Both are Family Physicians currently practising in Abbotsford, British Columbia.
Dr. Pankratz is the President of Canadian Physicians for Life and the
Vice President of Compassionate Healthcare Network.
Original article can be found here.
Part 1
Part 1
The current "debate" on the legitimacy of euthanasia is a good indicator of the overall moral state of Canadian society. This debate also illustrates how secularized some Christians have become, blindly adopting anti-Biblical concepts such as the "quality of life" or even the "right to die." It may be that many Christians have difficulty understanding the complexities of this issue - after all, doctors already hasten death by stopping life support or using high doses of morphine in cancer patients, don't they? And, isn't it cruel to deny a suffering person an easy death when they are dying anyway?
This two-part series addresses the issue of euthanasia from a Christian perspective. In part one, we will discuss definitions and contrast the Christian world view with the prevailing ideologies in our society that have engendered the push for euthanasia. In the next issue, we will discuss the ramifications of these disparate perspectives, examine the related issues of quality of life and autonomy, and conclude with thoughts about what each of us can do.
What Euthanasia is and is not
In a war of ideologies, the first casualties are the definitions of the terms used. Euphemisms abound when people resort to deceit in attempting to convince others. For example, in the language of the day, administering a lethal injection becomes "aid in dying." (And how can you be against giving "aid" to someone who is terminally ill?) What is generally meant by the term euthanasia is mercy killing - the deliberate ending of a person's life to reduce their suffering. More commonly used today, however, is the phrase the "right to die." These are noble sounding words that literally mean that someone can request that a doctor kill him. In the terminology battle, the proponents of euthanasia are seeking to redefine what is now known as a form of homicide and call it acceptable medical practice.
The debate is very much an ethical one. Natural death, which results from illness or degenerative processes, is the antithesis of mercy killing. Even when life could be prolonged by medical treatment and is not, the death that may ensue is a death from the underlying illness, not a result of the withdrawal of care. The withholding of medical therapy is reasonable when the treatment is disproportionately burdensome (that is, the therapy - not the disease - is hard on the person) and relatively ineffective ("futile"). In other words, we are not ethically bound to use unwanted, non- beneficial therapies that serve to only prolong a person's dying. In fact, not doing so shows profound respect for the boundaries of natural life.
It is important to understand that euthanasia cannot be equated with the current understanding of palliative care. Palliative care is the active relief of suffering in a terminally-ill individual, and although there are occasions when treatment may shorten life, this is not the intended or anticipated result. It is simply a side effect or complication of therapy and is therefore ethically permissible. Generally, adequate doses of narcotics to relieve pain do not shorten life.
The Christian World View
The underlying principles of our society were once based on the Biblical world view; indeed, western culture and our legal system were founded on it. An overview of selected Scriptures will reveal what this view of man is and how it is derived.
Genesis 9:6 was instructive for our forbears and should be for us as well:
"Whoever sheds man's blood, by man his blood shall be shed, for in the image of God has He made man." This scripture is more than a prohibition on the taking of innocent life. Being created by God, we are stewards of our lives rather than owners. Created to be like God, our lives have an eternal purpose; set apart for, and owned by God. Since we are created in the image of God, our lives have intrinsic and immeasurable value. This is the source of the "sanctity of life" concept. Because we are created in God's image, people have an inherent and God-given dignity. This is a far cry from the fluctuating self-esteem (based on wealth, abilities, etc.) that is mistaken for dignity by non-Christians.
A critical issue arises at this point. Secular humanism claims that every life has a "quality" attached to it. This means that circumstances, abilities (or disabilities), suffering, or other factors render a life better or worse, because the person has a greater or lesser degree of contentment or happiness. With contentment or happiness as the standard, some lives are deemed to have such low quality that it is reasonable to prefer death. This is the antithesis of the "sanctity of life" ethic, which maintains that every life, created in the image of God, has intrinsic, God-given value that is not reduced by circumstances. Paul teaches us: "I have learned the secret of being content in any and every situation" (Phil.4:12). In a world that confuses the right to pursue happiness with a non-existent right to attain happiness, the Christian perspective stands out in stark contrast.
As a related aside, it is the very people who are vigorously pursuing legalized death who should be the most afraid of it. The person assured of eternity with Christ knows that it is truly "better to be with Christ." For the believer, the issue is not what they themselves wish (life here or in heaven), for as Paul so aptly puts it, "I am torn between the two" (Phil. 1:23). The issue is, rather, what God wills. For the Christian, life is God's gift and its end is to be determined by Him. "There is no God besides me, I put to death and I bring to life" (Deuteronomy 32:39). God is sovereign over life and death: we have no jurisdiction in this area; therefore, we have no mandate to end lives.
God's dominion includes all of life, which means that suffering is a part of God's providence. Therefore, suffering that cannot be relieved by modern medical means is to be accepted as from the hand of a loving God who knows what He is doing, even when we do not understand. "Endure hardship as discipline; God is treating you as sons" (Hebrews 12:7). The purpose of suffering for the Christian is sanctification or "to be conformed to the likeness of His Son" (Romans 8:29) and "it produces a harvest of righteousness and peace" for those trained by it (Hebrews 12:10). "For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all" (2 Corinthians 4:17). In other words, although we are all made in God's image, we are each to a greater or lesser degree like Him, and God is carrying to completion this great work that He has begun in all believers (Phil. 1:6).
Death is part of life. As Ecclesiastes 3:2 tells us, there is a time to be born and a time to die. The wise among us should number their days (Psalm 90:10). According to Scripture, life in the body is not always the highest value (to live is Christ but to die is gain - Philippians 1:21). In fact, the measure of love is that a man lay down his life for his friends (John 15:13). The Christian can even welcome natural death knowing that "death has been swallowed up in victory" (1 Corinthians 15:54). Who doesn't look forward to that day when we will see Him "face to face"?
Therefore, in looking at suffering and impending death, the Christian should see God's sovereign hand and purpose, as well as the opportunity for ministering to the weak and vulnerable, with whom Christ Himself is identified. Feeding, clothing, or housing the needy is viewed by Christ as "whatever you did for one of the least of these brothers of mine you do for Me" (Matthew 25:40). We can certainly look forward to a deepened relationship with God and strengthening from Him in our time of need for "those who hope in the Lord will renew their strength. They will soar on wings like eagles" (Isaiah 40:31). For those who wish a richer knowledge of God and closer walk of obedience, "opting out" prematurely runs counter to the deepest desires of their heart.
In contrast, the atheistic or humanistic world view sees people as autonomous (self-ruling) biological entities whose life's purpose is pleasure, and whose end is complete extinction. This view logically results in a self-centred hedonism that sees life as utilitarian, (i.e., valuable only for what it offers), and sees little value in suffering. The logical conclusion of this perspective, generally denied by most people who hold this view, is nihilism - "is that all there is?" According to this perspective, life should not be continued unless it is a wanted life. Suffering is an unmitigated negative; thus there are some lives not worth living.
In conclusion, the Christian perspective of human life puts God in control of the issue. We trust the Author of life to allow only what ultimately benefits us to befall us. But this does not give us a passive role - we are called to be salt and light. In this issue, we believe this means to stand for compassionate care of the dying while standing against any form of killing. Yes, we are to debate intelligently, but, more importantly, we must seize opportunities to minister God's love to those who are needy and suffering. As we counter the deceit of the protagonists of euthanasia, revealing the truth behind the lies, if we don't also show how love can overcome the pain and fears of dying, we will not win over the hearts and minds of the very people Christ wishes to save. It is our vision to have an ambassador of Christ at every deathbed (the greatest opportunity here is as a hospice volunteer). Thus you and I can provide the most eloquent answer of all to the question of euthanasia - a reason to live, through companionship and meaning in suffering.
Part 2
Now we'll look at some rational arguments useful in opposing euthanasia and its underlying secular ideologies, and we'll discuss practical ways in which Christians can have influence for Christ in this important area of life.
In our society, the prevailing ideologies used to support euthanasia are based on two sets of criterion: 'quality of life' and personal autonomy. There has been much misinformation, intense emotion, and muddled thinking surrounding these terms. It is helpful to look at the assumptions underlying the 'quality of life' and autonomy premises. As we saw in part one, God claims sovereignty over life and death, and we have no mandate to end lives by euthanasia. However, even according to humanistic premises, the criterion of 'quality of life' and autonomy cannot validate euthanasia.
Quality of Life
The term 'quality of life' (QOL) was first introduced in the 1960s to refer to the overall welfare of a population. In the 1970s it evolved to refer to the welfare of the individual, where it was used to refer to such things as level of satisfaction, contentment, happiness, social harmony, and fulfilment. Since then, the popular term has been adopted by the pro-death movement, and its meaning has changed from 'quality of life' to 'quality of living' to the 'quality of a life' to the 'value of a life.' These changes in meaning have promoted the belief that a life with low quality is not worth living. The result has been the inevitable conclusion that some people are less valuable than others. Such people are said to be 'better off dead' or to have a 'right to die'.
In other words, the term L is now being used to morally justify killing humans, either voluntarily or involuntarily. For example, for over a decade the L term has been used to justify and promote the killing of unborn babies with Down Syndrome and other genetic defects, as well as the intentional starving to death of severely handicapped infants and brain damaged adults.
To the Christian, quality of life judgements are irrelevant. Because we are each created in the image of God, each human life is sacred and has intrinsic value. There is no such thing as a life not worth living - all life has meaning and purpose.
The Christian sees contentment, happiness, and fulfilment as resulting from one's attitude and response to situations. Secular humanists, however, equate QOL directly with a level of functioning and a degree of suffering. Furthermore, the humanists see suffering (be it physical, mental, emotional, or social) as generally having little purpose, and so they sometimes decide that the negative effect of suffering outweighs the value of continued life.
One of the problems with the use of the QOL concept is that we have no objective criterion for measuring it. Quality of life judgements are subjective, biased, and relative to unfixed factors such as emotional state, past experiences, family wishes and financial concerns. These judgements are often made by a third party on behalf of an incompetent person and amount to an outside observer's judgement of the value or quality of another's life. Therefore, those who possess a 'high' QOL end up deciding that someone is better off dead, often simply because that person can no longer decide for themselves (since a high QOL value is placed on rational thought). Some proponents of the QOL criterion even believe that an individual's QOL is reduced if he or she is a burden to society and caregivers.
Another danger in using QOL as a basis for euthanasia is that it leads from voluntary to involuntary euthanasia. This is what is known as the slippery slope.' It can be viewed from two perspectives. The logical perspective recognizes that if you grant that there are competent people who are better off dead, it logically follows that there are incompetent people who are better off dead. And if you grant further that competent people in such a state have a right to die, it follows that you should not deny incompetent people in a similar state that same right. This provides a logical basis for moving from euthanasia for the competent terminally ill or chronically suffering to involuntary euthanasia for the demented, severely handicapped, or comatose.
The psychological version of the 'slippery slope' states that 'once certain practices are accepted, people shall in fact go on to accept other practices as well.' This is supported by the practice of euthanasia in the Netherlands where the courts are now permitting euthanasia, not only for the competent terminally ill, but also for infants with serious handicaps, comatose patients, and even people suffering from severe depression.
There is a deliberate lack of clarity regarding the term QOL, and despite this confusion, the term is being used to influence life-and-death decisions affecting societally-devalued people. The term QOL should be abandoned entirely. Instead we should work to focus the public debate on some of the specific elements included under the term QOL, such as 'verbalised life satisfaction,' 'physical environmental quality, and 'social harmony. This will take the QOL talk away from the proponents of euthanasia, and it will help bring clarity to the debate by revealing the total subjectivity of the QOL idea.
Autonomy
In our egocentric society, autonomy (independence and self-government) receives great emphasis. However, autonomy can never be without restrictions. Obviously, any society - even one which does not embrace God's moral laws - must place some limits on personal freedom simply in order to function. Biblically, our individual autonomy must be limited by God's moral law.
Secular humanists deny this truth. They assert that the rights of the individual are paramount and that a person has a right to choose the time and nature of their own death. This amounts to death on demand. But even if we agreed with the autonomy argument, accepting that an individual should be permitted to choose death on demand, surely such a choice requires competence, informed consent, and voluntariness. To be truly autonomous, choice must be rational, fully-informed, and freely made. Are terminally-ill people really in a position to make such a choice? Likely not, considering that their mental competence is affected by underlying illnesses in 85% of cases, and that emotional competence is often affected by an initial, but reversible, phase of suicidal depression. In addition, fully-informed consent is often complicated by uncertainties of diagnosis and prognosis. Physicians are simply unable to accurately predict the timing of death or the quality of remaining life and may significantly misinform terminally-ill patients. A further complication is that the voluntariness of a person's choice may easily be compromised by pressures from doctors, nurses, family and society - all of whom have vested interests which may conflict with the patient's survival.
A counter-argument made by euthanasia proponents is that a system of intensive counselling and extensive assessment could safeguard the process - such as the guidelines for euthanasia in the Netherlands. However, a government commissioned study into the practice of euthanasia in the Netherlands shows that the guidelines are not always followed: A third of lethal injections are given without the patient's consent, and despite the requirement for persistent request, 59% of cases occur on the same day they are asked for, and 10% within the same hour! The study showed that physicians also frequently falsify death certificates and disregard the requirements for consulting a second physician.
Despite these objections, let us accept that there will be a very small number of rational, fully-informed, and freely made requests for euthanasia. The autonomy argument still fails to justify euthanasia because of the negative consequences euthanasia has on other people's autonomy. For example, the vast majority of terminally-ill people do not want euthanasia and yet are particularly vulnerable to feeling that they are a burden on society. If euthanasia is an option, they may now feel forced to justify their decision to remain alive, and this at a time when they may be least able to do so. Additionally, euthanasia may also result in a loss of individual autonomy because the final choice and power rests not with the patient, but with the physician who is the final authorizer of the lethal injection.
Death by choice advocates also talk about restricting euthanasia to the hard cases, such as the terminally ill with 'unbearable' suffering. They know that if the prohibition against killing is removed for one group of people, it will send us down the slope towards allowing it for others. What is a right for some becomes a right for all. In reality, safeguards are simply a smokescreen for death on demand, much like abortion for the sake of the mother's health proved to be a smokescreen for abortion on demand.
Autonomy - the right to choose - must be restricted; some choices are biblically wrong and/or undesirable, and we must proclaim God's truth in this area. In debate and discussion, we should also point out that even if autonomy were an acceptable criterion, when scrutinized, it cannot validate euthanasia.
What Then Should We Do?
Practically speaking:
We must oppose euthanasia:
1. Learn what the Bible says about the issue.
2. Prepare to educate others on this important issue.
3. Become actively involved in supporting the debate at professional and political levels.
4. Pray with an awareness that our battle is not ultimately with individuals but rather with deceptive ideologies and spiritual forces.
We must promote life:
1. Support and encourage pro-life doctors, politicians, and activists.
2. Support your local pro-life and hospice Societies through donations and volunteering. (Proper care of the terminally ill makes euthanasia irrelevant.)
3. Reach out and help the unwanted and despairing with care and compassion.
In doing so, we help supply people with the desire to live.
4. Recognize that withdrawal or refusal of treatment in the appropriate setting is not euthanasia. There is a time to let go. Such decisions require accurate information, personal humility, and God's wisdom.
Conclusion
As Christians, we are called to be salt and light within our spheres of influence. The Bible is clear on this. Interestingly, Albert Camus, a non-Christian Nobel Prize winner, concurs: 'The world expects for Christians that they will raise their voices so loudly and clearly and so formulate their protest that not even the simplest man can have the slightest doubt about what they are saying. Further, the world expects of Christians that they themselves will eschew all fuzzy abstractions and plant themselves firmly in front of the bloody face of history. We stand in need of folk who have determined to speak directly and unmistakably and come what may, to stand by what they have said.' Christians must, on the one hand, oppose euthanasia by boldly proclaiming God's truth, and on the other hand, promote life through a practical demonstration of His love and compassion.
This article was originally published in U-TURN.
email: church@tkc.com
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