Debate over euthanasia is not a modern phenomenon. The Greeks carried on a robust debate on the subject. The Pythagoreans opposed euthanasia, while the Stoics favored it in the case of incurable disease. Plato approved of it in cases of terminal illness.(1) But these influences lost out to Christian principles as well as the spread of acceptance of the Hippocratic Oath: "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to that effect."
In 1935 the Euthanasia Society of England was formed to promote the notion of a painless death for patients with incurable diseases. A few years later the Euthanasia Society of America was formed with essentially the same goals. In the last few years debate about euthanasia has been advanced by two individuals: Derek Humphry and Dr. Jack Kevorkian.
Derek Humphry has used his prominence as head of the Hemlock Society to promote euthanasia in this country. His book Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying became a bestseller and further influenced public opinion.
Another influential figure is Jack Kevorkian, who has been instrumental in helping people commit suicide. His book Prescription Medicide: The Goodness of Planned Death promotes his views of euthanasia and describes his patented suicide machine which he calls "the Mercitron." He first gained national attention by enabling Janet Adkins of Portland, Oregon, to kill herself in 1990. They met for dinner and then drove to a Volkswagen van where the machine waited. He placed an intravenous tube into her arm and dripped a saline solution until she pushed a button which delivered first a drug causing unconsciousness, and then a lethal drug that killed her. Since then he has helped dozens of other people do the same.
Over the years, public opinion has also been influenced by the tragic cases of a number of women described as being in a "persistent vegetative state." The first was Karen Ann Quinlan. Her parents, wanting to turn the respirator off, won approval in court. However, when it was turned off in 1976, Karen continued breathing and lived for another ten years. Another case was Nancy Cruzan, who was hurt in an automobile accident in 1983. Her parents went to court in 1987 to receive approval to remove her feeding tube. Various court cases ensued in Missouri, including her parents' appeal that was heard by the Supreme Court in 1990. Eventually they won the right to pull the feeding tube, and Nancy Cruzan died shortly thereafter.
Seven years after the Cruzan case, the Supreme Court had occasion to rule again on the issue of euthanasia. On June 26, 1997 the Supreme Court rejected euthanasia by stating that state laws banning physician-assisted suicide were constitutional. Some feared that these cases (Glucksburg v. Washington and Vacco v. Quill) would become for euthanasia what Roe v. Wade became for abortion. Instead, the justices rejected the concept of finding a constitutional "right to die" and chose not to interrupt the political debate (as Roe v. Wade did), and instead urged that the debate on euthanasia continue "as it should in a democratic society."
Voluntary, Active Euthanasia
It is helpful to distinguish between mercy-killing and what could be called mercy-dying. Taking a human life is not the same as allowing nature to take its course by allowing a terminal patient to die. The former is immoral (and perhaps even criminal), while the latter is not.
However, drawing a sharp line between these two categories is not as easy as it used to be. Modern medical technology has significantly blurred the line between hastening death and allowing nature to take its course.
Certain analgesics, for example, ease pain, but they can also shorten a patient's life by affecting respiration. An artificial heart will continue to beat even after the patient has died and therefore must be turned off by the doctor. So the distinction between actively promoting death and passively allowing nature to take its course is sometimes difficult to determine in practice. But this fundamental distinction between life-taking and death- permitting is still an important philosophical distinction.
Another concern with active euthanasia is that it eliminates the possibility for recovery. While this should be obvious, somehow this problem is frequently ignored in the euthanasia debate. Terminating a human life eliminates all possibility of recovery, while passively ceasing extraordinary means may not. Miraculous recovery from a bleak prognosis sometimes occurs. A doctor who prescribes active euthanasia for a patient may unwittingly prevent a possible recovery he did not anticipate.
A further concern with this so-called voluntary, active euthanasia is that these decisions might not always be freely made. The possibility for coercion is always present. Richard D. Lamm, former governor of Colorado, said that elderly, terminally ill patients have "a duty to die and get out of the way." Though those words were reported somewhat out of context, they nonetheless illustrate the pressure many elderly feel from hospital personnel.
The Dutch experience is instructive. A survey of Dutch physicians was done in 1990 by the Remmelink Committee. They found that 1,030 patients were killed without their consent. Of these, 140 were fully mentally competent and 110 were only slightly mentally impaired. The report also found that another 14,175 patients (1,701 of whom were mentally competent) were denied medical treatment without their consent and died.(2)
A more recent survey of the Dutch experience is even less encouraging. Doctors in the United States and the Netherlands have found that though euthanasia was originally intended for exceptional cases, it has become an accepted way of dealing with serious or terminal illness. The original guidelines (that patients with a terminal illness make a voluntary, persistent request that their lives be ended) have been expanded to include chronic ailments and psychological distress. They also found that 60 percent of Dutch physicians do not report their cases of assisted suicide (even though reporting is required by law) and about 25 percent of the physicians admit to ending patients' lives without their consent.(3)
Involuntary, Active Euthanasia
Involuntary euthanasia requires a second party who makes decisions about whether active measures should be taken to end a life. Foundational to this discussion is an erosion of the doctrine of the sanctity of life. But ever since the Supreme Court ruled in Roe v. Wade that the life of unborn babies could be terminated for reasons of convenience, the slide down society's slippery slope has continued even though the Supreme Court has been reluctant to legalize euthanasia.
The progression was inevitable. Once society begins to devalue the life of an unborn child, it is but a small step to begin to do the same with a child who has been born. Abortion slides naturally into infanticide and eventually into euthanasia. In the past few years doctors have allowed a number of so-called "Baby Does" to die–either by failing to perform lifesaving operations or else by not feeding the infants.
The progression toward euthanasia is inevitable. Once society becomes conformed to a "quality of life" standard for infants, it will more willingly accept the same standard for the elderly. As former Surgeon General C. Everett Koop has said, "Nothing surprises me anymore. My great concern is that there will be 10,000 Grandma Does for every Baby Doe."(4)
Again the Dutch experience is instructive. In the Netherlands, physicians have performed involuntary euthanasia because they thought the family had suffered too much or were tired of taking care of patients. American surgeon Robin Bernhoft relates an incident in which a Dutch doctor euthanized a twenty-six-year-old ballerina with arthritis in her toes. Since she could no longer pursue her career as a dancer, she was depressed and requested to be put to death. The doctor complied with her request and merely noted that "one doesn't enjoy such things, but it was her choice."(5)
In recent years media and political attention has been given to the idea of physician-assisted suicide. Some states have even attempted to pass legislation that would allow physicians in this country the legal right to put terminally ill patients to death. While the Dutch experience should be enough to demonstrate the danger of granting such rights, there are other good reasons to reject this idea.
First, physician-assisted suicide would change the nature of the medical profession itself. Physicians would be cast in the role of killers rather than healers. The Hippocratic Oath was written to place the medical profession on the foundation of healing, not killing. For 2,400 years patients have had the assurance that doctors follow an oath to heal them, not kill them. This would change with legalized euthanasia.
Second, medical care would be affected. Physicians would begin to ration health care so that elderly and severely disabled patients would not be receiving the same quality of care as everyone else. Legalizing euthanasia would result in less care, rather than better care, for the dying.
Third, legalizing euthanasia through physician-assisted suicide would effectively establish a right to die. The Constitution affirms that fundamental rights cannot be limited to one group (e.g., the terminally ill). They must apply to all. Legalizing physician-assisted suicide would open the door to anyone wanting the "right" to kill themselves. Soon this would apply not only to voluntary euthanasia but also to involuntary euthanasia as various court precedents begin to broaden the application of the right to die to other groups in society like the disabled or the clinically depressed.
Foundational to a biblical perspective on euthanasia is a proper understanding of the sanctity of human life. For centuries Western culture in general and Christians in particular have believed in the sanctity of human life. Unfortunately, this view is beginning to erode into a "quality of life" standard. The disabled, retarded, and infirm were seen as having a special place in God's world, but today medical personnel judge a person's fitness for life on the basis of a perceived quality of life or lack of such quality.
No longer is life seen as sacred and worthy of being saved. Now patients are evaluated and life-saving treatment is frequently denied, based on a subjective and arbitrary standard for the supposed quality of life. If a life is judged not worthy to be lived any longer, people feel obliged to end that life.
The Bible teaches that human beings are created in the image of God (Gen. 1:26) and therefore have dignity and value. Human life is sacred and should not be terminated merely because life is difficult or inconvenient. Psalm 139 teaches that humans are fearfully and wonderfully made. Society must not place an arbitrary standard of quality above God's absolute standard of human value and worth. This does not mean that people will no longer need to make difficult decisions about treatment and care, but it does mean that these decisions will be guided by an objective, absolute standard of human worth.
The Bible also teaches that God is sovereign over life and death. Christians can agree with Job when he said, "The Lord gave and the Lord has taken away. Blessed be the name of the Lord" (Job 1:21). The Lord said, "See now that I myself am He! There is no god besides me. I put to death and I bring to life, I have wounded and I will heal, and no one can deliver out of my hand" (Deut. 32:39). God has ordained our days (Ps. 139:16) and is in control of our lives.
Another foundational principle involves a biblical view of life- taking. The Bible specifically condemns murder (Exod. 20:13), and this would include active forms of euthanasia in which another person (doctor, nurse, or friend) hastens death in a patient. While there are situations described in Scripture in which life-taking may be permitted (e.g., self-defense or a just war), euthanasia should not be included with any of these established biblical categories. Active euthanasia, like murder, involves premeditated intent and therefore should be condemned as immoral and even criminal.
Although the Bible does not specifically speak to the issue of euthanasia, the story of the death of King Saul (2 Sam. 1:9-16) is instructive. Saul asked that a soldier put him to death as he lay dying on the battlefield. When David heard of this act, he ordered the soldier put to death for "destroying the Lord's anointed." Though the context is not euthanasia per se, it does show the respect we must show for a human life even in such tragic circumstances.
Christians should also reject the attempt by the modern euthanasia movement to promote a so-called "right to die." Secular society's attempt to establish this "right" is wrong for two reasons. First, giving a person a right to die is tantamount to promoting suicide, and suicide is condemned in the Bible. Man is forbidden to murder and that includes murder of oneself. Moreover, Christians are commanded to love others as they love themselves (Matt. 22:39; Eph. 5:29). Implicit in the command is an assumption of self-love as well as love for others.
Suicide is usually a selfish act. People kill themselves to get away from pain and problems, often leaving those problems to friends and family members who must pick up the pieces when the one who committed suicide is gone.
Second, this so-called "right to die" denies God the opportunity to work sovereignly within a shattered life and bring glory to Himself. When Joni Eareckson Tada realized that she would be spending the rest of her life as a quadriplegic, she asked in despair, "Why can't they just let me die?" When her friend Diana, trying to provide comfort, said to her, "The past is dead, Joni; you're alive," Joni responded, "Am I? This isn't living."(6) But through God's grace Joni's despair gave way to her firm conviction that even her accident was within God's plan for her life. Now she shares with the world her firm conviction that "suffering gets us ready for heaven."(7)
The Bible teaches that God's purposes are beyond our understanding. Job's reply to the Lord shows his acknowledgment of God's purposes: "I know that you can do all things; no plan of yours can be thwarted. You asked, 'Who is this that obscures my counsel without knowledge?' Surely I spoke of things I did not understand, things too wonderful for me to know" (Job 42:2-3). Isaiah 55:8-9 teaches, "For my thoughts are not your thoughts, neither are your ways my ways, declares the Lord. As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts."
Another foundational principle is a biblical view of death. Death is both unnatural and inevitable. It is an unnatural intrusion into our lives as a consequence of the fall (Gen. 2:17). It is the last enemy to be destroyed (1 Cor. 15:26, 56). Therefore Christians can reject humanistic ideas that assume death as nothing more than a natural transition. But the Bible also teaches that death (under the present conditions) is inevitable. There is "a time to be born and a time to die" (Eccles. 3:2). Death is a part of life and the doorway to another, better life.
When does death occur? Modern medicine defines death primarily as a biological event; yet Scripture defines death as a spiritual event that has biological consequences. Death, according to the Bible, occurs when the spirit leaves the body (Eccles. 12:7; James 2:26).
Unfortunately this does not offer much by way of clinical diagnosis for medical personnel. But it does suggest that a rigorous medical definition for death be used. A comatose patient may not be conscious, but from both a medical and biblical perspective he is very much alive, and treatment should be continued unless crucial vital signs and brain activity have ceased.
On the other hand, Christians must also reject the notion that everything must be done to save life at all costs. Believers, knowing that to be at home in the body is to be away from the Lord (2 Cor. 5:6), long for the time when they will be absent from the body and at home with the Lord (5:8). Death is gain for Christians (Phil. 1:21). Therefore they need not be so tied to this earth that they perform futile operations just to extend life a few more hours or days.
In a patient's last days, everything possible should be done to alleviate physical and emotional pain. Giving drugs to a patient to relieve pain is morally justifiable. Proverbs 31:6 says, "Give strong drink to him who is perishing, and wine to him whose life is bitter." As previously mentioned, some analgesics have the secondary effect of shortening life. But these should be permitted since the primary purpose is to relieve pain, even though they may secondarily shorten life.
Moreover, believers should provide counsel and spiritual care to dying patients (Gal. 6:2). Frequently emotional needs can be met both in the patient and in the family. Such times of grief also provide opportunities for witnessing. Those suffering loss are often more open to the gospel than at any other time.
Difficult philosophical and biblical questions are certain to continue swirling around the issue of euthanasia. But in the midst of these confusing issues should be the objective, absolute standards of Scripture, which provide guidance for the
1. Plato, Republic 3. 405.
2. R. Finigsen, "The Report of the Dutch Committee on Euthanasia," Issues in Law and Medicine, July 1991, 339-44.
3. Herbert Hendlin, Chris Rutenfrans, and Zbigniew Zylicz, "Physician-Assisted Suicide and Euthanasia in the Netherlands: Lessons from the Dutch," Journal of the American Medical Association 277 (4 June 1997): 1720-2.
4. Interview with Koop, "Focus on the Family" radio broadcast.
5. Robin Bernhoft, quoted in Euthanasia: False Light, produced by IAETF, P.O. Box 760, Steubenville, OH 43952.
6. Joni Eareckson, Joni (Grand Rapids: Zondervan, 1976).
7. Joni Eareckson, A Step Further (Grand Rapids: Zondervan, 1978).
©1998 Probe Ministries