Euthanasia and Christian identity: The Dutch Way. On European Adventism II


(Spectrumbot) #1

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

(Rheticus) #2

This is a critical issue facing all societies in the world, not just wealthy ones.

Few things will cripple a weak economy faster or kill more people than wasting resources keeping the most extreme cases “alive” without considering what else might be done with those resources, or whether the extreme cases want to be kept alive.

As a paramedic, I regularly transfer old people between nursing homes and hospitals while thinking “if this person was me or mine I would prefer death”.

Who says they do?

Is this a theological claim coming from an arbitrary subset of theologians? An administrative claim coming from some subset of people on the SdA payroll? Some survey?

I, for one (although an ex-SdA rather than a current one), see no difference between voluntarily withholding a lifesaving med and administering a death-hastening one.


#3

In light of the following definition of palliative care, I don’t understand how we are to see palliative care as “postponing death.”

Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Palliative care is the normal human response to the suffering of another human being who is suffering from a terminal condition, it seems to me.

One can, at the same time, relieve suffering to the best of one’s ability while anticipating death as inevitable.

Framing this as paradoxical in order to portray suicide/euthansia as “noble” is disturbing.


(Winona Winkler Wendth) #4

This is a well-presented and timely essay.

Yes. This is particularly true in the United States—and that “double postulate” underlies the political factioning we’re suffering with today. This is a conversation that must stay alive in order for this society to work; we can’t find ways to do that that by shutting one side of the conversation down. And because Adventism is a peculiarly American product, we suffer from those postulates acutely in the Denomination’s politics and policies . Making a final, wholistic determination on issues like this for the sake of unity is a mechanism for silencing one side, or another, on a complex, difficult topic that includes ethical problems not limited to ninety-year-old patients nearly at their last breath or accident victims who can’t survive without extreme mechanical support. What we do agree upon is the damaging nature of suffering—a human being who cannot think or be self-reflective is less than human, some philosophers assert, and endless, acute pain does exactly that—dehumanizes us. Adventists, with our all-creation approach to theology, which has historically underwritten our vegetarianism, should be most sensitive to this and its possible abuse. This is a timely, profound topic that needs conversation—voting on a church policy regarding euthanasia would likely damage this evolving discussion, prevent developing wisdoms,and generate another series of political battles none of us needs.
Thank you for this work.


(Elaine Nelson) #5

All humans wish to avoid suffering for themselves and others. But there are times and conditions which are contradictory: to alleviate pain sufficiently may hasten death in the already terminal patient.

This is where the Golden Rule applies: “Do for others what you would wish for yourself” but too many times the patient is unable to do anything for himself; this is when a health directive is necessary. Sadly, there have been reports of physicians and hospital staff refusing to follow the directive.

If Christian medical workers are truly dedicated to preventing suffering, when a patient is terminal, and the only life maintenance will be artificial, all necessary efforts should be made to avoid “unnecessary” suffering as it is always unnecessary if there is no hope for recovery.

My family knows my wishes: I have a health directive, and my daughter, a NP, is
fully agreed to those and I know that she will follow them.


#6

Please expand on that in the light of Webster’s definition, if you don’t mind, Winona–thanks.

dehumanize:
to treat (someone) as though he or she is not a human being
http://www.merriam-webster.com/dictionary/dehumanize


(Marianne Faust) #7

I’m wondering if there are studies about the psychological pressure upon those patients in the Netherlands vs those in other countries where this option isn’t there? How would I feel, when completely helpless, making quite some trouble for those caring for me… how soon would I suspect that some of them can’t wait until I ask for the pill…


(Kim Green) #8

This statement will/would be roundly dismissed by some as: “Acting as God”. Perhaps this is true, but the pragmatic act of living in the real world begs that there be some answers for limited resources, etc… The disparities in access to care and type of insurance will all insure that this is the case. But this dilemma also exists in education as well with the disabled having longer periods of education (21) and sometimes more expensive supports.

I agree with you and perhaps it is only the “intent” that changes if the outcome is the same. We, Americans are rather schizophrenic when it comes to different social issues…mental health and our judicial system. Sometimes it is only the perspective that gets a law passed but that in itself is not enough to change any inevitable consequences.


(Winona Winkler Wendth) #9

This would be a very long discussion, full of theoretical potholes. I wish I could remember the philosopher in whose company several of us history fellows at Claremont sat for an hour. Sadly, “A tiny bird-like man” and “Sorbonne, Africa, philosopher” won’t render good search results. His point (not unique to him) is that what makes us human is our ability to think and to be self-reflective; acute pain traps us in the here and now and shuts the mind down, foreclosing on that humanness. From my perspective, this makes sense; however, I do not hold to the politically self-serving and somewhat arbitrary anthro-centric notion of the mind. In any case, I’ll extend that notion to non-human creatures. This issue (as is euthanasia) is inextricably connected to that other one: the relative value of the human animal. Our own denomination has had some trouble with this, reading an anthropocentric message into scripture, in spite of the “Christ died for all of creation” we learned in Sabbath School and which, for years, was a major plank in the ethical platform for vegetarianism. But that, too, is different discussion. In short: If we are not sentient for an unending amount of time, our humanity is gone; pain does that. That’s what that means. This can whip back and strike us from the rear, as the “Temple of God” issue does—if we are weak, whether by our own design or not, are we not worth saving? Are the unusually healthy especially prized by God? If the temple is falling down, has God left the premises? If it hadn’t been built well, to begin with, will God not enter it? Hm m m . . . . From my personal perspective (and I’m allowed to have one that is not necessarily obviously written in scripture, just as I am allowed to have one about carburetors or MicroSoft Office or which fork to use for salad), allowing or perpetrating unending pain or unconsciousness is unacceptable. This holds for non-human animals as well as human ones. Like any general statement or position, however, I recognize that it must bend and adapt to matters at hand, and only a smart, wise, and well-lived person, preferably, in the company of others like her, knows how to think such issues through. In short: inflicting endless pain is robbing person of his or her humanity and is treating him or her as though that person is not human; inflicting any creature with endless pain is objectifying him or her. Many gallons of ink have been spilled on this topic, so expanding on notions like this in a conversational blog is not likely to be helpful.


(Rheticus) #10

There are two extremes that need to be considered, then the middle ground

1 - you are fully mentally capable, but unable to do anything for yourself except blink your eyes. Your care is costing about $1000 per day.

2 - you have severe dementia, and can not hold a coherent complex thought as you drool into your bowl of porridge. Your care is costing around $5000 per month.

You have $1M in assets, but your society does not provide any support beyond your assets at all under any circumstances. Once your assets are exhausted you will be carried to the potters field on the edge of the city and left there in the open to see if anyone will take pity on a stranger. They never do.

In the first case you can afford about 1000 days = 3 years of care.
In the second case you can afford about 200 months = 17 years.

Or you can die at any time and leave your assets to whomever you wish.

In the first case, do you really want society to stop you from taking the pill?

In the second case, do you really want to be kept alive, burning through $1M so your children can’t have it?


(Kim Green) #11

For me, this is the distilled summation of this article. Anyone who has had to deal with a loved one who is experiencing acute and intractable pain would see the moral and ethical “rightness” of them being able to say what should happen to their own bodies.
As Winona mentioned:

I have seen/still see people who could be referred to be barely “alive” though the body lives. The mind is trapped in a purgatory that has little connection to daily reality. It is for these whose quality of life is almost a very sad joke to say they truly “live”.

Thank-you for this excellent article.


(Paul Kevin Wells) #12

Winona, I agree with much you have said here. Having served a period as a hospice chaplain I was able to see up close a great many people in the final stages of dying. Some were in little to no physical pain and they couldn’t wait to die; others were in tremendous pain and wanted to hang on as long as possible.
Dying is a very personal experience and is not subject to linear or binary thinking. We need to do all that we can to provide for the comfort and well-being of those who are facing life-threatening illnesses (come to think of it all of us are dying anyway) and seek to preserve their dignity and under no circumstances should we ever objectify them. The loss of self-determination, or the illusion of it, inflicts a grievous injury to the humanity of the person who is dying. One more injury to a long list.
On a final note: No, you do not get to choose which fork to use for your salad if more than one fork is provided in a formal setting. Proper etiquette requires the salad fork be used for this purpose. To do anything else is just plain wrong and spiteful and could very well lead to the fall of Western Civilization.


(Winona Winkler Wendth) #13

Right: I am watching it crumble around me as I write.


(Thomas J Zwemer) #14

human life is the power to think and to do. Take that away and you are one with a carrot. So, I also have documents on file and in hand"do not resuscitate. We don’t need more carrots. I don’t plan to be one. Tom Z


(Winona Winkler Wendth) #15

There some interesting studies on the nature of choice related to this. Sheena Iyengar brings this up in a Ted.com lecture. On one hand, we want to choose; on the other, we have a hard time living with that choice.


#16

Thanks, Winona. That strikes me as the very Mirriam-Webster definition of “dehumanize” that I quoted above:

dehumanize:
to treat (someone) as though he or she were not a human being

What ground must one stand upon in order to define what a human being is?

Thanks.

sentient:
able to perceive or feel things

human being:
a man, woman, or child of the species Homo sapiens, distinguished from other animals by superior mental development, power of articulate speech, and upright stance.


(Marianne Faust) #17

should the cost of the care put even more pressure on patients?


(Marianne Faust) #18

I hope I will be able to say: not my will, but thy will…


(Winona Winkler Wendth) #19

If I had the answer to that, I’d start my own religion. Well, maybe not: too much of that, already.


#20

Winona said:
“If I had the answer to that, I’d start my own religion. Well, maybe not: too much of that, already.”

Are you, then, saying that you do not have standing to say which member of the species homo sapiens is, or is not, a human being?

Thanks.