A Christian case for assisted dying

Reverend Paul Badham is Professor Emeritus of Theology and Religious Studies at the University of Wales, a supporter of Inter-Faith Leaders for Dignity in Dying and author of Is There A Christian Case for Assisted Dying? The blog below is based on his recent talk to members of the Church in Wales’ Governing Body. The Church in Wales has decided on a policy of neutrality and study. They do not endorse any position at the present time but instead commend the issues for further prayer study and consideration.

I am glad that the Church in Wales is discussing this important and topical subject. In July Lord Falconer, the former Lord Chancellor, is bringing forward a bill to legalise assisted dying. It is designed for people in the final stages of terminal illness, who are suffering unbearably and want help to end their own lives. Safeguards proposed are that the option will be limited to adults of sound mind who have a voluntary, clear, settled and informed wish to die and who are able to self-administer the medication. Two doctors must confirm that the patient is terminally ill and expected to die within six months.

The value of palliative care

The numbers involved will be very low because with good palliative care, most suffering can be palliated. The hospice movement has been a fantastic success story and one which Christians are justly proud to have supported. But it does not meet all needs. Baroness Finlay, the leading palliative care specialist in Wales, has acknowledged that palliative care “does not get it right 100 per cent of the time”.  Unfortunately, it is also the case that some patients find the whole dying process unbearable. We know this because new members of societies like Dignity in Dying give as their principal reason for joining that they have witnessed at first hand the suffering of a parent or spouse and they want the law changed so that others do not suffer in the same way. That is certainly my own motivation.

“I remember my father in his last days saying he had never imagined there could be so many different varieties of pain.”

Religious arguments

Jesus’ key teaching
A Christian case for supporting assisted dying is based on Jesus’ teaching that the whole of religious law and prophetic teaching can be summarised as requiring us to love God and to love our neighbour as ourselves. Jesus’ golden rule was that we should always treat others as we wish to be treated ourselves. Applying this to assisted dying the argument is: When people’s sufferings are so great that they make repeated requests to die, it seems a denial of that loving compassion which is supposed to be the hallmark of Christianity to refuse their requests. If we truly love our neighbours as ourselves how can we deny them the death we would wish for ourselves in such a condition?

“When people’s sufferings are so great that they make repeated requests to die, it seems a denial of that loving compassion which is supposed to be the hallmark of Christianity to refuse their requests”

Do no murder
Some reject this argument because murder is forbidden by the sixth of the Ten Commandments. However the reason murder is condemned is that it is an act that deprives another person of all that life offers. But when a dying person is already being deprived of life by a terminal illness and wants help to hasten that process, the situation is rather different. However our natural abhorrence of taking another person’s life is the reason why in Britain the campaign is for assisted dying rather than voluntary euthanasia . In voluntary euthanasia the doctor administers a lethal drug. In assisted dying, patients must be able to self-administer so that right to the end it is their own choice.

God and the hour of our death
Some argue that only God should decide the hour of our death. But we need to be consistent. If we truly believed that only God should determine the hour of our death, then we should think it as wrong to use medical means to extend life as to shorten it . In past ages many Christians held precisely that view. Today if a person’s heart stops we assume that the hospital should normally attempt resuscitation even though for most of human history the time when the heart stopped was seen as the time that God had chosen to end that person’s life.

Suffering
Consistency is also needed in our attitude to suffering. We cannot say that that assisted dying is wrong because suffering is part of God’s plan for us unless we are prepared ,as Pope John Paul II was, to say that palliative care is also problematic . He believed that dying Christians should moderate their use of pain killers so that they could share in the suffering of Christ. Fortunately few carers adopt that position.

Parallels between birth and death
Similar issues arise with contraception. The papal encyclical against euthanasia uses the same arguments as the encyclical against contraception. Yet the vast majority of Christians today, including most catholic couples, believe in the legitimacy of planning when a new life should begin. To be consistent we should hold that if it is morally legitimate to seek medical assistance in the timing of birth and in the avoidance of suffering during birth it should be equally right to seek medical help and assistance in the timing of death and in the avoidance of suffering while dying.

Consequences of Change

Palliative care in Europe and Oregon
The primary reason people oppose changing n the law is that they are worried about potential damage to health care following such legislation. However we need not speculate pessimistically about what the consequences of legalising assisted dying might be. Instead we can look at what actually happens to health care in European countries and American States when they pass such legislation. When we do this we find that many of the fears that people have lack any real foundation.

For example, on March 14th. an editorial in the Church Times suggested that legalizing assisted dying might lead to the dismantling of palliative care services. Contrary to this the European Association for Palliative Care found that palliative provision had improved in Luxembourg, the Netherlands and Belgium since they legalised voluntary euthanasia. Indeed Belgium had actually introduced a universal right to palliative care alongside the right to die.

“absolutely none of the dire consequences that had been predicted had occurred”

In Oregon, the Hospice Association had passionately opposed the Dignity in Dying Act and had foretold it would cause all manner of problems. But after eight years experience of it, they issued a new position statement acknowledging that “absolutely none of the dire consequences that had been predicted had occurred” . Instead, the percentage of terminally ill Oregonians enjoying palliative care had risen from 22 to 51%.

Swiss and Dutch Geriatric Care
Opponents of assisted dying often claim that if assisted dying were to be legalised we would soon find that “ a right to die became a duty to die. “ But that hasn’t happened elsewhere . The Swiss, who have had the right to an assisted death for over seventy years , continue to live an average two and a half years longer than we do and they live longer with terminal illnesses.. Likewise the Netherlands, which is the country with the most voluntary euthanasia, is also the country which spends most money on long term geriatric care.

The Euro Health Consumer Index
It seems to be the case that legalizing assisted dying is associated with substantial expansion of health care provision for the elderly and dying. The reason for this is that If you prioritize what patients want, as you do when legalizing assisted dying, you find that what the vast majority want is not assistance to die but assistance to live more fully in the final stage of their life. Very few take up the option: assisted deaths make up 3% of all deaths in the Netherlands, and 2 % in Belgium. There is no slippery slope. The legalisation of assisted dying is primarily welcomed for the reassurance it gives. In Oregon for every 200 people who discuss the option with their doctor, only two end up being given lethal drugs and only one takes them. The rest simply have the comfort of knowing that assistance to die would be available if their suffering became unbearable.

Key data about comparative health care are available on-line from the World Health Organization and the OECD. For Europe, the best source to google is the Euro Health Consumer index . This index is based on official statistics and research reports on six areas essential to public health, These are patients’ rights, waiting times, medical outcomes, range of services, drugs available and ill-health prevention measures. Thirty-five countries are compared on the basis of these figures . In the 2013 consumer index the four European countries which allow voluntary euthanasia are all in the top seven with The Netherlands and Switzerland in first and second places. Belgians have the most generous health care system while the Dutch have access to Health Care Centres 24 hours a day seven days a week. There really is no evidence that allowing people to have an assisted death leads to a lowering of health standards or a decline in public safety. I can see no reason why we should expect a different result in Britain. We have the world’s sixth largest economy. If we chose to prioritize patient choice, including the choice of an assisted death, we might see the same impact on our health care provision as it has had in European Countries and American States which have taken this path.

The Challenge to the Church

Opinion polls repeatedly show popular support for legalising assisted dying. Among monthly Churchgoers it is 78% and among weekly Churchgoing Anglicans it is 61%. Unfortunately however the Church of England Bishops in the House of Lords are all against it. Professor Linda Woodhead’s research shows that assisted dying is the issue on which the Church of England’s leadership is most at odds with wider moral thought. Professor Rob Warner’s research on Christian University students found that moral issues were the principal factor in their rejection of the Church at University. In particular he found that Christian undergraduates believe voluntary euthanasia to be “infinitely more humane than doctrinaire enforcement of prolonged suffering on the terminally ill. It would be wonderful if the Governing Body of the Church in Wales could demonstrate that not all Anglican Church leaders hold views that many of their laity and youth see as morally blind.