Religious groups, bitterly torn over abortion during the past decade, are now under increasing pressure to take sides in the explosive issue of euthanasia, or so-called mercy killing.
The push to debate the ethics of helping others die has been suddenly accelerated by highly publicized suicides arranged by a doctor in Michigan, the unexpected brisk sales of a suicide manual for the ill and an initiative on Tuesday’s ballot in the state of Washington that would legalize doctor-assisted suicide.
“In a society that can’t agree when human life begins, it’s no surprise that we have trouble deciding when it should end,” said Margaret Battin, a University of Utah philosophy professor and specialist in bioethics and professional ethics. “If you think the abortion issue was emotional, just wait until we get fully into euthanasia and death.”
Many faiths--traditionally committed to defending the sanctity of human life--endorse the idea of withholding extraordinary life-prolonging measures from the terminally ill. But deep divisions exist about who has the right to terminate life--and at what point.
Battin is among many experts who believe euthanasia will be the major bioethical and social issue of the 1990s. As life expectancy continues to advance beyond the ability of medical science to provide a comfortable existence, the medical community, lawmakers, ethicists and religious leaders will have to fashion guidelines about euthanasia that they can live with.
A resolution that will be voted on next May by the 9-million-member United Methodist Church suggests that assisted suicide in some cases could be “responsible stewardship of God-given life” and calls on churches to “provide preparation in dealing with these complex issues.” While the resolution neither condemns nor condones suicide, it acknowledges that “some persons . . . may consider suicide as a means to hasten death.”
The ambiguous language of the Methodist statement is indicative of the uncertainty that exists among many in the religious community about the right to die and the role of the physician, the patient and the community in making end-of-life decisions.
The 1.6-million-member United Church of Christ in July became the first major mainline denomination to approve of active euthanasia--that is, when medical intervention is specifically intended to cause a person’s death. In 1988, the General Assembly of the Unitarian Universalist Assn. endorsed a terminally ill patient’s right to die “in accordance with one’s own choice.”
Several other denominations, including the Presbyterian Church (U.S.A.), are leaning toward the individual right to control one’s death. In the Episcopal Church, active euthanasia is under wide discussion.
The Islamic faith prohibits euthanasia of any kind. “The reason is a firm faith in God,” explained Dr. Hassan Hathout, a physician and outreach director of the Islamic Center of Southern California. “We don’t own ourselves. We are entrusted to God and the taking of life is the right of the one who gives it.”
While Roman Catholic tradition recognizes no moral obligation “to use all available medical procedures in every set of circumstances,” the Catholic bishops of Oregon and Washington last month condemned euthanasia as “a lethal, violent and unacceptable way of terminating care for the infirm.”
Nowhere is the battle over death and dying more vociferous than in Washington state, where voters will decide the fate of the right-to-die initiative that goes beyond “passive euthanasia,” or stopping treatment to let a patient die. Initiative 119 would permit doctors to kill conscious and competent patients who are judged to have fewer than six months to live and who make a written request to die.
(A similar initiative in California has been sponsored by a right-to-die organization, Californians Against Human Suffering. If 387,000 signatures are gathered by March 5, the measure will be voted on statewide in November, 1992.)
Approval of Initiative 119 would make Washington the first place in the world to legalize doctor-assisted suicide. It could also open the way to overturn the 2,000-year-old medical and moral dictum that enjoins doctors to do no harm to their patients.
Religious groups on both sides of the issue have been lining up their best speakers, waging aggressive media campaigns and raising unprecedented financial backing.
More than $717,000, or nearly half, of the money raised to defeat Initiative 119 and Initiative 120--a companion measure to liberalize abortions--has been contributed by the Catholic Church and its agencies, according to Public Disclosure Commission records.
“Without question, we have not . . . seen this kind of involvement from any religious organization” before, said the commission’s director, Graham Johnson.
“We realize we’re on point for the whole U.S.,” said Sister Sharon Park of the Washington State Catholic Conference.
Supporters of Initiative 119 have raised more than $1.86 million--a new record for a citizen initiative. Contributions include $315,000 from the Hemlock Society, founded by Derek Humphrey, author of the best-selling suicide manual “Final Exit,” and $25,000 from the Boston-based Unitarian Foundation, an arm of the Unitarian-Universalist Church.
More than 200 Catholic priests and 200 Protestant clergy in the state oppose Initiative 119, including the state’s three bishops of the 5.3-million-member Evangelical Lutheran Church in America.
Taking the opposite view are 300 individual members of Interfaith Clergy for Yes on 119, including Reform rabbis, Lutherans, Episcopalians, Baptists, Unitarian Universalists, United Methodists and ministers of the United Church of Christ and Disciples of Christ.
The Pacific Northwest Conference of the United Methodist Church, on a vote of 312 to 188 by its clergy and lay representatives, endorsed the initiative. The conference said that “every person as a creation of God . . . (has) the right to die with dignity, free of pain, suffering and humiliation.”
Already, a kind of quiet consensus seems to be developing at the bedside.
The American Hospital Assn. estimated last year that 70% of the 6,000 daily deaths in the United States are “somehow timed or negotiated with all concerned parties privately concurring on withdrawal of some death-delaying technology or not even starting it in the first place.”
“At the bedside level,” says Marsha Fowler of Azusa Pacific University in Azusa, who trains nurses to work as staff members of local churches, “the single most important bioethical issue . . . is the way in which one goes about dying--withholding treatment and withdrawing treatment once it’s started; and how you evaluate this in terms of the person’s spiritual walk and beliefs.”
Pastors and religious counselors are increasingly being called upon to help terminally ill people and their loved ones cope with what are often agonizing end-of-life decisions.
The Rev. Richard Spencer, pastor of Saratoga Presbyterian Church in Northern California, remembers how the family of a middle-aged man with brain cancer was divided over how much should be done to prolong his life--whether he should undergo further surgery or be brought home from the hospital to die.
Spencer helped the family work through their feelings. He said he assured them that not to try to keep the man alive “would be consistent with Christian responsibility and love--that they weren’t required to do everything possible for him but only everything that would be truly wise and to his benefit.”
Spencer also recalls a 32-year-old man suffering with colon cancer who wanted enough medication to relieve the intense pain of his final days. The man, his wife and Spencer were all aware that the secondary effect of a large dose of morphine--which he was given--would also hasten his death.
“He died within an hour, and it was a blessed relief,” Spencer said. “But there was no intent to kill, only to relieve pain.”
Communication between the three was through “brief words, nods, the touch of a hand and consenting support,” Spencer said. “You are really on holy ground there; it’s such an intense moment.”
Elizabeth Skoglund, a marriage and family counselor in Burbank who writes about end-of-life choices in her book, “A Reason to Live,” said that “whether or not we like it, there are gray areas. It is immoral and dangerous to terminate a life. But it’s equally immoral and dangerous to extend the dying process. Where you draw the line is where the gray comes in.”
Rabbi Harvey Field, president of the Board of Rabbis of Southern California and spiritual leader of Wilshire Boulevard Temple in Los Angeles, a Reform congregation, would draw the line more liberally than most of those in the Conservative--and certainly the Orthodox--wings of Judaism.
“The basic (Jewish) tradition is that you allow life to take its course; you neither foreshorten nor prolong it. . . . But I believe that where there is clearly a terminal situation, and the quality of life has deteriorated and will continue to deteriorate, the person really ought to have the choice in determining how he or she wishes to die,” Field said.
But he added that he would draw “that very delicate line” where the illness is not terminal; he opposes euthanasia when it becomes “another form of suicide.”
Several rabbinical groups are currently studying the issue, but all four branches of Judaism officially oppose active euthanasia.
Like the Roman Catholic Church, the 15-million-member Southern Baptist Convention, the nation’s largest Protestant body, opposes all forms of suicide or euthanasia.
“People suffering terminal illness are in a powerless position relative to those who can take their lives from them,” said Ned Dolejski, executive director of the Washington State Catholic Conference. He cited a recent study by the Dutch government of euthanasia practices in the Netherlands. The report indicated that less than 10% of euthanasia cases were reported to legal authorities and that last year more than 1,000 patients were put to death without their express permission. The lives of another 14,000 were shortened by painkilling medication without their consent, according to the report.
Dolejski said he feared that because of rocketing U.S. health-care costs, “useless” and “difficult” patients--especially the poor and defenseless--could be targeted for involuntary euthanasia.
Dolejski and James M. Wall, editor of the mainline Protestant magazine, Christian Century, stress the need to foster communal values of caring and comfort over what they perceive as America’s preoccupation with staunch individualism.
“There is, admittedly,” Wall writes, “a difference between the elderly terminal patient in terrible pain who wants all pain to cease and the despondent teen-ager whose pain is one of low self-esteem. But the difference is finally one of degree. The terminally ill person, out of personal suffering and a concern for the impact a lingering illness has on family and the immediate human circle, may turn to suicide.
“But the emotionally distraught teen-ager or adult may reach the same conclusion: my pain is too great, and my presence is detrimental to those around me. To make that decision before life involuntarily leaves us is a decision we are free to make, but it is a choice that is ultimately selfish.”
On the other hand, Battin, the University of Utah professor, says the greatest protection against abuse is to allow the individual to retain control “over this most intimate and personal of matters. . . . It’s controlled either way--either by the person whose death it is or by other parties. . . . Only voluntary choices should be respected.”
People admittedly can be manipulated into choosing to die, she continued, but “we now manipulate them into staying alive. . . . We coerce them into keeping on living.”
Surprisingly, perhaps, few on either side of the euthanasia argument seem to appeal directly to Bible passages for support.
Scripture is not nearly as clear on euthanasia as it is on abortion, said Lewis Smedes, professor of integrated studies at the Fuller Graduate School of Psychology in Pasadena. “People could abort even in Old Testament times,” noted Smedes, an 18-year member of the bioethics committee at Pasadena’s Huntington Memorial Hospital. “But nobody had a respirator to keep people going then. Eldercare was important.”
Euthanasia opponents sometimes cite the biblical commandment, “Thou shalt not kill” as justification for their position as well as Psalm 139, which speaks of God’s mysterious creation and watchfulness over human life. Those who say a life may sometimes be taken or someone permitted to die are more likely to appeal to the general Scriptural principles of compassion, human dignity and worth.
Smedes emphasizes the need “to hear special signals from God,” that, in the words of Ecclesiastes 12:7, indicate when it may be time to “let the dust return to the Earth as it was; and the spirit shall return unto God who gave it.”
Religious arguments alone do not persuade most people not to end their lives when they face terminal illness accompanied by great suffering, according to Corrine Bayley, vice president for ethics and corporate values at St. Joseph Health System in Orange, an agency serving seven regional Roman Catholic hospitals.
Rather, she said, care and compassion change the wish to die.
“Hospice staff will tell you that those who ask to end life no longer ask for that when they feel they are not abandoned, when they feel they are cared for, and when they have adequate pain control,” Bayley said.
But the Rev. Marvin Evans, a Unitarian-Universalist minister who is coordinator of the Interfaith Clergy for Yes on 119, says “love is best served by at least having available the voluntary option of asking your physician--and only your physician--to aid you in dying with dignity.”
Evans said several parishioners described the option as an “enormously liberating assurance.”
In neither case did the patient choose the option. “But knowing it was there made their last days far more meaningful and rich than being in horror of passing from life to death--that passage being inevitable,” Evans said.