Archive for February, 2008

Voluntary Active Euthanasia: A Compassionate Solution for Those in Pain?

Saturday, February 9th, 2008

Euthanasia (image courtesy Right to Life Australia)

DEBATE: MICHAEL MOORE, MLA & REV. SPENCER GEAR.This is Spencer Gear’s presentation.

8.00 pm Thursday 10 June 1993

Erindale Theatre, McBryde Cr., Wanniassa ACT, Australia

EXAMPLE

“Jennie was only forty-eight when she found the breast lump.The surgeon had been hopeful, but the pathology report showed the cancer was very aggressive and had already spread to the lymph nodes.Radiation and chemotherapy were completed.

Before long, Jennie’s cancer had spread to her spine.Itgalloped through her bones, liver and lungs.She lost weight very rapidly, became depressed, and required large doses of morphine.The medication only partially relieved her severe pain.Any movement was excruciating.

Eventually her husband Sam asked the doctor to give Jennie one large injection of morphine so that she won’t suffer anymore?She’s been in so much pain for so long.She just wants to get it over with… All involved were ready for Jennie to die” (Orr, et. al., Life & Death Decisions, 151-152).

IF THE LARGE INJECTION OF MORPHINE HAD CAUSED DEATH, THIS WOULD HAVE BEEN VOLUNTARY ACTIVE EUTHANASIA.

DEFINITION OF EUTHANASIA

I must define my terms.

Euthanasia is “the intentional killing of a person, for compassionate motives, whether the killing is by a direct action, such as a lethal injection, or by failing to perform an action necessary to maintain life” (from “Euthanasia: killing the dying.’It’s OK – isn’t it?’ Foundation For Human Development, Site 4A, 32 York Street, Sydney 2000).

Voluntary active means that the person asks to be killed.It must be realised however that those who promote euthanasia do not use the word “kill”, but it is the only accurate word to describe the reality of what happens.Besides, it is the word the law uses.

People are sometimes confused by the current debate on “the legality of disconnecting mechanical life support systems for long-term comatose patients or the patients’ right to request that no extraordinary means be used to keep them alive when all hope is gone.”This is often called passive euthanasia, but it is not euthanasia

This refers to the common law right of all Australians to decide which treatments they want to have for themselves.

But I must insist that this is not euthanasia.The Canadians got it correct in their 1983 Law Reform Commission when, following an inquiry, they concluded that “mercy killing not be made an offence separate from homicide” (in Brian Pollard, Euthanasia: Should We Kill the Dying?, p. 45).

Tonight when I use the term euthanasia, I will be referring to voluntary, active euthanasia.

OVERHEAD NO. 1

Euthanasia is not a compassionate solution to those in pain for the following reasons:

1.The first reason for not supporting voluntary active euthanasia is that: We already know the consequences of a permissive approach to euthanasia. We have glaring examples before us of where permissive euthanasia laws will lead us.

a.GERMANY

In Germany in 1920, there was a publication by a lawyer, Karl Binding, and a psychiatrist, Alfred Hoche, called The Permission to Destroy Life Not Worth Living, that opened the floodgates and led to open discussion and legislation to permit euthanasia in Germany in the 1920s and 1930s.

Initially, it was seen to have a beneficial social effect in dealing with the so-called “useless” sick.

Why did they do it?For the very same reasons that are being advocated today: compassion, quality of life, and to cut the cost of caring for these so-called “useless people”.They stressed the cost of caring for the handicapped, the retarded and the mentally ill.They were called “useless eaters”.

This led to experimentation on human beings and genocide.It was a small step from euthanasia to the Nazi government’skilling of 6 million Jews, and it is estimated that about 6 million others also were killed.

Dr. Leo Alexander, a Boston psychiatrist at the Nuremberg trials after World War II (in 1946 and 1947) says:”it started with the acceptance of the attitude basic in the euthanasia movement, that there is such a thing as life not worthy to be lived “Medical Science Under Dictatorship”, New England Journal of Medicine 241:39-47, July 14, 1949.(This was also covered in Newsweek magazine, July 9, 1973)].

It started when doctors, lawyers, legislators and even clergy–against their professional and ethical obligations to respect all human life, decided to destroy life that they considered not worth living

Michael, there is no way to control voluntary euthanasia.

We have a much more recent example in Holland.

b.HOLLAND

At St. Mark’s National Theological Centre, Canberra on Feb. 26, 1993, Michael, you said that your brief to the Parliamentary Council would be to give criteria (and you articulated them) similar to Holland.What is happening in Holland?

The official Dutch Government report (The Remmelink Report, 1991) gives conclusive evidence of abuse.The Dutch report shows clearly that doctors are killing without the explicit request of the patient.Doctors have violated the ‘strict medical guidelines’ provided by the Dutch courts (John Fleming, “Euthanasia, The Netherlands, and the Slippery Slopes”, Bioethics Research Notes Occasional Paper No.1, June 1992, published by the Southern Cross Bioethics Institute, PO Box 206, Plympton SA 5038, Australia).

OVERHEAD NO. 2

EUTHANASIA IN HOLLAND: CRITERIA LAID DOWN BY THE COURTS

(Although officially illegal at the time of the Remmelink Report)

1.The request for euthanasia must come only from the patient and must be entirely free and voluntary.

2.The patient’s request must be well considered, durable and persistent.

3.The patient must be experiencing intolerable (not necessarily physical) suffering, with no prospect of improvement.

4.Euthanasia must be a last resort.Other alternatives to alleviate the patient’s situation must have ben considered and found wanting.

5.Euthanasia must be performed by a physician.

6.The physician must consult with an independent physician colleague who has experience in the field.

Summarised by Mrs. Borst-Eilers, Vice-President of the Health Council (a body which provides scientific advice to the Dutch government on health issues).In I.J. Keown, “The Law and Practice of Euthanasia in The Netherlands”, The Law Quarterly Review, Vol. 108, January 1992, p. 56]

OVERHEAD NO. 3

BUT WHAT WERE THE RESULTS IN HOLLAND?

The Dutch report in the British medical journal, The Lancet, states that “in cases of euthanasia the physician often declares that the patient died a natural death” (p. 669).This report indicates that 0.8% of the 38.0% of all deaths involving euthanasia were “life-terminating acts without explicit and persistent request” (p. 670) (Paul J. van der Maas, Johannes J.M. Delden, Loes Pijnenborg, and Caspar W.N. Looman, “Euthanasia and other medical decisions concerning the end of life”,

The Lancet, 338:8768, September 14, 1991, 669).

This means that the deaths of about 1,000 Dutch people in a single year were caused by a doctor who hastened the death of a patient without the patient’s explicit request and consent.

But there is more.Another assessment is that the real number of physician assisted deaths, estimated by the Remmelink Committee Report is, in reality 25,306 which is made up of (they’re on the overhead projector for you to see):

  • 2,300euthanasia on request (Remmelink Report, 13),
  • 400 assisted suicide (ibid.15),
  • 1,000life-ending treatments without explicit request (ibid.),
  • 4,756died after request for non-treatment or the cessation of treatment

with the intention to accelerate the end of life. cf, ibid, 15; there were 5,800 such cases but only 82% (i.e. 4,756) of these patients actually died. cf Dutch Euthanasia Survey Report, 63ff

  • 8,750life prolonging treatment was withdrawn or withheld without the

request of the patient either with the implicit intention (4,750) or with the explicit intention (4,000) to terminate life.

[ibid., 69; There were 25,000 such cases but only 35% (i.e. 8,750) were done with the intention to terminate life. Cf ibid., 72; cf also Remmelink Report, 16),]


  • 8,100morphine overdose with the implicit intention (6,750) or explicit

intention (1,350) to terminate life. Of these, 61% were carried out without consultation with the patient, i.e. non-voluntary euthanasia.

  • There were 22,500 patients who received overdoses of morphine, cf

Remmelink Report, 16.36% were done with the intention to terminate life, cf Dutch Euthanasia Survey Report, 58.See ibid., 61, Tabel 7.7 (“Besluit niet besproken”)].

THIS TOTAL OF 25,306 PHYSICIAN-ASSISTED DEATHS AMOUNTED TO 19.61% OF TOTAL DEATHS [129,000] IN THE NETHERLANDS IN 1990.[“To this should be added the unspecified numbers of handicapped newborns, sick children, psychiatric patients, and patients with AIDS whose lives were terminated by doctors according to the Remmelink Report” (pp. 17-19). Source: Dutch-speaking Dr. Daniel Ch Overduin, Vita, Vol. 7, No. 1, March 1992, pp. 2-3]

OVERHEAD NO. 4

(Title of Lancet article, “”Euthanasia and other medical decisions concerning the end of life”)

Dr. John Keown, Director of the Centre for Health Care Law, in the Faculty of Law, University of Leicester, U.K., has completed a research project on euthanasia in Holland.He concludes:

OVERHEAD NO. 5

“It appears that the overwhelming majority of cases are falsely certified as death by natural causes and are never reported or investigated… It is clear from the evidence set out in Keown’s research that all that is known with certainty in the Netherlands is that euthanasia is being practised on a scale vastly exceeding the ‘known’ (truthfully reported and recorded) cases.There is little sense in which it can be said, in any of its forms, to be under control” (I.J. Keown, “The Law and Practice of Euthanasia in The Netherlands”, in The Law Quarterly Review, 108, January 1992, 67, 78).

Yet Michael Moore stated at St. Mark’s that he wants to follow the Dutch guidelines.

2. A second reason why euthanasia is not a compassionate solution is that there is no guarantee it will be limited to terminal illness for those in pain.The recent history of the euthanasia movement demonstrates this.

3.Michael has made his views clear.On the Matthew Abraham show, Radio 2CN, February 2, 1993, he was asked by:

Matthew Abraham: “What about an old married couple?Maybe in their 80s and they’ve been relatively independent in their own home, they don’t want to be of trouble to their kids, they’ve had a good life… They want to commit suicide as a couple…

Michael Moore:”I think it should be covered in the act and I think that under certain circumstances, given appropriate counselling and appropriate time to make that kind of decision.

He reinforced this at St. Mark’s National Theological Centre, Canberra on 26 Feb. 1993, I heard him say:

“I’m not just talking about the terminally ill, but also a couple, say who have been married 60 years, one of them is terminally ill and they want to die together.I would agree with that, but I don’t expect legislative support for that.”

No civilised society like ours will remain civilised if we endorse this kind or any other kind of homicide.

How can we say where to limit?Chronic illness?Mental illness?Multiple sclerosis?Those crippled with arthritis?Persons who are handicapped?What about some of the people I counsel, like a 16-year-old who is on drugs, severely depressed and suicidal?

This is one of Michael’s core problems–where to draw the line.

The most recent review of the need for euthanasia in Australia was the Social Development Committee of the Parliament of VictoriaThe report, called Options for Dying with Dignity in 1988 concluded: “It is neither desirable nor practicable for any legislative action to be taken establishing a right to die” (in Pollard, 45).

Those who start with euthanasia for the terminally ill, most often broaden their base:

One of the most blatant examples of how far euthanasia advocates will go is this (HOLD UP) Australian Human Rights Commission Occasional Paper No. 10 (published in August 1985): “Legal and Ethical Aspects of the Management of Newborns with Severe Disabilities”.

When published, this paper created quite an uproar because of what it recommended for babies with disabilities:

  • one of the main emphases was to support euthanasia for deformed newborn babies,
  • Dr Helga Kuhse promotes “a quick and painless injection” (to kill) for a Down’s Syndrome infant with an intestinal obstruction (p. 4).
  • Yet this Human Rights Commission document also cites the United Nations “Declaration of the Rights of the Child” which states: “The child who is physically, mentally or socially handicapped shall be given the special treatment, education and care required for his particular condition” (p. 28).

You can’t have it both ways: kill off the handicapped newborn, and give the handicapped special treatment, education and care.This is a shocking report advocating the killing of the handicapped newborn, all in the name of the Human Rights Commission.I believe this is eugenics (selective breeding).

Do you really think, if we were to legalise euthanasia, that doctors and nurses would stick to the rules?

In 1988, doctors surveyed in the State of Victoria were asked, “Have you ever taken steps to bring about the death of a patient who asked you to do so?”29% (of 369) replied “Yes”. (Helga Kuhse and Peter Singer, “Doctors’ Practices and Attitudes Regarding Voluntary Euthanasia”, The Medical Journal of Australia, 148:12, June 20, 1988, 623-627).

The situation with nurses is just as alarming.

In 1992, “of those nurses who had been asked by a patient to hasten death, 5% had taken active steps to do so without having been asked by a doctor.

Almost all of the 25% who had been asked by a doctor to engage in active steps to end a patient’s life had done so” (Helga Kuhse and Peter Singer, “Euthanasia: A survey of nurses’ attitudes and practices”, Australian Nurses’ Journal, 21:8, March 1992, 21-22).

With euthanasia illegal, some doctors and nurses are breaking the law.Do you honestly think they will follow, say Dutch guidelines, if they became legal?

3.The third reason: It is a strange paradox that euthanasia is being strongly promoted at a time when the medical profession has made great advances in the treatment of pain. This is not the time to recommend assistance in the killing of the terminally ill or others.

According to Dr. Bob Allan, president of the ACT branch of the Australian Medical Association, “Modern palliative care ensured that patients should never have to consider euthanasia on the grounds of severe pain.Treatments are available to ensure death with dignity and without pain” (The Canberra Times, Feb. 3, 1993, p. 5).

Medical doctors, Robert D. Orr and David L. Schiedermayer, conclude:

“The hospice movement has demonstrated that physicians should be better educated about pain management and better equipped to treat pain effectively.More than ninety-five percent of cancer patients can be kept virtually pain free if given adequate doses of pain medication at appropriate intervals” (Orr, Schiedermayer, & Biebel, Life & Death Decisions, Navpress, 1990, p. 165).

Retired anaesthetist at Concord Hospital, Sydney, Dr. Brian Pollard, says:

“Most cancer pain is well within the competence of any doctor to treat effectively.It is necessary to regard unrelieved pain as a medical emergency to be dealt with as energetically as possible and to address also the emotional turmoil which is usually present” Euthanasia: Sould We Kill the Dying? Little Hills Press, Bedford, U.K. 1989, pp. 9-10, 65).

At a time when there is every reason to offer caring, compassionate palliative care to the sufferer, Michael wants to eliminate the sufferer rather than eliminate the suffering.

4.A fourth reason is that it debases the medical profession and has harmful effects on the doctor/patient relationship.

The standard form of the Hippocratic Oath that is taken by many medical doctors, dating back to the time of the Greeks, says:

“I will follow that method of treatment which, according to my ability and judgment, I considerfor the benefit of my patients, and abstain from whatever is deleterious and mischievous.I will give no deadly medicine to anyone if asked, nor suggest any such counsel” (in Francis A. Schaeffer and C. Everett Koop, Whatever Happened to the Human Race, 207).

Dr Bob Allan, president of the ACT branch of the Australian Medical Association confirms this position.He stated in The Canberra Times that “the association’s position, and that of the World Medical Association, was that euthanasia, even if requested by a patient, was unethical.

“Dr Allan said doctors would have great moral difficulty in actively bringing about the end of a patient’s life.

“To actively set out to end someone’s life is an enormous break from medical standards” (The Canberra Times, “Euthanasia row fires both sides”, February 3, 1993, p. 5).

Michael Moore has stated in The Canberra Times (Feb. 3, 1993, p.5), “I’m interested in facilitating the right of people to make a decision about their own life.It is the most fundamental of human rights–the right to life and the right to death”.

Michael is fundamentally and legally wrong at this point.He is not advocating the right to die.People can do that legally now by committing suicide.Michael is advocating something much more devastating to our society.He is claiming the right for somebody to be killed on request in certain circumstances.He is also calling for the right of others to assist in the killing of others.

This right does not exist in our society and it should never be introduced if we want to maintain a country with respect for one another.

5.The fifth reason to resist voluntary active euthanasia is: There is a better alternative: promote life and become actively involved in compassionate care for the dying, persons who are handicapped, and other sufferers in our society.

This compassionate care involves a competent doctor effectively treating severe pain, emotional support and caring communication from others.Empathy is needed by the doctor and others.

We need to improve the standards of care for dying patients.I commend the ACT government’s initiatives to develop a hospice.It is urgently needed.

Inter-disciplinary teams will be needed involving doctors, nurses, clergy, social workers, other professionals and caring paraprofessionals.

6.The sixth and final reason: human beings are not animals, but unique beings made “in the image of God”.

As a doctor put it to me recently: We put down dogs, why shouldn’t we offer the elderly in a vegetative state the same?The reason is that human beings are not animals.Human beings are unique, “made in the image of God”, according to the Bible.

We could find support for this proposition by referring to Noam Chomsky’s work on the uniqueness of human language, or neurosurgeon, Wilder Penfield’s, research on the difference between the brain and the mind—both affirming the difference between human beings and animals.

As God’s image bearers, each of us has the capacity to be personal, rational, volitional, emotional, and moral. Our responsibility is to reflect God’s character and purposes in all that we do.

When we reduce human beings to animals, it logically follows that a whole range of horrendous evils could eventuate.

Human life is sacred and God has forbidden that any life be murdered.To do so it indirectly an attack on God.

Any society that engages in the killing of innocent life will pay a grave price.When we do not respect life before birth, if affects our view of life after birth.If we do not respect the dying, it will affect our attitude towards the living.As the Bible puts it: “For none of us lives to himself alone and none of us dies to himself alone.If we live, we live to the Lord, and if we die, we die to the Lord” (Romans 14:7-8).

Euthanasia is not a compassionate solution to those in pain for the following reasons:

1.We already know the consequences of a permissive approach to euthanasia.We have glaring examples before us of where permissive euthanasia laws will lead us.

2.There is no guarantee it will be limited to terminal illness for those in pain.The recent history of the euthanasia movement demonstrates this.

3.It is a strange paradox that euthanasia is being strongly promoted at a time when the medical profession has made great advances in the treatment of pain. This is not the time to recommend assistance in the killing of the terminally ill or others.

4.It debases the medical profession and has harmful effects on the doctor/patient relationship.

5.There is a better alternative: promote life and become actively involved in compassionate care for the dying, persons who are handicapped, and other sufferers in our society.

6.Human beings are not animals, but unique beings made “in the image of God”.

 


SUMMING UP

 

I oppose voluntary active euthanasia because of:

  • Abuse
  • Error
  • The historical examples
  • Distrust
  • Coercion

I CONCLUDE:

The case for euthanasia is based on the following:

  • It intentionally killing or assisting in the killing of innocent human beings.
  • It repudiates the doctor-patient relationship that is meant to promote life.
  • It flies in the face of the medical advances made in the treatment of pain and is at odds with compassionate methods of care.
  • It does not fully consider the historical examples that show euthanasia cannot be legislatively controlled.
  • It rests on presuppositions that do not respect human life.
  • It plays God.
  • Ethically, it rests on self-defeating assertions.
  • It is not in the patient’s or society’s best interests.
  • It eliminates the sufferer, rather than eliminating the suffering.

FRANCIS A. SCHAEFFER & C. EVERETT KOOP dedicated their book, Whatever Happened to the Human Race,

” To those who were robbed of life,

the unborn, the weak, the sick,

the old, during the dark ages of

madness, selfishness, lust and greed

for which the last decades of the

twentieth century are remembered”

(Fleming H. Revell Company, Old Tappan, New Jersey, p. 118).


For further study:

  1. Tony Sheldon, Utrecht, Holland, “Being ‘tired of life’ is not grounds for euthanasia” (British Medical Journal).
  2. Dutch legalise euthanasia” (BBC News)
  3. Deadly diagnosis in the Netherlands” (Concerned Women for America)
  4. Dutch doctors want to kill the healthy” (Christianity Today)
  5. Euthanasia does not seem to be under effective control in the Netherlands.”
  6. Dutch euthanasia law should apply to patients ‘suffering from living.” (British Medical Journal)
  7. Who killed Grandpa? (Chuck Colson)
  8. From a slippery slope to an avalanche” (Chuck Colson)
  9. Coming soon to a hospital near you” (Chuck Colson)
  10. Professor of Death: Peter Singer” (Christianity Today)
  11. Interview with Phillip Nitschke: Australian euthanasia advocate
  12. Bishop Fisher & Dr. Phillip Nitschke in Sydney euthanasia debate

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