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Stephen Goundrey-Smith is a pharmacist and Church
of England priest from Banbury, Oxfordshire
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Friday 12 May was a significant day for British society because Lord Joffe's proposed legislation to permit assisted dying was defeated in the House of Lords. The demise of this legislation was hastened (pardon
the pun) by united opposition to the bill by the Archbishop of Canterbury,
Anglican bishops and peers who are lay members of the Church of England.
This campaign was backed by leaders of other denominations.
In the light of the proposed legislation, and the impact that it would
have on pharmacists if passed, there has been some debate recently on
assisted dying within the pharmacy profession. Much of the correspondence
has reasonably focused on the impact that assisted dying would have on
palliative care services, respecting a patient’s choice to end
his or her own life, and a conscience clause for pharmacists who object
to assisted dying on moral grounds. However, religious faith — which
can be a primary factor for an individual’s views on assisted dying,
be they a patient or a professional — is often at best misunderstood
or at worst discounted or ridiculed. And yet the opposition to Lord Joffe’s
Bill came almost entirely from people with a faith world view. Health
professionals cannot ignore the issue of religious faith and its effects
on attitudes and values concerning health and illness. Nor can religion
be treated as an entirely abstract issue, since religious faith and values
are embodied in the patients we see every day, and religious faith is
an important motivating factor in many spheres of human activity.
The debate about active euthanasia, for which assisted dying might be
said to be a euphemism, is essentially a moral debate; that is to say,
it focuses on whether the act of killing a terminally ill patient is
morally justifiable in any circumstances and, conversely, whether it
is ever right, as a patient, to seek euthanasia. Yet the rationale for
religious views on euthanasia is much broader than the moral agency,
or responsibility, of the individuals
involved.
In Christianity, from a moral perspective, the chief point of reference
is the prohibition against killing in the sixth commandment, “You
shall not kill” (Exodus 20v13). But within the Christian tradition,
there are two distinct strands of thought concerning why killing another
human being is wrong. First, there is a clear biblical teaching that
the span of all human life is determined by God alone and, therefore,
someone who kills someone else for any reason is essentially usurping
God’s place as final arbiter of life and death. In a society where
more and more clinical scenarios are subject to human control — either
by the empowered patient or by medical professionals as a result of advances
in medical technology — this doctrine has increasing significance.
Many Christians, and indeed others of
religious faith, are uncomfortable about any practices which go against
the revealed will of an all-powerful God. Moreover, people of all faiths
or none should be concerned about the potential for the development of
hubris or human arrogance in attitudes to health care, for it is this
arrogance on the part of patients, relatives and professionals that will
lead to assisted dying on grounds of expedience and convenience, if assisted
dying were legalised.
Secondly, there is a clear understanding that individual human beings
are created in God’s image (Genesis 1v27). Because of this, each
human being has inestimable moral and spiritual value and, from a Christian
perspective, the taking of a life is, therefore, an offence against God.
If killing is condoned or sanctioned, then human life is devalued. Furthermore,
if a society sanctions any form of legalised killing, then human life
becomes devalued within that society, to the detriment of the whole society.
This impinges on all of the relationships of trust and care within that
society.
The ideological framework that supports assisted dying is essentially
a utilitarian one, ie, an act is morally justifiable if it does the greatest
good for the greatest number of people. Furthermore, according to utilitarianism,
with any act the end justifies the means and no account is taken of the
motivation for the act. According to the utilitarian approach, where
there are limited health care resources available, then it is justifiable
to ration these resources to extend the lives of those who are most valuable
to that society. Correspondingly, the terminally and intractably ill
have a duty to consider assisted dying so as not to be a burden to society.
Euthanasia is a means of achieving that end and, therefore, it is justifiable
in itself.
Set against this approach, religious objections to assisted dying might
appear to be blind individualistic moralism. However, although the utilitarian
arguments for assisted dying purport to be concerned with the good of
society as a whole, religious arguments against assisted dying are equally
about the well-being of society. In Christianity, the Ten Commandments
were given by God to help Israel live as a peaceful society. The fact
that many legal systems since have been based on the Judaeo-Christian
moral traditions are testimony to the value of these moral absolutes
in governing many different human societies over the centuries.
While a utilitarian approach seeks to make an extrinsic judgement on
the value of an individual’s life, in terms of their perceived
value to society, the religious view emphasises the non-negotiable, inherent
value of all individuals in society. Consequently, while it may be reasonable
to evaluate therapeutic interventions using economic methods such as
quality-adjusted life years and cost-benefit methodology, it is not reasonable
to analyse the value of the patient in the same way. For the utilitarian
approach, the end alone justifies the means, and the motivation for an
act is of no consequence. Yet, in human experience, the motivation for
any act is an important determinant for the quality of life in any society.
This is certainly the case for health professionals, many of whom are
personally motivated by, and derive considerable occupational satisfaction
from, the care of ill people. Furthermore, this “duty of care” is
a well-defined legal concept governing the conduct of health professionals.
Religious arguments against euthanasia and assisted dying are concerned
with the well-being of society as a whole and safeguarding its most vulnerable
members, in the context of what we know to be human nature. One thing
is certain: although Lord Joffe’s Bill was defeated, it will be
on the political agenda again in the future. When that happens, health
professionals will need to be ready and aware of both the clinical and
philosophical issues involved so that they will be able to assess the
implications for their practice, and for society as a whole. |
The
Pharmaceutical Journal