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The Euthansia Debate: Part One


Understanding the Issues


by J. P. Moreland



In June of 1990, Dr. Jack Kevorkian, a 63-year-old retired pathologist, was charged with first-degree murder after he helped an Oregon woman with Alzheimer's disease commit suicide in June 1990. The charge was dismissed in December 1990. (Michigan has no law against suicide.) In October of 1991, Marjorie Wantz used a suicide machine devised by Kevorkian to take her own life. Kevorkian also assisted Sherry Miller in an act of suicide by pulling a mask over her face so she would inhale carbon monoxide from a tank. Miller's veins were too delicate for a needle involved in Kevorkian's suicide machine. The police found both bodies in a cabin 40 miles north of Detroit. Miller was incapacitated by multiple sclerosis and Wantz suffered from a painful pelvic condition. Neither condition was life threatening.


During 1991, one of the top-selling books in America was Final Exit written by Derek Humphry. Humphry, co-founder of the National Hemlock Society (a right-to-die group), wrote the book to advocate the moral appropriateness of suicide and active euthanasia and to instruct people in the practical how-to's of taking their own lives. Based on the book's sales, there is a growing hunger for this type of information.


These cases illustrate the fact that the rise of advanced medical technologies, especially life-sustaining ones, has brought to center stage the various moral issues involved in euthanasia. People can be kept alive against their wishes or in states of pain and other forms of suffering (e.g., loss of control, fatigue, depression, and hopelessness). It is also possible to keep people alive who are in a coma or a persistent vegetative state. The former refers to a condition wherein the eyes are closed, the person cannot be aroused, and there is no sleep/wake cycle. The latter refers to a condition wherein there is no awareness (including awareness of pain and suffering), no rationality or emotionality, the eyes are open, and there is a wake/sleep cycle. In cases like this, the use of medical technologies raises questions about the moral appropriateness of sustaining life versus taking life or allowing someone to die.[1]


The major life-sustaining interventions that are involved in cases such as these are the following:[2]

1. Cardiopulmonary Resuscitation (CPR). This refers to a range of interventions that restore heartbeat and maintain blood flow and breathing following a cardiac or respiratory arrest (e.g., mouth-to-mouth resuscitation, electrical shock to restore the heart to its normal pacing).

2. Mechanical ventilation. This refers to the use of a machine to assist in breathing and in regulating the exchange of gases in the blood.

3. Renal dialysis. This has reference to an artificial method of sustaining the chemical balance of the blood when the kidneys have failed.

4. Antibiotics. This designates a number of drugs used to protect a patient from various types of life-threatening infections.

5. Nutritional support and hydration. This refers to artificial methods of providing nourishment and fluids. It usually involves the insertion of a feeding tube that delivers nutrition directly into the digestive tract or intravenous feeding that delivers nourishment directly into the bloodstream. Later, in Part Two of this series, I will look at the debate regarding the appropriateness of classifying artificial food and hydration as medical treatments.


The word "euthanasia" comes from the Greek words eu and thanatos and means "happy death" or "good death." Roughly speaking, there are two major views about euthanasia. The traditional view holds that it is always wrong to intentionally kill an innocent human being, but that given certain circumstances it is permissible to withhold or withdraw treatment and allow a patient to die. A more recent, radical view is embraced by groups such as the Hemlock Society and the Society for the Right to Die. It denies that there is a morally significant distinction between passive and active euthanasia (defined below) that allows the former and forbids the latter. Accordingly, this view argues that mercy killing, assisted suicide, and the like are permissible.


The issues surrounding the euthanasia debate are tips of a much larger iceberg. At stake are crucial world view considerations regarding what it is to be human, what the purpose of life, suffering, and death are, and whether or not life is a gift from God.


In this series I will explore the issues and options that are crucial for developing an informed perspective on euthanasia. In Part One, we will look at important ethical concepts that provide a background for understanding the nuances of the euthanasia controversy and I will state the main features of the traditional and radical views about euthanasia.


In Part Two, the focus will be on critiquing the radical view, defending the traditional view, looking at the issue of artificial food and hydration, and, finally, stating the world view considerations that the euthanasia debate exemplifies.


IMPORTANT ETHICAL DISTINCTIONS


Natural Moral Law


How should a Christian approach moral issues in a pluralistic culture? Should he or she try to work for a Christian state (one where the state is under Scripture) or should the goal be a just state?[3] Must a believer appeal to Scripture in a moral argument with an unbeliever or is there, in addition, a further source of moral truth and knowledge?


Throughout the history of Christianity, most Christian thinkers have acknowledged that there is something called natural moral law sourced in general revelation (certain knowable truths revealed by God through creation). Simply put, an advocate of natural moral law believes that there are certain moral laws or norms that are true and can be discerned by all men and women as men and women. These moral norms do, in fact, come from God, and the existence of such objective moral norms provides strong evidence for the existence of a moral, personal God. But one does not need to believe in God or appeal to Holy Scripture to know that certain moral precepts are genuine moral absolutes.[4]


Again, these basic principles of moral obligation are absolutes that are knowable (at least in principle) by all people everywhere without the aid of Scripture. What is meant by an absolute here? An absolute is an objectively true moral principle that is unchanging and cross-cultural. It is true whether or not anyone believes it to be true. Natural moral law theory implies that we discover morality -- we do not invent it.


Belief in a natural moral law seems to square with the Scriptures themselves. For example, one often finds the Old Testament prophets pronouncing judgments on Gentile nations who did not have the Law of Moses. The pronouncements of judgment often appeal to the fact that these nations have violated fundamental principles of morality which they know to be true -- breaking promises, lying, murdering, stealing, oppressing the poor and weak (e.g., Amos 1--2). These nations do not know the God of Israel nor do they possess Holy Scripture, but they are culpable for violating basic moral principles that they should know to be true simply because they are human beings with access to the natural moral law.


In the New Testament, texts such as Romans 1--2 indicate that Paul believed in a natural moral law. In this passage, Paul teaches that there is a universal knowledge of God and His moral law that is available to all men and women apart from the special revelation in the Bible. Humans, he tells us, can sin against nature (Rom. 1:26, 27); that is, against natural obligations that they should know are right because of the way things are in creation.


Furthermore, Paul candidly observes that "when Gentiles, who do not have the law, do by nature things required by the law, they are a law for themselves, even though they do not have the law, since they show that the requirements of the law are written on their hearts" (Rom. 2:14-15 NIV). In other words, Gentiles have a knowledge of right and wrong even though they have no access to Scripture. As C. S. Lewis put it, the great majority of civilizations have acknowledged "the doctrine of objective value, the belief that certain attitudes are really true, and others really false...."[5]


While we should not be naive about moral agreement, nevertheless, natural moral law theory offers the believer this strategy: he or she should work for a just state; that is, one in which the common good is in keeping with the natural moral law. And we can have confidence that everyone should have ac