Nurturing/ Teaching Courses
Review and Personal Reflection
By Dr Alex Tang
I have attempted to give an overview of the debate on euthanasia. We started off by having a brief survey of the public opinion of euthanasia in the world today. We found that even as repeated attempts at legislation has failed in many countries, euthanasia has become legal in the Netherlands, Colombia and the State of Michigan in the United States. Both the Roman Catholic Church and the various Protestant denominations remains united in its stand against euthanasia. There appears to be a strong lobby for euthanasia and the general public seems to be sympathetic towards its legalization. It appears that it is just a matter of time before further countries and states relaxes their law on euthanasia.
Next we defined our terms for suicide, euthanasia and death. Active euthanasia is the term meant when the word euthanasia is used. It means “one person intentionally causes the death of another who is terminally or seriously ill, often to end the latter’s pain and suffering”. We differentiate it from passive euthanasia which is often use to mean withholding or withdrawal of treatment. I agree with the Christian Medical Fellowship that passive euthanasia is an inaccurate term and should not be used. Withholding or withdrawal of treatment when the mode of treatment is deem ineffective is not euthanasia but good medical practice. We also differentiate between the term voluntary, involuntary and non-voluntary euthanasia. Death was defined by the Harvard brain death criteria and we identify some difficulties that can arise in declaring someone dead. We also introduce the term dignified death.
After defining our terms, we moved into the discussion for the basis of our deontological argument on euthanasia. We used the Christian Scriptures as our basis of our discussion and from it derived the principle for the sanctity of life. It is from God that we derived the sanctity of human life. We also found that the sanctity of human life is not absolute, from our discussion on the sixth commandment. We also affirm the stand against euthanasia from the principle of the sovereignty of God and the principle of stewardship. Human life is a gift from God and God has absolute dominion over it.
After looking at it from the theological and ethical perspective, we next moved onto the historical and traditional perspective. We noted that while the classical antiquity of ancient Greece and Rome do not have strong views against suicide and euthanasia, ancient Judaism condemn suicide and euthanasia. We also noted that the Pythagoreans who were associated with the Hippocratic Oath was a small and insignificant group during that time. The early Christians took most of the traditions of ancient Judaism which include its attitude towards suicide and euthanasia. It was Augustine who formulated and wrote down the doctrine of the church against suicide and euthanasia. He was supported later by Thomas Aquinas. The church was so strong politically, socially and economically that throughout the Middle Ages and beyond, there was no challenge to that doctrine. It was only during the ‘Age of Reason’ in the eighteen century that intellectuals dared to challenge the authority of the church teachings. Insidiously, the western civilisation began to turn away from its Judeo-Christian roots. The first crack in the medical front came with the liberalisation of laws allowing ‘therapeutic abortions’. This was followed by strong attacks on the church position on euthanasia.
Then we discussed the arguments for and against euthanasia. Unlike abortion, the issue of euthanasia is complex and has strong emotional, social and financial context. We see here that the argument for euthanasia was almost always consequentialist and if we do not refer to our deontological views for the defense, we can be easily swayed. An alternative was offered to euthanasia and also identifies areas in which individual Christians, churches and parachurch organisations can have a role.
It is always easy to discuss an issue but difficult to respond to its implications. The famous author, poet, literary critic and Nobel Prize Laureate for Literature, T.S. Eliot once pointed to this other level in ethics that will give us insight into a pastoral response to the euthanasia movement. After lecturing on a serious issue in American life, he was asked, “Mr. Elliot, what are we going to do about the problem we have discussed?” He replied, in effect, “You have asked the wrong question. You must understand that we face two types of problems in life. One kind of problem provokes the question, ‘What are we going to do about it?’ The other kind poses a subtler question, ‘How do we behave towards it?’”.
Medicine to me as a Christian doctor and paediatrician, is a divine vocation. I am called into it as much as another man is called into the ministry. The words that Thomas Syndenham, a Christian physician spoke in 1668 still ring true:
‘Whoever applies himself to medicine should seriously weigh the following considerations. First that he will one day have to render an account to the Supreme Judge of the lives of sick people entrusted to his care. Next, by whatever skill or knowledge he may, by the divine favour become possessed of, should be devoted above all things to the glory of God and the welfare of the human race. Thirdly he must remember that it is no mean or ignorable creature that he deals with. We may ascertain the worth of the human race since for its sake God’s only begotten Son became man and thereby ennobled the nature he took upon him. Finally, the physician should bear in mind that he himself is not exempt from the common lot but is subject to the same laws of mortality and disease as his fellows and he will care for the sick with more diligence and tenderness if he remembers that he himself is their fellow sufferer.’
As a Christian physician dealing with severely deformed infants and very sick and terminally ill patients, I often have to deal with the issue of euthanasia. Martin Luther once commented, “It is not by understanding, reading or speculating that one becomes a theologian, but through living, dying and being damned.”
Standing at the bedside of a young couple who has just given birth to a baby boy with anencephaly. Talking with parents and relatives in the waiting room of the intensive care unit. Sitting by the bedside of a terminal patient after all that has been possible, has been done and waiting for the heartbeat to cease. Dealing with emotionally distressed relatives in a cold hospital corridor at 3 am in the morning. It is at times like this that one’s theological and pastoral convictions are severely tested.
The basic tenet of the medical profession have been challenged. The pillar of ethical medical practice has always been an alliance of Judeo-Christian values and the Hippocratic Oath. It adherent would pledge “to use treatment to the sick according to my ability and judgement, but I will never use it to injure or wrong them. I will not give poison to anyone though asked to do so, nor will I suggest such a plan.” The physician is a healer, not a killer.
As Nigel Cameron wrote in The New Medicine : Life and Death after Hippocrates, the fundamental tenets of Hippocratic medicine was always to heal, motivated by an unexpressed, but very real compassion. Relief of suffering was a by-product of this commitment to help. Recently the cure of disease and the relief of suffering has became of equal importance. The former driven by a mechanistic view of human beings and the latter by a poorly defined sense of compassion, with patient autonomy the guiding principle and financial concerns lurking in the shadows.
The emancipation from the Hippocratic tradition led to a free-for-all in medical ethics:
"Once freed from the Hippocratic obligation to confine his role to healing, the physician is fatally compromised. The idea that his freedom to take an open-ended view of his patient’s interests can serve those interests better, since he is freed from a narrow obligation to heal and not to harm, is illusory. His freedom in fact exposes him to competing pressures from which the Hippocratic commitment preserved him. The more diverse the range of moral options, the more complex the decision he faces, the more unpredictable their outcome……..The tradition of healing and the sanctity of life is giving place to another, in which a malleable notion of respect does duty for sanctity, and healing itself is displaced by ‘relief of suffering’ as the chief goal of the medical enterprise, all in the service of an undefined ‘compassion’…….Suffering may best be served by acting or failing to act so as to bring about the death of the patient. Human life may be ‘respected’ by being deliberately brought to a close. These are the radically new options being taken up in contemporary medicine."
The shift in the basic tenets of the medical profession was subtle but significant. It is the duty of a Christian physician in his teachings, writings and medical practice to bring the focus back to healing. A doctor is a healer not a killer.
The basic tenet of my bioethics in the practice of medicine as a Christian physician is not the Hippocratic Oath but the three principles of the Scriptures; the principle of the sanctity of human life, the principle of the sovereignty of God and the principle of human stewardship. The objective of my practice of medicine is to heal; it means to use all my knowledge, my skills and my prayers to cure, when possible. If that is not possible, then to relieve pain. It is not my job to relieve suffering. I make the distinction between healing and the relief of suffering because I believe that suffering is a prophetic interaction between the sufferer and God. Pain can be treated by effective pain management. Suffering is treated by a deeper relationship with God or death. There are adequate demonstration on the power of faith and the power of prayer.
In my medical practice, I shall withhold or withdraw treatment when I am sure further treatment will not work or the prognosis is so poor that there is virtually no chance of improvement. Before I withhold or withdraw treatment, I will seek the opinion of another physician. I do not prolong dying. I do not consider the withholding or withdrawing treatment to be euthanasia. I consider it good medical practice to know ‘when to let go’. To know the limitations of medical care is an important aspect of medical practice.
However, I consider food and water to be basic needs of life and not treatment. Hence I do not consider the withholding or withdrawing tube or oral feeding as morally acceptable.
I am aware of the tremendous amount of suffering that my patients, their families and their community are going through. I emphasise with them. I acknowledge that suffering is not always ennobling. I believe that there may be very rare circumstances where there is unredemptive suffering.
In conclusion, I end with my daily prayer:
LORD, You called me to care for your children when they are sick. Help me to do it gladly and joyfully. When I get discouraged, remind me of the value of what I do, and help me to do it to the best of my abilities. Help me to see You in each of my patients, their families and my co-workers. Help me to understand that I serve as the instrument by which You heal and bring comfort to Your children. Give me a smile and a gentle sense of humour and help me to lighten the trying times.
I thank You for the many blessings You have given me, not only my medical understanding and skills, but also the opportunity to help others, as You have taught us to do. May I always remember that the giving of myself to others does not require that I totally deny my own needs or those of my family. Help me to continually strive for an appropriate balance between my vocation and my family. Help me to make my time with my family the highest in quality, especially when it is limited in quantity.
LORD, please give me a heart that listens carefully and patiently to others, especially my patients, their families, my own family, my co-workers, and to myself. Help me to recognise the needs of each and give me the willingness, the strength, the courage and the resources to meet these needs, according to Your will. May I learn something new each day, not getting lost in my daily routine, and help me to persist in my commitment to help others.
Soli Deo Gloria
 Quoted in William F. May, The Patient’s Ordeal ( Bloomington : Indiana University press,1991)p.3
 Quoted in Edward J. Larson & Darrel W.Admundsen, A Different Death : Euthanasia and the Christian Tradition (Downers Grove,IL: InterVarsity Press, 1998 ) p. 147
 Literally ‘no brain’. A severe congenital abnormally in which the baby is born without the cortex. As the brainstem is intact, the baby’s heart will beat and the baby will breath. He or she will not be able to do anything else. This is similar to a persistent vegetative state. What is the appropriate response? Leave the baby to die? Without fluids, the baby will die in a few days. Put in a ryle tube and give it milk? It may live for years. It has been ‘accepted practice’ amongst the medical profession to leave the baby to die without feeding either milk or water. For comment on this practice, see David Short, The Management of Handicapped Neonates – Why I have Changed My Attitude in Respect for Life, A Symposium (London : Christian Medical Fellowship,1984)p.41-47
 David B. Biebel, The Impact of Suffering on End-of-Life Decisions in Richard D. Land and Louis A. Moore ed, Life at Risk : The Crisis in Medical Ethics (Nashville : Broadman & Holman,1995) p. 179
 Nigel M. de S. Cameron, The New Medicine : Life and Death After Hippocrates (Wheaton IL: Crossway Books, 1991)p. 131-132
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