From Mr S. J. Smith, MRPharmS
SIR,—I have been following the recent correspondence in The Pharmaceutical Journal concerning euthanasia (or physician-assisted suicide).1–4
Fearon3 is quite correct in his assertion that suicide and "borderline actions" are against Christian theology. However, the other arguments he makes are rather flawed. He stated that
requests for physician-assisted suicide come from patients who are so ill that they are "incoherent" and that members of the family are almost certainly in opposition. Sadly, in my experience as a pharmacist and as a Christian minister, there are many people who request euthanasia who are clearly competent to make decisions concerning their care and who are all too often supported by their relatives. To take all these issues into account is to avoid the central issue at stake here.
Euthanasia is not wrong because it is repugnant to some people or because it raises practical concerns; it is wrong because it is objectively wrong. Over the past 200 years, much has been discovered about human beings in terms of anatomy, physiology, biochemistry and pharmacology. However, all of this scientific progress cannot negate the fact that human beings are created by God and that, while human beings share various characteristics with other animals, they have powers of conscience, reasoning and an aesthetic capacity that sets them apart from the beasts (Genesis 1 v26). In theological terms, humans are created by God in His own image. Human life is God's to give and God's to take away. For a human being to take deliberately another human life is therefore a form of blasphemy -an affront to God (Genesis 9 v6). Indeed, for humans to live together in trust, it is important that a prohibition against killing is a universal rule. Such a universal rule is seen in the Ten Commandments (Exodus 20 v13), with the commandment prohibiting murder. All of this has a number of important consequences.
First, conscience alone -a truly human characteristic -tells us that it is wrong to take another human life. This may explain why many of the pharmacists in the survey by Hanlon et al5 do not want to know whether a drug is to be used for euthanasia when, in so many other situations, pharmacists want as much information as possible to inform their clinical decisions. As a pharmacist, I certainly would want to know if a drug I dispensed was intended for euthanasia.
Second, the question of intention is vital. Wingfield4 notes that, as far as the law is concerned, much turns on the intention behind the administration of a medicine. This is what ethical theory calls the doctrine of double effect -if a drug is being given with the primary intention of easing pain then that administration is morally acceptable even if it has the (unforeseen) effect of hastening death.
Third, if all humans are created by one God and that God gives the same laws of physics and chemistry to all of his creatures, than any consumerist approach to medicine just will not do. As scientists, pharmacists are in a better position to understand this than most people. If it is objectively wrong to take human life, then it remains objectively wrong to do so, whether the person in question is a Christian, a Buddhist, a Muslim or a Jew. To say otherwise is akin to suggesting that furosemide will not cause diuresis in atheists because of their beliefs.
Fourth, if the doctrine of creation is universally true (irrespective of whether we happen to believe in it), then religious convictions are not just a matter of "personal certainty", as Wingfield puts it; they are a matter of community imperative. The prohibition against killing a fellow human being is a prohibition because it helps people to live together in peace. It is no accident that the word "ethics" is derived from the Greek ethos, meaning community.
Wingfield is right when she says that the pharmacy profession must face up to the prospect of physician-assisted suicide; I write this in the week that the Netherlands formally legalised euthanasia. And the central question is, as Wingfield perceives it, a question of human rights. There are many human rights. But there is no "human" right to die. She asks, "Whose life is it anyway?". The answer? It is God's.
References
1. Weiss M, Hanlon T. A role for the pharmacist in physician-assisted suicide. Pharm J 2000;265:649.
2. Hackett EA, Francis SA. Physician-assisted suicide: debate among pharmacist needed (letter). Pharm J 2000;265:716.
3. Fearon N. Physician-assisted suicide: disastrous (letter). Pharm J 2000;265:716.
4. Wingfield J. Whose life is it anyway? Pharm J 2000;265: 786.
5. Hanlon TRG, Weiss MC, Rees JR. British community pharmacists' views of physician-assisted suicide. J Med Ethics 2000;26:363-9.
Stephen Smith Sea Palling, Norfolk