[6]        Death: Euthanasia & Suicide

STORY: Take this case about euthanasia. A young wife collapsed for unknown reasons and was totally paralyzed for 13 years and was kept alive by feeding tubes. A doctor decided that she was in a persistent vegetative state (PVS). The husband said he wanted to stop his wife from suffering and he applied to court to stop the water and food that sustained her life. Should this be granted?

Here are the other facts. The husband already has a relationship out of marriage, with a woman and a child. When his wife was injured, he got $1.3 million out of a medical malpractice lawsuit and he promised to use the money to take care of her until she died naturally. Doctors said that she might relearn how to eat without the tubes. Yet, once the award was received, the husband refused all efforts to rehabilitate her, forcing her to simply lie in a bed for 10 years. There are recorded evidence that she vocalized, smiled and appeared to respond to her parents in a home movie. At a court order, the feeding was cut. After 6 days of hunger and thirst, she still did not die. Then the state legislature passed a bill forcing the doctors to continue the supply of water and food. For half a day after this, no doctor dared to come forward to feed the woman because the husband’s lawyer had faxed a letter to virtually every doctor in the region threatening to sue anyone who helped the woman. This is the case of Terri Schiavo, still being litigated in Florida. Now, if you are the judge, what would you do?

Background:

Increasing medical expenditures will lead to more debates on euthanasia (in order to save health cost). The amount spent on health is about 9% of GDP in Canada and about 12% of GDP in the US.

The proportion of elderly people continues to increase rapidly, thus putting more pressure on heath expenditure. The proportion of people aged 65 and over is: 8% in 1970; 12.5% in 2000; 21% in 2025.

In 1993, the Supreme Court of Canada upheld the “sanctity of life” over “the right to die” and prohibited assisted suicide. In 1995, a Senate committee recommended against euthanasia after lengthy public hearings.

Voters in Oregon approved doctor-assisted suicide for the terminally ill in 1994. In 1996, two US circuit courts of appeals (California & New York) struck down laws prohibiting assisted suicide (which exist in 33 states). But they were unanimously (9-0) reversed by the US Supreme Court in 1997.

Euthanasia is practised in the Netherlands presumably under strict guidelines but not really (officially 2-3% of all deaths, actually 19%).

27.  What is euthanasia?

a.   Euthanasia is the act to cause or hasten the death of a human being. “Euthanasia” comes from two Greek words meaning “good death”. However, such connotation of benevolence is quite misleading.

b.   While euthanasia usually means the killing of sick and dying people. It can be extended to include “mercy killing” which is the killing of healthy people to alleviate emotional and financial burden on relatives, such as killing newborns with Down’s Syndrome and killing comatose people.

c.   Types of euthanasia:

(1)  Active (direct) euthanasia: killing a person by committing some action that directly causes death, such as injecting a poison; some describe active euthanasia as “assisted suicide” but active euthanasia can be involuntary

(2)  Passive (indirect) euthanasia: killing a person by withholding some action that indirectly causes death, such as terminating medical treatment such as life support or surgical operation [By definition, it includes the withholding of food and water. However, it can be argued that withholding food and water is similar to suffocating a patient and is more like active euthanasia. Moreover, it is more cruel than suffocation because dying of hunger and thirst is extremely painful and can last a long time, e.g. Terri Schiavo did not die after almost 7 days without food and water.]

(3)  Voluntary euthanasia: killing a person who expresses a desire to die by euthanasia

(4)  Involuntary euthanasia: killing a person who did not express a desire to die by euthanasia, either because the person is incapable of making a decision physically (such as coma) or psychologically (such as mentally retarded), or because the decision is made without the knowledge and/or consent of the person by a close relative or a doctor

28.  Can Christians support euthanasia?

a.   The norms involved are:

(1)  “You shall not murder” (6th Commandment, Ex 20:13).

(2)  One has “the right to die”.

o        Humanists believe that man has sovereignty over his/her life (self-determination) and therefore has the ‘right’ or ‘freedom’ or ‘choice’ to terminate his/her life.

o        The “right to die” is to be exercised when the “quality of life” is too low (such as under extended torture of pain). Therefore it is better to die in dignity.

Right to die

Actually, the “right to die” is not found in the laws. It is extended from the umbrella of “right to privacy” which is used to justify abortion, infanticide, homosexual activities, and euthanasia. It should be noted that the right to privacy is not in the US Constitution.

b.   Arguments against euthanasia:

(1)  For Christians, one does not have the “right to die”:

o        God has sovereignty over our lives. We are only stewards of life (Ro 14:8). Determining the moment of death is God’s prerogative (Job 14:5; Ecc 3:2; Jas 4:14-15). We do not have the “right to die”. The decision to die is a violation of God’s sovereignty (Dt 32:39). Karl Barth: “Life is a loan from God entrusted to man for His service.”

o        The body is the temple of the Holy Spirit (1Co 3:16-17; 6:19-20). A Christian does not have the right to destroy it.

(2)  The “quality of life” argument cannot justify euthanasia:

(a)  The “sanctity of life” is above the “quality of life.”
(b)  The measurement of “quality of life” is always arbitrary and subjective.

Arbitrary: Pro-euthanasia people often use the example of patients under continuous intractable pain from diseases. But poor “quality of life” can be extended to many types of people because there is no fixed standard. It can include comatose people (described as in a “persistent vegetative state” or PVS), mentally retarded people, physically disabled people.

Subjective: Pro-euthanasia people may judge that handicapped people live in a low quality of life but handicapped people are often happy that they are alive.

(3)  Suffering is not equivalent to loss of dignity.

o        Pro-euthanasia people perceive a loss of physical or mental dignity when a person suffers intractable pain, becomes incoherent and confused, or feels that he has lost control of his destiny.

However, when a person can overcome his fear of both death and pain, and accept and transcend them with a deep peace at the end of his life, that is true dignity. Dignity is lost if a person lives in self-pity and fear.

With the advance in the science of pain management, modern pain killers can suppress practically all physical suffering. Therefore, it is unnecessary to be fearful of torture by pain.

(4)  Slippery slope (or wedge in the door) argument:

o        This argument is used in many ethical issues. The argument is that once you step onto a slippery slope, you cannot stop the downward sliding. Another analogy is that once the door is opened with a wedge, it can no longer be shut. In other words, once a moral justification for an immoral action is accepted, further immoral actions in a wider scale can and will be justified in the same way.

o        On the issue of euthanasia, once euthanasia is legalized for certain conditions, a widening the scope of killing will be inevitable.

When people become more comfortable with euthanasia, the justification for killing more categories of people will be accepted.

Once terminal patients in pain are allowed to die, then does it not become harder to deny the same right to someone who terminal patients not in pain, or someone who had an incurable but not terminal disease?

If competent individuals are allowed to seek death, then does it not become harder to deny terminating the lives of sick infants, mentally retarded infants, or adults in comas?

Once it is decided that those people are to die, it is hard to find any logical grounds for keeping similar people alive. For example, if the category includes those lacking the dignity of human beings, this can include many not terminally ill, nor in pain, nor desirous of death. They may simply fail to meet some ambiguous standard of what it means to be human.

In other words, “there is no logical or easily agreed upon reason why the range of cases should be restricted.” This is exactly what the US 2nd circuit court (New York) said when they justified euthanasia in 1996.

o        The legalization of euthanasia will likely lead to abuse in two directions:

Acceptance or legalization of more kinds of euthanasia in 5 steps: (a) voluntary passive euthanasia, (b) voluntary active euthanasia, (c) involuntary passive euthanasia, (d) involuntary active euthanasia of those who are unable to decide, (e) coerced or forced involuntary active euthanasia of those who could decide and are not willing to die. [Involuntary euthanasia could be imposed by relatives who want to get their inheritance, or doctors who want to save money.]

Increase in the scope of people designated for euthanasia: (a) initially only for terminal patients with continuous and intractable pain, (b) then for those who are not terminal but have continuous and intractable pain, (c) then extending to include those judged to be living with a low quality of life or lacking dignity: infants with birth defects like Down’s Syndrome, mentally retarded but otherwise healthy people, physically handicapped but otherwise healthy people (including the crippled, the blind, the dumb or other handicaps).

(5)  Other considerations:

(a)  Euthanasia is irreversible. If a mistake is made, there is no remedy.
(b)  Errors are possible because doctors may make errors in diagnosis and patients generally are unable to judge the seriousness of the case.
(c)  A terminal patient may not be actually terminal. A cure for the terminal disease may be found in time or God may heal with a miracle.
(d)  According to 3 separate studies, more than half of all patients judged to be in “persistent vegetative state” (PVS) eventually regain consciousness.

Miraculous recovery from coma

Mack, a policeman in the US, was shot 3 times in December 1979. He had cardiac arrest and severe brain damage. He did not respond to stimuli and was on life support for 7 months. Eventually, his family decided to let him die. His respirator was turned off and medications stopped. Surprisingly, he continued to breath on his own. In October 1981, he regained consciousness. He recovered back to 95% of preinjury intellectual ability although unable to use arms and legs. Question: What about unconscious patient like Mack, but live on for an extended period of time?

(e)  Once doctors are allowed to commit euthanasia, the trust and respect relationship between doctors and patients will be seriously compromised as a result of their violation of the Hippocratic Oath (sworn by all medical doctors).

Hippocratic Oath (sworn by all medical doctors)

Ancient: “I will adhere to that method of treatment which, to the best of my ability and judgment, I consider beneficial for my patients and I will disavow whatever is harmful and illegal; I will administer no fatal medicine to anyone even if solicited, nor will I offer such advice; in addition, I will not provide a woman with an implement useful for abortion.”

Modern: “That I will exercise my Art, solely for the cure of my patients and the prevention of disease and will give no drugs and perform no operation for a criminal purpose and far less suggest such thing.”

(f)  Euthanasia promotes suicide.
(g)  Involuntary euthanasia represents the weak and the powerless subject forcibly to the arbitrary will of the strong and the powerful. This is why most old people and handicapped people are against legalized euthanasia.

c.   Based on the many reasons above, Christians must not support euthanasia. However, Christians with a terminal and irreversible illness can sometimes justifiably refuse excessive or heroic medical treatment. Such refusal is not euthanasia.

·         The medical treatment is excessive if it would only cause pain and would lengthen the person’s lifespan by a modest or insignificant amount (of up to a few months).

·         The reason for such action is that sustaining life is necessary but prolonging dying is not an obligation.

·         In such cases, only “palliative care” (measures to increase patient’s comfort, pain control, supply of food and water, normal nursing care) should be provided.

d.   The use of pain killers that shorten life is permissible.

·         This is an application of the principle of the “double effect.” The principle states that it is immoral to shorten the life of a person deliberately, but if the primary purpose of a drug is to relieve severe pain, and the shortening of life is merely an anticipated side effect, giving the drug is permissible.

e.   The solution to allow a dignified death is not euthanasia but “hospice”.

·         Professional hospice care can be given either at home or in special facilities for the dying. Its purpose is to ease the psychological pain of loneliness and the physical pain of dying that many people suffer near the end of their lives.

·         Hospice is a facility to provide support and care for persons in the last phases of an incurable disease so that they might die as fully and comfortably as possible. It uses advanced techniques of pain control. There is room for family members to stay so that the feeling of loneliness can be dispelled. Death is neither hastened nor prolonged.

f.    Health cost considerations:

·         With the increase in the proportion of older people, it is likely that some measures such as euthanasia will be introduced as a means to cut health costs. While a declining standard in the health system is almost inevitable (such as limiting costly medical treatments and optional surgeries), to reduce health cost through euthanasia (which are murders) should never be an alternative.

29.  Can what happened on euthanasia demonstrate the slippery slope argument?

·         For those who believe that the slippery slope argument is an impossibility that would never occur in real life, the following real-life example will show how the slippery slope is not at all imaginary.

a.   Nazi Germany

·         The Nazis began with mercy killing in limited cases to relieve suffering.

·         Then they started killing people with physical and mental defects.

·         Finally, they changed to genocide of all Jews.

b.   Dr. Jack Kevorkian of Michigan:

·         Dr. Kevorkian began with assisting terminal patients to commit suicide.

·         Eventually, he claimed to have killed more than 130 people, many of them without terminal diseases.

·         A 2000 study (in The New England Journal of Medicine) reports that based on autopsy of 69 of the patients that Kevorkian killed, 75% were NOT terminally ill and were likely to live more than six months. In 5 of the cases, autopsies could find NO confirmed presence of ANY physical disease.

·         He was finally convicted of assisted suicide after the showing of his killing on TV in 1999 and is now in prison.

c.   Change in public opinion:

·         The increasingly wider acceptance of death can be shown by surveys in 1977 and 1994 which ask about attitudes of Americans on abortion-on-demand, active euthanasia for patients with incurable disease, right to commit suicide for people with incurable disease (note: not terminal disease). Americans agreeing with all three ways of ending life increased from 19% in 1977 to 33% in 1994, while the number disapproving of all three declined from 28% to 22%.

·         In Canada, polls on whether doctor-assisted suicide should be permitted show an increase from 45% in 1968 to 77% in 1989. Since then, the level has fluctuated only slightly. The support of euthanasia is clearly lower for older people (60% for those aged 55 and over).

d.   Holland -- the clearest example:

·         1960s: With the decay of traditional values, euthanasia began as a hidden practice.

·         1973: In a case where a physician killed her sick mother, she argued that euthanasia was already commonly practised among physicians. The physician got only a probation sentence and the court illegally ordered a law be written on euthanasia according to medical consensus. The court included certain conditions for acceptable euthanasia: for incurable patients, with unbearable suffering from a physical illness, with a written request for termination of life, requiring consultation with other physicians.

·         After that case, the courts imposed no more punishment for euthanasia, even if the explicit conditions were violated.

·         1987: A doctor asserted that, since 1980, he had given poison pills to many teenagers who have suffered from cancer, even when the disease was non-terminal.

·         1989: 77% of Dutch supported involuntary active euthanasia.

·         1990: Pro-euthanasia people always presented euthanasia as a rare and limited occurrence. But a government report found 9% of all deaths (a total of 11,440) by euthanasia: 2% were voluntary doctor-assisted suicide, 2% died from intentional overdose of medication with consent, 4% died from intentional overdose of medication without request or consent, 1% from involuntary euthanasia of lethal injection without request or consent. In other words, the rate of involuntary deaths was more than 8 times the homicide rate (10 per 100,000 vs. 1.2 per 100,000).

·         1993: The Dutch Parliament passed laws allowing euthanasia, though only supposedly under extreme circumstances: patient’s own free will, with a lasting longing for death (with repeated request), with unbearable suffering, no reasonable alternatives to relieve suffering, consented by at least 2 physicians.

·         1994: The Dutch Supreme Court ruled that physician-assisted suicide might be justifiable for patients with an unbearable mental illness even if they had no physical illness.

·         1997: Two-thirds of psychiatrists surveyed in the Netherlands believe physician-assisted suicide is an acceptable outcome for some who suffer a mental illness.

·         1999: Guidelines for euthanasia were obviously well-intentioned, but they were not fully enforced. A study found that, despite “strict guidelines” known to Dutch doctors, almost two-thirds of all cases of voluntary euthanasia and physician-assisted suicide in 1995 went unreported; 20% of active euthanasia took place without the patient’s express request; in 17% of cases, alternative palliative care options existed but not provided; in 56% of cases, the justification for killing was not “unbearable suffering” but “loss of dignity.” These all violated the guidelines.

·         2000: Holland formally legalized euthanasia which can be administered using loose guidelines. The law requires that patients be in a state of “unremitting, unbearable suffering.” However, the law does not require that this suffering be physical. In other words, a depressed person who is physically healthy may be euthanized. Additionally, the law does not require that a person be suffering from a terminal illness in order to request euthanasia.

·         NOW:

o        With no prosecution of physicians who violated the guidelines, death-on-demand and infant euthanasia by lethal injection are now practised.

o        Patients are now pressured to accept euthanasia. If a person 60 years of age or older cannot avoid entering a Dutch hospital, doctors and nurses will repeatedly suggest euthanasia to him, even if he has not asked for it, and even if he is suffering from only a minor illness. A comprehensive 1987 poll showed that 68% of all elderly Dutch citizens feared that they would be killed without their consent or without their knowledge; 90% of them were against euthanasia.

o        The number of nursing homes in the Netherlands has decreased more than 80% in the last 20 years (as many elderlies were killed), and the life expectancy of the few elderly people who remain in such homes is becoming shorter all the time. Most elderly people in Dutch nursing homes will only drink water from faucets and will touch no other liquid because they believe that their orange juice or milk may be spiked with deadly poison.

o        80% of Dutch doctors have admitted killing people deliberately through direct, active (not passive) euthanasia. The doctors lost trust of the patients as they violate the Hippocratic Oath of not harming their patients.

o        Why do the Dutch still support euthanasia if the problem is so serious? Because they, like many in the western culture, have an almost reflexive response to arguments based on “personal autonomy” or choice. They do not take time to understand the question and simply support choice. Pro-euthanasia forces also hide the truth and marginalize anti-euthanasia people as overly religious.

·         2003: The situation is probably changing when the Dutch elected a government of Christian Democrats who opposed euthanasia.

30.  How should Christians view suicide?

a.   The only difference between suicide and euthanasia is the person who commit the killing act, by self (suicide) or by others (euthanasia).

b.   The norms involved in suicide are similar to euthanasia: (1) 6th Commandment: “You shall not murder” (2) One has “the right to die”. In addition, there is a norm that one should love oneself (Mt 22:39; Eph 5:28-29).

c.   The Bible does not make explicit moral evaluation of suicide cases: Abimelech (Jdg 9:50-57), Saul (1Sa 31:1-6), Samson (Jdg 16:23-30), Judas (Mt 27:5). The first two cases are similar to euthanasia. However, note that Saul’s killer was executed (2Sa 1:1-16).

d.   Christian arguments against suicide:

(1)  God has sovereignty over our lives. We do not have the “right to die”.

(2)  The “sanctity of life” is above the “quality of life.”

(3)  Deciding whether life is successful or unsuccessful, tolerable or intolerable, worthwhile or worthless is arbitrary (no absolute standard) and temporal (sufferings may dissipate with time). Killing oneself (an irreversible act) based on an arbitrary and temporal decision is unwise.

(4)  Suicides injure others. The family may blame themselves for the death.

31.  How should Christians react to a different world view in the society (such as the secular belief that man possesses the “right to die”)?

a.   No matter what the society believes, Christians have to uphold and practise God’s principles (Ac 5:29).

b.   Christians have to try to clarify misconceptions in the public forum. For example, there is no unrestricted “right to die” and the government has no responsibility to protect such a fabricated right.

c.   Christians should try to convince others by using arguments based on general accepted principles (e.g. right of life on issues like euthanasia and abortion, and health and longevity on issues like homosexuality and smoking), and by suggesting practical and feasible alternatives.

d.   Christians should resist legislations that conflict with God’s principles through democratic and nonviolent means such as social action.

32.  Can Christians use cremation as a means to bury the dead?

a.   Cremation was frequently practised by ancient Greeks and Romans while Jews avoided cremation. The cremation of Saul and his sons in 1Sa 31:11-13 is the only exception found in the Bible.

b.   Some Christians argue against cremation. This is based on the fact that there will be no physical body (not even the skeleton) for resurrection when Jesus comes again (1Th 4:16).

c.   God has power to create the world out of nothing. Surely, He has the power to provide resurrected bodies for all His children. The Bible says that everyone will be resurrected. It is unlikely that resurrected bodies (including the skeleton) will be composed of destructible materials from our earthly existence.

d.   God promised eternal life for all believers. God’s promise will not fail because of some human action. Some Christian martyrs were burnt. Some Christians died in accidental fires. Does it mean that they will not be resurrected? Of course not.

e.   Conclusion:  The means to bury the dead has no bearing on salvation or eternal life. Cremation is allowable.