Terminally Ill Bill

Evidence submitted by Paul Badham at the request of, and on behalf of, the Modern Churchpeople's Union, to the Select Committee on the Assisted Dying for the Terminally Ill Bill.

from Signs of the Times, No. 20 - Jan 2006

Introduction to the Organisation and to the Author

A. The Modern Churchpeople's Union (The MCU) was founded in 1898 to encourage and protect exponents of liberal theological and ethical thought within the Church of England. Since the 1920's it has campaigned for the Churches to support the legalisation of euthanasia in the context of terminal illness. The MCU has asked Professor Badham (a Vice-President of the Union) to present evidence to the Select Committee along the lines of his articles in Studies in Christian Ethics. Conscious that the Committee will receive submissions from Christian bodies opposed to any relaxation of the present laws against euthanasia, the MCU is concerned that the Select Committee should be aware that there are also strong Christian arguments in favour of euthanasia, and that these arguments are supported by 66% of those members of the Church of England who worship on a weekly basis. [1]

B. Paul Badham has been Professor of Theology and Religious Studies in the University of Wales, Lampeter since 1991. Religious and ethical beliefs concerning life, death and immortality have been his major research area, and he has published six books relating to Christian beliefs about death, dying and immortality. The articles referred to by the MCU are:

Should Christians Accept the Validity of Voluntary Euthanasia? Studies in Christian Ethics, October 1995. Reprinted in Robin Gill, The Churches and Euthanasia, Cassells, 1998.

Euthanasia and the Christian Doctrine of God in Studies in Christian Ethics, June 1998.

A comparable chapter, A Theological Examination of the Case for Euthanasia was published in Paul Badham and Paul Ballard, Facing Death, University of Wales Press, 1996.

Memorandum of Evidence

1. Why people support the legalisation of assisted suicide.

The reason most people give for joining a voluntary euthanasia society is that they do not like what they see ahead of them. They do not themselves wish to endure the protracted dying process they have watched their parents go through. [2] Clive Seale's research has shown that 28% of all relatives believe that it would have been better if their loved one had died earlier than they actually did. When asked if their loved one had expressed a wish to die 24% said "yes". Of these 36% had explicitly asked for medical help to die. [3]

2. The lack of consistency in Christian opposition to euthanasia.

The primary theological argument against permitting assisted suicide is that issues of life and death are for God alone to determine. However there is a serious inconsistency in applying this principle when the question of shortening the dying process is discussed, and not applying the same principle when questions about the extension of the dying process arise. Almost all Christians today accept the desirability of vaccination, even though in 1829 Pope Leo XII ruled that anyone who accepted, or practised, vaccination was, "no longer a child of God". This was because vaccination infringed on God's sovereignty over life and death. [4]

3. Why Christian acceptance of birth control may foreshadow acceptance of euthanasia.

The closest parallel for the likelihood that most Churches will come to accept the morality of assisted suicide is the change in their attitude to birth control. Historically almost all Christians were opposed to birth control on the grounds that it challenged God's unique authority over issues of life and death. This stance has since been abandoned by almost all Church leaders in the protestant traditions as well as, in practice, by Roman Catholic laity. Hans Kung has shown that very similar arguments were used in the papal encyclical against euthanasia, Evangelium Vitae , as in the papal encyclical against birth control, Humanae Vitae. [5] The Pope's position is consistent. What is not consistent is the position of other Christians and their leaders. Most now accept that it is good for couples to consult together, and to obtain medical advice and help to plan their families, and to decide when it would be best for a new human life to begin. Yet many of the same people are opposed to such consultation and help being sought to determine when the battle against terminal illness should be abandoned, and the person be given help to die as painlessly as possible. However just as the practice of the Christian laity led to acceptance of birth control, so the views of the laity may ultimately change Church thinking on euthanasia. Professor Robin Gill has shown that 84% of Christians of all denominations who worship once a month support euthanasia, as do 66% of weekly Church-going Anglicans. [6]

4. Jesus' Golden Rule and the case for legalising assisted suicide.

The heart of Jesus' ethical teaching was the primacy of the law of love. Throughout his ministry, the main source of conflict between Jesus and the religious authorities of his day was Jesus' insistence that loving response to human need must always outweigh the detailed requirements of the Old Testament Law. Jesus believed that the essence of religious law was summed up in the maxim, "love your neighbour as yourself". His own Golden rule was, "Always treat others as you would like them to treat you." [7] This rule could be relevant to the case of a doctor wishing to help a terminally ill person to die. The suicide rate is higher for doctors than for almost all others. No doubt many factors contribute to this, but at least one is the fact that they know the implications of terminal illness, and have the means to release themselves from it. Dr. Michael Irwin claims that "many physicians and nurses have private arrangements that they will hasten each other's deaths should they ever be unfortunate enough to resemble the condition of some of their patients". [8] For doctors who have made such "arrangements", the legalising of assisted suicide would not only protect their colleagues from possible serious repercussions, it would also enable such doctors to give to their patients the treatment they wish for themselves. In behaving thus they would literally be following Jesus' golden rule.

5. Is suicide the ultimate sin?

One objection to legalising assisted suicide is the belief that suicide itself is the ultimate sin of despair against God. It is generally assumed that "The Everlasting... has fixed his canon 'gainst self-slaughter", and that "the calamity of so long life" must be endured. But this is Shakespeare speaking through Hamlet. [9] It is not the case that the canonical scriptures forbid suicide. Indeed those Biblical figures who chose "death before dishonour" received the praise of their contemporaries. [10] It is interesting that, though historically Jesus died a cruel death at the hands of his enemies, the fourth Gospel presents it as his own choice: "No one takes it from me. I lay it down of my own accord." [11] From a Christian perspective death is not viewed as a disaster, but as gateway to fuller life. In the early Church this was very firmly believed. According to St. Athanasius in the fourth century, the best evidence for the resurrection of Jesus is the way Christians, "treat death as nothing... they go eagerly to meet it... rather than remain in this present life." [12] Two-thirds of the early Christian martyrs were not sought out, but handed themselves in to the Roman authorities for execution. [13] Arthur Droge and James Tabor argue that before St. Augustine changed Christian attitudes to this question, many of the early Christians continued to hold the stoic understanding of suicide as, "a noble death". [14] The beliefs of the early Christians provide an interesting counter balance to those of their successors today who give priority to the prolongation of life at all costs.

6. The naturalness of death

The general biblical perspective is that there is a natural time for everything: "A time to live and a time to die". [15] In this context while premature death is seen as a tragedy, death in the fullness of time is something to be accepted. Ecclesiasticus 30:17 says "Death is better than a miserable life, and eternal rest than chronic sickness." This could be a motto for those who support euthanasia. One of the oldest Christian prayers, often attributed to St. Ambrose, is a prayer to God for a good death:

"Grant to life's day, a calm unclouded ending,

An eve untouched by shadows of decay." [16]

If this is something that Christian tradition has seen as appropriate to ask God for, should it not also be legitimate to ask this from one's fellow human beings?

7. Does palliative care remove the need for legalising assisted suicide?

It is often claimed that with the advance of palliative care the case for euthanasia is no longer as strong as it used to be. In some respects this is true. In comparison with death columns in newspapers thirty years ago, newspapers are now more likely to report that a person died "peacefully", than that the person died, "after much suffering bravely borne." However the fact that support for euthanasia has also grown over the same period indicates that pain is not the sole consideration. Many people find the inevitable indignities and limitations consequent on terminal illness "burdensome" and would wish to be spared from having to endure them. Now that intensive therapy facilities enable death to be kept at bay for longer, these factors have become increasingly significant.

8. How legalising assisted suicide could help the helpless.

It is sometimes claimed that that if assisted suicide were legalised this would put pressure on the terminally ill at their weakest point. However the well-known theologian Hans Kung counters this. He argues that it is the present situation, where people are denied assistance to die, which really puts pressure on the terminally ill. He claims that very often terminally ill people are "exposed to intolerable suffering at the very point when their helplessness is at its greatest". He urges that "it is precisely the most vulnerable who should be allowed the means to ensure that their lives are not dragged out endlessly". Kung believes that if assisted suicide were allowed it would enable people to die, not in lonely isolation, but "supported by true friends and with the help of an understanding doctor, in composure and confidence, in gratitude and in tranquil expectation." [17]

9. The evidence from the Netherlands

In reflecting on the likely impact of any bill legalising assisted suicide the evidence from the Netherlands needs to be carefully evaluated. Abuses consequent on permitting euthanasia in the Netherlands have been widely reported by British opponents of Euthanasia. However according to the Royal Dutch Medical Association, and the Dutch Society for Health Law, such opponents of euthanasia have conveyed, "a very inaccurate and unreliable impression about the extent and nature of the practice of voluntary euthanasia in that country". This conclusion is supported both by the findings of the Remmelink Commission, and by the encyclopaedic survey of the Dutch situation by Margaret Otlowski. The findings of the Remmelink Commission established that "voluntary euthanasia is in fact performed much less frequently than had earlier been thought." [18] What their figures showed was that "a large number of patients seek assurance from their doctors that active voluntary euthanasia will be available if the suffering becomes intolerable", [19] but relatively few go on to take advantage of this. According to Ruurd Veldhuis, in 1995, 34,500 people took the precaution of going through the necessary legal procedures to enable them to receive euthanasia "when time would come". But of these only 3,200, fewer than 10% of those who had obtained approval, ultimately did go ahead with it [20]. Margaret Otlowski concludes that "there is no indication that active euthanasia on request is practiced more often in The Netherlands than elsewhere." [21] Helga Kuhse and Peter Singer think that the primary benefit of the legalization of euthanasia in the Netherlands is that it has enabled doctor and patient to talk freely through all the options available. This has had the valuable consequence that "the open practice of voluntary euthanasia may have reduced the incidence of doctors acting without the consent of the patient in ways that the doctor foresees will result in the patient's death. [22]

10. Is the present position in the UK sustainable?

Hitherto it has been recognised in British medicine that in the pursuit of controlling pain, caring doctors may prescribe medication that they "foresee" but do not "intend" will shorten the lives of their patients. This way of "helping out" suffering patients is legal, but because death cannot be "intended" there can be no open discussion of the doctor's plans with either the patient or their relatives. No patient can know whether or not their doctor will actually help them out in this way. No doctor who acts in this way can now be wholly confident that their professional judgement will not be called into question by a "whistle-blower" who queries the need for the dosages being prescribed. Ever-increasing knowledge about the minimum dosages needed for controlling pain may make this way of helping people out in the final stage of illness hazardous for the doctor. The ruling in the Burke case has raised further problems. It is now significantly more difficult for doctors to choose to bring to an end life-sustaining treatment for terminally ill patients. In all questions of doubt, the issue must henceforth be resolved "in favour of the preservation of life". [23] All these factors suggest that the traditional understanding of how doctors may legitimately ease their patients out of terminal suffering are being increasingly called into question. In the light of this new situation the proposed careful legislation to allow physician-assisted suicide would bring peace of mind to both patient and doctor. In the increasing complexity of modern medical advances, such legislation would now seem necessary to enable good medical practice to continue.

12. A recommended amendment to the proposed legislation

Clause 4 section 8 says that the declaration shall remain in force for six months. This may put pressure on a patient to ask for implementation of assisted suicide before that date, rather than lose their authorisation for it, and face the hassle of going through the whole legal procedure again. This would seem unfortunate. Hence it would seem sensible to remove a time limit.

13. The opportunity this legislation offers for a Christian death

Historically it used to be the practice of all believers to summon a priest when death was thought near, so that the patient could be given the last rites, and die surrounded by an atmosphere of prayer and worship, as well as in the presence of family and friends. Modern technology has largely taken away that option. Most die alone in a hospital bed so attached to saline drips and other support systems that the older death-bed scene ceases to be possible. Yet if one were allowed and assisted to face the reality of the inevitable it would be possible for death to become an affirmation. One could imagine a situation where a Christian could say goodbye to family and friends, a Holy Communion service could be celebrated at the believer's bedside, and he or she could be given the last rites in preparation for the journey through death to the life immortal. In a context of faith this would seem a more Christian way of death than the present lonely extension of the dying process.

Notes

  1. Robin Gill, The Churches and Euthanasia Cassells 1998 p. 21. [back]
  2. P. Nowell Smith in Paul Badham, Ethics on the Frontiers of Human Existence New York 1992 p. 211. [back]
  3. Article by Clive Seale in The Times Higher Januarry 6th 1995 p. 16. [back]
  4. Derek Holnes, The Triumph of the Holy See Burns & Oates 1978, p. 82. [back]
  5. Hans Kung and Walter Jens, A Dignified Dying SCM 1995 p. 119. [back]
  6. Robin Gill, The Churches and Euthanasia Cassells 1998 p. 21. [back]
  7. Matthew 7:12. [back]
  8. Sunday Times 20th. July 1997. [back]
  9. Hamlet Act 1.Sc. 2. lines 129ff; Act iii, Sc.1 lines 56ff. [back]
  10. Judges 17:28-30;1 Samuel 31:3-6; 2 Samuel 1:11-27; 1 Maccabees 6:44; 2 Maccabees 14:41-42. [back]
  11. John 10:18. [back]
  12. St. Athanasius, On the Incarnation Mowbrays 1963, pp. 57-59. [back]
  13. A.Droge and J.Tabor, A Noble Death San Francisco 1992, p. 154. [back]
  14. Droge and Tabor, A Noble Death. [back]
  15. Ecclesiastes 3:2. [back]
  16. Hymns Ancient and Modern Revised, number 17. [back]
  17. Hans Kung and Walter Jens, A Dignified Dying SCM 1995 pp. 34,38,119-121. [back]
  18. Margaret Otlowski, Voluntary Euthanasia and the Common Law Oxford 1997, p. 437. [back]
  19. Otlowski, p. 441. [back]
  20. Ruurd Veldhuis, "Tired of Living, Afraid of Dying: reflections on the practice of euthanasia in The Netherlands" Studies in Christian Ethics Volume 11 Number 1. [back]
  21. Otlowski p. 437. [back]
  22. H.Kuhse and P.Singer, Editorial in Bioethics 3, 1992 p.4. Cited in Otlowski p. 439. [back]
  23. The Times July 31st. The Sunday Times August 1st. [back]

Revd Prof Paul Badham is Emeritus Professor of Theology and Religious Studies at the University of Wales, Trinity Saint David (Lampeter Campus) and a Modern Church Vice-president.