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 | 