Terri Schiavo has brought the topic of euthanasia to the
mainstream media in a way we have not seen since the flurry of "physician
assisted suicides" performed by Dr. Jack Kavorkian in the early 90s. And
truly, it seems we have not learned much in the intervening years.
What is euthanasia?
The Columbia Encyclopedia
defines euthanasia as "…either painlessly putting to death or failing to
prevent death from natural causes in cases of terminal illness or
irreversible coma. The term comes from the Greek expression for ‘good
From that fairly straightforward definition, the subject
becomes complicated when you begin to look at who makes the decision to
end a life, and how that decision is carried out.
J. P. Moreland explains how euthanasia is subdivided
into a number of different categories:
The Active/Passive Distinction
The active/passive distinction amounts to this:
Passive euthanasia (also called negative euthanasia) refers to the
withholding or withdrawing of a life-sustaining treatment when certain
justifiable conditions exist… and allowing the patient to die. Active
euthanasia (also called mercy killing or positive euthanasia) refers to
the intentional and/or direct killing of an innocent human life either
by that person (suicide) or by another (assisted suicide)….
The Voluntary/Nonvoluntary/Involuntary Distinction
Voluntary euthanasia occurs
whenever a competent, informed patient autonomously requests it.
Nonvoluntary euthanasia occurs whenever a person is incapable of
forming a judgment or expressing a wish in the matter (e.g., a defective
newborn or a comatose adult). Involuntary euthanasia occurs when
the person expresses a wish to live but is nevertheless killed or
allowed to die.
This distinction combines with the active/passive
distinction to form six different types of euthanasia: voluntary active,
voluntary passive, nonvoluntary active, nonvoluntary passive,
involuntary active, and involuntary passive.2
Why are these distinctions important?
Some ethicists have used these divisions to determine
"acceptable" and "unacceptable" euthanasia. For example, the article on
euthanasia from the Internet Encyclopedia of Philosophy explains:
Two additional concepts are relevant to the discussion
of euthanasia. First, voluntary euthanasia refers to mercy killing that
takes place with the explicit and voluntary consent of the patient,
either verbally or in a written document such as a living will. Second,
nonvoluntary euthanasia refers to the mercy killing of a patient who is
unconscious, comatose, or otherwise unable to explicitly make his
intentions known. In these cases it is often family members who make the
request. It is important not to confuse nonvoluntary mercy killing with
involuntary mercy killing. The latter would be done against the wishes
of the patient and would clearly count as murder.3
What constitutes life?
The above quoted Internet Encyclopedia of Philosophy
refers extensively to the conclusions of James Rachels, philosophy
professor at the University of Alabama. Rachels argues that "there is
nothing sacred or morally significant about being a human being with
The mere fact that something has biological
life, says Rachels, whether human or nonhuman, is relatively unimportant
from an ethical point of view. What is important is that someone has
biographical life. One’s biographical life is "the sum of one’s
aspirations, decision, activities, projects, and human relationships."5
So, according to Rachels, if an individual is incapable
of having aspirations, of making decisions, of taking on projects, they
cannot truly be said to have life. J. P. Moreland explains why Rachels’
"biographical life" designation is not a good indicator of the value of
Two implications follow from Rachels’s view: (1)
Certain infants without a prospect for biographical life, and certain
patients (e.g., comatose patients or those in a persistent vegetative
state) are of little intrinsic concern, morally speaking. Though they
may be alive in the biological sense, they are not alive in the
biographical sense. And the latter is what is relevant to morality. (2)
Higher forms of animals do have lives in the biographical sense because
they have thoughts, emotions, goals, cares, and so forth. They should be
given moral respect because of this. In fact, a chimpanzee with a
biographical life has more value than a human who only has biological
Compare Rachels’ "quality of life" view to what the
Bible says regarding life:
Genesis 1:26—Then God said, "Let us make man in our
image, in our likeness,…"
Genesis 2:7—the LORD God formed the man from the dust
of the ground and breathed into his nostrils the breath of life, and the
man became a living being.
Deuteronomy 30:20—For the LORD is your life,…
Deuteronomy 32:39—I put to death and I bring to life,
I have wounded and I will heal, and no one can deliver out of my hand.
1 Samuel 2:6—The LORD brings death and makes alive; he
brings down to the grave and raises up.
Acts 17:25, 28—…he himself gives all men life and
breath and everything else…. For in him we live and move and have our
From these verses it becomes clear that humans have
value because 1) we are made in the image of God; 2) God Himself has given
life to us; 3) God alone has the right to withdraw that life. Not one of
these criteria have any bearing on what the human being can or cannot
do—their so-called "quality" of life. Instead, human life is valuable
simply because it is human life, and that has been given by God, their
Creator and Sustainer.
When is it reasonable to withdraw or withhold
"extraordinary" measures used to prolong life?
Gerald Kelly explains that extraordinary measures are
"those which cannot be obtained or used without excessive expense, pain,
or other inconvenience, or which, if used, would not offer a reasonable
hope of benefit."7
Few physicians would argue that it is wrong to withhold
(not start) or withdraw (stop) certain extraordinary measures in certain
circumstances. For example, The Christian Medical & Dental Association
says, "We do not oppose withdrawal or failure to institute artificial
means of life support in patients who are clearly and irreversibly
deteriorating, in whom death appears imminent beyond reasonable hope of
Are food and water "extraordinary" or "artificial"
What about someone like Terri Schaivo for whom death is
not imminent, given that ordinary care, such as food and water are
continued? J. P. Moreland addressed the issue of nutrition in his "The
Some believe that food and water should be viewed as
any other treatment, and cases where passive euthanasia would be
justified in general — cases, for example, in which it would be
appropriate to stop renal dialysis — are cases where foregoing
artificial nutrition and hydration would be justified. On the other
hand, there are those who argue that artificial food and water should
not be foregone.... Three reasons are offered for this.
First, ethically speaking, artificial food and water
are in a category different from life-sustaining medical treatments. The
latter clearly function to treat some specific disease or to assist some
diseased bodily function. But food and water do not have as their direct
or immediate intention the cure of any pathological condition
Second, when an extraordinary treatment is foregone,
then death may result. But such a death need not be directly intended as
a final end for the person or as an immediately caused means to some end
(e.g., a painless state that death brings). It is the disease itself
that actually causes death directly. However, if food and water are
withdrawn or withheld, then death is intentionally brought about
directly and immediately by that act itself….
When food and water are withdrawn, however, this act
itself brings about a new and lethal situation for the person, namely, a
starvation or dehydration situation. The removal of food and water is
morally identical to denying a patient air by placing a plastic bag over
his or her head because they both directly and intentionally bring about
death in a very short time and they deny the patient ordinary, natural
resources needed to sustain life….
There is another reason that food and water are
morally different from an extraordinary life-sustaining treatment. If we
forego an extraordinary life-sustaining treatment, we are focusing on
the quality of the treatment itself, and our intention is to
spare a person an unduly burdensome means of medical intervention. On
the other hand, if we forego food and water, we are focusing on the
quality of the patient’s life itself, not the treatment. We are not
considering ordinary/extraordinary treatments, but valuable/unvaluable
lives. In the latter case, we make a judgment that the life of a
person who is in a certain situation is no longer morally valuable and
we violate our duty to respect human life.9
The Christian Medical & Dental Association issued an
ethics statement regarding nutrition in which they state:
We recognize that nutritional support is both a
universal human biologic requirement and a fundamental demonstration of
human caring. Because we believe there should be a basic covenant
between all of us to care for those who are incapacitated, we are
committed to the provision of food and water to those who cannot feed
…we believe that physicians, other health
professionals, and health care facilities should initiate and continue
nutritional support and hydration when their patients cannot feed
themselves. We are concerned that demented, severely retarded, and
comatose individuals are increasingly viewed as "useless mouths." We
reject this dehumanizing phrase. Rather than encouraging physicians to
withhold or withdraw such patients’ food and water, we encourage
physicians to respond to God’s call for improved physical, social,
financial, and spiritual support of all vulnerable human beings.10
The "Right to Die" vs. "The Right to Life"
Clearly the climate has changed in America. No longer is
the presumption of the courts on the side of life. The National Right to
Life Committee explains:
Just as pro-life groups predicted, the adoption of
living will legislation helped achieve a sea change in the practices of
the medical profession. We now see open advocacy—and implementation—of
both direct killing and involuntary denial of lifesaving
treatment against the express desires of the patient. Especially among
health care providers, but also among many in the general public, the
"quality of life" ethic has largely replaced the "equality of life" one.
The result is that we can no longer safely count on a
general respect for life to protect patients, or leave matters to be
worked out informally among doctors, patients, and their families. The
hard reality is that the presumption has now shifted to favor death, not
life, for people with significant disabilities. Because these
disabilities can happen to any one of us, our relatives, or our friends,
it is now essential to set down affirmatively in writing that should we
become disabled, we do want the presumption to be for life. Failure to
sign a Will to Live is now likely to leave you or your loved ones
unprotected, at the mercy of health care providers and courts dominated
by those with very different values from a universal respect for human
Terri Schiavo, and before her Karen Quinlan, have made
the issue of who decides when it’s time for someone to die a matter of
Unfortunately, we as a country have not taken the high
road in this matter. Like Adam and Eve in the Garden of Eden, we have
become caught up in the desire to "be like God." We can only wonder what
will be the consequences of our taking over God’s right to give and take
1 The Columbia Encyclopedia,
Sixth Edition. Copyright © 2003 Columbia University Press.
2 J. P. Moreland, "The Euthanasia
Debate: Understanding The Issues," Christian Research Institute—Statement
DE197-1, http://www.equip.org/free/DE197-1.htm , emphasis added.
3 "Euthanasia" The Internet
Encyclopedia of Philosophy, http://www.utm.edu/research/iep/e/euthanas.htm
4 Moreland, "The Euthanasia
Debate: Understanding The Issues".
5 Ibid., quoting James Rachels,
The End of Life (Oxford: Oxford University Press, 1986), p. 5.
6 Moreland, "The Euthanasia
Debate: Understanding The Issues".
7 Gerald Kelly, "Notes: The Duty
to Preserve Life," Theological Studies 12 (1951):550-556. From
8 CMDA, "Euthanasia Ethics
9 J. P. Moreland, "The Euthanasia
Debate: Assessing the
Options," Christian Research Institute Statement
DE 197-2, http://www.equip.org/free/DE197-2.htm
10 CMDA, "Withholding Nutrition,"
11 National Right to Life
Committee, "Why the Need for a ‘Will to Live’?"