Letter from the Church of England House
of Bishops and the Catholic Bishops' Conference of England and
We are writing to send your Committee a joint
submission from the Church of England House of Bishops and the
Catholic Bishops' Conference of England and Wales.
We believe very strongly that respect for human life
at all its stages is the foundation of a civilised society, and
that the long-term consequences of any change in the law to allow
euthanasia in limited circumstances would be immensely grave.
This is a view shared not just within our Churches, but very widely
among those of all faiths and none who share a moral outlook founded
on respect for human life and the protection of vulnerable people.
As you know, having considered the evidence
and the arguments against legalising euthanasia in great depth,
the House of Lords Committee on Medical Ethics in 1994 firmly
rejected any change in the law to allow euthanasia. They concluded:
"The right to refuse medical treatment
is far removed from the right to request assistance in dying.
We spent a long time considering the very strongly held and sincerely
expressed views of those witnesses who advocated voluntary euthanasia
. . . Ultimately, however, we do not believe that these arguments
are sufficient reason to weaken society's prohibition of intentional
killing. That prohibition is the cornerstone of law and of social
relationships. It protects each one of us impartially, embodying
the belief that all are equal. We do not wish that protection
to be diminished and we therefore recommend no change in the law
to permit euthanasia. We acknowledge that there are individual
cases in which euthanasia may be seen by some to be appropriate.
But individual cases cannot reasonably establish the foundation
of a policy which would have such serious and widespread repercussions."
[HMSO, London, 1994, paras 236-7].
We hope and pray that your Committee will reaffirm
and endorse that conclusion, given that the strength of the arguments
against euthanasia are undiminished, and the empirical evidence
of the damaging effects of legalising euthanasia in the Netherlands
is even stronger now.
In our submission we have sought briefly to
set out what seem to us the key fundamental principles and then
we make some specific points on this particular Bill. We hope
your Committee will find it helpful.
1. The arguments presented in this submission
grow out of our belief that God himself has given to humankind
the gift of life. As such, it is to be revered and cherished.
2. Christian beliefs about the special nature
and value of human life lie at the root of the Western Christian
humanist tradition, which remains greatly influential in shaping
the values held by many in our society. These beliefs are also
shared in whole or in part by many people of all faiths and none.
3. All human beings are to be valued, irrespective
of age, sex, race, religion, social status or their potential
4. Those who become vulnerable through illness
or disability deserve special care and protection. Adherence to
this principle provides a fundamental test as to what constitutes
a civilised society.
5. The whole of humankind is the recipient
of God's gift of life. Life is to be received with gratitude and
used responsibly. Human beings each have their own distinct identities
but these are formed by and take their place within complex networks
of relationships. All decisions about individual lives bear upon
others with whom we live in community.
6. For this reason, the law relating to
euthanasia is not simply concerned either with private morality
or with utilitarian approaches. This is one of the issues relatively
few in number but fundamental in importance on which justice calls
for a limit to moral or ethical pluralism. A positive choice has
to be made by society in favour of protecting the interests of
its vulnerable members even if this means limiting the freedom
of others to determine their end.
7. There are two considerations which are
often appealed to in defence of euthanasia individual autonomy
(the so-called "right" to die at a time of one's choosing)
and welfare (the view that at beyond a certain point some lives
are not worth living).
8. In recent years there has been an increasing
emphasis on individual rights and self-determination. In the world
of medicine; this has had its impact with patient autonomy being
accorded an ever higher priority in medical ethics. In the Assisted
Dying for the Terminally Ill Bill, the emphasis on autonomy is
evident in the way that "unbearable suffering" is given
a purely subjective definition: it is suffering " . . . which
the patient finds so severe as to be unacceptable . . . ".
The Bill requires the patient to be informed of alternative responses
including palliative care, but the patient must then be helped
to die if this is his or her settled wish. The Bill does however
restrict its scope to those who are terminally ill, where death
is likely to result "within a few months at most". But
if the principle of autonomy is being invoked to justify the Bill
it is difficult to see how this restriction could be defended.
The suffering caused by a non-terminal chronic illness, whether
mental or physical, may equally be "so severe as to be unacceptable"
to those affected. Why should euthanasia not be made available
to them too?
9. At this point the second considerationwelfarecomes
in. If it is not enough simply for the patient to want euthanasia,
then the justification often given is that it is in his or her
best interests to die. It is argued that in some situations life
has no value, especially if the patient cannot look forward to
any improvement and faces a slow and lingering death. But if this
is the justification, there is once again no basis for restricting
the scope of euthanasia to the terminally ill, or indeed to those
making a voluntary request.
10. Both autonomy and welfare considerations
can lead in practice to much more widespread euthanasia than was
originally envisaged. The submission to this Committee from the
Linacre Centre for Healthcare Ethics contains ample evidence of
this in the case of the Netherlands where, as they point out "we
see both an extension of euthanasia to those who are mentally
ill or `tired of life' and its extension to those who are unable
to consent such as infants and young children".
11. Neither of our Churches insists that
a dying or seriously ill person should be kept alive by all possible
means for as long as possible. On the other hand we do not believe
that the right to personal autonomy is absolute. Patients should
not be overtreated, and may reasonably refuse particular treatments
as too burdensome. Having said this, life should be respected,
whether in oneself or in another; the aim of giving or refusing
treatment should never be to make the patient die.
12. The exercise of personal autonomy necessarily
has to be limited in order that human beings may live together
in reasonable harmony. While at present people may exercise their
legal right to refuse treatment (although this may be overridden
in special but strictly limited circumstances), the law denies
that there is a legal right to die at a time of one's own choosing.
The consequences which could flow from a change in the law on
voluntary euthanasia would outweigh the benefits to be gained
from more rigid adherence to the notion of personal autonomy.
But in any case we believe (para 6) that respect for the life
of a vulnerable person is the overriding principle.
13. The right of personal autonomy cannot
demand action on the part of another. Patients cannot and should
not be able to demand that doctors collaborate in bringing about
their deaths, which is intrinsically illegal and morally wrong.
14. A serious consequence of introducing
euthanasia would be to undermine the relationship of trust between
doctors and patients. The value attaching to human life implies
that the primary duties of doctors caring for those with terminal
illness are to ensure their patients are as free from pain as
possible, given the information they and their carers request
or require to make informed choices about their future lives,
and are supported through the personal challenges which face them.
But if doctors were allowed in some circumstances to kill their
patients rather than care for them, this would inexorably lead
to an undermining of trust. Medical treatment would come to be
regarded by the vulnerable person as potentially life threatening
rather than as conferring benefit.
15. A change in the law to permit assisted
dying would also change the cultural air we all breathe, and affect
attitudes to older people and those with chronic illness. For
example, the law permitting abortion has profoundly changed society's
attitude towards the status of the foetus.
16. Doctors are rightly concerned to do
the best they possibly can for the actual patients in front of
them, and so are the families and friends of those who are ill.
It is hard to stand back from the trauma of the individual suffering
and look at the wider picture; to think about the long-term implications
of decisions made under the pressure of individual need. This
is why the law has to play its part in providing a framework within
which the medical profession can operate. A foundational guiding
principle of the current legal framework is that we should not
deliberately kill each other.
17. Behind many of the arguments in favour
of euthanasia lie powerful fears, and in particular the fear that
the alternative to euthanasia might be a lingering and painful
death, exacerbated by futile and burdensome medical treatment.
18. When death is imminent or inevitable,
the withholding or withdrawing of medical treatment that is judged
futile or burdensome is both moral and legal today as in the past.
Doctors do not have an overriding obligation to prolong life by
all available means. Treatment for a dying patient should be "proportionate"
to the therapeutic effect to be expected, and should not be disproportionately
painful, intrusive, risky, or costly, in the circumstances. Treatment
may therefore be withheld or withdrawn, though such decisions
should be guided by the principle that a pattern of care should
never be adopted with the intention, purpose or aim of terminating
the life or bringing about the death of a patient. Death, if it
ensues, will have resulted from the underlying condition which
required medical intervention, not as a direct consequence of
the decision to withhold or withdraw treatment.
19. The hospice movement developed from
a concern that people should be helped to die with dignity (that
is, to live with dignity until they die). This work has enriched
not only the lives of terminally ill people but also their carers,
volunteers, and health professionals, who have found that caring
for those who are dying can be a great source of blessing. Friendship,
companionship and above all love are the key characteristics of
a good death. Helping people to die well in this way is not the
preserve of any particular faith. It is a profoundly compassionate
and humane response to the reality of death which we all eventually
20. We are concerned that the lessons learned
in hospices about pain control, and emotional and spiritual support
should be applied throughout the health service to all dying people.
This requires that medical personnel remain aware of how advice
on pain control may be obtained, seek specialist help where necessary,
and that adequate resources are made available for the care of
sick and elderly people.
21. We believe that deliberately to kill
a dying person would be to reject them. Our duty is to be with
them, to offer appropriate physical, emotional and spiritual help
in their anxiety and depression, and to communicate through our
presence and care that they are supported by their fellow human
beings and the divine presence.
22. It is deeply misguided to propose a
law by which it would be legal for terminally ill people to be
killed or assisted in suicide by those caring for them, even if
there are safeguards to ensure it is only the terminally ill who
would qualify. To take this step would fundamentally undermine
the basis of law and medicine and undermine the duty of the state
to care for vulnerable people. It would risk a gradual erosion
of values in which over time the cold calculation of costs of
caring properly for the ill and the old would loom large. As a
result many who are ill or dying would feel a burden to others.
The right to die would become the duty to die.
23. The Bill is unnecessary. When death
is imminent or inevitable there is at present no legal or moral
obligation to give medical treatment that is futile or burdensome.
It is both moral and legal now for necessary pain relief to be
given even if it is likely that death will be hastened as a result.
But that is not murder or assisted suicide. What terminally ill
people need is to be cared for, not to be killed. They need excellent
palliative care including proper and effective regimes for pain
relief. They need to be treated with the compassion and respect
that this bill would put gravely at risk.
2 September 2004
1 In 1993 we made a joint submission to the House of
Lords Select Committee on Medical Ethics considering the question
of euthanasia. In presenting some arguments specific to this Bill,
we have drawn on and restated a number of principles set out in
that original submission, which we believe are just as valid today,
and apply equally to the Bill being considered by this Select
It is noteworthy that the 1994 House of Lords Select Committee
members came back from the Netherlands deeply disturbed that some
doctors there were not following required procedures. The Committee
was finally not persuaded that "it is possible to set secure
limits on voluntary euthanasia" and remained "concerned
that vulnerable people-the elderly, lonely, sick or distressed-would
feel pressure, whether real or imagined, to request early death
. . . the message which society sends to vulnerable and disadvantaged
people should not, however obliquely, encourage them to seek death,
but should assure them of our care and support." [paras 238-9]. Back