Dr Megan Best (a CASE Associate) will be one of the major speakers at a medical ethics conference being run by CASE on the 27th March 2010 titled 'Christian Perspectives on the End of Life'.Due to the success of our first conference in 2009, 'Medical Ethics: Perspectives on Life and Death', we have decided to run a second Sydney forum in 2010 for those interested in Christian views on the end of life. Speakers will include Dr Best, Frank Brennan, Russell Clark and Kate Bradford.
Dr Best wrote an interesting titled ‘The truth about dying’ for ABC News online recently (8th Feb). Her piece serves as a foretaste of just some of the issues that the conference will deal with. The following is an extract of what Dr Best wrote.
The Extract
I am a palliative care doctor. I look after people who are terminally ill. Let me tell you about a patient I looked after many years ago, during my training. Due to the usual department rotations of medical training, I had been on the spot when he was diagnosed with lung cancer—a tall Lebanese gentleman with an impressive moustache, patriarch of a large immigrant family
I had not seen him for some time, and when he appeared in the ward again, I could see that things had not gone well.
He was a shadow of his former self, gaunt and grey, though the moustache valiantly lingered on. It was like seeing an old friend; any familiar face is welcome in such a setting.
We soon were able to control his symptoms of pain and breathlessness with the appropriate medication. He did, however, continue to suffer.
I asked him what had been the most difficult experience of his illness. His answer surprised me, back then, though it would not now. Despite the trials of discovering he had cancer, experiencing the ravages of chemotherapy, battling with pain and breathlessness and increasing debilitation, the thing that had been most difficult for him was his loss of position in his family.
He no longer ruled the clan, his illness had resulted in a demotion. He found this intolerable, he wanted his authority back, and he wanted more time with his family.
Like most of my patients, thoughts of euthanasia did not cross his mind as a response to his suffering. He wanted more time, not less.
I have always found striking the discrepancy between the public support for euthanasia (among those who are healthy) and my patients’ desire for continued life. I was informed of a recent poll which claimed that 87 per cent of Australians support legalisation of euthanasia.
Research done on palliative care populations, however, tells a different story. A study done some years ago in Sydney found that less than one per cent of those referred to a palliative care service made persistent requests for euthanasia.
My own observation is that things haven’t changed much since then. Why the disparity?
I think there are many reasons why this is the case. The absence of death in everyday life no doubt contributes - it is a remote event often occurring in hospitals, and many of us base our understanding of what really happens on hearsay. And hearsay, especially from the distant past, has some horrifying stories to tell.Yet I think the main reason why our community voices such strong support for euthanasia is because it has been confused about some accepted end-of-life practices which are already legal, but poorly understood. These include withdrawal of life-prolonging treatment and symptom control.
The Conference
If you’d like to hear more from Dr Best or some of our other speakers please consider registering for the conference. You can find details on how to register HERE.
Related Posts
Talks by Dr John Wyatt at the 2009 New College Lectures titled ‘Bioethics and Future Hope’ (here)Previous post on ‘Matters of Life and Death’ (here)
Other resources on medical ethics on the CASE website (here)
Case magazine on the theme 'Living and Dying Ethically' (here)
Posts
24 comments:
Dr Best's comment to the effect that palliative care patients want to live and want more time, and rarely raise euthanasia was also made by a palliative care doctor on a Four Corners program on Monday night.
Interesting.
Thanks David, unfortunately I missed the program. Trevor
If you have the time, I'm sure you would find it worth watching.
It was called A Good Death and is currently available as video on demand from http://www.abc.net.au/4corners
Thanks a lot David. Trevor
Trevor,
It's not really surprising that there is a higher level of support for legalising euthanasia in the general population, compared to people in palliative care.
There is a big difference between believing that people in general should have a particular right, and in the exercising of that right at an individual level. I personally believe that there are certain circumstances where a person should not be prevented from ending their own life; whether I would choose to do this myself is another matter entirely, and would be heavily influenced by a multitude of issues, one of the main ones beings the innate desire to live that has been pre-programmed in all humans via a long process of Darwinian natural selection.
Other contributing factors would be:
(a) The fact that, on average, people in palliative care would be more likely to be religious than the population in general.
(b) Surely there would be many people who wouldn't bother making "persistent requests" for euthanasia since it is currently illegal!
The other thing I would note is that it is completely illogical to have "withdrawal of treatment" as a legal option, but not euthanasia.
Tim
Hi Tim,
Nice to hear from you. I don't accept the logic of the first point. Her point is that though 87% of people want to legalise euthanasia (presumably) based on the assumption that many people want to end their lives early in the midst of the pain and challenge of impending death, few want to die. As a medical practitioner she states that rarely do people want to end their lives.
As well, I don't see why you assume that people in palliative care would be more religious. Why do you assume this? And I don't think there is any evidence for your second reason. It didn't seem to stop Christian Rossiter.
I do tend to agree with your last comment, except where the maintenance of life support is the only thing keeping the person alive in an unconscious state. Even then, there are difficulties with such decisions.
Cheers,
Trevor
Trevor,
I'm not sure what you mean by "I don't accept the logic of the first point". I made two points in my first paragraph:
1
The availability of a right in general is a separate issue to the exercising of that right at an individual level.
2
The fact that we have evolved via natural selection is a contributing factor in our innate desire to resist death for as long as possible (and, as a consequence, we should see a lower level of support for euthanasia by people actually faced with the decision).
Which point do you not accept the logic of, and why?
As I said in my post, I am not disputing the apparent mismatch between euthanasia support in the general population and those in palliative care. All I am saying is that, while Dr Best seems to be surprised by it, it is exactly what I would expect in a modern, democratic society of homo-sapiens that have evolved via natural selection.
Regardless... the fact that people rarely want to end their lives is not an argument against legalising euthanasia. The main point to note is not that lots of people don't want to end their lives, but that some people do want to, but are currently prevented by law.
Regarding the religiosity of palliative care patients, I said that on average people in palliative care would be more likely to be religious. I think this is a perfectly valid statement. These days, older people are more religious than younger people (on average), and older people are more likely to be in palliative care. Do you disagree?
As for my second point, I have no idea whether there is credible evidence for it or not. It would be an interesting study... I guess you would pro-actively ask palliative care patients if they would consider euthanasia if it were legal, rather than merely passively noting the instances where they make persistent requests for it. Regardless... surely you can't deny that the current illegality of euthanasia would have some impact on the number of people that make "persistent requests" for it?
You may as well say, "Very few 14-year-olds try to buy alcohol". Well of course they don't, because it's illegal and they know there's only a slim chance they'll be able to. And it says nothing about how much 14-year-olds actually drink.
Tim
G'day Timaahy.
If it is the case that about 87% of healthy people say they support euthanasia, but very few people who are actually dying ask for euthanasia, if euthanasia is legalised, isn't it logical that some people will be euthanased who thought they wanted it if they later became debilitated, but who don't actually desire it in their debilitation?
This seems to me to be one of the many problems with changing the current situation and legalising euthanasia.
Concerning your earlier comment, I think that "withdrawal of treatment" is very different from ending a person's life with nembutal or by other means.
Thanks for your comments Tim and David.
Tim, the biggest issue for me is not that "some people do want to (end their life), but are currently prevented by law". That's not the issue at all. The issue is that some people want other people to kill them. This creates all sorts of ethical problems and dangers.
Cheers,
Trevor
David,
Yes, that is logical, but it’s not an argument against the concept of euthanasia, merely its implementation. It's like arguing against the concept of air travel because the first aircraft didn't have anywhere to put your luggage. It's not an argument against the concept of air travel, it's an argument for building a plane with somewhere to put your luggage.
There are all sorts of issues to work through, but I am yet to hear a good, secular, reasoned-based argument against euthanasia as a concept.
Yes, withdrawal of treatment is different... there have been studies that indicate we humans have an in-built moral distinction between action that leads to an outcome and inaction that leads to the same outcome. All I am saying is that, in this case, the two are not different enough to allow one but not the other. Either way, there can be no dispute as to which is the more humane option.
Tim
Trevor,
You are simply re-phrasing the same idea! We are both right in that, yes, some terminally ill people in severe pain want to end their lives but are currently prevented by law, and yes, this will sometimes involve a qualified medical professional performing an action that ends their life. If I were to follow a similar argument to yours, I could just say that the issue is not that people want to prolong others’ lives, but that people want to prolong others’ suffering. But that doesn’t really get us anywhere, does it?
Tim
Hi Tim,
It all comes down to a significant ethical issue. The law reflects a basic ethical principle that it is wrong for someone to take a life irrespective of the person's wishes. This is of course consistent with Christian belief and ethical principles. It is also consistent with the views of many people of different faiths (and no faith) who see dangers in allowing someone else to take a life, even if the person is said to have requested this action. The problem for me is where will this lead if the law is broken down in any way.
This is one of the issues that we'll discuss at the conference. Come along.
Trevor
Trevor,
You would have to admit, as the law does, that the taking of a life is more than a simple matter of right and wrong. The end of life is always regrettable, but I'm sure you can envisage situations where it is the lesser of two evils. All I am saying is that, under certain circumstances, euthanasia is one of those situations.
You also said that the "basic ethical principle that it is wrong for someone to take a life, irrespective of the person's wishes" is "consistent with Christian belief". I'm not sure that this is entirely true, given that Christianity is based on the taking of a man's life in accordance with his wishes!
Tim
Hi Tim,
No, the law in fact does say that it's wrong for you to take the life of another person.
Your second point is one we've discussed before. The point isn't relevant to the euthanasia argument. Jesus was killed by evil men. While he had the power not to offer himself as a sacrifice for mankind, it was his right (as God) to choose such an action. But again we're talking about men having the right to kill another person, not the Son of God having the right to choose to die for you and me. Like many people, I don't want the law changed to allow one person to kill another (even if the other person begs you to do it).
Cheers,
Trevor
Trevor,
Thanks for replying.
1
What about killing in self-defence? Aborting a late-term foetus to save the mother? Separating conjoined twins while knowing that only one can survive?
What about allowing someone to die by withdrawing treatment?
What about suicide? (Explicitly de-criminalised in NSW)
Can you not see the contradiction in allowing the last two, but not euthanasia?
2
You can't argue against euthanasia by continually repeating that there is a law against it. We don't get our sense of right and wrong from the law, we make our laws to reflect our sense of right and wrong, and this sense of right and wrong changes over time. Witness the changing of laws regarding slavery, female suffrage, the White Australia Policy, etc.
As a Christian, you should understand this concept better than most, given the multitude of barbaric laws in the Old Testament, which you presumably no longer follow.
The Zeitgeist moves, and the law should move with it.
3
Yes, we have discussed this before, but I'm still confused. I also agree with you... I don't think it's relevant to euthanasia either, but it's certainly relevant to Christianity's objection to it.
Christians allege:
- Jesus was fully human.
- Jesus never sinned.
- Jesus wanted to die, and allowed others to do it for him.
Based on the above, Christians believe there has been at least one occasion in history where a great amount of good has come from one human killing another because they wanted them to. Why do Christians believe that it was the only exception to the rule?
From the arguments you've presented, I just can't for the life of me reconcile the Christian objection to euthanasia with Christianity's core beliefs. I would be grateful if you or one of your other readers could explain the apparent contradiction further. I apologise if I am being slow or stupid – but I really do want to understand this.
Tim
G'day Tim
I'm interested in your comment about the multitude of barbaric laws in the Old Testament which Christians presumably no longer follow.
How much of the Old Testaments 929 chapters have you read?
I'm sorry to say that many Christians have only read parts of it, though the New Testament, which they do read, tells us that
it is given by God's inspiration and that useful to teach us what is true and to make us realize what is wrong in our lives. It corrects us when we are wrong and teaches us to do what is right.
God uses it to prepare and equip his people to do every good work. [2 Timothy 3:16-17]
When Paul spoke those words, he was referring to the Old Testament, though Christians now quite properly apply his words to all of holy Scripture.
I'm in the process of reading through the Old Testament [and the New] for the 8th time and so feel that I have some idea of what it says.
While it can appear shocking to a 21st century person in places, we need to bear in mind that in many cases the very parts that sound barbaric to us are modifying and improving the situation in the era in which the events took place.
There is a lot of compassion and social justice in the laws of the Old Testament. God's people are taught to care for the poor and the foreigner.
They are taught to be honest and to respect their neighbour's family and property.
Some of the parts of the OT which make us feel squeamish relate to teaching us about how God want us to live, and his hatred of evil.
He certainly applied harsh penalities to those who would not accept his rulership and who were lacking in compassion to the needy and downtrodden.
Have you read any of Chris Wright? He is an Old Testament specialist and has several excellent books which open up the OT for the contemporary reader.
The most pertinent one here is The God I Don't Understand.
I think a lot of what is written and spoken about the Old Testament is based on a caricature of it, and not on a sound knowledge of the OT itself.
There is as much love and compassion in the Old Testament as in the New, and the NT is equally as harsh in what it says about evil and those who will not follow God's ways.
Hi David,
Thanks for responding.
You said that "we need to bear in mind that in many cases the very parts that sound barbaric to us are modifying and improving the situation in the era in which the events took place". This is exactly my point!
The rest of your post concerns the Old Testament... I would love to address all the issues you raised, but I'm worried that we would start to fill Trevor's post with comments not directly related to the topic at hand. Let me know if you are happy to discuss further and I can give you my e-mail address.
Tim
Tim, you said: I just can't for the life of me reconcile the Christian objection to euthanasia with Christianity's core beliefs.
I think that Christianity's core belief is in God as our Creator who has the right to make the rules for us.
He tells us not to kill. The only exception to this is where people have committed crimes for which capital punishment is prescribed. In this case, an execution is authorised.
You could debate whether this is still the case for Christians as it was in the Old Testament, and you will find Christians have differing points of view.
But it is clear that humans are not permitted to take the life of another.
In the Bible suicide is presented in a negative way and is nowhere encouraged. This is not to say that it is a sin which cannot be forgiven, but taking someone else's life or taking your own is presented as wrongdoing.
It is interesting that Job, the man who suffered great loss, great unhappiness and great pain and discomfort, complains about his life and wishes he were dead. He says it would be better if he'd never been born.
He asks God to end his life, but never tries to do it himself. For Job, this would have been unthinkable.
Which core Christian beliefs do you think would make euthanasia permissible?
Where does the Bible encourage it?
Hi Tim,
I’ll have a go!
I’m not sure your third point (“Jesus wanted to die, and allowed others to do it for him”) is strictly correct. In Gethsemane, just before his arrest, Jesus pleads with the Father to be spared the ordeal he is to undergo: he clearly did not want to die. He was, however, willing to be obedient to the Father, even if that meant submitting to suffering and death.
Jesus’ perfect obedience in this (and all) matters is the model for humans to follow. Beyond that, I think we need to be wary of extrapolating willy-nilly to questions of human behaviour and ethics, given that it is a question of God the Father acting sovereignly and uniquely to effect the salvation of mankind by means of the death of his co-eternal (albeit human!) Son.
Please let me know if it is still not clear and I’ll try to explain further.
Regards,
Greg
David,
Almost every religion you can think of has a belief that "God [is] our creator who has the right to make rules for us", but Christianity's core belief is that Jesus is the son of god, died for our sins, and rose from the dead.
Again, Trevor's post concerned euthanasia so I won't say too much on capital punishment. I will only say that, as with a lot of other issues, there are parts of the Bible that seem to both support and oppose it, and this is one of the main problems with scriptural revelation.
As before, I would love to discuss this with you via e-mail if you are keen.
You also asked:
1
"Which core Christian beliefs do you think would make euthanasia permissible?"
I listed these beliefs in my post, under item number three. And I don't think these beliefs make euthanasia permissible (I have other, secular reasons for thinking it's permissible), but I do think there seems to be a contradiction between these beliefs and Christianity's objection to euthanasia.
Re-read my comments and question.
2
"Where does the Bible encourage it?"
I didn't say it did!
Thanks for responding.
Tim
Greg,
I knew I could count on you! :-)
Setting aside the issue of no one being around to hear his prayer at the time, I must admit that I have always found his prayer in the garden a little strange. I have spoken to an old school mate of mine, who is now a Catholic priest, and he said that it was impossible for Jesus to sin, since sin is an imperfection and Jesus, being god, could never have an imperfection. Jesus obviously knew this... so he knew he couldn't disobey his father, and he knew his father's wishes, and he knew his father wouldn't change his mind, so what was the point in asking?
That aside, your point is an interesting one. You are making a distinction between an outcome and the actions required to achieve that outcome. Jesus obviously wanted the outcome (the salvation of mankind) but he seems to have not wanted to go through what was required (crucifixion). The fact that he did (allegedly!) submit himself to crucifixion is testament to just how much he wanted that outcome. If you're willing to go through unendurable pain and humiliation at the hands of the very people you're trying to save, you want the outcome very, very much indeed. Why would you put yourself through that otherwise? If you say that Jesus didn't want to die, then you are saying that he didn't want to save mankind from original sin, which, from everything that Christianity teaches, is clearly not the case.
Even if I accept your point that he didn't want to die (I don't), the parallels with euthanasia are still strong, and not some "willy-nilly" extrapolation. The fact remains he willingly allowed others to kill him in pursuit of some end goal, which he thought noble. And if he never sinned, and was fully human, surely we can envisage a situation where another human can sinlessly do the same. I mentioned this in a previous post, but surely you wouldn't say that Maximillian Kolbe sinned?
Thanks for being patient, I appreciate it!
Tim
Hi Tim,
I’m sorry that I’ve been slow in responding. We’re in the middle of O’Week here and lots of things are going on. I’m keen not to drift too far off topic here, but I’ll pick up on some of your comments. The essence of where we started was Megan Best’s noted “…discrepancy between the public support for euthanasia (among those who are healthy) and (her) patients’ desire for continued life….Research done on palliative care populations… found that less than one per cent of those referred to a palliative care service made persistent requests for euthanasia.”
She was suggesting that the strong community push for euthanasia is unjustified based on the experience of the majority of people when faced with death. She also suggests that people become confused about what is and isn’t possible. You rightly point out that there are many varied practices which can prolong life but when withdrawn will end that life. These include withdrawal of life-prolonging treatment and symptom control. She wasn’t talking about suicide and I wasn’t talking about it either. Neither was I talking
My primary concern about Euthanasia is that it involves one person taking action that leads to the death of another person, or the withdrawal of food, water etc that leads to death (Christian Rossiter is the ultimate example). How are these judgements made? Medical practitioners are legally able to withdraw life support or treatment under certain circumstances. Allowing family members or carers to do likewise would be dangerous (in my view).
My constant reference to the law was to simply make the point that it is illegal for people to kill another person by their actions or withdrawal of support.
"Homicide" is the general term used to describe offences that cause fatal harm. It can be seen as lawful when done in self-defence Homicide may be lawful where the killing was done in self-defence. Unlawful forms of homicide are classified as murder and manslaughter. Murder requires the intention to kill or inflict grievous bodily harm, or recklessness.
Your suggestions about what to allow and not allow stroke at the very foundations of well established laws that reflect ethical and moral stances on the act of killing another person. A full reading of the Bible makes it clear that God prohibits murder. “You shall not murder” (Exodus 20:13). David has already commented on this.
Your use of Jesus’ death as a counter argument is not your strongest point. I can’t see the relevance of Jesus sacrificial death to your argument. This is hardly a justification for allowing people to kill one another. Jesus, the Son of God was killed by evil men, by the will of God, to act as an atoning sacrifice for the sins of the world. Jesus is God, and God ultimately is the arbiter of life and death, not you and me.
Your comment that “the Zeitgeist moves, and (so) the law should move with it” is not something with which I would agree. Such a view of the world assumes that there are no foundational truths, no real sense of right and wrong, and no yardstick by which to judge and justify human action. In such a scary world, people make up their minds about what is right and wrong, good or evil, and simply redraft laws that reflect these changing notions. I accept that the whole area of how and when life support is withdrawn is a grey area, that’s part of the reason for our conference. I don’t have all wisdom in this area (in fact I have many questions), in fact the medical profession has been asking itself many questions as well. This will be an important conference that I hope will help me to engage with others about this very important topic. Thanks for your comments. I’m sorry that you can’t make the conference.
Regards,
Trevor
Hi Tim,
Thanks for your thought provoking response.
Firstly: what was the point of Jesus praying at all? Quite simply, he was desperate – and desperate people (remember, Jesus was fully human as well as fully divine) will sometimes do desperate and even, viewed rationally, nonsensical things. It is precisely at that moment that Jesus’ humanity and divinity are most clearly shown: a human desperation to live, allied with a divine ability to submit to the Father’s will. By the way, it is perfectly possible that he related the contents of his prayer to the disciples later, so I don’t think “no one being around to hear it” has ever been an issue.
Re your next point, I’m still not sure you have grasped the significance of the distinction between being willing to undergo something, and actively wanting it to happen to one. Be that as it may, beyond a certain point, I would suggest, we come face to face here with questions of how God’s sovereign will operates, specifically as applied to the mechanics of the atonement - which is ultimately a mystery. I’m not going to pretend I have a glib answer to the complex issue you raise here (I’m not sure there is one, humanly speaking – though others might like to have a stab!), and would rather not comment further.
As to your final suggestion: I don’t think you have proved your point re Jesus and euthanasia, for the simple reason that Jesus (as I suggested earlier) didn’t want to die. I don’t think the highly theoretical line of argument you employ in any way overrules the simple fact of Jesus’ pleading with the Father to be permitted not to die. In the absence of any kind of clearly demonstrable (as against hypothetical) “death wish”, I can’t see how the “euthanasia” tag can possibly be applied to this scenario.
Over to you!
Regards,
Greg
Thanks Tim, David and Greg for your various comments that were very thought provoking. I think this conversation has just about run its course. Trevor
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