“An acceptance of the practice ofvoluntary euthanasia is incompatible with Christian belief in the sanctity of life but not with the attitudes of some ethical philosophers or medical practitioners” Discuss.

“The incarnation of the word of God as man in the person of Jesus reaffirms the sanctity and holiness of human life in its relationship with God” – John 1:14.

The second part of the position is Destiny. If God is the author of life then it follows that He is the one who determines when it should end. Thus in all ordinary circumstances it is not up to the individual whether he or she might add or subtract from his or her life.

“Naked I came from my mother’s womb, and naked I shall return; the Lord gave and the Lord has taken away; blessed be the name of the Lord”- Job 1:21

To choose life is the third part of the position. Running throughout the Bible is the command not to take life. Taking a life is broader than simply killing and the prohibition in the Ten Commandments not to kill is to be seen in the wider setting of respect for parents, for property of others, and relationships with wife, husband and neighbour. The injunction in Deuteronomy 30:19 to ‘choose life’ is the believer’s response to honour God and His creation.

“Thou shall not kill”- Exodus 20:13

The fourth and last part of the position is love. Love requires a Christian to respect and protect all humans regardless of status, gender and age. The Greek term often used by the New Testament is ‘agape’ and in its Christian usage suggests that love is active and requires a person to sacrifice his or her own happiness for others.

“Love bears all things, believes all things, hopes all things, endures all things” - I Corinthians 13:6

        

Peter Vardy (3) in his report ‘Euthanasia’ said that The Bible is sometimes appealed to by those in the Protestant tradition to prohibit Euthanasia. However it is not possible to absolutise the sixth commandment ‘Thou shalt not kill’. This is put forward in Exodus chapter 20:13, but the very next chapter (Ex 21:12-16) gives four reasons for killing a human being; if you strike your parents, if you kidnap someone, if you murder someone or if you curse your parents. The Bible has no universal prohibition against killing; it endorses war and provides for capital punishment. It does not even condemn the four cases that it records of suicide: Saul (1 Sam 31:4), Anthithopel (2 Sam 17:23), Samuel (Judges 16:30) and Judas (Matthew 27:5)

Christians, however, have two other components for the sanctity of life argument. The first is that suffering is part of God’s plan. This argument is put forward in Graham Greene’s Power and the Glory, where an unnamed whiskey priest argues that just as our thirst is part of the joy that we feel when we drink, so the suffering in this life is irrevocably bound to the joys of heaven. The second argument is one that is used by opponents of euthanasia and that is ‘Life is Sacred’. Something is sacred if it is sacrosanct it is holy by a sacred right. Thus if life is sacred, it is not so independently, but is sacred due to its relationship with God. For those people who do not believe in God life cannot be sacred.

Roman Catholics are against voluntary or direct euthanasia at any cost.

The Catholic declaration on Euthanasia (3) has four key parts, the document recognises that most people regard life as ‘something sacred’, the value of human life. Believers also see it as a gift of God’s love. There are three norms. The first is Universal prohibition against attempts on the life of an innocent person. The second is Universal duty to live one’s life in accord with God’s plan that human life be fruitful and find its full perfection in eternal life. The third Prohibits suicide on the grounds that suicide rejects God’s sovereignty and plan, refuses to love self, denies the natural instinct to live and avoids the duties of justice and charity. However, suicide is not to be confused with death, which occurs as an act of self-sacrifice for love of others and the glory of God.

In Peter Vardy’s Euthanasia, he says that the document recognises that the word has different means for different people. It defines euthanasia as “an act or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. It is not permissible for one to do this to another or to ask for it for oneself even when this request comes from the experience of prolonged or barely tolerable pain, suffering. Whilst seeing that some things like prolonged illness and advanced old age can bring about psychological conditions that facilitate the acceptance of death, nevertheless, death is something, which naturally cause people anguish. The document recognises that suffering may exceed its biological and psychological usefulness that it can cause the desire to remove it in any way and at whatever price. It accepts that very few who can limit their dosage of painkillers in order to associate in a conscious way with the suffering of Christ. It recalls Pope Pius XII who was asked if narcotics could be used which will relieve pain but shorten life. He said “ If no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties: Yes”  The fourth part of the declaration says that it is ‘important to protect, at the moment of death, both the dignity of the human person and the Xth concept of life against a technological attitude that threatens to become an abuse’ it interprets the phrase as ‘the right to die’ as “rather the right to die peacefully with human and Xth dignity”

The Church of England (10) believe that because human life is a gift of God to be preserved and nourished, the deliberate taking of human life is prohibited except in self-defence or the legitimate defence of others. Also that the distinction between deliberates killing and the administering of painkilling drugs or withdrawal of treatment is such as to have the effect of shortening life. In addition to the fact that it is now medically possible to keep people alive in circumstances where death might otherwise have brought relief from intolerable suffering, does not place on doctors an overriding obligation to prolong life by all available means. Crucial decisions in such circumstances should be made collaboratively and should involve more than one doctor. Another point is that it is a Christian imperative and a duty of the state to protect the interests of the most vulnerable, particularly those who may feel themselves to be burdensome to others or unwanted, and who thus might be under pressure to seek the hastening of their own deaths. They also say that there are limits to human autonomy, and thus to what human beings may do to themselves or require others to do for them. The last point is that the House urges great caution before any attempt is made to change public policy.

 It continues to commend those whose work in the Hospice movement. Christian Church’s encourage the support of hospices. Hospices are places for terminally ill people to be cared for and allowed to die in comfort and dignity without employing euthanasia. The first hospices were founded by Christians who were at the forefront in looking for compassionate alternatives to euthanasia.

The Methodist Church (10) is strongly against euthanasia but are willing to accept it if it is not legalised, many more people could blame euthanasia for death, and could be misused. Methodists see the problem of the slippery slope argument, they believe that if one person requests it, so may many others and if it is not legalised, doctors will continue to practice it, but the patients may not have legitimate reasons for wanting to die. They say there is difficulty of framing legalisation in such a way as to exclude the misuse in the shape of allowing difficult patients to be done away with, allowing relatives to short circuit the natural life course of a difficult individual. Also, that there is widespread opposition to euthanasia, born of convictions that human life is ‘sacred’, and that it is not right for us to play God with other people’s lives. Lastly, the Christian conviction is that ‘the life of men and women bears the stamp of God who “made man in his own image”- Genesis 1:27. This is the source of our basic dignity, and it is the Biblical basis for the sanctity of human life.’ What God has given, we should not take away.

So we can see that although there are many arguments forwarded by members of the church, there are also people who would consider allowing euthanasia if the circumstances were right and that they believed the person would be doing so for the right reasons (11).

In caring for patients, physicians, as individuals and as representatives of their profession, should act with integrity in providing medical treatment within certain norms of care and concern. Despite widely diverse national, cultural, religious, and political traditions, four prima facie moral values or principles summarize these norms:
          1 . Autonomy. All persons have a prima facie moral obligation to respect each other's autonomy insofar as such respect is compatible with the respect for the autonomy of all affected. This principle requires respect for patients' deliberated choices made in accordance with their own values, consciences, and religious convictions. Respect for patients' dignity and integrity, for honesty, and for promise-keeping are aspects of respect for autonomy. Respect for the autonomy of health care professionals is no less important and no more important than the respect for the autonomy of their patients.
          2. Non-Maleficence. All persons have a prima facie moral obligation not to harm each other. The infliction or risking of harm to others, including the risks of medical practice, can only be justified by the pursuit of other moral values—principally, in the case of medical practice, benefits to patients sufficient to outweigh the harm.
          3. Beneficence. All persons have some prima facie moral obligation to benefit others, to some degree, including, perhaps even especially, those in need. The extent and scope of this obligation are, however, highly influenced by both cultural and individual interpretation. In any case, health care providers acknowledge themselves to have a particular obligation to benefit their patients and to do so with minimal harm.
          4. Justice. All persons have a prima facie moral obligation to act justly or fairly to others in the context of respecting each other's rights, in the context of obeying morally acceptable laws, and in the context of the distribution of scarce resources. Interpretation of the precise nature and extent of these obligations is highly dependent on. both cultural and individual perspectives. (14)
 

These four principles or values do not comprise a single ethical theory. Indeed, they often conflict and require interpretation and balancing. The four principles are given different weight in different cultures, and some cultures would wish to add additional principles or values. Moreover, substantive disagreements exist within cultures about both their scope and relative weights. Nonetheless, their acknowledgment provides a valuable cross-cultural basis for medico-moral analysis, discussion, and decision making. It accepts that patients may refuse treatment that will eventually end their life, but it is opposed to lethal injections being the sole purpose to end life. But with the BMA, there are views on euthanasia from other countries. In Oregon doctors are allowed to provide the means for ending life, but the patient itself has to administer it. In Australia, however, more extensive participation from the doctor is allowed. And in Holland where euthanasia is legal, they will only allow euthanasia where there are explicit requests for it, and they will consider each situation carefully. With PAS however, the doctor will simply try to help the patient with his or her course of action, where with euthanasia, the doctor will be in control of the situation.

Many ethicists (3) also agree will some members of the medical profession. Grisez and Boyle believe that there are two basic assumptions used when defending euthanasia. The assumption that there is a difference between bodily life and personal life. They reject the view that if you are not bodily alive, that you are still a person. They say that the absence of a personal component, which is in the presence of a newborn child, yet not in the comatose, is what makes someone a candidate for euthanasia. “The human being is one and bodily life is good in itself”. Grisez and Boyle also reject the idea of the consequential theory, and in the rightness or wrongness of any human action. They say that euthanasia wrongly assumes that the choice for death over life can be morally right because it serves the higher goods of freedom, integrity or dignity. But according to their thought pattern, the basic goods cannot be compared and balanced off each other. They say that the key issue is whether an action is directly against a basic good.

        Alastair Campbell (12) writes of a woman named Anna. Anna was tetraplegic as a result of a road accident. She also suffered diffuse phantom pain, which had to be made bearable by high doses of analgesic. Anna decided she wanted to die and made it clear that she didn’t want to be resuscitated if she had an arrest. She was resuscitated but there were long debates over the allowance of her machine to be turned off. She flipped the switch but did not die immediately; she was then given more drugs to help her die. It was some hours later before her breathing ceased and she actually died. He says it is situations like Anna’s that lead to calls for a change in the law to legalise euthanasia. She wanted to die, so why could she not have been killed more quickly and effectively by lethal injection, and without the long delay over the debate to turn off the machine? Moreover, since she did not die as a result of the treatment discontinuation, but only after more administration of drugs, was there not a dishonesty in claiming that this all fell within the range of legally permissible treatment? Campbell then goes on to write of a premature baby named Zoe who had a serious disorder of the skin; the skin would break down both externally and internally and if touched would cause lesions on the skin and be extremely painful. Her condition cannot be cured but doctors decided to remove any form of life support but carry bottle-feeding her and to only provide medication for pain relief. Zoe could breathe without the help but died six days later of a probable infection started after intubation at birth. Campbell says that the same logic can surely be applied to Zoe as it was to Anna, why the prolongation of six days, when a lethal dose could have ended life in a matter of seconds? The only differences between the two were that Zoe’s wishes could not have been known, and that the pain was much greater in the case of Zoe.

        In Ethical Studies Bowie argues, “Kant believed that there is an objective moral law that we know through reason. Moral rules exist and that they are binding” according to Kant (15) we are rational beings who base their moral laws on one fundamental principle, ‘The Categorical Imperative’. This means that moral statements are categorical in that they prescribe an action irrespective of the result this is a deontological position. In his writing, Kant identified three principles in the Categorical Imperative. Two of these are of relevance to the euthanasia debate. The first is the notion of universal law, in other words moral laws must be applied to all situations, what is right for one person must be right for everyone. In terms of euthanasia, Kant would argue that if we were obliged to alleviate suffering by destroying the sufferer, it would be hard to imagine how human life would exist for long. Euthanasia is not an option because you cannot universalise the action of active euthanasia. The second principle of the Categorical Imperative is that we should treat humans as ends in themselves not as means to achieve some further end. He believed humans were the highest point of creation and as such required moral protection and that there could be no use of the individual for the sake of the many. We also have a duty to seek happiness of others as long as the actions are legal and that they do not infringe the freedom of others. So again in terms of euthanasia, we would use the terminally ill patient as an end. The death becomes the means to terminate the pain and relieve the emotional and physical burden of suffering from the family. Kant fundamentally believed “man cannot have power to dispose of his life” however, he also believed in human autonomy and that people were free to make rational choices, but how does that reflect on an absolutist deontological view? What about the universalisation rule? If we legalise euthanasia, the Kant argued that it would be the end of human life. Would it not be possible for someone to want euthanasia if they were terminally ill and in great suffering and hold the view that ending the life of someone who is not terminally ill and in the process of dying wrong. And are we really using people as means to an end if we allow them to practice euthanasia?

However the position of the Churches, the BMA and some ethicists like Grisez and Boyle have been challenged by supporters of the Pro Euthanasia movement, Peter Singer writes about the dilemma of life and death. He writes that the collapse of the traditional ethic is about to happen in many countries across the world (8).

        In April 1989, Anthony Bland was crushed at the Hillsborough disaster; he was in a Persistent Vegetative State (PVS) for four years. And although he was not ‘dead’ his lungs had been crushed and had deprived his brain of oxygen. In 1993, the decision to withdraw the feeding tubes from Anthony was passed at the high court. Although Bland had never expressed any wishes for this to happen if he was ever in this state, his family agreed it was for the best. The court threw out years of the traditional laws to consider the quality of the patient’s life when making the final decision.

        Marion Ploch was a German dental nurse who was in a car crash in 1992; as a result of this she was diagnosed brain dead. At the time Marion was pregnant, and with her parents’ consent, doctors kept Marion’s bodily functions maintained so that her baby could be born.

        In Oregon in 1994, people voted in favour of PAS with terminally ill people, and in 1995 in Australia, the Northern Territory became the first parliament in the world to legalise voluntary euthanasia.

        In the final chapter of his book ‘Rethinking Life and Death’ Singer identifies five ‘old’ commandments which he believes characterise the traditional ethic and proposes that we replace them with new ones. (8)

Daniel Maguire (3) is introduced in Peter Vardy’s ‘Euthanasia’ article; he argues that issues such as euthanasia can only be handled adequately within the broad context of a complete ethical theory. The special tasks of ethics is to bring sensitivity, reflection and method to the way people decide the sort of persons they ought to be and the sort of actions they ought to perform. Maguire rejects the idea of fatalistic theism, which forbids expanding the human dominion over dying because the time of death is organised by God alone. Maguire maintains that we have underestimated our dominion over life and death; we have been given the responsibility to discover the good and choose it, even when the good in question is death.

        Charles Curran (3) accepts life as a primordial value: he accepts the sanctity of life as a basic principle and respect for life as a moral imperative but since the dying process indicates that life has reached it’s limit, he does not see euthanasia as taking full control because the dying process has begun. He said, “I agree with the traditional argument against euthanasia, that man does not have full dominion over his life and, therefore, cannot positively interfere with his life… Man does have some dominion over the dying process because he can as a matter of fact shorten the time of his dying by not using or discontinuing even readily available means to prolong life”

Joseph Fletcher (3), however, completely opposes Grisez and Boyle’s position. He, as a consequentialist, believes that there are no absolutes and that the situation should be taken into account. He also believes in the Situationist theory of the most love-filled result of any action, and in some cases, sees that euthanasia is the most loving thing to do. He maintains that there is more to being a human than just being alive and that a key feature of humanity is rationality. This rationality, he says, can be used to make free choices, which in the case of euthanasia, is to die.  

Peter Vardy (3) writes in his article euthanasia, an assessment of the strengths and weaknesses to the arguments. He says that, these positions take seriously the values that come into conflict in situations where people are dying. It tries to determine the morality of an action on the basis of the total meaning of the action, not just the consequences. It regards the principle-prohibiting killing to be a valid principle for protecting life. While the position does not include consequences, it also includes much more when it considers the action as a whole. These positions recognise the complexities of individual situations whilst retaining a general rule against the taking of life unless the circumstances are exceptional. And that the human response to great pain and agony on the part of someone who is dying is recognised and the instinctive feeling that ‘to put someone out of their misery’ if this is what they sincerely wish. As weaknesses he states that Maguire draws the circumstances and consequences justifying euthanasia quite narrowly therefore his position is subject to the same sorts of criticisms as those levelled against the strict consequentialist position. Both Maguire and Curran appeal to the notion of human dominion as a theological ground for approaching euthanasia. But it can be argued that dominion merely states what needs to be proved in the euthanasia discussion. And that active intervention in another’s death may erode the character of the caring community. Even though Curran’s notion of the dying process results in a more restrictive position than Maguire’s, his position is still susceptible to this criticism since determining when the dying process begins is difficult now that we can put off some of dying by means of artificial life supports.

The situation of doctors (6) in the debate of euthanasia is always varied, some don’t want the responsibility of euthanasia, others believe it is wrong, but there are some doctors that do agree with euthanasia, or some forma of it at least.

        Doctors (5) believe that there is a huge difference between active and passive euthanasia. The ruling of the BMA emphasises that is the duty of the doctor to ensure that the patient dies with the most dignity and the least amount of pain possible. Moral principles come into play when a doctor is thinking of helping someone die. They can be the actor and help the person or they can be the ommisioner and choose not to ‘see’ euthanasia for what it is. Morally, a doctor can withhold treatment so as not to use extraordinary means to keep the person alive, but if they give the treatment, then decide to withdraw it, this would be active euthanasia, and many believe that this is wrong. In the case of doctors however, this may be the only way that they can help people who request euthanasia, as many are afraid of being stripped of their licence. The 1961 Suicide Act permits personal autonomy to choose without recrimination, but forbids third party involvement.

        The Netherlands, however, allows medics to carryout euthanasia (PAS), but the patient must express their wishes and if their condition is only likely to worsen, or there is unbearable pain, then PAS is allowed.

        American’s are campaigning for the legal use of living wills and in Australia, there are no uniform laws for or against it and a doctor may discontinue the use of a life support machine at the request of the patient.

There is increasing medical interest and support in the United Kingdom for legalising voluntary euthanasia. In 1990, a working party from the Institute of Medical Ethics said:

"A doctor, acting in good conscience, is ethically justified in assisting death if the need to relieve intense and unceasing pain or distress caused by incurable illness greatly outweighs the benefit to the patient of further prolonging 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 1994, a report published in the British Medical Journal showed that British doctors do practice voluntary euthanasia, despite the law. The study by Ward and Tate, from Cambridge University, found that 32% of doctors surveyed had agreed to a patient's request to be given treatment to help them die more quickly. A larger proportion – 46% – said they would consider giving treatment to help someone die if it were legal to do so. In November 1997, 200 GPs responded to a survey carried out by Pulse magazine. The survey revealed that 93 GPs (47%) had given treatment to ease a patient's death. 49% said that they had been in a position where they felt that easing a patient's death, other than with the intention of relieving symptoms only, was the right thing to do.

The most recent investigation was carried out by The Sunday Times, in November 1998. A confidential questionnaire, answered by 300 doctors, revealed that one in seven had broken the law and helped a patient to die at their request. The full results were:

Question Yes No

Have you ever been asked by a patient to help them die?

Yes 44% No 56%

Have you ever assisted a patient's death at their request?

Yes 15% No 83%

Do you think doctors should have the power to assist death without fear of prosecution:    

1. by withholding treatment

Yes 68% No 31%

2. by withdrawing treatment

Yes 67% No `32%

c) by administering pain killers in the knowledge that they are likely to shorten life?

Yes 60% No 37%

d) by prescribing lethal drugs for patients to take themselves?

Yes 18% No 75%

Do you believe in a patient's right to die?

Yes 63% No 33%

Do you think it is a good idea for patients to make living wills?

Yes 69% No 27%

Whilst most of the doctors who admit to having helped a patient to die seem to escape prosecution, some of them do, however, fall foul of the law. (13)

 

So is an acceptance of the practice of voluntary euthanasia incompatible with the Christian belief in the sanctity of life but not with the attitudes of some ethical philosophers and medical practitioners?

        The acceptance of Voluntary euthanasia has very mixed views from both Ethicists and Doctors. Many Doctors would not practice euthanasia, either because they would be afraid of going to prison if they did, or because they don’t feel that it is the right thing to do. Some doctors however, will allow PAS, this is because it brings their involvement with the death to an absolute minimum, and they cannot be blamed for the death.

        Voluntary euthanasia also has many mixed opinions from ethicists. Some ethicists like Fletcher and Maguire believe that if the person wishes euthanasia, and that it is the best option for them, then it should be allowed. They believe that we have the responsibility to choose life and death, even if death is the right option. However, some ethicists like Grisez and Boyle believe that there are certain basic human goods constitutive of human well being and the key issue when discussing euthanasia is whether an action is directly against a basic good.

As a first glance, you would say that the practice of euthanasia is incompatible with the Christian belief in the Sanctity of Life, with the Roman Catholic beliefs that any type of euthanasia is wrong, but even with them allowing the idea of double effect, this statement is disproved. Both the Methodist Church and the Church of England will allow euthanasia in certain situations. Members of the Methodist Church are now campaigning to make euthanasia legal as they believe if it isn’t made legal, people will continue to practice it, but without the legitimate means, and other lives will be at risk. The Church of England are against euthanasia, but see the fact that human life can go beyond the means of suffering, and will allow euthanasia if there is consent from more than one doctor and in only certain circumstances. The practice of euthanasia is incompatible with the Roman Catholic belief as they believe that life is a gift of God, and should only be given and taken away by him. Their belief in the Sanctity of Life is too great, and they will not allow euthanasia, but see self-sacrifice, not as suicide, but as a gift to God.

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