Is there a Christian Case for Assisted Dying: Voluntary Euthanasia Reassessed

By Paul Badham

Issues surrounding euthanasia and assisted dying continue to hit the headlines with strong feelings on both sides. In Is There a Christian Case for Assisted Dying? Paul Badham makes a significant and controversial contribution to this important and current debate.

• Language: English
• Publisher: SPCK
• Release date: Jan 23, 2009
• ISBN: 9780281063154

Book preview

Introduction

An inter-Christian debate

This book is a contribution to the inter-Christian debate on the question of assisted dying. Christian leadership is generally opposed to this, but ordinary churchgoers say they would greatly welcome legalization to permit assistance in dying for people suffering unbearably in the final stages of terminal illness. The book explores the theological issues behind the current debate, and examines the principal moral arguments used by Christians in two influential ethical traditions. It considers the morality of assisted dying in the light of the biblical evidence and of Jesus’ own approach to moral questions. The book also considers how this debate reflects the Christian understanding of our relationship with God and the theological value of suffering. One important theme in this book is the relevance of the Christian belief in life after death to the way we should approach our own dying. The book includes an examination and comparison of end-of-life decision-making in Britain, the Netherlands and the US State of Oregon and ends with an attempt to present a Christian case for assisted dying.

Voluntary euthanasia and assisted dying

Throughout this book reference is made to both voluntary euthanasia and to assisted dying. In either case it is axiomatic that this is in the context of a competent person suffering unbearably in terminal illness who explicitly and repeatedly requests assistance to die. In either case adequate safeguards need to be in place to ensure that this is truly the patient’s own decision. The difference between the two is that in voluntary euthanasia a doctor will administer medication leading to death, while in assisted dying, though the doctor provides the medication, responsibility for taking it is left to the patient. Euthanasia is legal in the Netherlands and Belgium whereas in Switzerland and Oregon only assisted dying is permitted. In 2008 Luxembourg legalized both possibilities. The legislation proposed by Lord Joffe in 2006 followed the example of Oregon in seeking the legalization of assisted dying. I shall discuss Lord Joffe’s Bill in Chapter 5. Essentially it was a bill concerned solely with mentally ‘competent’ people, who were suffering unbearably in the final stages of terminal illness and who repeatedly asked for assistance to die. Two doctors had to confirm that realistically nothing further could be done to restore them to health and that they would almost certainly die within weeks and at the most within six months. A solicitor had to witness the written request and a variety of further safeguards was built into the bill, as we shall see later. The bill was discussed at length by a committee of the House of Lords that collected a vast range of evidence from interested parties. Ultimately the bill was defeated, at least in part, by a very well-orchestrated campaign against it by a range of Christian organizations, and by the unanimous opposition of the Bench of Bishops in the House of Lords.

Dignity in Dying, a leading campaigning organization pro-moting patient choice at the end of life, supported all the safeguards in Lord Joffe’s Bill. However, it is possible that in supporting a future bill they may wish to extend assistance to that very small number of mentally ‘competent’ people who are no longer able to self-administer. Voluntary euthanasia is the term most widely used in the literature and so, except when it is vital to discrimin-ate, that is the expression most often used in this book.

Moral issues concerned with switching off life-support systems

Because the book is focused on voluntary euthanasia/assisted dying there is no sustained discussion of the morality of withdrawing or withholding life-support systems because it is now accepted that these are issues of clinical judgement rather than of morality. The guidance of the British Medical Association is that ‘decisions about whether to provide, withhold, or withdraw treatment are the responsibility of the treating doctor with the advice of the rest of the health care team and with reference to the Courts in particularly contentious, difficult or disputed cases’.¹ This position is fully accepted both by the Church of England House of Bishops and by the Roman Catholic Bishops’ Conference. In their joint submission concerning the Joffe Bill they explicitly say that ‘the withholding or withdrawing of medical treatment that is judged futile or burdensome is both moral and legal’.²

Financial issues

In this book I do not discuss financial arguments for or against the legalization of euthanasia or assisted dying. Opponents of euthanasia often express fears that if it were legalized this would be seized on as an opportunity to save money on palliative care. However, it is apparent from the evidence presented in Chapter 9 that in both Oregon and the Netherlands the legalization of assisted dying or euthanasia has been associated with a massive expansion of provision of palliative care. So it is not the case that the motivation of saving money is currently a factor. My view is that we are a sufficiently rich society that at present we should be well able to provide adequate palliative care for all who seek it, and that such costs should have a higher priority within our society. The costs of palliative care are relatively minor compared with the expenditure on ‘futile and burdensome’ treatments in hospitals where medical interventions continue to be made even when prospects of recovery are extremely slight. If economies need to be made it is there they could be found.

However, I accept the validity of the view expressed in Mary Warnock and Elisabeth Macdonald’s study, that if the average age of death continues to rise much faster than the number of years of healthy life we can expect to have, there will come a time when adequate support for an ageing population will become economically unsustainable. But I also agree with their suggestion that that problem ‘is something that may be left to the next generation of moralists’.³

The primary focus of this book

Where this book seeks to be distinctive is in focusing on distinct-ively Christian arguments. Hence there is a lot of discussion of the biblical evidence and the foundations of Christian ethical judgement in the teaching of Jesus. The book also explores the theological virtues of faith and hope, and the value of suffering within a Christian world-view. A primary feature of the book is its stress on the Christian hope of eternal life with God and hence a potential readiness to let go of this life in confidence and faith. However, because most Christian opposition to euthanasia has been based on worries about a ‘slippery slope’ the book also surveys the evidence from the Netherlands and from Oregon about what actually happens when euthanasia or assisted dying is legalized.

How the case for assisted dying has become stronger in recent years

While researching for this book I was struck by how much stronger the case for assisted dying has become than it was when I was researching for Facing Death and for Professor Robin Gill’s Euthanasia and the Churches in the mid-1990s. At that point many compassionate observers believed that good palliative care could solve almost all the problems of terminal illness and there was also a widespread perception that the acceptance of eutha-nasia in the Netherlands had led to serious abuses. Now the situation is very different. In Chapters 8 and 9 I show how more recent research by Drs Julia Lawton, Guy Brown and Elisabeth Macdonald has demonstrated that not even the best palliative care can enable us to escape the ‘bodily realities of the dying process’. At the same time the detailed investigations of Baroness Warnock, Professor Clive Seale and Dr Penney Lewis have shown that there is no evidence to support a negative view of the situ-ation in the Netherlands and indeed that international comparative studies show that in the Netherlands, and more recently in Oregon, well-thought-out ‘permissive legislation’ can provide greater security for the patient than the situation that applies in countries where euthanasia and assisted dying are forbidden, yet end-of-life decisions still have to be made.⁴

1

Why theology matters in the euthanasia debate

This book looks at the theological issues at the heart of current controversies about legalizing euthanasia or assisted dying. These issues are rarely discussed, yet they are central to the debate. This is because the side legislators take in the debate is more influ-enced by the theological presuppositions they bring to it than by the evidence to which either side appeals.

The ostensible factors in the debate

Characteristically, public discussion of euthanasia sees it as a medical, a philosophical, or a legal issue. On the medical front proponents of euthanasia claim that the sufferings endured by at least some terminally ill people could justify legalizing voluntary euthanasia. By contrast, opponents of euthanasia argue that good medical practice can alleviate such suffering in other ways, and that the trust between doctor and patient requires a continued ban on such so-called ‘mercy-killing’. On the philosophical front the debate tends to focus on issues of human rights and personal autonomy weighed against the needs of society as a whole. On the legal front discussion hinges on the problems of framing any legislation, and in particular the difficulty of legislating for particularly hard cases, without opening the floodgates to a kind of permissiveness towards euthanasia that might undermine the sanctity of human life.

The grounds for thinking religious issues are actually crucial

Although the considerations within which the issue of euthanasia is publicly debated are common to all, the way people evaluate these considerations depends for the most part on their religious outlook. As a generalization and being aware of exceptions on both sides, religious leaders see the balance of argument as coming down against euthanasia, while secular thinkers see the balance of argument coming down in favour of it. This was shown clearly in the evidence submitted to the House of Lords Committee on Medical Ethics in 1994, where Christian bodies urged a principled stand against euthanasia and the British Humanist Association pleaded for it. The Humanist case was that those who opposed eutha-nasia did so from ‘a religious outlook which not everyone shared’ and they urged ‘it is particularly hurtful to require someone who does not believe in God or afterlife to suffer intolerable pain or indignity in deference to a God or afterlife he does not accept’.¹ The difference between the Humanist and the Christian submissions was so marked that the House of Lords Committee ‘gave much thought’ to the consideration that ‘for those without religious belief, the individual is best able to decide what manner of death is fitting to the life which has been lived’.² The Select Committee recognized that they were dealing with a situation where there was a significant divide between the views of religious people on the one hand and those of secularists on the other, and they recognized their duty to try and prevent this fact from blurring the impartiality required of them as a body seeking to act on behalf of the community as a whole.

This issue was even more marked in the discussions surrounding Lord Joffe’s Bill in 2006 (which we shall discuss in Chapter 5). The evidence submitted on behalf of the Modern Churchpeople’s Union was highly unusual in offering support for the Bill from a Christian perspective.³ Almost all other Chris-tian organizations were very much to the fore in opposing the Bill, as indeed were virtually all other religious organizations. The Roman Catholic Archbishop of Cardiff arranged a massive lobbying campaign against the Bill and every Anglican bishop who spoke in the debate was strongly opposed to it. The dominance of Christian opposition to the Bill was noted in media coverage of the debate, which took the view that the Bill had been lost because of determined Christian opposition to it.

What this illustrates is that division of opinion about eutha-nasia tends to follow differences of opinion about matters of religion more than any other considerations. After all the bishops and the members of the British Humanist Association both have access to the same medical information and to the philosophical, social and legal considerations adduced by both sides in the euthanasia debate. And though this was not apparent in what people said during the debates, the divide actually came on the theological view that euthanasia is contrary to biblical and Christian teaching, that it infringes the prerogatives of God and that it amounts to human beings ‘playing God’ in taking decisions that God alone should take. It is also the case that theological ideas about God’s relation to us and the potential value of suffering to our full humanity have also been brought into the debate and need to be addressed. The distinctive character of this book is that it will seek both to address the theological arguments that underlie so much of the real divide and to place the debate on euthanasia in its historical and current context.

The support euthanasia enjoys with the Christian community

The importance of exploring euthanasia as a theological issue is that it is genuinely puzzling why in the public arena the issue of euthanasia is portrayed and indeed experienced by the Christian leadership as a struggle between a religious and an atheistic world-view. According to Tom Wright, Bishop of Durham, the Assisted Dying Bill is being pushed by a ‘militantly atheist and secularist lobby’.⁴ This is a strange perception when one reflects that the founding father of the British Voluntary Euthanasia Society (now known as Dignity in Dying) was the Very Revd Dr W. R. Inge, Dean of St Paul’s Cathedral and President of what was then known as the Modern Churchmen’s Union. He was assisted in his campaign for the legalization of euthanasia by his successor in both posts, Dean W. R. Matthews. Not only that but the strongest case for euthanasia I know is that written by Hans Küng, formerly theological adviser to the Second Vatican Council and subsequently Professor of Ecumenical Theology at the University of Tübingen.⁵ Küng is probably the best-known and most widely read theologian in the world. Euthanasia was defended by Joseph Fletcher, formerly Professor of Christian Ethics at Harvard and founder of the very influential school of Situation Ethics.⁶ It was also interesting that the Revd Baroness (Kathleen) Richardson of Calow, sometime Moderator of the Free Churches Council and President of the Methodist Conference, spoke in defence of the Joffe Bill.

Even more importantly opinion polls consistently show that the majority of ordinary Christians and churchgoers would welcome legislation to allow euthanasia for the terminally ill. Professor Robin Gill, who acted as spokesperson for the Church of England before the Committee of Inquiry into the Joffe Bill, analysed statistics on British social attitudes for his book Euthanasia and the Churches. These showed that in 1983–4 84 per cent of Chris-tians across all denominations who attended church at least once a month would welcome legislation to allow euthanasia for the terminally ill. That figure dropped to 45 per cent among weekly churchgoers. The clearest opposition came from weekly Roman Catholic worshippers where only 39 per cent wanted euthanasia legalized compared with 66 per cent of weekly churchgoing Anglicans and 75 per cent of monthly churchgoing Catholics.⁷ More recent figures from National Opinion Polls in 2004 relating to medically assisted dying showed that 81 per cent of Catholics and 81 per cent of Protestants would like this legalized.⁸

In the light of these findings Robin Gill believes that ‘the Christian