The Changing State of the Euthan

Janet Adkins was fifty four years old when she was diagnosed to have the early stages of Alzheimer’s disease. When informed about the course of the disease, she decided she did not want to live for years in this progressive, deteriorating condition. She decided to kill herself but she wanted her death to be painless and dignified. She sought the help of Dr. Jack Kevorkian, a pathologist from Michigan. On June 4, 1990 Dr.Kevorkian hooked her up to a cardiac monitor and an intravenous line. Janet Adkins pushed a button that released a lethal dose of medication which killed her in 5 minutes. A murder charge was filed against Dr. Kevorkian but it was dismissed because the law of State of Michigan in the United States was vague against assisted suicide.

In 1989, a panel of distinguished physicians was brought together by the society for the Right to Die. In the discussion, 10 of the panel’s 12 members agreed that if a hopelessly ill patient believed his or her condition was intolerable, then it should be permissible for a physician to provide the patient with the medical means and the medical knowledge to commit euthanasia. For example, the physician could prescribe sleeping pills for the patient and indicate how many pills there are in a lethal dose. [1] The World Medical Association in its 1992 State of Marbella however, confirmed its stand that euthanasia is unethical and must be condemned by the medical profession.[2] The Christian Medical and Dental Society (CMDS) of the United States in its Ethical Statement affirms that it “opposes physician-assisted suicide in any form.”[3]

McCormick observes that in our global society, there are five cultural trends which will cause the society to accept physician-assisted suicide: (1) the absolutisation of autonomy without considering whether the choices are good or bad, and the consequent intolerance of dependence on others,(2) the secularization of medicine which has divorced the profession from its moral tradition and has made it into a business,(3) the inadequate management of pain,(4) the nutrition-hydration debate and the distinction between killing and letting to die, and (5)the financial pressures of health care.[4] The sixth cultural trend that can be added is that all the above-mentioned occur in a moral vacuum.[5]

The Christian stand on euthanasia has always been against any form of euthanasia or assisted suicide. Pope John Paul II wrote in The Gospel of Life,

“ I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a person. This doctrine is based on the natural law and upon the written word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium.”(italics his)[6]

Beckwith and Geisler emphasises in stronger terms, “Active euthanasia, however good the motives, is in the same category as shooting someone with a gun or slitting the throat with a knife. Most moral people recognize it as a form of murder, regardless of the alleged merciful motives.”[7] However, lately there have been dissenting arguments. Both proponents and opponents are committed Christians who seek to apply Scriptural teachings in their lives. The central difference between those who favor and those who oppose assisted suicide and euthanasia lie in (1) the judgement they make about God’s purposes and power in the light of human suffering, and (2) their evaluation of whether adequate safeguards can be built into a policy of assisted suicide/euthanasia.[8]

In 1935, the Euthanasia Society of England was formed. Its objectives were twofold. Firstly, it was to convince the public that people suffering severely from fatal, terminal illness should be allowed a painless death if they request it and secondly, to promote legislation to that end. Despite the society’s effort, both 1936 and 1969 bills to legalise euthanasia were defeated in the House of Lords. On Thursday 17 February 1994, a press release from the House of Lords Select Committee on Medical Ethics reads :

“ Contrary to many expectations, the 14 members of the committee have reached an unanimous conclusion. They acknowledge that in difficult individual cases euthanasia may be seen by some to be appropriate, but argue that wider social considerations make its practice undesirable. “The issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole”. The committee argue that individual cases are not sufficient reason to weaken the prohibition on intentional killing which protects us all”[9]

The Dutch has one of the most liberal attitudes towards euthanasia. In 1984, the Royal Dutch Medical Association (RDMA) has issued guidelines describing those circumstances in which they felt it was professionally acceptable for a physician to take the life of a patient. [see Appendix 1 : Criteria for Euthanasia in the Netherlands]. Although euthanasia and assisted suicide remained illegal in the Netherlands, prosecutors nationwide agreed not to persecute physicians if the RDMA guidelines were followed. The Remmelink Report of 1991 had shown that of 128,786 deaths in the Netherlands in 1990, 1.8% were due to ‘euthanasia’. 0.3% to ‘assisted suicide’, and 0.8% to ‘life terminating acts without explicit and persistent request’. In other words, euthanasia was performed on more than 3,000 people in the Netherlands in 1990 and in more than 1,000 of those it was not voluntary.[10] On February 9, 1993 the lower house of the Dutch parliament approved legislation that, while not specifically legalizing euthanasia, guarantees immunity from persecution to physicians who follow the RDMA guidelines.[11]

The Euthanasia Society of America was formed in 1938. Public opinion in the United States has generally been against euthanasia until recently. The publicity given to Dr. Kevorkian[12], and another to the book ‘Final Exit’[13] polarised their views towards euthanasia and galvanised many towards action.

A state-wide citizen’s referendum to allow lethal injection euthanasia has failed narrowly in Washington in 1991 and in California in 1992, but in November 1994 the state of Oregon passed Measure 16 by 53%-47%. This gives qualifying patients (capable adults and residents of Oregon) with six months or less to live the right to ask attending doctors for drugs to end their lives.[14]

In Washington vs Glucksberg, the Supreme Court determined that Washington’s prohibition of assisted suicide did not violate the due process clause of the Constitution[15] March 6, 1996: The Ninth U.S.Circuit Court of Appeals rules that terminally ill adults have a “consitutional right to die”. Dissenting Judge Robert Beezer warns that the ruling will lead to killing the poor, elderly and disabled. April 2, 1996 : The Second U.S.Circuit Court of appeals strikes down two New York state laws that had banned physician-assisted suicide. The court proclaims that allowing patients to refuse life-prolonging measures but not helping patients kill themselves is “discriminatory”. June 26, 1997 : The U.S.Supreme Court refuses to establish physician-assisted suicide as a constitutional right under the specific arguments advanced in the two federal appeals court cases. However, it leaves the door open to the possibility of states legalising physician-assisted suicide under different statutes. March 25, 1998 : The first person dies under Oregon’s new voter-approved physician-assisted suicide law.[16] Euthanasia is being actively championed by organisations such as Society for the Right to Die[17], Hemlock Society, EXIT, and Concern for Dying.

Euthanasia was legalised in the Northern Territory of Australia in July 1996 but the legislation was overturned by the Australian Parliament on March 24 after four patients have died[18] Northern Territory have a population of only 150,000. Many of these are Aborigines. This bill was blocked by an interesting alliance of the ‘three As’ – the Australian Medical Association, the Anglican Church and the Aborigines.

Colombia passed a law allowing euthanasia in 12, June 1997. The decision concluded that euthanasia is permitted for individuals experiencing great pain, such as from AIDS, cancer, or renal deficiency, but not for degenerative diseases such as Alzheimer’s or Parkinson’s disease.[19] Philippines and South Africa are also considering legislation. Physician assisted suicide remains illegal in Canada after the 1993 Rodriquez v. British Columbia case.

Unlike the countries mentioned, Malaysia does not have any pro-euthanasia organisation. There has not been much discussion about euthanasia even though it is a ‘hot’ topic in the other parts of the world. A careful search through Medline[20] showed no articles on euthanasia was published by The Medical Journal of Malaysia (the official journal of the Malaysian Medical Association) and only seven articles on euthanasia in the Singapore Medical Journal. A review of the 1995-1997 contents of the Asian Beacon, a Malaysian Christian family magazine, also did not have any discussion on euthanasia.[21] It appears that euthanasia is considered an issue in Malaysia at the moment.

Healthcare in Malaysia is still very “paternalistic”. The doctors are regarded as authority figures and their decisions are seldom questioned. Even with the educated Malaysians, they may seek clarification but will still follow the recommendations of their doctors. Others may seek traditional treatments especially amongst the rural Malays.[22] Treatment outcome is often submitted to the “Will of God” ( Insyhak Allah). The Koranic condemnation of suicide is also an important consideration in Malaysia. The followers of Hinduism,Buddhism and Jainism regard euthanasia as unacceptable.[23]

But Malaysia is changing. More and more of those who are terminally ill are dying in the hospital. Where once the extended family is the norm, nowadays elderly and the sick increasingly have nowhere to go. Where once, the dying are taken home for his or her last moments, nowadays they are left to die in the sterile, unfriendly environment of the hospital or nursing home. As the population ages, the healthcare services improve but the public healthcare budget increasingly strained, as the political and social climate changes and people learn to question more, there may well come a time when the issues of euthanasia will be debated, as they are now in the more developed countries.

However, we should also – especially as believers – allow for non-linear developments and unpredictable differences in Asia and the less developed countries, as has been found possible dealing with people studies on large scales, despite the hype or talk on globalisation.

[1] Wanzer SH, Federman DD, Edelstein SJ, et al. The Physician’s Responsibility Towards Hopelessly Ill Patients : A Second Look ( New England Journal of Medicine, 1989 ) 320: 844-849

[2] Peter Saunders, Abortion and Euthanasia ( Christian Medical Fellowship http://www.cmf.org.uk/home.htm )

[3] Christian Medical & Dental Society Ethical Statement, Physician Assisted Suicide ( http://www.cmds.org/Ethics/4_5.htm )

[4] R.A.McCormick.Physician-assisted suicide:flight from compassion ( Christian Century) December 4, 1991; 108(35): 1132-1143

[5] Henri J.M.Nouwen, The Wounded Healer (New York : Doubleday, 1972,1979) In this book, Nouwen wrote of a generation that is lost, lives in a historically dislocated world with fragmented ideology. He suggests the faith of a ‘wounded minister’ can lead this generation to hope and redemption.

[6] Pope John Paul II, The Gospel of Life in Michael M.Uhlmann ed, Last Rights : Assisted Suicide and Euthanasia Debated (Grand Rapids, MI : Eerdmanns, 1998 ) p. 229

[7] Francis J. Beckwith & Norman L.Geisler, Matters of Life and Death (Grand Rapids. MI : Baker Book House, 1991) p. 142

[8] Committee on Medical Ethics, Episcopal Diocese of Washington, Assisted Suicide and Euthanasia : Christian Moral Perspectives, The Washington Report ( Harrsburg, PA : Morehouse Publishing, 1997 )

[9] Andrew Fergusson, Euthanasia ; An Update ( Christian Medical Fellowship http://www.cmf.org.uk/home.htm ) The Select Committee of the House of Lords on Medical Ethics received submissions from the Christian Medical Fellowship. See Submission from the CHRISTIAN MEDICAL FELLOWSHIP to the SELECT COMMITTEE OF THE HOUSE OF LORDS ON MEDICAL ETHICS ( http://www.cmf.org.uk/home.htm )

[10] Andrew Fergusson, Euthanasia ; An Update ( Christian Medical Fellowship http://www.cmf.org.uk/home.htm )

[11] Robert D.Orr, Why Doctors Should Not Kill (Christian Medical & Dental Society

http://www.cmds.org/Ethics/4_6_2.htm)

[12] Matt Bai, Death Wish ( Newsweek 1998) December 7:39-41 gives a good writeup on Jack Kervorkian.

[13] Derek Humphry, Final Exit ( Hemlock Society, 1991) was published in 1991. It is a ‘do-it-yourself’ suicide manual. It was an immediate best-seller. Joni Eareckson Tada described her reaction when she first watched Derek Humphry talking about the book on television and her observation on the book’s subsequent effect on Americans in her book When is It Right to Die (Grand Rapids, MI:Zondervan,1992)p. 26-37. Derek Humphry also highlights the success of his book, Final Exit in Dying With Dignity : Understanding Euthanasia (New York: Carol Publishing Group,1992)p. 27-36.

[14] Andrew Fergusson, Euthanasia ; An Update (Christian Medical Fellowship http://www.cmf.org.uk/home.htm )

[15] Gary P.Stewart et al, Basic Questions on Suicide and Euthanasia : Are They Ever Right? ( Grand Rapids, MI : Kregel Publications,1998)p.49

[16] Jonathan Imbody, Killing Isn’t Caring : What You Should Know about Physician-Assisted Suicide ( Christian Medical & Dental Society http://www.cmds.org/Ethics/Killing.htm )

[17] Formerly Euthanasia Society of America. In early 1990s, the Society for the Right to Die merged with Concern for Dying.

[18] Christopher Zinn, Australian voluntary euthanasia law is overturned (British Medical Journal, 5 April 1997) Vol 314:993

[19] Gary P.Stewart et al, Basic Questions on Suicide and Euthanasia : Are They Ever Right? ( Grand Rapids, MI : Kregel Publications,1998)p.51

[20] Medline is a large database containing the text of most of the world’s medical journals.

[21] Asian Beacon, Vol 30/5 1998

[22] Richard Winstedt, The Malay Magician ( Kuala Lumpur : Oxford University Press, 1951,1960)

[23] For a discussion on euthanasia in these three great religions, see Harold G. Coward, Julius J. Lipner and Katherine K. Young, Hindu Ethics : Purity, Abortion, and Euthanasia ( New York : State University of New York, 1989 ) p. 71 -121