THEOLOGICAL ASPECTS OF EUTHANASIA
Anthony Fisher O.P.
in John Keown (ed.), Examining Euthanasia: Legal, Ethical and Clinical
Perspectives. Cambridge: Cambridge University Press, 1995 [forthcoming]
Catholic writers on euthanasia usually offer a largely philosophical
position, drawing upon that 'common morality' which is shared by all
civilized societies, and eschewing the specifically religious or
confessional. This allows them the better to engage in debate in a
pluralist society and reflects the fact that morality can, in principle, be
recognized by any reasonable person of good will, undeflected by
distracting emotion, prejudice or convention. But because of our capacity
for misdirection, and because we believe that the human situation is only
adequately and reliably illuminated by the life and teachings of Jesus
Christ, Catholics naturally look to the Church's scriptures and tradition
for guidance. Morality is thus matter not only for philosophy but for
doctrine and theology. It is a guide to a life which both befits our human
nature and reason, and responds to our divine calling (Finnis & Fisher,
1993). This essay seeks to complement the more philosophical ones in the
present volume, by showing the specific contribution which Catholic
theology has to offer.
1. The euthanasia of King Saul
The story of the death of Saul, the first king of Israel, is related in
the books of Samuel. Saul was badly wounded in battle by a Philistine
arrow. Afraid of being tortured and humiliated by his captors, he pleaded
with his armour-bearer to kill him (1 Sam 31:1-4; 1 Chron 10:1-4).1 There
are two versions of what happened next. According to the first, the man
refused, so Saul committed suicide by falling on his own sword (1 Sam 31:5-
6; 1 Chron 10:4). In the other account a young Amelikite came upon the
wounded Saul leaning on his spear, perhaps attempting suicide. Saul begged
him, "Stand beside me and slay me, for anguish has seized me and yet my
life still lingers." So the youth obliged (2 Sam 1:6-10) in what today we
would call an act of voluntary euthanasia, assisted suicide or mercy-
killing.
We might note a few points about this incident. First, to use our
contemporary slogan, Saul was thought to be 'better off dead', or in
current medico-legal parlance, death was 'in his best interests': in so far
as these phrases can be given any coherent meaning at all, they mean that
he might reasonably have hoped to die, to 'go to his fathers'. Secondly,
every one else was, more or less, better off with Saul being dead: David
certainly was. Thirdly, the Amelikite who slew Saul seems to have done so
with the best of motives: he was trusted by Saul and did nothing furtively;
he formally mourned Saul's death and brought the crown and a full account
to David. And fourthly, as the lad reported, "I stood beside Saul and slew
him, because I was sure that he could not live after he had fallen" or, to
put it in a modern idiom, "I stood by him and actively helped him have a
peaceful death because I was sure he was terminally ill". So Saul died at
the hand of a merciful man, having asked for euthanasia, being terminally
ill and in great suffering at the time.
Yet the undoubted conclusion of this story is that despite being done
with the best will in the world, this was none the less a wicked act,
deserving the severest of punishments.2 When the lad arrived to tell David
the news, no doubt expecting jubilation and personal reward, David did not
rejoice even though Saul had been a great 'burden', indeed an enemy;
instead he immediately rent his clothes, wept and fasted in a ritual
demonstration of non-complicity and mourning, and had the youth punished
for having killed his friend and the Lord's anointed (2 Sam 1:11-27).
2. Choose life
The so-called 'sanctity of life' principle,3 like the rest of Catholic
morality, rests upon two complementary sources: revelation (or faith,
theology) and reason (or natural law, philosophy). The God of the Bible is
a living God who communicates his life to all living creatures, above all
to the pinnacle of his creation, human beings (Gen 2:7; Ps 104:29-30; Isa
45:9-13; Zech 12:1).4 Human beings are accorded great dignity, created
uniquely as God's image and likeness, little less than gods themselves,
intimately known by God, joined to him as in a marriage covenant, destined
and oriented to him as their ultimate goal (Gen 1:26-31, 9:6; Job 12:10; Ps
8; Wis 2:23; Isa 57:16; Hos 2; Zech 12:1; 1 Cor 11:7; Eph 5; Rev 1:16; cf.
Aquinas, S Th IIa II� 1-5). The Incarnation and Redemption further dignify
human beings: the Son of God himself became human, and died to redeem all
people and make them 'children of God'. I will return later to the
significance of Christ's passion for our present issue. For now it is
enough to note that in the Christian view of things, life is a trust given
into our stewardship by God (CDF, 1980; <Catechism>, 1994: #2280); we are
called to choose life not death, and the ways of life not of death; any
killing demands justification and the taking of innocent human life is
always contrary to God's law and to that trust (Gen 4:8-11; 9:1-6; Ex
20:13; 21:22-25; 23:7; Deut 5:17; 30:19; 2 Kings 8:12;15:16; Jer 7:30-
32;19:4; 26:141-15; Mt 19:18 etc.). As the Catholic Church has recently
put it:
Scripture specifies the prohibition in the fifth commandment: 'Do not
slay the innocent and the righteous' (Ex 23:7). The deliberate murder
of an innocent person is gravely contrary to the dignity of the human
being, to the golden rule and to the holiness of the Creator. The law
forbidding it is univerally valid: it obliges each and everyone,
always and everywhere. (Catechism, 1994:#2261)6
Even if motivated by 'mercy' or a concern for the 'best interests' of
someone who is thought to be 'better off dead', no one should assume the
r�le of the Author of Life and Death.7
In common with people of other religions and none, the Christian
'natural law' tradition teaches that human beings are of great and equal
worth and ought to be respected by others and protected by society; life is
a basic good of human beings, a reason for action, an aspect of their
fulfilment, a good they share in common and part of their common good;
human lives are of such intrinsic importance that no choice intentionally
to bring about the death of an innocent8 person can be right.9 This
sanctity of life principle has been much referred to in legal cases and
most recently in the House of Lords Select Committee report on euthanasia.
It is said to be deeply embedded in our law and ethics throughout the
world, recognized in international human rights documents, and basic to our
common morality. It has also informed medical ethics since at least as far
back as Hippocrates: killing is amongst the ways in which healthcare
workers may not deal with their patients. Thus classical medical ethics has
held that physicians might not be called upon to act as public executioners
(Emanuel, 1991, pp. 19-20). Likewise it has traditionally excluded both
active and passive euthanasia. For these reasons the court and the General
Medical Council held that Dr Nigel Cox had acted "wholly outside" and
"contrary to" his duty as a doctor when he killed a patient even though
(like King Saul) she was in severe pain and had asked to be killed.10
Most people regard killing someone arbitrarily, or simply for advantage
or the convenience of others, as inconsistent with a recognition of that
person's dignity and as obviously immoral. More difficult cases arise when
a person asks to be killed, especially where that person is 'weary of
life', or in great pain, or very dependent, or a strain on the financial
and personal resources of others. Similarly when the person is living in a
state of permanent unconsciousness: most people would sympathize with a
family and doctors who hoped that such a patient would die sooner rather
than later. The question is: should we hasten the death?
The theological answer to this seems to be a resounding no: 'you shall
not kill'. But this is no mere superstitious taboo or perverse decree from
on high. Rationally we must recognize that were we to say yes to medical
killing we would have to abandon the sanctity of life principle: and that
is exactly what the proponents of euthanasia always ultimately do.11 Thus
some deny that there is anything about human beings <per se> which is
especially or equally valuable or deserving of respect: rather, they
require certain qualifications, such as colour, creed, age, lack of
handicap, or (as is presently fashionable) consciousness.12 Others, aware
of the dangers of this elitist and discriminatory move, argue instead that
every person's right to life should be respected <in principle>, but that
in some situations it might legitimately be compromised to serve other
important 'values' such as the supposed 'best interests' or 'well-being' of
the patient or (more often) the interests of the bystanders. This in turn
highlights the fact that essential to respect for the precept against
killing and to the killing-letting die distinction of classical and
Christian medical ethics is a high view of human dignity and equality, and
of our moral responsibilities in acting and forbearing to act with respect
to it.
3. The Agony in the Garden: Liberal autonomy -v- Thy will be done
Having reviewed some implications of the death of the first king of
Israel, we might turn now to the story of the death of the last: the
Passion of Jesus Christ. Here God like David will rend his clothes asunder
at the news of the killing of the king, tearing the veil of the Temple from
top to bottom. But there is more to be gleaned for the purpose of the
present debate than the principle of the sanctity of life.
The story begins with the agony in the garden (Mt 26:36-46 <et par>; Lk
22:39-46). Jesus, contemplating the full horror of his suffering and death,
is 'scared to death', falls to the ground shaking, and sweats blood. There
is no Stoicism here, no romanticizing of sickness and death. Jesus enters
into the full horror of human suffering: the pain and torment, the
loneliness and abandonment. And like any of us would, he prays that this
cup be taken from him. Yet he finishes his prayer, not like Saul asking to
be speared (indeed, Jesus will be dead before the centurion arrives with
that relief), but with the daily prayer of the Christian: "Thy will be
done" (Mt 26:39,42 <et par>; cf. Mt 6:10 <et par>). Even the prospect of
humiliation, pain and death does not dispense him from his obedience to the
Father, the will of God, the law of the Lord.
This brings us to a second issue in the euthanasia debate and the one
which receives the most attention in the press and the liberal
philosophical academy: personal freedom or autonomy. Christian faith as
well as secular bioethics have always required respect not only for the
life of persons but for their free will. But 'autonomy' is now often
equated with absolute freedom of self-determination, as when the House of
Lords Committee (1994:#234), in keeping with recent legal trends, declared:
"We strongly endorse the right of the competent patient to refuse consent
to <any> medical treatment, <for whatever reason>". This sounds very
reasonable in our individualistic, consumer culture; but, from a Catholic
perspective, it is a distorted view of human dignity and freedom. First,
because few sick people fit the somewhat idealized picture of the freely
choosing agent: as the BMA itself recognized, "even apparently clear
patient requests for cessation of treatment sometimes stem from ambivalence
or may be affected by an undiagnosed depressive illness which, if
successfully treated, might affect the patient's attitude" (Lords,
1994:#45). The Lords themselves expressed concern about the extent to which
the elderly, lonely, sick or distressed feel themselves subject to
pressure, whether real or imagined (1994:#239).
Another problem with a one-sided stress on autonomy is that it is
radically asocial, even anti-social: all that matters is that I get my own
way. But we are social creatures and human freedom is always exercised
within a web of relationships. Christ does not attempt to go to his Passion
alone: he takes his best friends with him to the garden and asks them to
watch and pray with him. We too have to respect others; we have to consider
the implications of our choices for their lives and for the common good. If
we want to be 'put out of our misery' someone else must be involved: so
someone else's 'autonomy' is unavoidably affected. So too is the community,
for as Donne put it "No man is an island, entire of itself: every man is a
piece of the continent, a part of the main... Any man's death diminishes
me, because I am involved in mankind."
The third problem with much autonomy talk is that it fails to situate
human freedom within the range of opportunities and values which are the
context of human choice. The flip-side of the freedom of the patient to
consent or refuse treatment, for instance, is that patients must exercise
this freedom reasonably, in pursuit of their own good health and with
respect for the good of persons in community. Free will is not mere whimsy,
as the Agony of Christ in the garden demonstrated so graphically: we are
not free to do 'whatever we please' with our bodies, our lives, our
opportunities. We have to take into account our calling from God, the
intrinsic morality of our choices, and their self-constitutive effects:
what they do to us, what they make us, what they say about us. In the face
of decisions as momentous as are those over life and death, we should say
with Christ "not my will, Father, but thy will be done".
4. Mary stood by the cross: the duty to care
Next in the Passion narrative comes the arrest, trial and execution of
Jesus. It presents each of us with the challenge: how do I respond to the
suffering and impending death of others? In the garden and the court we see
Jesus abandoned by his disciples; on the other hand Simon of Cyrene helps
carry the cross and Jesus' mother and friend wait by the foot of the cross�
by his bedside, if you will. This points to another basic principle in this
area: the duty to care for others. Negatively, this means we may not harm
people or treat them negligently or with disrespect ('<primum non nocere>':
first do not harm); positively, it refers to our 'Good Samaritan' duties to
show kindness to others, especially the most needy, and to our special
responsibilities towards dependant persons in our particular care.
Time and again the Scriptures and the Christian tradition call us
generously to care for those in need: widow, orphan, alien, sick.
Compassion expressed in engagement with people to alleviate their suffering
was very much a part of Christ's own mission, and was the standard of
judgment he offered: when you saw me hungry, thirsty, sick, imprisoned, in
one of the least of these my brethren, did you help? (Mt 25:31-46). But
such engagement is not the preserve of Judeo-Christian faith: it is a duty
supported by documents ranging from the Koran to the International Covenant
on Economic, Social and Cultural Rights. It is almost universally agreed
that access to certain basic measures such as food, water, shelter,
clothing, sanitation, basic medical and nursing care should be available to
all out of respect for their human dignity.
In addition to these common humanitarian duties we all have towards
each other, healthcare workers have a special duty to do no harm to, nor
take any undue risks with, their patients, but rather to seek to promote
the patient's health. The principle that medicine is <therapy> (called in
the textbooks 'medical beneficence and non-maleficence') excludes the use
of medicine for other purposes such as social engineering, exploitative
experimentation, mere profit maximisation etc. and has traditionally
excluded euthanasia: killing cures no one, is not nursing care, not
therapy. It is normally possible to relieve another's suffering, at least
to some extent. There <are> positive alternatives to euthanasia: good
therapeutic and palliative care; the expert pain management for which the
hospice movement is rightly celebrated; good counselling and chaplaincy;
love and support of a thousand different kinds. We should not underestimate
the possibilities here nor overestimate the difficulty of realizing those
possibilities�both of which proponents of euthanasia are inclined to do.
On the other hand we must face the fact (as opponents of euthanasia
sometimes fail to do) that these positive alternatives may not eliminate
the suffering. There are some problems in life which have no morally and
practically available 'solution'. Then comes the really hard loving: the
loving of a family surrounding a comatose boy, of a husband whose wife's
Alzheimer's disease means she no longer recognizes him, of siblings playing
patiently with their profoundly handicapped brother, of a mother watching
patiently at the foot of her dying son's cross. Sometimes the best we can
do is to invest ourselves�our time, companionship, prayer and hope�in the
suffering, the comatose and the dying. By so supporting these people we
affirm that bodily life is not merely an instrumental good distinct from
the human person, but basic to humanity; we meet our fundamental duty of
respect and care for every human life however wounded or handicapped; and
we express our love for a particular person, maintaining our human
solidarity or communion with that person as best we can. This is a kind of
respecting and loving which no one should pretend is easy. The temptation
is always to look for a quick-fix, to do anything to make the problem go
away; and if not, to desert, to join Peter and the boys fleeing from the
scene, abandoning not just another human being but one to whom they had
pledged their lives.
Pain and death, we know, will not be eliminated in this life. Suffering
must be faced head-on, against the pervasive temptation to demand an
immediate technological fix for every discomfort, and to marginalize those
who suffer so that the rest can withdraw undisturbed. Faith recalls the
profounder possibilities for good occasioned by illness and pain: for the
sufferer, re-evaluation, conversion, growth in virtue, setting things right
with God and others; for onlookers, compassion and selfless behaviour. The
crucified God gives new significance to these redemptive possibilities in
suffering; contemplation of the cross and uniting oneself with Christ's
passion make possible greater endurance, assist in our redemption (e.g. Mt
27:34; Rom 8.17-18), and overcome temptations to a counterfeit mercy. We
are promised the Holy Spirit to help us in our weakness (Rom 8:26). But
death remains our last enemy and is cannot be tamed or befriended, only
conquered by Christ (1 Cor 15:26). In the end as we humbly admit our
incomprehension before these mysteries, we take confidence in the knowledge
that Christ has gone before us through pain and death into new life, and in
the hope that we will share with him an eternity without sickness or
pain.13
In medical situations there are many opportunities to save life; there
are likewise many ways to abandon people and even to kill them. I have
argued elsewhere that active and passive euthanasia are morally equivalent,
simply a matter of strategy, and I will not rehearse that argument
here.14 Suffice it here to say that passive euthanasia�intentional
killing by means of dehydration, starvation, failure to perform necessary
operations or to give appropriate drugs�is far more common in hospitals
than killing by more active means. Thus I am advised that infants with
certain handicaps are less likely to survive hospitalisation today than
they were a decade ago, despite advances in medicine. Two recent English
cases of what was arguably passive euthanasia of older handicapped persons
were those of Tony Bland and 'S'. Both young men were more or less
permanently unconscious and their assisted feeding was discontinued on the
basis (a) that this was in accord with responsible medical opinion, (b)
continued tube-feeding (and by implication, continued living) were not in
the patients' best interests, and (c) their continued feeding (and living)
were not in other people's interests.15 One might argue that assisted
feeding is an inappropriate 'treatment' for the persistently unconscious,
and should be withdrawn, without intending their deaths.16 But in both
these cases the <intention> was apparently to hasten the young men's
deaths, to kill by omitting to care, and the courts approved. Most
countries have had similar cases in recent years.
Medical abandonment and killing by deliberate neglect, sanctioned by
gradual erosion of the common law and gradual change in medical practice,
is the most likely way for euthanasia to become widespread. In many places
there is already considerable lobbying for the legalization of 'benign
neglect by physician' and this is well-supported by some medical
professional bodies and judicial fiats. Once again we must face the fact
that to allow such 'benign neglect' would be to compromise one of the most
basic principles of ethics, both religious and secular, a principle common
to society generally and (at least historically) to the healthcare
professions in particular: the duty of care for others.
5. Did God kill Jesus? The limits to the duty of care
There are, of course, limits to the duty of care as here are to every
positive duty. Catholic faith and common morality recognize that while one
may never intentionally kill, one need not strive relentlessly to preserve
the last vestiges of life. The sanctity of life principle does not require
'survival no matter what'. Indeed, a survival-at-any-cost approach may well
be due to therapeutic obstinacy, a refusal to face up to the limitations of
healthcare and to human mortality, a product of despair rather than respect
for life. Death is always an evil, but not the greatest evil; for many
people it is a merciful release, the natural end to a life-story well-
written and, as believers claim, the door to eternal life.
At some point in most people's life death becomes, as it were,
'inevitable'. If there is an opportunity to do so, it is important to
compose oneself to die well�a need which can be frustrated by too strenuous
an effort to prolong life. While one should always value life as a gift,
one may not be obliged to prolong it by means of highly intrusive or
'extraordinary' treatments. Care and respect for the dying often requires
palliative and hospice care, and if this is to be applied it will be
necessary for people to accept that death is near and that there is little
more that human effort can properly do to postpone it. Thus traditional
medical ethics and Catholic morality counsel against over-treatment as well
as under-treatment, and allow that some treatments will be withheld or
withdrawn for good therapeutic reasons: their continued use may be futile
or they may impose such a burden (in terms of pain, indignity, disruption,
confinement, risk, cost etc.) that those concerned judge it
disproportionate to the benefit gained (e.g. <Catechism>, 1994:#2278; CDF,
1980; Lords, 1994:##240,252-253).
Jesus as he hung upon the cross cried out and he was offered pain-
relief, an anaesthetic, vinegar (Mt 27:48 <et par>). Christian tradition
teaches that the taking of pain relief may be reasonable even if this has
the foreseen side-effect of shortening life (CDF, 1980; <Catechism>, 1994:
#2279). The same is true where treatments are withheld or withdrawn for
good reasons. This is the so-called 'doctrine of double-effect'. Put simply
it is this: when healthcare professionals do some otherwise good thing
(give a pain-relieving drug, withhold or withdraw some treatment...) and
death results earlier than it might otherwise have done, hastening death
need not be why they chose such a course of action. Accelerating death is
often no part of the healthcare worker's reason for such conduct; death may
or may not be foreseen, but it is not intended; it belongs neither to her
ultimate purpose, nor is it the means used to achieve that purpose.17 On
the other hand, a healthcare professional might give a pain-relieving drug
or fail to treat because she believes the patient would be 'better off
dead', or that others would be better off were the patient dead, etc. In
this case hastening the patient's death is certainly part or the whole of
the reason for the healthcare worker's chosen conduct and the course of
action is immoral. Thus the judgment that a treatment is too burdensome
('extraordinary') or that pain relief should be given is <not the same as a
judgment that a life is too burdensome: it does <not> involve any arbitrary
judgments of 'quality of life', 'best interests' or 'well-being' such that
a person's life is judged to lack overall value.
When we ask about intentions we are getting to the heart of our moral
character: who we are and what we are about. The difference between
intending-and-causing and foreseeing-but-not-intending is not alwayseasy to
discern, and people's intentions are often as confused as their motives are
mixed. But for the most part what is intentional is not in doubt, and
various questions and what-if tests can be used to clarify intentions. We
do not hold that the martyrs committed suicide even though they foresaw
their deaths would 'result from' talking the stands they did. Likewise with
Jesus' death. Jesus could have evaded his captors yet again; God could have
intervened and saved him. Yet God kept Jesus' executioners in being and
grace sufficient to do their dastardly deed. Yet still we say: God did not
kill Jesus; we killed Jesus. God's will in this was permissive only, as it
is whenever we choose to do evil; he is never the active agent of evil.
Likewise with double effect in our choices: there are often undesired side-
effects from our morally reasonable choices which we permit but do not
will, do not 'purpose'.18
6. Jesus is tried by the ideologies of our age
Finally, if we look back a little in our Passion narrative we will find
Jesus tried by the ideologies of <our> own age. First, there is Caiaphas,
the model of consequentialist reasoning, who declares: "better that one man
should die for the people..." (Jn 11:50; 18:1) just as some contemporary
high priests of bioethics would make new exceptions to the precept against
killing as a matter of 'mercy', 'best-interests' or for some 'greater
social good'. Here common morality and its Catholic variant replies
insistently: 'The end does not justify the means', 'Do not do evil that
good may come'.19 Next there is Pilate who, though staring Truth in the
face, shows himself the very model of modern liberal nihilism: "Truth: what
is that?" (Jn 18:38). Many of the governors of our age are equally inclined
to dodge difficult ethical questions, to pretend that medical ethics is all
a matter of private opinion, so that all standards are 'up for grabs' as
long as people are 'civil', 'kindly' and 'respectable'. To this common
morality responds: of course we should seek by whatever means are morally
and practically available to ease people's suffering. But beware: in hard
cases sympathy and compassion will tempt us to compromise our basic norms
and to fudge our laws. The temptation, one we all know in our moral lives,
is to think that what is right is so complex and difficult and relative to
each situation that we can allow just one, or a few, exceptions and still
hold the line 'as a general rule'. But rational reflection and human
experience suggest that the implications of such exceptions go far wider
than the relief of hard cases.
Apart from the intrinsic evil of killing people, medical killing
changes us individually, as healthcare professionals, and as a society.
Even discounting the person killed, euthanasia is not 'victimless' because
the person who carries it out is also significantly harmed in the process,
as is the wider community. The healthcare professional's character will be
very significantly shaped by killing a patient, however noble her
motivation. Such an action will change her attitudes, dispositions, taboos.
A healthcare worker who has decided that some patients may be killed has,
however well-meaningly, seriously undermined in herself a disposition
indispensable to the practice of good medicine: respect for the life and
health of every patient. So too with any community. Ethically,
psychologically and sociologically, euthanasia invites further extension of
'therapeutic killing', whether by the same healthcare worker or by others.
Euthanasia also discourages alternative responses to suffering, such as
research into cures and the provision of good palliative care and pain
management.
There are many other problems with the euthanasia answer which I have
no space to explore here: so I might just flag a few. How are we to
interpret the plea of patients or by-standers for euthanasia? Is it really
a plea for death or a plea for better pain-relief, better support, comfort
and love? What effect will medical killing have on the doctor-patient
relationship and medical ethics? How soon would licence for euthanasia
become a duty to take part in it, and how soon would we slip from voluntary
to non-voluntary euthanasia?20 There is also the spectre of the economic
pressure, in a rapidly-aging society in which healthcare costs are
escalating, to keep extending the occasions for medical killing as a cost-
cutting measure. In all, the House of Lords Committee (1994:#238) was right
to conclude that "these dangers are such that we believe any
decriminalization of voluntary euthanasia would give rise to more, and more
grave, problems than those it sought to address."
For all the polemics about 'well-being', 'dignity' and 'mercy' used
both by the euthanasia movement and now even by our institutions, we can
forget that dignity is not recognised by telling the old, infirm or
comatose how undignified their condition is, or how they would be better
off dead�as when judges called Tony Bland 'grotesquely alive', 'an object
of pity', 'the living dead', called 'S' a mere body for whom starving to
death would be 'no ill effect', and called some handicapped children
'cabbages'. For all the special pleading by the Caiaphases and Pilates of
our age, well-being and mercy are not served by medical abandonment, by
standing by while people starve to death or by intervening to kill them.
The so-called 'mercy' killer adds the final rejection to the many already
heaped upon the sick and dying by our community.21 Dignity in old age,
handicap, unconsciousness, and suffering are above all recognized by our
showing the infirm love and respect. Surely we can find more creative ways
of responding to suffering than killing.
Anscombe, G. E. M. (1963). <Intention>. 2nd ed, Oxford: Blackwell.
Aquinas, St Thomas. <Summa Theologi�>.
Ashley, B. & O'Rourke, K. (1989). <Healthcare Ethics: A Theological
Analysis>. 3rd ed., St Louis: Catholic Health Association.
Bailey, L. (1979). <Biblical Perspectives on Death>. Fortress Press.
Boyle, J. (1980). Toward understanding the principle of double effect.
<Ethics>, 90, 527-538.
---------- (1989). Sanctity of life and suicide: tensions and developments
within common morality. In: <Suicide and Euthanasia>, ed. B. Brody, pp.
221-250. Dordrecht: Kluwer.
Casey, J. (1991). <Food for the Journey>. St Louis: Catholic Health
Association.
Cassidy, S. (1994). <Light from the Dark Valley>. London: DLT.
<Catechism of the Catholic Church> ('Catechism'). English trans. London:
Chapman, 1994.
Clouser, K. D. (1973). The sanctity of life: analysis of a concept. <Annals
of Internal Medicine>, 78, 119-125.
Congregation for the Doctrine of the Faith ('CDF') (1974). <Qu�stio de
abortu: Declaration on Procured Abortion>.
---------- (1980). <Jura et Bona: Declaration on Euthanasia>.
---------- (1987). <Donum vit�: Instruction on Respect for Human Life in its
Origins>.
Delhaye, P. (1968). <The Christian Conscience>. New York: Desclee.
Donagan, A. (1977). <The Theory of Morality>. Chicago: UP.
Dougherty, F. (ed) (1982). <The Meaning of Suffering>. New York: Human
Sciences Press.
Dworkin, R. (1993). <Life's Dominion>. London: Harper Collins.
Emanuel, E. (1991). <The Ends of Human Lif>e. Cambridge MA: Harvard UP.
Finnis, J. & Fisher, A. (1993). Theology and the four principles: a Roman
Catholic view. In <Principles of Health Care Ethics>, ed. R. Gillon,
pp. 31-44. London: John Wiley & Sons.
Finnis, J. (1980). <Natural Law and Natural Rights>. Oxford: UP.
---------- (1993). Bland: crossing the Rubicon? <Law Quarterly Review>, 109,
329-337.
Fisher, A. (1993a). On not starving the unconscious. <New Blackfriars>,
74, 130-145.
---------- (1993b). Old law and new ethics: <Bland's Case> and not feeding the
comatose. <Law and Justice>, 116/117, 4-18.
---------- (1993c). Killing and letting die: what's the difference? <Signum>
21(16), 1-11.
---------- (1994). Consciousness: the new test of life. <Catholic Herald>, 4
March 1994, 5.
Glover, J. (1977). <Causing Death and Saving Lives>. Harmondsworth:
Penguin.
Gormally, L. (1993a). Against voluntary euthanasia. In: <Principles of
Health Care Ethics>, ed. R. Gillon, pp. 763-774. London: John Wiley &
Sons.
---------- (1993b). Definitons of personhood: implications for the care of PVS
patients. <Catholic Medical Quarterly>, 44(4), 7-12.
---------- (ed) (1994). <Euthanasia, Clinical Practice and the Law>. London:
Linacre Centre.
Grisez, G. (1983). <Christian Moral Principles>. Chicago: Franciscan
Herald Press.
---------- (1993). <Living a Christian Lif>e. Quincy IL: Franciscan Press.
Grisez, G. & Boyle, J. (1979). <Life and Death with Liberty and Justice: A
Contribution to the Euthanasia Debate>. Notre Dame: UP.
Hellwig, M. (1985). <Jesus: The Compassion of God>. Wilmington: Michael
Glazier.
House of Bishops of the Church of England and the Catholic Bishops'
Conference of England and Wales ('English Bishops') (1993). <Euthanasia
- No! Submission to the House of Lords Select Committee on Medical
Ethics>. London: Catholic Truth Society.
John Paul II (1985). Apostolic Letter on the Christian Significance of
Human Suffering. In: <Divine Providence and Human Suffering>, ed. J.
Wealsh & P. Walsh. Wilmington: Michael Glazier.
May, W. (1978). Double Effect, Principle of. In: <Encyclopedia of
Bioethics>. New York: Macmillan.
---------- (1977). <Human Existence, Medicine and Ethic>. Chicago: Franciscan
Herald Press.
O'Rourke, K. & Boyle, P. (1989). <Medical Ethics: Sources of Catholic
Teachings>. St Louis: Catholic Health Association.
Pollard, B. (1989). <Euthanasia: Should We Kill the Dying>? Sydney: Mount
Press.
Select Committee of the House of Lords on Medical Ethics ('Lords') (1994).
<Report of the Select Committee on Medical Ethics>. vol. 1. London:
HMSO.
Sena, P (1981). Biblical teaching on life and death. In: <Moral
Responsibility in Prolonging Life Decisions>, ed. D. McCarthy & A.
Moraczewski, pp. 3-19. St Louis: Pope John Center.
Soelle, D. (1975). <Suffering>. Philadelphia: Fortress Press.
Stone, J. (1994). Witholding life-sustaining treatment: the ultimate
decision. <New Law Journal>, 11 Feb 1994, 205-206.
Vatican Council II (1965). <Gaudium et Spes: Pastoral Constitution on the
Church in the Modern World>.
Warnock, M. (1992). <The Uses of Philosophy>. Oxford: Blackwell.
ENDNOTES
My particular thanks to Fr Robert Ombres, O.P. who helped me with this
piece.
1. Unlike Abimelech's armour-bearer who slew him at his request, lest he
suffer the humiliation of death at the hands of a woman: Judges 9:50-
57. Other scriptural examples of suicide include: Saul's armour-bearer
(1 Chron 10:5), Ahithophel (2 Sam 17:23), Zimri (1 Kings 16:18-19) and
Judas (Mt 27:5; Acts 1:18).
2. A fuller treatment of responsibility and sin in this area would require
consideration of the nature of conscience, and especially of the
'vexed' and the 'erroneous' conscience, and of the implications for
responsibility of passions (such as overwhelming sympathy) and moral
climate (such as upbringing in a pro-euthanasia society). See O'Rourke
& Boyle, 1989:ch.2, who refer liberally to the teachings of Vatican II
on the dignity of conscience; and Delhaye, 1968:36-99 on the scriptural
and patristic sources that underlie the teachings on conscience found
in Aquinas and in Vatican documents. The <Catechism>, 1994:#2282, notes
that "grave psychological disturbances, anguish or grave fear of
hardship, suffering or torture can diminish the responsibility of the
one committing suicide." On the other hand it also insists (#2277) that
killing in response to an error of judgment made in good faith is
nonetheless objectively evil.
3. See Boyle, 1989; <Catechism>, 1994:## 2258-2283; Clouser, 1973;
Donagan, 1977.
4. CDF, 1987: "Human life is sacred because from its beginning it involves
the creative action of God and it remains for ever in a special
relationship with the Creator, who is its sole end. God alone is the
Lord of life from its beginning until its end: no one can under any
circumstance claim for himself the right directly to destroy an
innocent human being." (quoted also in <Catechism>, 1994:#2258). See
also: Bailey, 1979; Sena, 1981.
5. CDF, 1974:#5: "Human life, even on this earth, is precious. Infused by
the creator, life is again taken back by him (cf. Gen 2:7; Wis l5:11).
It remains under his protection: man's blood cries out to him (cf. Gen
4:10) and he will demand an account of it, 'for in the image of God man
was made' (Gen 9:5-6). The commandment of God is formal: 'You shall not
kill' (Ex 20:13). Life is at the same time a gift and a responsibility.
It is received as a 'talent' (cf. Mt 25:14-30); it must be put to
proper use." Vatican Council II, 1965: #27: "The varieties of crime are
numerous. They include all offenses against life itself, such as murder
(<cuiusvis generis homicidia>), genocide, abortion, euthanasia and
suicide... all these and the like are criminal: they poison
civilization; they debase the perpetrators even more than the victims;
and they offend against the honour of the Creator".
6. Likewise CDF, 1980: "Human life is the basis of all goods, and is the
necessary source and condition of every human activity and of all
society... No one can make an attempt on the life of an innocent person
without opposing God's love for that person, without violating a
fundamental right, and therefore without committing a crime of the
utmost gravity... It is necessary to state firmly once more that
nothing and no one can in any way permit the killing of an innocent
human being, whether a foetus or an embryo, an infant or an adult, an
old person or one suffering from an incurable disease, or a person who
is dying." I have not been able to review here the development of the
tradition behind this teaching through the fathers, the scholastics and
the papal magisterium. CDF, 1980 includes references to some of Pius
XII's teaching in this area; O'Rourke & Boyle, 1989: 111-115 include
some texts from John Paul II. An example of a recent episcopal
statement is English Bishops, 1993.
7. <Catechism>, 1994:#2277: "an act or omision which, of itself or by
intention, causes death in order to eliminate suffering constitutes a
murder gravely contrary to the dignity of the human person and to the
respect due to the living God, his Creator. The error of judgment into
which one can fall in good faith does not change the nature of this
murderous act, which must always be forbidden and excluded."
8. I qualify the prohibition of intentionally killing with 'innocent' here
in line with common morality which has traditionally recognized a right
(and sometimes a duty) to render unjust aggressors unable to inflict
harm, even with lethal force. This might include justifiable capital
punishment and war, but obviously not euthanasia. On the justification
for the 'exceptions' see Fisher, 1993a and <Catechism>, 1994:#2263-
2267,2321 and the sources in each. Hereafter I use the terms person,
victim and life presuming (or at least allowing) the traditional
qualification 'innocent'.
9. cf. Ashley & O'Rourke, 1989:ch. 13; Donagan, 1977; Finnis, 1980;
Grisez, 1983:chs.5, 7,9; Grisez, 1993:ch.8; Grisez & Boyle, 1979; May,
1977:ch.6; Pollard, 1989.
10. <R v Cox> (1992) (Unreported; Ognall J in the Winchester Crown Court,
18 September 1992); likewise: <R v Adams> [1957] Crim LR 365; <R v
Arthur> (<The Times>, 5 November 1981; Farquhason J). In many places
there is considerable lobbying for the legalization of "physician aid-
in-dying" as practised in Holland.
11. My thought in this area has been much influenced by Gormally
1993a,b,1994.
12. This was the crucial qualification in the mind of the judges in
<Airedale NHS Trust v Bland> [1993] 2 WLR 322 ('<Bland's Case>'), so
much so that they were sometimes unclear about whether Anthony Bland
was really a living human being. Similar reasoning is to be found in
the works of Warnock, 1992 and Dworkin, 1993, among others, and has
been very effectively rebutted in Gormally, 1994.
13. For some reflections on suffering and death as they are understood in
the Judeo-Christian tradition see: Ashley & O'Rourke, 1989:47-49,197-
199; Casey, 1991:chs. 4,5; Cassidy, 1994; <Catechism>, 1994:##988-
1019,1500-10,1521; Dougherty, 1982; Hellwig, 1985; John Paul II, 1985;
Soelle, 1975.
14. See Fisher, 1993c and Finnis, 1980:176-77,195 (<contra> Glover, 1977
and so many since), on where action and omission are morally different
and where they are morally equivalent. The law recognizes the
equivalence of action and omission in some cases. Thus people have been
convicted for killing by omission: <R v Marriott> (1838) 8 C & P 425;
<R v Bubb> (1850) 4 Cox CC 455; <R v Nicholls> (1874) 13 Cox CC 75; <R
v Istan> [1893] 1 QB 450; <R v Gibbons & Proctor> (1918) 13 Cr App Rep
134; <R v Stone & Dobinson> [1977] QB 354; <R v Unnamed 44 year old
man> (Judge Geoffrey Grigson in Old Bailey, 7 March 1994); <Bland's
Case per> Lord Keith at 362, Lord Browne-Wilkinson at 383 and Lord
Mustill at 394; Smith & Hogan, <Criminal Law > (6th ed, 1988) at 52.
15. <Bland's Case>, regarding which see: Finnis, 1993 and Fisher, 1993a,b.
<Frenchay Healthcare NHS Trust v S> (unreported Court of Appeal 14
January 1994), regarding which see: Fisher, 1994 and Stone, 1994.
16. Though I have argued to the contrary in Fisher, 1993a. A good case
could certainly have been made, however, for not intervening surgically
and with aggressive antibiotics. It is mysterious that such
intervention occurred in the last year of Anthony Bland's life, when it
might have been withheld without ethical or legal difficulties.
17. 'Intentional' here is a term of ethical art. It refers to what one
does, identified by reference to one's chosen purpose in acting and the
means which are chosen precisely because of their relevance to that
project. When death is foreseen but not intended, its causation does
not feature among the reasons one has for acting; it is unintended,
perhaps even regretted. Some people treat intentional and foreseen-but-
unintended causation as morally equivalent, but this would mean one
could never build roads, engage in high-risk sports, perform high-risk
surgery, give analgesics for pain control which might reduce life span,
withhold treatment, and so on, while being opposed to killing.
18. Scriptural examples of just acts involving risk of death to the actor
are the deaths of Samson (Judges 16:23-31) and Eleazar (1 Macc 6:43-
46). For helpful accounts of intention and double effect: Anscombe,
1963; Aquinas, <S Th,> IIa II� 8-21, 79; Boyle, 1980; <Catechism>,
1994:##1737,2283; May, 1978.
19. See Finnis & Fisher, 1993 and sources therein for reasons why any
comparison which hopes to guide moral judgment by an overall 'weighing'
of the goods and evils at stake in morally significant options is
always made by feelings, not rational commensuration, and will
ultimately be only rationalization.
20. Lords, 1994:#238: "we do not think it possible to set secure limits on
voluntary euthanasia... it would not be possible to frame adequate
safeguards against non-voluntary euthanasia if voluntary euthanasia
were to be legalised...Moreover to create an exception to the general
prohibition on intentional killing would inevitably open the way to its
further erosion whether by design, by inadvertence, or by the human
tendency to test the limits of any regulation."
21. Lords, 1994:#239: "We believe that the message which society sends to
vulnerable and disadvantaged people should not, however obliquely,
encourage them to seek death, but should assure them of our care and
support in life."
-------------------------------------------------------------------
The electronic form of this document is copyrighted.
Copyright (c) Trinity Communications 1994.
Provided courtesy of:
The Catholic Resource Network
Trinity Communications
PO Box 3610
Manassas, VA 22110
Voice: 703-791-2576
Fax: 703-791-4250
Data: 703-791-4336
The Catholic Resource Network is a Catholic online information and
service system. To browse CRNET or join, set your modem to 8 data
bits, 1 stop bit and no parity, and call 1-703-791-4336.
-------------------------------------------------------------------
