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ss nucleus - spring 1994,  A Right to Die

A Right to Die

'It's my right' has become a rallying cry in this century, relating to almost any matter from human rights to the right to a holiday. Some very basic rights in the area of life and death are being claimed. A person's right to life itself is one with which we mostly have no argument; equally many of us regard a person's right to a good death as important - even when there is argument as to what constitutes a 'good death' for a given individual.

Recently, a 'right to die' has been canvassed. Death is seen not merely as an inevitable consequence of human mortality or as a something under divine control, but as something to be desired and demanded by people for themselves and for others under certain circumstances. This putative right involves two other rights - the right to kill myself - suicide was decriminalised in Britain in 1961 - and the right to be killed (in mercy). This latter mercy sounds so crude that it feels better when stated as the right to euthanasia.

In former generations human life was regarded as sacred and hence inviolable; nowadays, in the 'post- Christian' West, we take the lesser view of life as being worthy of respect. Respect, however, is a relative matter and with age, frailty or disability it might appear that a person's life had lost all dignity and value. Under these circumstances would it not be proper to allow a right to die?

For whom

Voluntary euthanasia would be a response to a person's right to request death. Such requests sometimes come from people who are incurably ill and who are in pain or have other unremitting symptoms, or who are mentally distressed. Sometimes the demand comes from depressed people or people who are mentally disturbed (for example, with schizophrenia) but who do not have a physical terminal illness. Someone who becomes severely disabled by an accident in the midst of healthy life, or by the frailty of old age, may feel themselves to be a burden on carers, relatives and society and may demand the right to die.

Whenever one discusses euthanasia instances are cited of people disabled by dementia (multi-infarct or Alzheimer's Disease), people in the persistent vegetative state, or for other reasons requiring total nursing care - and whose lives seem to the relatives and carers to be no longer worth living. They, like the severely congenitally deformed infant, cannot or do not, request euthanasia but it is felt that 'obviously they would if they could'. For them such requests concerning a right to die are non-voluntary (where the person has no ability to understand what is involved) or involuntary (where the person could ask, but does not).

The former group are saying, 'My life is not worth living, it is a burden to me and to others', for the latter, carers or society may say, 'His life is not worth living; it is merely a burden on others'. Either way, a right to die depends on perception of the quality of the life now lived as worse than being dead. Is this irrevocably and always true for such people? We must bear in mind that death is final: There is no way back if someone were to discover that life was better after all!

Arguments for a right to die

The arguments in favour of acceding a right to die in these circumstances are that it is appropriate to the patient's condition and, perhaps, wishes; that it feels right to the relatives; that it is economically sensible; and that it is medically comforting.

After all, it is what the patient wants! These are unhappy people, people who are suffering, people who request it. The Dutch guidelines insist that such requests must persist over a month and that treatable symptoms be absent. (Unfortunately these guidelines are not always observed!) Death would shorten their suffering - and in many cases it would have happened anyway sooner or later if they are terminally ill. It seems the 'dignified thing' to do, when care involves bathing, dressing, feeding, treatment of pressure sores, coping with urinary incontinence, and repeated enemas or manual removal of faeces.

The relatives have asked for it to be performed, and would now be able to concentrate on their own lives - and the settlement of the will or inheritance may even be helpful for business or socially.

Economically, it is obviously sensible. Many of these people will never be gainfully employed again; they require medications, dressings, food, and above all the expensive time of family or professional carers. Put bluntly, they are a drag on society.

It might actually be comforting for the doctor to know that he has done the last thing he could for his patient. He has tried to cure, then to ameliorate symptoms; now he has complied with the patient's or relatives' last wish. It could even be a relief not to sense an unexpressed accusation whenever he visits. Suicide is no longer a criminal act in Britain; why should assisting someone's suicide, or enabling death when the patient (due to frailty, paralysis or coma) cannot perform it, be a criminal act?

Arguments against a right to die

On the other side, we can argue that euthanasia should usually be unnecessary because of all that can be done medically; it would change the relationships between the patient and his carers and his place of care; it would breed fear and guilt; it is against all religious views, and it degrades personhood. Voluntary euthanasia is said to lead inevitably to involuntary and non-voluntary euthanasia, making the person's wishes irrelevant.

The Hospice movement in Britain has underlined the possibilities of relieving physical and even mental symptoms. Dr Admiraal of Holland, a strong proponent of euthanasia, himself says that pain, persistent physical symptoms and depression are not reasons for acceding to requests for euthanasia. So much can be done now to relieve these symptoms that, if they do persist, further advice should be sought. More research should be undertaken (and is being done) for particularly resistant areas of symptom control.

Euthanasia legalised would change relationships between the patient and his carers and place of care. Hospice and hospital would no longer be places of security, but places where some patients were killed by their carers. The doctor (and nurse?) would no longer always be providers of care but might be those who would terminate life.

Inevitably, this would lead to fear. It is said that, while the majority of young people in Holland are for euthanasia, 73% of elderly people live in fear that they will become a candidate. Every hospice and hospital knows of people who develop a paranoid fear that the nurses, doctors and medicines are to kill them; we deal with these paranoias with medication and with the assurance that we do not kill people. How difficult it would be to reassure such patients if we did actually kill some people deliberately!

During bereavement, many relatives go through a period of guilt - generally this is false guilt and can be talked through. If, however, it was the relatives' wishes that we acceded to, that feeling of guilt would be much stronger, because it would be based in fact.

Providing a dignified death, it can be argued that acceding to someone's view of themselves that 'life is not worth living' and that they are of no value is itself undignifying. Dignity is an acknowledgement of worth. When we agree with someone that their life has no value we are removing that person's dignity - which resides not in what they can produce or accomplish but in who they are. As soon as we begin to measure a person's worth by their economic value (or sex or racial origin or religious persuasion) we deny the dignity of being human. On the other hand, caring even to the extent of dealing with faeces and urine exemplifies the worth of a person in the carer's and society's eyes.

Measuring a person's worth in objective terms, whether economic or racial or religious, inevitably leads from voluntary to involuntary and non-voluntary euthanasia, for the worth of a person becomes an objective thing which does not depend on what that person wishes or wants. Nazi Germany was not the first place, nor the last, where euthanasia has led on to 'racial cleansing'.

No wonder, then, that killing people in mercy is not allowed under any religion. Hinduism and Buddhism, Judaism and Islam refuse to allow practice of euthanasia. Christianity, too, has refused to allow it in previous generations, even where pain relief and symptom control were not nearly as effective as they can now be.

The Christian viewpoint

The previous arguments are understandable to people of any faith or no faith. That is important as we discuss these issues.

However, for the Christian there is another perspective. Can we know what God's attitude, Christ's attitude is?

Throughout Scripture, God shows his deep concern for the poor and weak, the fatherless and the widow. Nowhere in Scripture is there a hint that the weak and frail should be helped to die, but rather supported and cared for.

The Lord Jesus gave himself, not only on the Cross to secure man's eternal forgiveness and heavenly life, but in daily life in healing the sick, feeding the hungry and even raising the dead to physical life again. Jesus' will must surely continue to be that we should provide and care for sick, frail, distressed and disabled people, relieving symptoms, sitting with them where physical or mental relief cannot be provided and giving them support to the end.

Jesus' parable of the Good Shepherd has spiritual connotations, but it relates also to present physical life. 'The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full.' (Jn 10:10)

Further Reading

  • Euthanasia; Report of Working Party, BMA (London) 1988
  • Saunders C M; Voluntary Euthanasia. Editorial, Palliative Medicine, Vol 6 No. 1 1992
  • Dickenson D, Johnson M: Death and Bereavement, OU and Sage Publications (London), 1993 particularly sections
    • 30: Henk ten Have: Euthanasia in the Netherlands
    • 31: IME Working Party: Assisted Death
    • 32: Robert Twycross: Assisted Death: A Reply
  • Is 58:6-12
  • Jn 10:1-20
  • Mt 4:23,24;8:14-16;14:13-21;15:29-38;25:31-46
  • Video and Workbook: Living Dangerously: CARE, London (1992)

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