Ending Life, Morality, and Meaning

Opponents of voluntary euthanasia and physician-assisted suicide often maintain that the procedures ought not to be accepted because ending an innocent human life would both be morally wrong in itself and have unfortunate consequences. A gravely suffering patient can grant that ending his life would involve such harm but still insist that he would have reason to continue living only if there were something to him in his abstaining from ending his life. Though relatively rarely, the notion of meaning of life has figured in recent medical ethical debate on voluntary euthanasia and physician-assisted suicide. And in current philosophical discussion on meaning of life outside the medical ethical debate on voluntary euthanasia and physician-assisted suicide several authors have argued that being moral and having a meaningful existence are connected to each other. In this article, I assess whether his intentionally refraining from causing the harm related to voluntary euthanasia and physician-assisted suicide would involve something to such a patient in the sense that it would promote the meaningfulness of his life.     

Moral philosophy and theology: why is there so little difference for Roman Catholics?

The cardinal question in Christian moral theory and bioethics is whether the knowledge that Christians have (1) by grace and (2) by revelation (e.g., regarding the character of human and cosmic history as reaching from creation through the Incarnation and the Redemption to the Second Coming and the restoration of all things) makes a crucial contribution to understanding morality, as for example issues such as the good death and the morality of physician-assisted suicide and euthanasia. This article argues that such a contribution is made by grace and revelation. The reduction of Roman Catholic moral theology and bioethics to secular bioethics is explored, as well as the necessity of the unique knowledge possessed by Christians for adequate end-of-life decision-making.     

Observations on the rejection of physician-assisted suicide: a Roman Catholic perspective.

Roman Catholic moral theology follows a centuries-old tradition of moral reflection. Contemporary Roman Catholic moral theory applies these traditional arguments to the realm of medical ethics, including the issues of active euthanasia and physician-assisted suicide. Unavoidable moral limits on licit medical intervention sometimes require that the moral duty to treat cede to the duty to cease treatment when measures become more harmful than beneficial to the patient. This does not reduce the need for the compassionate use of palliative care in response to suffering. However, it does mean that rather than being excessively committed to maintaining mere biological human life, or actively seeking death, that we learn a sober realism about the limits of human life. Catholic moral analysis examines an act objectively, both in its relation to the agent and as a material event in the world. This allows both the virtuous or vicious intentions of the agent and the effects of the action to be included in its moral evaluation. Thus, Catholic moral analysis is both quasi-deontological and quasi-consequentialist. Objectively, active euthanasia and physician-assisted suicide, as acts of deliberate killing, are seen as repugnant, in that they fail to incarnate a benign inner intention or to form an agent in virtue. Catholic moral theology is extremely skeptical that an act of intending death directly can be consonant with a sincere compassion for the dying, suffering person and views it as a direct negation of the precious gift of human life.     

The Moral Deliberations of 15 Clergy on Suicide and Assisted Death: A Qualitative Study

Given the relationship between moral objections to suicide, physician-assisted suicide (PAS), and euthanasia and religion, it is important to understand under what conditions clergy have moral objections to suicide, ending futile medical treatment, PAS, and euthanasia. This study used thematic analysis to explore the moral deliberations of 15 clergy and the right- and wrong-making properties of nine death and dying scenarios. Fifteen Catholic, Jewish, and Protestant clergy completed semi-structured interviews. Data analysis generated eight themes: sanctity of life, preservation of the natural course of life, pastoral care, support of the faith community, referral to professional services, end-of-life decision in community, consultation with medical professionals, and a shift to a hopeful narrative. Respondents consistently endorsed the priority of pastoral care, demonstrating a deep concern for the well-being of suffering congregants. In conclusion, respondents were consistent in the application of eight themes to end-of-life scenarios but differed in their approach to the removal of a feeding tube and being present for a PAS death. Every respondent objected to suicide.     

Racial Diversity, Religion, and Morality: Examining the Moral Views of Multiracial Church Attendees

Previous research has identified an important link between participation in a racially diverse faith community and more progressive views on racial, political, and social issues, but researchers have yet to examine whether multiracial church attendees differ from racially-homogeneous church attendees in terms of their moral views. This research note utilizes national data (2005 Baylor Religion Survey) to examine the relationship between involvement in a multiracial congregation and views toward activities that are understood to be morally contentious. I estimate logistic regression models to isolate the relationship between multiracial church attendance and support for nine morally contentious activities related to sexuality, families, substance use, and suicide. Analyses reveal that, net of other factors, persons who attend multiracial congregations are more likely to express support for extramarital sex, premarital cohabitation, planned unwed pregnancy, marijuana use, and euthanasia, compared to persons who attend homogeneous congregations where they are the majority race. Multiracial church attendees thus appear to hold more permissive moral views on certain issues relative to attendees of racially homogeneous congregations. Significant interactions are also found between multiracial church attendance, race, and religious tradition. Alternative explanatory accounts (social contact vs. self-selection) are considered.     

Individualism,authoritarianism, and attitudes toward assisted death: cross-cultural,cross-regional,and experimental evidence

We hypothesized that in individualistic cultures, individualism predicts positive attitudes toward assisted death, whereas authoritarianism is negatively associated with favorable views of this issue. Study 1 confirmed this hypothesis in a Polish sample (n=100). Study 2, using a German sample (n=102), found the predicted relationships for forms of assisted death that involved the individual self-determination of a terminally ill patient. In Study 3 (n=72), we found experimental evidence that priming individualistic aspects of the self-concept results in more favorable views of physician-assisted suicide. Using a representative sample (n=1158), Study 4 found that across the United States, regional levels of individualism are reflected in corresponding patterns of support for assisted suicide. The discussion focuses on assisted suicide as a cultural phenomenon and explores the implications of growing levels of individualism for public opinion and policy on assisted suicide.     

Physician-assisted death: doctrinal develoment vs. Christian tradition.

Physician-assisted suicide offers a moral and theological Rorschach test. Foundational commitments regarding morality and theology are disclosed by how the issue is perceived and by what moral problems it is seen to present. One of the cardinal differences disclosed is that between Western and Orthodox Christian approaches to theology in general, and the theology of dying and suicide in particular. Confrontation with the issue of suicide is likely to bring further doctrinal development in many of the Western Christian religions, so as to be able to accept physician-assisted suicide and euthanasia.     

Physician-assisted suicide and euthanasia: German Protestantism, conscience, and the limits of purely ethical reflection.

In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to "organize" a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. Behind this joint service to society the lines of the theological debate have to be ree-discovered. First it will be argued that a Protestant reading of the joint memoranda has to be based on the concept of individual conscience. The crucial questions are then: Whose conscience has the authority to decide? and: Can the physician assisted suicide be desired faithfully? Prominent in the current debate are Ulrich Eibach as a strict defender of the sanctity of life, and on the other side Walter Jens and Hans Kung, who argue for a right to physician assisted suicide under extreme conditions. I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.     

Religion and Attitudes Toward Physician-Assisted Suicide and Terminal Palliative Care

We assess religious differences in attitudes toward physician-assisted suicide and terminal palliative care, and go further than previous research by attempting to explain these variations. Using data from the 1998 General Social Survey, we fit OLS regression models to estimate the main effects of religious affiliation and indirect effects via religious involvement (church attendance and strength of affiliation). Both conservative and moderate Protestants are generally less accepting of physician-assisted suicide and terminal palliative care than nonaffiliates. However, both relationships are at least partially explained by church attendance and/or strength of affiliation.     

Euthanasia and the quality of life debate.

Orthodox Christian ethics is grounded in the sacredness of life principle. Yet, it can accept a quality of life approach where "quality" refers not to capacities or states, but to the relationship between the patient's condition and the quest for transcendent life goals (Walter and Shannon, 1990). The true quality of human life derives from the vocation to stewardship, which enjoins an attitude of humble acceptance toward beneficial or "redemptive" suffering. The proper response to suffering in terminal cases is not active euthanasia or physician-assisted suicide but appropriate pain management and personal care. In cases of PVS or deep coma, only the determination of higher brain death can warrant the withholding or withdrawing of food and hydration. Yet, artificial maintenance of biological existence is also immoral. Death is to be accepted and embraced as a transition to eternal life.     

Attitudes Toward Euthanasia and Justifying Reasons Of Elderly Israelis and Their Family Members

Abstract

The purpose of the current study was to reach an interpretive understanding of the reasons underlying favorable and unfavorable attitudes of Israeli elderly adults and their family members toward euthanasia. The informants were 47 individuals representing 19 families who were asked for their attitudes toward four case studies that represented withholding and withdrawing treatment, active euthanasia, and physician-assisted death. Results of the grounded theory analysis revealed that most of the participants favored withholding life-sustaining treatment and that almost half of them thought active euthanasia and physician-assisted suicide were morally acceptable as long as the decision was made by the individual patient himself or herself (voluntary). The reasons that justified their attitude positions were named according to six dimensions: promoting life, promoting death, self-control, dele-gators, allowing to die, and one-way street. The analysis further examined similar reasons that were provided as justifications for attitudes by two or more family members. These family reason dimensions were labeled according to their similarities to various ethical perspectives, including character ethics, natural laws, liberal individualism, communitarianism, beneficence, and casuistry. The research highlighted the importance of self-control as a core concern of individuals and family members when addressing the moral issues surrounding euthanasia.     

Physician-assisted suicide reconsidered: dying as a Christian in a post-Christian age.

The traditional Christian focus concerning dying is on repentance, not dignity. The goal of a traditional Christian death is not a pleasing, final chapter to life, but union with God: holiness. The pursuit of holiness requires putting on Christ and accepting His cross. In contrast, post-traditional Christian and secular concerns with self-determination, control, dignity, and self-esteem make physician-assisted suicide and voluntary active euthanasia plausible moral choices. Such is not the case within the context of the traditional Christian experience of God, which throughout its 2000 years has sternly condemned suicide and assisted suicide. The wrongness of such actions cannot adequately be appreciated outside the experience of that Christian life. Traditional Christian appreciations of death involve an epistemology and metaphysics of values in discordance with those of secular morality. This difference in the appreciation of the meaning of dying and death, as well as in the appreciation of the moral significance of suicide, discloses a new battle in the culture wars separating traditional Christian morality from that of the surrounding society.     

Problems, plans, and ambitions of German and foreign adolescents

In the present study, personal and social problems and ambitions of a group of foreign adolescents (Italians, Spaniards, and Greeks) living in Germany were compared with those of a group of German adolescents. Results showed that family and religion play a much more important and fundamental role for foreign adolescents than for Germans. Although parents seem to have the same importance for all adolescents, the emotional life in the families of Italians, Spaniards, and Greeks is much broader than that of Germans: for foreign adolescents, emotional relations with siblings and grandparents also are important. Again, although German and foreign adolescents do not show significant differences in their religious practices (e.g., church attendance), the latter have much deeper religious beliefs. The results are explained in terms of the different sociocultural backgrounds of these groups of adolescents.     

“Sanctity-of-Life“—A Bioethical Principle for a Right to Life?

For about five decades the phrase “sanctity-of-life“ has been part of the Anglo-American biomedical ethical discussion related to abortion and end-of-life questions. Nevertheless, the concept’s origin and meaning are unclear. Much controversy is based on the mistaken assumption that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. In this paper, I offer an analysis of the religious and philosophical history of the idea of “sanctity-of-life.” Drawing on biblical texts and interpretation as well as Kant’s secularization of the concept, I argue that “sanctity” has been misunderstood as an ontological feature of biological human life, and instead locate the idea within the historical virtue-ethical tradition, which understands sanctification as a personal achievement through one’s own actions.     

Assisted Suicide,Euthanasia, and Suicide Prevention: The Implications of the Dutch Experience

What impact would legalization of assisted suicide and euthanasia have on our ability to treat suicidal patients and to prevent suicide? Information from a study of the Dutch experience illustrates how legal sanction promotes a culture that transforms suicide into assisted suicide and euthanasia and encourages patients and doctors to see choosing death as a preferred way of dealing with serious or terminal illness. The extension of the right to euthanasia to those who are not physically ill further complicates the problem. So too does the tendency of doctors in such a culture to begin to feel that they can make decisions about ending the life of competent terminally ill patients without consulting the patient. “Normalizing” suicide as a medical option lays the groundwork for a society that turns euthanasia into a “cure” for suicidal depression.     

Proportionate palliative sedation and the giving of a deadly drug: the conundrum

Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes physician-assisted suicide and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not.     

Would we rather lose our life than lose our self? Lessons from the Dutch debate on euthanasia for patients with dementia

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of (late onset) Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care.