Ethics

Euthanasia

In view of increasing public interest in euthanasia, and in the light of the Nigel Cox and Tony Bland cases, the House of Lords set up a Select Committee on Medical Ethics to look seriously into the issue of euthanasia in 1993. During their deliberations they took submissions from a variety of persons and parties. Of these the Department of Health, the Home Office, The British Medical Association and the Royal College of Nursing all argued against any change in the law. The committee in its final report in February 1994, despite being earlier undecided on the issue, unanimously ruled that there should be no change in the law.[1] Lord Walton , the committee chairman, reflected on this in a speech to the House of Lords on 9 May 1994 in saying:

‘We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused. We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.’

The result is that despite mounting pressure (most lately via the Mental Incapacity Bill) euthanasia remains illegal in Britain.

However in the Netherlands there has been a steady escalation in euthanasia since the mid 1980s. According to the Remmelink Report,ii commissioned by the Dutch Ministry of Justice, there were over 3,000 deaths from euthanasia in the Netherlands in 1990. More than 1,000 of these were not voluntary. Other assessments have been far less conservative, and these figures pre-date February 1994 when euthanasia in that country was legally sanctioned.

Holland is moving rapidly down the slippery slope with the public conscience changing quickly to accept such action as acceptable. The Royal Dutch Medical Association (KNMG) and the 'Dutch Commission for the acceptability of life terminating Action’ have recommended that the active termination of the lives of patients suffering from dementia is morally acceptable under certain conditions. Two earlier reports of the commission affirmed the acceptability of similar action for severely handicapped neonates and comatose patients.[2] Case reports include a child killed for no other reason than it possessed abnormal genitalia [3] and a woman killed at her own request for reasons of ‘mental suffering’.[4]

Euthanasia was briefly legalised in the Northern Territory of Australia in July1996, but the legislation was overturned by the Australian Federal Parliament on March 24 last year after only four patients had died.[5] The Supreme Court of the United States made unanimous rulings last June that there was no fundamental right to assistance in committing suicide. So far Oregon is the only state to succeed in making physician assisted suicide legal. In spite of this Dr Kevorkian has presided over more than 50 such deaths in Michigan without being convicted in the last few years. In its 1992 Statement of Marbella, the World Medical Association[6] confirmed that assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession.

Colombia passed a law allowing euthanasia in May 1997 and the Phillipines and South Africa have also been considering legislation.

Many are unaware that what ended in the 1940s in the gas chambers of Auschwitz, Belsen and Treblinka had far more humble beginnings in the 1930s: in nursing homes, geriatric institutions and psychiatric hospitals all over Germany. Leo Alexander,[7] a psychiatrist who worked with the Office of the Chief of Counsel for War Crimes at Nuremberg, described the process in the New England Medical Journal in July 1949:

‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.’

Such a progression requires only four accelerating factors: favourable public opinion, a handful of willing doctors, economic pressure and a law allowing it. In most Western countries the first three ingredients are present already. When legislation comes into effect, and political and economic interests are brought to bear, the generated momentum can prove overwhelming.

Abortion

Although abortion has been practised at some level by most societies, legal abortion on a massive scale is a relatively recent phenomenon. Since the Soviet Union first legalised abortion in 1920, much of the rest of the world has followed suit: Scandinavia in the 30s, Asia beginning in the 40s and Western Europe from the late 60s. By 1982 only 28% of the world’s population lived in countries where abortion was largely illegal - mostly in Muslim countries, parts of Africa and Latin America. There are now estimated to be 55 million legal abortions performed each year worldwide.[8]

Britain was the first non-Scandinavian Western country to liberalise its abortion laws in 1967. Since then almost 4 million abortions have been performed in England, Wales and Scotland and there is currently one ‘legal’ abortion for every four live births.

In England and Wales the annual total has stabilised at about 170,000. The majority (98.6%) are performed on the grounds of risk of injury to the mental or physical health of the pregnant woman or her existing children. Only 1.1% are done because of fetal handicap and 0.013% to save the life of the mother. For 58% of women it is their first pregnancy and 67% have never been married. Most abortions (61%) are carried out in the private sector.

The typical woman having an abortion in the UK today is single, under 25, in her first pregnancy and having the procedure performed in a private institution for reasons of ‘risk of injury to the physical or mental health of the mother’.[9]

The dramatic increase in abortion worldwide this century has run counter to historically accepted codes of medical ethics. The Hippocratic Oath includes the resolution ‘I will not give to a woman a pessary to produce abortion’.[10] The Declaration of Geneva (1948) states ’I will maintain the utmost respect for human life from the time of conception even against threat...’[11] and the International Code of Medical Ethics (1949) affirms that ‘a doctor must always bear in mind the importance of preserving human life from the time of conception until death’.[12] In the same spirit the UN Declaration of Human Life (1948) asserts that ‘everyone has the right to life’[13] and the UN Declaration of the Rights of the Child (1959) that the child deserves ‘legal protection before as well as after birth’.[14]

When the legal abortion rate soared world-wide in the second half of this century the World Medical Association responded in 1970 by adopting the Declaration of Oslo.[15] This allowed ‘therapeutic’ abortion in circumstances ‘where the vital interests of the mother conflict with those of the unborn child’. Although the ‘utmost respect for human life from the time of conception’ as laid out in the Declaration of Geneva was affirmed, it was recognised that there was a ‘diversity of attitudes towards the life of the unborn child’. Accordingly it was allowed that ‘where the law allows therapeutic abortion to be performed... and this is not against the policy of the national medical association’ then ‘abortion should be performed’ under certain provisos. This declaration thus laid the framework for doctors to perform abortions if their ‘individual conviction and conscience’ allowed it and the law and the national medical association were not in disagreement.

The change appears minor but it represented a fundamental shift in the whole framework of medical ethics. The Judeo-Christian ethic with its concept of absolute right and wrong was discarded and ‘individual conscience’ enthroned as absolute in its place. ‘Individual conviction and conscience’ which ‘must be respected’ has replaced God as the arbiter of truth. The doctor is no longer obliged not to kill. Instead, by a strange twist he is now obliged not to stop other doctors killing if their ‘consciences’ dictate that they should.

As the abortion rate rocketed world-wide consistency of belief and practice were achieved by further amending the ethical codes. At the 35th World Medical Assembly held in Venice in October 1983 the WMA changed the Declaration of Geneva as follows: the words ‘from the time of conception’ were amended to ‘from its beginning’. The result is that now the medical profession are among the major facilitators of abortion.

What does the Bible say about euthanasia and abortion?

The sixth commandment

There are only two instances of voluntary euthanasia in the Bible.

In the first, Abimelech, believing himself to be fatally wounded with a fractured skull after being hit on the head by a millstone, asks his armour-bearer to kill him. His request is granted and the Israelite leader is thus spared the ‘indignity’ of being killed by a woman. The death is seen as just retribution for Abimelech’s own murder of his seventy brothers, and we are not told what happened, if anything, to the armour-bearer (Jdg 9:52-55).

In the second, an Amalekite despatches the mortally injured Saul, still alive after a failed attempt at suicide.

‘I happened to be on Mount Gilboa’ the young man said ‘and there was Saul, leaning on his spear, with the chariots and riders almost upon him. When he turned around and saw me, he called out to me and I said, ‘What can I do?’... Then he said to me ‘Stand over me and kill me. I am in the throes of death but I am still alive. So I stood over him and killed him because I knew that after he had fallen he could not survive’ (2 Sa 1:6-9).

Whether the story is true (it varies from the account of Saul’s death at the end of 1 Samuel 31) or the Amalekites fabrication in order to win favour in David’s eyes for despatching Saul and delivering him the crown, the new king’s reaction is interesting.

‘Why were you not afraid to lift your hand to destroy the Lord’s anointed?’ (2 Sa 1:14) he asks, and then apparently before receiving a reply, as if the confession in itself were sufficient grounds for a verdict to be made, orders the Amalekite’s execution.

In the mind of David at least, the compassionate killing of Saul constituted a capital offence, despite him being in great pain (presumably with peritonitis) and close to death without the possibility of analgesia, and most significantly of all, despite Saul’s own request to be killed.

There are no accounts of abortion in Scripture. Although ‘ripping open pregnant women’ is described as an evil practice deserving of judgment (Am 1:13; 2 Ki 8:12) it was clear that this was without the women’s consent or approval. However child sacrifice was a capital offence in ancient Israel (Lv 20:2).

Old Testament foundations

The sixth commandment ‘Thou shalt not kill’(AV) (Ex 20:13; Dt 5:17) has its roots in the creation narrative’s ‘Let us make man in our image’ (Gn 1:26) and in the Noahic Covenant’s ‘Whoever sheds the blood of man, by man shall his blood be shed’ (Gn 9:6). Man, being made in the image of God, is not to be killed.

The English language has created for us a confusion that is not present in the original text. There are in fact ten Hebrew words translated ‘kill’ in the authorized version of the Bible, all with different shades of meaning, but only one of them is implicated in the sixth commandment, the word ‘ratsach’. Its Greek equivalent is ‘phoneuo’ and it is most accurately translated ‘murder’(NIV). The meaning of the word is further defined in four main passages in the Pentateuch (Ex 21:12-14; Lv 24:17-21; Nu 35:16-31; Dt 19:4-13).

This resolves the ambiguity for us as we are left with a precise definition of what is prohibited, namely the ‘intentional killing of an innocent human being’. Let us consider this in more detail.

First, the commandment forbids ‘intentional’ killing. Anyone killing another human being unintentionally was able to flee to a city of refuge where he would gain some protection from the ‘avenger of blood’. The natural death of the high priest would later atone for the killing and the guilty party would be freed (Nu 35:28). However this ‘manslaughter’ provision applied only in very limited circumstances:

‘For instance, a man may go into the forest with his neighbour to cut wood, and as he swings his axe to fell a tree, the head may fly off and hit his neighbour and kill him’ (Dt 19:5).

Killing resulting from negligence was not excused as unintentional (Ex 21:29). Neither was killing ‘in hostility’ even if not necessarily premeditated (Nu 35:21).

Second, the commandment forbids the killing of an ‘innocent human being’. Under the Old Covenant God authorised or permitted killing in three situations: in the context of holy war, for capital offences and in self defence (Ex 22:2). The holy war conditions are clearly spelt out by Moses (Dt 20:10-18). In cities within the promised land everybody was to be killed, in cities at a distance the men only were to be killed and only if a preliminary offer of peace was not accepted.

There were over twenty capital offences ranging from murder to contempt of court. In these situations the Israelites had the obligation of carrying out the judicial killing as God’s representatives. The self defence provision only operated if someone who had broken into a house after dark intending to commit a crime was killed by the owner while protecting his family and property.

God authorised only the killing of the guilty. ‘Innocent’ blood could not be shed intentionally under any circumstances and is in fact uniformly condemned throughout Scripture (Ex 23:7; 2 Ki 21:16; Ps 106:37,38; Je 19:4).

We must not become confused here with legal, psychological or social definitions of murder. The Bible does not support the conclusions of others that murder is ‘the killing of a human being unlawfully with malice aforethought’[16] or killing with ‘a feeling of ill-will’[17],[18] or ‘illegal killing inimical to the community’.[19] It is rather ‘the intentional killing of an innocent human being’.

So in summary, the Old Testament teaching is that the intentional killing of any innocent human being is wrong. There is no provision for diminished responsibility on the basis of age or illness and there is no provision for compassionate killing even at the person’s request. Similarly there is no recognition of a ‘right to die’ as human life belongs to God (Ps 24:1) and is not the personal possession of any human being. Suicide is equally a breach of the sixth commandment. Only God has the authority to take human life. Man can only do so under God’s delegated authority.

New Testament principles

What of the New Testament? In Old Testament prophecy concerning the New Covenant we read that God’s spirit is to be put in believers in order to enable them to obey his laws and decrees (Ezk 36:24-27). God’s law instead of being written on tablets of stone is to be put in men’s minds and written on their hearts (Je 31:31-34). Law is not dispensed with. Rather the purpose of the Spirit is to enable the moral law to be properly obeyed.

This high view of Old Testament moral law is also evident in the teaching of Christ himself, who commanded his disciples to obey the teachers of the law in so far as they were faithful to the Law of Moses (Mt 23:2-3), and said that anyone who broke one of the least of the Law’s commandments and taught others to do the same would be called least in the Kingdom of Heaven. According to Christ not ‘the least stroke of a pen’ is to disappear from the Law until ‘heaven and earth disappear’. In fact his disciples are expected to go beyond mere observance of the letter of the Law to fulfilment of the very principle of love upon which it is based (Mt 5:17-20). So for example, in the eyes of Christ, hate and lust are to be regarded as seriously as murder and adultery (Mt 5:21-22, 27-28).

In apostolic teaching, while it is asserted that we are now ‘not under law but under grace’ (Rom 6:14) this statement refers not to our ethical obligations under the New Covenant but rather to the basis of our justification. Indeed we now have a much more exacting ethical obligation than mere observance of the letter of the Old Testament moral law, namely to live ‘according to the Spirit’. In other words, while our goodness or righteousness is ‘by faith’ (Rom 1:17) the evidence of the genuineness of our faith is that we perform good works (Jas 2:26) by living ‘according to the Spirit’.

For completeness I should comment about ‘holy war’ and capital punishment in a New Testament context. In the church age both the nature of our opposition and the mode of our victory have changed from that of Israel. Our opposition is no longer ‘flesh and blood’ but rather ‘spiritual forces of evil’ (Eph 6:12). Accordingly the mode of our victory is not by killing but in recognizing that Jesus has already triumphed over our enemies through the cross, and that by virtue of being ‘seated with him’ we share his position of authority over them (Eph 1:20-22, 2:6). This leaves aside the far more complex issue of whether Christians should submit to secular governing authorities to the extent of fighting for one country against another. This issue is outside the scope of this seminar.

With regard to capital punishment, or any judicial sentencing for that matter, this function has passed entirely to the state which is God’s instituted authority, his ‘servant’ and ‘agent of wrath to bring punishment on the wrongdoer’ (Rom 13:1-5). The church has no authority to carry out Old Testament punishments on its members. In fact the very most it can do is to excommunicate those who repeatedly refuse to respond to correction (1 Cor 5:12-13).

So in summary the New Testament gives us an even higher view of law than the Old and the absolute prohibition against intentional killing of innocent human beings remains in place.

Attacks on Biblical law

As I mentioned in the previous seminar biblical law is under attack from within the church from three distinct ideologies which we called for convenience antinomianism, situationism and legalism. All of these have a major bearing on the euthanasia debate. Let us consider them in turn.

Antinomianism dispenses with law altogether. The antinomian argues that since we are under grace, and not law, and since the death of Christ cleanses us from all unrighteousness, we are no longer under any obligation to obey the moral law. This flies in the face of Paul’s own rhetorical question ‘Shall we sin because we are not under law but under grace?’ to which he supplies his own answer ‘By no means!’ and goes on to point out that our freedom from the condemnation of the law means that we are now ‘slaves of righteousness’ and thereby obliged to obey God’s commands (Rom 6:15-18).

Situationism retains the law but claims that in certain situations the commandments may be suspended in favour of the higher principle of ‘love to one’s neighbour’ (Mt 22:39-40). The situationist argues that one may intentionally kill in certain situations and yet be acting ‘in love’. There are two main problems with this. Firstly, it clearly contravenes Christ’s own teaching that obedience to the greater commandments of the law does not in any way excuse disobedience to the lesser (Mt 5:17-20, 23:23). In the mind of Christ these ‘conflicts of duty’ simply do not occur. Secondly, it begs the question of what a ‘loving’ action is. The reality is that ‘individual conviction or conscience’ is made the arbiter of right and wrong, a return to ancient heresy of each doing ‘as he sees fit’ (Dt 12:8). This has tremendous dangers as we have already seen with our forgoing historical outline.

Legalism substitutes human oral tradition for God’s law and introduces a nonbiblical hierarchy of sins (Mk 7:8-13). God’s true commandments are distorted such that they become impractical and in fact impossible for all but a select group to obey. Thus the prohibition against ‘intentional killing of the innocent’ may become a directive to ‘strive officiously to sustain life at all costs’. The result is that the most important principles of love, justice and mercy are ultimately lost sight of and a new law is imposed (Mt 23:23). A tragic consequence can be that in the case of terminal care the attainable goals of caring, consoling and comforting are forgotten as the doctor driven more by guilt than compassion feels he must do everything technologically possible for the patient.

Antinomianism, Situationism and Legalism are all distortions of Christian teaching, in short they are heresies with dangerous consequences and need to be recognised as such and rejected. However we need to recognise that each is in part an overreaction to mistakes of the past: antinomianism to joyless obedience, situationism to obedience without compassion and pharisaism to lawless indulgence. In rejecting these false ‘isms’ we need to recognise that the best argument against them is the practical demonstration of joyful, compassionate, obedient Christian service.

This analysis will help us see that however appealing euthanasia may seem in any given situation; it can never be justified biblically. It is only God who can take innocent life. But it may not convince us in the issue of abortion. Is abortion the intentional killing of an innocent human being? Abortion is undoubtedly ‘intentional’. It is also ‘killing’ because the fetus is alive before and dead after the event. The fetus is 'innocent', not being guilty of any capital offence. Abortion then is certainly not manslaughter (as has been suggested[20]) because manslaughter is unintentional. Nor is it ‘justifiable homicide’,[21] [22] because homicide was only ever justifiable for guilty human beings.

But is the fetus a human being? This has become the key issue in the debate.

The status of life before birth

The fundamental issue in the abortion debate is whether life before birth is viewed in the same way by God as life after birth. If it is, then we must be obliged to treat human life in the womb with the same respect with which we would treat human life at any other stage of development. If it isn’t then we could argue that we are justified in employing some sort of sliding scale of value.[23] What does the Bible say?

Fundamental to the Bible’s teaching on the status of human life is the principle that God himself is completely just and impartial (2 Ch 19:7). It is therefore not surprising that Jesus and the apostles warned against partiality on the basis of wealth (Jas 2:3,4), sex, race, social standing (Gal 3:28) and age (Mt 19:14). Furthermore Old Testament teaching enjoined special respect and protection for easily exploited groups such as the poor (Pr 22:22-23), widows and orphans (Ex 22:22-24), aliens (Ex 22:21), the handicapped (Lv 19:14), slaves (Ex 21:2-6) and the elderly (Lv 19:32). It must follow that devaluing any human life, let alone vulnerable human life, is inconsistent with God’s justice. The heart of Christian ethical teaching is that we must love as Christ himself loved (Jn 13:34), that the strong should lay down their lives for the weak (Phil 2:5-8, Rom 5:6-8). To suggest that the weak may be sacrificed in the interests of the strong is not biblical morality.

Furthermore there are many specific references to life before birth in Scripture. Psalm 139:13-16 affirms God’s creation of, and communion with, the unborn child as well as implying the continuity between life before and after birth:

‘For you created my inmost being; you knit me together in my mother’s womb.
I praise you for I am fearfully and wonderfully made; your works are wonderful...
My frame was not hidden from you when I was made in the secret place...
your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be.’

God calls Isaiah and Jeremiah before birth (Is 49:1, Je 1:5) and forms Job ‘in the womb’ as well as bringing him out of it (Jb 10:8-9, 18-19). The Isaiah reference is particulary noteworthy because it comes from one of the so-called Servant Songs and therefore speaks prophetically of Christ himself.

Many other references to life before birth in the Bible reinforce these principles (eg. Gn 25:22-23, Ps 22:9,10, 51:5, 71:6, 119:73, Ec 11:5, Is 44:2,24, 49:5, Ho 12:3, Mt 1:18, Lk 1:15, 41-44) and there are over 60 references which mention the event of conception explicitly. In the Luke reference we see Elizabeth, the mother of John the Baptist, prophesying over Christ in his first week of gestation, and the baby John leaping in the womb. The Psalm 22 and the Genesis 25 references are also prophetic of Christ, so when we consider that he was ‘made like his brothers in every way’ (Heb 2:17) this must speak clearly of our status before birth as well.

In the face of the weight of this biblical testimony however, some Christians have justified attributing a lesser value to life before birth on the basis of Exodus 21:22-25. This argument dominated the literature of the Christian Medical Fellowship for decades [24] [25] [26] [27] [28] [29] [30] and perhaps accounts for the CMF’s silence at the time of the Abortion Act being passed. In reality the interpretation is flawed. Let us consider it in some detail.

‘If two men who are fighting hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever the woman’s husband demands and the court allows. But if there is serious injury, you are to take life for life, eye for eye ... bruise for bruise.’ (Ex 21:22-25)

The argument put forward is that fetal life must be of less value to God or ‘miscarriage’ would have been punishable by the death penalty. It is easier to understand how people come to this conclusion when the RSV version of the translation is considered:

‘...If men strive together, and hurt a woman with child, so that there is a miscarriage, and yet no harm follows...’

It is essential to stress first that this cannot be construed as a reference to abortion. There is no intention to hurt the unborn child and the woman is an innocent bystander to a fight who suffers accidental injury. However there are three key questions raised by the passage which have a bearing on the status of life before birth: Is this a premature live birth or a miscarriage? Does the fine apply to causing the death or the premature delivery of the baby? Does the set of punishments apply to injury of the child or mother or both?

The varied interpretations made by English translators virtually all add to the meaning of the original Hebrew text. Whereas the NIV reading implies a premature live birth, the RSV suggests that the baby is dead. The Hebrew doesn’t rule out either possibility but simply states that ‘her child’ (yeled) - or more correctly her offspring since the form of the noun is a generic plural -'goes out'(yatsa). Yeled in most biblical contexts means simply child (see for example Gn 21:8, Ru 4:16, 1 Ki 3:25) and yatsa elsewhere simply describes going forth (Gn 12:4, Ex 35:20). Because there is no indication in the Hebrew text that death of the baby has necessarily occurred it is therefore not justified to assume (as many authors do) that causing a miscarriage was punishable only by a fine. Equally, the Hebrew does not specify whether the 'serious injury' referred to is suffered by the mother or the child. Both readings are possible. If, as some commentators have argued,[31] the lex talionis (life for life etc) applies equally to the child, causing a stillbirth or miscarriage would have been punishable by death. This reading would be far more consistent with the rest of the biblical testimony about the status of life before birth. If the Hebrew leaves room for doubt then surely we are obliged to give the fetus the benefit of that doubt. It is extremely dangerous in any area of biblical interpretation to base our whole practice on an unwarranted deduction from a single verse.

If God himself does not discriminate between individuals and affirms the humanity of life before birth recognising conception as a strategic event, dare we act differently? How can we justifiably claim that unborn children are not neighbours to whom we owe responsibility? The burden of proof must certainly be with those who are trying to justify abortion.

If, as we have argued, life before birth has the same status as life after birth in the eyes of God, it must follow that if we wouldn’t approve of infanticide in a given situation, neither should we approve of abortion. We would not sanction the destruction of a newborn baby who was grossly deformed, or conceived as a result of rape or the child of a minor. We would rather look for some way to make the best of a bad situation, to work the evil for good - by using our medical skills, or helping practically or financially or perhaps by arranging adoption. Shouldn’t we then treat the fetus in the same way?

Most arguments that have been put forward to devalue life before birth are based more on human feeling and intuition than divine revelation. For example, some[32] assume that being made in God’s image involves possessing a certain level of rationality, consciousness or capacity for relationship and then argue that this is impossible without a certain level of neurological function. Scripture simply tells us that man is made in God’s image (Gn 1:27; 9:6). A human being not yet born has value not because she knows God but because God knows her! (Ps 139:13-16) Human status is bestowed from above, given by grace, rather than being earned.

Others[33] assign human value on the basis of how we feel. It is argued that because we mourn miscarriages less than stillbirths, early life is less important. However to imagine that our status depends on how much we are valued by other people is again to undermine the Bible’s teaching that it is ultimately what God thinks of us that really matters.

Some[34] presuppose lack of value by repeatedly referring to the fetus as ‘a potential human being’. But it is surely more correct to call it a potential infant or adult or even a human being with potential. Speculation about whether or not the fetus possesses a soul also involves presuppositions. Whilst we must admit to some sort of dualism at the time of death (something after all survives death to be judged) the Bible gives no support to the notion that ‘the soul enters the body’ at some point after conception. To argue from the special case of Christ[35] using Hebrews 10:5 ‘a body you prepared for me’ is not justified. Christ was pre-existent. We are not. If we want to argue from the special case of Christ then we have the Holy Spirit’s own testimony (Lk 1:42) that Christ was present in Mary’s womb at about 14 days’ gestation (see vv 36,56-8). Can we really support with any conviction that he wasn’t present at conception given Gabriel’s visit and prophecy at this time? (Lk 1:26,36)

In Bishop Ryle’s words, ‘If the thing is not in the Bible, cannot be deduced from the Bible, or is not in manifest harmony with the Bible, we should have none of it.’ There is no biblical basis whatsoever for assuming that human life before birth has any less status in the eyes of God than life after birth. The Scriptures rather support the conclusion that God values both equally.

The Cross

Both euthanasia and abortion raise many difficult questions and we’ll look at some of them in the time remaining but I want first to say something about the relevance of the cross to this whole discussion. If we do make a stand as Christians in any area of medicine (and particularly in the areas of abortion and euthanasia) we need to be working for better alternatives. This will be different for each person depending on their gifts and position of influence but for abortion it may mean being engaged in counselling, helping to set up support networks, lobbying to introduce legislation which will give more protection to the unborn, giving financially to those involved in all these sorts of work - as well as being firm in our resolve not to be a party to the shedding of innocent blood ourselves - be it intentional or by default. Part of carrying the cross too involves using our time, talents and money in searching for compassionate Christian alternatives where the world offers diabolical quick-fix solutions - and if necessary, putting our careers, reputations and lives on the line.

Jesus approach to the woman caught in adultery (Jn 8:1-11) was not to condemn but to forgive, to call her on to a better lifestyle and ultimately to make it possible for her by dying on the cross in her place. There are many similarities between this situation and that of abortion: The sexual sin that so often leads to an unplanned pregnancy, the absent but equally guilty male partner and the condemning crowds.

In both abortion and euthanasia we often seem to have only two equally undesirable alternatives to choose from. For the patient dying in pain it is seen as either living hell or the euthanasia needle. For the woman with an unplanned pregnancy, it it seen as either a life worse than death for an unloved child or the abortionist’s curette.

In both scenarios, as for the woman caught in adultery there is a third way. For the dying patient it finds its shape in the hospice movement and good palliative care. Thankfully that safety net is already in place and was one of the major planks in the argument leading the House of Lords to rule against euthanasia.

For the unplanned pregnancy there was no similar safety net in place when the Abortion Act was passed in Britain in 1967. But now we are seeing the rise of crisis pregnancy counselling services (such as those run by CARE for Life) tending to the needs of women and helping them either in keeping their babies or in the adoption process.

In both cases the third way is the way of the cross. It calls us to expend our time, money and energy in finding compassionate solutions to bad situations.

Difficult Questions

In closing and perhaps in anticipation of some of the questions you may have in mind I want to say a few words about the difficult questions these issues raise. More detail can be found in my papers ‘Deadly Questions on Abortion’ and ‘Twelve Reasons why voluntary euthanasia should not be legalised’ both of which are available on this site.

Reasons why euthanasia should not be legalised

1. Voluntary euthanasia is unnecessary because alternative treatments exist
This is not to deny that there are many patients presently dying in homes and hospitals who are not benefiting from advances in palliative care. There are indeed many having suboptimal care either because facilities do not exist in the immediate area or because local medical practitioners lack the training and skills necessary to manage terminally ill patients properly. The solution to this is to make appropriate and effective care and training more widely available, not to give doctors the easy option of euthanasia. A law enabling euthanasia will undermine individual and corporate incentives for creative caring.

2. Requests for voluntary euthanasia are rarely free and voluntary
Patients with a terminal illness are vulnerable and may well be suffering from fear about the future and anxiety about the effect their illnesses are having on others. Those who regularly manage terminally ill patients recognise that they often suffer from depression or a false sense of worthlessness which may affect their judgment. Their decision-making may equally be affected by confusion, dementia or troublesome symptoms which could be relieved with appropriate treatment. Patients who say ‘let me die’ usually, after effective symptom relief, are most grateful that we didn’t accede to their requests. Terminally ill patients also adapt to a level of disability that they would not have previously anticipated they could live with and come to value what life they have left. Many elderly people already feel a burden to family, carers and a society which is cost conscious and may be short of resources. They may feel great pressure to request euthanasia ‘freely and voluntarily’. These patients need to hear that they are valued and loved as they are. They need to know that we are committed first and foremost to their well-being.

3. Voluntary euthanasia denies patients the final stage of growth
It is during the time of a terminal illness that people have a unique opportunity to reflect on the way they have lived their lives, to make amends for wrongs done, to provide for the future security of loved ones and to prepare mentally and spiritually for their own death. Those involved in hospice work often observe a mending of family relationships and rediscovery of mutual love and responsibility that may not have been evident for years. It is often through facing the hardship that terminal illness brings, and through learning to accept the practical help of others that human character and maturity develops most fully. Death, if properly managed, can be the final stage of growth. It can also be a time when words are spoken and strength imparted that will help sustain 'those left behind' through the years ahead.

Losing the opportunity of caring for vulnerable people denies us an essential part of our humanity. We conquer suffering, not by being insulated from its realities, but by facing it.Voluntary euthanasia, by artificially shortening life, denies these possibilities.

4. Voluntary euthanasia undermines medical research
One of the major driving forces behind the exceptional medical advances made this century has been the desire to develop treatments for previously fatal illnesses, and the eagerness to alleviate hitherto unmanageable symptoms. Medical research is essential if medicine is to advance further. When the focus changes from curing the condition to killing the individual with the condition, this whole process is threatened. The increasing acceptance of prenatal diagnosis and abortion for conditions like spina bifida, Down’s syndrome and cystic fibrosis is threatening the very dramatic progress made in the management of these conditions, especially over the last two decades. Rather than being employed to care and console, funds are being diverted to fuel the strategy of ‘search and destroy’.

If euthanasia is legalised we can expect advances in ktenology (the science of killing) at the expense of treatment and symptom control. This will in turn encourage further calls for euthanasia.

5. Hard cases make bad laws
Legalisation of euthanasia is usually championed by those who have witnessed a loved one die in unpleasant circumstances, often without the benefits of optimal palliative care. This leads to demands for a ‘right to die’, but allowing difficult cases to create a precedent for legalised killing is the wrong response. We need rather to evaluate these difficult cases so that we can do better in the future. This was clearly demonstrated in the case of Nigel Cox, the Winchester rheumatologist found guilty of attempted murder after giving a patient with rheumatoid arthritis a lethal injection of potassium chloride in August 1991. Had he consulted more widely he could have relieved his patient’s symptoms without killing her.[36]

The European Association for Palliative Care recently registered its strong opposition to the legalisation of euthanasia.[37] If care is aimed at achieving ‘the best possible quality of life for patients and their families’ by focusing on a patient’s physical, psychosocial, and spiritual suffering, requests for euthanasia are extremely uncommon. The answer is not to change the law, but rather to improve our standards of care.

6. Autonomy is important but never absolute
Autonomy is important. We all value the opportunity of living in a free society, but also recognise that personal autonomy has its limits. Rights need protection, but must be balanced against responsibilities and restrictions if we are to be truly free.

We are not free to do things which limit or violate the reasonable freedoms of others. No man is an island. No person makes the decision to end his or her life in isolation. There are others who are affected: friends and relatives left behind, and the healthcare staff involved in the decision-making process. Western society no longer recognises suicide as a crime, but still appreciates that a person’s decision to take his or her own life can have profound, often lifelong effects on the lives of others. There may be guilt, anger or bitterness felt by those left behind. Personal autonomy is never absolute. The effect of personal decisions on others now living or in future generations must also be considered.

7. Voluntary euthanasia gives too much power to doctors
Calls for voluntary euthanasia have been encouraged either by the failure of doctors to provide adequate symptom control, or by their insistence on providing inappropriate and meddlesome interventions which neither lengthen life nor improve its quality. This has understandably provoked a distrust of doctors by patients who feel that they are being neglected or exploited. The natural reaction is to seek to make doctors more accountable.

Ironically, voluntary euthanasia legislation makes doctors less accountable, and gives them more power. Patients generally decide in favour of euthanasia on the basis of information given to them by doctors: information about their diagnosis, prognosis, treatments available and anticipated degree of future suffering. If a doctor confidently suggests a certain course of action it can be very difficult for a patient to resist. However it can be very difficult to be certain in these areas. Diagnoses may be mistaken.[38] Prognoses may be wildly misjudged. New treatments which the doctor is unaware of may have recently been developed or about to be developed. The doctor may not be up-to-date in symptom control.

Doctors are human and subject to temptation. Sometimes their own decision-making may be affected, consciously or unconsciously, by their degree of tiredness or the way they feel about the patient. Voluntary euthanasia gives the medical practitioner power which can be too easily abused, and a level of responsibility he should not rightly be entitled to have. Voluntary euthanasia makes the doctor the most dangerous man in the state.

8. Voluntary euthanasia leads inevitably to involuntary euthanasia
When voluntary euthanasia has been previously accepted and legalised, it has led inevitably to involuntary euthanasia, regardless of the intentions of the legislators. This was demonstrated in Nazi Germany and also more recently in the Netherlands where as early as 1991 there were over 1,000 non-voluntary euthanasia cases reported.

Summary

We need to recognise that requests for voluntary euthanasia are extremely rare in situations where the physical, emotional and spiritual needs of terminally ill patients are properly met. As the symptoms which prompt the request for euthanasia can be almost always managed with therapies currently available, our highest priority must be to ensure that top quality terminal care is readily available.

While recognising the importance of individual patient autonomy, history has clearly demonstrated that legalised euthanasia poses serious risks to society as a whole. Patients can be coerced and exploited, the search for better therapies is compromised and involuntary euthanasia inevitably follows.

Legislation allowing voluntary euthanasia should be firmly resisted on the grounds that it sidesteps true compassionate care (because effective alternatives exist) and ultimately undermines rather than protects patient autonomy.

Deadly Questions...on abortion

1. How can a non-sentient being have value?
Peter Singer, editor of the Bioethics Journal, puts the secular view of humanity in a nutshell: ‘Once the religious mumbo-jumbo surrounding the term 'human' has been stripped away... we will not regard as sacrosanct the life of every member of our species, no matter how limited its capacity for intelligent or even conscious life may be’.[39] To Singer and many influential thinkers like him, man is nothing but the product of matter, chance and time in a godless universe, nothing but a highly specialised animal. The value of an individual human being is determined by his level of rationality, self-consciousness, physical attributes or capacity for relationship. Human life that has less of these qualities is of less value and can be disposed of. This ‘Darwinian’ ethic with its aim of ‘survival of the fittest’ puts the demented, the mentally handicapped, the brain-injured and the unborn in great danger.

By contrast the Christian view is that all human beings are made in God’s image.[40] If they lack the means to feel, think or form relationships as we do they still have dignity by virtue of the fact that they are made and known by God. Biblical morality dictates that the weak deserve special protection[41] and in God’s economy, the strong lay down their lives for the weak.[42] After all, protecting the vulnerable is what ‘knowing God’ is all about.[43] Even if it could be established that fetuses feel nothing, should this really make a difference to the way we treat them? Does anaesthesia legitimise killing?

Having said this, we do not even know that the fetus is ‘non-sentient’. We do know that brain function, as measured by EEG is present in the fetus at about six weeks after conception[44] and that responses to tactile sensation (skin tightening, bending, fist forming) can be observed at seven to eight weeks gestation. At nine to ten weeks the fetus squints and swallows and breathing movements begin at eleven to twelve weeks. By sixteen weeks he will respond violently to stimuli that you or I would find painful. Pain is a peculiarly personal and subjective experience and there is no biochemical or physiological test we can do to tell us if fetuses (or any other persons) experience it. By the same token we lack any proof that animals feel pain, but judging by their responses, it seems charitable to assume that they do. No one would dare suggest dismembering newborn kittens (which ironically are born blind, deaf and helpless at nine weeks gestation!).

2. Don’t women have a right to choose?
Any woman with an unplanned pregnancy will understandably feel under pressure, especially if the father of the child is not supportive. Whether she opts for abortion, adoption or keeping the baby the decision will change her life forever. She needs to know that the fetus is not just ‘part of her body’. It is a genetically distinct and vulnerable human being, which has come into existence, almost always, because of choices she and her partner have made.

Some argue that only women can decide about abortion because only women understand what it is like to be pregnant. While this has a certain validity it also has shortcomings. It is rather like arguing that only drivers should be able to decide about road rules because only drivers understand the pressures of driving. However the actions of motorists can have profound effects on passengers, bystanders and the drivers of other cars as well. In the same way there is a ‘passenger’ in the womb and other parties outside it to consider.

No man (or woman) is an island. We all value the opportunity of living in a free society, but also recognise that personal autonomy has its limits. Rights need protection but they are not absolute. They must be balanced against responsibilities. We are not free to do things which limit or violate the reasonable freedoms of others. In the human community abortion is not simply a matter between a woman and her doctor. There are others to consider: the father, any other citizens who may be affected by the decision and, not least, the unborn child herself.

Although there are exceptions, most unwanted pregnancies result from a conscious decision to engage in sexual intercourse by people who are equipped neither for pregnancy nor parenthood (67% of women having abortions in Britain have never been married).[45] It is only natural to regret wrong decisions made in the heat of the moment, but killing an innocent human being to avert the consequences of choices we have made is never morally justifiable. The right to life is the most fundamental right of all.

Solo mothers will need support, and adoption even with its difficulties is always an option to be considered. There are many childless couples spending thousands of pounds on infertility treatment because babies they could have provided a home for have been among the 4.8 million terminated in Britain since 1968.

3. Won’t refusing abortion simply mean that women suffer?
A common myth is that women will not change their minds about having an abortion when offered practical help and given the facts about fetal development. Many do, and pregnancy counselling organisations like CARE for Life[46] have made a substantial contribution in helping women whose turning to abortion is simply a cry for help. But even women refused abortions do not necessarily seek them. An early Swedish study[47] of 4274 women refused abortion showed that 85.6% completed their pregnancies and only 10% sought an abortion elsewhere.[48] Another similar study followed up 249 such women for 7 to 10 years finding that 73% were satisfied with the way things had turned out, and 69% were taking care of the child.[49] Most unwanted pregnancies, if not aborted result in wanted children. Conversely most abused children come from wanted pregnancies. Since the Abortion Act came into force in Britain in 1968 the incidence of child abuse has doubled.[50]

Many believe that women refused abortion are at risk of mental illness. However Representatives of the Royal College of Psychiatry giving evidence to the Rawlinson Commission[51] have stated that there are no psychiatric grounds for abortion. This is in spite of the fact that most abortions are carried out on alleged grounds of damage to the mother’s mental health. In fact for suicidal pregnant women abortion will increase depression and the risk of post-abortion psychosis.[52] What they really need is proper psychiatric treatment. As a general rule pregnancy enhances rather than damages mental health; the incidence of suicide in non-pregnant women of childbearing age is 18 times that in pregnant women.[53]

While first trimester abortions are usually physically safe (for the mother) complications do however occur: Uterine perforation, haemorrhage, sepsis, cervical lacerations and retained placentae in the short term; and chronic pelvic inflammatory disease, subfertility, cervical incompetence, rhesus isoimmunisation and menstrual disturbances in the long term. The prospective and joint RCGP/RCOG study showed that 10% of women had complications within 3 weeks of the procedure.[54] As complications should be reported by one week on the statutory ‘yellow’ form and most occur after this time the true complication rate may well be higher. Women damaged by abortion are unlikely to return to the institution which damaged them simply to be counted.

Early psychiatric morbidity appears to be about 10%.[55] The long term sequelae are difficult to evaluate as follow up rates are low for a variety of reasons, not least that many wish not to be reminded of their experience. In some patients post-abortion psychosis can be crippling,[56] and those who feel ambiguous about the decision are particularly vulnerable.

4. Surely we can’t return to the days of back street abortionists and abortion tourism?
The argument that ‘safe and legal’ abortion is necessary to stop ‘thousands of women’ dying at the hands of back street abortionists is ill-founded. Claims about death rates have been wildly exaggerated; take for example, the pro-choice newspaper which claimed in 1989 that 600,000 Brazilian women died from illegal abortions each year.[57] A look at UN statistics reveals that there were only 2,507 maternal deaths in Brazil in 1988 - from all causes![58] Similarly the figure of 200,000 abortion deaths worldwide promoted by leading politicians (such as Baroness Chalker) has been acknowledged to be hugely exaggerated. The UNFPA Report ‘The State of the World’s Population’, published in August 1994, put the figure at 60,000. Even this is a guestimate. Dr Bernard Nathanson, who was a major figure in the effort to legalise abortion in the US and presided over 60,000 abortions before having a change of heart, gives some insight into the reasons for the disparity between the real and the claimed:

‘...we emphasised the frame of the individual case, not the mass statistics, but when we spoke of the latter it was always '5,000 to 10,000 deaths a year'. I confess that I knew the figures were totally false... but the overriding concern was to get the laws eliminated, and anything within reason that had to be done was permissible.’[59]

The truth is that, throughout the world, abortion deaths have fallen steeply in line with maternal deaths, owing to advances in medical science. According to WHO figures this trend has occurred regardless of whether abortion is legal or illegal in particular countries.[60] Ireland, which has maintained an absolute law against abortion, has the lowest maternal mortality rate in the world.[61] Prior to the Abortion Act mortality from criminal abortion in Britain was very low (approx 20 per year); compared with the 180,000 unborn children who now die annually. This was because many so-called back street abortions were performed (albeit illegally) by doctors in relatively ‘safe’ circumstances.[62]

It’s also claimed, by pro-choice law ‘reformers’, that women denied abortions at home will simply travel to other countries to obtain them. While this did happen to a limited extent in the past, it was never in numbers approaching those in countries where abortion is legal. Legalisation has increased abortion rates dramatically, to the extent that deaths (of unborn children) from abortion worldwide now number 55 million per year.[63] Abortion rates among Irish women (who can easily travel) are still only a third that of British women.

5. What about abortion for rape?
If life before birth has the same status as life after birth then it follows that if we wouldn’t approve of infanticide in a given situation, then neither should we approve of abortion. Would we sanction the destruction of a neonate who was grossly deformed, conceived as a result of rape or the child of a minor? Wouldn’t we rather look for some way to make the best of a bad situation by using our medical skills, helping practically or financially, or perhaps by arranging adoption?

These difficult cases must be seen in this light. Rape is a very serious crime that itself was a capital offence in the Old Testament. However pregnancy arising from rape is extremely rare; and even alleged rape is a factor in less than 1% of abortions. In the USA in any one year, one in a thousand women report rape and of these a similar proportion become pregnant. Furthermore in the only major study of pregnant rape victims ever done, 75 to 85% chose against abortion.[64] This is because many women who have been raped believe that abortion is immoral, that the child is simply a second innocent victim, and that if they get through the pregnancy they will have conquered the rape. Giving birth in such circumstances is a display of courage, strength and honour. Abortion, by contrast, simply sacrifices a second innocent party to the crime.

I am forced to the conclusion that the Christian solution, difficult though that may be, is to care for the child at least until birth when adoption can be considered (especially if the mother is young). However, one cannot advocate this without at the same time realising that it puts every onus on us as Christians to do everything we can to help an equally innocent (and much sinned against) mother.

6. What about abortion for fetal handicap?
Abortions for fetal handicap make up only 1.1% of the total in Britain, but over 90 are performed on infants of viable age each year. This puts the issue in sharp perspective. Whereas profoundly handicapped 26 week old neonates are (quite rightly) given every chance of survival, older babies still in utero can be legally killed in Britain for less serious abnormalities. Many women will not now consider having a child with any form of handicap, so biochemical screens, preimplantation diagnosis, chorionic villous biopsy and amniocentesis are increasingly available. Apart from the small number of tests done in order to prepare parents in advance for the arrival of a child with special needs, or to identify surgically correctable anomalies, most screening is performed to identify handicapped fetuses so that they can be aborted. This is a form of discrimination that would not be tolerated in any other group apart from unborn children. While no one is denying the huge psychological and financial cost of raising a handicapped child, we would not use this as an excuse for killing in any other field of medicine. Our obligation is to do the very best with what we have to ‘strengthen what remains’.

This is not to deny the often extreme hardship incurred by those who have to care for children with special needs. It’s a responsibility that the community must share; but it is sheer nonsense to assert that people with spina bifida, Down’s syndrome, or some worse anomaly cannot, with the right support, live useful and fulfilling lives. Even those whose anomalies are incompatible with life can make a valuable contribution to the world and to others; and they are undoubtedly precious in the eyes of God.[65]

7. What about abortion to save the life of the mother?
Usually when the mother’s life is at risk, the baby is viable and so can be saved simply by bringing forward the time of delivery. On very rare occasions it may be necessary to terminate a mid-trimester pregnancy in an emergency in order to save the life of the mother. Here we are not saying that the baby’s life is less important than that of the mother, but simply (since the baby will die regardless) that it is better to intervene to save one life rather than to stand by and watch two die. Even in these situations it is usually possible to deliver the baby in such a way that the parents can have some short time with it. In the UK only 0.013% of all abortions are performed ‘to save the life of the mother’ and it is even questionable whether many of these require such radical action. Ireland’s leading obstetricians stated in 1992:

‘... we affirm that there are no medical circumstances justifying direct abortion, that is, no circumstances in which the life of the mother may only be saved by directly terminating the life of her unborn child’.[66]

This was not unsubstantiated. The National Maternity Hospital in Dublin investigated in detail the 21 maternal deaths which occurred among the 74,317 pregnancies managed in 1970-1979. The conclusion was that abortion wouldn’t have saved the mother’s life in a single case.[67]

Alan Guttmacher, former President of the pro-abortion US Planned Parenthood Federation has said:

‘Today it is possible for almost any patient to be brought through pregnancy alive, unless she suffers from a fatal illness such as cancer or leukemia, and if so, abortion would be unlikely to prolong, much less save life’.[68]

In fact, women with cancer will often forego chemotherapy for the sake of the baby[69] and this brings us back to our starting point. When we recognise how precious human life before birth really is, we begin to see the evil of abortion in all its stark reality.