Last year's Synod approved the motion "that the Synod
welcomes compassionate and considered debate regarding the
practice of euthanasia, and encourages all Anglicans to support
the development and resourcing of effective and available
palliative care for all people with terminal illness."
The aspect which 1 believe has been missing from the general
debate in Australia in the last couple of years is the
"development and resourcing of effective and available
palliative care for all people with terminal illness." The
role of the national Church and local parish churches in
providing support to those at the end of life is, I suggest, one
which will grow over the next fifty years as the population ages.
How can we as Anglicans support the provision of effective care
for people living with terminal illness?
According to the World Health Organisation, palliative care is
"the active total care of patients whose disease is
not responsive to curative treatment. Control of pain, of other
symptoms, and of psychological, social and spiritual problems is
paramount. The goal of palliative care is achievement of the best
possible quality of life for patients and their families. Many
aspects of palliative care are also applicable earlier in the
course of the illness, in conjunction with anticancer treatment.
Palliative care:
Palliative care is, at its core, total holistic care which uses
such medical technology as is most appropriate. It is not heroic
in the preservation of life at all costs. Palliative care is not
solely medical care, but also includes lowtechnology care from
doctors, nurses, therapists, religious ministers, and others who
can assist with the quality of life. For that reason, palliative
care is often a less expensive option than highly
interventionist, technologically advanced hospital care.
Palliative care can take place in the home. in the hospice, or in
a hospital environment.
A recent article in the Economist
suggested that there are three core questions in the discussion
of euthanasia:
· Do human beings have a right to decide how and when they will
die?
· If they do, does this include a right to have help in
implementing that decision?
· if it does, is it possible to write legislation that will
protect those who are old and sick, or chronically disabled, but
who do not want to die?
Crowther defines active euthanasia as "an act of
premeditated homicide". In discussing the range of
publications now available in the US and other countries on how
to do it yourself, he cites the advantages of euthanasia as
economy and the removal of responsibility from the medical
profession (in making decisions about ending life). Crowther
defines the disadvantages as: religious attitudes and beliefs
regarding the sanctity of life, difficulty in defining situations
in which it may be permitted and in controlling enforcement of
law, differing interpretations of rules, and difficulties in
resisting pressures from the patient's family and friends (who
may be in favour of relieving suffering).
Interestingly enough, the advantages are very tangible, if quite
negative. The disadvantages as Crowther explains them are much
less specific attitudes, interpretations, difficulties. Crowther
adds:
"There is a further compelling disadvantage which arises
from the fact that it is extremely difficult or even impossible
to forecast how one would feel towards living when faced with a
terminal illness when in good health. It is too easy to simply
say mercy killing would be the answer when considering the
questions from a stance of good health and often with little or
no experience of strictly limited life. Those professionals
working with terminally ill people find that it is very rare
indeed for patients genuinely to want their life shortened; in
the vast majority of cases, even though the horizons of life may
be very limited, life is precious both to the patients and to the
friends and relatives. Much more often the suggestion of wanting
life terminated is a cry for help with symptoms and personal
distress in the knowledge that it is safe to suggest it and
communicate in that way."(emphasis mine)
Tony Burke put this argument forcefully when he wrote
"By always involving a second person, euthanasia is
about how we respond to somebody who is suicidal. It is about
that response, from the doctor or the community the Parliament.
That's why it can never be simply an issue of individual rights.
If it only involves an individual, then by definition, it is not
euthanasia. I cannot see what's so compassionate about telling
people who feel worthless that they're right."
This is why euthanasia is not about suicide. It is interesting in
this light to consider that the name of the Northern Territory
legislation is "the right to die". We already have the
right to die. In fact, as the Economist drily comments, "no
matter how zealously you drink your orange juice, eat your fruit
and vegetables, organise your sleep and do your exercises, the
fact remains that one day you will be dead." The emotive
suggestion that the government is somehow taking away our
individual rights is, I believe, at the heart of the confusion
regarding euthanasia. The Advertiser's editorial entitled
"the right to choose to die", encapsulated this
confusion when it stated "if you believe, as we do, that the
individual has sovereignty over his or her life and body then the
State should not intervene" but then went on to say that
"where life has become intolerable and its end inevitable,
the timing of that final event should not be left to the illegal
mercy of doctors or natural causes."
Legalising euthanasia is about legislating the ability to take
life. In doing so we make a communal statement about how we as a
society value life. Christopher Newell, a consultant ethicist and
member of the General Synod's Social Responsibilities Commission,
put it this way: "The moment that we introduce a "right
to die" we place this in direct conflict with the
"right to live" values which protect all of us in
community, especially those who are weak and powerless."
In answer to The Economist's first question do human beings have
a right to decide how and when they will die? I suggest that we
each have that individual right. Whether others have the right to
do it for us is a separate question.
The National Council for Hospice and Specialist Palliative Care
Services, in its submission to the British House of Lords Select
Committee on Medical Ethics, discussed this tension between
personal autonomy and the principle of the sanctity of life:
"Neither the sanctity of life nor the principle of respect
for autonomy are absolute. In our moral framework there are no
absolute principles which can never be overridden by others, and
so dilemmas arise when the relative weights of the principles
have to be compared in circumstances where they conflict.
"Medical, law and everyday morality support a strong
universal prohibition on killing. All of us have a strong prima
facie right against all others not to be killed. We may or may
not, depending on the relationships and circumstances, owe a duty
to preserve each other's lives. We do not have to preserve life
at all costs. The principle of respect for life is essentially a
prohibition against killing, which all societies have adopted in
some form in order to survive. It also entails a variable duty to
strive to preserve the lives of others.
"Similarly, modem morality supports the principles of
respect for autonomy i.e. selfrule by informed, rational persons.
However, where the needs of another individual or society are
deemed to be more important or desirable than the achievement of
the individual's goal, then that person's right of autonomy may
legitimately be infringed. The principle of respect for autonomy
is not absolute.”
For this reason, the current practice in which some doctors are
considered to practice euthanasia, while seen as inconsistent by
some, recognises that each case needs to be considered on its own
merits. Legalising the ability to shorten someone's life does not
provide the protection which those who are more vulnerable in our
society require.
Elected governments pass legislation in order to ensure the
greatest good for society, including those who are least able to
choose for themselves, as Tony Burke stated: "No one is
ignoring the issue of euthanasia. Around the world parliaments
are considering it and rejecting it. They are rejecting
euthanasia essentially on the basis of one single unifying
principle: the people who will be most at risk are the most
vulnerable and a law that fails to protect people who are
vulnerable will always be a bad law." Therefore, the
response to The Economist's second question does this include a
right to have help in implementing that decision? must be no.
Kellehear, in his compelling article on social attitudes towards
death, suggests that although it is commonly considered that we
are a deathdenying society, we have in fact confused death with
disease.
"Interactionally, the sick role is preferable to the dying
role because to be sick there is noone to blame and relationships
are workable. When dying, the doctor has failed to cure, the
patient becomes stigmatised through the medicalised view of
death...in other words, the medicalisation of death has not
transformed our general view of death into one that denies its
impact, its existence, or its "sting" as it were.
Medicalising death has meant the transformation of the dying role
into a low status, technology intensive and potentially
contaminating situation in need of sanitising. Death has been
reinterpreted but the new interpretation is not denial.”
In Oregon, in the United States, some health care organisations
have offered to pay for death rather than for longterm care. It
is not difficult to see that as the population ages and people
live for longer periods with debilitating illnesses, the economic
question of how to distribute limited resources will lead to the
conclusion that the process of dying is not worth funding. I
suggest that the question of euthanasia is not fundamentally a
question of providing "a good death", but of providing
a good life.
To The Economist's third question is it possible to write
legislation that will protect those who are old and sick, or
chronically disabled, but who do not want to die? I believe the
answer is no. This is not because people are at heart
untrustworthy, or because devious minds will deliberately set
about to kill the vulnerable. It is because the one right which
humans have enshrined in social laws, customs and family systems
is the right to life. To deny that fundamental humanising belief,
even with the best of intentions, is to begin to erode the duty
of care which we have one to another.
As Christians, we are called to create
community, to love one another and seek to serve one another as
Jesus showed us in his life and actions The fact that some people
die in indignity and great suffering should not spur us to end
their lives but should galvanise our energies to find ways of
ensuring that every moment of their lives is lived with dignity.
One of the common arguments for legalising euthanasia is that of
not allowing people to suffer, the "they shoot horses"
argument. One of the fears expressed by some palliative care
practitioners is that legalising euthanasia will mean that less
funding is provided for research into ways of preventing pain and
ensuring quality of life. Once legislation is enshrined which
says that sometimes we are able to kill people, the distinction
between killing and letting die becomes more blurred than it is
currently.
There will never be a perfect solution for this issue. The fact
is that we will all die, some of us in extremely traumatic
circumstances. The reality is that more of us will live for
longer periods with chronic or severe illness. Some of us will be
in positions to ease the pain of others, and in some situations,
we will in doing so shorten their lives. To acknowledge that and
to legalise the practice are two different things. To try to
avoid suffering by assisted suicide or euthanasia indicates not
only that life is only precious when it is easy, but that we as a
community no longer have an imperative to care for one another no
matter what the cost.
Linda Kurti
Cancer pain relief and palliative care;
Report of a WHO Expert Committee, WHO, Geneva, 1990
“Last Rights”, The Economist, 21/6/97
Crowther, AGO (1993) Euthanasia, Sheffield: Trent Palliative Care
Centre, occassional Paper 10, p11
“Sanctity of life and the right to choose death”, The
Australian 17/10/96
The Economist, 21/6/97
“The right to choose to die”, The Advertiser, 26/5/95
“Killing people and community”, Church Scene, 25/10/96
National Council for Hospice and Specialist Palliative Care
Services (1993), Key Ethical Issues in Palliative Care.
Occassional Paper 3, p4
Burke, 17/10/96
Kellehear, A. “Are we a ‘death-denying society’? A
sociological review” Social Science and Medicine 1984,
18(9): 713-723.
The Economist, 21/6/97
Executive Officer: Theo
Mackaay (08) 9336 1348
Anglican Social Responsibilities Commission, Province of Western
Australia
Tel (08) 9321 7033
Fax (08) 9321 5821
email: [email protected]
16-Nov-97