ROY CLEMENTS ARCHIVE
Euthanasia 2: Whose Life is it Anyway?
Euthanasia: The Theological Issues
The previous essay, Officiously, to Keep Alive?, highlighted some of the consequences of any relaxation of the law so as to permit euthanasia. This one examines the moral and theological objections to two of the principal arguments used by proponents of euthanasia: (a) the "right" to die and (b) compassion for the suffering. The former is closely related to the ethical debate about suicide. The latter involves a consideration of where the sanctity of life should be placed in our hierarchy of moral values. In both cases the Bible has a distinctive contribution to make and Christians accordingly have a distinctive testimony to bear.
I saw it in a book
In a zoology book—
‘Every individual is absolutely unique,
The first and last of its identical kind’.
Unique! The first and last!
Never anybody else just like me!
I am the only one just like me,
I am a race by myself;
When I die the world will have lost me
The three hundred thousand billionth chance
Think of it!
The three hundred thousand billionth possibility—
Think if it hadn't happened.
But it did—and never can again.
All the combinations and changes and chances
That made me
Can never again come together
Exactly the same.
I am a person of distinction.
I am I.
(John Barton "Egomania" - abridged)
John Barton’s celebration of human individuality is emotively expressed, but as an argument for the value of human life it is logically flawed. The modern biochemical understanding of human genetics which inspired his poem has if anything tended to diminish respect for the sanctity of life. Rationalised now in the reductionist mechanical terms of molecular synthesis, the mystery of our humanity has been dispelled. Unique individuals we may be, but only in the sense that dice thrown at random must by necessity result in a single number. No two snowflakes are identical either but that does not mean that each one is intrinsically precious. The mere fact that every human being is a unique genotype, the product of an almost unrepeatable permutation of the DNA code, does not mean we have the right to see ourselves as possessing scarcity value. Any economist will tell us that the value of an item depends not so much on its rarity, as on whether anybody wants it. In what sense, then, is an unwanted life valuable? Valuable to whom?
Suppose even the person whose life it is no longer has an interest in its preservation? Is there any reason such an unwanted life should not be terminated? The euthanasia debate is one of several related contemporary ethical controversies which hinge on the value of human life. John Barton will not find their solution in his zoology book. It is the thesis of this essay, however, that the Bible has an indispensable contribution to make.
In a widely reviewed book on the subject, Life’s Dominion (Harper Collins, 1993), Prof. Ronald Dworkin acknowledges that all human beings do seem to share an intuitive conviction about the sanctity of life. Ironically, both pro- and anti- euthanasia camps feel as passionately about the issue as they do precisely because they agree that it matters how a human being dies. Dworkin insists that no satisfactory explanation of this can be found in a purely secular understanding of human existence. There is something essentially "religious" about it. The Bible would undoubtedly agree with that assessment. A human being cannot be adequately described by analogy to animals or computers in the way that psychology in recent years has sought to do. Such models fail to do justice to a number of distinctive features of the human personality, not least our reverence for life. There is something unique about a human being, and the Bible identifies what it is:
The Image of God
"But you must not eat meat that has the lifeblood still in it. And for your lifeblood I will surely demand an accounting... Whoever sheds the blood of man, by man shall his blood be shed; for in the image of God has God made man." (Genesis 9:4-6)
Two provisions of the Old Testament law find their roots in this ancient text and both affirm the special value of human life: capital punishment for murder (see Numbers 35:30-34) and reverence for spilt blood (see Leviticus 17:10-14). As to the former, there were other capital crimes in the mosaic penal code, of course, but none carried a mandatory death penalty in the way murder did. This was not merely a question of deterrence. There was something especially heinous about the violent taking of human life that shamed the whole community; it "polluted the land". Only the forfeiture of the life of the murderer would suffice to cleanse such defilement. The safety of conviction was guarded by stringent laws of evidence (perjury for instance was itself punishable by death in the trial of a capital crime). But if conviction was secured the judges of Israel were not empowered to accept any ransom for the life of a murderer.
Kosher food restrictions are similarly grounded in reverence for life. In some way life is representatively present "in the blood". It is God’s possession and no general right of disposal is granted to us. Even animal blood is not to be shed in a careless or contemptuous fashion and human blood is not to be shed at all. For human life is not just a gift of God’s grace but a reflection of his personal nature. Murder is thus not simply an anti-social act. It is a breach of God’s own property rights and a blasphemy against his "image".
This distinctive biblical view of human nature as divine image enables us to make sense of our intuitive moral consciousness about the sanctity of life. Built into us there is a profound awareness both of our human dignity and our human responsibility. The debate about euthanasia is concerned with how we should most appropriately act in order to affirm these twin aspects of our human uniqueness. As in so many questions of moral controversy, we need a word from our Creator if we are not to make a disastrous error of judgement.
Suicide and the Bible
Suicide is not a criminal offence in the Mosaic code. In fact it occurs only rarely in the Old Testament. Nevertheless, there is a clearly discernible antipathy to suicide in the Bible. On those occasions when it is recorded it is always in a context of moral disapprobation. The only suicide that comes close to being honourable is that of Samson (Judges 16:28-31). But he can hardly be regarded as a model of moral integrity and sound judgement. And since he was already a prisoner of the Philistines and presumably bound to be executed soon anyway, it is arguable that his death was not a true suicide at all, but rather a heroic act of military self-sacrifice. In all other cases suicide is clearly associated with folly, godlessness and sinful pride (see Abimelech, Judges 9:52-55; Saul, I Samuel 31:1-6; and Ahithophel, 2 Samuel 17:23). The suicide of Saul is of particular interest in that we are explicitiy told he died under the judgement of God (I Chronicles 10:13-14) and that a pagan Amalekite who claimed (deceitfully) to have assisted his despatch, far from being rewarded by David for his compassion, was executed for regicide (2 Samuel 1:5-10).
Old Testament saints are sometimes brought to depths of suicidal depression, but it is noteworthy that they never take their own lives or ask others to do so. Elijah begs God to die (I Kings 16:17-19) but is instead sent on a sabbatical to Mount Horeb. Job wishes he had been still-born rather than live to suffer such pain (Job 3:11) but he refuses the easy way out suggested by his wife (Job 2:9-10). In every case it is the mark of the godly that they acknowledge with melancholic Jeremiah:
"I know, 0 Lord, that a man’s life is not his own; it is not for man to direct his steps." (Jeremiah l0:23)
In the New Testament one might have anticipated a more positive evaluation of suicide, due to the much clearer and more certain expectation of life beyond the grave. Did Jesus not insist that only those who "hated" their lives in this world would find eternal life in the next (John 12:25)? But, in fact, though the apostles testify that death holds no fear for a Christian (see Philippians 1:23; 2 Corinthians 5:8), yet no encouragement at all is given to seek its early entry. Jesus speaks of a unique authority invested in him by God to "lay down his life" (John 10:17-l8). But even his voluntary death is not a suicide. Judas alone in the New Testament is reported to have taken his own life (Matthew 27:5), the final confirmation of his reprobate heart. Unlike Peter, he found no new beginning in the wake of his failure and treachery, but surrendered instead to faithless remorse and despair.
The Christian Consensus
The consistent witness of the Bible, then, is to the moral turpitude of suicide. The sanctity of life places a bar on self-murder, just as it does on the murder of others. In this it stands in contrast to many other ancient religious traditions which have often glorified suicide. Norse paganism, for instance, encouraged warrior suicide as a certain path to heaven, a mythology that informed the kamikaze pilots of Hirohito’s Japan, too. Buddhism honours self-immolation as a laudable act of pacifist protest. The Hindu practice of suttee required a widow to throw herself onto the funeral pyre of her dead husband. And in the Graeco-Roman world, suicide was regarded as the "honourable" way out for a soldier who failed in his duty (eg. the Philippian gaoler, Acts 16:27) or a miscreant philosopher (eg. Socrates and the famous hemlock). It is true that some schools of Greek thought were opposed to suicide, notably Plato, Aristotle and the Pythagoreans. But others were decidedly in favour, especially the Stoics, who saw suicide as the ultimate renunciation of desire and a model rational response to an irrational world. Zeno is reputed to have hanged hirnself because he hurt his finger. In modern times there have been some rather similar examples of suicide as a philosophical expression of despair or protest among the existentialists.
But moral censure of suicide has always characterised the Judaeo-Christian tradition, following the biblical lead outlined above. Once again, there are isolated exceptions. Jews and Christians have sometimes approved or even venerated suicide where it has been performed for reasons of religious conscience—in order to avoid rape or capture by persecuting authorities, for instance. The mass suicide at Massada is perhaps the best known example from Jewish history. There are a handful of instances of suicide in somewhat similar circumstances by early Christians which are recounted admiringly by church fathers like Ambrose and Jerome. Generally speaking, however, the weight of Jewish and Christian opinion has always been overwhelmingly against the practice. It was Augustine who formulated the first detailed moral and theological argument against suicide in his City of God, mainly to counter the fanatical excesses of Donatists and ascetics who, quite literally, sought to make martyrs of themselves. Augustine’s scholarship was later reinforced by Aquinas in his Summa Theologica. As a result, the mediaeval church was unanimous in its view that suicide was not just a sin, but a uniquely serious sin, since it left no opportunity for repentance. Accordingly suicides were excommunicated and denied burial rites. In Dante’s Divine Comedy, the suicide is condemned to a particularly bleak and torturous part of Hell.
In Britain, despite some influential voices both Christian (eg. John Donne) and anti-Christian (eg. David Hume) to the contrary, the moral consensus remained implacably hostile to suicide well into the present century. In fact, during the early nineteenth century opposition to it intensified with the introduction of laws that penalised attempted suicide with considerable severity. These were still being enforced by the courts in the mid 1950’s.
A Swing in Secular Opinion
The last fifty years, however, have seen a dramatic shift in public attitudes on this score. Increasingly suicide has come to be regarded as a symptom of social deprivation or mental illness, rather than as an immoral act.
The classic work of Emile Durkheim (Suicide, 1912) perhaps marked the beginning of this change. He showed that suicide rates were greatly increased in the atomised and individualistic culture of industrial cities. But it is the development of modern psychiatry that has had an even more important effect. In an influential series of papers published between 1955 and 1978 Peter Sainsbury studied the aetiology of suicide. He came to the conclusion that over 95 per cent of suicides suffer from some form of mental disturbance. Alcohol or drug abuse is involved in about 20 per cent of cases. Organic brain impairment is diagnosable in about 4 per cent of cases. And with very few exceptions indeed all the remainder were classifiable as "mentally ill", the vast majority of these being subsumed under the psychiatric label "clinically depressed".
As a result of the general acceptance of these statistics, the grounds on which society resists suicide have been quietly but very significantly transformed. The decriminalisation of suicide in 1961 was a far more important watershed in this respect than is often realised. Moral censure had been replaced by medical paternalism. The suicide is no longer sinful but sick. They need not punishment but therapy.
The Right to Die?
In 1972 Granada Television presented a play by Brian Clark which highlighted the implications of this change very poignantly. It was later adapted as a film and has been widely influential in promoting pro-euthanasia opinion. Entitled, Whose Life is is Anyway?, it is the story of Ken Harrison, a young man of great intelligence who is tragically rendered quadriplegic as a result of a motor accident. He decides he wishes to die rather than face life in such a severely handicapped state. But since he is incapable of killing himself and euthanasia is illegal, the only way he can achieve his goal is by discharging himself from hospital. Without specialist supportive care he will die within a week. Dr Emerson, representing the hospital, will not permit it. He takes the view that Harrison is suffering from depression and is therefore incapable of giving valid consent to his treatment. In a particularly moving episode, Dr Emerson prepares to inject tranquilliser into Harrison against his will. The paralysed patient, helpless to resist, protests indignantly, but Emerson will not be deterred. "You are depressed, " he insists. "It takes time to get over such injuries." The forcible violation of Harrison’s body by the hypodermic needle which follows is presented by the dramatist in a way that quite deliberately makes the andience feel it is witnessing some kind of rape. Harrison subsequently employs a lawyer who issues a writ of habeas corpus, alleging that his client is being deprived of liberty without proper cause. The resulting judicial hearing rehearses the euthanasia debate and in particular the relevance of psychiatric assessment to the establishment of consent.
In an important series on the moral limits of the criminal law, Joel Feinberg (Harm to Self 1986) refers to Brian Clark’s play and observes that the diagnosis of "clinical depression" has in effect created a "Catch-22" situation for any would-be suicide in the late twentieth century. For to express a desire to die is, according to currently accepted medical wisdom, by definition to be depressed. And to be depressed is by definition to be incapable of valid consent in matters of medical treatment. This means that doctors, who have a legally enforceable duty of care towards their patients, must intervene aggressively and against their patients’ will to prevent suicide.
In some respects, proponents of a "right to die" are simply issuing a protest against this authoritarian conspiracy. Whether doctors do it out of professional hubris (‘We know what is best for our patients’), or fear of malpractice suits (assisted suicide is still a criminal offence), or simply to avoid Department of Health interference (the incidence of suicide is regularly used by government departments to assess the efficiency of psychiatric hospitals), it is medical staff who offer the chief barrier to anyone wishing to terminate their life today. Should they arrogate this role to themselves as often as they do? In my earlier essay I commented on the practical difficulty of framing a pro-euthanasia law which would be proof against individuals giving consent in a state of temporary morbidity. There are undoubtedly many people who pass through suicidal phases which they later disown when their mood lightens as a result of psychiatric treatment. Nevertheless, Peter Sainsbury’s statistics have been challenged. Is it really only the mentally unbalanced who wish to take their own lives?
The medicalisation of suicide has in fact proven to be a major stepping-stone towards public acceptance of euthanasia. The right to refuse medical treatment is already recognised in law and the "right to die" is all too easily defended as a logical extension of this principle. Peter Sainsbury’s statistics are now the only serious objection to this, and they hinge on a definition of "mental illness" which many psychiatrists would agree is unduly broad and could potentially be used to undermine the liberty of individuals.
An Opportunity for Christian Apologetics
By bestowing a social absolution on suicide, the door to voluntary euthanasia has been opened unwittingly. It will only be closed again by a reaffirmation not of the medical but of the moral objection to suicide. And this in turn hinges on the sanctity of life, a doctrine which we have argued lacks a convincing rational basis except by reference to the biblical view of human beings as made "in the image of God". Herein lies an unusual opportunity for Christian apologetics. Many people, in spite of the secularisation of late twentieth century culture, feel decidedly uneasy about euthanasia. Even those who support it find it hard to explain why human dignity in matters of life and death matters so much to them. Like the altar "To the Unknown God" in ancient Athens, our intuitive consciousness of the sanctity of life is a pointer to the inadequacy of our contemporary deities and an Achilles’ heel in the philosophy of our neo-pagan society.
If Christians are to exploit that vulnerability, however, it is important that they get the argument right. Well-intentioned opponents of euthanasia must beware of blanket condemnation of the "right to die" argument. The Bible resolutely defends the self-determination of the individual. God permits men and women to sin, even though he disapproves of their actions. "Your blood be upon your own heads!" warns the apostle Paul (Acts 18:6). Recognition of the divine image demands that human beings be given the dignity of free choice, even in matters upon which their eternal destiny depends. Insofar, therefore, as the "right to die" advocates are protesting against an excessive medical paternalism they deserve Christian support. Human beings should certainly be encouraged to take responsibility for their own lives.
But that is precisely the point! By claiming the "right to die" the suicide is shirking that very responsibility.
The Bible is not unfamiliar with the language of "rights" (eg. I Corinthians 9:4), but it never discusses ethics in such terms. It prefers always to speak of duty and responsibility. The liberty which God has invested in us as his image-bearers is not the freedom to do as we want, but as we ought. Karl Barth expresses it well:
"True freedom is not a choice between alternatives; our one freedom is obedience to the will of God. What we call freedom as ‘free-will’ is not freedom. We are free if we agree with God, otherwise we are prisoners. The liberty of free-will is sin!" (Table Talk, 1962)
Though it is often possible to express a moral duty as a "right" possessed by the beneficiary of the duty (eg. "Thou shalt not steal" is equivalent to a "right" of private property), such an inversion all too easily becomes a vehicle for the illegitimate assertion of human autonomy. And the "right to die" is arguably the ultimate expression of that autonomy. It is an anarchist charter permitting the individual to deny all responsibility to God and neighbour.
A society, however, which is no longer willing to discuss human behavioural norms within the context of responsible freedom can only resist suicide by resort to some kind of paternalistic authoritananism. Respect for the "image of God" demands that Christians resist that authoritarianism as well as the irresponsibility that gives rise to it. Suicide is no more a purely medical problem than AIDS. The debate about voluntary euthanasia, like that about AIDS, provides Christians with a notable opportunity to challenge the moral conscience of society. God has not granted us the "right to die" and deep in our hearts we all know it; "None of us lives to himself alone, and none of us dies to himself alone, … each of us will give an account of himself to God." (Romans 14:7,12). The plausibility of the Word of God can only be strengthened by Christians who are prepared to say so in the public square.
An Act of Mercy?
But the "right to die" is not the only argument employed by the supporters of euthanasia. From the Christian point of view a far stronger case can be made for the argument from compassion. Suffering is not regarded in the Bible as a natural phenomenon to be accepted with stoic fatalism. It is a tragic curse that has invaded human experience as a consequence of the Fall (see Genesis 3:16-19) and it will be eradicated when that Fall is finally and completely remedied (see Romans 8:18, Revelation 21:21). Much of the ministry of Jesus was taken up with healing, as a pointer to this pain-free world that is to come. And Christians have rightly seen the relief of suffering as a necessary part of their witness to him and his Kingdom.
The question which the euthanasia debate raises is where does the relief of suffering figure in our hierarchy of values? Is it conceivable that on occasions it should take an even higher priority than the sanctity of life?
First it must be conceded that the Bible does give some moral principles more importance than others. Jesus rebukes the scribes and Pharisees for their neglect of the "weightier" matters of the Law, namely "justice, mercy and faithfulness" (Matthew 23:23). He insists that the "most important" commandment is that of love (Mark 12:29-31).
Furthermore, it must be conceded that the Bible does not absolutise the sanctity of life in such a way that it can never be overruled by other moral considerations. Sometimes, for instance, the demands of justice mean that human life must be taken—as in a just war or in the execution of a criminal. So we cannot a priori exclude the possibility that mercy-killing might be legitimate as a lesser-evil decision in certain circumstances. Indeed, it is not difficult to construct scenarios where the case for mercy-killing seems immensely compelling. The mortally wounded soldier in agony on the battlefield without access to medical assistance is a classic case in point. The family of an American pioneer about to be raped and tortured by hostile natives is another.
However, there are strong grounds for believing that such situations must be very unusual and extreme if they are not to dishonour the sanctity of life.
Firstly, it is important to notice in this connection that the value which the Bible places upon human life has nothing to do with physical or mental perfection, nor with economic utility. A human being is valuable, irrespective of what they can do, simply because of what they are: made in the image of God. The whole human race is "handicapped" as a result of the Fall, but our value to God has not been forfeited in consequence. On the contrary, Jesus insists we are precious to the fatherly heart of God (Matthew 6:25-26). Those who are suffering and the physically or mentally disadvantaged are not to be dismissed because of the inferior "quality" of their lives. Rather they are encouraged to look forward to the redeemed world where "the eyes of the blind will be opened and the ears of the deaf unstopped" (Isaiah 35:5).
What About Tony Bland?
No-one can deny that life support technology has created a grey area on the border of death which raises particularly difficult problems of ethical judgement. In my previous essay I discussed the case of Tony Bland, a patient in "persistent vegetative state". How much cognitive function must a person retain to still be classified as "alive"? Is it possible that at some deep intra-psychic level a p.v.s. victim still possesses the capacity to relate to the image of God, even though all human relationships have been rendered impossible by brain damage? The "image of God" bestows such value on a human being that, at the very least, it would seem necessary to err on the side of caution in deciding that question. An observation by Prof. Oliver O’Donovan in the context of the abortion debate is relevant:
"To allow (abortion) because one does not know for certain that (the foetus) is a human being, is to engage in moral thought in a rare spirit of frivolity. In just such a spirit a rescue team might decide not to go out on a cold night if there was at least an even chance that the lost mountaineers were already dead."
(The Christian and The Unborn Child, Grove Booklets, 1973)
It would seem much more in keeping with the great seriousness that the Bible attributes to murder to give a p.v.s victim the benefit of the doubt, at least until medical science is able to affirm with confidence that all capacity for inner consciousness has been irretrievably lost, and that the patient may be regarded, therefore, as no more than an animated corpse.
Kill or Care?
But if respect for the inalienable "image of God" means that we dare not terminate a human life simply on grounds of handicap or pain, what does the paramount ethical principle of love demand of us in a situation of acute suffering? It is at this point that the Christian must beware of the hypocrisy which loads people with burdens and will not lift a finger to help carry them (Luke 11:46). Modern analgesic drugs mean that few if any need to suffer irremediable pain. But care for the suffering demands more than access to a morphine injection. Jesus’ matchless story of the Good Samaritan (Luke 10:25-37) remains a classic exposition of the sacrificial nature of neighbour-love. And his final words to the scribe whose question prompted that parable remain a startling challenge to all who would aspire to Christian discipleship:
"Go and do likewise"
The debate about euthanasia not only provides Christians with a special opportunity for apologetics, it provides an opportunity too for the demonstration of that practical love which Jesus insisted was the hallmark of his community (John l3:34-35). If we fail in the latter we shall have no right to expect to succeed in the former argument.
See also Euthanasia (from News Items)
this essay was first published by Cambridge Papers in March 1994