Throughout its history Christian Medical Fellowship has campaigned quietly but consistently against euthanasia. There has never been greater cause for concern. In September 1991 there were more than 60 mentions of euthanasia in national newspapers and magazines. In a two week period in October/November that year there were at least three nationwide television programmes and two national radio programmes. In November 1991 the voters of Washington State decided (against expectation) not to legislate for euthanasia, but only by 54% to 46%, and also that November a committee of enquiry in the European Parliament investigated controversial pro-euthanasia proposals.

The last attempt to introduce euthanasia legislation in Parliament was in May 1990, a few weeks after the abortion and embryo-research legislation. The proposal was lost by 101 votes to 35, but what of the 500 MPs who did not vote? It is expected that there will be a much more serious attempt at permissive legislation very soon, and an All-Party Parliamentary Pro- Euthanasia Group has been formed.

Why is there such a drive at this time? There are at least four reasons:

1. Some of the drive is coming from overseas. Doctors in the USA practise more interventionist treatment and some of this may be inappropriate. Patients are naturally afraid of being overtreated and of `dying without dignity' and are ready to be persuaded that euthanasia is the only answer.
2. There is an understandable element of such fear in this country too.
3. Economic factors add to the pressure. In a controversial article in 1990 [1] Dr Mary Bliss, a geriatrician in East London, argued that euthanasia was an acceptable and necessary answer to the costs of care. A careful reading of her paper confirms that the euthanasia she advocates would not always be voluntary. (See `Definitions' below.)
4. Consequent upon the loss of Christian faith in our culture, there is a growing sense of hopelessness. A CMF Member began a public lecture on euthanasia by showing a slide featuring that well-known cliche -- `Where there's life, there's hope' -- and proceeded to cross it out with the words `I don't believe it. I've been in plenty of situations where there seems no hope. But I do believe in this...'
   The next slide read: `Where there's hope, there's life'. The debate was won at that point.

As Christians we have the answer to that sense of hopelessness, and we have the answers to that loss of direction which the whole profession is suffering at this time.

Definitions

`Euthanasia' comes from the Greek `eu-thanatos', which literally translates as `well-death' or `easy-death'. Of course we would all want a good death for ourselves, our loved ones, and our patients, but the word `euthanasia' is most commonly expressed as `mercy killing'.

A more helpful definition is as follows:

`Euthanasia is the intentional killing by act or omission of a person whose life is felt not to be worth living.'

This emphasises killing. Proponents of euthanasia object to this, but that is what the dispatch of the patient is by any dictionary definition. Proponents try and draw an analogy from the difference between rape and lovemaking, but their emotive example is illogical -- the fact in their example is that sexual intercourse has taken place and the motive does not alter that fact. In euthanasia, the fact is that someone is dead.

The definition emphasises the moral, ethical and legal concept of `intent' (or `motive'). There is a world of difference between a medical act designed to end life, such as a lethal injection, and the abandonment of treatment which is ineffective or inappropriate. One is killing, the other is good medical practice, and the profession and the law have always recognised the difference. It has been summarised as the difference between `mercy killing' and `mercy dying'.

The definition confirms that patients can be killed by doing things to them or by not doing things to them. Again, it is the `intent' that matters. (This definition does away with the unhelpful and unnecessary concepts of `active' and `passive euthanasia', which have simply confused many, including doctors.)

The word `person' is deliberately used rather than `patient' because of the very reasonable fear that any permissive legislation would lead to euthanasia being performed on categories of people who would not normally be termed `patients'.

The last part of the definition teases as to who feels the person's life is not worth living, and the word `euthanasia' is then qualified to:

Voluntary euthanasia. The person themself feels their life is not worth living. This is of course the only sort of euthanasia publicly advocated, and much is made of `persistent and durable' requests. Privately, this would still be the only sort of euthanasia advocated by the majority of proponents, but there are exceptions.[2]

Non-voluntary euthanasia is that where the person is not competent to decide for themselves, for example, the person is demented.

Involuntary euthanasia is that performed when a competent person is not consulted and is arguably against their real will.

Spiritual considerations

Although an overwhelming case can be made against euthanasia on purely pragmatic grounds (see below), people's presuppositions will influence their thinking. Christians believe that man and woman are made `in the image of God',[3] that God prohibits killing outside (possibly) judicial situations and in `just war',[4] that `You are not your own; you were bought at a price'[5] and that, taking the analogy that we value something by what we are prepared to pay for it, `God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life'.[6] There are of course many other texts illustrating these concepts, and Christians should begin by considering these wonderful truths.

Jews and Muslims have similar absolute prohibitions, although there are obviously significant theological differences. It is not yet clear what influence the increasing New Age (Hindu) concept of reincarnation will have in this area.

The secular materialistic humanism which perhaps predominates in our society sees death as the end of everything, and provides the most fertile soil for euthanasia.

Philosophical arguments

There are essentially only two arguments in favour of euthanasia. One is compassion (and we need to ask what the word really means) and the other, which will be considered at length here, is that of autonomy. This means `self-determination' and to a limited extent is a concept which Christians can support in that it does recognise the value of each individual human being. However, when autonomy leads to the clamour of `it's my right' drowning out any sense of `my responsibilities', caution is needed.

It is argued that a patient might choose to commit suicide, which is no longer (since 1961) unlawful in Britain, and the morality of suicide is arguable, though others apart from Christians argue against it. If a patient is prevented by disease from committing suicide, should they not have a `right' to be killed at their free and informed and repeated request? It seems a powerful argument. However:

1. Exercise of the patient's autonomy infringes the autonomy of the doctor performing euthanasia. It would be argued that if the doctor freely consented, this was no problem, but what happens to the character of the healer?
2. Autonomy is about the capacity to make moral choices. A request alone would not be sufficient; the doctor would have to look at the reasons for the request. Can a seriously ill, frightened patient ever be in a position to make a proper moral choice? In the very act which claims to endorse autonomy, would medicine in fact be ignoring it?
3. Once it was decided there were valid reasons for killing people because their quality of life had been estimated and found wanting, and the law was changed accordingly, a very significant change would have taken place in that a class of people would be created who had lost their right not to have their lives taken from them. (Thus a fundamental barrier would be removed that prevents my life being taken from me...)

This would create a `slippery slope' in logic which is actually even more significant than the `slippery slope' in utilitarian practice, which is the one usually mentioned (see below).

Pragmatic and practical points

(It is with these that the debate will be won, but Christians should be inspired by all the above.)

Let us assume there was now legislation permitting euthanasia. How could society be sure:

1. There was the right diagnosis? There are plenty of examples of wrong diagnoses from the hospice literature!
2. There was the right prognosis? Most doctors become wise enough not to attempt to answer the question `How long have I got?' Appropriate care can make a huge difference.
3. There was the right patient? This may seem ludicrously far-fetched, but every year the defence society journals recount wrong operations performed, wrong limbs removed...
4. The patient was not depressed? ie suffering a false sense of worthlessness. (The Dutch talk confidently of a `persistent durable request' but Dr Admiraal is known to have performed euthanasia within three days of first request...)
5. The patient was not confused? ie acute physical illness was rendering the patient unable to make judgments. (There would of course be no autonomy here.)
6. The patient was not demented? Any euthanasia here could not be voluntary.
7. The patient was not suffering a false sense of `burden'? ie whilst not depressed clinically, but feeling worthless. The very existence of euthanasia legislation would send a strong signal that society deemed some to have life of insufficient value...
8. The patient was not being pressurised by relatives? It is said that `Where there's a will, there's an anxious relative' but even the most caring of relatives could be transmitting messages because of their own sense of pressure.
9. The patient was not being pressurised by other carers? Again, there could be several different motives here.
10. The patient (or attendants) were not being pressurised by a community short of resources?

    Many of these points relate to: `How could euthanasia be policed?' The key witness is dead. Other pragmatic points include:

11. What about the effect on the doctor?
12. What about the effect on the nurses and other professional carers?
13. What about the effect on surviving relatives?
14. Would a `slippery slope' in practice occur here as it has in Holland? Official 1991 Dutch statistics 7 show that many hundreds if not thousands of cases of euthanasia which are not voluntary take place there. This evidence deserves studying by all CMF Members as it alone ought to prevent the UK legalising euthanasia.

The positive alternative

This account has attempted to clarify the confusion of language by pointing to a simple and genuine difference between `killing people' and `good medical practice'. It was the good medical practice of the (initially Christian) hospice movement which removed the drive for euthanasia in the terminal cancer situation.

Good medical practice and adequate resources are needed to care for those dying with AIDS, and for the increasing numbers of the very elderly, more than 75% of whom are in no way demented. Christians are making encouraging initiatives in these areas, but more work is needed.

The legalisation of euthanasia must be resisted, and we must preach `Thou shalt not...' but we must also teach by example, demonstrating Christ's love for every human being.