Clear Thinking on Euthanasia

With a Labor/Green government now in power, the culture of death is being further emboldened to push its agenda. A number of states are pushing for legalised euthanasia and already the Greens’ federal leader Bob Brown is telling us that our number one national priority must be the right to kill.

Indeed, people now speak about a “right to die” and many pro-euthanasia societies have sprung up, actively lobbying on behalf of their cause. The push for legalised euthanasia is on the increase, and some nations have already headed down that path, most notably the Netherlands.

This push is often done in the name of compassion. But it is a strange kind of compassion which says that the way to relieve suffering is to kill the sufferer. With so many advances in palliative care and the treatment of pain, it really is quite unnecessary to argue for the legalised killing of patients, even if well-intentioned.

The case against legalised euthanasia needs to be spelled out in detail. I have done that in other articles, but sometimes we need to go back to basics. In order to think clearly about this issue, we must make sure our terminology is carefully and sharply defined.

Terminology

It needs to be pointed out from the outset that euthanasia is not about halting futile treatment. Nor is it about the alleviation of suffering (this is known as palliative care). Euthanasia is an act that directly and intentionally causes a person’s death. As one ethicist states, there is a “crucial difference between taking a life intentionally and allowing a death naturally. The first is homicide, and the second is a natural death”.

The distinction amounts to this: there is a huge difference between letting nature take its course and actively hastening or inducing a patient’s death. Because this is such an important point, and one which is so often confused (often deliberately by the pro-euthanasia camp), it is worth spending a bit of time on this, quoting a number of authorities.

Ethicist Daniel Callahan offers this distinction between allowing to die and intentional killing: “A lethal injection will kill both a healthy person and a sick person. A physician’s omitted treatment will have no effect on a healthy person. . . . It will only, in contrast, bring the life of a sick person to an end because of an underlying fatal disease. . . . the doctor who, at the patient’s request, omits or terminates unwanted treatment does not kill at all. Her underlying disease, not his action, is the physical cause of the death.”

As Andrew Lansdown explains, “euthanasia has little to do with refusing futile or extreme treatment. The man who rejects a heart transplant or declines a third bout of chemotherapy is not committing suicide, but rather is accepting the inevitability of his own death. The doctor who withholds or withdraws undue treatment at the request of a terminally ill patient is not killing his patient but rather is refusing to prolong his patient’s life at any cost. Properly understood, euthanasia involves an intentional act to end a person’s life. Opponents of euthanasia do not advocate the unnecessary and unwelcome prolonging of human life by artificial means. Rather, they oppose active measures to bring human life to a premature end.”

Indeed, it needs to be repeated that the refusal of treatment is not to be confused with euthanasia. Both the cause and intent of death are quite different. As ethicist Margaret Somerville explains, “In refusals of treatment that result in death, the person dies from their underlying disease – a natural death. The withdrawal of treatment is the occasion on which death occurs, but not its cause. If the person had no fatal illness, they would not die. In contrast in euthanasia, the cause of death is the lethal injection. Without that, the person would not die at that time from that cause.”

Monique David puts it this way: “Currently, there is much confusion; many accept euthanasia because they do not want their lives to be maintained artificially nor to become victims of excessive treatment. However, these practices can be legitimately refused by the patient or their family through the ethical perspective of the right to die within the limits of natural death. Euthanasia and assisted suicide advocates claim something else: the right to terminate life at the moment and in the way that the individual chooses – or that someone chooses for them.

“Therefore, we should not use these terms to refer to the right to die (because this right is intrinsic), but rather to the right to be killed. This desire, expressed as a personal right, demands the intervention of a third party and a legal system that authorizes it. In other words, euthanasia and assisted suicide imply that doctors become agents of death and that society legally recognizes a criminal act to be lawful; or even more pernicious, a medical act.”

As ethicist Leon Kass reminds us, the ambiguity of the term “right to die” blurs the “difference in content and intention between the already well-established common-law right to refuse surgery or other unwanted medical treatments and hospitalization, and the newly alleged ‘right to die.’ The former permits the refusal of therapy, even a respirator, even if it means accepting an increased risk of death. The latter permits the refusal of therapy, such as renal dialysis or the feeding tube, so that death will occur. The former would seem to be more about choosing how to live while dying, the latter mainly about a choice for death.”

Finally, George Pitcher also makes some important distinctions: “Doctors regularly discontinue futile treatment. But they don’t do it in order to end a patient’s life. They are simply recognizing that death cannot be prevented by treatment. We need to understand that end-of-life decisions, which are made every day by doctors, aren’t the same as life-ending decisions.”

One further issue in terminology needs to be addressed. This has to do with pain relief and the hastening of death. It should be pointed out that some forms of pain relief may have the unintended consequence of hastening death. When a suffering patient receives an injection of morphine to relieve pain, this may contribute to the speeding up of death.

But when pain relievers are administered, normally the intention is to relieve pain, not hasten death. In ethics this is known as the principle of double effect. The intent was to do good (relieve pain) while an unintended side effect may occur (the hastening of death). Intention, again, is an important part of this whole debate.

John and Paul Feinberg explain the principle: “We are obligated both to preserve life and to relieve pain. Sometimes it may be impossible to do both. If it is impossible to preserve the life of the terminally ill, we are not immoral if we do not. Of course, there is still the obligation to relieve pain and suffering. If we do what we can to relieve pain and in the process hasten death, there is still no moral blame, since we could not preserve life.”

Margaret Somerville points out the differences between euthanasia and pain-relief treatment: “In both cases there is an effort to relieve suffering. The difference is that the primary aim of euthanasia is to do so by inflicting death, whereas the primary aim of pain-relief treatment is simply to relieve pain – not to shorten life or cause death (although either might be a secondary effect).”

Euthanasia, then, is about one thing only: the killing of another person. The intent is to kill someone. It does not matter whether this is done with a gun or a lethal injection – the effect is the same. No civilised society can permit the legalised killing of its own citizens, even if done in the name of compassion.

[1307 words]

24 Replies to “Clear Thinking on Euthanasia”

  1. Thanks Bill.

    Yes my father (a GP) has also spoken on the advances in palliative care.

    Another term that would be good to define is “Dignity”.
    Both sides have used the term – but it has a totally different meaning.

    Malcolm Davey

  2. Thanks Malcolm

    Yes that is another term. There would be many more worth covering, and I am in the middle of a 10,000 word paper on the issue, which will likely blow out to a much longer paper. So stay tuned.

    Bill Muehlenberg, CultureWatch

  3. The time has come when doctors, etc., should be “contents labelled”, like supermarket food, enabling “consumer choice”, so that a patient is able to choose a doctor who is NOT part of the Culture of Death and doesn’t perform euthanasia, abortions, etc. People who believe in the value/valuing of human life need to stand up and demand this.

    Malcolm – I’ve come to the conclusion that it’s best to avoid use of the word “dignity” entirely, since for the pro-death people, it’s something they can easily manipulate to serve their argument, it sounds “nice”; and, to be honest, I think the idea of a “dignified” death as opposed to an “undignified” one is rather bogus – who defines them, and for whom?

    John Thomas, UK

  4. Thanks Bill
    As with all arguments of this sort, the exceptions are used to promote a new rule. eg pro abortion activists bring up cases of unwanted pregnancy through rape or the risk to the mothers health through a continued pregnancy etc.But how many abortions fit these categories? With euthanasia we hear the arguments of desperately ill people who want to end their life; but many people have gone through periods of wanting to end their life for all sorts of reasons only to change their mind. And then ,of course once euthanasia is legalized their will be added pressure on those diagnosed with a serious illness to “do the right thing” and get it over with. But many people have recovered after being given a death sentence from a doctor and many have continued to live a high quality of life even during the last days, months or years of their life.
    And not all extreme pain is life threatening so to use the example of ending suffering for those in pain may well extend the concept of “compassionate” euthanasia to people whose suffering is not life threatening.
    Not to mention of course that people are already able to take their own life if they so desire without legalising assisted suicide. Above all, for Christians, the issue is what is God’s view and He is clear on this and related issues.
    Glenn Christopherson

  5. When I was younger I was involved in an incident which I received injuries. I was in pain and greatly desired relief and made many requests to medical staff that my life be terminated. Thankfully the staff realised that the pain that I was experiencing would pass. I have since had over 40 years of prosperous, meaningful life. Yes, I understand the person’s need for relief, but from what area are they requesting, defeat or victory, surrender or fight? We are overcomers, how can we be overcomers when the first thing we do is surrender. Yes, dignified death has a nice sound to it but it does seem to me to be a long term result against a short term problem. Remember once you are dead there is no return regardless of discoveries made.
    Jim Sturla

  6. Its just so true isn’t it?

    I’ve learnt so much on this site Bill and the links been offered. I now know these people called the (left), these are the perverse culture. They want to do the opposite to God in every form. They steal our language, twist our intentions, call good evil, the list goes on. As Glenn says, they use extreme cases (rape)

    Here is one thing I’ve learnt through a police friend of mine. Warning this is (graphic): When they find people who have commits suicide in there cars, they are always hunched forward, attempting to or with there hand is on the key. They cant control there muscles properly anymore. Tthey have changed there mind and want to turn the key off. Graphic yes, but it’s real and it’s happening.

    Daniel Kempton, Perth

  7. Bill, you will no doubt be aware that the Voluntary Euthanasia Bill 2010 in WA has been defeated in its 2nd reading – 11 for and 24 against. A small glimmer of light in dark days.

    As for “dignified death”; One is dignified, or one is not. Death is neither.

    Kev Downes

  8. As ‘moral’ human beings, one of our key responsibilities is to preserve human live, rather than killing them. We have simply removed all hope, love and grace.. My major concern is with the baby boomers. Many of the baby boomers are approaching the youthful age of 70, and in a short period of time the younger generation will find any excuse to terminate their loved ones lives prematurely.

    As Glenn stated “With euthanasia we hear the arguments of desperately ill people who want to end their life”. This argument is built on the minority, and unfortunately the world view have fallen for this deception.

    Panage Kontos

  9. Hello Bill. I was shocked the other morning to hear Bob Brown on talk-back radio going on about euthanasia. Parliament hasn’t even had its first sitting day and the Greens real agenda is already out. The hypocrisy was so overwhelming I couldn’t stand it and had to switch off the radio. You see, Brown has always been a big government proponent at all costs who would gladly strip us of any individual rights just like any other fascist worth his salt. In fact, he would gladly control our actions, our thoughts and impose on us all sorts of crazy UN treaties. Yet when it comes to this matter he takes a completely contrary view. You see, euthanasia is a States matter, not a Commonwealth matter. So his argument on radio for pushing this legislation was not about euthanasia but to “restore the legitimate” rights of States to democratically determine their own matters. I wonder what his stance would be if Victoria wanted to exercise a State right to criminalise homosexuality or to log old growth forests?

    Frank Norros

  10. As I understand it, the issue is voluntary euthenasia. I was listening to talk back radio on the ABC and one lady mentioned that she didn’t want her mother to go through the terrible fate of Alzheimers, like her mother before her.

    Sounds so caring, and the host sympathised with her too.

    But so little real thought was demonstrated in this conversation, which to me was a littel vingette which reveals how inadequate is popular thinking on this issue.

    If her mother is ‘disabled’ she is unable to decide for voluntary euthenasia, plain and simple. If she is mentally well, there is a real issue in allowing people to ‘pull the plug’ on a maybe. My own dad vowed that he had a stash of pills and would use them when he needed to, so frightened he was of losign his mental faculties. Well he descended into Alzheimers and forgot where the pills were.

    The wonderful thing was how everyone circled around him and loved him through those last months. He sure relished the love and care lavished on him, I can tell you.

    Rob Robertson

  11. As this debate has been re-ignited by the Party of Green Death, I have heard a reasonable amount of talkback radio on the topic.

    The presenters and their guests speaking in favour, and the listeners calling in favour of euthanasia, almost always with a personal experience, all seem to focus on their own reactions and emotions as they watched their loved ones go through “such terrible pain”.

    They all talk about the senselessness of this dying “in incurable pain” – but without a Biblical worldview they don’t see that death is an enemy.

    So I wonder if euthanasia is another solution to the wrong problem – the problem of those remaining alive as they watch someone die.

    I ponder if the basic problem is once again that the community (ie. the West) has bought into a world view of scientific and evolutionary perfection – where dying has to be clinically clean, and free of any guilt (for both the dying one and the living ones)? And even that is a temporary stopping place on the way to scientific immortality (cryogenic research, anyone?).

    I know we would all like to depart “innocently” but since there is none righteous, that’s an impossibility. To use a Biblical reference “it is appointed for men to die once, but after this the judgment” (Heb 9:27 NKJV). There is no problem with a right to die – we are already destined for it.

    Hence I think I am concluding that euthanasia is based in another of those non-Biblical worldviews.

    I haven’t faced this personally with my own parents, so my thinking is dry and clinical…

    John Angelico

  12. Thanks Bill
    A few years ago my uncle ended up in a Dutch hospital with cancer. He was very sick and you can imagine that his wife (my auntie) was very distressed. As he was in a lot of pain the doctor asked my auntie would she agree for the doctor to give her husband a injection. She agreed, thinking it was for the pain. Two hours later she realized he had died. This was legal according to Dutch law.

    Another family member was sick and her children suggested for her to go to the hospital. She refused. Two weeks later we received a death notice of her passing. Later we were told that her children (all adults) had taken her out for the day. At night they dropped her off at the hospital. The next day she was dead.

    This is what Australians can expect if euthanasia is made legal here.

    Anne Van Tilburg

  13. Many thanks for that Anne. Yet I had someone comment on another post, “I don’t share your concerns about the potential for gross abuse of euthanasia laws. We do live in a law-abiding country, and I have confidence that laws could be appropriately framed with strong protections against abuse.”

    That’s just what they said in Holland! As I replied to this fellow, I will stick to the evidence and the facts of history, and not his naive optimism.

    Bless you,
    Bill Muehlenberg, CultureWatch

  14. Hi Bill,

    This is a complex issue and a very slippery slope indeed. I have been witness to two family members who in their last days were “comforted” using modern palliative care. They were both unconscious and suffering multiple organ failure so they were given morphine to aid them. Did this hasten their departure?? Who knows but according to the nurse at one particular passing, it is quite common to increase the morphine levels in such cases.

    I suspect it happens more often than we think behind closed doors and will continue in very special circumstances regardless of what laws are in place. I have a real problem if people are being dropped off to be disposed of like a lost dog but if I was unconscious, in pain and almost dead, I would hope someone would do the humane thing for me.

    Ben Green

  15. Thanks Ben

    The humane thing would be to care for you, comfort you, and offer you pain management. That would be real care, not knocking you off. All the more reason to urge our government to put more resources into palliative care, which is very effective indeed.

    Bill Muehlenberg, CultureWatch

  16. Damien, I’m a nurse, and I agree with Dr Andrew Pesce that the system we have now is wonderful with palliative care and end-of-life choices. It’s important to be clear about what you want and to have everyone ensure your wishes are followed, as in, don’t let the nursing home send you to the hospital for all sorts of things to be done.

    Ben, I work on a ward that uses Morphine to control pain for people who have realised that no more can be done to keep them alive and have chosen palliation. No way is Morphine increased to hasten death. Some require nothing. Others already have a steady infusion (so no peaks and troughs of pain) and if they grimace or moan we give them a tiny top-up, because no one has to be in pain. One lady was started on palliation and came good through no prayer or miracle, and active treatment was recommenced.

    I think the painful part is for people who want to keep being as active as possible and controlling their pain. Because they don’t want to be drowsy or nauseated, either. But these are not people who want to be killed. They want to be alert and available to their family as long as possible. There are so many options for pain control, including skin patches, so prayer is needed for just the thing that will work for them, as different things work for different people.

    Rebecca Field

  17. Another aspect of this issue from a Christian perspective is the eternal well-being of the sufferer. The last days of life may well be when a person turns to Christ. To rob someone of that option may well have very negative future consequences (hell) I had a distant family member who died of AIDS and in the last weeks of life who put their trust in Christ and although in much pain was a vibrant witness for the gospel.
    Glenn Christopherson

  18. Great article Bill.

    We all remember quite well the last time we heard “Let them die with dignity”. (Nazi Germany on the eve of world war II)

    Many of the aged, infirmed including first world war veterans were killed using the same catch cry.

    Australia has willfully (or unwittingly) voted in a government (the ALP/Green alliance) with a solid culture of death.

    Tony Zegenhagen

  19. Bill, could I answer to Ben’s comment on palliative care.
    Both my parents lived with me. Mum had many strokes and was confined to a wheelchair. Dad looked after her until he had a massive stroke. That is when I took them in and together with my husband looked after them.
    Dad had cancer and at the end of his life palliative care assisted us with caring for him. I stress, he never had any pain as the nurses gave him morphine, but it was done with a small electric cadget which was attached to his body and as the pain went up so did the morphine. As the pain went down so did the morphine. He was never over-dosed and was lucid until about a week before his death.
    Truly he died with dignity and I cannot thank the palliative care staff enough for the kindness and care they showed to an old man who was my dad.
    Anne Van Tilburg

  20. On the pain relief euthanasia subject. Actually well used analgesics prevent patients wanting to die. In ancient times, actually about 43 years ago, one of my patients was aggrieved because I said he could not attend church whilst he had an infusion into an artery. I was afraid it might be dislodged. Pain relief was so well administered on that ward that he was unwilling to miss any activity. If people really want to help the ill then help them to live fully whilst they can and help them prepare for life to come instead of cutting one short and sending them to the next unprepared.

    Katherine Fishley

  21. The Medical profession has no need within its ranks of 007s – some with the ‘right’ to kill. Vets are better trained for terminally “putting to sleep”. Are any lining up for the ‘right’ to do so to humans? Despite what euthanasiasts claim watertight control are impossible within medical practice; nor are estimates of longevity accurate beyond about 48 hours. Often it is the pain of relatives which such death relieves rather than of the ‘patient’.
    It is a strange ‘right’ being sought; to do what one cannot avoid doing.
    Arthur Hartwig

  22. An excellent summary of the realities and misconceptions surrounding this issue. Thank you Bill for the clarity of your presentation.
    Sadly I think that only serious prayer and fasting can clear the way for a fair hearing in the public domain for this and similar articles. I confess I am very slack in the fasting department even though I know this issue is not going away any time soon. We have had an encouraging victory in Western Australia this week but are by no means complacent.
    Anna Cook

  23. The outstanding philosopher David Oderberg has an interesting article on ‘the doctrine of double effect’ that ought to be required reading if one wants an informed approach to the euthanasia debate.

    http://www.reading.ac.uk/AcaDepts/ld/Philos/dso/papers/Doctrine%20of%20Double%20Effect.pdf

    One of the four key principles is this one;

    “There must be a proportionate, or sufficiently serious, reason for causing the evil effect.”

    So in the case of pain relief it would be required that the patient be in serious enough pain and have the proper functioning of their body impaired to a great enough extent that it would warrant pain relief that would hasten death.

    But Its a good article Bill but I have one minor quibble. I don’t agree with Callahan that “A physician’s omitted treatment will have no effect on a healthy person. . . . It will only, in contrast, bring the life of a sick person to an end because of an underlying fatal disease. . . . the doctor who, at the patient’s request, omits or terminates unwanted treatment does not kill at all.”

    I think the doctor can be said to be counterfactually responsible for the death of the patient (just as if I see my baby in the bath drowning and I do nothing to save her then I am responsible for her death). The key point is, as Bill mentions, the DDE. The doctors intention is not the death of a perfectly healthy person with a full life ahead of them but, rather, not to prolong a life artificially or one where the normal functioning of the body is impaired to an extent that recovery is impossible.

    Again the emphasis is on the person conceived as a biological whole not just on the subjective feelings of the individual. Its the Western dualistic view of the human that elevates the subjective viewpoint of the patient over the biological that justifies ‘mercy killings’ of this sought (the same fundamental assumption justifies abortion as Nancy Pearcey points out in her latest book).

    Damien Spillane

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