13th April, 2005

JIM REIHER

What a complicated and messy subject “euthanasia” is. To even begin to discuss it, we need to define some terms. You see, there is not just one “type” of euthanasia. There are a number.

The word essentially means to induce a gentle and painless death. It includes the notion of ending life, to prevent further suffering. But note some differences when we start thinking about it.

There is passive euthanasia - where we end life-sustaining treatment that is keeping someone alive. And there is active euthanasia - where we actually inject a drug into someone to kill them because we (or they) feel that their life is no longer possessing any “quality”.

The definitions don’t end there however. There is also voluntary euthanasia - where the person dying wants to die. And then there is involuntary euthanasia, when the decision is made by others and the person concerned has not or cannot communicate their opinion about it. There is also another level of involuntary euthanasia, where the person dying does not want to die, but the decision is made anyway by others with the power (and perhaps legal right) to do so.

Picture: Mark Csabai (www.sxc.hu) "Where is the Christian position on all this? Is there a single Christian position? Or is there an acceptable greyness about a lot (or even a little bit) of this?"

The shades of possibilities don’t end there either. Let me offer a scale of the least harsh to the most harsh types of euthanasia. I would suggest that such a list might go something like this:

• Passive, voluntary euthanasia where the person does it to themselves (that is, they turn off their own machine, or they stop taking the medicines needed to keep them alive).
• Passive, voluntary euthanasia with the help of another party - if the person physically cant do it to themselves, they may ask someone to do it for them.
• Passive, involuntary euthanasia where the person’s wishes are unable to be known, and someone else turns the machine off, or makes the decision to hold off on the life sustaining medicine. The decision might be made by loving family. Or by legal guardians who love and care for the person. Or by legal guardians not particularly loving or immediate family. Or by doctors or hospitals. Or by politicians and courts.
• Passive, involuntary euthanasia where the person’s wishes to stay alive are rejected, and the machine is turned off despite such wishes. (All the options above exist for this too).
• Active, voluntary euthanasia where the person has indicated they want to die, and they do it to themselves.
• Active, voluntary euthanasia where the person has indicated they want to die, but they are incapable of doing it to themselves, so they ask for assistance from another.
• Active, involuntary euthanasia where the person’s wishes are unable to be known, but someone else makes the decision to inject the drug (or do whatever other method is deemed to assist in the most painless way). All the options could be listed here too.
• Active, involuntary euthanasia where the person’s wishes to stay alive are rejected, and someone does the deed to them. Again all the options could be listed.

Some might not like that arrangement above and some will argue that some of the placements need to be rearranged. What do you think? Does passive action, make it less severe and more acceptable, than the individual’s wishes being followed? Is a loving family’s wishes for active euthanasia more acceptable than a government decision or a hospital decision to do passive euthanasia? Maybe every single option listed above is wrong. Maybe just some of them.

Where is the Christian position on all this? Is there a single Christian position? Or is there an acceptable greyness about a lot (or even a little bit) of this?

The issues are complex and many. Some would say that if we can maintain life, we should. In modern Western nations especially, we have technology like we have never had before. We have the means to sustain life in ways that would never have been possible in days gone by. The use of highly expensive technology for the elite rich of the world raises questions of inequality and self-indulgence that advocates of passive euthanasia will quickly note. Opponents to such an argument will say that to not use medical technology, because it is dear or only available to some, is foolishness and illogical: it undermines the goal of caring for whoever we can whenever we can. You don’t let everyone die because you might only be able to save some. And if we don’t use technology because it is expensive or only available to some, where does the logic of that stop? At what dollar value do we say it is OK to sustain life? Do we stop using asthma pumps because some poor families of the world loose children to asthma? Is it self-indulgent to allow diabetics to use insulin to keep them alive?

Some people are concerned with allowing hospitals or doctors or (worse still) politicians or courts, the right to decide who will live and who will die. If we allow such detached persons or organisations to make the decisions, how can we be sure that the decisions will be made in the best interests of the patient or families concerned? If hospital beds could be freed up and made available for other cases that are actually curable, then wouldn’t it be tempting to doctors and hospitals to decide to let some people die or even assist in that process actively? In some countries where hospitals make a lot more money using beds for (say) cosmetic surgery, than keeping a pensioner on life support, then isn’t it possible that they might make decisions for economic reasons and not patient care reasons?

The old argument that we are ending suffering by turning off machines, or injecting a drug to bring on death so as to help alleviate pain, is also questioned these days. Today there is amazing pain relief available: most dying patients do not experience intolerable pain any more. The whole science and practice of caring for the sick and dying has developed and matured and technology has taken it to new heights once thought unreachable.

And for those who believe in an afterlife (which may or may not include a purgatory, a hell, heaven or whatever we call our understanding of afterlife) - then, depending on the reality out there, it may not be ending the patient’s pain to quietly kill them or more quickly send them off to meet their maker. This argument is not all that nice a one to entertain, but it can highlight that fact that we don’t really care primarily for the comfort of the suffering dying patient. Perhaps we really care more for the comfort of the family who have to care for or put up with the prolonged and difficult dying process of the patient. Letting someone die quickly or assisting someone to die, might be removing a burden from family members. Is the growing interest in euthanasia in the West, really just a reflection of our incredibly self-centred and self-absorbed society?

Christians need to ask some hard questions, that think about both sides of the debate:
• Is caring for a “hopeless case” a waste of time? (Answer: no)
• Is there really any such thing as a “hopeless case”? (How do we define that?)
• Is serving a person who is destined to die, a worthwhile thing to do? (Yes).
• Is there ever a point where we can say that there is no quality of life? (Possibly, though this is subjective. Many a severely handicapped person has what they believe to be a worthwhile life.)
• Even if there is a point where we can say “there is no quality of life here” - is that enough justification to end that life? (Who makes the call? Who really can decide this?)
• On the other hand, must all life always be prolonged? With modern medical technology being what it is today, is that an act of love?
• Can some forms of life support be prolonging the death process, rather than prolonging life? (Possibly.)
• Could our obsession to keep people alive at all costs, for as long as possible, be a reflection of fear of death and lack of faith in God? (Possibly, for some - though there is irony here if the Christians are the most vocal to oppose it.)
• Is suicide ever not a sin? (There were some suicides recorded in the Bible: King Saul and his armour bearer, and Judas to name a few.)

• Is assisting a person to suicide, ever not a sin?
• Can love motive a person to help kill a loved one? (Probably, in some circumstances.) If so, is love enough to justify the action? (Different Christians will answer that one differently!)
Is pain necessarily meant to be avoided at all costs? (Suffering is seen in Scripture sometimes as a blessing, and not always as a burden or curse. … Though that is easy for me to say, as I sit here in comfort!)
• Should Christians try to make non-Christians live according to Christian principles? (If they want to kill themselves via euthanasia, then who are we to say they can’t? Of course, if they want to kill people who don’t want to be killed, that’s another whole question).
• How risky is it to allow governments or hospitals the right to turn off machines or actively kill patients? Even if it is meant to be done for good reasons, there must be an element of concern that institutions will shift the parameters of their rationale over time. There will be a definitional “creep” where allowances are made for things that originally were not meant to be included.
• If we permit doctors and hospitals to make decisions to actively kill what might be deemed “hopeless cases”, will the very sick and elderly become insecure about going to hospital? Will there be massive changes in attitudes towards medical care that could undermine trust in the system. Will people grow to see doctors and hospitals as suspiciously as we see politicians and used car salesmen?

When all is said and done, (and a lot more could be said that what is shared here) - any form of legalised euthanasia is risky. Our motives will never be pure and it seems to go against the general exhortations of scripture that encourage us to love life, to serve others sacrificially, to bear up in faith during painful and troubled times, and to let God decide when we die. There are grey areas, and grace should always be sprinkled over these extraordinarily difficult decisions. But cautious reflection, and love for life are always wise starting points too.

Jim Reiher (BA (double major in history), BA in Theology, Dip Ed. MA in Theology (Hons)) is a full time lecturer for Tabor College Victoria, lecturing in church history and New Testament; and also has speciality interest areas in women’s ministry, creative ministry, and the New Age movement.

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