Some of the most difficult problems faced by medical practitioners today are not strictly medical but ethical. For example, when–if ever–is it right to withhold medical treatment of a terminally ill patient, or even to prescribe medication that will hasten death and thus relieve the pain and distress the patient has endured for “long enough”?
The patient may be a hopelessly and helplessly deformed and handicapped child, with or without a correctable abnormality or treatable illness, which, if not treated, would result in premature death. Or he/she may be a senior who has an untreatable and progressively disabling medical condition rendering him/her useless to self and society. They may, as many do, ask for some injection to terminate life, or one of the “suicide machines” of which we have all been made aware by the media in recent years.
In most places, these are not yet legal, but they seem to be used with increasing frequency, probably much more than is reported.
In some countries, active non-voluntary euthanasia (that is, without the consent of the patient) is carried out frequently. In 1991, it was confirmed by a Dutch government report that 1,030 cases of non-voluntary euthanasia took place in Holland: one death in every 50 was then reported as the result of euthanasia. The figures have probably risen since then.
We can be sure that there have been significant increases in corresponding figures in North America.
The decline in moral and ethical values is widespread in North American society, and affects physicians with the rest of society. The Toronto Star reported a poll in Canada in October 1994, indicating that “78% of Canadians believed that, under specific conditions, dying individuals should be able to request help from their doctors to end their lives.” That is an increase of 33% in 25 years. The widespread acceptance of the concept of euthanasia has been attributed, at least in part, to the “de-Christianization of formerly Christian nations.”
What should be the Christian’s attitude to this subject? The believer, of course, looks to the Word of God for guidance on all ethical and moral matters. Very early in its pages, stress is laid on the sanctity of human life, which is based on the uniqueness of man, created in the image of God and after His likeness (Gen. 1:26-27), quite separate and distinct from the rest of creation. No other creature is so described.
The sanctity of human life is emphasized in Genesis 9 (vv. 5-6), based on the uniqueness of man’s creation: “Whoso sheddeth man’s blood, by man shall his blood be shed: for in the image of God made He man.” Men (and animals, v. 5) are to be held responsible for the taking of human lives and punished accordingly. One who takes the life of another human being, who is equally made in the image of the Creator, expresses contempt for the Creator, represented by that human being. By taking the life of another, whether by a sword or gun, or by administering a chemical to terminate life, or withholding what is necessary for its continuance, a person forfeits his own right to live; hence the Scriptural basis for capital punishment. This divine prohibition against the taking of human life has never been repealed. It was the sixth of the ten commandments: “Thou shalt not kill” (Ex. 20:13). The Son of God reinforced it in His teachings; for example, in the Sermon on the Mount, in Matthew 5:21- 22.
“Euthanasia” literally means “dying well”: that is, gentle, easy death. The word was introduced with this meaning in the seventeenth century. Every physician should strive for this objective when treating a terminally ill or severely and hopelessly handicapped patient, who is not expected ever to recover.
However, like many other words in the dictionary, this one has altered or expanded its meaning and has come to be applied to “mercy killing”–deliberate termination of life of a person with irremediable, distressing, painful disease or disability. It has even been used of the intentional shortening of life of persons so deficient mentally or physically as to be considered of no value to society.
Euthanasia has been divided into various categories. One such classification follows:
1. Active Euthanasia: The administration of a poisonous or noxious substance with intent to kill. Legally this is regarded as murder, or, at least manslaughter, a criminal offense. However, “suicide machines” have been used, and large doses of drugs given to hasten death and little punitive action has been taken.
2. Administration of therapeutic doses of pain-killing medication in the knowledge that, because of the development of tolerance to the drug, increasing dosage will become necessary to keep the patient pain-free, but will ultimately hasten death. With increasing knowledge of available pain-relieving drugs, and experience in their use in terminally-ill patients, it seems possible to treat the majority of these so that they are relatively free of distressing symptoms and may have a genuine “gentle, easy death.”
3) Passive Euthanasia: withholding therapeutic measures which could prolong life, thus allowing the disease process to take its course, resulting in the patient’s death.
Any of these options may be considered “voluntary” or “involuntary” depending on whether they are used with or without the patient’s consent. Decisions regarding giving and withholding treatment for incurable patients who are slowly and painfully dying, are often very difficult. A number of questions have to be considered, for example:
1. Could the resources spent in keeping a patient alive with life-support systems be better spent on others who would benefit more from it? Should such treatment be on a “first come, first serve” basis? It is difficult, and maybe unwise, to discontinue such treatment for one patient in order to give it to another who might benefit more, if there is no other system available.
2. In some cases, the use of such measures is merely prolonging the act of dying. Is this a wise use of resources? In any case, is it wise to give any treatment, however costly, if it does no more than keep the patient alive? Sometimes, however, there is wisdom in keeping a patient alive, if there is reasonable hope of newer therapeutic measures being available in time for the patient to benefit. There have been many examples of patients, thought to be incurably terminal, who survived when life support measures were withdrawn.
Christians have a special responsibility in the circumstances we have been considering, whether they are physicians, nurses, or paramedical workers; relatives, neighbors, or friends of the patient. Many doctors and nurses have been drawn to palliative care because of a Christian desire to make a difference to the lives of the dying. We all have a responsibility to love our neighbors as ourselves (Mt. 19:19). In the words of the “Golden Rule” given by our Lord in the Sermon on the Mount: “All things whatsoever ye would that men should do to you, do ye even so to them: for this is the law and the prophets” (Mt. 7:12). We should bestow “tender, loving care” and do whatever we can to relieve their distress, and help the other caregivers.
If the patient is a believer, longing to be “at home with the Lord,” we may not be as anxious to hold on to him/her but willing to let them go. On the other hand, if the patient is an unbeliever, we have added responsibilities, to seek to introduce them to the Best Friend in life and death. This should, of course, be done discreetly and wisely, and perhaps more by what we do than by what we say. The Lord Jesus was the best example of compassion and care for the sick and dying–and dead!–for whom only He could do anything, and we should seek to emulate His compassion and sympathy for those in need. Such gentle, sympathetic care will help to provide true euthanasia, gentle, easy dying, for patients in these distressing circumstances.