Yes to euthanasia?

Say 'yes' to euthanasia and you've had it. Why? Because euthanasia is a highly emotional taboo, a social prohibition imposed by legal, medical and ethical customs. Life is designated as sacred, absolute and, as such, untouchable even in cases of prolonged, intolerable suffering when help is sought by a terminally ill patient.

But isn't such a death undignified? Isn't a fight against death at all costs when healing is impossible nonsensical, even? Artificially prolonged life in the end becomes a torment, especially when indescribable pain is no longer relieved even by the strongest sedatives.

Here is a historical, relevant case. May, a 72-year-old woman with irreparable brain damage after a cardiac arrest, is lying in a coma and needs to be fed intravenously. Should she stop being fed after three years so that she can finally go to sleep in peace? Yes, thought her son and the doctor treating her. No, said the nursing staff who appealed to the law. As a result the drip feeding was continued. And so this woman lay comatose for a further nine months until she could finally die.

Is such a procedure meaningful, morally responsible? Yes, said the court and fined both the doctor and son DM4,800 and DM6,400 respectively for attempted murder. No, said the federal court in Karlsruhe which referred the case to another chamber of the State jurisdiction. The reason given was that the court had illegitimately ignored the wish of the patient who eight years before her death had already expressed a wish for treatment to be stopped in certain circumstances.

This case is quoted by Hans Küng in the introduction to an important book A Dignified Dying, which was spawned from a series of discussions on voluntary euthanasia held at the University of Tübingen in 1994. The federal court decision means that in the end greater attention should be paid to the patient's wishes.

Also, this court decision applied only to so-called 'passive' euthanasia, e.g. switching off a drip or a machine like a ventilator, quite different from 'active' euthanasia, say, an overdose of morphine. "But, in the light of that decision," argues Küng, "must not 'active' or 'direct' help in dying be also allowed in certain cases?"

Euthanasia, both 'passive' and 'active' has always been a problem legally, medically and ethically. The State must see that human life is always protected against premature shortening of life. But also against inappropriate lengthening of life. How is euthanasia interpreted by traditional State laws - as 'killing on request' or as 'merely taking part in a suicide'?

If the latter, then, is not a crime, because one can commit suicide with impunity. If the former, then it is punishable by law. Doctors too have conflicting ethical views on this subject. Some even refuse to have a drip stopped for personal moral reasons, which should not be discarded.

Küng, the distinguished theologian, examines the case of voluntary euthanasia in certain well-defined circumstances and comes down firmly in favour of it. He analyses the principles of classical moral theology and gives his reply. First moral theology states that no extraordinary means need be applied in sustaining life.

So no patient is ethically obliged to accept any possible therapy to prolong life. In such a case the patient should decide. The moral problem is over help in dying. Should this be interpreted as 'mercy killing'? Has a terminally ill patient a right to self-determination? May a doctor offer help in dying, considering his 'Hippocratic oath'?

Morally speaking, human life is God's creation and gift, and in principle it is beyond human power to control. Küng subjects this theological argument to examination by mentioning the case of his 22-year-old brother who had an inoperable brain tumour, and after a year of great suffering choked on the rising fluid in his lungs. Küng asks: "Is this the death that God gives? Should patients 'submissively' accept this till the end as 'God-given', 'divinely willed", even 'pleasing to God'?"

As a Catholic theologian Küng knows the traditional arguments of theology. Yes, he argues, life is God's gift and therefore beyond our control. But in accordance with God's will, life is also a human task and so our responsibility. Human life is solely God's 'creation'. But is it not primarily a voluntary 'creation' by parents, and so something for which man is responsible?

It is also argued that men must endure to their 'ordained end'. But what end is ordained? Does God really control the reduction of human life to purely biological life? Euthanasia is also said to be a rejection of God's loving providence. But what is the meaning of all this in the face of a life that is definitely destroyed and full of intolerable suffering, especially when only a vegetable existence is possible?

Hans Küng's argument is for human responsibility not only for life but also for a dignified dying.