A CHRISTIAN RESPONSE TO EUTHANASIA INTRODUCTION Advances in medicine and medical technology over the last few decades have made it increasingly possible for life to be prolonged. Those patients who were thought to be incurable and fatally ill now live longer and more fulfilling lives than ever before. It has been suggested, however, that doctors too often employ extraordinary or heroic methods in order to keep a patient alive---methods which may be unnecessary, given the patient's prognosis. For some people, the answer is euthanasia. Laws should be made, they say, to protect a person's "right to die," and to allow "mercy killing." But what is euthanasia? Is it ethical? More importantly, does the practice conform to biblical teachings? What is the proper Christian response? Defining Terms Euthanasia is a compound word derived from the Greek: `eu' meaning "well," and `thanatos' meaning "death." Its original meaning, as applied by the ancient Greeks, referred to the "art and discipline of dying in peace and dignity" (Wertham, 1973, p 28). During the nineteenth century, the word was given a different connotation, being applied to the theory or (more recently) the practice of causing painless death, particularly in those suffering from incurable, painful diseases. Euthanasia reached its extreme form in the Germany of 1920. It was in this year that Karl Binding and Alfred Hoche published a little book entitled `The Release of the Destruction of Life Devoid of Value'. The authors proposed that killing "worthless people" should be made legally acceptable. Their book had a major part to play in the euthanasia program of Nazi Germany---a program which resulted in the death of the very young, the very old, and the physically and mentally disabled (see Wertham, 1973). Such clinical, socially or politically motivated killing, is known as involuntary euthanasia, death selection, or managerial euthanasia. Efforts today are directed toward the legalization of voluntary euthanasia. This can be carried out either actively by "the intentional use of medical technology in such a way as to induce or hasten death," or passively by "the abandonment (or withdrawal) of `ordinary,' reasonable and prudent medical care" (St. Martin, 1975, 27[1]:62). Active voluntary euthanasia has gained more attention in light of the AIDS epidemic. Gay newspapers carry ads by the Hemlock Society---a pro- euthanasia group which publishes a do-it-yourself book on suicide. The book includes tables on what drugs to use, their brand names, how to obtain them, and what is needed to succeed at killing oneself. THE ISSUES Euthanasia is a difficult issue because many people see a gray area between "death with dignity" and "mercy killing." Most Christians would probably say that it is wrong to "euthanatize" a friend with a Colt .44, or to "put someone out of their misery" with an overdose of morphine, even at the request of the one suffering. They would regard such attempts to end life as murder on the part of the euthanatist, and self-murder on the part of the one being euthanatized (Romans 13:9). Christians are often not so sure in other situations. They hate to see suffering as much as anyone, but they want to do what is right in the sight of God (I John 3:22). It is hoped that this tract will expose some of the issues, and lay some important ground rules which will be of practical use to the Christian seeking to do God's will. Death with Dignity Pro-euthanasia groups assert that many patients are being denied a dignified death. Hence, they suggest, legislation is needed to allow patients and doctors more "options" in life-and-death situations. This "death with dignity" plea, and its implications, should not go unchallenged. Professor Kurfees comments: Is it not required of all of us, family, nurse and doctor to always secure the most dignified management of every case? We all want that. Such phrases and buzz words cloud the issue. They inject the false notion that many people are not dying with dignity: that there are those in the medical profession who are not keenly aware of these matters. Those who use such words cast aspersions and raise a false issue, for all wish for a dignified end to life. This ploy is calumniation [slander-TJM] (1988, p 4). The point is, no informed person is arguing that people should be denied a truly humanitarian death. Extraordinary Treatment Pro-euthanasia groups believe that doctors routinely use extraordinary medical procedures---often against the will of the patient and family involved. In their opinion, this practice only serves to prolong the dying process, and cause emotional strain and economic hardship. Debate then arises over what is meant by extraordinary versus ordinary treatment. Normally, extraordinary treatment has referred to efforts which would be of no use in improving prognosis, or would increase the likelihood of death due to high risk factors. Certain experimental cancer drugs might fall into this category. Conversely, ordinary treatment has meant routine care, regardless of access to medical facilities. Hygiene, nourishment, and relief from pain and physical distress have been listed in this category. The current trend is to ignore or blur this optional/compulsory distinction so that any treatment may be withheld or withdrawn if it will sustain life. However, it should be understood that any competent person (or parent/guardian of a minor or incompetent) can accept or reject medical treatment. No one has taken away the rights of a cancer patient to forgo chemotherapy and radiation treatments. Likewise, the presiding doctor is under no compulsion to offer extraordinary treatment. As the medical expert on the case, however, he will make every effort to offer the best advice to the patient and family. The primary concern of most physicians is to apply all reasonable care to save a person's life. Cerebral Death vs. Brain Death In a well-equipped hospital, all manner of devices and procedures are available to sustain life. This often means that equally sophisticated devices and procedures are needed to help doctors decide when death has occurred. Medical and legal death is usually deemed to occur when the patient shows no sign of life, when there is no evidence of any brain activity, and when there is no hope of restoring any such activity. At this point, the doctor may remove ventilators and other life support. Note that this "brain death" applies to the whole brain. It includes the cerebrum, which is thought to be responsible for voluntary actions and conscious thought, and it includes the cerebellum and brain stem, which coordinate muscular movements and control involuntary body functions. Brain death becomes a controversial issue when patients with inactive cerebrums continue to live for many months or years. Whether life support is necessary, some people wish to curb such instances of "persistent vegetative state" by changing the legal definition of death to mean the point at which only the cerebrum has ceased to function. By declaring "cerebral death," doctors no longer have to wait until the entire brain has ceased to function. They are free to withdraw food, water, and any other care because the patient is legally dead. Reduced economic, social, and emotional burdens are the perceived benefits. Cerebral death also reflects on organ donation. If death is pronounced while the body is still alive, then organs can be removed before cellular deterioration has occurred. The idea of declaring death at the point of cerebral inactivity has been criticized for several reasons. In particular, it seems to make no allowance for those situations in which patients with apparently inactive cerebrums are able, with treatment, to regain their memory, personality, and other signs of conscious human existence. For example, a child with Reye's syndrome accompanied by coma and minimal brain function can later recover with normal physical and mental capacities. Also, people have appeared to die by drowning in near-freezing water, only to be resuscitated after many minutes because the severe and sudden cold suspended the consumption of oxygen in the body's cells. Normally, doctors will act to save a person's life in these situations, but the classification of cerebral death removes some of this hope. Life: Sanctity or Quality? One issue continues to arise in many discussions of medical ethics: the sanctity of life versus the quality of life (see Major, 1989). Christians usually take the first position because of their belief in God's divine creation of human life (Genesis 1:26,27). Hence the reasoning in Genesis 6:9, "Whosoever sheds the blood of man, by man shall his blood be shed; for God made man in his own image." The second position makes decisions based on an assessment of a person's ability to participate in society and communicate with other people. This is the overriding consideration in much of the pro-euthanasia dialogue. Note the comments by AIDS counselor Marty James about his friend Keith: "When he was finally given the terminal diagnosis, it became an issue for him of the quality of life, and for him his dying was, in fact, healing" ("A `Humane and Dignified Death'," 1988, p 5). Mr. James helped Keith end his life with 30 barbiturates. This is not to say that Christians object to a quality life, anymore than they object to a humanitarian death. Rather, the Christian's quality of life is based on the sanctity of his life. For him, a good life is a life spent in doing God's will that he may look forward to a perfect existence in heaven (Galatians 2:20; I Corinthians 15:53-58). The difference between these two outlooks is, therefore, that quality of life advocates believe human life has value only if it is good, whereas Christians believe a human life is good because it has an intrinsic, definite value. Pro-euthanasia groups and the media tend to focus on a patient's right to self-determination. Yet such rights mean nothing without a recognition of the fundamental sanctity of human life. Christians, and many in the medical profession, do not want to do everything that can be done, but everything that should be done. As stated previously, the intention of most doctors is to apply all reasonable care to save life, not to find ways in which to end life. CASE STUDIES Karen Ann Quinlan Several court cases over the last two decades have had a significant impact on the euthanasia controversy, although they have not resolved any of the issues to everyone's satisfaction. The original, landmark case is that of Karen Ann Quinlan (e.g., see Horan, 1977). Karen was in a comatose state, apparently caused by a combination of alcohol and tranquilizers. Although she was in an irreversible coma and would never return to a "cognitive, sapient state," she responded when pinched and her brain was still active. For these reasons, her doctors decided to maintain her on a respirator. But Karen's father, Joseph Quinlan, wanted to remove the respirator because he was convinced it was the only thing keeping her alive. He sued the hospital to disconnect the life support systems, and eventually won the case in the New Jersey Supreme Court in 1976. Consequently, "to pull the plug" is now a common part of the vernacular. Terminating Karen's life support may have been the case, but the sanctity of her life was the issue. The state and the doctors, acting in accord with normal practice, were caring for Karen regardless of any hope for a "normal" life in the future. Mr. Quinlan, however, acted to end Karen's life by the withdrawal of life-sustaining measures. His decision was based on his family's quality of life, and his perception of Karen's quality of life. Ironically, she would survive for almost ten years, in spite of these efforts. Although she never regained a "cognitive, sapient state," Karen was cared for in a nursing home until her death in 1985. The Quinlan case is also significant because the ruling effectively enforced constitutional rights where common law and medical common sense had formerly applied. The Court asserted the power to rule over the expertise of the medical profession which had normally worked in consultation with the family and, whenever possible, the patient. Several state courts have since ruled on the basis of constitutional rights in similar situations. Nancy Beth Cruzan The most controversial cases in the last decade have centered on the withdrawal of food and water. None has received more attention than the case of Nancy Beth Cruzan. Nancy sustained extensive brain damage in an auto accident in 1983, and was placed in a Missouri rehabilitation center for long-term care. In the ensuing years, the family requested that the feeding tube be withdrawn, but the institution and the state Department of Health refused to comply. On June 25, 1990, the U.S. Supreme Court ruled against the family, and upheld the Missouri law which required clear and convincing evidence that an unconscious patient had previously stated his or her desire not to be sustained on life support. Then, on December 14, the parents obtained a court order to withdraw the feeding tube. Nancy died twelve days later, aged 33. Most ethicists opposed to euthanasia likewise are opposed to suspending tube feeding. Food and water, argues legal expert Dennis J. Horan, is an ordinary means of life support, and as such it should not be withdrawn "merely because the ultimate prognosis is useless" (no date, p 10). In a debate before the Florida legislature, Justice David Kopelman of the Probate Family court in Dedham, Massachusetts, noted that death by starvation and dehydration could hardly be considered a "good death." According to the Illinois Citizens for Life, feeding tubes are no more medical treatment than hunger and thirst are illnesses (see Gow, 1990). As always, the issue should be considered in terms of life's sanctity. If nutrients and fluids were keeping Nancy alive and in a stable condition, it would seem that this therapy was successful and should have been continued. However, if the feeding tube was withdrawn with the intention of ending her life or hastening her death, then this amounts to mercy killing. Christians should consider other examples on a case-by-case basis. Does this mean that Christian ethics is situational? Far from it. The consideration of each case rests on firm biblical foundations. It begins with a respect for life, with a love for fellow mankind, with a denial of self-interest, and with a prayer that all will be done according to God's will (Romans 8:27). SOME ANSWERS Living Wills It has been suggested that difficult cases, like those of Karen and Nancy, could be avoided if people made out "living wills." The idea of a living will is to give doctors an indication of the treatment desired by their unconscious patients. Thus, if a person is in a comatose state following an accident, and there is no hope of recovery, a will might tell the doctors to withhold or withdraw any life sustaining treatment. Living wills seem practical, and there is nothing intrinsically immoral about such statements (as long as they remain consistent with the sanctity-of-life ethic). Again, no one is under any moral or legal obligation to accept or reject medical treatment, even if such decisions are made through the substitute of a written document. Living wills are not without their problems, however. First, living wills cannot be expected to anticipate every situation. The language they use must be sufficiently broad to allow doctors a number of choices, yet specific enough to exclude misinterpretation and foul play. Unfortunately, living wills commonly use ambiguous expressions such as "extraordinary treatment." As we have already seen, these phrases mean different things to different people. What may be an extraordinary treatment at the signing of the will may become a potentially successful therapy sometime later. Many wills include instructions which depend on some prognosis for life expectancy, even though such predictions are notoriously inaccurate. Indeed, medical researchers have found that terminally ill patients often possess a great will to survive through some significant event in their life. This has shown to be the case among Jews around the Passover, and Chinese women around the Harvest Moon Festival (see Phillips and Smith, 1990). Hence, living wills have the potential to ignore the complexities of medical science, and remove the dynamic interaction between doctor, patient, and family. The second problem, and the greatest concern for Christians, relates to living will legislation. At present, such legislation is limited in power and extent. However, discussions at several euthanasia conferences in the mid-1980's made it evident that living will acts are simply the first item on the agenda (Hobbs, 1986, pp 6-9). Once the "right to die" idea is accepted and its meaning broadened, then the "right to kill" can be incorporated into living wills. Some see involuntary euthanasia, … la Nazi Germany, as the final resting place of the current legislative momentum (Kurfees, 1988, p 8). Living wills are potential ethical time bombs. Ideally, they are rendered unnecessary by the motivation of Christian families to act with pure intentions in accordance with God's Word. In any case, it is the responsibility of Christians to discuss their specific choices for treatment in given situations with their doctors, and with as many of their family members as possible. The Biblical Command to Care As discussed previously, the foundation for Christian consideration of death and dying is the sanctity of life. In addition, the Bible has some definite guidelines which can be applied to the care of the elderly and afflicted. Consider the following points: * James 1:27 instructs the Christian to visit orphans and widows and provide for their needs. The righteous are to plead the cause of the poor and oppressed (Isaiah 1:11,23). Those who are strong are to help the weak (Romans 15:1). * Ephesians 6:2 commands each person to "Honor thy father and thy mother." According to I Timothy 5:8, failing to care for one's own family is a denial of the faith, and makes one "worse than an infidel." The elderly should be respected (Leviticus 19:32). The psalmist prayed, "Cast me not off in the time of old age; Forsake me not when my strength faileth" (Psalm 71:9). * Job would have been a prime case for euthanasia, but God preserved his life and blessed it. * Christians should recognize that our suffering in this world is "not worthy to be compared with the glory which shall be revealed in us" (Romans 8:18). [For more information on this point, see the tracts "Why Human Suffering?" by Calvin Barber, and "Does Human Suffering Disprove the Existence of God?" by Wayne Jackson, both of which are available from the address below.] CONCLUSION Euthanasia represents a natural progression from the legalization of abortion on demand. After all, if one can justify the taking of "unwanted" or "useless" life inside the womb, then why not take "unwanted," "useless" life outside the womb? In addressing a pro-euthanasia group, Professor Matthew Connoly suggested that there was indeed a better way; that there is more than "a stark choice between suicide and suffering." Here is an abstract from a speech given at the Hemlock Society's Conference in Los Angeles, February, 1985: "Experience with hospice care in England and in the U.S. has shown repeatedly that in every case, pain and suffering can be overwhelmingly reduced. In many cases it can be abolished altogether. This care, which may (and for financial reasons perhaps must) include home care, is not easy. It demands infinite love and compassion. It must include the latest scientific knowledge on analgesic drugs, nerve blocks, spinal morphine injections and so on. BUT IT CAN BE DONE! IT CAN BE DONE! IT CAN BE DONE!" (quoted in Hobbs, p 19). REFERENCES Binding, Karl and Alfred Hoche (1920), `The Release of the Destruction of Life Devoid of Value' (Santa Ana, CA: reprinted by `L.I.F.E.'). Gow, Haven Bradford (1990), "Even Brain-Damaged Persons Possess Dignity," `Christian News', December 31, p 4. Hobbs, Lottie Beth (1986), `"Forsake Me Not When My Strength Fails"--- What about Euthanasia?' (Fort Worth, TX: Pro-Family Forum). Horan, Dennis J. (no date), "Euthanasia and Brain Death: Ethical and Legal Considerations," `Studies in Law and Medicine' (Chicago: Americans United for Life), No. 1. Horan, Dennis J. (1977), "The Quinlan Case," `Death, Dying, and Euthanasia', edited by D.J. Horan & D. Mall (Washington, D.C.: University Publications of America), pp 523-533. A `Humane and Dignified Death'" (1988), ABC News Nightline, #1789, March 31, reported by Chris Bury (New York: Journal Graphics). Kurfees, James F. (1988), "On Living Wills," `Journal of Biblical Ethics in Medicine', 2:4-9,19. Major, Trevor J. (1989), "Life: Sanctity or Quality," `Journal of Biblical Ethics in Medicine', 3:75,76. Phillips, David P. and Daniel G. Smith (1990), "Postponement of Death Until Symbolically Meaningful Occasions," `Journal of the American Medical Association', 262:1947-1951. St. Martin, Martin (1975), "Euthanasia: The Three-in-One Issue," `Baylor Law Review', 27[1]:62. Wertham, Fredric (1973), `The German Euthanasia Program' (Cincinnati, OH: Hayes Publishing). This file may be copied, but is distributed on the understanding that it will not be modified or edited, and will not be used for commercial purposes. Further, it may not be copied without due reference to the original publication source, author, year, and name and address of the publisher. Apologetics Press 230 Landmark Drive Mongomery, AL 36117-2752 Downloaded from: The Christian Connection of Palm Beach 300/1200/2400 bps 407/533/5216