Thursday, June 19, 2008

Euthanasia and the Worldview of Suicide

Those who don't believe in God are obliged to play God. Playing God on the slippery slope is not very comfortable, but unless you are religious, there is no alternative."

- Minette Marrin
[1]


"Purveyors of postmodern ideologies must consider whether it is possible to diminish human beings in theory, without, at the same time, making individual human lives worthless in the real world."

- David Hirsch
[2]


Many of the political and ethical issues we face in the contemporary world are like icebergs floating in the ocean. We see the surface of the iceberg, or maybe just its tiny tip, but we do not see the vast structure under the water holding up the visible portion. Likewise the position one takes on a political or ethical issue is normally the result of a vast supporting structure. This structure often remains just as invisible as the underwater portion of an iceberg.


The supporting structure to political and ethical standpoints is one’s worldview. We all have a worldview whether we realize it or not. More often than not, a person fails to realize that their worldview is operating in the background to produce the spectrum of political opinions he or she holds.



Now imagine if we were trying to destroy an iceberg and after destroying the visible tip we thought our job was finished. That would be akin to the way that many conservative and Christian activists approach political discourse, content merely to address the latest manifestation of a competing worldview without penetrating to the root of the problem (if I can be permitted to temporarily mix metaphors).



This problem was impressed on me in 2006 when I joined thousands of other UK Christians to fight against a bill that would have legalized physician assisted suicide. This was a perfect opportunity to uncover, understand and address the worldview of our opponents, yet for the most part the church missed this valuable opportunity. As usual, both sides were content to simply attack the surface manifestations of their opponents’ worldview, without ever debating the foundational points of divergence.



Since the debate over physician assisted suicide is far from over, I would like to suggest how the debate can be restructured in terms of worldview. God-willing, this will equip Christians for the next time the debate flares up.



Worldviews in Collision



The Christian position on the sanctity of life is rooted in the Genesis account of creation. Here we are told that mankind was made in the image of God. “So God created man in His own image; in the image of God He created him; male and female He created them.” (Gen. 1:27)



The doctrine of the Image Deo is the basis for the sanctity of human life. Our life has a value to it that plant and animal life, though important, does not share. Thus, when God expressly forbad murder in Genesis 9, the reason He gave is because man was made in the image of God. “Surely for your lifeblood I will demand a reckoning… Whoever sheds man’s blood by man his blood shall be shed; For in the image of God He made man.” (Gen. 9:5-6)



Western society has acknowledged the sanctity of life in a way no other civilization ever has. This is because historically the foundation of our society has been rooted in the Judeo-Christian worldview. At the center of this worldview is the dignity of man as a being uniquely created in the image of God.



At the time of the ‘Enlightenment’, this worldview was challenged. The spiritual understanding of reality was replaced by a purely mechanical understanding of things.[3] This gave rise to the worldview known as ‘Materialism’ or ‘Naturalism.’ Materialism, according to the Concise Routledge Encyclopedia of Philosophy, is the view that “all entities and processes are composed of – or are reducible to – matter, material forces or physical processes. …materialism entails the denial of the reality of spiritual beings, consciousness and mental or psychic states or processes, as ontologically distinct from, or independent of, material changes or processes.” Put more simply, the universe of the materialist is one in which everything, including you and me, is reduced to physics and chemistry.



Materialism’s Chief Casualty: Man

At the time of the Enlightenment, many people found the materialist worldview appealing because it meant that God became irrelevant. Man, not God, became the measure of all things. Human experience rather than God and His revelation, became the central hub for making sense of our world and experience. Similarly, mankind and non-spiritual explanations became the ultimate criterion for determining value. These are generalizations, of course, but they do denote a general trend that can be found in the writings of the 18th century, especially those which came out of France. In these writings there is a great sense of optimism about the new worldview, because by getting rid of God, the role of man was being elevated.



Or so they thought. In actuality, the opposite happened. When you get rid of God, what are you left with to call man? A meaningless collection of particles that are separated from the beasts only by virtue of complexity. Getting rid of God did not elevate man; rather, it dragged man down. Human beings ceased having the dignity that derived from being created in God’s image. Thus, ironically man became the chief casualty in a worldview that originally sought to glorify him.



Now the important point to grasp is this: although the worldview of materialism robbed man of his value as an image of God, the effects of this worldview were not actually felt at the time of the Enlightenment. The materialists of the Enlightenment still believed in the innate value and dignity of man because of the residue of the Christian worldview. When a civilization moves from one worldview to another, it often takes hundreds of years for the old worldview to wear off, even in the thinking and practice of those who have rejected the old worldview. So the materialists of the Enlightenment really had the best of both worlds: the could advocate materialism, along with the corollary that God was no longer an inconvenient obstacle, while still working on the borrowed capital of thousands of years of Christian heritage. Though in theory man materialism made man no different to the beasts, both being collections of predetermined chemicals in a universe bereft of any higher spiritual meaning, in practice everyone still acted and thought as if mankind had innate value.



This state of affairs continued for a long time. Even when Darwinism charged the materialistic worldview with an enormous boost in the 19th century, the borrowed capital of the Christian worldview still continued to function, lending innate value to our concept of man. Even those who no longer believed that man had been made in the image of God, still acted as if he was.



The Borrowed Capital Runs Out

In the later half of the last century, this barrowed capital ran out. Actually, it wasn’t quite so defined as that, because it has been a very gradual process. We see this progression in how artists depicted man. Ever since the Enlightenment, the paintings of man have gradually become more and more fragmented, obscure and meaningless. But it wasn’t until very recently that we have felt the full force of the materialistic worldview on every level of society. Abortion is only one example. If mankind is not the very image of God, then the value of human life becomes a matter of ‘choice.’



With something like abortion, it’s easy enough to see the impact wrought by materialism. What is harder to grasp is the more subtle ways this worldview has permeated every level of our society. The worldview of materialism does not need to be stated, defended or spelled out in order to affect us. This is because materialism is the worldview that exists by default whenever things are not explained spiritually. If something is not understood spiritually, then by definition it is understood in terms of the non-spiritual, that is, the material. This means it is very easy for a Christian to unwittingly be a practicing materialist. Many Christians believe in God and the Bible, they believe that Jesus died for their sins and they are saved, but they still do not view all of life through the lens of the spiritual – they are practicing materialists. Harry Blamires points out that materialism remains


"the unexamined presupposition in the very air we breath as thinking beings. The average citizen these days is a victim of daily, hourly brainwashing by the media, the press, the radio, television, the adverts and so much else in our cultural environment that is hammering into his head the notion that this life in time is the only thing that matters – that all questions of meaning, purpose, good and evil are exclusively a matter of a seventy year life-span on this planet. You don’t have to keep on saying this explicitly in order to convey it. All you have to do is to provide a ceaseless flood of entertainment, news, discussion, comment which bypasses all questions of spiritual reality and ignores even the possibility of supernatural life."[4]



That is, I fear, an apt description of the situation in which we now find ourselves. You may still be hard pressed to find actual atheists around, yet our whole environment is atheistic in so far as it gets on and functions without reference to God. Questions of value are addressed, discussed and answered without reference to the spiritual. A corollary to this is that when people consider why it is wrong to kill, they cannot appeal to principles like the sanctity of life or the innate value of human beings, since such principles are ultimately rooted in a spiritual landscape foreign to the modern worldview. If man is not in the image of God, but simply a random collection of molecules, then it is a leap of faith to believe he has any special significance, let alone innate value. As I already mentioned, for a long time our civilization still held to these principles unthinkingly, as the residue of the Christian worldview. But that borrowed capital has run out.



Utilitarian Ethics

As the borrowed capital runs out, the result is not social anarchy. People are not killing each other in the streets. We still have to have some kind of ethical framework to function. In the materialistic worldview of today, the ethical framework is an implicit consensus that actions should be promoted which promote the general welfare. This general welfare is seen as the collective happiness of mankind. Now you won’t hear very many people talking like that, but it is still the implicit principle people fall back on to defend public policy or personal choice. This can be seen in the way personal choices are viewed as legitimate so long as they promote my own welfare without infringing on anyone else’s. In fact, it has become an unspoken axiom that so long as these conditions are met – that an action is going to make me happy and it isn’t going to interfere with anyone else’s happiness - that you cannot criticize the decision. On the larger scale, to convince someone that a political decision is legitimate, all you have to do is to show them that it promotes the public welfare (that is, happiness, security, stability) of the citizens, without radically infringing on anyone else’s welfare, and then the case is won. This approach to ethics is called utilitarianism.


In his book Postmodern Times, Gene Edward Veith writes that


"Utilitarians decided moral issues, not by appealing to transcendent absolutes, but by studying the effect of an action upon the system. Stealing is wrong, not because the Ten Commandments say so, but because stealing interferes with the economic functioning of society. Something is good if it makes the system run more smoothly. Something is evil if it interferes with the cogs of the vast machine. Practicality becomes the sole moral criterion. If it works, it must be good."[5]



If I had more space, I think I could show that the contemporary concept of ‘human rights’ is based on this same model. Although people talk about human rights today as if they are innate and inviolable, they are really derivative of this utilitarian ethical framework. The right to pursue my own autonomous path, rooted in a deep sense of entitlement to my own well-being, is the basis of many, if not all, human rights today.



The Ethics of Suicide

The utilitarian framework can still say that murder is wrong. Obviously, it would not advance the general welfare of society to allow indiscriminate killing. But what happens if I want to kill myself? Moreover, what happens if I think killing myself will be in my best interests?



Traditionally, our legal system has always prohibited suicide on the basis that human life has innate value. But if personal value is derived from personal welfare and happiness, then suicide can be justified provided I believe it will benefit me. For example, if I am suffering or depressed and suicide relieves me of this burden, then why shouldn’t I have the chance, even the right, to take my life?



This is the reasoning of the euthanasia lobby and it is a consistent outworking of the materialistic worldview as well as the utilitarian mindset that follows from it.



The Slippery Slope

As the borrowed capital of the Christian worldview continues to run out, euthanasia is just the beginning. If we analyze the utilitarian principles on which euthanasia is based, we find, alarmingly, that these principles justify a lot more than merely suicide.



Consider, for example, the principle of preventing suffering, which is the primary argument urged to support physician assisted suicide. Now the prevention of suffering, though important, is not itself sufficient to ensure that an action is morally right. If it were, as the defenders of euthanasia imply, then we would be compelled to kill people who are perpetually unhappy, or eliminate groups of people that contribute to the unhappiness of society. The result would then almost definitely be a situation similar to Holland, where the utilitarian principle on which euthanasia is based is carried to its logical consequence.



Dutch judicial authorities have made an agreement with the Groningen university clinic, that authorizes euthanasia in children under twelve without their consent. Dutch parents who choose to raise disabled children have been known to hear comments like, ‘Such a thing should have been given a lethal injection.’ In August of 2005, the primary association of Dutch doctors asked the Health Ministry to create an independent board for considering euthanasia cases for terminally ill people ‘with no free will.’ Among those with ‘no free will’ were children, severely mentally retarded people and those in an irreversible coma. Prominent Dutch voices are now calling for an “end of life pill” to be handed to everyone who reaches 75.



One of the questions that gets raised whenever Britain considering legalizing physician assisted suicide is, are we going to descend down this same slippery slope? Lord Joffe, who was responsible for introducing the controversial bill, himself said, revealingly, ‘We are starting off, this is a first stage… I believe that this Bill initially should be limited, although I would prefer it to be of much wider application… But I can assure you that I would prefer that the law did apply to patients who were younger and who were not terminally ill but who were suffering unbearably, and if there is a move to insert this into the Bill I would support it.’[6]



For many people, Lord Joffe’s appeal to cutting short pain and suffering for the dying, seems like the compassionate course. However, someone (it might have been Chesterton) once said that compassion is the last refuge for those who have no morals. It is dangerous when appeal to compassion overrides more fundamental ethical principles. Let us not forget that eugenic selection can be masked by compassion just as easily as assisted suicide. Provided that more people benefit than are harmed, social engineering might be defended with similar utilitarian arguments.



Equally dangerous is the fact that those who advocate assisted suicide are urging that assisted suicide brings ‘healing’ in a more general sense, since it releases the sufferer from pain. But once the distinction between healing and harm is blurred in this way, involuntary euthanasia can also be defended on grounds of ‘healing’ for those who suffer. To go one step further, it might be argued that it is ‘healing’ for our nation when certain segments of society are targeted for elimination. For example, in Germany in 1920, a document was published which suggested that killing mentally ill, retarded and deformed children was a ‘healing treatment.’[7] If doctors can treat the death of one individual as a ‘treatment option’, what is to stop government from treating the death of thousands – for example, minority groups – as a ‘treatment option’ for society? The genocide of the elderly might similarly be view as a ‘healing treatment’ for our economy since a significant portion of our healthcare budget is spent on those in the last year of life. Only by maintaining the conventional distinction between healing and harm in the small areas, will we be protected from their confusion in the larger areas.



Only by maintaining the conventional distinction between healing and harm in the small areas, will we be protected from their confusion in the larger areas. Yet what is conventional can never be maintained for long without being rooted in a worldview. The worldview of materialism does not give us a sustainable criteria for distinguishing between healing and harm in these difficult areas. Utilitarianism offers no safeguard against those who would confuse these categories on a wider scale, in the name of general welfare. Neither does postmodernism, in any of its manifestations, offer any safeguard, since the relativism it offers presents a flexibility to truth that can bend to accommodate any circumstance or agenda, however harmful and subversive.



Vulnerable People at Risk

History has shown that utilitarianism usually always exploits those who are weak and vulnerable. Veith points out that “Utilitarianism was the view that justified slavery, exploitive child labor, and the starvation of the poor, all in the name of economic efficiency.”
[8]



In a consistently applied utilitarianism, it is always the vulnerable people who suffer, usually the really young, the really old and the disabled. This is the logical result of determining a person’s value by how that person benefits either himself or society. On the other hand, the vulnerable, disabled, weak or dysfunctional are protected when we affirm that human life is intrinsically valuable regardless of external conditions.



The fact that physician assisted suicide and euthanasia put vulnerable people at risk does not in itself make it wrong, as if I were arguing against these practices on utilitarian grounds. However, the effect that these practices have on vulnerable does serve as a useful illustration of what happens when our criteria for valuing life is reduced to a person’s external circumstances or internal state of consciousness.



Physician assisted suicide puts vulnerable people at risk because it could create conditions whereby vulnerable people would feel pressure, whether real or imaginary, to request early death. The elderly, lonely, sick or disabled may ‘choose death’ so as not to be a burden to others. No amount of precautions to ensure the death is voluntary can stop such pressures from effecting a person’s decision. In the state of Oregon, for example, the number of people who requested assisted suicide because they felt a burden to their families or carers raised from 12% in 1998 to 63% in 2000.[9] In the minds of such people, the ‘right to die’ became a duty to die.
Another way that physician assisted suicide puts vulnerable people at risk is by assuming the dying or infirmed can handle a dangerous degree of autonomy. People whose minds have been worn down through pain, depression or senility gain enormous security from knowing they can trust their doctor to make decisions in their best interests. It is not hard to see how the possibility of physician assisted suicide could severely undermine this relationship of trust.
[10]



If physician assisted suicide or euthanasia become legalized, then those who are responsible for providing or financing palliative care may begin to resent the ones who choose to ‘stick it out.’ Here again, vulnerable people are put at risk. Professionals responsible for offering palliative care may cease to meet the emotional and psychological needs of those who suffer acutely yet reject assisted dying, on the grounds that “this person’s suffering isn’t necessary anyway, because they can always have a PAS [physician assisted suicide].”



Another way that euthanasia would put vulnerable people at risk is by endangering terminally ill patients who do not choose to have a PAS. In the Netherlands, the progression from assisted suicide to involuntary euthanasia is well documented. The Remmelink Report analyzed that one in three of the deaths caused by euthanasia were ‘without explicit request.’ Even though doctors in Holland are legally required to gain consent, once they begin looking upon death as a ‘treatment’ option, it is something they feel compelled to give. In 1990 Dutch doctors killed more than 1,000 patients without their request.[11] Five years later, another study found that out of 4,500 euthanasia deaths, one in five occurred without the consent of the patient.[12] These figures do not even include the thousands of cases of indirect euthanasia where treatment was withheld with the direct intention of shortening life without any explicit request from the patient.



Pain abating drugs are now so highly developed that most types of pain can be relieved. When a patient thinks his/her suffering is unbearable, this is often a reflection of depression, fear or other non-medical treatable issues. These other factors may make a person feel like cutting off their life in a sudden moment of despair, even when the level of physical suffering is manageable. “Palliative care specialists have noted that unbearable suffering prompting the request for assisted dying is often a reflection of unresolved psychological issues.”[13] In all such cases, there may be solutions other than death that the patient has not considered or does not know about, such as support, discussion, counseling, reassurance, therapy, anti-depressant drugs, etc. It requires considerable skill to know when these other methods are viable solutions, and it is not to be expected that every doctor will have this expertise.



Evidence from Holland suggests that some patients with terminal diseases or disabilities fear their doctors who may regularly offer euthanasia. Many Dutch patients are asking to be transferred to German hospitals because they fear their doctors. Further, patients who are opposed to PAS on moral grounds, may fear their own decisions once their rationality has been worn down through pain or senility.



All of this reinforces the contention that vulnerable people are put at risk so long as the value of human life is seen to rest with the mental state of the sufferer.[14] Vulnerable people are the first casualty when personal value or identity is dependent on either external circumstances or one’s state of consciousness.



Redefining the Human Person

Tony Bland was a patient in a permanent non-fatal coma. Philosophers such as John Harris from Manchester University and Peter Singer from Harvard, argued that Tony may have been human, but he was not a person. Tony Bland’s consultant neurologist, a follower of Harris, also took this view. When asked whether he saw Tony as a person, Howe replied,

“No, his personhood had gone when his chest was crushed; he was not a person in the sense that I understand it, in an ethical sense. A person is someone who has the capacity to value their life: that’s the definition given by Professor Harris from Manchester, and I think it’s the best one I have seen. A person is that creature, that sentient creature, which has the capacity to value its own life, so by that definition chimpanzees and gorillas are persons; we should not kill them, any more than we should kill other human beings who don’t want to be killed.”
[15]

Tony was allowed to be slowly starved to death.



One hopes that most people, whether they are Christians or not, would have an instinctive revulsion to the definition of a person as someone who has the capacity to value their life. One also hopes those who find this definition distasteful would back up to consider whether their worldview can actually sustain a more stable criterion of value. After all, if human beings are simply highly evolved apes, if human beings are separated from the animals merely by virtue of complexity, then it is hard to see how personal value and ethical standards can be rooted in anything more stable than consciousness. In the end, a totally consistent materialism cannot even fall back on consciousness-derived-value. Someone once asked George Wall, a professor of Harvard University, who Shakespeare was in his view. Wall replied that Shakespeare was a random collection of molecules that existed four hundred years ago. None of us can boast to be anything better if the materialism is correct – we are all random collections of molecules. Now here’s the point: who cares if that random collection of molecules values it’s consciousness – there can be no real value, not in the objective sense that makes that thing we call ethics possible. For that, you need the Biblical worldview.


Psalm 11:3 asks, “If the foundations are destroyed, what can the righteous do?” By advancing the Christian worldview in our own lives, families and communities, we can begin to rebuild the foundations. Already this is happening with so many different families wanting to give their children a Christian education, and so many different ministries devoted to articulating and applying the Christian worldview to every aspect of life. So there is a lot to be encouraged about. For many years the church was living on the borrowed capital of the Christian worldview just as much as the world was, without properly thinking things through. Now that this borrowed capital has run out, Christians seem to be waking up, returning to their foundations and really trying to articulate the Biblical worldview. That has been a good thing, something which I think the devil never anticipated. We should be encouraged.




[1] Minette Marrin, 'An Acceptable Way to Arrange Our Death', The Sunday Times, May 14th 2006.

[2] David Hirsch, The Deconstruction of Literature: Criticism after Auschwitz (Hanover, NH: Brown University Press, 1991), p. 165.

[3] See my book The Decent Drapery of Life, available from http://www.lulu.com/ (forthcoming).



[4] Harry Blamires, lecture, “The collision between Christian and secular thinking”, available online at www.christian.org.uk/downloads/audio/archive1990/01_secularage.htm



[5] Gene Veith, Postmodern Times.



[6] Transcript of parliamentary session, available online at http://www.parliament.the-stationery-office.co.uk/pa/ld200405/ldselect/ldasdy/86/4091603.htm



[7] See David Stolinsky's article, ‘Assisted Suicide of the Medical Profession’, 20 March, 2006, available online at http://www.stolinsky.com/news/news/news_item.asp?NewsID=249

[8] Veith, op. cit.

[9] Data taken from ‘interview with neonatologist Carlo Bellieni, 6th May 2005.

[10] See “Euthanasia – the erosion of trust?” Royal College of Physicians Journal, Vol 5: March/April: editorial.)

[11] See Keown J, Euthanasia Examined, Cambridge University Press, 1995, p. 270.

[12] See Jochemsen H and Keown J, ‘Voluntary Euthanasia under control?’; see also Journal of Medical Ethics, 1999; 25: 16-21; see also van der Maas, J.; van Delden, J.J.M. and Pigenborg, L., Euthanasia and Other Medical Decisions Concerning the End of Life: An Investigation Performed Upon Request of the Commission of Inquiry into the Medical Practice Concerning Euthanasia (Elsevier Science Publishers, Amsterdam, 1992), pp 73, 75, 181 - 182.

[13] “Written evidence to the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill”, collated by The Royal College of Physicians of London.

[14] Even though euthanasia puts vulnerable people at risk, advocates of the practice paradoxically uge that assisted suicide is the ‘compassionate’ course for those whose suffering is unbearable. The emotional appeal of this argument is accentuated by the fact that they routinely take a handful of difficult, extreme cases, and then uses those to argue for a change in law. However, it is dangerous when appeal to compassion overrides more fundamental ethical principles. Eugenic selection can be masked by compassion just as easily as assisted suicide. (This point was made by Arlov Bellieni, MD, in ‘Witholding and Withdrawing Neonatal Therapy: An Alternative Glance’ from Ethics & Medicine: An International Journal of Bioethics.)



[15] Cited by Andrew Dunnett in A Euthanasia: The Heart of the Matter, Hodder and Stoughton, 1999 , pp. 78-79.



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