asked by a patient to help them die?
44%
56%
Have you ever assisted a patient's death at their request?
5%
83%
Do you think doctors should have the power to assist death without fear of prosecution:
a) by withholding treatment
68%
31%
b) by withdrawing treatment
67%
32%
c) by administering pain killers in the knowledge that they are likely to shorten life?
60%
37%
d) by prescribing lethal drugs for patients to take themselves?
8%
75%
Do you believe in a patient's right to die?
63%
33%
Do you think it is a good idea for patients to make living wills?
69%
27%
Annie Linsell, a campaigner for legalising assisted dying, said before she died in 1997,
" The hospice movement consistently maintains that in most cases it manages the pain of terminally ill patients. What they cannot control however, is the loss of personal dignity and that is a very individual criterion that no one but the patient can comment on."
From this, The Voluntary Euthanasia Society argues that euthanasia is not about patients giving up on the face of suffering, but indeed having control to decide their destiny. Their motto being; "No euthanasia without palliative care".
Hypocrite's oath has a large influence on many doctors, even in contemporary society. It was established over 2,500 years ago in Greece. Part of this oath states:
"I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect"
A doctor who follows this oath also promises not to give a woman an abortion, however in this day and age abortion is actually legal and many, many doctors perform this operation. I would seem that the oath has been updated to modern day medical practices. The British Medical Association is campaigning to update the oath again for euthanasia.