Euthanasia

Susanna Chan 陳廣慧

(指導老師郭鴻標 博士)

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Introduction:

 

To have a good death is something shared by most of us.  With the development of modern medical technology and hospital service, many illnesses become curable nowadays.  However, technology still has its limits.  We are not free from illness and death since the day we were born.  For those terminal patients who suffer from intorable pain physically and sometimes emotionally as well, is it ethical for them to choose euthanasia to end their lives?  What are the reasons that prompt them to do so?  Are these reasons justified and indisputable?  Is there any ethical values and imperatives that rules out euthanasia as the only choice left the patients?  The aim of the paper is to deal with these issues.

 

I.  Definition

 

The word “Euthanasia” is composed of two Greek words: “eu” and “thanatos” and originally means “gentle or easy death”.  In modern sense, it is also an expression of “mercy killing”.  Since there is a variety of ways in which the word is used, it is important for us to provide a helpful definition for the sake of discussion.

 

The most common definition of euthanasia connotes the active, intentional termination of a patient’s life by a doctor through direct measures to end suffering based on the belief that the patient would be better off dead.  It is also often called “voluntary direct euthanasia” (VDE).  In medical context, the death of a patient can be caused by many different ways, such as an omission or the side-effect of an increasing use of pain-killing drugs.  For those who are in persistent vegetative state (pvs) or high risk new-born babies, their death may result from the will of their family members or parents.  There are basically three kinds of euthanasia when the desire or will of the patient is taken into consideration.  Voluntary euthansia is carried out at the request of the individual whose life is ended; involuntary euthanasia is carried out without the request for consent of the competent individual whose life is ended; nonvoluntary euthanasia is carried out on incompetent individuals.  The focus of this paper is placed mainly on the issue of voluntary active euthanasia (VAE).  In some countries, VAE is also called physiciant-assisted suicide (PAS).

 

The criminal law in most jurisdictions, including Hong Kong, regards active intentional killing by doctors as the same offence as active intentional killing by anyone else: murder or homicide.  Despite the fact that voluntary euthanasia is prohibited in Hong kong, it is allowed in such countries as Holland, Switzerland, Oregan of the US and etc.   The term “euthanasia” used here mainly refers to voluntary euthanasia – the implementation of a decision that a particular individual’s life will come to an end before it need do so -- a decision may involve direct interventions or withholding of life-prolonging measures and that decision coincides with the individual’s own wishes.[1] 

 

II.  The Moral Reasons behand Euthanasia

 

1.  To Avoid Pain and Suffering

 

Actual or anticipated pain and suffering is undoubtely one of the major reasons for those terminally ill patients to ask for euthanasia.  They prefer die to receive those treatments which would only prolong dying.  Feelings of pain or suffering do not necessarily come from the physical conditions only, but also the psychological and emotional states of the patients.  In 1993 a Canadian woman named Sue Rodriguez, who suffered from a terminal illness, asked for the termination of her life since she was told that her body would stop functionning very soon.[2]  Since she did not want to rely on life-sustaining machines and nurses to sustain life and believe that death would come in a foreseeable future, she wanted to die with artificial means before her body collapsed totally. [3]  In the United Kingdom, there is also a case showing that suffering from acute pain prompted an individual named Lillian Boyes to ask for voluntary euthanasia and her doctor complied. [4]      

 

Does pain and suffering pose sufficient reason for an individual to opt for euthanasia?  In fact, in the modern medical system of many countries, the provision of comfort-only or palliative care are available for patients to relieve pain and suffering effectively[5].  It is also regarded as an obligation of physicians towards patients as part of medical ethics.   A study of 110 AIDS patients conducted in 1990 in London shows that active provision of palliative care led to a comparatively small percent of patients to consider euthanasia seriously as a choice.[6] 

 

It is understandable that suffering and pain either actual or anticipated causes people to opt for death than life, especially when the chance for recovery is slim.  In the Bible, there are also people who killed themselves or pled with God to take their lives[7], when suffering from pain and/or emotional agony.  However, the story of Job serves as a good example of great endurance and faith.[8]  He did yearn for an end to his suffering and pain, that is death indeed, but there is no evidence that he considered seriously killing himself as an option.[9]

 

2.        The Loss of the Value of Life and Dignity

 

The growing fear and anxiety over the loss of the sense of self-control and the value of life caused by chronic illness are shared by many of us nowadays.  In (post)modern society, the value of life is often equivalent to how much we achieve in life and/or how much we experience in life.[10]  Driven by the fear that they would one day lose control of their lives because of the plight of illness and be hooked up to all those tubes and machines at the mercy of medical professionals, patients would find euthanasia a better way out[11].  The individuals who choose death want to take control of his/her fate and determine whether to take treatment or not.  They would find that their life is stolen away by chronic illness and dignity is slowly eroded by increased dependence on long-term caregivers.  In Hong Kong, a well-known young man called Ben Chai (斌仔), who has been remaining in hospital for more than 10 years after an accident at a very young age, wrote to the Hong Kong government in 2003 to appeal for the enactment of euthanasia.[12]  He did so because he found it not only very lonely but also meaningless to stay in the hospital for the rest of his life.   He even finished a book called I Want Euthanasia in 2007 to defend for his pro-death choice.  In the book, he expressed his deep disappointment over his life and could not help compare his future and value of life with those of physically able persons.[13]

 

Though life to those people like Ben Chai becomes a great trial and their feelings are hardly shared by the physically able persons like us, it  does not mean that the loss of value of life justifies an individual to choose euthanasia.   According to a medical research, sometimes patients suffer from depression and by a combination of empathy, psychotherapy and medication, they are able to regain courage to keep on living and view life positively.[14]  But when such a depression is met by physicians, family and friends who reaffirm the death wish, as might happen if physician-assisted suicide became an accepted practice, then it could only increase.[15]  In Hong Kong, there are also patients who suffered from terminally illness and yet embraced a

positive view of life, like Tzi Mou (子鶩) and Chuen ChangYok (全湛玉).[16]

A Japanese Christian writer who cannot move except for his eye brows writes books to tell the world how wonderful the world is to him.[17] 

These stories serve as a demonstration that despite illness and disability, life is still worth living and the value of life is not necessarily dependent on how much one achieves in life. 

 

From the Biblical account, we know that God created the whole world and everything in it and saw them as good.  Though we sin against him and have to die because of our sin, apostle Paul told us that “ for in him (God) we live and move and have our being” (Acts 17:2).  Because God is our creator, we are assured that we don’t need to justify or explain our continued existence, even though such a form of existence seems to bear no values in our own eyes.[18]  The value of life is not defined in our own terms but God.   

 

3.  To Relieve the Burden of Family Members or Loved Ones

 

In the Mainland China, a news coverage this year reported that a young woman called Li Yan, aged 28, suffering from chronic illness, called for the National People’s Congress to legalize euthanasia in the country so that she can end her life.[19] Since she has lost almost all the ability to maintain her daily life and has to depend on her mother for nearly everything, she is afraid that if her mother died before her, her life would be in misery.[20] She wanted to die before her mother and found it the best way to relieve the financial, physical and emotional burdens of her parents.  In many cases, parental care and responsibilities are the key contributing factors for those chronically ill and highly disabled people like Li Yan to continue to exist, expecially in those societies where welfare system is not well developed or accepted.  It could be out of love for the parents or fear of losing them that drives an individual to try to end his/her life prematurely.  Sometimes, it is a highly handicapped wife that wants to die so that her husband would be free from the responsibilities to take care of her or vice versa.  The motivation to die could be due to a kind of self-sacrificial love.

 

However, to eliminate one’s life on the ground that their death would lighten the burden of another person is not well-founded.  Taking Li as an example, it is out of her speculation that she would outlive her mother one day and her death would be a benefit to her mother.  There is no need for us to doubt Li’s love for her mother, but she cannot be 100 per cent sure that it is also her mother’s desire for her.  The means that Li chose does not justify the ends that she wanted to achieve.  There is so much unknown and speculations involved that there is no absolute necessity for Li to ask for euthanasia.  Unless one is absolutely sure that his/her death is necessary for the well-being of another person, one is obliged to die.[21]

 

In Christian history, honerable and praiseworthy death such as martyrdom did happened since church started to take root in the world.  At the beginning, many church fathers were persecuted to death because they were unwilling to give up their faith in God.  According to Stanley Hauerwas, the preservation of life in all conditions is not necessarily the ultimate goal of an individual because there is a higher goal to be attained than that[22].  To him, the goal is related to the building up and sustaining of a community with shared values and stories, such as mutual trust, care and Christian convictions.[23]  As Hauerwas points out in a critique of suicide, the obligations of sick and dying persons do not entail any sort of calculation of the “burdensomeness” of their care:

 

“ We fear being a burden for others, but even more to ourselves.  Yet it is only by recognizing that in fact we are inescapably a burden than we face the reality and opportunity of living truthfully.”[24] 

 

Thus, in view of Hauerwas, dying and living in a community had better be an expression of the truth that each of us trustfully depends on God and one another.

 

4.      It is affected by Medical Personnels 

 

In 1995, a programme Death on Request, produced by a Dutch company, was screened by the BBC, in which a patient with motor neurone disease, Cees van Wendel de Joode, asked for and was given VAE by his physician.[25]  The physician said he had to offer VAE because “what else can I offer the man?  I can give him wonderful equipment so he can make himself understood.  I can give him the finest wheelchair there is, but in the end it is only a stopgap. He is going to die and he knows it.”  A second doctor who was consulted by the first physician told Cees that to qualify for VAE he must be experiencing ‘hopeless suffering with no chance of a cure’ and that Cees satisfied this criterion.  The doctor added: “You have an incurable disease which will soon end in death.  And unless something is done you will suffer terribly.  You will probably suffocate.”  But the programme host pointed out that Professor Stephen Hawking is alive twenty-five years after he was diagnosed with the same illness and, while far more incapacitated than Cees, has managed to live a brilliantly productive life. 

 

Since Cees is from the Netherland where VAE has been legally sanctioned since 1984, it is held that he has been given no choice except for the choice between terrible suffering or death.[26]  The attitude of doctors towards euthanasia does have a great impact on the decision a patient will make concerning euthanasia.  If euthanasia is allowed, doctors are likely to perform it and regard it as the only choice left for the patient.  In this way, vulnerable people could end up avoiding asking for medical help, for fear that their doctors would recommend euthanasia.[27] On the contrary, patients could also forgo treatment and ask for euthanasia on the belief that it is the only best choice for them.

 

III.  The Morality of Euthanasia

 

Arguments For Euthanasia:

1.        From a human right perspective

 

German Theologian Hans Küng, former priest of the Catholic Church, argues in favor of euthanasia including VAE.  The reason is simply: the terminally ill patients have a right to self-determination for a dignified dying, Christian and non-Christian alike.[28] Though human life is a “gift of the love of God”, life is at the same time also a human task and thus made our responsibility (and not that of others).[29]  As human beings are involved and responsible for the processes of life (for example, both father and mother decide when to have children and how many children they want), it is natural that God also makes the ending of life their responsibility.  According to his line of argument, God’s will and human autonomy both play a crucial role in the creation, continuation and end of human life.  The exercise of God’s sovereign control over human beings does not mean that God has an “ordained end” for all that no one is allowed to breach.  For those terminally ill patients who suffer from intolerable pain, it is their right, not the physicians, to decide whether they should continue to rely on artificial means to prolong suffering or not. 

 

Arguments against Euthanasia

 

1.     It is equilivent to committing suicide because

 

 

a.         Life is sacred

 

In the Bible we learn that human beings have been created in the image of God, blessed by God at creation, and regarded by God as “very good” (Genesis 1:26-31 NRSV).  Theologian Arthur J. Dyck points out that for this reason alone one can surely say that God has rendered human life “sacred”, endowing it with a worth that human beings cannot even fathom let alone calculate.[30]  His argument is furthered by that of Karl Barth who regards respect for life as something God has commanded of all human beings[31].

 

The notion of the sacredness of life calls for one to love and respect life rather than death.  According to Dyck, the loss of love for one’s life is a signal that something is wrong with a person[32].  To him, it is love for one’s own life, and that of others, that elicits the perception that a suicide should be prevented, and the love of life should be restored. [33] 

 

b.        It is against the Sixth Commandment

 

The Sixth Commandment “You shall not kill” prohibits one to taking the life of others.  The endorsement of euthanasia means that doctors are given the power to kill their patients.  On the part of patients, their decision to hasten die is also a violation of the Six Commandment.  It is tantamount to committing suicide.  The commandment against murder has almost universally been interpreted to apply also to taking one’s own life.[34]  Those who kill the sick are to be viewed as murderers, according to the Hebrew tradition.  God authorized only the killing of the guilty.  “Innocent” blood could not be intentionally shed under any circumstances.  In the Bible, there are a few accounts of suicide and the scripture reminds silents on the moral status of the matter.  However, the silence cannot be counted as approval of or indifference to the practice.[35]   

 

2.  The Role of Doctors is Changed

 

The role of doctors is to heal rather than to kill.  In the ancient Hippocratic Oath, physicians would swear to practice and prescribe to the best of their ability for the good of their patients, and to try to avoid harming them.  Despites its paternalistic inclination, the Hippocratic Oath had traditionally been taken as an oath by physicians pertaining to the ethical practice of medicine.  The Oath never sanctioned euthanasia because it would have changed the belief, value and practice of doctors.  It is understandable that they may want to help patients hasten the end of life if the illness is incurable and the pain of patients is intorable.  However, the introduction of euthanasia would cause conflict in the role of doctors and have long lasting effect on the doctor patient relationship.  Doctors may become the ones who are hardened to death and to causing death to patients.  Reciprocally patients may start to doubt the intensions of their doctors.  The trust between them is likely to be eroded.  In the Netherlands disabled people already describe a growing mistrust of their doctors and fear of being admitted to hospitals - which should be places of care and safety for the vulnerable members of society.[36] 

 

The distrust of patients towards doctors is supported by statistics.  Survey conducted in the Netherland in 1990 showed that some 1000 cases (0.8% of all deaths) in which physicians prescribed, supplied or administered a drug with the explicit purpose of hastening the end of life without an explicit request of the patient. [37]  Most of the cases involved seriously ill and terminal patients who could not express their wishes, but it was found out that there was a “small number” of cases in which the decision could have been discussed with the patient.[38]  In other words, some physicians intentionally killed patients without being asked to do so. 

 

3.  Suffering is Part of Our life

 

Since first human being sinned against God, suffering and pain also started to enter the world.  The Bible gives us an image of the suffering Messiah Jesus Christ who is “a man of sorrow, and familiar with suffering.” (Isaiah 53: 3ff).  Apostle Paul, when faced with what has been taken as a physical ailment, asked God to heal him but of no avail.  He did not express feelings of disappointment; rather he accepted his affliction as necessary for God’s purpose (2Cor12: 8-10).  When facing with suffering and pain, we are not to kill ourselves so as to put an end to it.  On the night before Jesus was betrayed, he told his disciples in the upper room that they would have trouble in this world and encouraged them to be brave because he had overcome the world (John 16:33).  Jesus did not give his followers a false picture of a trouble-free life in this world.  He himself chose to die on the cross to identify with the infirmity of human nature.  In contrast to the cross, the resurrection of Christ means liberation: freedom from anxiety, sin, death, pains and corruption.  However, before the new heaven and the new world arrive, we are not entirely free from trouble and suffering this life.  In his theology of the cross, Martin Luther makes known to us the hiddenness of God at the cross and asks us to trust in God because He is especially working in us through pain and suffering.[39]  He himself was plagued with bouts of serious illness, but he did not view such illnesses as divine punishement but as the natural consequences of humanity’s fallen state to be countered with both prayer and meditation.[40]  In an age before pain medication, Luther bore his great illnesses until his natual death.[41]

 

4.  Individual and Community Do Not Exist Separately

 

We do not exist individually; rather, we are social being.  Euthanasis is not just a private decision but also has moral impact on the community at large.  The moral reasons for individuals to continue to live lie in the fact that their personal convictions will affect the cultural values of the community.[42]  To Hauerwas, our convictions to continuous existence despite the adversities are an expression of our Christian character and such a character will in turn shape the moral characteristics of the community we are in.[43]  On the contrary, if we give up our lives by submitting ourselves to euthanasia, we send forth to the community a signal or message that one can stop his/her existence in the world by artificial means at his/her own wishes assisted by physicians.  Once euthanasia become a social practice and social norm, it is difficult, if not impossible, for individuals to choose not to comply. 

 

Christian faith and tradition are at odds with euthanasia.  Euthanasia undermines our notions of living bravely in the face of suffering as individuals and as communities.  Although community is not always a warm feeling, to keeping on living despite severe afflictions is a way to affirm our continued contribution and affirmation of the goodness and care of the community in which we exist.[44]  It aso acts as a source of strength and consolation for ourselves and our community.

      

 

5.     Autonomy, its Responsibility and Value

 

Advocates for euthanasia argue that patients ought to have the right and autonomy to take their own lives if they so desire.  They may reject traditional views about the sacredness of life and allow individuals to make their own personal decisions about when and how to die and such a decision merits respect.  However, the autonomy of individuals is not absolute because it requires another party to fulfill it.  Physicians are the ones who are bound to “kill” even if they do not necessarily agree with the idea of the patients.  In the UK, it is a contestable issue for doctors as to whether they should assist dying patient to commit suicide or not.[45]  The fact is that we do not live as atomized individuals; rather, we live our lives in the moral company of others.[46]  It does not mean that individuals cannot choose what they want for themselves.  It just means that the value of autonomy should be given way to more important values such as the sacredness of human life and the immorality of killing an innocent life when the former value is in conflict with the latter ones.  It is consistent with the teachings of the scripture in which apostle Paul put aside his freedom in order to serve others and bring them to Christ.[47]  In other words, the exercise of autonomy is not inviolable if higher goals are to be promoted or, at least, not to be sacrificed.       

 

In Conclusion:

 

Euthanasia, the termination of one’s life with medical means, is not a justified choice for patients for reasons mentioned above.  Life is precious because it is created in God’s image.  We are not free to end it at our own wishes.  When we are dying and suffering from great pain and anxiety, we can still have hope.  We can place our hope on Jesus who also shares our suffering, others in the community to relieve our pain and the Resurrection promised by our Heavenly Father.

 


Bibliography

 

John Keown, ed.  Euthanasia Examined: Ethical, Clinical and Legal Perspective.  Cambridge: Cambridge University Press, 1995.  

 

Hans Küng and Walter Jens, Dying with Dignity: A Plea for Personal Responsibility. New York: Continuum, 1995.

 

Hans Küng and Walter Jens, A Dignified Dying. Munich: SCM Press LTD, 1995.

 

James B. Tubbs. Jr. Christian Theology and Medical Ethics: Four Contemporary Approaches. Dordrecht: Kluwer Academic Publishers: 1996.

 

Edward J. Larson & Darrel W. Amundsen, Euthanasia & the Christian Tradition: A Different Death. Downers Grove: InterVarsity Press, 1998.

 

Michael Manning, Euthanasia and Physician-Assisted Suicide: Killing or Caring? New York: Paulist Press, 1998.

 

Margaret P. Battin, Rosamond Rhodes & Anita Silvers eds.  Physician Assisted Suicide: Expanding the Debate. New York: Routledge, 1998.

 

John Berkman & Michael Cartwright eds.  The Hauerwas Reader.  Durham: Duke University Press, 2001.

 

John Keown, Euthanasia, Ethics and Public Policy: an Argument Against Legalisation. Cambridge: Cambridge University Press, 2002.

 

Arthur J. Dyck. Life’s Worth: the Case against Assisted Suicide.  Grand Rapids: Eerdmans, 2002.

 

史密玆著柯美玲等譯。《祗是道德》。北:中華福音神學院。1988年。P. 178.

 

鄭順佳。《天理人情—基督教倫理解碼》。香港:三聯書店。2005年。

 

Yahoo News. www. hk.news.yahoo.com.

 

Christian Medical Fellowship website: www.cmf.org.uk.

 



[1] John Keown, ed.  Euthanasia Examined: Ethical, Clinical and Legal Perspective.  Cambridge: Cambridge University Press, 1995. p. 6.

[2] Margaret P. Battin, Rosamond Rhodes & Anita Silvers eds.  Physician Assisted Suicide: Expanding the Debate. New York: Routledge, 1998. p. 123.

[3] Ibid.

[4] John Keown, 1995. p.7.

[5] Arthur J. Dyck. Life’s Worth: the Case against Assisted Suicide.  Grand Rapids: Eerdmans, 2002, p. 54.

[6] Ibid. p. 4.

[7] In the OT, Abimelech and Saul killed themselves or requested another to do it on their behalf.  Also, Elijah cried out in despair, “It is enough; now, O Lord, take my life” (I King 19:4).  Even Moses pled with God, “Please kill me at once, if I have found favor in your sight” (Num 11:15).

[8] Edward J. Larson & Darrel W. Amundsen, Euthanasia & the Christian Tradition: A Different Death. Downers Grove: InterVarsity Press, 1998, p. 54-5.

[9] Ibid. p. 55.

[10] Hans Küng and Walter Jens, Dying with Dignity: A Plea for Personal Responsibility. New York: Continuum, 1995. p. 4.

[11] Michael Manning, Euthanasia and Physician-Assisted Suicide: Killing or Caring? New York: Paulist Press, 1998. p. 27.

[12] Yahoo News. www. hk.news.yahoo.com. Dated 07-05-2005.

[13] Ibid. Dated 06-05-2005.

[14] Edward J. Larson & Darrel W. Amundsen, p. 251.

[15] Ibid.

[16] Tzi Mou suffered from chronic illness since he was born and died at 23.  He was well known for his love of not just his own life but also the life of others.  The support from his mother was also very important for him.    Miss Chuem ChangYok was diagnozied with cancer.  Her battle for the terminally illness was recorded in her new book to encourage people suffering from illness to keep going. Cited in Yahoo News. Dated 11-05-2005.

[17] The story is collected in one of the books written by a then Taiwanese writer 杏林子。

[18] Margaret P. Battin, Rosamond Rhodes & Anita Silvers eds. p.340.

[19] Yahoo News. Dated 13-03-2007.

[20] “I love Life but I don’t want to live” from Sinablog. http://blog.sina.com.cn. Dated: 12-10-2006.

[21] 史密玆著柯美玲等譯。《祗是道德》。北:中華福音神學院。1988年。P. 178.

[22] James B. Tubbs. Jr. Christian Theology and Medical Ethics: Four Contemporary Approaches. Dordrecht: Kluwer Academic Publishers: 1996. p. 115.

[23] Ibid. p.114.

[24] Hauerwas, S.: 1986, Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church, University of Notre Dame Press, Notre Dame. Page. 107 cited in James B. Tubbs. Jr. p.115.

[25] John Keown, Euthanasia, Ethics and Public Policy: an Argument Against Legalisation. Cambridge: Cambridge University Press, 2002, p. 137.

 

[26] Ibid. p. 138.

[27] cited from Christian Medical Fellowship website: www.cmf.org.uk. Uploaded in 2003.

[28] Hans Küng and Walter Jens, A Dignified Dying. Munich: SCM Press LTD, 1995, p. 22.

[29] Hans Küng and Walter Jens, p. 26.

[30] Arthur J. Dyck. P. 87.

 

[31] Ibid.

[32] Authur J. Dyck, p. 93.

[33] Ibid.

[34] Margaret P. Battin, Rosamond Rhodes & Anita Silvers, eds. p. 335.

[35] Ibid.

[36] cited from Christian Medical Fellowship website. www.cmf.org.hk. CMF file uploaded in 2003.

[37] John Keown, Euthanasia, Ethics and Public Policy: an Argument Against Legalisation. Cambridge: Cambridge University Press, 2002, p. 104.

[38] Ibid.

[39] 鄭順佳。《天理人情基督教倫理解碼》。香港:三聯書店。2005年。P. 146.

[40] Edward J. Larson & Darrel W. Amundsen, p. 147.

[41] Ibid.

[42] John Berkman & Michael Cartwright eds.  The Hauerwas Reader.  Durham: Duke University Press, 2001. p.584-5.

[43] Ibid.

[44] Ibid. p.590.

[45] “Should Doctors Assist Dying?” An Internet TV programme in Christian Medical Fellowship website. www.cmf.org.uk.

[46] John Keown, p.54.

[47] “Though I am free and belong to no man.  I make myself a slave to everyone, to win as many as possible.” (I Corinthians 9:19).