Herman C. Hanko is professor of Church History and New Testament in the Protestant Reformed Seminary.

The problem of euthanasia is a difficult and complex one, partly because the term is used for so many different procedures and under so many different circumstances. Generally speaking, the term can refer: to withholding of that which is necessary to sustain life. But one can withhold life support equipment such as respirators or heart-lung machines; one can even withhold food and water, whether given by mouth or given intravenously. That is one kind of euthanasia, usually called. passive euthanasia. But there is another kind which can be called active euthanasia in which a person is given some substance which will terminate life. It is actually putting people out of their misery by terminating their life. A complication of this is the removal of life-support equipment when a person can be kept alive by it, but will inevitably die without it. Is it right “to pull the plug,” even when the person on life-support equipment is in a coma?

The circumstances are also complicating factors. Usually the question of euthanasia arises in connection with the very young and the very old, with those just born or with those whose bodies are debilitated through disease and old age. Babies are born with various diseases for which there are no cures, or with mental and physical handicaps of such seriousness that they will never be able to live a normal life. Sometimes babies are born whose lives can be saved only by putting them on life-support equipment; but it may be that on such equipment they will be able to live indefinitely, while the time will never come when they can be taken off such equipment. Ought older people be put on life-support equipment when they have a terminal illness? Ought medical treatment be begun or continued even when the best hope is that death will be postponed a few years? And to complicate such a situation, ought death be postponed a few years when the remaining years will be years of great pain, years in which the body wastes away, years of suffering for the sick and for the family of the ill?

These are only some of the complicating factors. Are doctors always able to predict with certainty what will be the end of one with disease? Or of one who has suffered brain damage? Every one knows of cases in which doctors predicted imminent death, only to watch such a “terminally ill” person live for years and die of some other cause. Every one knows of severe cases of brain damage in which doctors predicted that the person would remain a vegetable, only to discover that the person has not only regained consciousness, but, with much help and love, has been able to regain a normal life in his or her family and among friends. Doctors are not always right, as they themselves would be the first to admit. Ought one’s decision to use or not to use life support equipment take into account the fallibility of doctors?

Add to all these problems an additional problem which is increasingly being discussed in medical circles: the astronomical cost of such medical treatment which is necessary to support life. Not only is the cost far beyond the ability of most people to pay, but it is increasingly true that the cost is far beyond the ability of many medical insurance companies to pay. The result is that certain decisions have to be made strictly on the basis of cost factors. Some people are allowed to die while others are kept alive, and costs determine the decision.

Such a list of difficult questions grows longer the more one thinks about the problem. And there are no easy answers.

That is, there are no easy answers for the Christian. Sometimes the world seems to think that the answers are easily come by. In our last article we mentioned an interview with our present Surgeon-General, himself a Christian and professed Calvinist, in which he discusses many aspects of euthanasia. I want to refer to some of the things Dr. C. Everett Koop said in this interview and quote from him. The interview is found in the September 25, 1985 issue ofPresbyterian Journal.

In the first place, he warns against a liberal movement in this country which is actively promoting euthanasia. In answer to the question: “How would you define euthanasia?” Dr. Koop said,

Euthanasia means happy death. If we stick completely to the terminology, I would be very pleased to practice “happy death” for my patients who are dying, which means I would keep them comfortable, I would keep them pain free, I would love them and nurture them until they leave this world. 

But euthanasia today does not mean that. Euthanasia is masked in terms such as death with dignity. It is implied in the Living Will. What it means is that you do anything you can actively or passively to hasten the demise of someone who is considered to be either a nuisance or no longer productive . . . .

In answer to the question: “In 1976 you published ‘Right to Live, Right to Die.’ You warned then of euthanasia. After nearly ten years, is the warning still appropriate?” Dr. Koop answered:

I think there is a statement in the book you mentioned, and I certainly have used it many times in lectures, that the euthanasia forces are abroad in our land as they never have been before. That is just as true today as it was then except that they are abroad in our land in much more subtle ways. 

They have changed the wording of the Living Will so it opens the door to euthanasia a little wider. You have people talking about durable power of attorney. It sounds so magnificent until you realize what people are accomplishing by it. 

You get into the not so subtle things about societies like Hemlock and the publication in Scotland about how to go about preparing for your own suicide. 

There’s the subtle approach of the news media publishing not just editorials on the subject but news accounts of relatively insignificant occasions which sound as though policy were being established. 

Last fall for just a two week period, I tore out of the ten major papers in the country all the articles on euthanasia. I was amazed first of all at the quantity, but I was also amazed at what people reported that I thought was more editorializing than reporting. 

If three doctors met in an obscure town in France and said they felt that old people should be eased out of this life, the headline was, “Doctors Think Patients Should Have Right To Die.” So What? The whole hype of the media is that this is here; its gaining momentum; it’s snowballing; and if you want to be with it, you’ve got to get on the bandwagon . . . .

What Koop says here is true. It was not so many months ago that Readers Digest carried an article, very sentimental and moving, in which the glories of euthanasia were extolled by means of an actual description of a case.

Another question asked Dr. Koop was: “. . . Are there other strategies of the euthanasia movement?” To this Koop responded:

Yes, several things. In emphasizing the finiteness of resources, they have gotten across to a whole segment of the elderly population that somehow because they are living, they are depriving someone else of a prior right to those resources. And I think that is a most reprehensible thing to have gotten across to elderly people. 

It’s done so subtly, and its done by the media in the way you and I have just been talking. When I was doing research for Whatever Happened to the Human Race?, I went to nursing homes and talked to people who felt the pressure. Old people were apologizing to me for using a bed, for being alive, for taking medication, because they “knew” somebody else deserved it more, I think that’s pitiful. 

One of the things that is so ironic to me is that while we are talking about the fact we can’t afford people to live in a nursing home with this kind of care, we have panels come out and say we should start a whole new project on the artificial heart. It just doesn’t make sense. While one half of the scientific world is saying we can’t afford to care for these nonproductive elderly people, the other half is saying we are so excited about the artificial heart—let’s try it.

The so-called “Living Will” has been suggested as a way of getting out of this dilemma. A Living Will is a statement drawn up by a person, similar to a will, and legally binding in many states, in which a person specifically requests not to be given any extraordinary treatment in the event of serious illness or injury. Dr. Koop warns against this also and the dangers of it.

I think the problems are in two categories. There is the very commonplace changing of the mind of individuals who thought the Living Will was great before they were in a situation where it would be used. And now they are not so sure, but they might not know how to reverse it. 

The other thing is that if you have a Living Will, it sends a signal that you don’t want anything done. What the patient might have had in mind when he wrote it is extra-, extra-, extraordinary care—pumping on his chest 15 times so he’ll be brought back to life only to die the next day, or a respirator to keep him going for six hours in great discomfort when he might have died by himself earlier. 

But medical personnel may interpret the Living Will so as to assume the patient doesn’t want his life prolonged by any means. If they treat the patient aggressively and prolong life, they might be sued for not following directions. 

The counterbalance to that is the person who doesn’t have a Living Will and who might under ordinary circumstances in the hands of a good physician be allowed to slowly pass out of this life as he is dying. He may be overly resuscitated and put on life support equipment because again, fear of litigation is such that the doctors don’t want him to go without the extra effort. 

You and I could be in the same accident—you, a young man with a Living Will and I, an old man without one. As a result of the above, you might die and I might live.

These are some of the problems which have to be faced in a discussion of the rightness or wrongness of euthanasia.