Palliative Care Bill

End of Life issues are on the agenda at the Scottish Parliament this month. Gil Paterson's proposed Palliative Care Bill has gathered enough support from MSPs to be taken forward. The draft Bill can be read here. The Scotsman published an interview with Mr. Paterson where he discusses his reasons for proposing the Bill. We are supportive of the principles of this Bill.

End of Life issues Presentation and Service

Last night I was at the evening service at St Andrew's Parish Church in Bo'ness where members from churches in the neighbourhood met to listen to a talk on end of life issues by Dr. Murdo Macdonald. Dr Macdonald is the policy officer of the Society, Religion and Technology Project at the Church of Scotland. He presented us with a much needed update of the current legal framework for assisted suicide in Scotland and the differences between the Scottish position and the position in England. His comments were based on the End of Life Issues report to the General Assembly last year.
After the talk, there was the possibility for questions and also prayer as some of the issues talked about were intensily emotional.

Biblical Truth and the affirmation of Life

"No one can keep himself from dying ort put off the day of his death. That is the battle we cannot escape; we cannot cheat our way out".

Legalisation of euthanasia will not produce a solution to the needs of the individual sufferer; or address the health-care challenges of contemporary society. It is the expression of an attitude to life which belittles the sovereignty of God, diminishes the importance of sustaining relationships, and inhibits the pursuit of life-affirming answers for people in need and distress. Christians must be active in promoting positive alternatives derived from Biblical truth, so that the momentum toward intentional killing may be curbed. The Church of Scotland has an obligation before God to assert God’s interest in life, rather than in death; to exercise Christian compassion towards the sufferer, the disabled and the dying; and to encourage the relief of symptoms and improvement in the quality of life for such people. The Church cannot support euthanasia as a means to anything of these ends, and rejects the introduction of death as a treatment option in any clinical situation. Jesus said: ‘I am come that they may have Life, and that they may have it more abundantly’ (John 10:10). This declaration applies at the end of life or in the midst of distress, just as much as it does in any other circumstances, or any other time.




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Christian Action in Caring for At-Risk People

It is not enough to oppose the progression of pro-euthanasia arguments, nor simply to oppose voluntary euthanasia societies and similar bodies. If the Church is not say 'no' to euthanasia, it must be ready to say 'yes' to life-affirming alternatives. The Christian Gospel is a Gospel of HOPE and in particular of hope in the context of death and hopelesness. In the situation of terminal care the challenge is to bring effective relief within the context of Christian hope. It has been characteristic of the Church though the ages that it has been in the forefront of work for the suffering, the dying, and the hopeless. The hospice movement owes its existence largely to Christian initiatives which, while they have been followed by secular involvement, remain a positive motivation.

The roots lie in the need for Christians to do, rather than merely protest. A belief in the eternal worth and dignity of human beings is the mark of the Christian since the Lord Himself gave the worth of His own life and death to each one and afforded us the dignity of His eternal love.

Where the elderly, the disabled, the dying and the dementing are held in respect as fellow human beigns, they cease to be seen in negative terms. They also cease to be seen as an alien 'other' kind of person for whom the best thing is to give up on life, but are valued as individuals and to the Christian as individuals for whom Christ died. To quote from Dr. John Wyatt, a prominent paediatric specialist:

In summary, Biblical Christianity does not devalue individuals becuase of their disability. In fact, from a Christian perspective, all of us are disabled in some sense.... and the differences between us are therefore only iun degree. The essence of humanity is not in our functional ability, which may be impaired rto a greater or lesser extent, but in our creation as beings made in God's image. Functional impairment in itself does not impair our dignity or worth as human beings. The central purpose of human life is seen not in the selfish pursuit of pleasure through use of our bodily functions, but in mutual loving relationships with others and with God Himself. In Christian terms it is these personal relationships of love and self-giving which give life its 'quality'. (Survival of the wakest: CMF Publication).

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The Demand for Euthanasia for Children

There is no demand from parents for intentional killing and the matter is raised more by ethicists and theoreticians than by anyone in the practical field. The majority of paediatricians are against intentional killing and medically assisted suicide, but there is a small group who would support its introduction.

One report indicates that children have been supplied with a lethal injection and have been encouraged to administer this to themselves 'when all eslse has failed'. In such a situation, you wonder whether compassion and care had indeed failed the child!

Unconscious Children
These are usually sufferers from trauma, head injury, and brain lesions of various kinds. The most freqeunt problem encountered is head injury related to traffic accidents. They have often been dealt withi in adult intensive care units until recently, when paediatric units have been opened. The criteria for brainstorm death are the same as in adults. Similar debates occur over brainstem death in children as in adult cases. 'Switch-off' decisions are generally made on the same grounds of negative expectation of recovery, but practice varies.

The parents have the veto and often wish to continue life support initially, but may reach a point of acceptance of the futility of this after an opportunity to come to terms with the realities of the situation. Improved resucitation techniques have really introduced these problems, since many would have died without these being applied.

Where the life support requires to be switched off, this is usually done with the parents present, one of them helding the child in the period after the switch off.

The normal expectation is that death will occur. However the expectation of death may not always be fulfilled, and a brain damaged child requiring a major level of support remains. In one incident following which the child was fosteres in a loving home with excellent care, major guilt still produces problems for the parents. The case for euthanasia in such cases would rest more upon the suffering of the parents rather than that of the child.

Additional readings
Some of these readings might be useful
Shepperdson, B. (1983). Abortion and Euthanasia of Down's Syndrome Children. the Parents view.

Journal of medical Ethics

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Engelhardt, T (1989). Ethical Issues in Aiding the Death of Young Children.An excerpt is available here.

Macdonald WL (1998)> Situational factors an attitudes towards voluntary euthanasia. The abstract is available here.





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Koelzer and Brittingham: The Ethics & standards of Euthanasia and Palliative Care

Viktor Koelzer and Sara Brittingham have presented an excellent overview of the ethics and standards of euthanasia and palliative care

This is an article recently published on The Lancet Student. The authors review research that shows that there is alot of insecurity and misinformation in the provision of end-of-life care amongst medical staff. As the authors are medical students themselves they speak with knowledge about the need to have more information about end-of-life issues in order to develop their skills and confidence on dealing with terminally ill patients. The authors then go on to review the historical, ethical and leval aspects of palliative care and voluntary euthanasia in Europe. They reiterate their emphasis on compassion and respect in the provision of end-of-life care whilest respecting and adhering to the law and the ethical principles of our society. Koelzer and Brittingham then proceed to compare and contrast palliative care approaches with voluntary euthanasia approaches. They authors present contrasting approaches to addressing issues such as pain management, patient autonomy, spiritual support and communication.

Both voluntary euthanasia and palliative care options currently co-exit in Europe. It is clear that each country within the EU is addressing this issue in relation to its cultural and ethical framework, however, what seems clear if that some elements such as the Hippocratic oath and a common Judeo-Christian perspective are prevalent within the palliative care approaches in Europe. The authors state their view as follows

..."In the early stages of medicine, hardly any disease could be cured; instead, the patients were accompanied and comforted, trying to palliate suffering (10). One of the earliest medical codices, the Hippocratic Oath (400 B.C.), stated that doctors must never “give deadly medicine to anyone if asked nor suggest any such counsel”. This definite statement leads us to assume that disagreements about medically assisted death were already a matter of debate during this time. With the rise of Christianity in Europe, arguments against VE were further based on religious beliefs. Thomas Aquinas(approx. 1225-1274), one of the most important Catholic scholars of the middle ages stated in his main work “Summa Theologiae” that not only killing but also suicide was a capital sin, and emphasized the Christian virtues of “caritas” (Lat. benevolence) and “misericordia” (Lat. mercy) in the care of patients. In our opinion these values are still central in palliatice care today, emphasizing the Christian roots of the palliative care movement.

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This is thoughtful article for anyone interested in this debate.

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Hello World

This blog has been created to examine a variety of issues surrounding the end of life debate. The pressure for the introduction of euthanasia as a legally accepted teatment option in the UK and internationally is prevalent. This blog will present current positions surrounding voluntary euthanasia and assisted suicide whilest being informed by a perspective that proposes compassion for patients and their carers through the strengthening of palliative care options.