Memorandum by the Modern Churchpeople's
Union
INTRODUCTION TO
THE ORGANISATION
AND TO
THE AUTHOR
(A) The Modern Churchpeople's Union (The
MCU) was founded in 1898 to encourage and protect exponents of
liberal theological and ethical thought within the Church of England.
Since the 1920s it has campaigned for the Churches to support
the legalisation of euthanasia in the context of terminal illness.
The MCU has asked Professor Badham (a Vice-President of the Union)
to present evidence to the Select Committee along the lines of
his articles in Studies in Christian Ethics. Conscious that the
Committee will receive submissions from Christian bodies opposed
to any relaxation of the present laws against euthanasia, the
MCU is concerned that the Select Committee should be aware that
there are also strong Christian arguments in favour of euthanasia,
and that these arguments are supported by 66 per cent of those
members of the Church of England who worship on a weekly basis.[60]
(B) Paul Badham has been Professor of Theology
and Religious Studies in the University of Wales, Lampeter since
1991. Religious and ethical beliefs concerning life, death and
immortality have been his major research area, and he has published
six books relating to Christian beliefs about death, dying and
immortality. The articles referred to by the MCU are:
Should Christians Accept the Validity of Voluntary
Euthanasia? Studies in Christian Ethics October 1995. Reprinted
in Robin Gill, The Churches and Euthanasia Cassells, 1998.
Euthanasia and the Christian Doctrine of God
in Studies in Christian Ethics June 1998.
A comparable chapter, A Theological Examination
of the Case for Euthanasia was published in Paul Badham and
Paul Ballard Facing Death University of Wales Press 1996.
MEMORANDUM OF
EVIDENCE
1. Why people support the legalisation of
assisted suicide
The reason most people give for joining a voluntary
euthanasia society is that they do not like what they see ahead
of them. They do not themselves wish to endure the protracted
dying process they have watched their parents go through.[61]
Clive Seale's research has shown that 28 per cent of all relatives
believe that it would have been better if their loved one had
died earlier than they actually did. When asked if their loved
one had expressed a wish to die 24 per cent said "yes".
Of these 36 per cent had explicitly asked for medical help to
die.[62]
2. The lack of consistency in Christian opposition
to euthanasia
The primary theological argument against permitting
assisted suicide is that issues of life and death are for God
alone to determine. However there is a serious inconsistency in
applying this principle when the question of shortening the dying
process is discussed, and not applying the same principle when
questions about the extension of the dying process arise. Almost
all Christians today accept the desirability of vaccination, even
though in 1829 Pope Leo XII ruled that anyone who accepted, or
practised, vaccination was, "no longer a child of God".
This was because vaccination infringed on God's sovereignty over
life and death.[63]
3. Why Christian acceptance of birth control
may foreshadow acceptance of euthanasia
The closest parallel for the likelihood that
most Churches will come to accept the morality of assisted suicide
is the change in their attitude to birth control. Historically
almost all Christians were opposed to birth control on the grounds
that it challenged God's unique authority over issues of life
and death. This stance has since been abandoned by almost all
Church leaders in the protestant traditions as well as, in practice,
by Roman Catholic laity. Hans Kung has shown that very similar
arguments were used in the papal encyclical against euthanasia,
Evangelium Vitae, as in the papal encyclical against birth control,
Humanae Vitae.[64]
The Pope's position is consistent. What is not consistent is the
position of other Christians and their leaders. Most now accept
that it is good for couples to consult together, and to obtain
medical advice and help to plan their families, and to decide
when it would be best for a new human life to begin. Yet many
of the same people are opposed to such consultation and help being
sought to determine when the battle against terminal illness should
be abandoned, and the person be given help to die as painlessly
as possible. However just as the practice of the Christian laity
led to acceptance of birth control, so the views of the laity
may ultimately change Church thinking on euthanasia. Professor
Robin Gill has shown that 84 per cent of Christians of all denominations
who worship once a month support euthanasia, as do 66 per cent
of weekly Church-going Anglicans.[65]
4. Jesus' Golden Rule and the case for legalising
assisted suicide
The heart of Jesus' ethical teaching was the
primacy of the law of love. Throughout his ministry, the main
source of conflict between Jesus and the religious authorities
of his day was Jesus' insistence that loving response to human
need must always outweigh the detailed requirements of the Old
Testament Law. Jesus believed that the essence of religious law
was summed up in the maxim, "love your neighbour as yourself".
His own Golden rule was, "Always treat others as you would
like them to treat you."[66]
This rule could be relevant to the case of a doctor wishing to
help a terminally ill person to die. The suicide rate is higher
for doctors than for almost all others. No doubt many factors
contribute to this, but at least one is the fact that they know
the implications of terminal illness, and have the means to release
themselves from it. Dr. Michael Irwin claims that "many physicians
and nurses have private arrangements that they will hasten each
other's deaths should they ever be unfortunate enough to resemble
the condition of some of their patients".[67]
For doctors who have made such "arrangements", the legalising
of assisted suicide would not only protect their colleagues from
possible serious repercussions, it would also enable such doctors
to give to their patients the treatment they wish for themselves.
In behaving thus they would literally be following Jesus' golden
rule.
5. Is suicide the ultimate sin?
One objection to legalising assisted suicide
is the belief that suicide itself is the ultimate sin of despair
against God. It is generally assumed that "The Everlasting
. . . has fixed his canon `gainst self-slaughter", and that
"the calamity of so long life" must be endured. But
this is Shakespeare speaking through Hamlet.[68]
It is not the case that the canonical scriptures forbid suicide.
Indeed those Biblical figures who chose "death before dishonour"
received the praise of their contemporaries.[69]
It is interesting that, though historically Jesus died a cruel
death at the hands of his enemies, the fourth Gospel presents
it as his own choice: "No one takes it from me. I lay it
down of my own accord."[70]
From a Christian perspective death is not viewed as a disaster,
but as gateway to fuller life. In the early Church this was very
firmly believed. According to St Athanasius in the fourth century,
the best evidence for the resurrection of Jesus is the way Christians,
"treat death as nothing . . . they go eagerly to meet it
. . . rather than remain in this present life."[71]
Two-thirds of the early Christian martyrs were not sought out,
but handed themselves in to the Roman authorities for execution.[72]
Arthur Droge and James Tabor argue that before St Augustine changed
Christian attitudes to this question, many of the early Christians
continued to hold the stoic understanding of suicide as, "a
noble death".[73]
The beliefs of the early Christians provide an interesting counter
balance to those of their successors today who give priority to
the prolongation of life at all costs.
6. The naturalness of death
The general biblical perspective is that there
is a natural time for everything: "A time to live and a time
to die".[74]
In this context while premature death is seen as a tragedy, death
in the fullness of time is something to be accepted. Ecclesiasticus
30:17 says "Death is better than a miserable life, and eternal
rest than chronic sickness." This could be a motto for those
who support euthanasia. One of the oldest Christian prayers, often
attributed to St Ambrose, is a prayer to God for a good death:
If this is something that Christian tradition
has seen as appropriate to ask God for, should it not also be
legitimate to ask this from one's fellow human beings?
7. Does palliative care remove the need for
legalising assisted suicide?
It is often claimed that with the advance of
palliative care the case for euthanasia is no longer as strong
as it used to be. In some respects this is true. In comparison
with death columns in newspapers 30 years ago, newspapers are
now more likely to report that a person died "peacefully",
than that the person died, "after much suffering bravely
borne." However the fact that support for euthanasia has
also grown over the same period indicates that pain is not the
sole consideration. Many people find the inevitable indignities
and limitations consequent on terminal illness "burdensome"
and would wish to be spared from having to endure them. Now that
intensive therapy facilities enable death to be kept at bay for
longer, these factors have become increasingly significant.
8. How legalising assisted suicide could help
the helpless
It is sometimes claimed that that if assisted
suicide were legalised this would put pressure on the terminally
ill at their weakest point. However the well-known theologian
Hans Kung counters this. He argues that it is the present situation,
where people are denied assistance to die, which really puts pressure
on the terminally ill. He claims that very often terminally ill
people are "exposed to intolerable suffering at the very
point when their helplessness is at its greatest". He urges
that "it is precisely the most vulnerable who should be allowed
the means to ensure that their lives are not dragged out endlessly".
Kung believes that if assisted suicide were allowed it would enable
people to die, not in lonely isolation, but "supported by
true friends and with the help of an understanding doctor, in
composure and confidence, in gratitude and in tranquil expectation."[76]
9. The evidence from the Netherlands
In reflecting on the likely impact of any bill
legalising assisted suicide the evidence from the Netherlands
needs to be carefully evaluated. Abuses consequent on permitting
euthanasia in the Netherlands have been widely reported by British
opponents of Euthanasia. However according to the Royal Dutch
Medical Association, and the Dutch Society for Health Law, such
opponents of euthanasia have conveyed, "a very inaccurate
and unreliable impression about the extent and nature of the practice
of voluntary euthanasia in that country". This conclusion
is supported both by the findings of the Remmelink Commission,
and by the encyclopaedic survey of the Dutch situation by Margaret
Otlowski. The findings of the Remmelink Commission established
that "voluntary euthanasia is in fact performed much less
frequently than had earlier been thought."[77]
What their figures showed was that "a large number of patients
seek assurance from their doctors that active voluntary euthanasia
will be available if the suffering becomes intolerable",[78]
but relatively few go on to take advantage of this. According
to Ruurd Veldhuis, in 1995, 34,500 people took the precaution
of going through the necessary legal procedures to enable them
to receive euthanasia "when time would come". But of
these only 3,200, fewer than 10 per cent of those who had obtained
approval, ultimately did go ahead with it.[79]
Margaret Otlowski concludes that "there is no indication
that active euthanasia on request is practiced more often in The
Netherlands than elsewhere."[80]
Helga Kuhse and Peter Singer think that the primary benefit of
the legalisation of euthanasia in the Netherlands is that it has
enabled doctor and patient to talk freely through all the options
available. This has had the valuable consequence that "the
open practice of voluntary euthanasia may have reduced the incidence
of doctors acting without the consent of the patient in ways that
the doctor foresees will result in the patient's death.[81]
10. Is the present position in the UK sustainable?
Hitherto it has been recognised in British
medicine that in the pursuit of controlling pain, caring doctors
may prescribe medication that they "foresee" but do
not "intend" will shorten the lives of their patients.
This way of "helping out" suffering patients is legal,
but because death cannot be "intended" there can be
no open discussion of the doctor's plans with either the patient
or their relatives. No patient can know whether or not their doctor
will actually help them out in this way. No doctor who acts in
this way can now be wholly confident that their professional judgement
will not be called into question by a "whistle-blower"
who queries the need for the dosages being prescribed. Ever-increasing
knowledge about the minimum dosages needed for controlling pain
may make this way of helping people out in the final stage of
illness hazardous for the doctor. The ruling in the Burke case
has raised further problems. It is now significantly more difficult
for doctors to choose to bring to an end life-sustaining treatment
for terminally ill patients. In all questions of doubt, the issue
must henceforth be resolved "in favour of the preservation
of life".[82]
All these factors suggest that the traditional understanding of
how doctors may legitimately ease their patients out of terminal
suffering are being increasingly called into question. In the
light of this new situation the proposed careful legislation to
allow physician-assisted suicide would bring peace of mind to
both patient and doctor. In the increasing complexity of modern
medical advances, such legislation would now seem necessary to
enable good medical practice to continue.
11. A recommended amendment to the proposed
legislation
Clause 4 section 8 says that the declaration
shall remain in force for six months. This may put pressure on
a patient to ask for implementation of assisted suicide before
that date, rather than lose their authorisation for it, and face
the hassle of going through the whole legal procedure again. This
would seem unfortunate. Hence it would seem sensible to remove
a time limit.
12. The opportunity this legislation offers
for a Christian death
Historically it used to be the practice of all
believers to summon a priest when death was thought near, so that
the patient could be given the last rites, and die surrounded
by an atmosphere of prayer and worship, as well as in the presence
of family and friends. Modern technology has largely taken away
that option. Most die alone in a hospital bed so attached to saline
drips and other support systems that the older death-bed scene
ceases to be possible. Yet if one were allowed and assisted to
face the reality of the inevitable it would be possible for death
to become an affirmation. One could imagine a situation where
a Christian could say goodbye to family and friends, a Holy Communion
service could be celebrated at the believer's bedside, and he
or she could be given the last rites in preparation for the journey
through death to the life immortal. In a context of faith this
would seem a more Christian way of death than the present lonely
extension of the dying process.
SUMMARY OF
EVIDENCE
Knowing that the Select Committee is likely
to receive submissions from Christian bodies opposed to euthanasia,
the MCU is anxious that the Christian case for euthanasia should
also be heard. Euthanasia is supported by 66 per cent of members
of the Church of England who worship each week. Most people want
assisted suicide to be legalised so that they don't have to suffer
as they saw the generation above them suffer. 28 per cent believe
that it would have been better if their loved one had died sooner
than they did.
Christian opposition to euthanasia is based
on the idea that God alone should determine issues of life and
death. Yet all Christians accept the legitimacy of keeping death
at bay. Most also accept the legitimacy of family planning and
choosing when a baby should be born. The papal encyclical against
euthanasia used similar arguments to the encyclical against birth
control. Christians who think it right to seek medical help in
the timing of birth should think it equally right to seek medical
help in the timing of death.
Jesus' maxim "always treat others as you
would like them to treat you" is relevant to assisted suicide.
More doctors commit suicide than any other profession. In at least
some cases such suicides are in response to knowledge of terminal
illness. Some doctors and nurses have pacts to help each other
out if they face suffering in terminal illness. Such doctors should
treat their patients as they themselves wish to be treated.
Christians who lived before St. Augustine did
not see suicide as intrinsically wrong. Old Testament heroes who
committed suicide were praised for doing so. Christians have often
seen Jesus as choosing to lay down his life. Death at the end
of a long life should be seen as natural, not as something to
be feared. If it is moral to pray to God for an easy death, it
should be equally moral to ask for a doctor's help for it.
Although good palliative care will encourage
many not to ask for assisted suicide it will not cover all cases.
"Suffering" goes much wider than pain. Hans Kung believes
that it is the weakest and most vulnerable who suffer most under
the present system. They would have the most to gain if assisted
suicide were legalised. Most of the terminally ill people in the
Netherlands who go through the legal procedures necessary for
euthanasia do so, because they want the assurance of knowing,
that if their suffering becomes intolerable, they will be released
from it. But fewer than one in ten of these will ultimately go
ahead with euthanasia. The main benefit of the Dutch legislation
is that it enables doctors and patients freely to explore all
possibilities.
We need assisted suicide to be made legal because
the traditional understanding of good medical practice is breaking
down. The giving of medication to control pain "foreseeing"
but not "intending" the shortening of life is becoming
hazardous for the doctor. The legalising of assisted suicide would
also enable the revival of the Christian death-bed, with its opportunities
for final farewells, and for commending the person to God.
60 Robin Gill, The Churches and Euthanasia
Cassells 1998 p 21. Back
61
P Nowell Smith in Paul Badham, Ethics on the Frontiers of
Human Existence New York 1992 p 211. Back
62
Article by Clive Seale in The Times Higher 6 January 1995
p 16. Back
63
Derek Holnes, The Triumph of the Holy See Burns &
Oates 1978, p 82. Back
64
Hans Kung and Walter Jens, A Dignified Dying SCM 1995
p 119. Back
65
Robin Gill, The Churches and Euthanasia Cassells 1998
p 21. Back
66
Matthew 7:12. Back
67
Sunday Times 20 July 1997. Back
68
Hamlet Act 1. Scene 2. lines 129ff; Act iii, Scene 1 lines 56ff. Back
69
Judges 17: 28-30; 1 Samuel 31: 3-6; 2 Samuel 1: 11-27; 1 Maccabees
6: 44; 2 Maccabees 14: 41-42. Back
70
John 10:18. Back
71
St Athanasius, On the Incarnation Mowbrays 1963, pp 57-59. Back
72
A Droge and J Tabor, A Noble Death San Francisco 1992,
p 154 Back
73
Droge and Tabor, A Noble Death. Back
74
Ecclesiastes 3:2. Back
75
Hymns Ancient and Modern Revised number 17. Back
76
Hans Kung and Walter Jens, A Dignified Dying SCM 1995
pp 34, 38, 119-121. Back
77
Margaret Otlowski, Voluntary Euthanasia and the Common Law
Oxford 1997, p 437. Back
78
Otlowski, 441. Back
79
Ruurd Veldhuis, "Tired of Living, Afraid of Dying: reflections
on the practice of euthanasia in The Netherlands" Studies
in Christian Ethics Volume 11 Number 1. Back
80
Otlowski 437. Back
81
H Kuhse and P Singer, Editorial in Bioethics 3, 1992 p
4 Cited in Otlowski p .439. Back
82
The Times 31 July. The Sunday Times 1 August. Back
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