Euthanasia and signs of the times
Learn what euthanasia means, what things have been used to justify it, and where accepting it leads
This text discusses euthanasia, also known as mercy killing, which basically means causing death to a patient who does not want to live anymore or whose life others do not consider worth living anymore. It is a topic you see occasionally pop up whenever some parties demand its legalization. The motive behind it may be concerned with bringing an end to one’s suffering, economic reasons or retaining dignity even in death. Some important terms include:
Voluntary euthanasia means manslaughter on the person’s own request. It is comparable to assisted suicide.
Involuntary euthanasia means killing someone in the belief that it is best for them to die. Other people make that choice because the victim is unable to express their opinion.
Enforced euthanasia is the killing of a person against their will.
Active euthanasia means manslaughter through an act, like administering deadly poison, e.g.
Passive euthanasia means speeding up death by quitting treatment or preventing access to nutrients and water. Morally it is not that distinct from active euthanasia, since both are meant to end in death.
How to approach this serious topic, which touches upon the deepest questions of life: the meaningfulness of human life, suffering and neighbors? These are the matters examined below. First, we are going to address the most common claims used to defend euthanasia.
What is meaningful life? One argument for supporting euthanasia has been that a severe handicap or an illness might prevent people from having a dignified and meaningful life. It is thought that people with such issues could never attain a level of quality in their life that would make them happy or satisfied.
An important question is who determines the quality of life? For instance, many people handicapped from birth (e.g., Down syndrome) can be happy and satisfied with their life. They can bring joy to others, although their life might be more limited than other’s. It is wrong to say their life is meaningless. If we measure our value only in efficiency, that is when we forget humanity.
What about pain medication and the effect of medicine on the quality of life? It is peculiar how the topic of euthanasia has only emerged during the modern day, when conditions to alleviate pain are better than ever. It is easy to alleviate bodily pain through medication today. Many, who have injured themselves in accidents or are in pain, can now with the help of medicine live a satisfactory life. Often, the problem is not the pain but depression, which leads people wishing for death. It is possible to get over depression, and pains can also be removed in extreme cases through anesthesia. Anyone can go through seasons of depression and pains.
Some might express how thankful they are for the extension of life they have received through life support machines and tubes (a monthly supplement from Helsingin Sanomat, 1992 / 7 – an article “Eläköön elämä” [Hurrah life]) – the same machines that many supporters of euthanasia consider degrading and ill-fitting to human dignity. That is why it is wrong to claim one speaks for all when saying that a handicap or an illness is a hinderance to the quality of life. Some people have even woken up and completely recovered from a deep coma after many months. These kinds of cases exist, too.
Oddly enough, society places physically well and intelligent people high on the quality of life ranking, despite the fact that they are sometimes the most unhappy.
On the other hand, society considers poor people’s quality of life low, although they can sometimes be the most satisfied. (1)
An important criticism for advanced directive could be that it often reflects the attitudes of a fit and healthy person towards treating serious illnesses. It is well-known that people change their opinions on the matter. A healthy person does not make the same choices as an ill person would. When the expected lifespan is shortened, life often begins to feel much more precious. A doctor with cancer made his colleague promise to give him a deadly injection when the illness would get worse. But once the illness did get worse, the patient got frightened and became so distrustful that he even refused pain relief injections.
Many severely injured patients tend to choose life over death, however. Only one person with tetraplegia (paralysis of all four limbs) from a group saved by a breathing machine after an accident, wished that they would have died instead. Two of the patients were unsure, but 18 had hoped to receive temporary breathing machine aid again if needed. (2) (3)
Many who have injured themselves or have been born with a birth defect, can feel talks about euthanasia distressing. Although, supporters of euthanasia often mention love in their speeches, they look at things through their own perspective. Their mindset can be entirely different to that of a person in a difficult situation. The following quotation is a good illustration of this:
The disabled and able people of our society do not need any more strengthening of the human image created by wrong merchants and advertisers of competitions, sports, health, beauty, easy life – and easy death… We are often led to believe that happiness and suffering do not fit at the same time in one person and in one life or death. We are being told that a disabled person is only disabled, and cannot be healthy, human and so much more at the same time. Claiming that helplessness and dependence are only negative things is a crucial weapon in the mindset held up by benefactors. Similarly, a dangerous weapon is speeches about dignified human life – benefactors claim such a thing exists and also determine what it is. Us disabled are not influencing the masses’ modern way of thinking.
A typical spokesperson and fosterer of the masses is Jorma Palo, as he writes that humiliation is a part of the suffering of a severely disabled person. Humiliation is a part of everyone’s life, in one shape or form at certain points in our lives. We know that humiliation can be escaped, denied, or avenged, but too few realize that we can face it head on without fleeing. We do not have the mindset we need to understand that amid humiliation one can grow and even find something new and important. Of course, humiliating others is wrong, but that is an entirely different matter. The actions of Palo, in my opinion, borderline the humiliation of severely disabled people. Life humiliates in a different way than people. A severely disabled person can perceive a situation completely differently, depending on their carer’s approach. (4)
Our other example shows how people can think differently when healthy, in contrast to a situation where they have lost their mobility. Most quadriplegics wanted to live. Quite often it is not the illnesses that affect the will to live, but depression. Even physically healthy people can suffer from depression.
In one study, healthy young people were asked, whether they wished to be revived back to life through intensive care if they became permanently immobilized due to an accident. Almost all of them answered that they would rather die. When 60 youngsters with quadriplegia, who had been suddenly disabled, were interviewed, only one of them said he wished that he would have not been revived in the results. Two of them did not know, but all the rest wanted to live. They had found a meaningful life despite them being paralyzed. (5)
Economy. Euthanasia has also been justified with economic reasons. It is the other main argument used to support euthanasia. The same argument was also used by the Nazis in their propaganda.
However, there is reason to doubt calculations concerning medical treatments and other costs. Cost saving is not conclusive for the whole:
Like always, accountants are prowling on us, decked down to their teeth in blatant demands about cutting costs. That could be achieved, indeed, if everyone had an advanced directive, palliative care was conducted more efficiently, and if we put an end to “unnecessary” (we will soon come back to discuss the meaning of this word) treatments. In February, 1994, Emanuel and Emanuel from Harvard Medical School published an inclusive analysis on the issue based on articles written all around the world, and the following conclusion was met: “None of the solitary cost savings regarding end of life, whether it concerns advanced directive, palliative care, or ending unnecessary treatments, are critical. Everything points to the same direction: saving in treatment costs, regarding the ending of life, are not significant. The amount that could be saved, if we were to cut down on aggressive, life sustaining procedures performed on dying patients, would be 3,3 % at most of the total costs in health care.” That’s how people talk about saving money in terms of death; a rigorous beneficial approach to the difficult, bioethical problems currently on the health care debate. At least this one critical area is making us trip over our own feet. (6)
Calculations on medical treatments and other costs can thus be called into question. Although, it is true that there are costs to treatments in the form of salaries, etc., but the same money will circle back into society. Hospital workers pay taxes, buy food and commodities (all including value added tax) like other people. Another alternative is to lay them off and to pay unemployment benefits, but does that make any sense? It would only lead to increased unemployment and would bring the economy to a pause. On the whole it would be a more disadvantaged solution.
Employment could be increased by hiring more workers in the healthcare sector, where many current employees are over-worked. If all other taxpayers’ payroll tax in Finland, e.g., (2 million workers, average income of 35 000 euros) would be raised by 0,5 percent and it would be used to hire more workers, it would increase employment with ca. 7000 persons (hiring would not necessitate the use of debt money). This money would then return to circulation and society in the form of taxes and other payments.
In a city like Helsinki (500 000 inhabitants) it would mean ca. 700 new workers, and in a place like Lahti (100 000 inhabitants) 140 new workers, respectively. If the payroll tax were raised by 0,25 %, it would mean half of these numbers. This many workers entering the health care sector would make working much more pleasant and provide an opportunity to offer more humane care to elders and the sick. It has been observed that most people are willing to pay more taxes to uphold quality services.
History and medicine. An insight into the history of medicine in the Western world reveals that it has been greatly influenced by the Hippocratic Oath, traditions built around it, and also ethical mindset originating from the Christian understanding of humanity. Those aspects have influenced in a way that made people value the human life from the very beginning, up to conception. The most important principles have included saving human lives and alleviating pain in the best way possible. This approach comes apparent in in the Finnish Medical Association’s book called Lääkärin etiikka [Doctor’s ethics], which emphasizes that a patient should never be left without treatment:
Life expanding procedures can be given up when death is certainly expected, and the patient cannot be cured. This has been called passive aided death, but it really is about regular work of a doctor where decisions must be made about the most suitable treatment option to the patient. Active aided death, meaning expediting death, could denote acting on the wishes of a patient to be killed. The general stance of doctors in Finland towards aided death is negative. Traditional ethics for a doctor do not accept using medical knowledge to purposefully cause death. Criminal law charges a severe punishment for manslaughter, even if it was on the request of the killed. Many think the whole euthanasia concept should be abandoned, as it only causes the idea that a doctor could be the cause of death and not the illness. There are illnesses that cannot be cured, but we never leave a patient without treatment. (7)
What is the situation today? Many philosophical parties want to dismiss the good and safe tradition that has been predominant in medicine for centuries. The first step towards this direction was demanding the legalization of abortion. It was not the medical parties that were after it, but selfish supporters of enjoyment culture. They thought that it is okay to kill a child if he or she happened to be in the way of the parents’ plans. These days, nearly all abortions are done due to social reasons, not because the mother’s life would be in danger, e.g. In India and in China baby girls are being killed in abortions, in the Western world both genders are killed. (In India there are only 914 women for every 1000 men. Since we are able to check the sex of the fetus early on, it has led to millions of abortions on unborn girls.)
What is the new direction? It is likely that accepting a murder of a child inside the mother’s womb will result in the same being accepted outside the womb. Logically thought, it is argued that if killing is acceptable in the womb, why should there be a difference to doing it outside the womb. In some countries there have already been discussions of ending the life of severely handicapped newborn babies, coma patients, and severely disabled people. Similar arguments that were used to defend abortion are being used to also support euthanasia. When the discussion moves further along, it is possible that what signifies a meaningful life gets even narrower. Philosophical parties lead the direction and discussion to a place where the undenied vale of human life loses its significance. (In the Netherlands, where the practice is the most far-gone, more than a tenth of elderly people expressed being afraid of their doctors killing them against their will . Thousands carry a card with them stating that they do not wish to be killed against their will, in case they end up in a hospital.) Albert Schweitzer has stated:
When humans lose their respect for any kind of life, they lose respect for life in general. (9)
The current shift is not new or modern way of thinking. If we go back to Germany in the 1920s and 1930s, we can see that a similar atmosphere was already present before the Nazis took over. Hitler did not create this ideology, as it came from the philosophers. An important factor, specifically, was a book published in the beginning of the 1920s by psychiatrist Alfred Hochen and judge Karl Bilding, as their book discussed worthless people and unworthy lives. That and the Nazi propaganda made it possible that people would accept the idea of life that is less worthy. It all started small. Everything was also influenced by such trends like liberal theology and evolutionism. Those ideologies had a lot of supporters in the beginning of the 20th century Germany.
It became clear for the people researching war crimes that this widespread killing started from slight changes in attitude. In the beginning the doctors’ approach underwent only a slight change. The notion of life not worth living was accepted. Initially this concerned only chronically ill people. Slowly, the scope of people, who were deemed killable, widened to socially unprofitable ones, those who had differnt ideologies, racially discriminated ones and eventually to all non-Germans. It is imperial to understand that this way of thinking started from a slight change in the attitude towards fatally ill ones, who were considered lost despite all efforts. This tiny change in the attidudes of doctors is then worth keeping an eye on. (10)
How is the shift taking place? Changes in society’s moral – accepting abortion, free sexual affairs etc. – often follow the same pattern. The same formula has repeated itself several times and led to changes in people’s attitudes. In this pattern the following function as the most crucial factors:
1. A few loud individuals will proclaim new moral that abandons behavior which for centuries has been considered right. This happened at the end of the 1960s, when free sexual affairs and abortions were proclaimed. Similarly, these days people have a positive attitude towards homosexuality, which used to be considered a distortion of sexuality and was understood to arise from certain conditions and environmental surroundings. Euthanasia is a similar phenomenon in this discussion:
I was away from my homeland for three years, the years 1965 to 1968. When I returned in the autumn of 1968, I was very surprised at the change that had taken place in the atmosphere of public conversation. This concerned both the tone of conversation and also the framing of questions.
(...) In the world of high school, those who demanded justification of sexual relationships were the ones blowing their trombones loudly. They insisted, for instance, that boys and girls should be allowed to live together in university dormitories even though they were not married.
It seemed as though the Teenager Union had been conquered by new leaders, who announced not only socialism and school democracy but also an idea of free sexual relationships.
All in all, what was new with the situation was that there were reference groups speaking about sexual questions much more openly than it had been normal in public. These groups accused the society and the church of double standards. (11)
2. The media gives way to the representatives of the new moral considering them as some kinds of heroes:
Illegal couples were interviewed in public, as though they were some kind of heroes of a new moral standard, who had dared to rise against the morals of the bourgeois society. Homosexuals were interviewed in the same way and people demanded abortion to be legalized. (12)
3. Gallup polls enforce the shift. When more and more people begin to support the new practice, it affects others reading the polls.
4. The fourth phase happens when legislators confirm the new practice as the new norm and right way to act, although it has been seen as something wrong throughout times. William Booth, founder of the Salvation Army, predicted this to happen right before the Second Coming of Jesus. There would be legislators who would not have a single ounce of respect for God and His commandments. It is difficult to deny the direction of the shift being anything but that.
1. "At that time politics is without God. (...) There will be a day when the official state politics of the entire West is of the kind that nobody in a leading position fears God (...) the new generation of political leaders will rule Europe; a generation that does not fear God in the least;
Murder. When people defend euthanasia, they might use beautiful words, such as love, precious death, assisted death, easy death, good death, or liberating oneself from a life that is not worth living. People use the same terminology as the Nazis in their propaganda in the 1930s.
However, the previous cases are about killing a person. Moreover, when we talk about a good or precious death, it actually means life. Life in the last moments can be good or bad, but death itself is the limit for everyone and it happens in an instant.
The use of language is therefore relevant and this is referred to in the following quotation. Circular expressions make us more sympathetic to this matter than direct words.
In 2004, the British Euthanasia Association changed its name to Dignity in Dying. As of this writing, direct words such as "euthanasia", "suicide" or "mercy killing" were carefully avoided on their website. Instead, vague circular expressions were used, such as "dignified death with the least possible suffering," "the opportunity to choose and control our mode of death," "aid to death," and "the decision to end the suffering that became unbearable."
Not everyone has been
convinced by this approach. A commentator for the Daily Telegraph said: "It
says something when an organization has to refer to itself in a circular
expression. The Euthanasia Association now plans to call itself a Dignified
Death. Whom of us wouldn't want to die with dignity? It’s not hard to believe
that promoters of euthanasia (indeed!) are afraid to say directly what they’re
actually driving, namely killing people. ” (13)
In reality, euthanasia is either a murder or a suicide. It does not take into account the possibility that we might be eternal beings and have to account for our every act, and that murderers have no place in the kingdom of God. Some might argue against this possibility, but how can they prove that the following verses are not true? These verses should be taken seriously, instead of diminishing them:
- (Mark 7:21-23) For from within, out of the heart of men, proceed evil thoughts, adulteries, fornications, murders,
22 Thefts, covetousness, wickedness, deceit, lasciviousness, an evil eye, blasphemy, pride, foolishness:
23 All these evil things come from within, and defile the man.
- (1 Tim 1:9) Knowing this, that the law is not made for a righteous man, but for the lawless and disobedient, for the ungodly and for sinners, for unholy and profane, for murderers of fathers and murderers of mothers, for murderers,
- (1 John 3:15) Whoever hates his brother is a murderer: and you know that no murderer has eternal life abiding in him.
- (Rev 21:8) But the fearful, and unbelieving, and the abominable, and murderers, and fornicators, and sorcerers, and idolaters, and all liars, shall have their part in the lake which burns with fire and brimstone: which is the second death.
- (Rev 22:15) For without are dogs, and sorcerers, and fornicators, and murderers, and idolaters, and whoever loves and makes a lie.
When will there not be treatment? When dealing with care for the dying and their last moments, it is justified to develop palliative care. This is commonly agreed on. We must have procedures in place to make sure that every patient receives good and individual care in a safe environment, and has their pains alleviated. This is possible with modern medicine, and with enough medical staff with the right motivation. This has been the general practice and goal for centuries, e.g., in the Finnish health care, as well as in many other countries.
What about situations where a person is clearly dying and there is no hope of them getting better? (Usually, the process of dying lasts from a few hours to a few days. Death has begun when a person weakens quickly without any hope for recovery.) In such situations it can be argued to quit intensive care, because it will not help, or it might even be detrimental. It is not euthanasia but quitting ineffectual treatment. It is good to distinguish between the two. However, in such cases we can still take care of alleviating symptoms and such.
There becomes a time in every patient’s life, when remedying medication is no longer useful to the patient and instead becomes counterproductive. In such cases there will be a positive treatment outcome to good palliative care that enables pain-free death. Whereas, ineffective treatment and prolonging death are serious malpractices. Giving up ineffective treatment is not an act of taking responsibilities from God. Giving up treatment in such situations is no different to avoiding commencing unnecessary treatment. Neither procedure secures the outcome, and the decisions are not made to kill. Naturally, these decisions must be discussed in the care team and grounds for giving up the treatment and resuscitation must be made clear to all persons concerned. (16)
Joni Eareckson Tada explains further (17):
My fathers death taught my family to look for wisdom. We wished to help our father to live until the end and to let him die, when the time comes. Providing food for the hungry and water for the thirsty ones are the fundamentals of humanity. Although, it was quite clear that my father was closer to death, we wanted to make him as comfortable as possible. God’s wisdom includes compassion and remorse. Taking care of neighbors is one of the absolute commands in the Bible.
Doctors, however, told my family that in some cases feeding and giving water to a patient, whether it was done via mouth or via tubes, is pointless and, on top of that, painful for the patient. Rita Marker from an international anti-euthanasia working committee says:
When a paptient is very close to death, they can be in such a state that liquids increase their discomfort, because their body can no longer use them. Food does not digest either, when the human body starts to “close” when the process of dying has begun. A moment comes, when it can be said that the human is really dying. (18)
Ideal society. When aspiring towards an ideal society, economic aspects are often highly regarded. They are heavily emphasized, and their significance cannot be diminished. Economy going sideways can weaken the whole society. It has happened many times in history.
The most important factor in achieving ideal society is the inner attitudes of people, however: do they care about each other, or are their hearts filled with selfishness, hate, and coldness? Major problems in society do not seem to be economical, but instead, are caused by flawed attitudes towards our neighbors: the poor, ill, elderly, foreigners, disabled, etc. The quality of society is measured in how well they approach these and other groups. Ideal society takes care of all people and everyone is valued regardless of their background. But going into the opposite direction will make people miserable. Society can tilt to either direction, depending on the way people think.
We are going to look at a few related verses. They address justice and the right approach to our neighbors. Following these guidelines will improve the overall well-being of society. Abiding by the other commandments will also encourage the same development (Mark 10:19,20: You know the commandments, Do not commit adultery, Do not kill, Do not steal, Do not bear false witness, Defraud not, Honor your father and mother. And he answered and said to him, Master, all these have I observed from my youth.):
Attitude towards neighbors
- (Matt 22:35-40) Then one of them, which was a lawyer, asked him a question, tempting him, and saying,
36 Master, which is the great commandment in the law?
37 Jesus said to him, You shall love the Lord your God with all your heart, and with all your soul, and with all your mind.
38 This is the first and great commandment.
39 And the second is like to it, You shall love your neighbor as yourself.
40 On these two commandments hang all the law and the prophets.
- (Gal 6:2) Bear you one another's burdens, and so fulfill the law of Christ.
- (Mark 14:6,7) And Jesus said, Let her alone; why trouble you her? she has worked a good work on me.
7 For you have the poor with you always, and whenever you will you may do them good: but me you have not always.
- (1 John 3:17) But whoever has this world's good, and sees his brother have need, and shuts up his bowels of compassion from him, how dwells the love of God in him?
- (James 2:1-4,8,9) My brothers, have not the faith of our Lord Jesus Christ, the Lord of glory, with respect of persons.
2 For if there come to your assembly a man with a gold ring, in goodly apparel, and there come in also a poor man in vile raiment;
3 And you have respect to him that wears the gay clothing, and say to him, Sit you here in a good place; and say to the poor, Stand you there, or sit here under my footstool:
4 Are you not then partial in yourselves, and are become judges of evil thoughts?
8 If you fulfill the royal law according to the scripture, You shall love your neighbor as yourself, you do well:
9 But if you have respect to persons, you commit sin, and are convinced of the law as transgressors.
- (Deut 16:19) You shall not wrest judgment; you shall not respect persons, neither take a gift: for a gift does blind the eyes of the wise, and pervert the words of the righteous.
- (Prov 17:15) He that justifies the wicked, and he that comdemns the just, even they both are abomination to the LORD.
- ( Isaiah 61:8) For I the LORD love judgment, I hate robbery for burnt offering; and I will direct their work in truth, and I will make an everlasting covenant with them.
- (Lev 19:33,34) And if a stranger sojourn with you in your land, you shall not vex him.
34 But the stranger that dwells with you shall be to you as one born among you, and you shall love him as yourself; for you were strangers in the land of Egypt: I am the LORD your God.
- (Jer 7:4-7) Trust you not in lying words, saying, The temple of the LORD, The temple of the LORD, The temple of the LORD, are these.
5 For if you thoroughly amend your ways and your doings; if you thoroughly execute judgment between a man and his neighbor;
6 If you oppress not the stranger, the fatherless, and the widow, and shed not innocent blood in this place, neither walk after other gods to your hurt:
7 Then will I cause you to dwell in this place, in the land that I gave to your fathers, for ever and ever.
- (Lev 19:32) You shall rise up before the hoary head, and honor the face of the old man, and fear your God: I am the LORD.
1. Joni Eareckson Tada: Oikeus elää, oikeus kuolla (When is it Right to Die?), p. 65
2. Gardner B P et al., Ventilation or dignified death for patients with high tetraplegia. BMJ, 1985, 291: 1620-22
3. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 91
4. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 126,127
5. Päivi Räsänen: Kutsuttu elämään, p. 106
6. Bernard Nathanson: Antakaa minun elää (The Hand of God), p. 130
7. Lääkärin etiikka, 1992, p. 41-42
8. Richard Miniter, ”The Dutch Way of Death”, Opinion Journal (huhtikuu 28, 2001)
9. Marja Rantanen, Olavi Ronkainen: Äänetön huuto, p. 7
10. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 38,39
11. Matti Joensuu: Avoliitto, avioliitto ja perhe, p. 12-14
12. Matti Joensuu: Avoliitto, avioliitto ja perhe, p. 12-14
14. Quote from article: Finlay, I.G. et.al., Palliative Medicine, 19:444-453
15. John Wyatt: Elämän & kuoleman kysymyksiä (Matters of Life and Death), p. 204,205
16. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 92
17. Joni Eareckson Tada: Oikeus elää, oikeus kuolla (When is it Right to Die?), p. 151,152
18. Rita L. Marker: New Covenant, January 1991
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