Long-term Illness, Euthanasia and Palliative Care

This article was written for the Cylchgrawn Efengylaidd, the Welsh language magazine of the Evangelical Movement of Wales.

Everyone is already suffering from a long-term illness.  It need not be arthritis, diabetes, heart disease, dementia, or even cancer.  Yet it is a fatal illness because it will cause your death.  That solemn truth is asserted by Hebrews 9:27, ‘… man is destined to die once …’  Everyone reading this article will die this century.  With the exception of those living at the time of the Second Coming, death will be the normal, inescapable experience of all human beings.

Christians understand why we must die.  The original creation was all about life.  Death entered our world as a result of sin.  It was the austere promise of Genesis 2:27, ‘... you will surely die’ and the disobedience of Adam and Eve that brought about this long-term illness that culminates in death.  Immortal Adam became mortal Adam.  Romans 5:12 is one of the keys to unlocking the enormity of the global fallout from the Fall, ‘Therefore, just as sin entered the world through one man, and death through sin, and in this way death came to all men, because all sinned.’

But modern men and women generally regard death as a distasteful, embarrassing affair.  They want to shun it as if it has no place in the human experience.  On the other hand, wise Christians understand the great issues of life and death.  Christians understand that God is the Creator (Genesis 1:27), the Giver (1 Timothy 6:13) and the Sustainer of human life (Psalm 54:4).  But God is also the Taker of human life.  Our death, as well as our life, is in this God’s hands, 'The LORD brings death and makes alive …' (1 Samuel 2:6).  How could it be otherwise with a sovereign God?  Such sovereignty at life's end is asserted by the psalmist with words of no more than two syllables, '... when you take away their breath, they die and return to the dust' (Psalm 104:29).  Thus, our death is in the hands of God, according to His will, at His timing, at the place of His choice.  Would you want it any other way?  Therefore, to decide upon, or engineer, or bring about death, whether our own, or someone else’s is to usurp God’s prerogative.  It is to challenge his providence.

Furthermore, Christians understand that among the greatest of God's gifts is human life, '… he himself gives all men life and breath and everything else' (Acts 17:25).  Human life is not a right, or a choice, or a reward, or a punishment – it is a supreme gift.  This gift of earthly life begins with our conception and ends with our natural death.  Such a gift from God must be valuable, so it deserves to be carefully nurtured and protected (Deuteronomy 30:19).  Simply put, we are to be good stewards of our lives.

Such biblical precepts stick in the craw of today’s secular humanists.  They reject this notion of ‘stewardship’ in favour of ‘ownership’.  ‘It’s my life, my body, I shall do with it as I please’, is their proud, autonomous cry.  But we do not ‘own’ our lives.  By creation, both Christians and non-Christians, belong to God (Genesis 1:27; Romans 4:16).  And good stewardship never involves the intentional return of the gift – grace is never to be shunned.  Therefore, deliberately and prematurely ending human life by any means, including suicide and euthanasia, can never be regarded as good stewardship.

After the Fall, with man striving to arrogate the role of God and seeking to be in control, it was bound to go wrong.  Violence and untimely death were sure to be among its ugly outcomes.  And so it was – the first unnatural death, the original killing of one bearing the imago Dei, was just around the corner (Genesis 4:8).  Thus, unnatural death entered human history and rapidly flourished.  Consider, for example, the current drive to legalise euthanasia.  This is basically yet another reflection of men's and women's longing to be entirely autonomous and to bring about unnatural death.  They have already obtained the legal authority and the practical means to end human life 'in vitro' (embryo destruction), 'in utero' (abortion) and 'ex utero' (infanticide), now they crave to square the circle to include life 'in senio' (euthanasia, in old age).  Such unnatural deaths are a curse.

Currently, the clamour is for the legalisation of voluntary euthanasia, that is, killing with the patient’s request.  Because a doctor is often involved in prescribing or helping the patient take the fatal dose of drugs, it is also known as doctor-assisted suicide.  Already this has been legalised in the Netherlands, Belgium, Switzerland and the US states of Oregon, Washington and Vermont.  Other jurisdictions, including France, Australia and the United Kingdom, are contemplating such moves.  Yet thankfully there is still a remarkably strong, worldwide disapproval of euthanasia and assisted suicide with a dozen and more legislatures having voted against it in the last three years.

The situation in the UK is simple.  The 1961 Suicide Act decriminalised suicide, but it included penalties for anyone who, ‘… aids, abets, counsels or procures the suicide of another …’  In other words, the Act punishes those who assist, with imprisonment up to 14 years, and, at the same time, it protects the vulnerable – that is what good laws always do.

A few have challenged this law.  We are familiar with the names of Diane Pretty and Debbie Purdy, who have taken their cases through the UK courts.  And between 2002 and 2012, a total of 217 Britons have travelled on one-way tickets to be put to death at the Dignitas ‘clinic’ in Switzerland.  A few politicians have also sought to legalise euthanasia in Parliament.  Lord Joel Joffe has sponsored three such bills in the House of Lords.  The last one, in 2006, was roundly defeated by 148 votes to 100.  Now, in 2013, Lord Charlie Falconer, the former Lord Chancellor, has tabled his Assisted Dying Bill in the House of Lords.  It would allow doctors to provide a lethal dose of drugs to mentally-competent, terminally-ill patients, who are judged to have less than six months to live.

All such proposed euthanasia legislation is so defeatist.  There is a huge irony that anyone should want to be euthanased when palliative care is now making wonderful progress in caring for the physical, mental and spiritual needs of the dying.  We should all be thankful that palliative care is one of the fastest growing specialties in medicine.  Consider this unambiguous statement from the World Health Organisation in 1990, ‘With the development of modern methods of palliative care legislation of voluntary euthanasia is unnecessary.’

Palliative care is therefore much of the answer, the antidote, to euthanasia.  The greater part of pain and adverse symptoms can now be controlled.  Hospices are excellent is providing such care, which is now being extended to numerous hospitals, as well as to patients’ homes.  It is not perfect – it needs to be improved, made more accessible and given to more non-cancer patients.  The dying require better care and more resources, not killing.  Of course, it is cheaper to kill, rather than care – £10 for a fatal dose of barbiturates versus £1,000 per week in care.  And that fact must have been discussed in the corridors of Whitehall and the Welsh Assembly.

This modern hospice movement was pioneered in the 1960s by the late Cecily Saunders, a most remarkable woman of whom it is said, ‘She changed the face of dying.’  Hers is a wonderful story of passion and dogged determination.  Her legacy has been continued, at least in my mind, by Baroness Ilora Finlay, professor of palliative medicine at Cardiff University School of Medicine, and a resolute opponent of any euthanasia legislation.

Finally, if dying and death are inevitable, and euthanasia and assisted suicide are anathema, how should Christians respond?  Of course, we must care practically for the dying, often in ways that are costly of our time, money and energy.  But there is something else, more fundamental, that must also be grasped.  Unlike us, the Bible tackles these issues, in-depth and head on.  It has been argued that there are only two topics throughout the whole Book – life and death.  To counter modern-day euthanasia and assisted suicide, it is my conviction that while most of us have a decent practical theology of living, we need to develop a better theology of dying and death so that we, and our loved ones, can not only live well, but also die well, to be witnesses to God’s grace and mercy in both.

Is that what is being taught in your church?  Are you being prepared for life’s last great endeavour?  Are you ready to face the ‘last enemy’ and meet your Maker?  If not, why not?  As the Old Testament teacher reminds us, ‘… for death is the destiny of every man; the living should take this to heart’ (Ecclesiastes 7:2).

Dr John R Ling is the author of several books including, The Edge of Life – Dying, Death and Euthanasia (Day One Publications).  His personal website is www.johnling.co.uk