Notes on End-of-Life Issues – Euthanasia and Assisted Suicide
Pilgrims’ Friend Society Conference at Fleckney 2014.
Dr John R. Ling –

Themes from the Scriptures
    1] Human life is unique and special.  Genesis 1:1; Genesis 1:27.
    2] Human life begins at conception.  Jeremiah 1:5; Matthew 1:20.
    3] Human life requires stewardship.  Ecclesiastes 5:18; 1 Peter 3:7.
    4] Human life ends in natural death.  1 Samuel 2:6; Psalm 104:29.
    5] Human life is not to be taken.  Genesis 4:9-10; Exodus 20:13.
    6] Human life demands special care.  Exodus 4:10-12; Isaiah 35:5-6.

History of Medical Ethics and Practice
    1] Hippocratic oath and the Judaeo-Christian doctrines.
    2] The indisputable link between abortion and euthanasia.

Euthanasia and Assisted Suicide Defined
    1] Voluntary, non-voluntary and involuntary euthanasia.
    2] Active and passive euthanasia – a false distinction, intention is the key.

Lexical and Social Engineering
    1] Abortion is now not really killing a human being, it is a TOP or a RPOC.
    2] Euthanasia was once ‘mercy killing’, then ‘the right to die’ and ‘death with
        dignity’ and ‘assisted suicide’, now ‘assisted dying’.
    3] Voluntary Euthanasia Society [VES] is now called Dignity in Dying.

Understanding Suicide
    1] The Suicide Act 1961 – it punishes those who assist, it protects the vulnerable.
    2] Suicides in the Bible – none was approved by God.

The Current Situation – Worldwide
    1] Netherlands, Belgium, Switzerland, Oregon, Washington State and Quebec(?).
    2] Recent rejections by legislations around the world.

Euthanasia in the Netherlands
    1] The Remmelink Report (1991). Voluntary leads to non-voluntary euthanasia.
    2] Groenewoud et al. (2000) New England Journal of Medicine 342: 551-556.

Recent Challenges to UK Law
    1] Lord Joffe Bills – 2003, 2004 and 2005.
    2] 2006 ADTI Bill – assisted dying only – defeated in the Lords by 148 vs. 100.
    3] 2009 Coroners and Justice Bill.
    4] 2011 The Commission on Assisted Dying.
    5] 2014 Lord Falconer and Margo MacDonald (Patrick Harvie) Bills.

Euthanasia and Palliative Care – the Great Paradox
    1] Symptom control has now taken the greater part of pain out of dying.
    2] Not perfect – hospices vs. hospitals vs. homes.
    3] Needs to be extended to more non-cancer patients.
    4] The dying need better care and more resources, not killing.

The ‘Clamour’ for Euthanasia Legislation
    1] Polls show 82% of the public favour some form of legalisation.
    2] Medical professions show little interest and it is opposed by disability groups.
    3] Few MPs and politicians advocate it – all Bills at Westminster defeated.
    4] Members of the general public not exactly queuing up to be euthanased.

Doctors and Euthanasia
    1] Dedicated healer would become life terminator – an eerie prospect.
    2] Historic patient-doctor relationship of trust and respect would end.
    3] Would need a new profession of euthanasiasts – social executioners.
    4] Second-rate, end-of-life care fosters substandard medicine, DNR, etc.

Legal Criteria for Euthanasia
    1] Could not be simply for ‘incurable’ diseases.
    2] Fatal diagnosis does not necessarily mean an imminent death.
    3] Misdiagnoses and spontaneous remissions do occur.
    4] Could not be degree of pain – many distressing illnesses are painless.
    5] Depressives often change their minds and a buoyancy returns.
    6] End of ‘rational existence’ is unreliable – ‘the last days must not be lost days.’

Burdens of Legalised Euthanasia
    1] The elderly would feel a burden – ‘the right to die’ becomes ‘the duty to die’.
    2] Emotional burdens – dutiful carers would feel cheated.
    3] Financial burdens - 'Is it my time to decide to go?'
    4] Formalised ‘quality of life’ assessments – a mathematical balancing act.
    5] Decisions made under acute depression/duress are often bad.

6] Burdens must be faced and solved, not ignored and shelved.

Fears Associated with Dying
    1] Most of us will die simply and quietly, not hooked up to life support.
    2] Life support is used properly to get over an acute crisis.
    3] The hunt for transplantable organs – probably not.
    4] Futile and burdensome medicine – ‘heroic’ measures for what?
    5] Lethal doses of drugs and painkillers – unlikely.
    6] The Liverpool Care Pathway – good and bad, depending on medical staff.
    7] There really is a time to die!  Ecclesiastes 3:2.

The Cases of Anthony Bland, ‘M’, Tony Nicklinson, ‘Martin’ and Paul Lamb
    1] Anthony Bland – a victim of the Hillsborough disaster, 1989.
    2] He was in PVS, able to breathe, tube fed, not on life support.
    3] 4 February 1993, the Law Lords’ decision and Peter Singer’s assessment.
    4] ‘M’ is in a ‘minimally conscious state’, not PVS.
    5] 28 September 2011, Mr Justice Baker refused to sanction her death.
    6] 16 August 2012, the locked-in syndrome Tony Nicklinson and ‘Martin’ decisions.
    7] 31 July 2013, Paul Lamb's case dismissed, 'Martin's' upheld - DPP to clarify professionals' roles.

The Three Medical Dominoes
    Abortion, infanticide and euthanasia – medicine corrupted.

What Must We Do?
    1] Pray,  2] Educate,  3] Engage,  4] Care,  5] Join and Give.

How to Die Well
    1] Hebrews 9:27 The reality, proximity and finality of death.
    2] Amos 4:12 ‘... prepare to meet your God.’
    3] Prepare for our own death and that of others.
    4] Grasp Genesis 1-3, Ecclesiastes 7:2, Romans 5:12, 1 Cor. 15:26, etc.
    5] Hope in John 14:2-3, Deut. 31:6 to Hebrews 13:5, Matthew 5:4, etc.
    6] Think about death and heaven – they’re coming!

Ling, John R. (2002).  The Edge of Life – Dying, Death and Euthanasia.  Day One.
Ling, John R. (2014).  Bioethical Issues - Understanding and Responding to the Culture of Death.  Day One.

The best UK website dealing with these issues is,

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compiled, 24 September 2013.