Euthanasia is any intentional, direct act causing someone's death under the guise of mercy. It is typically used in instances of terminal, incurable and/or painful disease, illness or injury. The means of euthanasia can include administration of a lethal drug, suffocation, carbon monoxide poisoning, a bullet, or the withholding or withdrawal of life sustaining medical therapies, including hydration and nutrition. Euthanasia may be either voluntary (upon the request of the patient) or involuntary (upon the recommendation of others).
Assisted suicide is one form of voluntary euthanasia. The typical candidate has the will to die, but lacks the means and/or ability to kill himself, usually due to the extent of his illness or injury. His self-determined death requires the help of others - a loved one, friend, or physician.
The Netherlands was the first jurisdiction to legalize euthanasia, and only Oregon, Belgium and Switzerland have followed that country's lead. Well on their way down the slippery-slope of death, Dutch doctors extended their "guidelines" to include killing teenagers and, more recently, disabled babies.1
Even though doctors, friends and relatives may sympathize with a person's desire for death, and be willing to help, they hesitate to involve themselves in an act that may result in prison time. Most remain ambivalent about whether they would personally request or participate in it.2 Advocates offer several reasons for legalizing assisted suicide, but there are many compelling arguments against it.
Killing is forbidden by God
Advocates of euthanasia and assisted suicide abandon God's law in order to assert a "right to die." Despite the euphemisms used to describe assisted suicide and euthanasia - "mercy killing," "death with dignity," "compassion in dying" - it still involves murder.
To some, ending another person's suffering through euthanasia is as humane as putting a suffering animal to sleep. However, human beings are not animals. The Sixth Commandment forbids killing oneself and one another (Exodus 20:13).
God gave man dominion over everything except other human beings. Why? We are made in His image, and our value is determined by that divine-human relationship. Genesis 9:6 spells out the seriousness of any violation of that prohibition: "Whoso sheddeth man's blood, by man shall his blood be shed: for in the image of God made he man."
Elsewhere in Scripture, death is presented as the beginning of suffering for the unbeliever, not its end (Hebrews 9:27; Matthew 25:46; Revelation 20:15). To this day, God maintains sovereignty over the timing of death (1 Samuel 2:6; Job 14:5; John 21:22-23; Philippians 1:21-24). Finally, the people whose suicides are recorded in the Bible - Saul, Abimelech, Ahithophel, Zimri, and Judas Iscariot - are shown to be living outside of fellowship with God at the time of their deaths, and are clearly not meant to be our examples. "There is a way that seems right to a man, but its end is the way of death." (Prov.14:12)
Doctors must not kill
Rather than dying from an underlying medical condition, the patient who is euthanized dies at the hands of those with the power and knowledge to do so (typically physicians). Doctors already control the entrance gates of life, through the abortion of millions of preborn children. Physician-assisted suicide would also grant them control of the exit gates.
A surprising number of doctors, nurses and pharmacists say they would participate in a patient's suicide if asked, and some admit to having done it. Thankfully, associations representing doctors and nurses stand opposed to physician-assisted suicide; the American Pharmacists Association takes no position.3 Opposition to involvement in suicide and euthanasia among medical professionals is based on the following arguments:
- Traditional codes of medical ethics include the principle of "first do no harm." Doctors are expected to use their skills and knowledge to benefit their patients. Within the Judeo-Christian framework, it is understood that causing death is not "beneficial."
- Physicians occupy a position of trust within society. Imagine what would happen to the near-sacred doctor-patient relationship when doctors acquire skills in the latest techniques of euthanasia.
- Assisted suicide takes doctors beyond the realm of ending suffering, and removes an important barrier necessary for protecting the vulnerable. Physicians wield enormous power and, therefore, should continue to be held to a higher standard.
Suicide request a cry for help
Historically, a desire to commit suicide has been viewed as the wish of an incompetent person. Studies show that many people who resort to suicide are depressed. Today, however, some consider assisted suicide a rational response to physical and mental pain. In Oregon, fewer than one-third of patients who killed themselves with legally obtained lethal prescriptions were first referred by their doctors to a psychiatrist for treatment.4
Many doctors fail to respond to the pain and depression of their dying patients, for which there is no excuse. Current pain management techniques offer physicians a variety of tools to control most forms of pain, and research continues to provide even more effective methods. The hospice movement demonstrates that pain can be managed without massive doses of narcotics. As of 2001, new rules require hospitals to measure the pain of each admitted patient and properly relieve it.
Using both drug and non-drug therapies, appropriate pain management will control the pain of 99 percent of patients. Treatments already exist to care for the few whose pain continues. These methods may render the patient unconscious but are effective and legal. Consequently, it is not simplistic to say that if a person experiences the kind of pain that most people believe justifies mercy killing, his or her physician may be guilty of medical malpractice. Aid-in-dying for this reason is unwarranted.5
Some advocates argue that if assisted suicide remains a criminal offense, physicians will be reluctant to administer pain medication in large enough doses because this might hasten death, when death is not intended. They contend that doctors routinely practice euthanasia by knowingly administering such doses that can have the effect of suppressing respiration. They say this predicament makes legalization of assisted suicide necessary, since any death within a hospital or long term care facility forces an investigation of the cause of death and into possible criminal actions on the part of caregivers.
Medical ethicists, however, draw a moral distinction between actions and intentions. Under the principle of double effect, doctors may prescribe pain medication with the intent of making the patient more comfortable, even though death may be an undesired, unintended second effect.
Assisted suicide unnecessary
Many people mistakenly believe it's possible to be kept alive indefinitely by artificial life support. People fear being "brain dead," with bodily functions mechanically maintained. No one wants to be in a "persistent vegetative state," unable to communicate or experience a life of acceptable quality.
Ignorance fuels these fears. Although life support technology is powerful, it is not miraculous. When a person loses all spontaneous, integrated organ function and organs begin to deteriorate, death has occurred. Mechanical life support and resuscitation techniques are powerless at this point. At issue here is not what the technology does but when it is applied. For instance, no one objects to using a ventilator when undergoing major surgery.
The body is a unity of integrated organ systems. A machine cannot extend life by sustaining one organ apart from the rest. Also, patients already have the right to refuse all medical treatment, including life-extending treatment. Patient autonomy is universally recognized within the medical community and the law.
Assisted suicide's slippery slope toward euthanasia
"Quality of life" arguments in favor of assisted suicide are potent, yet dangerous. One quality-of-life marker is "brain death," a distinction of dubious precision. Various tests to confirm brain death are available, but none are flawless.
What is brain death? According to the Uniform Determination of Death Act, the federal standard adopted by most states, a person is not dead until all brain functions have ceased irreversibly. Many believe, however, that the loss of only part of the brain (the "higher" brain controlling thoughts, emotions and consciousness) would be enough to pronounce death.
The loss of brain function is significant, but equating it with death is a philosophical, not medical, conclusion. If death is defined as the loss of higher brain function, we're defining life in strictly non-physical terms. If an intact higher brain is required for a person to be considered "alive," we cannot say that personhood begins at conception, since at that point no organ systems of any kind are present, including the brain.
Once the "right to die" becomes standard, the door allowing non-physicians to assist with suicides will be opened. Ultimately, it will lead to involuntary euthanasia. There is no logical place for the killing to stop. The idea that death is a "benefit" for some people is gaining wide acceptance as our population ages. The fear of suffering is so strong that death is preferred.
Alternative to suicide: Tender, loving care
The lengthy dying process of a loved one can strain a family's finances and place severe emotional burden on family members. Advocates of euthanasia and assisted suicide insist we should spare them and society the expense, bringing us dangerously close to creating a "duty to die."
It's unlikely that decisions regarding assisted suicide will be totally free from outside influences. Family members and friends will influence decisions to seek aid in dying, just as they influence nearly all treatment decisions to some degree. In Oregon, an alarming number of those who sought aid in dying cited such concerns as their main rationale.4
One can certainly empathize with families facing the challenges associated with a dying loved one. However, the Bible says we should "bear one another's burdens," not escape them by killing one another. The sufficiency of God's grace (2 Corinthians 12:9-10) is not a hollow promise. Its significance is only realized in the midst of hardship. (See information about respite care and LIFT.)
There's nothing wrong with desiring independence and a self-sufficient life, but "none of us lives to himself and no man dies to himself" (Romans 14:7). In both Old and New Testaments, the family is the primary source of charity and compassion toward its members (1 Timothy 5:8).
Dying is inconvenient but not surprising. The only thing uncertain about it is how and when one will die. We should prepare financially for dying as we do for retirement. We should work to eliminate the high cost of dying and diminish the way public sympathies and perceptions are manipulated to promote legalization of physician-assisted suicide.
Three promises we owe the dying
We can weaken the attraction of euthanasia and assisted suicide by making (and keeping) three promises to the dying:6
- You will never be a burden. The person who is gradually slipping into dependence on others must be made to believe his or her most basic needs will never become burdensome to caregivers. We must joyfully and generously meet our biblical obligation to care for one another at the end of life. We show mercy because God is merciful (Luke 6:36). Circumstances may be inconvenient, but people? Never!
- You will not die in pain. We should take a person's pain seriously, and make every effort to alleviate it (Proverbs 31:6,7). Alert non-professionals can observe a patient's verbal and non-verbal expressions of pain, report them to those in a position to provide relief, and offer comfort.
- You will not die alone. Solomon wrote, "It is better to go to the house of mourning, than to go to the house of feasting: for that is the end of all men; and the living will lay it to heart" (Ecclesiastes 7:2). Critically ill people have obvious physical needs, but spiritual and emotional ones as well. Rather than withdraw at such times - expecting professionals to take over - Christians must be on hand to offer patients and loved ones encouragement, continued friendship, and practical support.
Baptists for Life designed LIFT (Loving Individuals in Final Transition) to enable Christians to fulfill these three promises to the terminally and chronically ill. To learn more about this hands-on, pro-life, church-based ministry, please contact us.
Endnotes
1 Tony Sheldon, "The Netherlands regulates ending the lives of severely ill neonates," British Medical Journal (331:1357), 12/05.
2 EJ Emanuel, et al, "Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers," Journal of the American Medical Association (284:19), 11/15/00.
3 American Nurses Association position on assisted suicide and active euthanasia, enacted December 8, 1994; American Medical Association House of Delegates: "It is the policy of the AMA that physician assisted suicide is fundamentally inconsistent with the physician's professional role" (H-140.952); Report of the 2004 Session of the American Pharmacists Association House of Delegates: "APhA supports informed decision-making based upon the professional judgment of pharmacists, rather than endorsing a particular moral stance on the issue of physician-assisted suicide."
4 "Eighth Annual Report on Oregon's Death with Dignity Act," Oregon Department of Human Services, March 9, 2006 (http://www.oregon.gov/DHS/ph/pas/docs/year8.pdf).
5 Analysis of 69 of the suicide doctor's "patients" revealed that only 25 percent were terminally ill, and only 35 percent were experiencing chronic pain. Roscoe and Dragovic, "Dr. Jack Kevorkian and Cases of Euthanasia in Oakland County, Michigan, 1990-1998," correspondence, NEJM (343:23), 12/7/00.
6 Mark B. Blocher, The Right to Die? Caring Alternatives to Euthanasia (Chicago: Moody Press, 1999), p. 193.