Jurriën den Hollander, Ministerial Secretary of the SDA Netherlands Union Conference, invited me to present, to deacons and pastors gathered May 3-4, 2015 at the Union Headquarters (at Huis ter Heide, a location between Utrecht and Amersfoort), on the topic of Euthanasia. Is not common for SDA pastors, even less for SDA local communities, to deal with avant-garde, extra-ecclesiastical topics like this one, even though jurisdictions today where Euthanasia or assisted suicide is legal include countries like Belgium, Luxembourg, Colombia, Switzerland, Japan, Estonia, Albania or the US states of Washington, Oregon, Montana and, starting in 2015, the Canadian Province of Quebec.
But the first country to have legalized Euthanasia has been the Netherlands, with the “Termination of Life on Request and Assisted Suicide Act” that took effect on April 1, 2002. The law was proposed by Els Borst, minister of Health from the Dutch D66 political party. The incremental rise of Euthanasia in the Netherlands these last years is consistent, with 13% in 2009, 19% in 2010, 18% in 2011, 13% in 2012 and 15% in 2013. Requests have risen steadily since 2003 when 1,626 people applied for medically administered Euthanasia to reach 4,829 in 2013. An increase of 200% in ten years. The trend is very clear and uncontroversial.
This simple fact calls attention to two important, related issues.
First, every Adventist community, not just the Dutch SDA church, is called to continuously interact with its own unique, socio-cultural context – sometimes adapting itself, sometimes being critical. An exclusively “Affirmative Theology”, characteristic of self-referential and identitarian religious communities and often described as the only possible theology, actually is both myopic and unproductive. Every meaningful and relevant theology always configures itself as “Contextual Theology”, i.e. a theology that pays attention to and cares for the immediate social and cultural surrounding of people it intends to serve. And this visionary and courageous type of religious understanding is precisely what the Dutch SDA community is trying to cultivate through its pastors and deacons.
Second, contrary to what we may think, Euthanasia is not a peripheral or a secondary topic that concerns only a few little countries like Netherlands, Belgium or Luxembourg where “Right-to die” regulations exist as civil laws. It's rather a worldwide issue because what is going on behind this topic is a new relationship to death and suffering that concerns us all. And, even though few countries have passed on laws on Euthanasia, I would dare to say that in all countries – worldwide and without exception – people deal daily with related and parallel juridico-medical End-of-Life issues like “Living Will”, “Palliative Care” or “Over-medication”. In other words medicine and technology have created today an unknown asymmetry between pathology and death. While in the past and in all cultures there existed a synchrony between disease and the End-of-Life, this symmetry doesn't exist anymore. By enlarging the time and psychological space between disease and death, medicine today has modified our relation to death paradoxically postponing it (“palliative care” and “over-medication”) and at the same time anticipating it (“Euthanasia” and “Physician assisted Suicide”). This simple new fact redefines what, in olden times we called a “desire for dying”, into a concept now expressible via Euthanasia. This is not inappropriate and odd but rather a legitimate, personal, human and noble request.
Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering. In most cases Euthanasia is carried out because the person who dies asks for it, although there are cases called Euthanasia where a person can't make such a request. But beyond these juridico-medical nuances I would like to describe it critically, in its more cultural level, as: the process in which the body is understood both as a “Governable Body” and a “Sovereign Self”. And both movements can be understood in their more extreme forms and consequences. Euthanasia is in fact the cultural place in which death and the body appear the most disenchanted – reduced to mere things at our disposal. But Euthanasia is also the cultural place in which self-determination reaches is climax. We decide on our own death. This double cultural affirmation at the core of Euthanasia can be brought back to one of the founders of Western Modernity: Descartes. We find in Descartes, on one side, a reductive view of the body that allows the birth and development of all Western medicine. The body (“res extensa”) is reduced to one of its multiple characteristics: measurement. As such it becomes just disenchanted flesh, i.e. a sophisticated machine that can be governed completely from the outside. And this first implicit postulate present in Euthanasia is actually shared not only by all Western medicine but also by various Western ethics. On the other side (and together with this underestimation of the body) we find in Descartes the parallel and corresponding over-evaluation of the self. The rational individual (“res cogitans”) is able to build up a full experience of autonomy and self-determination. In this way the second implicit postulate present in Euthanasia – that of a “Sovereign Self”, able to chose its own death – is actually shared not only by modern medicine but also by all Western anthropocentric culture.
The irreversible trend in favor of freedom and self-determination, typical of Western individualist societies, is a never ending process. This fact is visible in the history of human rights. At the beginning, in the 19th century, a new awareness and sensibility for human dignity and autonomy took the form of a political fight. People affirmed for themselves the right to be active citizens in the “res publica” by claiming the right to vote and the prerogative to make their voice heard in public affairs. Nobody but themselves should choose leaders of their own community. These political and civic rights represented the first generation of human rights and the affirmation of freedom in this particular realm. But after awhile political rights were not sufficient to answer new aspirations and everyday needs of people and communities. Individuals are concrete persons who need to work, have a place to stay, get instruction and have systems to take care of their health. So, people added additional claims that became known as social, economic and cultural rights. These are human rights of the second generation. But the fight for freedom emigrated still to other unpredicted spaces where new forms of oppression threatened people’s integrity and well-being. Communities started discovering their interdependence and close belonging. They saw that alienation is not limited to a country or one community. Modern nations have a common life and a common destiny because we all dwell on the same planet. In this way the third generation of human rights, known as solidarity rights, emerged. Belong to these: the right to peace, to solidarity between the north and the south countries, to a clean environment, to a sustainable development etc. But now, while the other three fronts remain, a new one is gradually being opened. People are called to fight for freedom in their own bodies. All the bioethical questions (living will, Euthanasia, artificial procreation) are part of this new fight for freedom in a realm that is the nearest to us: our own body. No strong power – political, civic or religious – can choose for us and tell us how are we ought to administrate our bodies. Bioethics is today this cultural dimension in which we are called to fight for freedom and self-determination and where human rights of the fourth generation are forged and need to be gained and defended. And Euthanasia just embodies and summarizes this fight.
Can we really abandon this double postulate of “Governable Body” and “Sovereign Self”? I don't think so. All Western culture is built upon these two principles. Even more, Adventist ethics and anthropology itself works with the same two postulates. For this reason those who oppose Euthanasia are just opposing the last added ring of a well-accepted, massively shared cultural chain of anthropological presuppositions. Thus to favor Euthanasia shouldn't appear so weird and surprising. Does it mean that we Adventists can only accept and suffer under external cultural paradigms? No. The fidelity to the Gospel obliges us also to be critical of our own culture. But it is one thing to be “only critical” and another to be “also critical”. To be also critical, in the case of the Dutch SDA community, means to assess and monitor two new trends present today in the Netherlands: 1) the increasing amount of “non-voluntary” Euthanasia (mentally ill patients) and 2) the introduction, since 2005, of Euthanasia for children under the age of twelve, after Pediatrician Eduard Verhagen helped establish the Dutch Euthanasia guidelines for infants, known as the “Groningen Protocol”. This guideline, while not a civil law, is the protocol used nowadays by the Dutch Pediatric Association (NVK) to deal with Euthanasia in infants.
In a more general setting I will conclude with the Adventist Statement on Euthanasia called “Care for the dying”. Notwithstanding its limits (it's a top-down document, not preceded by a larger cultural reflexion and not necessarily representative of the membership's views and convictions), even this document cannot avoid the double mandate of every religious community: try to adapt itself and at the same time remain critical of its own socio-cultural context. In fact this Statement says:
“Developments in modern medicine have added to the complexity of decisions about care for the dying. In times past, little could be done to extend human life. But the power of today's medicine to forestall death has generated difficult moral and ethical questions. What constraints does Christian faith place upon the use of such power? When should the goal of postponing the moment of death give way to the goal of alleviating pain at the end of life? Who may appropriately make these decisions? What limits, if any, should Christian love place on actions designed to end human suffering?...It has become common to discuss such questions under the heading of euthanasia. Much confusion exists with regard to this expression. The original and literal meaning of this term was "good death." Now the term is used in two significantly different ways. Often euthanasia refers to "mercy killing," or intentionally taking the life of a patient in order to avoid painful dying or in order to alleviate burdens for a patient's family or society. (This is so called active euthanasia.) However, euthanasia is also used, inappropriately in the Seventh-day Adventist view, to refer to the withholding or withdrawal of medical interventions that artificially extend human life, thus allowing a person to die naturally. (This is so called passive euthanasia.) Seventh-day Adventists believe that allowing a patient to die by foregoing medical interventions that only prolong suffering and postpone the moment of death is morally different from actions that have as their primary intention the direct taking of a life”.
Hanz Gutierrez is a Peruvian theologian, philosopher and physician. Currently he is Chair of the Systematic Theology Department at the Italian Adventist Theological Faculty of “Villa Aurora” and director of the CECSUR (Cultural Center for Human and Religious Sciences) in Florence, Italy
This is a companion discussion topic for the original entry at http://spectrummagazine.org/node/6811