The killing game

Archbishop Peter Jensen argues that euthanasia can never be voluntary.

Voluntary euthanasia is the unfinished business of the moral revolution of the mid-20th century. In the name of individual freedom, censorship of pornography was rejected; abortion on demand was instituted; and the nature of marriage was changed.

In the 1960s and 1970s there also began agitation for voluntary euthanasia or assisted suicide to become lawful in Australia. Suicide itself was decriminalised during the period, athough it remains a crime to assist someone else to commit suicide. Voluntary euthanasia presupposes a right to suicide. Hence some people prefer to call it ‘assisted suicide’.

The continued rejection by Federal and State governments of voluntary euthanasia legislation is, at first sight, extremely puzzling. Opinion polls suggest a considerable public acceptance of this idea. The politician who is prepared to make this part of his or her stated policies would almost certainly gain considerable support. There have been television documentaries offering favourable support, and even at the level of popular television dramas the issues have been canvassed sympathetically.

In speaking of voluntary eu-thanasia we are not directly addressing those agonising decisions about the end of life which so frequently face the medical profession. Indeed there are legitimate choices about palliative care which may as a side-effect, so to speak, shorten the dying process. Someone has to make these decisions; we feel that there ought to be rational and ethical grounds for making them.

Little as I know about the practice of medicine, allow me to express my deep sympathy with those who have the daily responsibility for making such significant choices. We expect you to show wisdom, justice and compassion, but we find it as hard as you do to determine what should be done in concrete cases.

I well remember being asked by a women if she should let her husband die when, from the point of view of the medical profession, all hope had passed without heroic surgical effort, and even then only a vegetative life was the best possible outcome. Accompanied by a professional Christian ethicist I sat and thought about this real problem and concluded that either decision was morally justifiable. This apparently vague conclusion did not help the lady in question; she determined that her husband should live – to the surprise of the doctor and her two ethical advisers. Her husband has survived and has returned to a very significant level of human interaction.

The case in favour of voluntary euthanasia is powerful, clear and simple. It consists of two parts. First there is the relief of suffering. When faced with the suffering, mental or physical, of the terminally ill, and when faced with the prospect or the actuality of our own suffering, we determine to prevent it. We do not allow fatally ill animals to suffer; why should we stand by and see humans go through pain for no good purpose? Compassion should move us to allow this for others even if we do not allow it for ourselves.

Secondly, there is the rights of the individual. Where a person is of a sufficient age to take responsibility, and where the person’s reason is sound, they must have the right to make their own choice about their life. Others must not make this choice for them. That is why we speak of voluntary euthanasia.

On its own, the original meaning of ‘euthanasia’ is that of a good death, or as we may say ‘a death with dignity’. To add the word ‘voluntary’ is to insist that the choice for such a death must be mine alone. If others deny me that choice and kill me without my permission, even if they think that it is in my best interests, they deprive me of my rights. As well, however, if others deny me that choice and refuse to allow me or assist me to take my own life, they too deny me my rights.

Despite these arguments, acceptance of voluntary euthanasia would be very dangerous indeed, and would change the nature of the health care professions. There are a number of problems with the proposal, but the difficulty I want to address is this: we cannot truly talk of euthanasia being voluntary.

I realise talk of individual rights has become very persuasive in the contemporary world. It seems to be fundamental to the way we think and view each other and ourselves. But it is worth noting that this is not the only possible way of viewing the world. There is really a clash of philosophies here. The triumph of the individualistic philosophy is at the expense of what may be called ‘relational philosophy’. Your choice about voluntary euthanasia may well depend upon whether you favour an individualistic or a relational philosophy.

By introducing the word ‘voluntary’, advocates of assisted suicide are making the point that euthanasia can only be morally justified when it is agreed to by the subject, when a mature and balanced individual is making the decision for himself or herself.

The word ‘voluntary’ suggests we are taking personal responsibility, unaffected by internal factors that would distort the thinking process or external factors such as the manipulation of others. Many advocates of voluntary euthanasia recognise, therefore, that suicide is not just the province of the terminally ill. Such responsibility is able to be exercised by people of all ages (from adolescence onwards) and in all states of health. That is to say, a person may be able to commit voluntary euthanasia before they grow sick or elderly.

Let’s start by thinking about suicide itself. Do we have a right to take our own lives? Suicides used to be totally condemned and victims buried in unconsecrated ground. Today we have a far greater sympathy with those who take their lives, and recognise that such an act is easily done at a time of immense stress or by people who are mentally ill. Nonetheless, in general terms no responsible person advocates suicide or sees the suicide rate as anything but tragic. Do we really want to say that suicide is an individual’s right?

Most of us agree that one of the great tests of morality is of love for others. Christ’s command, ‘You must love your neighbour as yourself’ is the rule of morality widely accepted, if not practised. In a contemporary world, our emphasis on human freedom and our determination to act as independent agents means that we think of suicide as a purely individual action.

In fact there are few suicides which do not have a major impact on others. The death of a loved person is always sad, but there is a special grief associated with suicide, a grief followed by feelings of guilt, despair and helplessness. In a profound sense, suicide touches the lives of anyone who loves the victim. It is a declaration that I have nothing more to give you and you can receive nothing from me. We can come to understand this tragedy if there is a question of mental illness. It is very hard to accept the verdict of an otherwise sane person who chooses to leave our relationship in this way, even under conditions of extreme illness.

When we talk about voluntary euthanasia, we are usually thinking of assisted suicide. In order for the suicide to be successful and not botched, advice is given, and others may have to enter into the actual administration. Advocates for voluntary euthanasia, aware of the possible abuses of euthanasia, insist on elaborate legal precautions.

In short, my suicide is never a decision for myself alone, but is one in which the community as a whole is deeply affected. This will be particularly clear if the community ever introduces assisted suicide. By making it legal we will have taken a step towards ‘normalising’ suicide - making it justifiable, dependant only on the choice of the individual. Is that a good message to send?
We are not mere individuals. We always need, and involve, others, which brings us to the nub of the problem: the clash between the individualistic and the relational philosophies of life.

Can euthanasia be voluntary? Most advocates agree that we are looking for mature, balanced and independent people to make the decision to commit suicide in this way. It has to be a high test because the issue is literally life and death. As I have already indicated, consistent voluntary euthanasia advocates will not restrict voluntary euthanasia to those who are at present suffering. They want it to be available at all stages of life and in whatever health the person is. We have already had one case in Australia of an otherwise healthy elderly person taking her life because she was tired of it. There is no reason, in theory, why young teenage men should not be justified in making the same decision and in seeking help to do it. And yet, I think that most of us believe it is not right for us to provide or encourage suicide in such a broad way.

The problem, of course, is in establishing that a really sick person is sufficiently mature, balanced and independent for a decision of this nature. Terminally ill patients precisely may not meet this test. Acute pain, physical or mental, diminishes our independence and distorts our view of the world. Can a person in such pain make a decision which can be called ‘voluntary’? The example of torture suggests that the word ‘voluntary’ is the wrong category for such a situation. A person in acute pain may seek release through death where palliative care, properly administered, may change the mood entirely.

Terminally ill patients want a dignified death; that is not to say that they want a premature one. Advocates of voluntary euthanasia appeal to our sense of compassion. But compassion needs eyes to see what is compassionate in a given situation. Surely the way of love is to provide the best palliative care and to surround the elderly and especially the terminally ill with the best and most compassionate care that we can provide. My fear is that the advent of voluntary euthanasia will end with us seeing the elderly, the incapacitated and long-term patients as burdensome. Indeed, I am told that some of the early evidence from the Netherlands showed doctors taking decisions about life and death into their own hands. The very ethos created by voluntary euthanasia will make it hard to respect the alleged voluntary aspect of it.

But there is a more profound question. To what extent do any of us make completely voluntary decisions in the sense needed for voluntary euthanasia to be moral? Despite our society’s belief that we are, above all, individuals, the fact of the matter is that human beings are communal creatures and understand ourselves in the light of what others think about us.

The question of whether a patient wants voluntary euthanasia cannot, therefore, be settled by the patient making an independent decision. Such cases may perhaps occur, but they will become rarer as time goes on. It will be settled in case after case by what the patient thinks others want him or her to do.

The patient endures a constant sense of helplessness within the hospital system. The patient depends upon their doctor, and will want to know whether the doctor thinks it is time for them to exit. Further, it is a notorious fact that patients frequently misunderstand what doctors tell them. The fault may lie with the poor communication skills of the doctor, or the stress and sense of helplessness of the patient. But the most intelligent patients frequently misunderstand the reality of their situation. All the more is this the case when a disease is potentially or actually fatal.

The death of a patient, however elderly, has very significant consequences in family life. It is frequently a turning point. The burden of looking after an elderly relative is now finished; an estate, perhaps a very rich estate, will now be divided. The patient is looking for advice and help about what they should do from the very people who will be most deeply affected by their death. In many cases, that death will be received with relief or even gratitude. Can we ever be sure that even the most loving family will not by covert or overt means point the patient towards an assisted suicide which will not be the patient’s true desire or even be in their best interests?

But there is something even more sinister here. With the baby boomers moving into the latter end of their lives, health services are faced with a massive overload. So far, our governments have resisted calls for voluntary euthanasia. Who can say, faced with the gigantic financial burden yet to be shouldered by the community, that governments will not accede to voluntary euthanasia primarily for fiscal reasons? In that event, the medical profession, so long regarded as a life- giving force in the community, will become deliverers of death. The patient will never be able to be sure whether the advice given by his or her doctor is activated by the interests of the patient or the needs of the system.

I conclude with two experiences. The first is observing the death from cancer of my own mother. I knew of her indomitable will to live even to the end despite the suffering. I knew also that if one of us as members of her family had ever said to her that we would like her to go, in order that we did not suffer from her sufferings, she would have volunteered to exit earlier. Indeed we would not have had to say anything; a hint from us plus a system in which assisted suicide was a possibility, and she would have demanded her own death, hiding her true feelings from us. Her so-called voluntary euthanasia would have arisen from the manipulation of her family.

The second experience is that of being a Christian. The Bible clearly endorses the relational rather than the individualistic idea of being human. The view of the Bible is far more realistic than that of the modern individualistic philosophy with all its talk about ‘my rights’.

The Bible does not see us merely as individuals. The individual is cherished – he or she is in the image of God. Yet the Bible also sees us as parts of communities. The Bible’s chief value is not freedom but love. In fact, it sees love as the basis of true freedom. More than that, the Bible also teaches us, and everyday experience confirms it, that human beings cherished and loved as they are by God, are deeply flawed. There is evil in our hearts as well as good. We cannot be trusted to be entirely good. We cannot trust ourselves and we cannot trust others.

The claim for voluntary euthanasia depends upon the philosophy that we are primarily individuals and it depends upon a belief that human beings will consistently choose good.

The truth of the matter is that, despite the urge we may have to help another person end their suffering rather than endure it, we cannot afford to take this responsibility upon ourselves. Even if in an individual case our motives are entirely good, the individual case must not open the doors for a general practice in which so often motives will be mixed or even worse. Our danger is that we are attempting to do a god-like thing without the power, wisdom or goodness of God.

What can we do? We should resist the call for voluntary euthanasia. We must continue to allow the dying to die, and we must do all we can to comfort their passing, to use our resources to relieve their pain, and to use our human resources to keep them in loving relationship until they pass from our help entirely. This, I think, is the path of wisdom; I am sure that it is the path that compassion needs to tread.

This is an edited extract of Archbishop Jensen’s address given at Westmead Hospital on March 18.

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