EUTHANASIA

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In 1995, the Northern Territory of Australia legalised voluntary Euthanasia and the first patient to die under this legislation did so in 1996, The legislation was overturned by the federal governmentand a debate is now underway in Australia and elsewhere round the world.

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 Ch. 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 which it records of suicide: Saul (1 Sam. 31:4); Anthithopel (2 Sam. 17: 23); Samuel (Judges 16:30); Judas (Matt. 27:5)

Central to the debate about euthanasia are the following issues:

  1. Does God exist and do human beings have a duty to God in considering how to behave? If they do, then it may be held that it is not permissible to take life as this is God’s prerogative. If there is no God, then perhaps the individual should be able to make the final decision whether to live or die, for instance by the use of ‘living wills’ combined with medical and legal safeguards. However even in this latter case the impact on wider society may need to be considered and the basis for any ethical judgement evaluated.
  1. Is the maintenance of life an absolute value which no other ‘good’ can outweigh?
  1. Does one hold that an act is morally right or wrong because of the very nature of the act or, by contrast, does one hold that it is the consequences of the act which make it right or wrong?
  1. Is euthanasia the start of a ‘slippery slope’ that may justify the killing of handicapped people and others?
  1. Does one adopt a Natural Law approach, a Situation Ethics approach or does one favour Proportionalism? Each of these positions is likely to result in different approaches to the problem

The notes below set out the Catholic position on Euthanasia and then various alternatives starting with Grisez who is a Catholic theologian supporting the Church’s official view and then the views of those who disagree. The reason the Catholic position is discussed in some detail is that it is clearly formulated and the differences between scholars in this tradition can helpfully illuminate the issues. At the beginning, however, it is important to distinguish between:

  1. Acts whose direct aim and intention is the bringing about of death (euthanasia falls under this heading) and acts such as providing pain relief whose main purpose is not to bring death but may cause death as a side-effect. There is generally considered to be no moral problem with the second of these positions.
  2. Acts of omission and acts of commission. The former involve not doing something (for instance not giving a blood transfusion) whilst the latter involve a positive action (administering an injection or giving tablets). Leaving someone to die would fall under the first heading and would not be classified as euthanasia. The British Medical Association recognises a distinction between withholding treatment that may be burdensome and deliberately bringing a person’s life to an end. Its 1988 statement on Euthanasia maintained that the deliberate bringing to an end of life should remain a crime.

  1. A distinction needs to be drawn between ‘ordinary’ and ‘extraordinary’ means - this was particularly important in the days of warfare before anaesthetics when a decision could be made to forego amputation even if this meant the death of the individual. ‘Extraordinary’ means effectively means ‘disproportionate’ means - in other words means of attempting to save life which are out of proportion, in terms of the pain suffered, to the possibility of saving life. A major problem is what is decided to be ‘extraordinary’ means and in relation to what is this to be measured (e.g. length of subsequent life; quality of life; pain during the procedure, etc.)

Advances in medical technology mean that the issues are now much more complicated than in the past and, under (a) above, the difference between the two positions may have to do with the motive and intention of the person administering treatment and this is not easy to determine.

CATHOLIC DECLARATION ON EUTHANASIA 1980

In developing its position the document considers ethically relevant both Christian religious convictions as well as the accumulated wisdom of the human experience of suffering, sickness, dying and death. It represents the official moral position on euthanasia of the RC magisterium. Even though this is not an 'infallible' teaching, it is still normative for the Catholic community. As 'normative' this moral position calls for the presumption of truth on the part of the faithful who ought to attend carefully to this teaching.

This is not to say, however, that this teaching is the exclusive basis of one's conscientious judgement. Nor does it say that no one may ever disagree with certain aspects of this teaching. For this teaching to be 'normative' and for the faithful to 'attend' to it means that this teaching deserves the respect, not of unquestioning or uncritical obedience, but of an attitude which takes a critically alert, thoughtful and respectful approach to its interpretation and use.

I. The Value of Human Life

This recognises that most people regard life 'as something sacred'. Believers also see life as a gift of God's love. There are 3 norms (a) Universal prohibition against attempts on the life of an innocent person. (b) 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. (c) 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.

II. Euthanasia

The document recognises that the word has different means for different people. 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 and barely tolerable pain.The document holds that the pleas of gravely ill people who ask for death should be seen as an anguished plea for help and love, not only in terms of medical care, but also for human and supernatural support and comfort.

III. The Meaning of Suffering for Christians and the Use of Painkillers

Whilst seeing that some things e.g. prolonged illness, advanced old age, can bring about psychological conditions that facilitate the acceptance of death, nevertheless, death is something which naturally causes people anguish. The document recognises that suffering may so 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 it is only a very few who can limit their dosage of pain killers in order to associate in a conscious way with the sufferings of Christ - it does however affirm that ‘suffering has a special place in God’s plan of salvation’.. Most people will want to use analgesics and may do so even though this drugs will reduce consciousness and shorten life. It recalls Pius XII who was asked if narcotics can 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 declaration goes on to explain that in such a case, pain relief and not death is the of intention. Death is a by-product to pain relief.

IV. Due proportion in the use of remedies

The document says that it is "Important to protect, at the moment of death, both the dignity of the human person and the Xtn concept of life against a technological attitude that threatens to become an abuse." Interprets the phrase 'the right to die' as "rather the right to die peacefully with human and Xtn dignity."

Decisions about how the ill will live whilst dying should be taken by the sick person. Given the complexities of real life the document says "In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person's name, or of the doctors to decide in the light of moral obligations of the various aspects of the case." "However, is it necessary in all circumstances to have recourse to all possible remedies?" The documents refers to the standard terminology of 'ordinary' and 'extraordinary' means (see previous notes), but recognises that these terms lack clarity. Cites with approval an alternative distinction between 'proportionate' and ‘disproportionate' means. Disproportionate means to preserve life occur when the gains of continuing life outweigh the costs to the patient.

[It is significant that Proportionalism is the Declaration's basic approach to applying the traditional principle of ordinary/extraordinary means when solving dilemmas affecting the duration of life.] It advocates weighing of relative values (such as risk, cost, burden to patient and benefit) and recognises that some means are disproportionate to the result sought. In addition to these general principles, the document adds some clarifications [these serve to clarify its proportionalism]. [a] With the patient's consent, it is ethical to use risky and experimental techniques when alternative remedies are not available. [b] Such techniques can be abandoned when the results fall short of expectations, but the patient's consent and consideration of the reasonable wishes of the patient's family and the advice of the doctors is vital, [c] Also "it is permissible to make do with the normal means that medicine can offer." No one is obliged to use a technique which is risky or burdensome. Such refusal is not suicide as long as the refusal of treatment is "considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community." [d] When death is imminent, an individual may in good conscience "refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due the sick person in similar cases is not interrupted."

Conclusion

Death is unavoidable and we should be ready to accept it with full responsibility as the end of our earthly existence and as the opening to immortal life. While technical skills are certainly needed in caring for the sick and dying, "kindness and heartfelt charity" are even more so.

The Declaration recognises the complexity of issues surrounding the ending of life as well as the uniqueness of individual circumstances. It appreciates traditional wisdom in the Catholic tradition of medical ethics while at the same time recognising the many obstacles to applying this wisdom in contemporary situations of health care. It is flexible in the way is states some principles and its introduction of proportionalism is significant whilst the firm prohibition on death as the main intention behind any procedure is retained. There remains emphasis on the value of suffering (which, of course, not all accept).

GERMAIN GRISEZ & JOSEPH M BOYLE jr. Life and Death with Liberty and Justice Notre Dame Press (1979) p336-439

These authors challenge what they see as two basic assumptions of a pro-euthanasia position.

  1. The assumption that there is a distinction between bodily life and personal life. In other words they reject the view that one can cease to be a person and yet still be bodily alive. They reject the view that it is the distinctively human component which is not yet present in the unborn or newly born and which is lost in the irreversibly comatose. The absence of this personal component is what makes one a candidate for euthanasia. The human being is one and bodily life is a good in itself,
  1. They also reject the consequentialist position that consequences determine the rightness or wrongness of human actions.

Their basic premise is that there are certain basic human goods constitutive of human well-being. The fundamental human goods which are inherently worthwhile and give meaning to one's life and serve as motives for human action include : play and recreation; knowledge of truth and appreciation of beauty, life and health, friendship and self-integration (NOTE the inclusion of ‘life’ in this list)..These goods cannot be measured against one another in order to establish any form of hierarchy. These basic human goods provide motives for moral action and are the source of the moral obligation to promote human well-being. Once this is accepted, then it can never be right to act against one of these basic goods. If this is accepted, then euthanasia would be absolutely prohibited because it intends to realise some good (such as freedom from pain or dignity) by directly turning against one or more basic goods (life or health).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 (particularly the right to life) cannot be compared and balanced off each other.

Killing (e.g. voluntary and non-voluntary euthanasia) is an action directly against the basic good of life -not every death-dealing deed (e.g. refusing, withdrawing or withholding life-prolonging treatment) is an act of killing in the strictly morally strict sense. The key issue is whether an action is directly against a basic good.

JOSEPH FLETCHER

Fletcher is a consequentialist (a position specifically rejected by the Vatican’s ‘Veritatis Splendour’ - in other words Fletcher believes that the rightness or wrongness of actions are to be judged not according to something intrinsic to the action but in terms of the consequences of the action. This is directly opposed, therefore, to the position taken by Grisez and Boyle above. Fletcher rejects any absolutes and believes that the situation has to be taken into account and a decision has to be made as to the most loving thing to do in the circumstances (see notes on the difference between Natural Law and Situation Ethics for details of a situationists viewpoint and for criticisms of it). Fletcher maintains that there is more to being human than just being alive and that the key feature of humanity is rationality - this rationality may, in certain circumstances, be used to make a free choice to die.

DANIEL C MAGUIREDeath by Choice (Image Books)

This can be described as in some ways a proportionists position. It holds that:

life is a basic but not an absolute good

one is bound to respect life, but no one is obliged to prolong it in every circumstance

Maguire argues that issues such as euthanasia can only be handled adequately within the broad context of a complete ethical theory. The special task 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. The first step = discover the moral objective. This is done by asking reality-revealing questions such as what, why, how, who, where, when, what if and what else. Only when this is done can evaluations, using rational analysis, feelings, creative imagination, group experience, the discerning judgement of the moral subject(s) involved, etc. be undertaken.

The Central Questions: (1)‘Can it be moral and should it be legal to take direct action to terminate life in certain circumstances?’. Maguire answers ‘Yes’. (2) ‘Must we in all cases await the good pleasure of biochemical and organic factors and allow these to determine the time and manner of death?‘ Answer ‘No’ (3)‘Can the will of God regarding a person's death be manifested only through the collapse of sick or wounded organs?’ Answer ‘No’ (4) ‘Can the will of God be discovered through human sensitivity and reasoning?’ Answer ‘Yes’. (5) ‘Could there be circumstances when it would be reasonable and therefore moral to terminate life through either positive action or calculated benign neglect?’ Answer ‘Yes’.

Maguire rejects the idea of a kind of fatalistic theism which forbids expanding the human dominion over dying because the time of death is organised by God alone - this implies that human beings are God’s property. If we should not intervene in nature then all medicine would be immoral, there is no essential difference between ending life and preserving life. 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