Euthanasia

And Assisted Suicide

Some prior reading is required for this lesson.  Esther's Guarded Condition originally appeared in the July/August 2007 issue of Touchstone: A Journal of Mere Christianity and is reprinted with permission. www.touchstonemag.com

As the World Sees It

The questions of euthanasia and physician-assisted suicide are still debated by those whose calling is Christian Ethics – but the world by and large has accepted both as being ethical.  We examine the world’s view first.

The nature of man

Much of the debate is rooted in stating the nature of man.  The Christian view is very different from the view of the medical community, as can be seen in the reading.  It is useful to see the world’s view:

• Man is simply the cleverest of the primates.  There is nothing intrinsically different between man and chimpanzee; we’re just higher up on the evolutionary scale.  This might not seem important until you remember that we regularly shoot horses – euthanasia for animals has been accepted for generations.  It is considered a mercy to dumb animals.  So why would we not do so for the cleverest of the apes?
• For those more forward, consider “bio-ethics.”  The premise of same is that anything which gets my genetic material into the gene pool is intrinsically good.  (So, for example, I would help my kid brother because his genetic material is so similar).  This method often has a problem with knowing why something is good or not – but it’s clear that the dying are not going to contribute to the gene pool anymore – so why continue to keep them alive?
• For the medical professional, once it’s determined that someone is terminal, the attitude changes from “save” to “dispose.”  In the coldest of ways, the terminally ill should be in hospice – thus eliminating the perceived problems of hospital space and medical victory.

How are ethics formed?

Some of the decisions outlined in the pre-reading might seem odd at first.  We need to consider how ethical decisions get made in this environment:

• First, there are what we may call “professional ethics” – the written and unwritten codes of conduct which surround the culture we call medicine.  Most doctors don’t make ethical decisions; they repeat them.
• For many, “if it’s legal, it’s moral.”  Ethical decisions boil down to whatever the law will allow.  If my emotions tell me that euthanasia is a good thing, then we need only look to the law to see if it’s OK.  And sometimes, we don’t even do that.  Physician assisted suicide is legal in Oregon; thirty-eight other states prohibit it. 
• On some matters, the medical profession is influenced by public opinion.  This has been a powerful factor in making abortion acceptable.  I can recall being told of a doctor who was denied membership in the local AMA chapter because everyone knew he did abortions.  (This was before Roe v. Wade).  Today, such a doctor is perfectly acceptable – even lauded for his “courage.”

Justification

But, we may ask, is there any possible justification for euthanasia and physician assisted suicide?  Here are three such arguments:

• With regard to physician-assisted suicide, we may argue that the patient – a free moral agent – makes the decision.  The doctor only gives the patient the means.  It’s freedom of choice.
• Times have changed.  When the Bible was written, anesthetics were unknown.  The first surgery using ether as an anesthetic was performed in the 19^th century.  We no longer can rely solely on the Bible (nor need we) to make ethical decisions today.  Indeed, it may be argued that God intended dental work to be painful; why are you opposing God’s will by going to a dentist who uses Novocain?
• Finally, what if the patient wants to die?  I know of at least one woman who committed suicide because the pain from the cancer became too much for her to bear.  (This was some years ago, when the use of morphine for cancer patients was considered excessive).  Should we oblige her to live on in agony?

As the Scripture has it

If you ask the typical conservative Christian, “How do you make ethical decisions?”, you will get an answer like, “From the Bible.”  But try as you might, euthanasia is mentioned nowhere in the Bible.  There are six suicides in the Scripture (Samson, Saul and his armor bearer, Ahithophel, Zimri and Judas Iscariot) – and none of them are condemned.  So making ethical decisions about euthanasia and assisted suicide will require a little more thought.

The nature of man

Your view of man very much determines your willingness to permit euthanasia.  Briefly, here’s man as presented in the Bible:

• Man is created in the image of God – and therefore is qualitatively different from animals.  They shoot horses; they don’t shoot people.  And that’s how it should be.
• That qualitative difference is the spirit of man – a gift from God which returns to Him at death.[1]  Therefore euthanasia and suicide both involve the rejection of God’s gift.
• Particularly for Christians, we are bought with a price.[2]  We are therefore to honor God with our bodies, for we are not our own.  It’s not my existence; it’s the existence I borrow from the I AM, redeemed at the Cross.  I am not privileged, therefore, to determine the hour of my death.

Two questions for Christians

We need to put a little organization in our thoughts.  There are really two separate questions involved in euthanasia:

1. Just how do Christians make ethical decisions, especially in an area where there is no explicit scripture?
2. Should those ethical decisions have the force of law, or should they apply to Christians only?

Christian ethical decisions

So just how do Christians make ethical decisions?

• Where possible, we are to take the guidance given in the Scriptures.  The “gray areas” are usually found where there is no explicit guidance.
• In certain circumstances, these ethics are determined by the professionals in the profession.  Christian doctors should be the primary source of medical ethics for doctors.[3] 
• Sometimes, ethics for Christians are determined by opinion poll.  By this I mean that Christian leaders develop a consensus position which is supported by the ordinary Christian.  There is no stricture in the Scriptures concerning drunk driving – but the average Christian has a good idea of what the answer should be.
• Finally – and perhaps most important – there is the matter of tradition.  Tradition is simply the vote of those no longer walking on top of the grass.  Often enough we can trace a moral position back in time to show that this is the consensus of the church not only today – but back through time as well. 

Christian Ethics and Public Life

So then, having made our ethical decision, should we campaign to give it the force of law?

Can we “legislate morality?”

Sure we can.  Bank robbery is clearly immoral, but not specifically condemned in the Scripture (no banks, only moneylenders).  We legislate that kind of morality on a regular basis.  But there is a decision to make in so doing:

• Should this moral decision be cast in law, so that the power of the state will help eliminate the unethical behavior?
• Or, should this decision be one that distinguishes the Christian from the rest of the world? 

An example might help:  in the 19^th century it was common to find laws prohibiting adultery.  A man could be jailed for seducing another man’s wife.  Today, marital faithfulness is a sign of a Christian marriage – or at least should be.  

We need to be aware of the enemy’s methods in this:  In the name of your principles, I demand the right to speak.  In the name of mine, I demand that you be silent.  Those who want to promote (e.g.) abortion are very strident in being heard – and very strict about you being silent. 

One principle which might help us is this:  there exists what is called “natural law.”  For hundreds of years the English law books did not contain a definition of murder – it was part of the Common Law, unwritten but binding.  It was “common” in the sense that it bound all citizens – even non-Christians.  Bank robbery is wrong because robbery is wrong, and the Scripture only adds to the voices proclaiming natural law.[4]

Dealing with the other view

Esther’s condition (see reading) may teach us a few things which will be pragmatic for us:

• Get your legal documents in order – the living will and medical power of attorney.  Don’t leave such judgments to the doctor. 
• Prepare for the problem.  If the environment is hostile, be prepared to have someone with the dying person around the clock.  Know what his or her wishes are, and don’t hesitate to speak up.
• Be vigilant.  Assume that the problem will arise, watch for it, and consistently deal with it as you have planned.

Another point of view

If you detect that the author has been through this mill as well, you are correct.  I’ve had to deal with the doctor who was perfectly willing to give someone more morphine even if the patient’s blood pressure was 60/0.  That’s an offer to “take care of the problem for you.”  At the time I faced the decision as to whether or not to put a direct feeding tube into Mom’s stomach.  The doctors represented this as an “extraordinary measure.”  I asked the family if anyone had any thoughts on the subject.  Here’s what I got from one of my sons[5]:

Dad,

This is my response to your call this evening.  Let me say first of all that I recognize that it's your decision and I will honor whatever choice you make.  I'm writing this more because you asked for my opinion than because I have a great deal of certainty about it.  It seemed like you were leaning toward withdrawing the feeding tube and, as you put it, "allowing nature to take its course."  That particular way of framing the issue sets off alarm bells in my head, and I apologize if this sounds like I'm back in my (thoroughly awful) criminal law class in school.

I am uncomfortable with the idea of withholding nutrition, even though providing nutrition at this stage would in the doctors' opinions require removal of the current feeding tube and insertion of a new and more permanent one through more invasive means.  As it's been described to me, the permanent feeding tube doesn't seem an extraordinary or disproportionate measure.  Feeding a patient seems more like part of ordinary care, not heroic measures.  It doesn't seem like the permanent feeding tube would materially increase her suffering, and it also doesn't seem like it would interfere with the palliative care the doctors are thinking of, even if it would likely preclude improvement. 

You mentioned that withdrawal of the feeding tube would likely result in death within two weeks or so.  I know that younger and healthier people can survive somewhat longer without food, but if the period is likely to be that long, then it looks uncomfortably like deliberate starvation.  I don't desire to prolong Grandma's suffering, of course, but withholding nutrition seems like a step on to the wrong side of the line.

To put the case strongly, she is still alive and it is possible to keep her alive through means that don't strike me as excessive, although they are clearly somewhat undignified (although I don't see that having a nurse change the bedpan, for example, is particularly more or less dignified under the circumstances).  Nature and Providence may take their courses as well with the feeding tube as without it. 

Obviously, I wasn't there to talk to the doctor, but it sounds like something of a false dilemma problem:  The doctors sound like they're saying that the choices are (a) a feeding tube, which will prolong suffering in a semi-comatose (translation: life not worth living, in the doctors' view) state indefinitely, or (b) slow death by malnutrition, but elimination of suffering.  Put that way, I have to fight the hypothetical (why will the feeding tube interfere with elimination of suffering?  why do we humans get to decide whether life is or isn't worth living?).  I don't mean to make it sound like a law-school class discussion, and I'm sure the doctors have the best of intentions, but in a profession dominated by amoral narcissists, one learns to be suspicious of this sort of argument.

Those are my (unfortunately rather disjointed) thoughts.  I think I'd opt for the permanent feeding tube based on the information that I have, but I know that you have better information and I will honor your decision.  Although the foregoing may make it seem otherwise, I don't have a strong opinion about this or any real claim to certainty.  I know it's not an easy decision to make and I am praying that God will guide your thoughts and your decision in accordance with His will and purpose. 

I never had to make the decision – Mom died in the night.  But I hope you will take caution from my tale.