The subject of euthanasia is a difficult and sensitive area of ethics. Much media attention is given to cases where someone ends the life of a partner who is terminally ill or who is in great pain, and public sympathy is enlisted for those who act out of compassion, rather than from cold, abstract principles. Pressure for the legalisation of at least some forms of euthanasia lays great stress on compassion. How could an act of love be wrong in such an extreme situation?
Christians who oppose euthanasia must do so with wisdom and grace. Often those to whom we speak are not discussing 'cases': they are thinking of particular names and faces, of loved ones who have died or are facing death. The truth of what God requires of us is not to be used merely as a weapon to win arguments, but rather as a means of showing a 'better way' which honours the Creator and respects his image-bearers.
Defining the terms
Clear use of terminology is essential with regard to euthanasia, since careless use of language can blur (sometimes deliberately) important distinctions. We should define terms carefully in order to avoid confusion. Thus we may note the following definitions:
(i) active euthanasia: a deliberate intervention undertaken with the express intention of ending a life, usually in a situation where a disease is incurable or terminal, or where suffering is considered to be intolerable.
(ii) passive euthanasia: similar to (i), but in this case the intention to end life is put into effect by an omission to act, e.g. by not giving medication. This must be carefully distinguished from (iii), although the two are sometimes confused.
(iii) withdrawal of treatment: this takes place in cases where treatment is proving ineffective in bringing about recovery or is causing more distress than it is relieving (it is 'unduly burdensome'). In such cases it is good medical practice either to withdraw treatment or not to start it. There is no intention to end life and this should not be described as euthanasia.
(iv) voluntary euthanasia: where the death of a patient is brought about at his own request. This is usually the focus of campaigns for the legalisation of euthanasia.
(v) non-voluntary euthanasia: where the death is of a person who apparently does not have the capacity to know or express his wishes regarding the continuation of life, e.g. in cases of severe brain damage, senile dementia, persistent vegetative state (as in the 1993 case of Tony Bland).
(vi) involuntary euthanasia: ending the life of a patient capable of giving request or consent, who does not do so. This is the equivalent of murder.
Arguments for euthanasia
(a) Normality. Death is said to be a perfectly normal process and so euthanasia may be regarded as simply bringing forward the date of inevitable death. Why should that be seen as problematic or immoral?
(b) Autonomy. To be fully human, it is said, we must be regarded as autonomous, as having the right to exercise complete self-determination, especially in the realm of life-and-death decisions. A person's individual freedom must be paramount.
(c) Suffering. In arguments for euthanasia much is made of the need for compassion for those who are suffering. The media often carry harrowing reports of the sufferings of some patients, and those who put an end to that suffering are portrayed as compassionate people who could find no other way to help. It has to be recognised that the consequences of chronic or terminal illness may be very distressing, and a patient may suffer a great deal both physically and psychologically. The inadequacies of health care provision may well exacerbate a patient's suffering. Not to provide relief, even at the cost of a life, may seem very hard-hearted, putting an abstract principle before a flesh-and-blood person.
(d) Indignity. Illness or disability may bring considerable loss of dignity and a patient may become almost completely dependent on others for even the most basic functions. Indignity may exacerbate psychological suffering. Is such a life really 'human'?
(e) Burden. Protracted illness can be very costly in terms of Health Service resources, and some treatments may be extremely expensive even in the short term. Chronic and terminal patients consume resources which could be used to care for others who will recover to live productive lives. Such patients may also feel they are a burden to their families and their carers. Would it not be a noble step to lift the burden by ending one's life?
Underlying many arguments for euthanasia is the loss of a biblical view of human beings. If a patient is not perceived as one who bears the image of God, however great his suffering or disability (physical or mental), then his life will be more readily disposable. If human beings are purely material, the produce of blind chance, and of evolutionary forces, what value has a human life above that of animals, especially the higher primates? Some influential ethicists argue that it has none. Peter Singer of Princeton University claims that a healthy gorilla baby has more value than a handicapped human baby. If death is the end, there is nothing to be feared beyond it: Why not choose the time of your departure? If life is pointless, so is suffering, so why not end it by whatever means are available?
Whilst many who are not Christians oppose euthanasia, they struggle to offer credible arguments for the special character of human life. Only an ethic built on biblical, Christian foundations will be adequate to resist the growing volume of support of the legalisation of (voluntary) euthanasia.
Three elements of Christian doctrine are crucial:
1. Revelation. Christians are not relying for ethical guidance on human reason, intuition or 'gut feelings'. In the Bible we have the authoritative Word of God which provides all the necessary principles for decision-making. This does not dispense with the need for hard thinking to understand the meaning and application of Scripture, but the principles to be applied, once discovered, are God-given.
2. God. Fundamental is the truth that he is a sovereign Creator, the giver and taker of life. He has made human beings in his image, with a capacity for a relationship with their Creator, and it is he who confers dignity and value on them, such that the Son of God was willing to go to the cross to redeem a vast multitude of them. Thus God is also a sovereign Redeemer.
3. Man. Human beings, even fallen sinful ones, have dignity because they are created in God's image. Our dignity does not depend on our having certain physical or mental faculties intact, or even functioning adequately. Out of this fact arises the sanctity of human life as a gift of God. Except in biblically-specific cases, it is not in man's hands to take life away.
The standard for human conduct is set out in God's Law, summarized in the Ten Commandments. As Christ showed, the Law embraces two basic commands, love for God and love for neighbour (Matthew 22:39; Leviticus 19:18). That neighbour-love, shaped by the other commandments, must guide end-of-life decisions. As Paul states in Romans 14:7, 'none of us lives to himself alone and none of us dies to himself alone'. We are interdependent; life and death are not placed in our hands.
The Christian case against Euthanasia
(a) Normality. Death is not a normal process. As Genesis 3 indicates, God made man for life. Death is an intruder in God's good creation, albeit under his sovereign control. We must be submissive to his providence, whilst seeking all legitimate means of relieving suffering. Taking death into our own hands is not an option, and the Christian community has the responsibility to model a better way of dealing with dying than the choice to 'end it all' prematurely. The church is to show what is possible by the grace of God.
(b) Autonomy. We believe that a person has a 'right to life', but deny that he has a 'right to death'. If such a right to terminal self-destruction is admitted, several dangerous consequences can be envisaged.
First of all, my 'right to die' would entail that someone else (doctor, nurse, pharmacist) has a duty to provide the means of death. A right is meaningless if it cannot be enforced against anyone. What becomes of the right of a person placed under such a duty against his principles? A 'conscience clause' allowing him to 'opt out' is fragile protection.
In the second place, once a door has been opened to a 'right to die', it is all too easy for this to become a 'duty to die' in certain circumstances. Once society allows life to be taken, there may well be situations where a patient feels he ought to take this route. Is he not consuming precious Health Service resources? Is he not wearing out his family and his carers? The granting of a 'right to die' crosses a line, removes a barrier, which dangerously weakens respect for life.
In reality, no-one is autonomous, either in relation to God or in relation to other people. As members of society, our freedoms are curtailed in many ways by the rights of others. A claim to absolute autonomy is an assertion of sinful pride.
(c) Suffering. We must distinguish suffering from pain. The same level of pain causes different amounts of suffering in different patients, and much depends on the patient's attitude and the support of others (or the lack of it). Much can be done to alleviate suffering by giving proper care and support. Here there is great scope for Christian ministry by relieving loneliness, alleviating fear, supporting through depression. Proper provision in these areas would often avoid a request for euthanasia, perhaps bringing about a changed attitude to death. Christians will of course seek to view suffering and death in the light of the sovereign and loving will of their Father.
As far as pain is concerned, many horror stories about the agonies of terminal patients (if accurate) reflect failures on the part of those providing care, perhaps through ignorance of the best means of pain relief or the pressure of busyness. There have been great advances in palliative care in recent years, especially within the hospice movement, and experts in this field assert that most of the pain of most patients can be comprehensively relieved.
(d) Indignity. There is much in death that is undignified. That underlines the fact that death is an intruder in God's good creation. Nevertheless Christians must assert that God has given us a dignity as his image-bearers that cannot be lost. In his mercy he has also provided means of mitigating some of the undignified aspects of disease and death. Moreover, suffering is not the enemy of dignity - a bad response to suffering is. Faced with the right attitude, by God's grace, suffering may in fact bring out great dignity in the sufferer. Christians must be careful to assert the true basis of human dignity and treat others accordingly.
(e) Burden. The attitudes of carers, families, medical authorities and others may (deliberately or otherwise) convey to a patient that he is a burden, emotionally, economically or in other ways. It is also difficult for most people to come to terms with dependence on others. 'I don't want to be a burden to anyone' is a common statement.
In an increasingly individualistic society Christians must assert the value of every person and the need for special care for the weak and vulnerable. A seriously or terminally ill person should not be regarded as a burden but as someone who needs special care. Such cases provide opportunities for showing Christian love and compassion. We will each have different opportunities and responsibilities for such a ministry, and it is a vital ministry. Loud protests against euthanasia count for little if there is no willingness to do the things that will reduce demands for euthanasia. In some situations Christians may have to provide specifically Christian care where other options are inadequate or non-existent. We must carry the burdens of those in need with a positive approach, so that they do not feel burdensome. The Lord himself will commend such ministry in these terms: 'Whatever you did for one of the least of these brothers of mine, you did it for me' (Matthew 25:40).