EUTHANASIA: CONFLICTING POSITIONS
David Smith
Increasingly over the last number of years cases involving alleged incidents of
euthanasia have come before the courts. At the same time groups in different
countries have campaigned to gain legal recognition for some degree of assistedsuicide and euthanasia. Therefore, within the public at large there is an increasing
awareness of the differing viewpoints on the morality of euthanasia.
The term euthanasia comes from the Greek and means painless, happy death.1
Webster's dictionary goes on to define euthanasia as “an easy and painless death,
or, an act or method of causing death painlessly so as to end suffering: advocated
by some as a way to deal with victims of incurable disease”. It is defined as the
“termination of human life by painless means for the purpose of ending severe
physical suffering” by various Voluntary Euthanasia societies.2 Its meaning has,
therefore, broadened from “painless” and “easy death” to an interventionist act of
“mercy killing”. Prior to any discussion of the reasons for this increased interest in
euthanasia and the response of the Church it is essential to have a clear
understanding of the different terminology involved.
TERMINOLOGY
The terminology can be dealt with under two headings: the matter of consent, and
the action and intentionality of the person or persons assisting the patient. There
are three ways in which consent can be understood: voluntary, involuntary and
non-voluntary. Typically euthanasia would be said to be voluntary if it were carried
out at the patient’s request. There are, of course, bound to be problems about
whether the request was entirely un-coerced and rationally made, and in some
cases these may be irresolvable. But in other cases it will be clear enough if, as in
countries where euthanasia is legal, e.g. the Netherlands, the legal guidelines were
adhered to, or if the patient had given explicit instructions. The latter is referred to
as an Advanced Directive or Living Will3. If, however, someone does not explicitly
request euthanasia this does not mean that they do not want it; it would be
reasonable, however, to assume that they do not. Euthanasia in such a case
would be involuntary, and, even more obviously, it would be if someone had clearly
expressed a wish to live as long as possible, whatever the circumstances.
There is a third category which is in many ways the most important. Newborn
babies do not yet have, and comatose or severely brain-damaged adults have lost,
the capacity to request or refuse euthanasia. In such cases neither consent nor the
lack of it can be said to be a factor, so euthanasia, if considered, could be neither
voluntary, nor involuntary, but non-voluntary.4
The Cox Case
In 1992 Dr Nigel Cox, a consultant rheumatologist, was convicted of
attempting to murder Mrs Lillian Boyes, one of his patients. Mrs Boyes had
been terminally ill with rheumatoid arthritis; she suffered from septicaemia and
had abscesses and ulcers on her limbs. Her heart was calcified, her lungs
were malfunctioning. She had gangrene and a number of fractures of the
lumbar spine. There is no doubt that Mrs Boyes was in excruciating pain. Dr
Cox had administered heroin in an attempt to alleviate her suffering, but to no
avail. Mrs Boyes had begun to request that Dr Cox end her life. It was then
that he injected her with potassium chloride, and she died shortly thereafter.
Many people praised Dr Cox for his humane act, and expressed the hope that
they might be treated similarly by their doctors if they were in equally severe
pain and in the final stages of a terminal illness. It is clear, however, that the
criminal law views his behaviour quite differently since he was charged with
murder and, the body having been cremated before a conclusive cause of
death could be established, convicted of attempted murder.5
Besides the issues of consent there is the distinction made between passive and
active euthanasia. There are many doctors who believe that passive euthanasia,
either the withholding or withdrawal of treatment is morally and legally preferable to
active and deliberate intervention to cause the death of a patient. The phrase
“passive euthanasia” is, however, a misleading and mistaken phrase. In such
cases, the person involved is not killed, nor is the death of the person intended by
the withholding of additional treatment. The aim is to allow the inevitability of the
death process to take its course, to spare the person additional and unjustifiable
pain, to save him/her from the indignities of hopeless manipulations, and to avoid
increasing the financial and emotional burdens on his/her family. Other
commentators counter this reasoning by arguing that “acts of deliberate omission
are morally no different from acts of commission”.6 They insist that “letting die” by
either the withholding or withdrawal of treatment can and does lead to needless
cruelty and is a grotesque perversion of moral reasoning.7
Closely linked to the whole question of euthanasia is the issue of physician assisted
suicide. In 1999 the British Medical Association initiated a discussion on this issue.
The aim of this discussion is to try and arrive at a consensus on physician assisted
suicide. Physician assisted suicide involves a doctor intentionally giving a person
advice or the means to commit suicide. It describes situations where competent
people want to kill themselves but lack the means or the ability. In the State of
Oregon in the USA where it is legal, doctors provide a lethal dose of drugs, and the
action to end life, if taken, is done by the patient. Some request the means but
never use them but the doctor’s responsibility and intention remain the same.
Death can only be by assisted suicide if the patient acts on him or herself. If the
patient is unable to act, for example if he or she cannot inject or cause medication
to be swallowed, the patient lacks the ability to commit suicide and the act, if
performed by the doctor or someone else, is one of euthanasia.
Dr Jack Kervorkian
Dr Jack Kervorkian is well known in the United States for his practice of
assisted suicide. In 1990 he assisted Janet Adkins to die. Since then he
claims to have assisted in over 100 deaths. He has been tried three times by
the US Courts and acquitted in all three cases by juries. However, recently he
escalated his practice from assisting suicide to direct mercy killing in the case
of Thomas Youk, who suffered from amyotrophic lateral sclerosis. He
prepared a video showing his every action and the exact moment of Youk’s
death, and appeared with the video on a national television news programme,
daring the authorities to prosecute him. He was brought to trial and convicted
on charges of second-degree murder.
CHANGING SOCIAL ATTITUDES
Recent surveys demonstrate a changing attitude towards euthanasia and assisted
suicide in Western European and North American society. A survey of seven EC
countries indicated that over 70% of people favoured some form of voluntary
euthanasia.8 In a similar survey conducted in the USA in 1990 64% favoured the
legalisation of active euthanasia.9 In the Netherlands where euthanasia, within
strict guidelines, has recently been legalised10 there are approximately 9,000
explicit requests for euthanasia each year: less than a third of these are agreed to.
Some 3% of all deaths in the Netherlands are instances of euthanasia or assisted
suicide.11 In the Netherlands it was established that patients requested euthanasia
for reasons of “loss of dignity” (mentioned in 57% of cases), “pain” (46%),
“unworthy dying” (46%), “dependence on others” (33%), and “tiredness of life”
(23%). Only in a minority of cases was pain given as the sole reason for requesting
euthanasia12. Increasingly the media reports surveys of the medical profession in
different countries whose members actually advocate some form of euthanasia
policy or who admit to assisting one or more of their patients to die.
The question as to why euthanasia, “quality of life” and “loss of dignity”, feature so
prominently in Western consciousness needs to be addressed. A number of
reasons for this interest can be suggested. Firstly, traditional Western religious
orthodoxies, which condemned suicide and euthanasia, have lost their grip on our
societies. Secular reappraisal of the rights of individuals to control their own lives,
including the circumstances of their own deaths, have introduced discussions of
voluntary euthanasia and suicide as a part of an extensive list of rights to control
oneself and to engage in consensual acts with willing others. The principle of selfdetermination aptly demonstrates this approach to life. Recent Appeal Court
judgements in the United Kingdom appear to uphold this principle. Lord Justice
Butler-Sloss when commenting on the rights of a patient to accept or reject
treatment reasoned: “The starting point for consideration, in my view, is the right of
a human being to make his own decisions and to decide whether to accept or reject
treatment, the right of self-determination.” In the same judgement Lord Justice
Hoffmann, while citing the decriminalisation of suicide in 1961, argued that a
recognition of “the principle of self-determination should in that case prevail over the
sanctity of life.”
This growing recognition of the right of the individual to self-determination and the
perceived need to limit state authority which infringes on this right has occurred just
as medicine has succeeded, either directly or indirectly, in prolonging the lives of
individuals. However, such success is often a mixed blessing. Individuals now
survive catastrophic accidents, diseases, and other mal-events, only to be faced
with severe circumscription of their abilities, both physical and mental. Human
bodies can be kept alive for years in the absence of whole-brain death and in the
absence of consciousness. The process of dying can be extended weeks and
months. Diseases that would have more quickly killed in the past now can leave
individuals totally paralysed but fully alert. Though medicine may succeed in
dramatically extending life, it does so at times without having secured a quality of
life acceptable to many who will have to live it.
This raises the question of technology. If medical intervention is likely to prolong
one’s life but runs a substantial risk of doing so at the expense of an unacceptable
quality of life, one may be afraid to take the risk of being saved if one is exposed to
the danger of being locked into an unacceptable quality of life, from which one can
find no easy exit. There are cases when individuals may wish to avoid a life-saving
procedure because they fear that they will not be allowed to turn down the life
saved, should the quality not be acceptable.
The decision to accept treatment may secure only a very short survival burdened
by significant suffering. Some would undoubtedly decide in the face of certain
death in favour of a merciful dosage of an opiate to accelerate death or directly
accomplish it. Such choices are not usually offered to patients because of the
fear they would involve criminally proscribed acts of assisted suicide or voluntary
euthanasia. Such hesitations exist, though in many circumstances the provision
of sufficient medication to control pain has been acceptable to moral theologians,
and perhaps fairly generally, even if it may increase the wish of dying sooner, as
long as death is not directly intended, and the pain relief does not result from a
dose sufficient to kill rather than simply to blunt pain.
Finally, the interest in assisted suicide and voluntary euthanasia has been spurred
by the costs of protracted survival. There is evidence to indicate that 20% or more
of the patients who use intensive-care units (ICUs) are receiving treatment, from
which there is no likelihood of survival.13 Some of these funds could be saved and
re-allocated by discontinuing treatment when it offers no benefit and only prolongs
dying and suffering.
Many people believe that our capacity to prolong life has given us control over our
dying, to the point that we must now often choose when we are to die.
Commentators, therefore, believe it is within this context that a re-assessment of
the moral assumptions of public policies that support the criminalization of assisted
suicide and euthanasia need to be discussed.
THE CHRISTIAN CHURCHES’ RESPONSE TO EUTHANASIA
The Christian churches make a substantial case against any form of euthanasia,
appealing to both religious and secular principles. While there are significant
common arguments, their different approaches demonstrate the richness of the
Christian tradition. Yet it should also be noted that divergent views are expressed
by theologians who attempt to move the debate into the relational and contextual
spheres of life.
The following principles underline the theological arguments regarding euthanasia:
It is considered an offence against the exclusive right of God as Creator over the
life and death of a human being. It also offends against the good of the society and
contradicts self-love.
Theology argues that God’s creation and sustaining of creation is a gift because it
is utterly free and unconstrained. For human beings not only is this life a great gift
but it is also accompanied by responsibilities. Humanity honours, serves and loves
God by respecting, fostering and loving the goods he has created and put in our
charge. The gifts of creation, particularly the goods of human existence, are to be
developed, fostered and actively protected against whatever threatens them. That
is why when medical care is necessary and available, people are morally obliged to
have recourse to it, up to the point where it becomes futile, or where it would itself
involve burdens that the patient need not feel obliged to undergo.14
Other theologians who do not refer to the property rights of God over the human
person reject active euthanasia from the principle of the common good and selflove.
(1)
The first argument, based on the principle of the common good, emphasises
the danger of escalation. It is feared that legalisation of voluntary
euthanasia would create a precedent to extend the practice to handicapped
and sick individuals also, who do not suffer so much themselves, but rather
are a burden to society. Whether or not there is such a danger depends on
the basic approach of those who are in favour of euthanasia.
(2)
The second argument centres on the fundamental value of trust between the
physician and patient which could seriously suffer and possibly perish, if
physicians could practise mercy killing. Furthermore, there could be a
detrimental effect upon medical progress if euthanasia were regarded as an
acceptable solution to medical problems.
(3)
The third argument concentrates on the free consent of the patient. The
question raised is: how can consent be discerned and is it actually free?
Some physicians point out that the wish of the sick person for euthanasia is
often only a hidden plea for more help and more personal concern and care,
or the result of a temporary depression or a momentary disturbance caused
by heavy medication. This wish, they argue, disappears when better help
and personal care are provided.15 Finally, the wish could also be the result
of an imagined or real social pressure. An old person, for instance, who is
suffering from an incurable terminal disease might feel a kind of moral
obligation to request euthanasia in order to relieve the burden imposed on
relatives.
(4)
The fourth argument from the common good is that euthanasia will have a
harmful effect upon society. As long as human dignity is not based simply
on usefulness to society, people such as the mentally ill, the severely
handicapped, the very young and the incurably sick must be treated with
respect and their lives safeguarded. An acceptance even of voluntary
euthanasia “would seem to involve a weakening of this basic position”.16
It is apparent from our discussion thus far that some authors emphasise the value
of life above all else. However, there is always the danger that this might be
absolutized in a somewhat rigid manner. This would be contrary to the Christian
tradition which teaches that life is a fundamental value but not an absolute one. If
emphasis is placed on relational values it might be possible to envisage a situation
in which the interests of a particular patient might be best served by assisting that
person to die. A greater emphasis on relationships between doctors and patients
may also help to overcome the danger of abuse which is referred to so often when
discussing euthanasia. It should be possible to contemplate the possibility that, in
meeting the demands of the doctor-patient relationship by helping the patient to die,
a physician may be expressing something entirely positive.
Nevertheless, the dangers of this relational approach need to be pointed out. It is in
danger of confining itself to individual ethics which are based on primarily subjective
grounds. Euthanasia is, however, fundamentally a problem of social ethics17 and
concerns all basic human relationships, not just the interpersonal doctor-patient
one. At an individual level it may be possible to argue in favour of it, but the
possible effect on social life, such as undermining the ethos of the caring
profession, the implications for the family and society seem to militate against
legislating in favour of it.
THE ROMAN CATHOLIC CHURCH
The Catholic Church’s response to the emphasis on the right to selfdetermination and the desire for the decriminalisation of voluntary euthanasia
and assisted suicide is extensively covered in recent conciliar, papal and
episcopal teachings. In the Constitution Gaudium et Spes the Second Vatican
Council taught that euthanasia is “opposed to life itself” and “violates the integrity
of the human person”.18 The Constitution in teaching that whatever is opposed to
life, such as euthanasia, is an “infamy” has found subsequent repetition in
important and pivotal documentation.
In 1980, for example, the Congregation for the Doctrine of the Faith issued the
Declaration on Euthanasia. This declaration confirms and elaborates the teaching
of the Second Vatican Council. It explains that human life is a gift from God over
which humans have stewardship but not absolute dominion. Since life is the basic
and necessary condition for all other human goods, its destruction is an especially
grievous violation of the moral law, whether the victim consents or not.
Particularly important is the Declaration’s definition of euthanasia as “an action or
an omission which of itself or by intention causes death, in order that all suffering
may in this way be eliminated”.19 Morally what is important is that one intends the
person’s death, either as an end in itself, or as a means to another end, such as
ending the person’s suffering. Documents like Guidelines for Legislation on Life
Sustaining Treatment (1984) by the National Conference of Catholic Bishops of the
USA and Instruction on Respect for Human Life in Its Origin and on the Dignity of
Procreation (1987) by the Congregation for the Doctrine of the Faith all appeal to
the distinctive approach of Catholic theology and to the tradition that not only
condemns direct attacks on innocent life, but also promotes a general view of life as
a sacred trust over which we can claim stewardship but not absolute dominion.
Whilst taking into account this bias in favour of human life in Catholic theology,
moral theologians have traditionally not seen physical life as having an absolute
value.20 The inevitability of death as part of the human condition is enough to show
that one is not obliged, indeed, should not act as if life had to be prolonged
indefinitely. The problem is finding concrete criteria which allow one to let the dying
process run its course.
THE CHURCH OF ENGLAND
The Church of England teachings on euthanasia are found in a document entitled
On Dying Well and in various House of Bishops’ statements. They take exception
to terminology such as “right to die” in the euthanasia debate because it “suffers
from a dangerous ambiguity.” It can mean that a person has the right to determine
whether he or she should live or die, which implies that a person can claim
assistance from the medical profession in bringing about their death. It can also
mean that an individual can consent to the doctor ending their life, where pain
cannot be controlled. Finally, it can mean that patients in extremis should not be
subjected to troublesome treatments which cannot restore them to health, and
doctors may use drugs to control pain even at the risk of shortening life.21
To counter the pro-euthanasia compassionate argument they insist that the value of
human life does not consist simply of a scale of pleasure and pain. Rather, the
value of human life consists in a variety of virtues and graces as well as in pleasure.
Therefore, what a person consists of is not only what he or she does, but also how
he or she endures. This does not mean that suffering is in itself good, or that it
necessarily ennobles. But that “suffering as exposure to what is beyond one's
voluntary control, suffering as undergoing, even as diminishment, is part of the
pattern of becoming human. Even dying need not be simply the ebbing away of
life; it may be integrated into life and so made instrumental to a fuller life in God.”22
This understanding of suffering provides the context for the use of technology in
care.
They argued that because human life is a gift from God to be preserved and
nourished, the deliberate taking of human life is prohibited except in self-defence or
the legitimate defence of others. When addressing the distinction between
deliberate killing and the administration of painkilling drugs or withdrawal of
treatment that may have the effect of shortening life, the bishops affirmed that the
sanctity of life must remain the guiding principle. This would ensure the proper selfunderstanding of the medical profession as protectors of life and maintain the
necessary public confidence in the medical profession. In referring to the medical
possibility of keeping people alive in circumstances where death might otherwise
have brought relief from intolerable suffering, they point out that doctors do not
have an overriding obligation to prolong life by all available means. Crucial
decisions in such circumstances should be made collaboratively and should involve
more than one medically qualified person. They go on to argue that it is a Christian
imperative and a duty of the State to protect the interests of the most vulnerable,
particularly those who may feel themselves to be burdensome to others or
unwanted, and who thus might be under pressure to seek the hastening of their
own deaths.
In 1993, in an act of ecumenical solidarity, the Church of England’s House of
Bishops, the Catholic Bishops’ Conference of England and Wales and the leaders
of the Free Churches in England made a public joint submission to the House of
Lords Select Committee on Medical Ethics. In this submission they stated that they
believed that God himself has given to humankind the gift of life. As such, it is to be
revered and cherished. Christian beliefs about the special nature and value of
human life lie at the root of the Western Christian humanist tradition, which remains
greatly influential in shaping the values held by many in society. These beliefs are
also shared in whole or in part by other faith communities. All human beings are to
be valued, irrespective of age, sex, race, religion, social status or their potential for
achievement. Those who become vulnerable through illness or disability deserve
special care and protection. Adherence to this principle provides a fundamental
test as to what constitutes a civilised society. The whole of humankind is the
recipient of God’s gift of life. It is to be received with gratitude and used
responsibly. Human beings each have their own distinct identities but these are
formed by and take their place within complex networks of relationships. All
decisions about individual lives bear upon others with whom we live in community.
For this reason, the law relating to euthanasia is not simply concerned either with
private morality or with a utilitarian approach to life. On this issue there can be no
moral pluralism. A positive choice has to be made by society in favour of protecting
the interests of its vulnerable members even if this means limiting the freedom of
others to determine their end.23
They concluded by saying that “deliberately to kill a dying person would be to reject
them.”24 Because human life is a gift from God to be preserved and cherished, the
deliberate taking of human life is prohibited except in self-defence or the legitimate
defence of others. Therefore, all Churches are resolutely opposed to legalising
euthanasia even though it may be put forward as a means of relieving suffering,
shortening the anguish of families or friends, or saving scarce resources.25
What the Christian churches argue for is the development of a society in which the
true meaning of life and death can be understood. A caring community in which the
need for euthanasia becomes irrelevant is a significant characteristic of such a
society. Nobody would disagree with these aims, but the reality of our world still
remains. People actually suffer and die without adequate medical and social care.
Are the Christian churches ignoring this reality and the very real anguish that
prolonged pain and suffering cause the afflicted person and those who have to coendure this pain as they care for the sufferer?
ORDINARY AND EXTRAORDINARY TREATMENT
As we have already noted from the Churches’ positions, a distinction is drawn
between ordinary and extraordinary care. Moral theologians, whilst taking into
account the bias in favour of human life in Christian theology, have traditionally not
seen physical life as having an absolute value. The inevitability of death as part of
the human condition is enough to show that one is not obliged, indeed, should not
act as if life had to be prolonged indefinitely. The problem is finding criteria which
one may utilise to allow the dying process to run its course.
It has been common in Christian teaching to refer to a distinction between
“ordinary” and “extraordinary” means in answering questions about when a patient
is obliged to accept treatment. In conformity with traditional moral theology certain
contemporary writers have treated this distinction as synonymous with a distinction
between what is obligatory and what is optional for a particular patient.26 If it is
understood in this way the distinction clearly needs to be explained by reference to
considerations which are invoked in determining whether treatment is obligatory.
Traditionally moral theology taught that while extraordinary treatment can
permissibly be forgone, ordinary treatment cannot. Pius XII in his Discourse of 24
November 1957, follows the distinction of ordinary and extraordinary, but at once
veers away from laying down a hard and fast line of demarcation. Instead he
suggests that a prudential judgement must be made in concrete cases taking
variable circumstances, such as persons, place, epochs and culture, into account.27
A clear definition of the distinction between ordinary and extraordinary means is
supplied by Paul Ramsey. He writes that ordinary means of preserving life are all
medicines, treatments, and operations, which offer a reasonable hope of benefit for
the patient and which can be obtained and used without excessive expense, pain,
and other inconveniences. Extraordinary means of preserving life are all those
medicines, treatments, and operations which cannot be obtained without excessive
expense, pain, or other inconvenience, or which, if used, would not offer a
reasonable hope of benefit.28 Therefore when a treatment was judged by the
patient (or by others acting as surrogates) to be excessively burdensome, neither
the patient nor the surrogate were obliged to begin or continue it. But before a
treatment can be considered to be excessively burdensome it is necessary to
weigh its burden against whatever benefits it promises. Consequently, it is
misleading to suppose that it is possible to compile a specific list of treatments
which classifies some as ordinary and others as extraordinary, such that it could
help determine whether they should be employed with any particular patient. A
treatment that is ordinary for one patient in particular circumstances can be
extraordinary for another; or indeed extraordinary for that same patient in different
circumstances.
Due to the possibility of ambiguity over the application of these distinctions,29
numerous criticisms have been levelled against them. Moralists have, therefore,
tended to favour terms like “beneficial”, “non-beneficial”, “excessive burdens” and
“no reasonable hope of recovery.” The traditional starting point for this discussion
is the traditional principle of medical ethics: “to do no harm”. This principle of
beneficence implies at least the following four things: first, one ought not to inflict
evil or harm; second, one ought to prevent evil or harm; third, one ought to remove
evil; fourth, one ought to do or promote good.30 Where it is decided that it is right to
inflict injury on patients, it is on the grounds that life and health will be better served
by causing the injury - for example, surgery - so that in the long run, pain and
suffering will be diminished by this intervention. “Beneficial means” are not
necessarily the same as “standard treatment” or “ordinary means”. A good
example of this point is given by Sissella Bok: “Take the case of the person dying of
cancer, in great pain, close to death, who develops pneumonia. Certainly
antibiotics are now the standard arsenal of medicine; yet many would consider it
cruel and extraordinary to use them to prolong such a patient’s care.”31
A polemical issue which needs to be confronted in a discussion of the distinction
between ordinary and extraordinary treatment is what “quality of life” is a patient
being healed for. This issue does not concern dying terminal patients but focuses
on non-dying terminal patients, or others who, at the price of painful and detrimental
interventions, can survive. It is due to the successes of modern medicine and not
its failures that society cannot avoid taking into account the quality of life
dimension.32
There are two quality of life criteria relevant to decisions to treat, or to continue
treatment or to stop treatment. The first considers the capacity to experience and
to relate. It is evident that certain treatments do create excessive hardships for an
individual and distort and jeopardise their grasp on the overall meaning of life. This
is because human relationships, which are the very possibility of growth in love of
God and neighbour, would be threatened, strained or submerged so that they
would no longer function as the heart and meaning of the individual’s life as they
should. Something other than the “higher, more important good” would occupy first
place. Life, the condition of other values and achievements, would usurp the place
of these and become itself the ultimate value. When that happens, the value of
human life has been disrupted out of context.33
The second criterion of “quality of life” considers the intensity of a patient’s pain and
suffering and his or her susceptibility to treatment. If, despite treatment, there is not
and cannot be even a minimal capacity to experience, and to relate, or if the level of
pain and suffering will be prolonged, excruciating and intractable, then a decision to
cease or not initiate treatment can be preferable to treatment.
Thus, when medicine can intervene to improve the quality of the relation between
the patient’s condition and the pursuit of life’s goals, then such an intervention can
be considered a benefit to the patient and is in his or her best interests. However,
when a proposed intervention cannot offer the patient any reasonable hope for
pursuing life’s purposes at all because of the condition of the patient; or can only
offer the patient a condition where the pursuit of life’s purposes will be filled with
profound frustration or with utter neglect of these purposes because of the energy
needed merely to sustain physical life; then medical interventions can only be a
burden to the life treated. In such instances, they are contrary to the best interests
of the patient, are harmful to the patient, and medicine having reached its limits on
the basis of its own reason for existence should not intervene except to relieve pain
or to comfort the patient.
From Dialogue, Issue 23 (November 2004.
Notes
eu -- well, plus thanatos -- death.
2
C. Koop, “The Right to Die: The Moral Dilemmas”, in Euthanasia:The Moral Issues, Edited by R. Baird and
S. Rosenbaum (New York: Prometheus Books, 1989), p. 69.
3
An “Advanced Directive” or “Living Will” is an instruction that one wishes to have treatment withdrawn or
withheld in specific circumstances (i.e. when one is unconscious/in pain/no longer able to give consent etc). In
the Mr Tony Bland case the Law Lords ruled that “Advanced Directives” or “Living Wills” were legal.
4
R. Campbell and D. Collinson, Ending Lives (Oxford: Basil Blackwell, 1991), p. 123.
Pamela Ferguson, “Causing death or allowing to die? Developments in the law”, Journal of Medical
Ethics 23 (1997): 368.
6
J, Fletcher, “Sanctity of Life versus Quality of Life”, in Euthanasia:The Moral Issues, op. cit. p. 94.
7
James Rachel, “Active and Passive Euthanasia”, in R. Baird and S. Rosenbaum, op. cit., pp. 48-49.
8
M. Kidron and R. Segal, The New State of the World Atlas (London: Simon & Schuster, 1991), p. 51.
9
Newsweek, 18 June 1990, p. 37.
10
The Tablet, 20 February 1993, p. 254.
11
P. van der Mass, J. van Delden, L. Pijnenborg and C. Looman, "Euthanasia and other medical decisions
concerning the end of life", The Lancet, 14 September 1991. cited in The Tablet, 19 October 1991, p. 1293.
12
ibid., 1294.
13
H. Engelhardt, “Death by Free Choice”, in Suicide and Euthanasia, Edited by B. Brody (London: Kluwer
Academic Publishers, 1989), p. 254.
14
A Working Party Report of the Linacre Centre, “Euthanasia and Clinical Practice: Trends, Principles and
Alternatives (1982)”, in Euthanasia, Clinical Practice and the Law. Edited by L. Gormally (London: The
Linacre Centre for health Care Ethics, 1994), p. 51.
15
In a very convincing way that fact has been evidenced by the alternative of the St Christopher Hospice,
founded by Dr Cecily Saunders for terminally ill patients. In these hospices no artificial prolongation of life is
undertaken, not even intravenous feeding. Its formula is a blend of pain relief, tender care and the close
involvement of the family in the process of dying. 40,000 Britons who die each year of cancer are treated in a
hospice or receive hospice-style care at home. The average life span of a patient in hospice treatment is just
three weeks. The cost is sizeable. But this is no more than in the intensive care facilities, where most hospice
patients would otherwise end up. Euthanasia is not practised by the hospice.
16
K. Kelly, “Why Should Catholics Oppose Euthanasia Legislation?”, op. cit., pp 5-6.
17
B. Haring, Free and Faith in Christ, Vol 3 (London: St Pauls Publications, 1981), p 88.
18
Gaudium et Spes, No. 27 in Vatican Council II: The Conciliar and Post Conciliar Documents, 1981 edition,
edited by A. Flannery, (Dublin: Dominican Publications, 1980), p. 928.
19
Declaration on Euthanasia, in Vatican Council II: More Post Conciliar Documents, Vol 2, edited by A.
Flannery (Dublin: Dominican Publications, 1982), p. 512.
20
Kevin Kelly, The Tablet, 13 March 1993, p. 332.
21
Ibid., p. 7-9.
22
Ibid., p. 21.
23
“Euthanasia and the Law”, Briefing 22 July 1993. Refer Doctrine and Life 43(1993): 493.
24
Ibid., p. 496.
25
Ibid., p. 494.
26
Notably Paul Ramsey in The Patient as Person. Ramsey’s understanding in turn derived from his reading
of Gerald Kelly, “The Duty of Using Artificial Means of Preserving Life”, Theological Studies 11(1950): 203220, and the same author’s “The Duty to Preserve Life”, Theological Studies 12 (1951): 550-556.
27
Pope Pius XII, AAS 39(1957): 1027-1033.
28
P. Ramsey, op. cit. p. 122.
29
To avoid ambiguities some writers suggest the terminology should be abandoned. E.g. Paul Ramsey Ethics
at the Edges of Life. Medical and Legal Intersections 1978, p. 155.; Robert Veatch, Death, Dying and the
Biological Revolution 1976, p. 110.
30
W. Frankena, Ethics (Englewood Cliffs, N.J.: 1973), p. 42.
31
S. Bok, “Death and Dying: Ethical Views”, in Encyclopedia of Bioethics I, p. 27.
32
J. Fletcher, “Sanctity of Life versus Quality of Life”, op. cit., p. 86.
33
R. McCormick, “To Save or Let Die”, in Quality of Life:The New Medical Dilemma. Edited by J. Walter
and T. Shannon (New York, Paulist Press, 1990), p. 31.
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