A Christian Response to Euthanasia
By Dr. H. Robert C. Pankratz and Dr. Richard M. Welsh
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Euthanasia in the Netherlands (Below)
Doctor Unpunished For Dutch Suicide (Below)
Call for No-Consent Euthanasia (Below)
The current "debate" on the legitimacy of euthanasia is a good indicator of the overall moral state of Canadian society. This debate also illustrates how secularized some Christians have become, blindly adopting anti-Biblical concepts such as the "quality of life" or even the "right to die." It may be that many Christians have difficulty understanding the complexities of this issue - after all, doctors already hasten death by stopping life support or using high doses of morphine in cancer patients, don't they? And, isn't it cruel to deny a suffering person an easy death when they are dying anyway?
This two-part series addresses the issue of euthanasia from a Christian perspective. In part one, we will discuss definitions and contrast the Christian worldview with the prevailing ideologies in our society that have engendered the push for euthanasia. In the next issue, we will discuss the ramifications of these disparate perspectives, examine the related issues of quality of life and autonomy, and conclude with thoughts about what each of us can do.
What Euthanasia is and isn't
In a war of ideologies, the first casualties are the definitions of the terms used. Euphemisms abound when people resort to deceit in attempting to convince others. For example, in the language of the day, administering a lethal injection becomes "aid in dying." (And how can you be against giving "aid" to someone who is terminally ill?) What is generally meant by the term euthanasia is mercy killing - the deliberate ending of a person's life to reduce their suffering. More commonly used today, however, is the phrase the "right to die." These are noble sounding words that literally mean that someone can request that a doctor kill him. In the terminology battle, the proponents of euthanasia are seeking to redefine what is now known as a form of homicide and call it acceptable medical practice.
The debate is very much an ethical one. Natural death, which results from illness or degenerative processes, is the antithesis of mercy killing. Even when life could be prolonged by medical treatment and is not, the death that may ensue is a death from the underlying illness, not a result of the withdrawal of care. The withholding of medical therapy is reasonable when the treatment is disproportionately burdensome (that is, the therapy - not the disease - is hard on the person), and relatively ineffective ("futile"). In other words, we are not ethically bound to use unwanted, non-beneficial therapies that serve to only prolong a person's dying. In fact, not doing so shows profound respect for the boundaries of natural life.
It is important to understand that euthanasia cannot be equated with the current understanding of palliative care. Palliative care is the active relief of suffering in a terminally ill individual and although there are occasions when treatment may shorten life, this is not the intended or anticipated result. It is simply a side effect or complication of therapy and is therefore ethically permissible. Generally, adequate doses of narcotics to relieve pain do not shorten life.
The Christian World View
The underlying principles of our society were once based on the Biblical world view; indeed, western culture and our legal system were founded on it. An overview of selected Scriptures will reveal what this view of man is and how it is derived.
Genesis 9:6 was instructive for our forbearers and should be for us as well: "Whoever sheds man's blood, by man his blood shall be shed, for in the image of God has He made man." This scripture is more than a prohibition on the taking of innocent life. Being created by God, we are stewards of our lives rather than owners. Created to be like God, our lives have an eternal purpose; set apart for, and owned by God. Since we are created in the image of God, our lives have intrinsic and immeasurable value. This is the source of the "sanctity of life" concept. Because we are created in God's image, people have an inherent and God-given dignity. This is a far cry from the fluctuating self-esteem (based on wealth, abilities, etc.) that is mistaken for dignity by non-Christians.
A critical issue arises at this point. Secular humanism claims that every life has a "quality" attached to it. This means that circumstances, abilities (or disabilities), suffering, or other factors render a life better or worse, because the person has a greater or lesser degree of contentment or happiness. With contentment or happiness as the standard, some lives are deemed to have such low quality that it is reasonable to prefer death. This is the antithesis of the "sanctity of life" ethic, which maintains that every life, created in the image of God, has intrinsic, God-given, value that is not reduced by circumstances. Paul teaches us "I have learned the secret of being content in any and every situation" (Phil.4:12). In a world that confuses the right to pursue happiness with a nonexistent right to attain happiness, the Christian perspective stands out in stark contrast.
As a related aside, it is the very people who are vigorously pursuing legalized death who should be the most afraid of it. The person assured of eternity with Christ knows that it is truly "better to be with Christ." For the believer, the issue is not what they themselves wish (life here or in heaven), for as Paul so aptly puts it, "I am torn between the two" (Phil. 1:23). The issue is, rather, what God wills. For the Christian life is God's gift and its end is to be determined by Him. "There is no God besides me, I put to death and I bring to life" (Deuteronomy 32:39). God is sovereign over life and death: we have no jurisdiction in this area, therefore we have no mandate to end lives. God's dominion includes all of life, which means that suffering is a part of God's providence. Therefore, suffering that cannot be relieved by modern medical means is to be accepted as from the hand of a loving God who knows what He is doing, even when we do not understand. "Endure hardship as discipline; God is treating you as sons" (Hebrews 12:7). The purpose of suffering for the Christian is sanctification or "to be conformed to the likeness of His Son" (Romans 8:29) and "it produces a harvest of righteousness and peace" for those trained by it (Hebrews 12:10). "For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all" (2 Corinthians 4:17). In other words, although we are all made in God's image, we are each to a greater or lesser degree like Him, and God is carrying to completion this great work that He has begun in all believers (Phil. 1:6).
Death is part of life. As Ecclesiastes 3:2 tells us, there is a time to be born and a time to die. The wise among us should number their days (Psalm 90:10). According to Scripture, life in the body is not always the highest value (to live is Christ but to die is gain - Philippians 1:21). In fact, the measure of love is that a man lay down his life for his friends (John 15:13). The Christian can even welcome natural death knowing that "death has been swallowed up in victory" (1 Corinthians 15:54). Who doesn't look forward to that day when we will see Him "face to face"?
Therefore, in looking at suffering and impending death the Christian should see God's sovereign hand and purpose, as well as the opportunity for ministering to the weak and vulnerable, with whom Christ Himself is identified. Feeding, clothing, or housing the needy is viewed by Christ as "whatever you did for one of the least of these brothers of mine you do for Me" (Matthew 25:40). We can certainly look forward to a deepened relationship with God and strengthening from Him in our time of need for "those who hope in the Lord will renew their strength. They will soar on wings like eagles" (Isaiah 40:31). For those who wish a richer knowledge of God and closer walk of obedience, "opting out" prematurely runs counter to the deepest desires of their heart.
The atheistic or humanistic worldview sees people as autonomous (self-ruling) independent biological entities, whose life's purpose is pleasure, and whose end is complete extinction. This view logically results in a self- centered hedonism that sees life as utilitarian, (i.e., valuable only for what it offers), and sees little value in suffering. The logical conclusion of this perspective, generally denied by most people who hold this view, is nihilism - "is that all there is?" According to this perspective, life should not be continued unless it is a wanted life. Suffering is an unmitigated negative; thus there are some lives not worth living.
The Christian perspective of human life puts God in control of this issue. We are to trust Him to allow to befall us only that which will ultimately benefit us. We can also see enormous opportunities to minister God's love to those who are needy and suffering. We are called to be salt; regarding euthanasia, this means to stand for compassionate care of the dying while standing against any form of killing. To do the latter, Christians must not let the protagonists of euthanasia define the terms of this debate. We must expose the euphemisms and work for the use of accurate terms.
In the last issue we looked at the subject of euthanasia, or mercy killing, from a Christian perspective. We saw that each human life - including the terminally ill and suffering - is created in the image of God and must be stewarded and handled according to God's moral laws. In this issue, we'll look at some rational arguments useful in opposing euthanasia and its underlying secular ideologies, and we'll discuss practical ways in which Christians can have influence for Christ in this important area of life.
In our society, the prevailing ideologies used to support euthanasia are based on two sets of criterion: 'quality of life' and personal autonomy. There has been much misinformation, intense emotion, and muddled thinking surrounding these terms. It is helpful to look at the assumptions underlying the 'quality of life' and autonomy premises. As we saw in part one, God claims sovereignty over life and death, and we have no mandate to end lives by euthanasia. However, even according to humanistic premises, the criterion of 'quality of life' and autonomy cannot validate euthanasia.
Quality of Life
The term 'quality of life' (QOL) was first introduced in the 1960s to refer to the overall welfare of a population. In the 1970s it evolved to refer to the welfare of the individual, where it was used to refer to such things as level of satisfaction, contentment, happiness, social harmony, and fulfillment. Since then, the popular term has been adopted by the pro-death movement, and its meaning has changed from 'quality of life' to 'quality of living' to the 'quality of a life' to the 'value of a life.' These changes in meaning have promoted the belief that a life with low quality is not worth living. The result has been the inevitable conclusion that some people are less valuable than others. Such people are said to be 'better off dead' or to have a 'right to die'
In other words, the term L is now being used to morally justify killing humans, either voluntarily or involuntarily. For example, for over a decade the L term has been used to justify and promote the killing of unborn babies with Down syndrome and other genetic defects, as well as the intentional starving to death of severely handicapped infants and brain-damaged adults.
To the Christian, quality of life judgments are irrelevant. Because we are each created in the image of God, each human life is sacred and has intrinsic value. There is no such thing as a life not worth living - all life has meaning and purpose.
The Christian sees contentment, happiness, and fulfillment as resulting from one's attitude and response to situations. Secular humanists, however, equate QOL directly with a level of functioning and a degree of suffering. Furthermore, the humanists see suffering (be it physical, mental, emotional, or social) as generally having little purpose, and so they sometimes decide that the negative effect of suffering outweighs the value of continued life.
One of the problems with the use of the QOL concept is that we have no objective criterion for measuring it. Quality of life judgments are subjective, biased, and relative to unfixed factors such as emotional state, past experiences, family wishes and financial concerns. These judgments are often made by a third party on behalf of an incompetent person and amount to an outside observer's judgment of the value or quality of another's life. Therefore, those who possess a 'high' QOL end up deciding that someone is better off dead, often simply because that person can no longer decide for themselves (since a high QOL value is placed on rational thought). Some proponents of the QOL criterion even believe that an individualís QOL is reduced if he or she is a burden to society and caregivers.
Another danger in using QOL as a basis for euthanasia is that it leads from voluntary to involuntary euthanasia. This is what is known as the 'slippery slope. 'It can be viewed from two perspectives. The logical perspective recognizes that if you grant that there are competent people who are better off dead, it logically follows that there are incompetent people who are better off dead. And if you grant further that competent people in such a state have a right to die, it follows that you should not deny incompetent people in a similar state that same right. This provides a logical basis for moving from euthanasia for the competent terminally ill or chronically suffering to involuntary euthanasia for the demented, severely handicapped, or comatose.
The psychological version of the 'slippery slope' states that 'once certain practices are accepted, people shall in fact go on to accept other practices as well.' This is supported by the practice of euthanasia in the Netherlands where the courts are now permitting euthanasia, not only for the competent terminally ill, but also for infants with serious handicaps, comatose patients, and even people suffering from severe depression.
There is a deliberate lack of clarity regarding the term QOL, and despite this confusion, the term is being used to influence life-and-death decisions affecting societally-devalued people. The term QOL should be abandoned entirely. Instead we should work to focus the public debate on some of the specific elements included under the term QOL, such as “verbalized life satisfaction,' 'physical environmental quality, 'and 'social harmony. This will take the QOL talk away from the proponents of euthanasia, and it will help bring clarity to the debate by revealing the total subjectivity of the QOL idea.
In our egocentric society, autonomy (independence and self-government) receives great emphasis. However, autonomy can never be without restrictions. Obviously, any society - even one which does not embrace God's moral laws - must place some limits on personal freedom simply in order to function. Biblically, our individual autonomy must be limited by God's moral law.
Secular humanists deny this truth. They assert that the rights of the individual are paramount and that a person has a right to choose the time and nature of their own death. This amounts to death on demand. But even if we agreed with the autonomy argument, accepting that an individual should be permitted to choose death on demand, surely such a choice requires competence, informed consent, and voluntariness. To be truly autonomous, choice must be rational, fully informed, and freely made. Are terminally ill people really in a position to make such a choice? Likely not, considering that their mental competence is affected by underlying illnesses in 85% of cases, and that emotional competence is often affected by an initial, but reversible, phase of suicidal depression. In addition, fully informed consent is often complicated by uncertainties of diagnosis and prognosis. Physicians are simply unable to accurately predict the timing of death or the quality of remaining life and may significantly misinform terminally ill patients. A further complication is that the voluntariness of a person's choice may easily be compromised by pressures from doctors, nurses, family and society - all of who have vested interests which may conflict with the patient's survival.
A counter-argument made by euthanasia proponents is that a system of intensive counseling and extensive assessment could safeguard the process - such as the guidelines for euthanasia in the Netherlands. However, a government commissioned study into the practice of euthanasia in the Netherlands shows that the guidelines are not always followed: A third of lethal injections are given without the patient's consent, and despite the requirement for persistent request, 59% of cases occur on the same day they are asked for, and 10% within the same hour! The study showed that physicians also frequently falsify death certificates and disregard the requirements for consulting a second physician.
Despite these objections, let us accept that there will be a very small number of rational, fully informed, and freely made requests for euthanasia. The autonomy argument still fails to justify euthanasia because of the negative consequences euthanasia has on other people's autonomy. For example, the vast majority of terminally ill people do not want euthanasia and yet are particularly vulnerable to feeling that they are a burden on society. If euthanasia is an option, they may now feel forced to justify their decision to remain alive, and this at a time when they may be least able to do so. Additionally, euthanasia may also result in a loss of individual autonomy because the final choice and power rests not with the patient, but with the physician who is the final authorizer of the lethal injection.
Death by choice advocates also talk about restricting euthanasia to the hard cases, such as the terminally ill with 'unbearable' suffering. They know that if the prohibition against killing is removed for one group of people, it will send us down the slope towards allowing it for others. What is a right for some becomes a right for all. In reality, safeguards are simply a smokescreen for death on demand, much like abortion for the sake of the mother's health proved to be a smokescreen for abortion on demand.
Autonomy - the right to choose - must be restricted; some choices are biblically wrong and/or undesirable, and we must proclaim God's truth in this area. In debate and discussion, we should also point out that even if autonomy were an acceptable criterion, when scrutinized, it cannot validate euthanasia.
What Then Should We Do?
Practically speaking we should do the following:
We must oppose euthanasia:
1. Learn what the Bible says about the issue.
2. Prepare to educate others on this important issue.
3. Become actively involved in supporting the debate at professional and political levels.
4. Pray with an awareness that our battle is not ultimately with individuals but rather with deceptive ideologies and spiritual forces.
We must promote life:
1. Support and encourage pro-life doctors, politicians, and activists.
2. Support your local pro-life and hospice Societies through donations and volunteering. (Proper care of the terminally ill makes euthanasia irrelevant.)
3. Reach out and help the unwanted and despairing with care and compassion. In doing so, we help supply people with the desire to live.
4. Recognize that withdrawal or refusal of treatment in the appropriate setting is not euthanasia. There is a time to let go. Such decisions require accurate information, personal humility, and Godís wisdom.
As Christians, we are called to be salt and light within our spheres of influence. The Bible is clear on this. Interestingly, Albert Camus, a non-Christian Nobel Prize winner, concurs: 'The world expects for Christians that they will raise their voices so loudly and clearly and so formulate their protest that not even the simplest man can have the slightest doubt about what they are saying. Further, the world expects of Christians that they themselves will eschew all fuzzy abstractions and plant themselves firmly in front of the bloody face of history. We stand in need of folk who have determined to speak directly and unmistakably and come what may, to stand by what they have said.' Christians must, on the one hand, oppose euthanasia by boldly proclaiming God's truth, and on the other hand, promote life through a practical demonstration of His love and compassion.
Dr. Pankratz and Dr. Welsh are Family Physicians currently practicing in Abbotsford, B.C. Dr. Pankratz is the President of Canadian Physicians for Life and the Vice President of Compassionate Healthcare Network
Euthanasia in the Netherlands
Copyright © 1996 - 2004, International Task Force. All Rights Reserved.
Right-to-die advocates often point to Holland as the model for how well physician-assisted, voluntary euthanasia for terminally-ill, competent patients can work without abuse. But the facts indicate otherwise.
Dutch Penal Code Articles 293 and 294 make both euthanasia and assisted suicide illegal, even today. However, as the result of various court cases, doctors who directly kill patients or help patients kill themselves will not be prosecuted as long as they follow certain guidelines. In addition to the current requirements that physicians report every euthanasia/assisted-suicide death to the local prosecutor and that the patient's death request must be enduring (carefully considered and requested on more than one occasion), the Rotterdam court in 1981 established the following guidelines:
The patient must be experiencing unbearable pain.
The patient must be conscious.
The death request must be voluntary.
The patient must have been given alternatives to euthanasia and time to consider these alternatives.
There must be no other reasonable solutions to the problem.
The patient's death cannot inflict unnecessary suffering on others.
There must be more than one person involved in the euthanasia decision.
Only a doctor can euthanize a patient.
Great care must be taken in actually making the death decision. (1)
Since 1981, these guidelines have been interpreted by the Dutch courts and Royal Dutch Medical Association (KNMG) in ever-broadening terms. One example is the interpretation of the "unbearable pain" requirement reflected in the Hague Court of Appeal's 1986 decision. The court ruled that the pain guideline was not limited to physical pain, and that "psychic suffering" or "the potential disfigurement of personality" could also be grounds for euthanasia. (2)
The main argument in favor of euthanasia in Holland has always been the need for more patient autonomy -- that patients have the right to make their own end-of-life decisions. Yet, over the past 20 years, Dutch euthanasia practice has ultimately given doctors, not patients, more and more power. The question of whether a patient should live or die is often decided exclusively by a doctor or a team of physicians.(3)
The Dutch define "euthanasia" in a very limited way: "Euthanasia is understood [as] an action which aims at taking the life of another at the latter's expressed request. It concerns an action of which death is the purpose and the result." (4) (Emphasis added.) This definition applies only to voluntary euthanasia and excludes what the rest of the world refers to as non-voluntary or involuntary euthanasia, the killing of a patient without the patient's knowledge or consent. The Dutch call this "life-terminating treatment."
Some physicians use this distinction between "euthanasia" and "life-terminating treatment" to avoid having a patient's death classified as "euthanasia," thus freeing doctors from following the established euthanasia guidelines and reporting the death to local authorities. One such example was discussed during the December 1990 Institute for Bioethics conference in Maastricht, Holland. A physician from The Netherlands Cancer Institute told of approximately 30 cases a year where doctors ended patients' lives after the patients intentionally had been put into a coma by means of a morphine injection. The Cancer Institute physician then stated that these deaths were not considered "euthanasia" because they were not voluntary, and that to have discussed the plan to end these patients' lives with the patients would have been "rude" since they all knew they had incurable conditions. (5)
For the sake of clarity in this fact sheet, the direct and intentional termination of a patient's life, performed without the patient's consent, will be termed "involuntary euthanasia."
The Remmelink Report-- On September 10, 1991, the results of the first, official government study of the practice of Dutch euthanasia were released. The two volume report (6)--popularly referred to as the Remmelink Report (after Professor J. Remmelink, M.J., attorney general of the High Council of the Netherlands, who headed the study committee)--documents the prevalence of involuntary euthanasia in Holland, as well as the fact that, to a large degree, doctors have taken over end-of-life decision making regarding euthanasia. The data indicate that, despite long-standing, court-approved euthanasia guidelines developed to protect patients, abuse has become an accepted norm. According to the Remmelink Report, in 1990:
∑ 2,300 people died as the result of doctors killing them upon request (active, voluntary euthanasia).(7)
∑ 400 people died as a result of doctors providing them with the means to kill themselves (physician-assisted suicide).(8)
∑ 1,040 people (an average of 3 per day) died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients' knowledge or consent.(9)
∑ 14% of these patients were fully competent. (10)
∑ 72% had never given any indication that they would want their lives terminated. (11)
∑ In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible. (12)
∑ In addition, 8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the primary purpose of controlling pain, but to hasten the patient's death. (13) In 61% of these cases (4,941 patients), the intentional overdose was given without the patient's consent.(14)
∑ According to the Remmelink Report, Dutch physicians deliberately and intentionally ended the lives of 11,840 people by lethal overdoses or injections--a figure which accounts for 9.1% of the annual overall death rate of 130,000 per year. The majority of all euthanasia deaths in Holland are involuntary deaths.
∑ The Remmelink Report figures cited here do not include thousands of other cases, also reported in the study, in which life-sustaining treatment was withheld or withdrawn without the patient's consent and with the intention of causing the patient's death. (15) Nor do the figures include cases of involuntary euthanasia performed on disabled newborns, children with life-threatening conditions, or psychiatric patients. (16)
∑ The most frequently cited reasons given for ending the lives of patients without their knowledge or consent were: "low quality of life," "no prospect for improvement," and "the family couldn't take it anymore."(17)
∑ In 45% of cases involving hospitalized patients who were involuntarily euthanized, the patients' families had no knowledge that their loved ones' lives were deliberately terminated by doctors. (18)
∑ According to the 1990 census, the population of Holland is approximately 15 million. That is only half the population of California. To get some idea of how the Remmelink Report statistics would apply to the U.S., those figures would have to be multiplied 16.6 times (based on the 1990 U.S. census population of approximately 250 million).
Falsified Death Certificates ---In the overwhelming majority of Dutch euthanasia cases, doctors--in order to avoid additional paperwork and scrutiny from local authorities--deliberately falsify patients' death certificates, stating that the deaths occurred from natural causes. (19) In reference to Dutch euthanasia guidelines and the requirement that physicians report all euthanasia and assisted-suicide deaths to local prosecutors, a government health inspector recently told the New York Times: "In the end the system depends on the integrity of the physician, of what and how he reports. If the family doctor does not report a case of voluntary euthanasia or an assisted suicide, there is nothing to control." (20)
Inadequate Pain Control and Comfort Care -- In 1988, the British Medical Association released the findings of a study on Dutch euthanasia conducted at the request of British right-to-die advocates. The study found that, in spite of the fact that medical care is provided to everyone in Holland, palliative care (comfort care) programs, with adequate pain control techniques and knowledge, were poorly developed. (21) Where euthanasia is an accepted medical solution to patients' pain and suffering, there is little incentive to develop programs which provide modern, available, and effective pain control for patients. As of mid-1990, only two hospice programs were in operation in all of Holland, and the services they provided were very limited. (22)
Broadening Interpretations of Euthanasia Guidelines
∑ In July 1992, the Dutch Pediatric Association announced that it was issuing formal guidelines for killing severely handicapped newborns. Dr. Zier Versluys, chairman of the association's Working Group on Neonatal Ethics, said that "Both for the parents and the children, an early death is better than life." Dr. Versluys also indicated that euthanasia is an integral part of good medical practice in relation to newborn babies. (23) Doctors would judge if a baby's "quality of life" is such that the baby should be killed.
∑ A 2/15/93 statement released by the Dutch Justice Ministry proposed extending the court-approved, euthanasia guidelines to formally include "active medical intervention to cut short life without an express request." (Emphasis added.) Liesbeth Rensman, a spokesperson for the Ministry, said that this would be the first step toward the official sanctioning of euthanasia for those who cannot ask for it, particularly psychiatric patients and handicapped newborns.(24)
∑ A 4/21/93 landmark Dutch court decision affirmed euthanasia for psychiatric reasons. The court found that psychiatrist Dr. Boudewijn Chabot was medically justified and followed established euthanasia guidelines in helping his physically healthy, but depressed, patient commit suicide. The patient, 50-year-old Hilly Bosscher, said she wanted to die after the deaths of her two children and the subsequent breakup of her marriage.(25)
Euthanasia "Fallout" -- The effects of euthanasia policy and practice have been felt in all segments of Dutch society:
∑ Some Dutch doctors provide "self-help programs" for adolescents to end their lives. (26)
∑ General practitioners wishing to admit elderly patients to hospitals have sometimes been advised to give the patients lethal injections instead. (27)
∑ Cost containment is one of the main aims of Dutch health care policy. (28)
∑ Euthanasia training has been part of both medical and nursing school curricula. (29)
∑ Euthanasia has been administered to people with diabetes, rheumatism, multiple sclerosis, AIDS, bronchitis, and accident victims. (30)
∑ In 1990, the Dutch Patients' Association, a disability rights organization, developed wallet-size cards which state that if the signer is admitted to a hospital "no treatment be administered with the intention to terminate life." Many in Holland see the card as a necessity to help prevent involuntary euthanasia being performed on those who do not want their lives ended, especially those whose lives are considered low in quality. (31)
∑ In 1993, the Dutch senior citizens' group, the Protestant Christian Elderly Society, surveyed 2,066 seniors on general health care issues. The Survey did not address the euthanasia issue in any way, yet ten percent of the elderly respondents clearly indicated that, because of the Dutch euthanasia policy, they are afraid that their lives could be terminated without their request. According to the Elderly Society director, Hans Homans. "They are afraid that at a certain moment, on the basis of age, a treatment will be considered no longer economically viable, and an early end to their lives will be made." (32)
The Irony of History -- During World War ll, Holland was the only occupied country whose doctors refused to participate in the German euthanasia program. Dutch physicians openly defied an order to treat only those patients who had a good chance of full recovery. They recognized that to comply with the order would have been the first step away from their duty to care for all patients. The German officer who gave that order was later executed for war crimes. Remarkably, during the entire German occupation of Holland, Dutch doctors never recommended nor participated in one euthanasia death. (33) Commenting on this fact in his essay "The Humane Holocaust," highly respected British journalist Malcolm Muggeridge wrote that it took only a few decades "to transform a war crime into an act of compassion." (34)
Implications of the Dutch Euthanasia Experience
∑ Right-to-die advocates often argue that euthanasia and assisted suicide are "choice issues." The Dutch experience clearly indicates that, where voluntary euthanasia and assisted suicide are accepted practice, a significant number of patients end up having no choice at all.
∑ Euthanasia does not remain a "right" only for the terminally-ill, competent adult who requests it, no matter how many safeguards are established. As a "right," it inevitably is applied to those who are chronically ill, disabled, elderly, mentally ill, mentally retarded, and depressed-- the rationale being that such individuals should have the same "right" to end their suffering as anyone else, even if they do not or cannot voluntarily request death.
∑ Euthanasia, by its very nature, is an abuse and the ultimate abandonment of patients.
∑ In actual practice, euthanasia only gives doctors greater power and a license to kill.
∑ Once the power to kill is bestowed on physicians, the inherent nature of the doctor/patient relationship is adversely affected. A patient can no longer be sure what role the doctor will play--healer or killer.
∑ Unlike Holland, where medical care is automatically provided for everyone, in the U.S. millions of people cannot afford medical treatment. If euthanasia and assisted-suicide were to become accepted in the U.S., death would be the only "medical option" many could afford.
∑ Even with health care reform in the U.S., many people would still not have long-standing relationships with their doctors. Large numbers of Americans would belong to health maintenance organizations (HMOs) and managed care programs, and they often would not even know the physicians who end up treating them. Given those circumstances, doctors would be ill-equipped to recognize if a patient's euthanasia request was the result of depression or the sometimes subtle pressures placed on the patient to "get out of the way." Also, given the current push for health care cost containment in the U.S., medical groups and facilities many be tempted to view patients in terms of their treatment costs instead of their innate value as human beings. For some, the "bottom line" would be, "Dead patients cost less than live ones."
∑ Giving doctors the legal power to kill their patients is dangerous public policy.
1. Carlos Gomez, Regulating Death (New York: Free Press, 1991), p.32. Hereafter cited as Regulating Death.
2. Ibid., p.39.
3. H. Jochemsen, trans., "Report of the Royal Dutch Society of Medicine on 'Life-Terminating Actions with Incompetent Patients, Part 1: Severely Handicapped Newborns.'" Issues in Law & Medicine, vol. 7, no.3 (1991), p. 366.
4. From KNMG Euthanasia Guidelines as quoted in Regulating Death, p. 40.
5. Alexander Morgan Capron, "Euthanasia in the Netherlands--American Observations," Hastings Center Report (March, April 1992), p. 31.
6. Medical Decisions About the End of Life, I. Report of the Committee to Study the Medical Practice Concerning Euthanasia. II. The Study for the Committee on Medical Practice Concerning Euthanasia (2 vols.), The Hague, September 19, 1991. Hereafter cited as Report I and Report II, respectively.
7. Report I, p. 13.
9. Ibid.,p. 15.
10. Report II, p.49, table 6.4.
11. Ibid., p.50, table 6.6.
12. Ibid., table 6.5.
13. Ibid., p. 58, table 7.2.
14. Ibid., p. 72.
16. Report I, pp. 17-18.
17. Report II, p. 52, table 6.7.
18. Ibid., table 6.8.
19. I.J. Keown, "The Law and Practice of Euthanasia in The Netherlands," The Law Quarterly Review (January 1992), pp. 67-68.
20. Marlise Simons, "Dutch Move to Enact Law Making Euthanasia Easier," New York Times, 2/9/93, p.A1.
21. Euthanasia: Report of the Working Party to Review the British Medical Association's Guidance on Euthanasia, British Medical Association, May 5, 1988, p. 49, no. 195.
22. Rita L. Marker, Deadly Compassion -The Death of Ann Humphry and the Truth About Euthanasia (New York; William Morrow and Company, 1993), p. 157. Hereafter cited as Deadly Compassion.
23. Abner Katzman, "Dutch debate mercy killing of babies," Contra Costa Times, 7/30/92, p. 3B.
24. "Critics fear euthanasia soon needn't be requested," Vancouver Sun, 2/17/93, p. Al0. Also, "Dutch may broaden rules to permit involuntary euthanasia," Contra Costa Times, 2/17/93, p. 4B.
25. New York Times, 4/5/93. p.A3, and Washington Times, 4/22/93, p.A2.
26. "It's Almost Over -- More Letters on Debbie," Letter to the editor by G.B. Humphrey, M.D., Ph.D., University Hospital, Groningen, The Netherlands, Journal of the American Medical Association, vol. 260, no. 6 (8/12/88), p. 788.
27."Involuntary Euthanasia in Holland," Wall Street Journal, 9/29/87, p.3.
28. "Restructuring Health Care", The Lancet (1/28/89), p.209.
29."The Member's Aid Service of the Dutch Association for Voluntary Euthanasia," Euthanasia Review, vol. 1, no. 3 (Fall 1986), p.153.
30. "Suicide on Prescription," Sunday Observer (London, England), 4/30/89, p. 22.
31. Deadly Compassion, p. 156.
32. "Elderly Dutch afraid of euthanasia policy," Canberra Times (Australia), 6/11/93.
33. Leo Alexander, "Medical Science Under Dictatorship," New England Journal of Medicine, vol.241 (July 14, 1949), p.45.
34. Nancy Gibbs, "Love and Let Die," Time Magazine (March 19, 1990), p.67.
Doctor Unpunished For Dutch Suicide
The Amazing 1994 Case of Hilly Bosscher
On June 22, 1994, The Supreme Court of Holland made a landmark ruling today that a psychiatrist who helped a physically healthy woman commit suicide would not be punished.
The court found that the psychiatrist, Doctor Boudewijn Chabot, was guilty of giving a fatal dose of sleeping pills to a severely depressed woman who was otherwise perfectly healthy. But the court said that he should not face a criminal penalty.
Previous court cases regarding euthanasia centered on physically ill patients, but Dr. Chabot's case broke new ground because his patient's suffering was mental. The patient, Hilly Bosscher, 50, reportedly had asked him to help her commit suicide because she had lost the will to live after a failed marriage and the deaths of her two sons.
Dr. Chabot's lawyer, Eugene Sutorius, said that the ruling established the principle that mercy killings were allowed in cases of mental suffering, apart from cases of physical suffering.
Theoretically, euthanasia and assisted suicide were illegal in Holland at the time (1994), although a 1981 law had lessened the chance of prosecution, and a law passed in 1993 actually issued guidelines for doctors to perform mercy killings!
Basically, Dutch doctors can escape prosecution by demonstrating that their consciences gave no choice but to end a patient's life. The patient must be suffering intolerable pain and must have repeatedly asked to die. Relatives and another doctor must be consulted. Without doubt all of this seems quite amazing to many of us who may be unfamiliar with Dutch life, but it does clearly show how once the principle of euthanasia is accepted, a slippery slope clearly emerges.
Copyright Robin A. Brace. UK Apologetics.
Call for No-Consent Euthanasia
Sarah Boseley , health editor
Thursday June 8, 2006
Doctors should be able to end lives swiftly and humanely, says professor.
One of the country's (UK) leading experts on medical ethics today calls for doctors to be able to end the lives of some terminally ill patients "swiftly, humanely and without guilt" - even if they have not given consent.
Len Doyal, emeritus professor of medical ethics at Queen Mary, University of London, takes the euthanasia debate into new and highly contentious territory. He says doctors should recognise that they are already killing patients when they remove feeding tubes from those whose lives are judged to be no longer worth living. Some will suffer a "slow and distressing death" as a result.
It would be better if their lives were ended without this unnecessary delay, Professor Doyal writes in an article in Clinical Ethics, published by The Royal Society of Medicine. He calls for the law and professional guidance to be changed.
Critics said yesterday that the views of Prof Doyal, a member of the British Medical Association medical ethics committee for nine years, were the "very worst form of medical paternalism".
Prof Doyal was a supporter of Lord Joffe's assisted dying bill that would have allowed terminally ill patients to request a cocktail of drugs to end their lives early. Opponents of the bill shelved it by voting for a postponement for further debate. But Prof Doyal is now taking the debate a stage further.
He argues that doctors are already effectively practicing euthanasia on patients who have no consciousness beyond the capacity to suffer pain and says this should extend to those patients who can no longer speak for themselves.
He says he is not the only medical professional to hold this view. In the article, Prof Doyal says withdrawing life-saving treatment from severely incompetent patients - which may involve turning off a ventilator, ending antibiotics or withdrawing a feeding tube - is "believed to be morally appropriate because it constitutes doing nothing. It is disease that does the dirty work, not the clinician. Yet this argument cannot wash away the foreseeable suffering of severely incompetent patients sometimes forced to die avoidably slow and distressing deaths."
He draws a parallel with a father who sees his baby drowning in the bath and fails to do anything to save it. The father foresaw the certainty of the death and did nothing and would therefore be morally considered to have killed the child.
"Clinicians who starve severely incompetent patients to death are not deemed by law to have killed them actively, even if they begin the process by the removal of feeding tubes. The legal fiction that such starvation is not active killing is no more than clumsy judicial camouflage of the euthanasia that is actually occurring."
His concern, he says, is not only with patients who are in a permanent vegetative state and therefore feel nothing at all.
"The category of patients that concerns me most are the patients where we are not sure. There is still some brain function, but they will never have any brain awareness or cognitive function, but they seem to be suffering,"
he told the Guardian. This could, for instance, happen after an accident or a stroke. He does not believe that legalising non-voluntary euthanasia for such patients would lead to more or inappropriate deaths.
"We have a situation where these decisions are being made all the time and yet we have no coherent system of regulation for them. We really don't know what is going on out there, as they do in Holland where all this is legal or in Oregon where they have physician-assisted suicide.
"Where you have legalisation, you have the best data about what is going on because people are not afraid to report it," he added.
Peter Saunders, the campaign director of Care Not Killing, an alliance of healthcare professionals and others opposed to euthanasia and the Joffe bill, said Prof Doyal was confusing the withdrawal of treatment that was more of a burden than a benefit to a dying patient with actively ending life.
"Doyal is advocating the very worst form of medical paternalism whereby doctors can end the lives of patients after making a judgment that their lives are of no value and claim that they are simply acting in their patients' best interests," he said.
"The clear lesson from the Netherlands, where over 1,000 patients are killed by doctors every year without their consent and where babies with special needs are killed ... is that when voluntary euthanasia is legalised involuntary euthanasia inevitably follows."
The British Medical Association declined to comment on Prof Doyal's article. "We have a neutral position," said a spokeswoman. "We leave it to society to decide."
(This report was lifted straight from the Guardian newspaper website exactly as represented there. This newspaper is the British newspaper probably least sympathetic to Christian values).
Copyright Robin A. Brace, 2006. UK Apologetics.
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