Sermon
preached by the Rector on 12 December 2004Some
months ago, I decided that it would be good for us, from time to time,
to explore together an issue in today's world. The hot topic I chose as
the first of these was euthanasia. At the time I hadn't realised just
how hot a topic it would be! In two days' time, the House of Commons
will be voting on the third reading of the Mental Capacity Bill, a Bill
which many people fear will open a back door to legalised euthanasia in
this country. At the same time, Lord Joffe's Assisted Dying for the
Terminally Ill Bill is currently at the Select Committee stage in the
House of Lords. It seeks to legalise assisted suicide and is due to
report early next year. As I say, this is a hot issue! What are we to
make of it as Christian believers today? Well,
let me begin by saying that I believe in euthanasia - but let me very
quickly explain what I mean by saying that I believe in 'dying well',
which is the literal meaning of the word 'euthanasia'. This has always
been seen as one of the main aims of the medical profession - helping
people to 'die well', free from distress and pain. What I most
certainly don't believe in is what the word has been broadened to
include: the deliberate ending of human life. THE LEGAL POSITION At
the moment, the Netherlands is the only country in the European Union
in which so-called 'mercy killing' has any legal basis. But pressure to
change the law in other countries, including the UK, is growing. It's
an issue which we need to face up to. So - what are the reasons given
for being in favour of euthanasia and how may we respond? THE RELIEF OF SUFFERING The
first and most obvious reason for allowing euthanasia is to reduce
suffering. The argument goes that we should regard the act of
deliberately ending life as part of what it means to care for someone
properly. Those who support euthanasia report cases where patients have
had to die in agony or been forced to endure inappropriate treatment
and brutal resuscitation. It's an argument which has many
supporters. But the answer to such bad
medicine is not euthanasia but good medicine. Tomorrow evening, St
Nicolas is hosting one of several carol services of remembrance and
celebration for the children's hospice, Naomi House. The remarkable
rise of the hospice movement has shown very clearly that the process of
dying need not be as painful as many fear it will be. Dame Cicely
Saunders, who founded the hospice movement, said this over 40 years
ago: 'We are now always able to control pain in terminal cancer in the
patients sent to us and only very rarely indeed do we have to make them
continually asleep in so doing'. Some years
later, she took a former chairman of the Voluntary Euthanasia Society
round St Joseph's Hospice. She says, "He came away saying, 'I didn't
know you could do it. If all patients died something like this, we
could disband the society... I'd like to come and die in your Home'.
Dame Cicely comments: 'If you relieve a person's pain and if you can
make him feel like a wanted person, then you are not going to be asked
about euthanasia... I think euthanasia is an admission of defeat, and a
totally negative approach. One should be working to see that it is not
needed". A
LIFE NOT WORTH LIVING? Quite apart from
this, the argument about suffering is based on the idea that there
might be such a thing as a human life which is not worth
living. But such a statement needs to be
challenged. For human life is not like other forms of life. Let me put
it like this. We have no difficulty with the idea of taking an animal
and 'putting it out of its misery'. But there is something about human
beings that makes us hesitate before doing the same thing to them.
Human life commands a different degree of awe and respect. From
a Christian viewpoint, this respect comes from the fact that we are
made in the image of God, something underlined further by the fact
that, as we celebrate at Christmas time, humanity was the form chosen
by God when he came to earth in the person of Jesus Christ. And
so we believe that life is God's gift - a gift which is all the more
special by the way he has invested something of himself in each of us.
The fact that we are uniquely made in God's image is the reason the
Bible gives for saying that the taking of innocent life is wrong in
Genesis 9:5-6. As God's gift, life is something which is his to give
(Genesis 2:7) and, at the time of his choosing, his to take (Job
30:23). We are not simply creatures whose
job it is to live out our time on this planet in as pain-free a way as
possible. Here's how one report put it: 'because man is a spirit, talk
of the quality of his life is not an adequate reason for deciding to
suppress his existence'. THE 'RIGHT TO DIE' Another
line of argument from those in favour of euthanasia is the claim that
just as we have a 'right to life' so we also have a 'right to death'.
They argue that the question of when my life shall end is a matter
which I should decide. As society has developed and recognised other
rights (such as the right to choose those who govern us and the right
to choose who to marry) so, as a mark of our maturity as a race, we
should allow ourselves the 'right to die' when we choose as
well. But hang on a moment! Who says we
have a 'right to life'? When any of us could die at any time, to claim
some sort of 'right to life' is like whistling in the wind. What we
actually have is not so much a 'right to life' as a 'right not to be
killed'. If that's true, then having the 'right not to be killed' is
clearly incompatible with having at the same time the 'right to be
killed' when we so choose. But in fact, the
whole idea of a so-called 'right to die' is a red herring anyway. For
most people think that the 'right to be killed' would really only apply
in situations where someone was suffering so much that they could be
thought of as better off dead. The chief concern is not so much the
'right to die' as the 'right not to suffer', which brings us back to
where we earlier. A further difficulty is
that one person's right becomes another person's duty. If we were to
agree that people have the 'right to be killed', we would have taken on
a rather uncomfortable obligation. For it would then be nothing less
than our duty to assist someone to exercise their so-called right to
die, whether we wanted to or not and whether we agreed with them or
not. Another difficulty stems from the role
of the doctor. Doctors have a mandate to heal, full stop. A patient's
motives in requesting their doctor's help don't come into it. A
doctor's duty is simply to seek to improve health. What the patient
does with such health (for example a burglar returning to crime) is up
to him. The problem with euthanasia is that
it doesn't stem from such a universal mandate but from the much less
secure basis of the stated wish of the patient himself or herself. Is
it right to take such an irreversible step as the ending of life on the
solitary basis of a patient's stated motive? How can anyone take such a
decision now on the basis of the imagined prospect of what suffering
might be like in the future? But then, once that future time of great
distress and depression arrives, how can such a step be taken then
either, a step which, at a time of calmer reflection after pain has
been eased, might well be vigorously rejected? When is the decision to
be made? One of the things about living in
a society is that we accept certain limits to our own freedom of action
in the interests of others. It is difficult to see how voluntary
euthanasia could be legalised without infringing the liberty of those
who need protection from being killed against their will. That's
because if the main reason for allowing euthanasia is to relieve
someone's suffering, then why do we need their permission? If we see
someone suffering, why not just end it for them? If they say 'no', all
we have to do is to conclude that the balance of their mind must be
disturbed and do it anyway. In other words, the step from voluntary to
involuntary euthanasia is a very small one. Germany
in the 1930's provides a horrifying picture of the slippery slope that
is created when euthanasia is allowed: "The first to be killed were the
aged, the infirm, the senile and mentally retarded, and defective
children. Eventually, as World War II approached, the doomed
undesirables included epileptics, World War I amputees, children with
badly modelled ears and even bed wetters". MODERN MEDICAL PRACTICE One
important strand in the pro-euthanasia argument relates to the
greatly-increased skills of the medical profession in keeping alive
people who would previously have been beyond the scope of active
treatment. Some of those who fear the excesses of modern medicine
suggest that euthanasia should be employed as a safeguard against
unwelcome intrusion by medical technology. Others
suggest, not so much that euthanasia should be employed, but that it
already is being employed and that such 'institutionalised hypocrisy'
should be brought out into the open and recognised in law. There are
three particular situations for us to consider. 1. SWITCHING
OFF THE MACHINE First then, is it
euthanasia when a doctor switches off the life support machine of a
patient judged to be 'brain dead'? In cases like this, we need to make
a distinction between 'human life' and 'biological life'. To extinguish
human life, with its "ability, actual or in potential, to respond to
others or to be self-aware" would indeed constitute euthanasia. But
where this actual or potential ability is no longer present, where the
patient is clinically 'brain dead', withdrawal of therapy is not the
same as euthanasia. For in an important sense, death has already taken
place. The patient is no longer 'there'. 2. THE
DIFFERENCE BETWEEN ACT AND OMISSION Secondly,
many who think that doctors already practice euthanasia argue that
there is no real moral distinction between a doctor not giving
treatment which he regards as inappropriate (sometimes called 'passive'
euthanasia) and an 'active' euthanasia which deliberately takes
positive steps to hasten death. Clearly, if there is no such
distinction, then we ought to allow both. For
example, take a patient who develops pneumonia on top of another
terminal and untreatable condition. Should antibiotics be employed? Is
there any difference between deciding not to prescribe antibiotics in a
case like this and deciding to give someone a quick injection to kill
them off straight away? The answer is yes,
there is. For although the consequence, namely the death of the
patient, is the same, morality is concerned with the intentions of
those involved. Although treatment with antibiotics might be withheld
with the intention of causing death, it need not be. Treatment may also
be withheld for other reasons and without intending to cause death,
even though it is known that death is likely to occur. Such
reasons include the knowledge that the process of dying has already
begun. Doctors have the mandate to prolong life, yes, but not to
prolong the process of dying. Take the terminally-ill patient who
contracts pneumonia, for example. Although the pneumonia might resolve
if antibiotics are given, the underlying terminal condition means that,
overall, the treatment would not in fact be successful. Withholding
inappropriate treatment is not the same as actively taking steps to
hasten death. 3. HASTENING
DEATH BY ACCIDENT OR DESIGN So much for
passive euthanasia. But some people argue that doctors already practice
active euthanasia in prescribing drugs like morphine in terminal
illness. The argument is that because a patient treated with morphine
is likely to suffer depression of the brain centre that controls
breathing which is in turn likely to lead to fatal pneumonia, such
prescriptions are tantamount to euthanasia. But
again we return to the issue of intention. If the doctor's intention is
to cause death, then yes, he would be practicing euthanasia. But in
fact, the doctor's intention would normally be primarily to provide
pain relief. Death might occur, yes, but even though forseeable, it is
an unintended consequence. This is an area
in which doctors experience the tension between their duty to save life
and their duty to relieve suffering. They have no right or obligation
to try and drag a patient back from an irreversibly terminal disease
and delay a death which has already begun. But neither do they have the
right deliberately to accelerate death, even when asked to. Failure to
delay death is not necessarily the same as deliberately advancing
it. IN
CONCLUSION I said earlier that the Bible
views our life as a gift from God. But I want to add that life is more
than a gift - it is also something we hold on trust. The thing is that
our lives are not ours to do with as we please: they belong twice over
to the God who both created and redeemed us. At the end of the day
then, to choose death is to deny God's love and faithfulness. It's to
say that God made a mistake when he entrusted us with life and that he
continues to make a mistake by sustaining that life in us. Whereas, in
fact, all human life, from the most limited to the most fulfilled, is
part of his divine providence, both in times of sorrow and in times of
joy. To quote Job 1:21: '...The Lord gave and the Lord has taken away;
may the name of the Lord be praised.' It
seems to me that voluntary euthanasia is not morally justifiable and
mustn't be confused with proper ways of treating sick people. Dame
Cicely Saunders focuses the issue in this way: "When a man asks for
death someone has failed him". Our concern needs to be with helping our
fellow human beings to seek life, not death. Not failing one another
but valuing ourselves as those created in God's image and those for
whom Christ died to bring to eternal life. Let
me conclude with some comments about the Mental Capacity Bill. To quote
from the summary provided by the Department of Constitutional Affairs,
it "provides a statutory framework to empower and protect vulnerable
people who may not be able to make their own decisions. It makes it
clear who can take decisions in which situations and how they should go
about this. It enables people to plan ahead for a time when they may
lose capacity." So what's the problem? Well
the answer is that there are serious concerns about what are known as
'advance directives' (also called advance decisions to refuse
treatment) being given the force of law. The concern is that doctors
could easily find themselves being forced by law to withhold
life-saving treatment, against their better judgment, on the basis of a
statement the patient made in the past, a statement which need not even
be in writing. How would a doctor know for certain that the patient who
has lost capacity hasn't changed his mind since making such a
directive? How would the doctor know whether or not the patient had
realised all the consequences of refusing treatment? What would stop
elderly or disabled people who don't want to be a burden to others
feeling under pressure to make advance directives? And so on. The
basic concern is that this Bill would allow euthanasia to come into law
'through the back door'. The Bill fails to distinguish between medical
treatment on the one hand and basic care on the other. As we have seen,
to withdraw treatment, if it has become futile or is causing undue
suffering, is already quite legal, and entirely right. However, if
aspects of basic care such as nutrition and hydration can be legally
withdrawn, the effect is to legalise intentional killing by omission.
It's true that the Government has stated that it is not in favour of
euthanasia. But it has failed to ensure that this Bill could not
sometimes result in the intentional killing of those who become
mentally incapacitated. Iain Duncan Smith puts it very graphically:
"Not only will people be sentenced to death but they will die in the
most horrible of ways... For those who cannot communicate and who are
out of sight, the possibility is that they could be starved or
dehydrated to death." Parliament votes on
Tuesday and so it's nearly too late for us to do much about this.
Nearly too late - but not quite! If you would like to make your voice
heard (on either side of the debate!) then do equip yourself with this
leaflet and these two letters, one addressed to the Prime Minister, and
the other addressed to our local MP, David Rendel. They'll be available
at the back after the service. The letters call for the rejection of
the Bill unless the Government accepts amendments reversing the
provisions that are in danger of bringing in euthanasia, and also call
for the Government to allow a free vote for Labour MPs on what is
clearly a matter of conscience. You may feel able to add your name and
address here and now and have your letter sent off with others from the
church today. Or you may prefer to take them home and send them - or
your own re-written versions of them - by letter, fax or email to reach
the House of Commons by Tuesday. Whatever
we feel able to do or not do in terms of writing letters, let us pray
that God will move in the hearts of our leaders and cause them to
strengthen rather than weaken the protection the law offers the weak
and the vulnerable. In the words of Proverbs 31, let us 'Speak up for
those who cannot speak for themselves, for the rights of all who are
destitute. Speak up and judge fairly; defend the rights of the poor and
needy.' Amen. © 2005 David Stone |