Euthanasia and signs of the times

Learn what euthanasia means, what things have been used to justify it, and where accepting it leads

This article deals with euthanasia, or mercy death, which in practice means producing death for a patient whose life he or others do not consider worth living. It is a subject that sometimes resurfaces when some people call for it to be legalised. The motive may be to stop suffering, financial reasons, or to preserve dignity in death. Important terms in this area include:

Voluntary euthanasia means manslaughter on the person’s own request. It is comparable to assisted suicide.

Non-voluntary euthanasia means killing someone in the belief that it is best for them to die. Other people make that choice because the victim is unable to express their opinion.

Involuntary euthanasia is the killing of a person against their will.

Active euthanasia means manslaughter through an act, like administering deadly poison.

Passive euthanasia means speeding up death by quitting treatment or preventing access to nutrients and water. Morally it is not far from active euthanasia, since both are meant to end in death.

But how to approach this serious topic, which touches upon the deepest questions of life: the meaningfulness of human life, suffering and neighbors? These are the matters examined below. The purpose is to first discuss the most common arguments, which have been used to defend euthanasia.

What is meaningful life? One of the justifications for euthanasia has been that if a person has a serious disability or illness, it prevents him/her from living a dignified and meaningful life. It is thought that his/her quality of life cannot be such that he/she would be satisfied and happy.

However, the important question is who defines a person's quality of life? For example, many people with disabilities from birth (e.g. Down's syndrome) can be happy and satisfied in their lives. They can bring joy to their surroundings, although their lives may be more limited than others. It is wrong to say that they do not lead meaningful lives. If we measure our own worth only in efficiency, then we forget humanity.

What about painkillers and medical help for quality of life? It is remarkable that the euthanasia debate has only come up in modern times, when the conditions for pain relief are better than ever. Now it is easy to relieve physical pain through medication. Many who have been injured in accidents or have suffered pain can use them to live a fulfilling life. Most often, the problem is not pain, but depression, which drives a person to want to die. However, it is possible to recover from depression, and the pain can also be removed in extreme cases through anesthesia. Everyone can experience periods of depression and physical pain during their lifetime.

Some can also say that they are grateful to be given more time to live with the help of breathing machines and tubes (a monthly supplement from Helsingin Sanomat, 1992 / 7 – an article “Eläköön elämä” [Hurrah life]) - which many supporters of euthanasia consider degrading and ill-fitting to human dignity. Therefore, it is wrong to speak for all people, that some disease or disability is an obstacle to their quality of life. The same people may have later fully recovered or woken up from a deep coma after months. Such cases are also known.

Oddly enough, society places physically well and intelligent people high on the quality of life ranking, despite the fact that they are sometimes the most unhappy.

On the other hand, society considers poor people’s quality of life low, although they can sometimes be the most satisfied. (1)

An important criticism against the treatment will can be considered to be that it often tells about the attitude of a fit and healthy person to the treatment of a serious illness. It is quite well known that people's opinions change on this matter. A healthy person does not make the same choices as a sick person. As life expectancy decreases, life often feels more precious. A doctor with cancer insisted his colleague to give himself a lethal injection as the disease worsened. Then, when the cancer worsened, the patient became frightened and was so distrustful that he refused even painkiller injections.

However, most severely disabled patients choose life over death. After the accident, only one of the tetraplegics (quadriplegics) who were saved by a ventilator wished to be allowed to die. Two patients were uncertain, but 18 wished for temporary ventilator assistance again if necessary. (2) (3)

Many who have injured themselves or have been born with a birth defect, can feel talks about euthanasia distressing. Although, supporters of euthanasia often mention love in their speeches, they look at things through their own perspective. Their mindset can be entirely different to that of a person in a difficult situation. The following quotation is a good illustration of this:

The disabled and non-disabled people in our society do not need any more strengthening of the image of humanity that has been created for us by the false traders and advertisers of competition, sport, health, beauty, easy life – and easy death.... They also always try to tell us that happiness and suffering cannot fit in the same person and in the same life or death at the same time. It is argued to us that a disabled person is only a disabled person and not at the same time also healthy and human and much more. A very important weapon in maintaining the thinking of those in power is also the notion that helplessness and dependence are only negative things. In the same way, a dangerous weapon is also talk about a decent life - those in power claim that there is such a thing and then they define what it is. Today, we disabled people are not influencing the direction of mainstream thinking.

The representative and consolidator of the mainstream of typical thinking is Jorma Palo when he writes about humiliation as too difficult a disability-related suffering. Humiliation comes to most people for various reasons at some point in their lives. We know that humiliation can be tried to escape and deny or take revenge, but too few of us realize that it can be faced face to face and without running away. We don't have a picture that can be found in the mind when it is necessary, how to grow in the middle of humiliation and find something new and important. Of course, it's a completely different thing that it's not right to humiliate another person. In my opinion, Palo's own actions are already very close to humiliating people with severe disabilities. However, life itself is humiliating, unlike a person who does wrong. Even a disabled person who is being cared for feels the situation to be very different depending on how the other person who is caring for them relates to them. (4)

Another example shows how people may think the exact opposite when being healthy than in a situation where they have lost their ability to function. Most quadriplegics wanted to live. Quite often it is not the illnesses that affect the will to live, but depression. Even physically healthy people can suffer from depression.

In one study, healthy young people were asked whether they would want to be resuscitated by intensive care if they were to become permanently immobilized in an accident. Almost all answered that they would rather die. When 60 youngsters with quadriplegia, who had been suddenly disabled, were interviewed, only one of them said that he should not have been resuscitated. Two couldn't answer, but everyone else wanted to live. They had found a meaningful life even with paralysis. (5)

Economy. Euthanasia has also been justified with economic reasons. It is the other main argument used to support euthanasia. The same argument was also used by the Nazis in their propaganda.

However, there is reason to doubt calculations concerning medical treatments and other costs. Cost saving is not conclusive for the whole:

As always, the accountants are stalking us, armed to the teeth with blatant demands to cut costs. Of course, they would be achieved if everyone only had care wills, if hospice care were organized more efficiently, and if "unnecessary" (we'll come back to consider the meaning of that word soon) treatments were stopped. In February 1994, Emanuel and Emanuel of Harvard Medical School published a comprehensive review of articles written on this topic around the world and concluded: “No individual cost savings at the end of life - whether related to treatment wills, hospice care or the cessation of unnecessary care - are decisive. Everything points in the same direction: savings in treatment measures related to the end of life are not significant. The amount that would perhaps be saved by reducing aggressive, life-sustaining procedures for dying patients is at most 3.3% of total healthcare costs.” So much for saving in dying; from a strict utilitarian moral approach to the difficult, bioethical problems that are currently present in the health care debate. At least in this one critical area, we are now tripping over our own feet. (6)

Calculations on medical treatments and other costs can thus be called into question. Although, it is true that there are costs to treatments in the form of salaries, etc., the same money will circle back into society. Hospital workers pay taxes, buy food and commodities (all including value added tax) like other people. Another alternative is to lay them off and to pay unemployment benefits, but does that make any sense? It would only lead to increased unemployment and would bring the economy to a pause. On the whole it would be a more disadvantaged solution.

Employment could be increased by hiring more workers in the healthcare sector, where many current employees are over-worked. If all other taxpayers’ payroll tax in Finland, e.g., (2 million workers, average income of 35 000 euros) would be raised by 0,5 percent and it would be used to hire more workers, it would increase employment with ca. 7000 persons (no debt money should be used for hiring). This money would then return to circulation and society in the form of taxes and other payments.

In a city like Helsinki (500 000 inhabitants) it would mean ca. 700 new workers, and in a place like Lahti (100 000 inhabitants) 140 new workers, respectively. If the payroll tax were raised by 0,25 %, it would mean half of these numbers. This many workers entering the health care sector would make working much more pleasant and provide an opportunity to offer more humane care to elders and the sick. It has been observed that most people are willing to pay more taxes to uphold quality services.

History and medicine. An insight into the history of medicine in the Western world reveals that it has been greatly influenced by the Hippocratic Oath, traditions built around it, and also ethical mindset originating from the Christian understanding of humanity. Those aspects have influenced in a way that made people value the human life from the very beginning, i.e. from the moment of conception. The most important principles have included saving human lives and alleviating pain in the best way possible. This approach comes apparent in in the Finnish Medical Association’s book called Lääkärin etiikka [Doctor’s ethics], which emphasizes that a patient should never be left without treatment:

Life-prolonging procedures can be waived when death is definitely expected and the patient cannot be cured. This has been called passive assistance of death, but it is a question of a completely ordinary doctor's work, where decisions must be made constantly to choose the most suitable treatment method for the patient. On the other hand, active euthanasia, i.e. hastening death, could be acting in accordance with the patient's request when he wants to be killed. The general attitude of doctors towards assisted dying in Finland is repulsive. The traditional ethics of a doctor does not accept the use of medical skills to intentionally kill a person. The Criminal Code prescribes a severe punishment for killing a person, even if it is done at the person's own request. Many people think that the whole concept of euthanasia should be abandoned, because it only gives the impression that the doctor is causing the death of the patient instead of the disease. There are diseases that cannot be cured, but the patient is never left without treatment. (7)

What is the situation today? Many philosophical circles want to destroy the good and safe tradition that has prevailed in medicine throughout the decades. The first step towards this direction was demanding the legalization of abortion. It was not demanded by medical circles, but by adherents of a self-centered culture of pleasure. They thought that it is okay to kill a child if he or she happened to be in the way of the parents’ plans. These days, nearly all abortions are done due to social reasons, not because the mother’s life would be in danger. E.g. in India and in China baby girls are being killed in abortions, in the Western world both genders are killed. (In India there are only 914 women for every 1000 men. Since it is possible to check the sex of the fetus early on, it has led to millions of abortions of unborn girls.)

What is the new direction? It is likely that accepting a murder of a child inside the mother’s womb will result in the same being accepted outside the womb. It is logically thought that if the killing of a child in the womb is justified, why should there be a difference to doing it outside the womb. In some countries there have already been discussions of ending the life of severely handicapped newborn babies, coma patients, and severely disabled people. Similar arguments that were used to defend abortion are being used to also support euthanasia. As the conversation progresses, it is possible that the boundaries become more and more narrow in terms of what constitutes meaningful life. Philosophical circles are taking development and discussion in a direction in which the absolute value of human life is losing its relevance more and more. (In Holland, where the practice has been taken the furthest, more than a tenth of older people said they feared their doctors would kill them against their will. [8] Thousands carry a card in their pockets there that mentions that they don't want to be killed against their will if they are hospitalized.) Albert Schweitzer stated:

When a person loses respect for any form of life, he loses respect for life as a whole. (9)

Modern development is not new or modern thinking. If we go back to Germany in the 1920s and 1930s, a similar atmosphere prevailed there even before the Nazis came to power. Hitler did not create this way of thinking, but it came from the table of philosophers. An important factor was especially the book published by psychiatrist Alfred Hoche and judge Karl Bilding in the early 1920s, which talked about worthless people and a life that is not worth living. That and Nazi propaganda paved the way for people to accept the idea of a life that is inferior. It all started from a small beginning. Trends such as liberal theology and evolutionism were also strongly influenced in the background. They had a lot of support in Germany in the early 1900s.

It became clear for the people researching war crimes that this widespread killing started from slight changes in attitude. In the beginning the doctors’ approach underwent only a slight change. The notion of life not worth living was accepted. Initially this concerned only chronically ill people. Slowly, the scope of people, who were deemed killable, widened to socially unprofitable ones, those who had differnt ideologies, racially discriminated ones and eventually to all non-Germans. It is important to realize that this train of thought started from a small change of attitude towards the hopelessly ill, who were thought no longer to be rehabilitated. Such a minor change in the doctor's attitude is therefore worth examining. (10)

How does development take place? When there have been changes in society in the area of morality – the acceptance of abortion, free sexual relations, etc. – the changes have often followed the same pattern. The same pattern has been repeated several times and led to a change in people's attitudes. In this model, the most important steps are the following factors:

1. A few loud people proclaim a new morality, rejecting the behavior that has been considered correct for decades. This happened in the late 1960s, when the idea of free sexual relations and abortion were proclaimed. Likewise, homosexuality, which used to be considered a distortion and was understood to be due to circumstances, is viewed favorably today. Euthanasia is one similar thing in this discussion:

I was away from my homeland for three years, the years 1965 to 1968. When I returned in the autumn of 1968, I was very surprised at the change that had taken place in the atmosphere of public conversation. This concerned both the tone of conversation and also the framing of questions.

(...) In the student world, those who demanded justification of sexual relationships were the ones blowing their trombones loudly. They insisted, for instance, that boys and girls should be allowed to live together in university dormitories even though they were not married.

It seemed that the Teen League had been taken over by new leaders who proclaimed not only socialism and school democracy, but also the idea of free sexual relations.

All in all, what was new was that reference groups had formed that spoke much more openly about gender issues than had previously been customary in public, accusing society and the Church of applying double standards. (11)

2. The media gives space to the representatives of the new morality, considering them as some kind of heroes:

Couples living unlegalized cohabitation were interviewed in public as some kind of heroes of a new morality who dared to stand up against the morality of a degenerate bourgeois society. Similarly, homosexuals were interviewed and free abortion was called for (12)

3. Gallup polls confirm the change in direction. As more and more people turn to support the new practice, it affects others who read these polls.

4. The fourth stage is when the legislators confirm a new practice, considering it right, even though the same thing has been considered wrong throughout the ages. William Booth, the founder of the Salvation Army, predicted this would happen just before Jesus' return. Legislators would arise who do not respect God and his commandments in the slightest. It is hard to deny that development has gone in this direction.

1. "Then there will be politics without God... The day will come when the official state policy of the entire Western world will be such that no one at any governing level will fear God anymore... a new generation of political leaders will rule Europe, a generation that will no longer be in the least bit afraid of God;

Murder. When defending euthanasia, beautiful words such as love, dignified death, assisted death, easy death, good death or liberating oneself from a life that is not worth living may often be used. The same vocabulary is used as the Nazis used in their propaganda in the 1930s.

However, the previous cases are about killing a person. Furthermore, when talking about a good or dignified death, what is actually meant is life. Life in the last moments can be good or bad, but death itself is the limit for everyone and it happens in an instant.

The use of language is therefore important, and this is what the following quote refers to. Circular expressions get us to sympathize more easily than direct words.

In 2004, the British Euthanasia Association changed its name to Dignity in Dying. At the time of writing, their website carefully avoided such direct words as "euthanasia", "suicide" or "mercy killing". Instead, vague phrases such as "a dignified death with as little suffering as possible", "the ability to choose and control how we die", "assisted death" and "the decision to end suffering that has become unbearable" were used instead.

Not everyone is convinced by this approach. One Daily Telegraph commentator said: "It says something when an organization has to refer to itself by a roundabout term. The Euthanasia Society now plans to call itself Dignity in Dying. Who among us would not want to die with dignity? It’s not hard to believe that the promoters of euthanasia (indeed!) are afraid to say directly what they’re actually driving, namely killing people. ” (13)

One hospice nurse responded to the description of assisted suicide with the term "assisted death": "Midwives assist in childbirth, and palliative care nurses assist with special palliative care. Assisting is not the same as killing. The term 'assisted death' offends those of us who provide good end-of-life care. It is a deception in which killing is sanitized to make it more acceptable to the general public. It implies that a person can only die with dignity if they are killed." (14) (15)

In fact, in euthanasia it is a question of murder or suicide. It does not take into account the possibility that we are eternal beings, that we will be judged for our actions, and that murderers will be damned outside the kingdom of God. Some may argue against this possibility, but how can they prove that the following verses on this subject are not true? They should be taken seriously and not underestimated:

- (Mark 7:21-23) For from within, out of the heart of men, proceed evil thoughts, adulteries, fornications, murders,

22 Thefts, covetousness, wickedness, deceit, lasciviousness, an evil eye, blasphemy, pride, foolishness:

23 All these evil things come from within, and defile the man.

- (1 Tim 1:9) Knowing this, that the law is not made for a righteous man, but for the lawless and disobedient, for the ungodly and for sinners, for unholy and profane, for murderers of fathers and murderers of mothers, for murderers,

- (1 John 3:15) Whoever hates his brother is a murderer: and you know that no murderer has eternal life abiding in him.

- (Rev 21:8) But the fearful, and unbelieving, and the abominable, and murderers, and fornicators, and sorcerers, and idolaters, and all liars, shall have their part in the lake which burns with fire and brimstone: which is the second death.

- (Rev 22:15) For without are dogs, and sorcerers, and fornicators, and murderers, and idolaters, and whoever loves and makes a lie.

When not to treat? When it comes to the care of the dying and the last moments, it is justified to develop hospice care. This is generally granted. Measures must be taken so that every patient can experience good and individual care in a safe environment, and where their pain is alleviated. It is possible to achieve this with the help of modern medicine and if there are enough nursing staff and they have the right motivation. This has been a common practice and goal for decades, e.g. in Finnish nursing, as well as in numerous other countries.

What about a situation where a person is clearly already dying and there is no hope of his recovery? (Usually, the dying process lasts from a few hours to a few days. Death has begun when a person rapidly weakens and there is no hope of his recovery.) In this situation, it can certainly be justified to stop intensive care, because it is not beneficial or can even be harmful. It is not euthanasia, but the termination of useless treatment. It is good to distinguish between these two things. However, even in these cases, care can be taken to ease the symptoms.

However, there comes a time in every patient's life when the use of curative medicine would cause more harm than good to the patient. In this case, enabling a good and painless death with the help of hospice care is a positive treatment result. Unnecessary treatment and prolonging death, on the other hand, is a serious medical error. If unnecessary treatment is given up, it is not a question of the doctor taking on tasks that belong to God. Stopping treatment in such a situation is no more strange than avoiding starting unnecessary treatment. Naturally, these decisions must be discussed in the treatment team, and the grounds for stopping treatment and forgoing resuscitation must be made clear to all involved. (16)

Joni Eareckson Tada explains further (17):

My father’s death taught my family to look for wisdom. We wished to help our father to live until the end and to let him die, when the time comes. Providing food for the hungry and water for the thirsty ones are the fundamentals of humanity. Although it was clear that dad was close to death, we wanted to make him feel as comfortable as possible. God's wisdom includes compassion and pity. Taking care of neighbors is one of the absolute commands in the Bible.

Doctors, however, told my family that in some cases feeding and giving water to a patient, whether it was done via mouth or via tubes, is pointless and, on top of that, painful for the patient. Rita Marker from an international anti-euthanasia working committee says:

When a patient is very close to death, they can be in such a state that liquids increase their discomfort, because their body can no longer use them.

Food does not digest either, when the human body starts to “close” when the process of dying has begun. A moment comes, when it can be said that the human is really dying. (18)

An ideal society. When aiming for an ideal society, a great value is often placed on financial matters. They are highly emphasized and their value cannot be underestimated. If the economy goes into bad shape, it can destabilize the order of the whole society. That has happened several times throughout history.

However, the most important factor in achieving an ideal society is the inner attitude of people: do they care for each other or is their heart filled with selfishness, hatred and lack of love? After all, the biggest problems in society are not financial, but they arise from the wrong attitude towards our neighbors: the poor, the sick, the elderly, foreigners, the disabled, etc. The level of society can be measured in how it treats these and other groups. In an ideal society, all people are considered and valued depending on their background, but going the other way makes people feel uncomfortable. Society can go either way, depending on which thought patterns fill people's minds.

Let's look at a few verses on the subject. They deal with justice and the right attitude towards one's neighbor. If this advice is widely followed, it will increase the overall well-being of society. Following the other commandments leads in the same direction (Mark 10:19,20: You know the commandments, Do not commit adultery, Do not kill, Do not steal, Do not bear false witness, Defraud not, Honor your father and mother. And he answered and said to him, Master, all these have I observed from my youth.):

Attitude towards neighbors

- (Matt 22:35-40) Then one of them, which was a lawyer, asked him a question, tempting him, and saying,

36 Master, which is the great commandment in the law?

37 Jesus said to him, You shall love the Lord your God with all your heart, and with all your soul, and with all your mind.

38 This is the first and great commandment.

39 And the second is like to it, You shall love your neighbor as yourself.

40 On these two commandments hang all the law and the prophets.

- (Gal 6:2) Bear you one another's burdens, and so fulfill the law of Christ.

The poor

- (Mark 14:6,7) And Jesus said, Let her alone; why trouble you her? she has worked a good work on me.

7 For you have the poor with you always, and whenever you will you may do them good: but me you have not always.

- (1 John 3:17) But whoever has this world's good, and sees his brother have need, and shuts up his bowels of compassion from him, how dwells the love of God in him?

- (James 2:1-4,8,9) My brothers, have not the faith of our Lord Jesus Christ, the Lord of glory, with respect of persons.

2 For if there come to your assembly a man with a gold ring, in goodly apparel, and there come in also a poor man in vile raiment;

3 And you have respect to him that wears the gay clothing, and say to him, Sit you here in a good place; and say to the poor, Stand you there, or sit here under my footstool:

4 Are you not then partial in yourselves, and are become judges of evil thoughts?

8 If you fulfill the royal law according to the scripture, You shall love your neighbor as yourself, you do well:

9 But if you have respect to persons, you commit sin, and are convinced of the law as transgressors.

Justice

- (Deut 16:19) You shall not wrest judgment; you shall not respect persons, neither take a gift: for a gift does blind the eyes of the wise, and pervert the words of the righteous.

- (Prov 17:15) He that justifies the wicked, and he that comdemns the just, even they both are abomination to the LORD.

- ( Isaiah 61:8) For I the LORD love judgment, I hate robbery for burnt offering; and I will direct their work in truth, and I will make an everlasting covenant with them.

Foreigners

- (Lev 19:33,34) And if a stranger sojourn with you in your land, you shall not vex him.

34 But the stranger that dwells with you shall be to you as one born among you, and you shall love him as yourself; for you were strangers in the land of Egypt: I am the LORD your God.

- (Lev 24:22) You shall have one manner of law, as well for the stranger, as for one of your own country: for I am the LORD your God.

- (Jer 7:4-7) Trust you not in lying words, saying, The temple of the LORD, The temple of the LORD, The temple of the LORD, are these.

5 For if you thoroughly amend your ways and your doings; if you thoroughly execute judgment between a man and his neighbor;

6 If you oppress not the stranger, the fatherless, and the widow, and shed not innocent blood in this place, neither walk after other gods to your hurt:

7 Then will I cause you to dwell in this place, in the land that I gave to your fathers, for ever and ever.

Elderly

- (Lev 19:32) You shall rise up before the hoary head, and honor the face of the old man, and fear your God: I am the LORD.

REFERENCES:

1. Joni Eareckson Tada: Oikeus elää, oikeus kuolla (When is it Right to Die?), p. 65

2. Gardner B P et al., Ventilation or dignified death for patients with high tetraplegia. BMJ, 1985, 291: 1620-22

3. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 91

4. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 126,127

5. Päivi Räsänen: Kutsuttu elämään, p. 106

6. Bernard Nathanson: Antakaa minun elää (The Hand of God), p. 130

7. Lääkärin etiikka, 1992, p. 41-42

8. Richard Miniter, ”The Dutch Way of Death”, Opinion Journal (huhtikuu 28, 2001)

9. Marja Rantanen, Olavi Ronkainen: Äänetön huuto, p. 7

10. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 38,39

11. Matti Joensuu: Avoliitto, avioliitto ja perhe, p. 12-14

12. Matti Joensuu: Avoliitto, avioliitto ja perhe, p. 12-14

13. http://telegraph.co.uk/comment/telegraph-view/3622559/Euthanasias-euphemism.html

14. Quote from article: Finlay, I.G. et.al., Palliative Medicine, 19:444-453

15. John Wyatt: Elämän & kuoleman kysymyksiä (Matters of Life and Death), p. 204,205

16. Pekka Reinikainen, Päivi Räsänen, Reino Pöyhiä: Eutanasia – vastaus kärsimyksen ongelmaan? p. 92

17. Joni Eareckson Tada: Oikeus elää, oikeus kuolla (When is it Right to Die?), p. 151,152

18. Rita L. Marker: New Covenant, January 1991