'The Edge of Life - Dying Death and Euthanasia'.
A warning to all readers
It may seem impertinent, even rude, at the very beginning of a book, to cause you alarm, but I have some disturbing news for you. Let me tell you straight. Hopefully, you are sitting down. Ready? Here it is - you are going to die. Most of us have already had some brushes with death - we have fallen off ladders, been in car accidents, and so on - but the real thing, the big one, your very own finale, is coming. When it will happen, I cannot be sure, but I think it will be sooner than most of you imagine. It is already a few minutes nearer than when you first picked up this book. Death is that most certain of certainties. Axiomatically, life is so uncertain. It is so fragile. Now we inhale, then exhale, inhale, exhale, but it will not continue like this, will it? It will come to a halt. It will finish. Your breathing, heartbeat, brain, and then your entire life, will come to a stop. As the title of this book suggests, you and I are already living on the edge of life. This certainty and proximity of death should unsettle us. They should also cause us to ask the fundamental question that underlies this book - am I ready to die? If not, then it would be wise to start thinking about dying and death, and even to begin making some preparations to face them. This book has been written to help you do exactly that.
When I began writing this book, it was to be a straightforward examination of just the one issue, euthanasia. To tell the truth, the partly-written manuscript grew to be so irksome that I hid it away in a box for several months and instead wrote an easier and more heartening book entitled, Responding to the Culture of Death - A Primer of Bioethical Issues. Then I realized that a book about euthanasia alone was bound to be dreary because the subject is skewed. What it needed was to be balanced by the topics of dying and death. These may not seem like jolly corrective themes, but believe me, they are. So, I broadened my original remit and have now written about these three edge-of-life topics, together with some of the other bioethical issues that surround them.
Throughout, I have had three simple aims. First, I want to persuade you that thinking about dying and death is not only prudent, but also beneficial. Such contemplations need not be morbid or depressing. In fact, I expect the outcome to be quite the opposite. With death in view, we are much more likely to live well. ‘My people live well and die well.’ That boast, or something pretty similar, has often been attributed to John Wesley, that remarkable eighteenth-century Christian leader. Strangely, I can find no evidence, anywhere, that he actually said or wrote it, but no matter, because it remains a grand and fitting epitaph for every Christian. All Christians should aim for a good life and a good death. Thinking about dying and death will turn us into realists. We will realize what little time we have left - the clock is ticking and its ratchet goes only one way. That thought alone should provoke us to become more useful people, and it should preserve us from idleness and triviality. Carpe diem should be our motto. For the non-Christian and the Christian alike, the end of this life is coming into view, fast. Are you prepared for your last lap? When Christians see that finishing tape, they should want to run faster and better (Hebrews 12:1-3). For the non-Christian, there must be hesitation, serious doubt, and some stark questions to ponder. That is my number one aim, to get you to think about, understand, and prepare for dying and death.
My second aim is to persuade you
of the horrors of modern-day euthanasia. Euthanasia is like a wretched spanner
in the works. The fact that people out there might want to kill you and me
before our natural end, the fact that some doctors are willing to do the dirty
deed, and the fact that some politicians and other influential decision-makers
approve of such a course of action, is alarming. Euthanasia should make us all
uneasy. Most Christians, indeed, most morally-sensitive people, feel that they
should be opposed to euthanasia, but they are usually none too sure why - they
have not yet thought sufficiently seriously about the issue. Euthanasia is
wrong, above all, because it is counter to a proper understanding of the dignity
and value of human life, and because it distrusts the providence of God.
Supporters of euthanasia argue in its favour mainly on the grounds of so-called
compassion and personal autonomy - these people are gravely mistaken and
misguided. Aim number two is therefore to help you unravel and understand
modern-day euthanasia and several other of its associated topics.
Whenever a family member or a friend is dying, and death becomes imminent, all kinds of new problems and complex burdens arise. And when you and I are dying, we too will create similar difficulties and become the cause of stress and strain for our loved ones. These problems will need solving and these burdens will need bearing. Usually, it is not easy. At these crucial times, what we, and they, will need are not anodyne instructions or lukewarm platitudes, but ‘principled compassion’. This is the proper PC, namely, the sort of care and caring that is deeply rooted within the ethical framework of the Bible. This is another of the enduring themes of this book. That you will become genuinely convinced of the need to give, and one day, to receive, this principled compassion is my aim number three.
We all want to live well and die well. Therefore we all need a deep, deep understanding of both living and dying. The raw truth is that we need a practical theology of living and of dying. The latter is a particularly scarce item. Overall, this book seeks to begin to redress that dearth. If reading it helps anyone perform these two great tasks of living and dying any better, then my labours will have been well rewarded.
‘But in this world nothing can be said to be certain, except death and taxes.’
In a book with a title like this one, I knew it would be tricky to avoid quoting this droll adage. In the end, obviously, I could not resist. However, I want to put a somewhat different spin on it from Benjamin Franklin’s eighteenth-century original. While taxes and death remain unavoidable, my contention is that nowadays taxes are being used for death. That is, more and more countries are adopting public policies that are putting to death their very own citizens, and we are all paying for this human slaughter with our taxes. Abortion, infanticide and euthanasia are costing us dear. And the cost is not just financial, it is also psychological, medical, social and bioethical. In truth, the three issues of abortion, infanticide, and latterly, euthanasia are ripping us all apart.
issues - one mindset
There seem to be no limits to the cruelty inflicted on humans by humans. Indeed, much of our history can be viewed as a catalogue of cruelty by the human race towards the human race - men, women and children. And we are not talking here about the cruelties of war, or famine, or political strife, or personal animosity. No - there is this other, far more remarkable, category of human cruelty.
It is one of the curious, even bizarre, features of our so-called civilized, educated, wealthy and sophisticated societies that we insist on, and persist in, deliberately putting to death our own defenceless, young offspring. And currently, we do it to millions and millions each year. This is a human cruelty above all others. It is spearheaded by the practice of abortion and then, by default, infanticide. And now, our world is displaying an increasing enthusiasm for hastening the death of its more elderly citizens, by euthanasia.
Euthanasia is undeniably linked to these two already well-established, life-ending practices. To be sure, it comes from the same mindset, the same songsheet, as abortion and infanticide. Others have used a different, perhaps more striking, analogy. They have likened this lethal trio to a row of three upended dominoes - when the first practice is initially tolerated, then sanctioned, and finally legalized, it topples over and inexorably knocks over the second, and then the third. This is the ‘domino theory’ applied to bioethics. Abortion leads to infanticide leads to euthanasia. And so it has come to pass, not just in theory, but also in earnest practice.
1.2 Abortion - the number one issue
Abortion was the number one bioethical issue of the twentieth century - euthanasia is set to collect the same accolade for the twenty-first. History is full of lessons and warnings, so a brief examination of some of the events that precipitated changes in abortion law, and some of the features that have developed in the aftermath of legalized abortion, can be salutary, yet instructive.
For centuries, legal safeguards for the unborn child had been enshrined in several Acts of Parliament. Calls for changes to these protective laws had been isolated and muted until the 1930s, when some concerted and strident voices started to be raised. This pro-abortion rhetoric came initially from just a few propagandists, especially from members of the Abortion Law Reform Association (ALRA), and it was largely countered by those from within the medical, political and legal establishments. Then, some illegal abortions were revealed. Next, a few hard cases were placarded. Finally, one or two lawsuits ensued. It was all shrewd publicity. The notion that ‘hard cases make bad law’ was conveniently forgotten. These various colliding elements, foisted on a largely uninformed, but by now, anxious public, by a vocal, well-organized and well-heeled minority, culminated in the 1967 Abortion Act - arguably the most cruel and discriminatory piece of legislation ever to appear on our Statute Book.
What was legalized, or, at least, declared to be no longer ‘unlawful’, in Great Britain in 1967, spread across the USA in 1973, and subsequently has become the norm in almost every country. This legalization of abortion has profoundly changed our world, forever, and entirely for the worse. It has wrecked the medical profession in both its ethics and practice. The supposed beneficiaries, namely, pregnant women, have been damaged physically, and especially psychologically. It has helped undermine marriage. It has abrogated the protective role of fathers. It has distorted family life and increased grief, guilt and remorse among its members. It has subverted deep relationships between men, women and children. It has brought uncertainty to born children and grandparents. It has confounded adoption. It has reintroduced eugenics. It has hardened our compassion towards the weak. It has upset our demographic balance. More could be added to this blacklist, but these are enough. The aftermath of legalized abortion certainly makes for a breathtaking compendium of personal tragedy and social decline. One cruel law, written on just three-and-a-half sides of official Parliamentary paper, ushered in the practice of a cruel medicine, the ramifications of which have affected, and infected, us all. Pre-eminently, this advent of easy, legal abortion has changed our view of unborn human life. What was once protected by law and described by adjectives such as, ‘unique’, ‘precious’ and ‘inviolable’, is now legally vulnerable and regarded in many quarters as ‘cheap’, ‘insignificant’ and ‘disposable’. The irrefutable evidence to support such seemingly-audacious statements is found among the tens of millions of abortions that are carried out each year, worldwide. The vast, vast majority of these are performed on preborn children who are both completely normal and entirely healthy - can this practice be anything other than savage medicine?
1.3 Infanticide - the go-between issue
The abortion domino has well and truly fallen, and it has knocked over the next one - infanticide is now part of our scheme of things. Uncounted and untold thousands, even millions, of newborn children are deliberately killed every year. Infanticide stands, or rather, falls, as the inevitable intermediary between abortion and euthanasia. Unlike abortion, infanticide is still widely unlawful, but like abortion that does not stop it being widely practised. It is linked to abortion because one kills the unborn child, and the other kills the newborn child. It is linked to euthanasia because it is in reality, neonatal euthanasia. Truly, it is the go-between issue.
Abortion and infanticide are two horrible examples of medical practices that have thrived under such frivolous euphemisms as, ‘freedom of choice’ and ‘a woman’s right to choose’. To choose what? To destroy her own offspring, her own unborn, or newborn, child? When abortion and infanticide are put together with the more recent practice of human embryo experimentation, they demonstrate how entirely comprehensive our medicalized destruction of human life has become during the first part of the age spectrum. Indeed, early human life itself has become trivialized.
But why stop there? What about life at the other end of the age spectrum? If a six-month-old unborn child, who is sentient and viable, can be legally killed, just because his mother so chooses, and a kicking and whimpering child, who just happens to display some disability six hours after birth, can also suffer the same outcome, then why cannot a six-year-old child, or, most poignantly in the context of this book, a sixty-six-year-old man, be killed? After all, they too can be inconvenient and unwanted by their relatives, unproductive and costly for society. Just what is the logic of our current prohibition on euthanasia? Surely, it cannot be medical squeamishness? Surely, it cannot be anything as philosophically flimsy as an age-related barrier? Surely, sauce for the little gosling can also be sauce for that old goose and gander? What holds us back from a wholesale purging of our old people’s homes and hospital wards? Just think, for one moment, of the financial savings that such a policy would bring to the National Health Service. Consider the benefits that euthanasia would bring in terms of sparing scarce medical resources, preserving personal peace and reducing emotional turmoil. Can you see how near the surface the implementation of a public policy of euthanasia must be in the minds of some? Such a move would also bring about a neat and tidy symmetry. The legalization of euthanasia for the elderly would complete our control of all human life. We already have abortion for the unborn, and infanticide for the newborn. Euthanasia for the elderly would allow us to regard any, and even all, human life as worthless, futile and expendable.
1.4 Euthanasia - the current issue
Euthanasia is one of the central issues of this book. It may be difficult to believe, but once upon a time, euthanasia was a wonderful word. It originally referred to what everybody wanted, ‘a good, happy death’. Then, during the nineteenth century, the meaning of the word was changed so that it became associated with putting people to death before their natural end. Now, modern-day, twenty-first century euthanasia has become a decidedly ugly word.
Despite this somewhat confusing etymology, euthanasia, that is, the deliberate killing of people prematurely, has been practised, albeit probably sporadically, and in smallish numbers, from ancient times. Now, at the beginning of the third millennium, it has mushroomed into one of the most controversial issues of medical ethics and practice. So it is not a new issue. Nor is it a simple issue. Euthanasia is enmeshed with several other topics as complex and diverse as dying and death, autonomy, eugenics, permanent vegetative state, ageing, and the like. Furthermore, the same long and winding process that preceded the legalization of abortion has already begun with respect to euthanasia, and the outcome looks similarly bleak, and almost as inevitable.
The great social experiment of euthanasia must never be allowed to be conducted. There are good reasons, derived from the precedents of abortion and infanticide, to believe that legalized euthanasia, even of the voluntary variety, will launch an ethical disintegration and an additional dimension of dehumanization within society that we have not yet even dared to consider. It will distort our bioethical perceptions to such an extent that once legalized it will be prescribed for those who are neither dying, nor able to give their consent. Furthermore, we would be wholly naive to assume that any law permitting euthanasia will not produce widespread, inhumane abuses. The poor and the vulnerable will be further marginalized. Care for the elderly will inevitably decline. ‘Why waste time and money on them?’, will become the popular cry. Human life will be further demeaned. We must never allow all this to happen. Herein is one of the challenges of this book - will you be part of the problem, or part of the solution?
1.5 The approach of other books
Of all the books about euthanasia published during the last two decades, any listing of the most influential would have to include The End of Life - Euthanasia and Morality, by James Rachels (1986), Should the Baby Live?, by Helga Kuhse and Peter Singer (1986), and An Intelligent Person’s Guide to Ethics, by Mary Warnock (1998).
It is intriguing to note that all of these pro-euthanasia authors, and many others too, begin their books by describing one or two exceptionally difficult human cases. They would, I am sure, say that they were simply ‘setting the scene’. Nevertheless, it is reminiscent of the tactics used by members of ALRA as part of their scare-mongering strategy to liberalize abortion law during the last century. I would contend that the selection, by these authors, of such emotionally-charged examples are designed to confuse genuinely-inquiring readers in order to win them over to the author’s viewpoint. Furthermore, this approach demonstrates just how muddled these moral philosophers are. They all have got it the wrong way round - they have put the cartload of examples before the ethical horse. For them, the hard cases become the centre of focus. Such an approach inevitably gives rise to their beloved ‘situation ethics’, whereby the particular case, rather than the search for an underlying general principle, takes centre stage and determines the ethic as well as the ensuing action. Their back-to-front arguments are from the particular to the general - welcome to the topsy-turvy world of modern moral philosophy! And, since these authors’ worldviews are, without exception, secular humanistic and utilitarian, their recommended practical responses are, naturally, unprincipled and pragmatic. After all, that is what situation ethics is all about. And whatever you do, don’t mention ‘absolutes’ - they all despise them. Of course they do. For them, the only absolute is that there are no absolutes!
1.6 The approach of this book
This book begins quite differently. Part 1 begins, not with individual cases, but with foundational principles - plain, universal principles, derived from the Bible. Once these ethical principles have been laid down, the primary issues will be bolted on in Part 2. This is the proper way to build, be it a house, or an ethical worldview - foundations first, then the superstructure. And because the threat and awfulness of euthanasia cannot be grasped adequately without a decent understanding of dying and death, it is these three grand topics that become interwoven and highlighted throughout all the Parts of this book. To ensure that the primary issues of Part 2 cannot be dismissed as merely abstract concepts, some traumatic, ground-breaking case studies are examined in Part 3. Next, a whole raft of other secondary, but related, bioethical issues are explained in Part 4. Then, and as important as any other portion of this book, Part 5 contains some practical, pro-life responses to these issues. Part 6 is the coda. An adequate appreciation of edge-of-life issues requires some historical background, some contemporary quotations, some ethical perspective, some unsentimental analysis, and some up-to-date information - these too are included throughout the following pages.
But to begin at the beginning, these issues will be considered within the ethical warp and weft of biblical truth. This is no antediluvian, anti-intellectual, quasi-religious cop-out. Indeed, it is quite the reverse, for two very good reasons. First, the Bible declares itself to be true (John 17:17; 2 Timothy 3:16). This means that the information it conveys is inerrant, and the standards it sets are absolute. In other words, we are here dealing with unconditional, non-negotiable, true, truths. The Bible therefore provides us with the real basis for discussing, for example, who we are as human beings, and how we should live, individually, in families, and in society - both before men and before God. This is immensely liberating - it releases us from the bondage and uncertainty of the shifting relativism of society’s current mindset, namely, secular humanism.
Second, the Bible makes far greater demands upon those who follow its teaching than does any man-made system of ethics. It compels us, for instance, not just to care for our families, and help our friends, but, revolutionarily, it commands us to love our enemies (Luke 6:27). The normal Christian life is one of cross-bearing and denial of self (Matthew 16:24). The Scriptures’ portrayal of the good life is one of service, giving of our time, energy and talents for the benefit of others. In the context of this book, it means that we are to uphold and promote the utmost respect for all human life. We are to defend, protect and cherish all men, women and children. Such a valiant enterprise will be neither effortless, nor trouble-free. Legalizing and giving in to euthanasia, that is the real cop-out, the easy evasion, the secular humanist’s dodge, the utilitarian’s fudge.
Opposing euthanasia will never be the simple or comfortable option. There are some rather clever people out there who are bent on legalizing euthanasia - some of them are the most engaging people you will ever meet, and sometimes their arguments sound so plausible. Countering them will be demanding. Many of them are from the political and medical establishments and they often have high media profiles, as well as friends in high places. Therefore, we need to be sure of our principles and the veracity of our cause. Yet, however clever their pro-euthanasia arguments and tactics are, it is profoundly reassuring to know that there are objective truths upon which we can construct and sustain an entirely robust anti-euthanasia stance. And in the final analysis, euthanasia will be defeated because ordinary people, like you and me (no, not like you and me, but actually you and me), not only knew, but also acted upon, these truths.
This is the Bible’s two-fold configuration for all aspects of Christian living. First, the truths, the doctrines, the statutes, the precepts, the principles are presented. These are the credenda - things to be believed. Second, comes the call to think, to speak, and to live those very truths. These are the agenda - things to be done. So it must be for those who are mandated to care for all those made in the image of God, and who are therefore implacably opposed to euthanasia. First, principles. Second, action. This is the overall pattern of this book. First, the ethical bedrock is assembled, and upon this, all the major and minor edge-of-life issues are examined and judged. Second, the answers and practical responses to these issues are developed and applied. Together, the credenda and agenda generate that greatest of all responses, principled compassion.
1.7 This book is for all
But this book is not just for Christians, it is aimed at a much wider readership - all the living. Whatever your mindset or worldview, dying, death and euthanasia are issues that you will be forced to confront. And they will require answers from you. So where will you find a solid ethical grounding, a sure philosophical base, upon which you can build a secure bioethical superstructure to provide those answers? Currently, the predominant driving force behind ethics, and particularly medical ethics, is secular humanism. This is a man-made, man-centred, shifting utilitarianism - it believes that whatever action produces the greatest good for the greatest number of people must be true. But just look at what this mindset has produced. Its fruit are a bunch of horrors including abortion-on-demand, destructive experimentation on human embryos, infanticide, and now, euthanasia. Medicine’s once-proud ethics and practices have come to this miserable end - its modern mantra has become, ‘killing the patient can be OK’.
Of course, medical personnel are at the sharp end of these fatal practices. Nevertheless, this book is not a vendetta, or some smug diatribe, against doctors and other healthcare professionals - all of us are, to some extent, blameworthy. Nevertheless, doctors and their associates should know better than to participate in abortion, infanticide and euthanasia, but many of them have become little more than the unthinking pawns of society. They have become our social executioners - we have asked them to carry out these ghastly deeds, and they have complied, usually, it must be said, without much honourable resistance, or praiseworthy hesitation. Thus, one by one, healthcare professionals, and their previously-illustrious medical specialties, have fallen. Obstetrics and gynaecology have already been ruined by the practice of abortion. Paediatrics has become contaminated by infanticide. And now geriatrics is under siege from euthanasia. There is currently a widespread belief throughout the medical profession, and elsewhere, that some human beings are morally valueless, substandard non-persons who can, and even should, be put down. That is, they should be selected, and then culled by abortion, infanticide, or euthanasia.
So this book is not just for Christians, nor just for healthcare professionals. It is for all, because none can escape dying and death. Many of us have already had to face them, as it were, by proxy, usually with the loss of our parents, or elderly relatives. Such times are invariably difficult and we were probably surprised how unprepared and how emotionally affected we were, even when these events were anticipated. Such times will come again, and next time, hopefully, we will be more prepared and better able to cope. But dying and death have an additional and intensely personal edge to them - our own dying and death are not far away. Their inevitability and nearness should rattle us.
If dying and death are inescapable, and have always been challenging and tough, now there is this additional edge-of-life obstacle, euthanasia. Recent developments in medical ethics and practice confirm the increasing probability of our having to face such a predicament. It may be on behalf of an aged aunt, a father, a brother, or a wife, and eventually, on behalf of no one else, but ourself. And what will you think, and say, and do then? To be forewarned is to be forearmed. Now is the time to understand the issues, rehearse the arguments and formulate your responses - in the heat of the moment, at the hospital bedside, will generally be too late.
This book seeks to be a guidebook to the edge of life. It is not a comprehensive book, though it does seek to tackle the key issues and answer the main questions. It is not a medical textbook, though a little medical knowledge will be provided where necessary. It is not a counselling handbook, though communicating with others and seeking their advice and support is a recommended strategy. It is not an academic book, though it remains serious rather than lightweight, yet also warm-hearted rather than frosty. In addition, there is an intentional development of ideas and themes throughout its six Parts and it therefore makes most sense to read it from beginning to end. However, that will not be everyone’s practice - many readers will want to dip into single chapters. To allow for this, most chapters have been written to be largely free-standing. This, of course, demands some repetition - please bear with it. On the other hand, who does not benefit from a little recapitulation now and again?
These edge-of-life issues will test us all to the full. How then will you think, speak, and act realistically and properly when confronted by them? Hopefully, this book will help. We can be very good at evading reality, avoiding the truth, and seeking to minimize our discomfort as we press on, searching for that life of personal peace and affluence. Getting to grips with these edge-of-life issues will shatter some of these pursuits. But it will also highlight the fundamentals of life and death. And this is the huge payoff from facing dying and death - it exchanges doubt, and fatuity for certainty and reality.
Whenever I walk through our local cemetery, I always pause by one grave. On it is inscribed this message for the living from Psalm 90:12, ‘Teach us to number our days aright, that we may gain a heart of wisdom.’ It will not be long before we will all be in a similar graveyard somewhere, scattered on the ground, or buried six feet under. For some people, death is the ultimate unknown and therefore frightening. For others, death itself holds little fear, but the process of dying can be a fearful prospect. The wise will therefore start now to number their days and begin to prepare for a good death, for what will be their ‘true euthanasia’. And the preparation starts here. In the realm of bioethics, we must learn how to walk before we can run, but, even before that, we must discover how to get up onto our bioethical feet and simply stand. Principles and themes from the Scriptures will enable us to do just that - so, look to the next page.