The Christian Response

We have been discussing issues relating to the availability of euthanasia for children. It is therefore appropriate to ask what is the Christian approach to this difficult topic. The traditional Christian approach is as follows:

1. Palliative Care with response and resources and higher motivation.
2. Better communication in respect of the child, taking account of the need for counselling and a recognition and respect for the child, equally, as a person formed in the image of God.
3. Valid motivation: the phrase ‘compassion mingled with respect’, attributed to Mother Teresa, perhaps sums up the most constructive attitude and is very much in keeping with the spirit of the Lord’s words – ‘In as much as ye did it unto one of the least of these, my brothers, ye did it unto me’ (Matthew 25:40). The irreducible minimum of care was defined as – fluid and nutrition, analgesia and tender loving care (TLC). If a community is to claim to be civilised, it must care for its disadvantaged.

Here are some references if you wish to read more on the subject.

H Tristram Engelhardt, A Smith Iltis (2005)
End-of-life: the traditional Christian view.The Lancet.

RM Hare(1975)
Euthanasia: a Christian view.Philosophic exchange





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Alternatives to the Progression of Euthanasia

There is increasing evidence that requests for euthanasia come from patients whose sympotm control has been less than adequate, and these requests are very rarely sustained after good symptom control has been established. Often the demand arises out of fear of unbearable suffering. When it becomes apparent that this fear is unfounded and that relief will be available, the fear itself is allayed and the apparent need for euthanasia is diminished.

Hospice care and palliative medicine

Over the past three decades the Hospice Movement has led the way in improving the care of dying patients. This improvement has been achieved not only by in-patient units, but also, and more extensively, by the community of palliative care services provided by Macmillan Nurses and Marie Curie Nursing staff. The underlying philosophy of the movement has been the recognition of the importance of quality of life involving physical, emotional, psychosocial, intellectual and spiritual aspects of that quality.

Much of the development has been towards patients with advanced cancer, but the principles are just as appliclable to other conditions and the benefits should be available to all. Palliative care has tended to be sought by hospital as well as general practitioners, as a last resort, towards the end of the course of an illness but there is much to be said for earlier referral. The skills of palliative care require to be applied as an integral part of the management of the condition and should be considered much more often and applied at an earlier time if the greatest benefit in terms of quality of life is to be obtained.

Multi-disciplinary Caring

An integrated approach to the patient's problems is achieved best by a multi-disciplinary team which will involve medical, nursing, paramedical and other professional personnel, and the input of religions institutions is by no means irrelevant in this context. The hospital chaplain or minister may be an extremely important member of the team.

The principle challenge is to duplicate the hight standards of patient care and symptom relief as established in the field of cancer care, to influence the approach to the terminal stages of many other diseases.

Pain relief is a major issue in the quality of life.Pain relief has improved significantly even in the area of non-malignant pain which can be very debilitating and has proved more difficult to control. Pain control clinics while patchy in availability are making advances in methods and approaches to persistent pain.

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Compassion should never lead us to kill

Lord Falconer's article in The Times entitled "A more civilised approach to suicide" argues in favour of decriminalising relatives who escort a loved on to a suicide clinic abroad. He then makes an appeal for compassion for the families of the terminally ill, who are already under tremendous pressure. Compassion should never be equated with facilitation of a medically assisted death.


Compassion need not kill
The treatment of illness and the relief of suffering have advanced very considerably in the past decades. Symptom control has also made major advances. Our understanding of the nature of pain and human responses to it are increasing steadily. Pharmacological and physical methods for its relief are available and effective for conditions and circumstances which would have been previously resistant. Drug delivery systems, special formulation, chemotherapeutic agents, physical techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) are pushing back the thresholds of pain and bringing relief to those who are appropriately assessed and treated.

The Ethos of Medical Practice
It is no part of the doctor's tradition or ethos to kill. This option was open in pre-Hippocratic Medicine, but Hippocratic tradition, and later, Judeo-Christian teaching set out to change this and to oblige the doctor to preserve and sustain life by every means possible. It has always been accepted that death could not be postponed indefinitely, but the duty of the doctor as expressed by Ambroise Pare 'to cure sometimes, to alleviate often, to comfort always', has stopped short of death as a treatment option. There is still in most doctors an abhorrence of killing, even accidentally, and a deeper abhorrence of doing so intentionally.

Doctors who have to deal with the very ill and terminally ill will admit to having been tempted at some time to bring a patient's life to an end. Doctors, with a few exceptions are not in the forefront of the demand for eithanasia or medically assisted suicide. They are however involved in the ethical, moral and practical issues (Lack of information, or equipment or resources) around terminal care. There is a basic need is for better clinical awareness of the principles of good management of troublesome symptoms and, as a consequence, better education and training of health-care professionals in these principles. Good clinical judgment is based on knowledge, compassion and integrity.

Ian Galloway, convener of the Church & Society Council recently presented the views of the church of Scotland in an articpublished an article on Interfaith Matters. In there he states

Pain management is a significant component within palliative care. Since its inception, palliative care education has used the model of multidisciplinary education. Palliative care is synonymous with holistic care which includes physical, psychological, social and spiritual needs. It is an approach which seeks to maximise the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems. In recent years the provision of spiritual and religious care has benefitted greatly from multi-faith and multicultural approaches to healthcare and the move towards professionalisation of healthcare chaplaincy. If palliative care includes good spiritual care and a managed approach to pain, then some of the issues leading to calls for physician assisted suicide may be resolved.

Rvd. Galloway's views have been picked up by other bloggers.

The irreducible minimum of care has been defined as -fuid and nutrition, analgesia and tender loving care. The phrase 'compassion mingled with respect' attributed to Mother Teresa, perhaps sums up a more constructive attitude towards end-or-life issues. If a community is to claim to be civilised and compassionate it must care for those facing the last moments of their lives withou hastening that end.



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You are precious in my eyes and I love you!

By Revd Ian Galloway, Convener of Church of Scotland’s Church and Society Council has written a passionate defense of the Christian approach to end-of-life issues.

"You are precious in my eyes and I love you”. This could be the refrain of a popular love song, but it is not; it comes from the Hebrew Scriptures (Isaiah 43:4) and is one of the foundations to understanding a Christian approach to end-of-life issues. How can honour and love be at the heart of the euthanasia debate? A Christian understanding of the value of human life derives from the belief that we are made in the image of God and that God loves, honours and respects us. There is something of the sacred within each one of us. This perspective on the value of human life has particular consequences in our ageing population where there are inevitably scarce resources available to take care of the aged, the frail and the infirm. Medical advances, life-supporting technology and pharmacological solutions have increased life expectancy and the expectation of cure to the point that illness and death are perhaps less accepted as part of normal human experience.

The full article is printed in the Interfaith Matters newspaper which is the organ of the Edinburgh Interfaith Association, EIFA. The full newspaper can be downloaded here.
Reverend Galloway's article was "in print" about the same time that Margo MacDonald MSP put forward a Proposed End of Life Choices Bill to the Scottish Parliament. Since then the end of life debate has grown across the country.

On the other hand a different approach to dealing with difficult end of life issues has been proposed by Roseanna Cunningham. She presented a Proposed Palliative Care (Scotland) Bill
The Proposed Palliative Care Bill and the Proposed End of Life Choices (Scotland)Bill and can both be viewed and downloaded at the Scottish Parliament's website.
If you have any comments on the article or on any aspects of these issues please express your comments right here on the blog.










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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.