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End of Life Choice Bill: A Response

Euthanasia is a weighty subject—a subject that cannot be broached without reflecting upon human suffering, harm, and death. Since the proposal of the End of Life Choice Bill (ELCB), euthanasia has been the subject of extensive public and private debate here in Aotearoa. For those unfamiliar with the bill, it proposes the legalisation of voluntary euthanasia for any person over the age of 18 who has a “grievous and irremediable medical condition”, who “experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable”, and who can “understand the nature and consequences of assisted dying”[i]. In December 2017 the bill passed its first reading, and the second reading will be held once the Justice Committee have finished receiving public submissions. In this post, I will argue that the ELCB is flawed in such a way that renders it unacceptable as public policy. Briefly, my argument is that the safeguards in the bill are unable to sufficiently minimise the risk of patient manipulation, and, since the government should not accept legislation for euthanasia that fails in this regard, the bill should not be accepted.


Safeguards

Section 8(h) states that attending physicians must do their best to ensure that patients’ requests for euthanasia are free from external pressure, and three primary safeguards are outlined[ii]. The physician must:

  • Talk to “other health practitioners who are in regular contact with the person”
  • Talk with “members of the person’s family approved by the person”
  • Fill out a form detailing the actions he or she took to ensure that these obligations were fulfilled.

My contention is that although these safeguards offer some protection against manipulation, they do not sufficiently minimise the risk. As an example, consider this situation:

A family stands to benefit from the death of a terminally-ill relative. As such, they manipulate their ill relative into requesting euthanasia, even though it is not a choice she wants to make. Nonetheless, she informs her health practitioner of the “decision”, and requests euthanasia. The physician talks to the patient, as per the safeguards, who falsely affirms that the request was autonomous. The physician then converses with the family, who do not admit to having manipulated the patient. Consequently, the physician sends the necessary forms to the Registrar, which approves the request, and the patient is euthanised.

This example indicates that, even when the safeguards are followed, patients can nonetheless be manipulated into requesting euthanasia against their wishes.

Objections

There are two obvious rejoinders that would nullify this argument. Firstly, someone might contend that it is all very well and good to theorise about these kinds of abusive situations, but, in reality, no one would ever do such a thing. To this objection, I would quote ethicist J. D. Velleman: “no one would ever do such a thing as abuse his own children or parents—except that many people do”[iii]. In light of the atrocities that have occurred and do regularly occur in our society, the aforementioned scenario hardly seems unlikely. But, if it is not unlikely, then it deserves to be seriously considered, and should be a significant factor in our assessment of the worthiness of this bill.

Secondly, many people argue that there is no evidence of significant abuse or error occurring in countries and states where assisted-dying is currently legal. As one study indicates, “rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for [vulnerable groups]”[iv]. When considering an increase in euthanasia among elderly persons, other researchers state “we deem it less plausible [than other explanations] that the trends indicate more vulnerable groups feeling increasingly forced to choose euthanasia”[v].

Two responses come to mind. Firstly, interpretation of these findings is mixed. Though some researchers conclude that there is no indication of abuse, others question both their methodologies and conclusions[vi]. In some cases, the data is consistent with error and abuse. For example, a study of euthanasia in Belgium found that life-ending measures were frequently enacted without an explicit request, and that in these situations “family burden and the consideration that life was not to be needlessly prolonged were more often reasons for using life-ending drugs”[vii].

However, a more fundamental consideration is this: if manipulation were occuring, it is not clear that we should expect to find evidence. After all, the abused person is deceased, and therefore cannot testify, while those who committed the abuse are unlikely to admit their wrongdoing. Since these are probably the only parties privy to the abuse, a lack of evidence is what we should expect both if manipulation is occuring, and if it is not. Therefore, absence of evidence does not equal absence of abuse.


In sum, I do not believe that the ELCB provides adequate safeguards against manipulation, and therefore it should not be accepted. If euthanasia is to be legalised, we as a society have a duty to make sure it does not adversely affect vulnerable people. As such, any proposed legislation must be subjected to rigourous scrutiny to determine whether it achieves this end. In this regard, I believe the End of Life Choice Bill fails.

 

Endnotes:


[i]ELCB Section 4: http://www.legislation.govt.nz/bill/member/2017/0269/latest/DLM7285950.html

[ii] ELCB Section 8: http://www.legislation.govt.nz/bill/member/2017/0269/latest/DLM7285956.html

[iii] Velleman, J.D. (1992). Against the right to die. Journal of medicine and philosophy, 17(6), p. 675.

[iv] Battin, M. P., van der Heide, A., Ganzini, L., van der Wal, G., & Onwuteaka-Philipsen, B. D. (2007). Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics 33, p. 591.

[v] Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2016). Euthanasia in Belgium: trends in reported cases between 2003 and 2013. Canadian Medical Association Journal 188(16), p. 412.

[vi] E.g. Finlay, I. G., & George, R. (2011). Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on. Journal of Medical Ethics 37, pp. 171-174.

[vii] Chambaere, K., Bilsen, J., Cohen, J., Onwuteaka-Philipsen, B. D., & Mortier F, D. L. (2010). Physcian-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal 182(9), pp. 896-897.

 

Tauranga Event: Faith & Reason in a Broken World

This weekend, Christian Philosopher Trent Dougherty will be in Tauranga to speak at two events on the problem of evil and suffering.

Here are the details:

SATURDAY 9th July – 7pm: Faith & Reason in the face of Evil and Suffering
Bethlehem Community Church, 183 Moffat Rd, Bethlehem, Tauranga
What reasons can the Christian Faith give when faced with the horrendous evil we see in the world around us?  In this lecture Trent will give guidelines for the integration of faith and reason and how they apply to the problem of evil and suffering.

SUNDAY 10th July – 7pm: Exposing Atheistic Naturalism’s Answer to Evil
Bethlehem Community Church, 183 Moffat Rd, Bethlehem, Tauranga
Atheists claim that naturalism (the view that only matter, energy and time exist – with no God intervening from the outside) gives a better explanation of suffering in the world.  But in this lecture Trent will show that at every turn, naturalism’s attempt to answer the problem of evil and suffering backfires.

Both events are free, but donations are welcome.

Trent Dougherty is the Assistant Professor of Philosophy at Baylor University in the US.  He has a PhD in Philosophy of Religion, Epistemology and Probability Theory from the University of Rochester and an MA in Philosophy from the University of Missouri-Columbia.  He has published articles and book reviews in many journals including Religious Studies Review, Notre Dame Philosophical Review, Philosophia Christi and many others.

 

Why is the world the way it is?

John Piper, Pastor for Preaching at Bethlehem Baptist Church in Minneapolis, addresses the important issue of suffering in this sermon at Saint Andrew’s in Sanford, Florida:

The Supremacy of Christ & the Sorrow of Calamity.

Suffering through Romans: Part Four

In the first part of this series, I briefly sketched the historical and socio-cultural backdrop of the Roman Empire, its capital city Rome, and its citizens. In the second and third parts, I surveyed the theme of suffering in Romans within the wider of context of Pauline theology. In this final part, I will move on to our appropriate response to suffering in the present, and some thoughts on what application we can draw from this thematic exploration. Read more

Suffering through Romans: Part Three

In the first part of this series I briefly sketched the historical and socio-cultural backdrop of the Roman Empire, its capital city Rome, and its citizens. In the second part I surveyed this theme in Romans within the wider of context of Pauline theology. In this third part I will cover the scope of suffering.

Read more

Suffering through Romans: Part Two

In the first part of this series I briefly sketched the historical and socio-cultural backdrop of the Roman Empire, its capital city Rome, and its citizens. In this second part I will survey this theme in Romans within the wider of context of Pauline theology. Read more

Suffering through Romans: Part One

“Go! This man is my chosen instrument to proclaim my name to the Gentiles and their kings and to the people of Israel. I will show him how much he must suffer for my name.” – Acts 9:15-16

In this series I shall survey this theme in Romans within the wider of context of Pauline theology. This includes the origin and scope of pain, and the appropriate response to suffering in the present. I shall then give some thoughts on application drawn from this thematic exploration. In Part One I shall briefly sketch the historical and socio-cultural backdrop of the Roman Empire, its capital city Rome, and its citizens. Read more

John Lennox on God, Christchurch, and the Problem of Pain

Howick Baptist has made available the video and audio from Professor John Lennox’s  sermon at their Sunday service. Read more

Evil and the Evidence for God

“No argument from evil I am aware of makes it likely or even reasonable to believe there is no God. Evil cannot carry that evidential load. But suppose I’m wrong. Suppose evil is evidence to think God does not exist. Does it follow that it’s reasonable to believe there is no God?

Let’s approach this question by way of analogy. Suppose you learn in your European Culture class today that 95 percent of the French population can’t swim. That statistic is some evidence to think that Pierre, your friend from Paris, can’t swim. Does it follow that you should believe Pierre can’t swim? Of course not. What if you and Pierre spent last Saturday afternoon together swimming and chatting about the fine-tuning argument and Albert Camus’ The Plague? Surely, in that case, it isn’t reasonable for you to believe Pierre can’t swim. Your experience with him is much better evidence to think he can swim even though the statistical evidence by itself makes it very likely that he cannot.

The same goes with evil and God. Even if evil is some evidence that there is no God, you might have much better evidence to think that God exists; in that case, it wouldn’t be reasonable for you to believe there is no God.

This line of thought naturally leads to some weighty questions not the least of which are these: Is the evidence for God significantly better than the evidence that evil provides against God? What sources of evidence are there? How should we balance the evidence for and against theism?”

Daniel Howard-Snyder, “God, Evil, and Suffering” in Reason for the Hope Within edited by Michael J. Murray (William B. Eerdmans Publishing Company) page 114.

Suffering and the Christian understanding of truth

No Christian teacher is worth listening to who is not willing to suffer if need be for the truth that is being taught. The readiness to suffer for the sake of the truth is intrinsic to the whole fabric of Christian living, and hence teaching, and thus not an optional part of the equation of the equipping of the public teacher of Christianity.

Paul’s teaching was personally validated by his willingness to be “exposed to hardship, even to the point of being shut up like a common criminal; but the word of God is not shut up” (2 Tim. 2:9). Some hearers will find in the truth of the one who was “nailed to the cross” merely a “stone of stumbling” and “folly” (1 Cor. 1:23; cf. Rom. 8:17, 18). Jesus did not hesitate to make it clear that his disciples must be prepared to “be handed over for punishment and execution; and men of all nations will hate you for your allegiance to me.”

The truth, Christianly understood, is an event in history, a birth, death, and resurrection, God’s own personal coming to us in mercy and grace, a Word spoken through a personal life lived, a personal event in which we are called personally to participate. To tell the truth rightly is to follow the one who is truth.

The “right method” for guarding Christian truth was set forth in Luther’s three concise instructions: oratio, meditatio, tentatio – first by prayer, then by textual meditation, but decisively by suffering temptation and the experience of testing through affliction. Listen to him poignantly acknowledge how much he owed to his enemies: “Through the raging of the devil they have so buffeted, distressed, and terrified me that they have made me a fairly good theologian, which I would not have become without them.”

Thomas C. Oden, Defending the Faith: Christian Apologetics in a Non-Christian World, paper presented at The 1995 Evangelical Theological Society Annual Meeting

What do Christians mean when they say 'God cannot suffer'?

God is impassible, which means that no one can inflict suffering, pain, or any sort of distress upon him. Insofar as God enters into experience of that kind, it is by empathy for his creatures and according to his own deliberate decision, not as his creatures’ victim. The words “of that kind” are important, for this impassibility has never been taken by Christian mainstreamers to mean that God is a stranger to joy and delight; it has, rather, been construed as an assertion of the permanence of God’s joy and delight; which no pain clouds. How the formula applies to the atoning sufferings of the incarnate Son is a special and open question, on which different views have been, and are, maintained . . . The historical answer [to the question of what is meant by ‘God cannot suffer’] is: not impassivity, unconcern, and impersonal detachment in face of the creation; not insensitivity and indifference to the distresses of a fallen world; not inability or unwillingness to empathize with human pain and grief; but simply that God’s experiences do not come upon him as ours come upon us, for his are foreknown, willed and chosen by himself, and not involuntary surprises forced on him from outside, apart from his own decision, in the way that ours regularly are. In other words, he is never in reality the victim whom man makes to suffer: even the Son on his cross, where “a victime led, thy blood was shed,” was suffering by his Father’s conscious foreknowledge and choice, and those who made him suffer, however free and guilty their action, were real if unwitting tools of divine wisdom and agents of the divine plan (cf. Acts 2:23; 1 Peter 1:20).

J. I. Packer, “Theism for Our Time,” pages 7-8, 16-17.