V.E.S.S. Edinburgh March 1991
A Theological Perspective on Euthanasia
In one sense I feel quite at home. Looking out over this sea of faces you might very well be any congregation in any church, insofar as the majority of you are women rather than men, and also the tendency to avoid at all costs the front "pews" and go to the back ones!
This subject is enormous, and all I am going to do is be very selective and give you, as Dr Beloff said, ‘A’ theological perspective. What I am going to say mustn’t be regarded as being authoritative, but I hope it won’t be regarded as being eccentric, either, since there are plenty of competent theologians who see the issues before us more or less as I do. If this were a sermon I’d begin with a text, and the text I would take would be from Joshua ch.3 v.4: "You have not passed this way before." That was said to the children of Israel just before they crossed the Jordan, into unknown territory, and we men and women of the 20th century have been, for at last 150 years, travelling in unknown territory too. I’d like to read to you some comments about this new territory in which we now find ourselves. Here is an historian:
It is a truth universally acknowledged in text books that about a hundred years ago something tremendous happened in the history of thought. Three great explosions took place in rapid succession which rocked the fabric of Christendom and sent the believers scuttling for shelter.
And here is a theologian:
We are standing, as it were, near to an explosion of knowledge, and until the dust settles, we hardly know what buildings remain standing, or how many of us have survived to take part in the work of reconstruction.
(George F Woods)
That’s an indication of the kind of revolution that we are still living through, which began substantially about a hundred and fifty years ago. But there wasn’t just one explosion, one Big Bang then silence; the explosion set off a chain reaction which is still reverberating. And the explosions have not been clean; our imaginations as well as our ways of thinking have been irradiated by fallout. We are all infected or irradiated or contaminated, or whatever word you want to use, by the fallout of these explosions. Consider for a moment three representative names: Marx, Freud, Einstein. I don’t suppose many of us would care to sit an examination on the teaching of any one of them, yet the lives of every one of us have been profoundly affected by their thought. Marx- society; Freud - the individual soul; Einstein -mathematics: no such three figures and significantly pre-eminent in the same fields of study have been alive at the same time since the days of Confucius, Buddha and Pythagoras in the 6th century BC. It is arguable that the first three have affected the world in a far more revolutionary way than the second three. Or, again, consider Darwin, in relation to the animal world; Marx in relation to the social world; and Freud, in relation to the personal world. And this is to list what every schoolboy and schoolgirl knows.
It is impossible for anyone in our society today, even only a little educated, to think as even his recent forefathers thought. Here is the response of one theologian, who was also a scientist, to his awareness of these great revolutions:
I have been saying for years that the Church urgently needs a new theology, even a new guide to sainthood expressed in terms and concepts belonging to psycho-analysis, neuro pharmacology, social psychology and molecular biology, yet holding fast to the great two commandments of our religion: loving God and loving your neighbour. For myself I am not prepared to play at being a 6th century Christian, nor yet an 11th century one. I must be a 20th century Christian or nothing, prepared to face all the knowledge that scientists have brought, to test all things, and to hold fast to that which is good.
The subject is voluntary euthanasia. Of course it’s not possible to narrow the subject down simply to voluntary euthanasia. There’s a constant spillage over into involuntary euthanasia, and we’ve just got to know a little of the sorts of debates that take place to realize that euthanasia is not confined to the end of life, but also occurs at the beginning: the controversy about euthanasia and the end of life is inseparable from the controversy about abortion. There’s a story of a worm that put its head through the soil and saw a centipede walking along and was filled with astonishment and said, ‘Gosh, that’s wonderful. How do you do that?' And the centipede said, ‘What do you mean? How do I do what?’ ‘How do you integrate all your legs?’ And the centipede said, ‘It’s quite easy, watch’ - and tripped! When anyone becomes self-conscious about something which he always has taken for granted, and has lived with hitherto unexamined but now challenged assumptions controlling his understanding and attitudes to life, he becomes insecure. Nowhere is this more true than the whole area of issues of life and death.
I’m willing to bet, a small amount of money (I’m a cautious kind of chap!), that most people here would think that if you are going to give "A Theological Perspective on Voluntary Euthanasia" you would begin with some text from the Bible. Well if you think that, it means you don’t really know your Bible. It is one of the prevalent assumptions of Western religious culture that the Bible clearly and emphatically forbids suicide. Inspection of biblical texts, however, shows that this is by no means the case. To begin with there is no explicit prohibition of suicide in the Bible. The biblical texts do describe a number of cases of suicide: eight in the Old Testament, two in the Apocrypha and one in the New Testament. None of these passages offers explicit comment on the morality of the act: nor is there anywhere in the Bible an explicit discussion of the ethical issues. So, if we are to discuss "A Theological Perspective on Euthanasia’’, we cannot go to the Bible and read off explicit approval or disapproval. You will find no comment at all. (I’ve got the references if anyone wants to take them down afterwards.) There is lots of evidence of an indirect sort, both in the Old Testament and the New Testament about how one should live one’s life in general terms, but there is nothing specifically said about suicide, and on the suicides they do describe, there is no judgement at all. So that takes us from scriptures to subsequent years of the Church’s existence.
In Christian history the person who first clearly formulated what is regarded as the usual Orthodox attitude towards suicide is St Augustine. He set the pattern which continued for many centuries, continuing through the Reformation too. There were a few exceptions: Thomas More’s "Utopia" included Euthanasia; so did Bacon in "New Atlantis". John Donne, who was Dean of St Paul’s, London, in the 17th century, wrote a pamphlet called "Biathanatos", which he subtitled "Declaration of that paradox, or thesis, that self -homicide is not so naturally sin, that it may never be otherwise".
Over the years since Augustine, there have been three basic attitudes towards suicide and Euthanasia. One, based on what is called ‘physicalism’, another based on ‘ecclesiastical positivism’, and a third based on ‘personalism’. The views based on physicalism were dominant until the reign of Pope Pius XII (1940—60): a limited ‘physical body’, physiological approach, combined with a static understanding of natural law ruled the day. But gradually, as new understandings forced the abandonment of the traditional understandings of physiology (e.g. on human generation) that ‘physical’ approach became less and less defensible and so there was a gradual movement away from that into what is called ‘ecclesiastical positivism’. Ecclesiastical positivism dealt much more directly with what was believed to be the revealed will of God expressed through an infallible magisterium, and even when the magisterium is not explicitly infallible, it is temerarious to question its judgements. Then the third one, ‘personalism’. After the Second Vatican Council came the tremendous wrestlings in the Catholic Church both on contraception and at that time on abortion, too. The Commission set up to advise the Pope was expected (by competent Roman Catholics theologians, as well as others) to say that, given the new situation, given the new understandings of human generation, given new contraceptive inventions like pills and so on, some kind of qualified approval of contraception, and some kind of qualified approval of abortion might be given. All such hopes were killed by "Humanae Vitae" and its absolute prohibitions. Roman Catholic theologians and moralists began then wrestling with the question "How do we deal with the consequences of this negative absolutism?", so ‘personalism’ became more and more the basis of ethical judgements in the Roman Catholic Church. The whole person, not only the physical, biological, but the whole person, embracing psychological, social and spiritual aspects. There is no doubt at all that today the official Roman Catholic view on issues of life and death is solid, authoritative and unhesitating.
But behind that absolutely rigid and clear cut forcefully expressed public condemnation there is profound disagreement and division. If you are an officially accredited teacher, and you question too explicitly or too publicly, then you will find that your teaching licence is withdrawn. But the contention is going on just the same, and there are several very interesting people whose names I could mention who have sometimes discreetly, sometimes openly, challenged the official Roman line on contraception, abortion and Euthanasia. Even in the official Roman teaching you can see how the official line, as it were, is getting frayed round the edges, because the realities of the human situation as they are encountered, even by the Roman Catholic doctors and nurses, have led to modifications and permissions: for example, distinguishing between ordinary and extraordinary means in ministering to people in need, or introducing the law of double effect; that you can administer a drug which you know will shorten or even terminate a patient’s life, as long as the effect you desire is not the termination of life but the alleviation of suffering. But you’ve just got to stop for a moment and look at these ‘qualifiers’ to realise how very slippery they are, how highly subjective they are. One doctor’s extraordinary means is another doctor’s ordinary means, and yet they are the people who are going to decide. Or the law of double effect: the intention within any individual’s heart and mind is extremely difficult to identify. You never know whether the primary purpose of the doctor administering the drug is to terminate life with the incidental alleviation of suffering, or his intention is to alleviate suffering with the incidental termination of life. So here we have a very, very strong official line with every appearance of authoritative, infallible moral certainty, but in factit is fraying at the edges. One of the very serious consequences of the official Roman Catholic absolutism is that there is no vigorous public discussion, no developing Catholic casuistry on these subjects, to the impoverishment of other Churches too.
One of the first contemporary pieces of coherent work done on the questions we have been considering was a book called "Morals and Medicine" by Joseph Fletcher (1954). Since 1954 there has been an absolute explosion of writing, commissions and all kinds of programmes on both radio and television broadcast. The membership of the Voluntary Euthanasia Society may not be increasing by leaps and bounds, but education is taking place in our society about Euthanasia and the issues associated with it, and interest and concern have increased by leaps and bounds. Everywhere I go, I’ve found that I’ve never got to introduce the subject but people introduce it themselves. And then I’ve got to judge, "How far can I go in speaking to this person?", because there’s a tremendous taboo in Western Christianity about the taking of life. There’s very little taboo really about taking a life in war- the last three months of the Gulf Crisis have shown that - but there’s a tremendous taboo on the issues of life, death and Euthanasia. It takes a very long time for attitudes and understandings to change. Let me illustrate just how long it can take.
The Anglican Church first debated contraception at the Lambeth Conference in 1908, and every ten years since then the Lambeth Conference discussed it, but it wasn’t until 1958, fifty years later, that the bishops at Lambeth said that in certain circumstances contraception was something which Christian couples could conscientiously practice. At the time, that was regarded by some Christians (certainly almost all Roman Catholics and some Anglicans), as an abdication of moral principle. Now look where the absolutism of "Humanae Vitae" has landed the Roman Catholic Church. As with contraception in the past, so with Euthanasia now; a slow but steady growth in interest, knowledge and acceptance is discernible. I understand from your own literature that 75% of British society are sympathetic to, if not actively supportive of Euthanasia. We have also got the example of what is happening in Holland, and in the United States, but you are all sufficiently familiar with this, so I don’t need to spell it out.
Traditional Orthodox opposition is based on two main foundations. One is the sovereignty of God and the other is the redemptive efficacy of suffering. Let’s look at these. First the sovereignty of God.
Here is a typical exposition in Roman Catholic theological writing:
Almighty God, as the creator of the universe is the one supreme Lord and master. In the most absolute sense all things belong to him. If perchance certain individuals are born with physical or mental deficiencies, who is the man to pass judgement on the creative act of God? Is the creature to say that the Almighty has erred- for man is merely the custodian of life, not its Master. The fundamental immorality of Euthanasia, therefore, lies in its direct violation of the supreme dominion of God over his creation.
Another Roman Catholic theologian says Euthanasia is the destruction of " ‘the temple of God’ and a violation of the property rights of Jesus Christ."
This challenge is an echo of St Paul’s argument in his Epistle to the Romans: Who are you, he asks, to question God? Is the pot going to question the potter? But, as one distinguished New Testament scholar put it, "The trouble is, man is not a pot. Man will question God." And there is lots and lots of evidence of the questioning of God in the scriptures. In the Psalms and in the Book of Job. Does God want to bludgeon us into silence? What do we mean when we say "the supreme dominion of God over creation?" That God reserves for himself alone, the right to decide at what moment a life shall cease?
Here is how one Episcopalian responds:
As to this doctrine, it seems more than enough to answer that if such a divine monopoly theory is valid, then it follows with equal force that it is immoral to lengthen life. Is medical care after all only a form of human self-assertion, or demonic pretension, by which men, especially physicians, try to put themselves in God’s place? Prolonging life on this divine-monopoly view, when a life appears to be ending through natural or physical causes is just as much an interference with natural determinism as mercifully ending it before physiology does it in its own amoral way.
This argument that we must not tamper with life also assumes that physiological life is sacrosanct. William Temple once pointed out "The notion that life is absolutely sacred is Hindu or Buddhist, not Christian". He said further that the argument that it cannot be right to kill a fellow human being will not stand up because-
…such a plea can only rest upon belief that life, physiological life, is sacrosanct. This is not a Christian idea at all; for, if it were, the martyrs would be wrong.
If the sanctity is in life, it must be wrong to give your life for a noble cause, as well as to take another’s. But the Christian must be ready to give life gladly for his faith, as for a noble cause. Of course, this implies that, as compared with some things, the loss of life is a small evil; and if so, then, as compared with some other things, the taking of life is a small injury.
Another writer makes the same point thus —
Are we not allowing ourselves to be deceived, by our self-preserving tendency, to rationalize a merely instinctive urge, and to attribute spiritual and ethical significance to phenomena appertaining to the realm of crude, biological utility?
You must weigh these arguments and come to your own conclusions.
Now let’s look at the redemptive efficacy of suffering. Here is a Roman Catholic moral theologian writing about the Christian meaning of suffering:
The advocates of Euthanasia, moreover, disregard the supernatural destiny of man and the role which suffering can play in the achievement of sanctity. They do not realize the ability of man, aided by God’s grace, to bear sufferings patiently. They do not know how resignation to pain can serve as penance and temporal punishment for personal moral failures. Lacking a true belief in the supernatural, they have no respect for the power of faith and prayer to produce miracles in even the most hopeless cases. Neither can they understand how the Communion of Saints makes possible vicarious suffering, that is the ability of man to endure pain for the spiritual good of fellow man. The proponents of ‘mercy killing’, steeped as they are in a materialistic philosophy of life, cannot grasp the significance of these profound vital truths of Christianity.
Now that to me is as typical of the kind of excessively cerebral passionless thinking of many of the Roman Catholic moral theologians and it seems to me an inadequate consideration of the actual experience of men and women.
This thesis rests on a one-sided belief that pain and suffering serve some further purpose. Certainly, in the Christian tradition, thinkers have distinguished between ‘constructive’ and ‘destructive’ pain, pain which serves some further purpose, and permits, encourages further spiritual growth, as against pain which does not. Certainly in my ministry and amongst your own friends and acquaintances, you must have come across cases in which pain has had a most wonderful purifying, strengthening, sanctifying effect. We must also have come across cases in which pain has been wholly destructive, both for the patient concerned and for the patient’s family. And I wouldn’t want in any way to give the impression that I am writing off the effectiveness of this suffering. It can be so. But I wouldn’t like to say what kind of proportion of cases are ‘destructive’ and which ‘constructive’.
Some of you may know a book that was very popular in this country called "Jean~ Way". This was an example of someone who experienced very constructive suffering. Another even more famous one, of course, is in Tolstoy’s "The Death of Ivan Ilych" who, in the last two hours of his anguished life experienced transforming spiritual enlightenment.
So it can happen. But we mustn’t assume that it always happens. I would be very chary of accepting the judgement of somebody who was, in a pejorative sense, an ‘academic’ theologian, and whose theology was not worked out in the actual. anguish of sharing human suffering. here is Fletcher, the American Anglican:
A common objection in religious quarters is that suffering is part of the divine plan for the good of man’s soul, and must therefore be accepted. Does this mean that physician’s Hippocratic Oath is opposed to Christian virtue and doctrine? If this simple and naive idea of suffering were a valid one, then one would not be able to give our moral approval to anesthetics, or to provide any medical relief for human suffering. Such has been the objection of many religionists at every stage of medical conquest, for example the use of anesthetics at childbirth.
The nicest story I know about Queen Victoria is about when she was having her umpteenth baby and the English bishops gathered round her at Windsor and pleaded with her to set an example to the women of England and to abjure the use of the new fangled invention of this dreadful man in Edinburgh called Simpson, and not use this modern pain reducing childbirth drug, because it said in the scriptures, "I will greatly multiply your pain in childbearing. In pain shall you bring forth children". This dumpy old frump in black stood up and said, "Since we are having the baby, we shall have the anaesthetic!"
That was a great breakthrough, because rather like Edward VII’s appendicitis making appendectomy a popular pastime in British surgery, Queen Victoria made it respectable for women to have comparatively painless childbirth.
The Church has a dreadful record in opposing things, a kind of spirit that always says ‘No’. The opposition of the Church by and large, not individual church people, but the official Church, to Euthanasia, is an expression of that spirit. Fletcher goes on-
…Another anomaly in our mores of life and death, that we are, after much struggle, now fairly secure in the righteousness of easing suffering at birth, but we still feel it is wrong to ease suffering at death! Life may be begun without suffering, but it may not be ended without it, if it happens that nature combines death and suffering.
Those who have some acquaintance with the theological habit of mind can understand how even the question of Euthanasia may be coloured by visions of the Cross as a symbol of redemptive suffering in Christian doctrine…
The picture of a dying man is a sacred sign of Christendom. But when it is applied to suffering in general it becomes, of course, a rather uncritical exemplarism, which ignores the unique theological claims of the doctrine of the Atonement and the saving power of the cross as a singular event …
It is, at least, difficult to see how any theological basis for the suffering argument against medical Euthanasia would be any different, or any more compelling, for keeping childbirth natural and ‘as God hath provided it’. It is much more realistic and humble to take as our principle the rule ‘Blessed are the merciful for they shall obtain mercy’.
It is in relation to this, that I want to read to you a paragraph from one of the series of lectures we’ve been hearing in Edinburgh Diocese. This quotation is from a lecture by a woman theologian, a wife and mother:
One of my friends would, if she either really believed in God or was quite sure that he did not exist, be tempted to kill herself tomorrow. That is to say, if she thought that, around the nightmare which her life has largely been, there was ultimate safety, love and acceptance; or if she could know that there was nothing, she would not live longer with the constant wounding which being alive in the world is to her. At the worst times all that blocks her desire to take herself out of it is the risk that the God of her childhood, the creator and sustainer of hell, might then produce for her an endless environment for which this ghastly world was merely a premonitory trial run.
You can see how this girl is trapped because her mind is so infected with the understanding of God that she received as a child. Not much ‘mercy’ here!
What I want to do now is to invoke testimony rather than argument, testimony on the question of Euthanasia at the beginning of life, which we call abortion. I don’t know how many of you are "Independent" readers but earlier this week Clare Tomalin was interviewed by Angela Lambert and this is part of the interview:
I’d thought there was something a bit odd about the pregnancy. It was my fifth after all and I knew the difference. The baby was taken away very quickly after the birth and eventually the obstetrician came into my room. We were just opening a bottle of champagne when he said, ‘Don’t do that’. I said "What?". And he said, ‘There’s something wrong with your baby.' (The child was spina bifida)
Well, we had to decide whether to have the operation to close his back. They said afterwards that if they hadn’t done it he would have died. But they didn’t tell me that at the time. I think if I’d known then what I know now I would probably not have had the operation done. Now my son is aged twenty, and I adore him. I’d give my life for him, but I see how hard it is for him. He’s paralysed from waist down, he can’t even stand up, but he jolly well copes. lie looks like an old ragamuffin, falling out of his wheelchair, but he looks alive, he’s so stoical, he never complains, he has a passionately devoted, intelligent mother who’s fought for him and for his education. But still his life is tremendously difficult.
Now I'd like to read from a book by a woman who is a professor of theology. She’s got a son called Arthur who is twenty-two, and for twenty-two years several times a day, Frances Young or her husband(who’s had to give up his job to look after Arthur) changes his nappies, feeds him, picks him up, puts him down. Arthur cannot stand, cannot speak, cannot feed himself; he is subject to convulsion fits and is incontinent. She’s talking about looking after Arthur:
There would be periods of acute distress, refusal to co-operate with eating, dressing, changing or anything, inability to sleep, rejection of all handling, comfort or affection. During this period progress seemed to stand still. We were relieved when things were simply bearable: the bad patches were somewhat intermittent and mosUy we were able to maintain the regular routine. The worst feature of it was that when he was distressed there would be a gradual build up of distress in me, until I could no longer contain my feelings. It was his rejection of comfort, rejection of love and care that hurt, it was the distress for his distress that undermined my ability to cope. There seemed no point in his life. If you put an animal out of his misery on compassionate grounds, why not Arthur?
I found myself voicing this in an article, …voicing my protest at the success of antibiotics that kept children like Arthur alive into adulthood for no reason at all: was there not a moral difference between killing and letting nature take its compassionate course. Next time Arthur had a chest infection why could I not refuse treatment? How could we justify his continued misery when the future held nothing for him?
She goes on:
"Don’t know" is the response to the question, ‘Should handicapped people be kept alive?’ The dogmatism of the Life organisation comes under judgement because they outlaw the possibility of ‘making judgements’ and learning to live with the consequences because they will not recognise the necessity of taking responsibility rather than falling back on unalterable principles. There is some delicacy in coming to a decision between right and wrong. The problem with law making about abortion is that law cannot allow for delicacy. Clear cut rules determining decisions have to be laid down:’
Here is another Christian testimony. This woman is a historian at Cambridge and she herself suffers from acute chronic osteoporosis. She had a child called Bridget who was very bright indeed but who had an acute and chronic genetic disease called cystinosis, a rare metabolic disease which affects various parts of the body before killing from renal failure. All her life she had been in and out of Great Orrnond Street Hospital. Now she was almost twenty and the doctors had proposed a new and threatening treatment which might cause dementia.
The final twist was, however, that none of the decision—making was now ours. Finally, this fourth time, we had struck at more medical interference. But she was now nineteen. Legally, the choice was nothing to do with us: indeed, it came as something of a shock to be told later that we would have been taken to the High Court if she had gone into renal failure again when she was only fifteen or sixteen, and we had not backed a further transplant, even before the advent of the new drug. When we embarked on all this, and I caught the London train when she was one, we did not know that it would be like being caught up in some vast machine. However, if the decision and the power were nothing to do with us, the responsibility of the background care was still entirely ours. Only legal and medical fiction could, and did, pretend otherwise. And to be utterly powerless, and almost completely responsible, is a bad combination.
But where was the girl, in all this? She had the brutal experience of choosing life for herself, not death, and knowing her parents would choose death. She did not know about the dementia, the knowledge that had finally swung us against further interference. The doctors did not tell her, and we could not, feeling she was too young for such a load, though not, it seemed, too young to be asked to choose life or death. So she chose, not knowing what she chose, or why we would have chosen otherwise. The depths of rejection were potentially immense. She, and we, were put in impossible positions.
We are profoundly thankful to have had this daughter, who has enriched us beyond belief, partly through pain I could not have dreamt of. She is, in herself, a triumph. Yet I have come seriously to doubt whether life should be sustained when it can only be done through massive and repeated medical intervention, especially when there is no community care, apart from the family, to which these young adults can suitably move on. Who is going to sustain the quality of this girl’s life, when we physically no longer can?-
But we still wonder even whether it is proper for a child to live from kidney transplant to kidney transplant, given that they are now known to wear out. The ethical problems are immense, and we are all surely feeling our way round a very grey area. Neither the response ‘Just pop in a kidney’ nor ours ‘No child ought to be subjected to this degree of stress’, can be right. Both are much too simple. Paediatricians never look at their results twenty years on. If we adopt our own approach, doctors might never have found out how to do something as life-saving and simple as an appendectomy.
There is no conclusion. I have no conclusion. We are all jointly engaged on redemptive work, which is, of its nature, agonizing. I would not, despite the agony, have missed it and the enrichment it has brought. But I do think it has taxed my husband and me almost to the limit, and there are times when I wonder frankly how much longer I can endure the pain and uncertainty of it. The situation itself is almost unendurable. Essentially, modern medicine sticks a family down on one of the ‘frontiers of medical knowledge’ and says ‘Make your home here, and make it a good one; make your children secure, and safe, and loved’. We try, but could anyone succeed?
Margaret Spufford is speaking about the beginning of life. What she says clearly applies equally to the end of life, and the prolonging of life modern medicine makes possible.
I recommend these two books to you. The first is called "Face to Face" by Frances Young. (T & T paperback). The second is called "Celebration" by Margaret Spufford (Collins Fount Paperback).
"A Theological Perspective on Euthanasia". I have already gone on quite long enough, but also, perhaps, enough to indicate where the issues lie, and my own position regarding them. Perhaps the many aspects I have ignored can best be dealt with in your questions, which I hope will follow.
The Right Reverend Alastair Haggart, addressing a local meeting of the Voluntary Euthanasia Society.