Euthanasia and Assisted Suicide
EUTHANASIA AND ASSISTED SUICIDE
The Issue
Euthanasia is regarded as ‘the action of directly causing the quick and painless death of a person or omitting to prevent it when intervention was within the agent’s powers’. 1
Euthanasia is found in three forms:
Voluntary Euthanasia is where a person asks of their own free and competent will for someone to assist them in ending their life;
Non-voluntary Euthanasia is where the person whose life is ended cannot choose between life and death. This may include cases such as newborns who have been born with significant physical and mental abnormalities, or people who have been rendered unable to communicate due to a life-altering illness or accident;
Involuntary Euthanasia is performed on a person who could have, given they had the opportunity, opposed such actions being performed upon themselves. In this instance, consent for euthanasia was not asked for or given and the person has been killed without their consent.
The main reason euthanasia is sought is to end a person’s suffering. Primarily the suffering is a physical symptom of a terminal illness, but sometimes mental or emotional suffering is considered a valid form of suffering for which euthanasia may be sought. The call to be compassionate and end one’s suffering is fundamental in the argument for euthanasia to be legalised. As of 2016, only ten nations (Netherlands, Belgium, Luxemburg, Ireland, Colombia, Germany, Albania, Switzerland, Canada and Japan) and five American States (Oregon, Washington, California, Montana and Vermont) have legalised euthanasia, or assisted suicide as euthanasia is also known. 2 The debate for legalised euthanasia is actively ongoing in many more countries, including Australia.
We live in an era when many people are living longer and surviving illnesses which would have previously proven fatal. For some individuals, however, these extra years lack quality and it is in this context that the question of euthanasia usually arises.
Statement of Position
The Salvation Army accepts the following principles:
- All people deserve to have their suffering minimised in every possible way consistent with respect for the sanctity of life.
- It is not suicide for people to choose to refuse or terminate medical treatment.
- It is not euthanasia for health care professionals to withhold or withdraw medical treatment that only prolongs the dying process.
- To provide supportive care for the alleviation of intolerable pain and suffering (e.g. by way of analgesics) may be appropriate even if the dying process is shortened as a side effect.
Death is a human reality. Even with the most advanced medical science and attentive care giving, cure is not always possible, and pain and suffering cannot always be overcome. We must never use anyone’s suffering as a justification for causing their death, however, or judge a person’s life as not worth living.
Respecting the sanctity of human life means we value all human beings irrespective of age, health status, gender, race, religion, social status or their potential for achievement.
We know that God’s healing power at times intervenes and that dying persons are restored to life. But even so, life in this world is not God’s ultimate destiny for human beings. The Christian faith regards death as the transition from earthly life to life eternal (2 Timothy 4:6-8; 2 Corinthians 4: 16-18), a life that all can enter with hope and confidence through faith in Jesus Christ.
Proponents of euthanasia and assisted suicide emphasise two key arguments: a) individual autonomy (which is interpreted to include a right to be in control of one’s own mortality) and b) a compassionate response to human suffering.
The Salvation Army similarly prizes human autonomy highly, but believes human beings do not have the right to death by their own act or by the commissioning of another person to secure it. The Salvation Army considers each person to be of infinite value, possessing inherent dignity, and that each life is a gift from God to be cherished, nurtured and redeemed. Human life, made in the image of God, is sacred and has an eternal destiny (Genesis 1:27). Human beings were created for relationships and for those relationships to be expressed living in community, including in times of death (1 Corinthians 12: 26; 1 John 3:14).
The priority that governs Christian compassion in the process of dying is to maximise care. We all know the fear of suffering and the frustration of being unable to relieve it fully, however, our continuing focus is not to eliminate suffering people but to find better ways of dealing with their suffering.
From The Salvation Army International Positional Statement on Euthanasia and Assisted Suicide, July 2013
Principles
Euthanasia and the principle of double effect
It is considered that there is a morally relevant difference between the intended outcomes of an action and the outcomes that although foreseen, were not intended. For example, the terminally ill are routinely given high-dose painkillers for the express intention of ensuring they are pain free, even though a double effect will most likely be the depression of their respiratory system and a hastening of their death. Where the sole intention of administering high-dose pain killers is for patient comfort, it is not considered an act of euthanasia even though this action may hasten death.
The impact upon doctor-patient relationship
There is a real danger that as we see an increase in euthanasia being performed, we will see a decrease in not only practical palliative care concerns, such as less hospice beds available, but also in the research required to further enhance our palliative expertise. Another medical concern is that by allowing physicians to legally administer death, there would be an undermining of trust and faith in our medical professionals. A study cited by Dr Peter Browning, Professor of Religion at Drury University, indicates that two-thirds of nursing home residents in Holland are fearful that one day their doctors will kill them, and that “the greatest influence of this policy [euthanasia] on the population of Holland is heightened anxiety.”3 Any policy that undermines trust in the doctor-patient relationship is dangerous and detrimental to society.
The ‘slippery slope’ concern for euthanasia
The concern is “that introduction of one form of euthanasia (regarded as ‘acceptable’ because of the requirement of consent and the specification of detailed safeguards) will invariably lead, in practical terms, to less acceptable forms (e.g. voluntary euthanasia without proper safeguards, or even non-voluntary euthanasia).”4 Proponents of euthanasia claim this transition from ‘safe’ to ‘unsafe’ modes of euthanasia is very unlikely to happen, however cases of non-voluntary and involuntary euthanasia already occur. According to the Netherlands Bureau of Statistics for 2011, 4360 people died under the country’s End of Life provisions (euthanasia and assisted suicide), of which 310 did not give a specific request. It may have been the person’s intention at one point in their life but they were not asked and not given an opportunity to decide for themselves.5 Any step towards unsafe end of life activity is to be opposed.
Biblical and Theological Background
The sanctity of life
The Salvation Army believes in the sanctity of human life. Humankind was created in the image of God.6 All people – without exception – are of value to him, holding a special place in his creation7 , irrespective of age, gender, race, religion, health or social status, or their potential for achievement. The Bible makes it clear that human life is sacred: it is God who gives life8 , and God who decides when it ends9 , and as such any reasons for ending it must be more compelling than human consent or convenience.
Meaning in suffering
Central to the whole euthanasia debate is the concept of “suffering”. Whether one is suffering physically (such as pain from bone cancer) or emotionally (such as the loss of one’s dignity by whatever means), it is one of the key triggers for a person’s desire to enact euthanasia. Secular society often judges suffering as meaningless and as a result attempts to remove it from all aspects of our lives. Yet in a world devoid of any suffering, it is likely that we would lose the capacity to experience compassion. The suffering of others in some mysterious way makes us all more human and able to deal with our own sufferings when they arise. Therefore, meaningful suffering is an experience that transforms, enriches, and extends the sufferer and their community. 10
The Bible reveals the compassion that God has for those suffering from illness – Jesus healed the sick11 and wept with the grieving. 12 The Salvation Army believes we need to display this same concern for the sick and dying. Human life is a sacred gift from God. Dignity is neither conferred nor withheld by human choice; it is inherent in each person. As individuals and communities we are called to respect the sacred value of human life and at all times to show each other care. Love of others The love for others – our neighbours – is a core doctrine of the Church and exemplified to us by Jesus whose death on the cross was done out of love for us.13 So too we must love others to the point where our sufferings are nothing to us in comparison to the love we have toward our neighbour.14 As a Christian community we are called to care for each other and to help bear each other's burdens. We learn something profound when we learn to need others and lean on others for support. Euthanasia removes this opportunity to learn empathy and compassion, and lessens what it is to be human. The knowledge produced by suffering is critical to our progress as a community in which all, even the most vulnerable, are cared for and protected.
Practical Responses
An increased role for the Church
Palliative care specialist Ira Byock states that “of the fundamental needs of people as they die, only the need to control physical symptoms is uniquely medical. They need shelter from the elements, a place to be. They need help with personal hygiene and assistance with elimination. They need nourishment or, as death comes close, sips of fluid to moisten their mouth and throat. They need companionship and they need others to recognize their continued existence.” 15 While some churches can provide palliative medical care, most do not have this facility. However all churches can certainly undertake the other requirements Doctor Byock has highlighted. As social isolation increases within our communities, the Church is mandated to step in and provide the care and support dying people require.
An increased role for palliative care
For those who are dying, we must do all we can to ensure they are as pain-free and as comfortable as possible. In order to do so we need carers and physicians whose lives are dedicated to striving for better models of palliative care and for new and more advanced means for delivering end of life pathways that not only alleviate suffering but ensure a person dies with dignity. Death must be no longer seen as something to cure but rather part of living, and for the dying, the “goal of the church and community should be to help them live well.”16 Only when dying is viewed as part of living do we see positive practices, such as palliative care, emerge and excelled in.
References and Suggestions for further reading:
Browning, Peter D. “Community Care of the Dying: Beyond the Euthanasia Debate.” Encounter 66 (2005): 23-44.
Hauerwas, Stanley. God, Medicine, and Suffering. Grand Rapids: Eerdmans, 1990.
Louw, Daniel J. Meaning in Suffering: a theological reflection on the cross and the resurrection for pastoral care and counselling. Berlin: Peter Lang, 2000.
McGrath, Alister. A Journey through Suffering. London: Hodder & Stoughton, 1992.
Verhey, Allen. The Christian Art of Dying: Learning from Jesus. Grand Rapids; Eerdmans, 2011.
Zdenkowski, George, and Australia. Human Rights and Equal Opportunity Commission. Human rights and Euthanasia. Sydney: Human Rights and Equal Opportunity Commission, 1996.
The Salvation Army International Positional Statement on Euthanasia and Assisted Suicide, July 2013. http://www.salvationarmy.org/isjc/ipseuthanasia
Footnotes
1 Oxford Dictionary of Philosophy, Revised 2nd ed., s.v. “euthanasia.”
2 ‘Assisted Suicide’ laws act as a form of legalised euthanasia.
3 Peter D.Browning, “Community Care of the Dying: Beyond the Euthanasia Debate.” Encounter, 66 (2005): 23- 44. URL: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=4d025764-f66a-4b8c-8431- f733c86e5b60%40sessionmgr115&vid=1&hid=126 [Accessed: 30.10.12]
4 George Zdenkowski, and Australia. Human Rights and Equal Opportunity Commission. Human rights and euthanasia. (Sydney : Human Rights and Equal Opportunity Commission, 1996), 3.
5 http://statline.cbs.nl/StatWeb/publication/?VW=T&DM=SLen&PA=81655ENG&LA=en [Accessed: 20.5.13]
11 John 4:43-54; Matthew 4:23-25; Matthew 8:14-17; Luke 5:12-16
15 Ira Byock, Dying Well: Peace and Possibilities at the End of Life (New York: Riverhead Books, 1997), 246-247, quoted in Browning, “Community Care of the Dying “, 41.
16 Browning, “Community Care of the Dying “, 23.