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Autonomy and Euthanasia

May 2021 | by Alan Thomas

In previous articles we have reflected on the Bible’s teaching that while death is an evil, its miseries never justify intentional killing, and that important decisions should be made in discussion with others: for this is both biblical wisdom and a consequence of our imageness.

Without other human beings, we are incomplete – and our decisions always have implications for others too. Trying to live as if I can make all my decisions on my own without reference to other people is foolish and selfish and, of course, godless.

Wisdom means taking advice. Being made in God’s image means taking other people into account, because all my decisions necessarily affect other people. But powerful arguments in modern ethics flow from the doctrine of autonomy, including the assertion that I have a right to die.

Today in medical ethics, patient autonomy is widely regarded as the big issue, the one that trumps all others. When making decisions, doctors are told that patient choice is paramount and the era of medical paternalism is past.

But autonomy is not a biblical emphasis. We exist in relationships, we share our lives with other people. We make our decisions together before God and together share the consequences of our decisions.

This autonomy emphasis reflects the individualism of our wider society and our anti-authority pride. People believe that armed with Google, the internet, and Wikipedia they can decide on their own medical care, and so turn up to meet their beleaguered GP with the evidence on how they should be treated.

Whatever you think of this (and clearly I think medical qualifications and training still matter a lot!), the autonomy emphasis becomes most dangerous in the narrower medical ethical field of life and death. We have seen this for a long time in the abortion battleground: I decide what I do with my body, shouts the pregnant woman insisting on her right to abortion. It is her autonomous decision.

Except that there is another life and another person and a relationship to take into account. Indeed, many other relationships are impacted by such decisions.

We now find autonomy driving debates about end-of-life care and euthanasia. Autonomy here becomes the basis for the so-called ‘right to die’.

But slick though this may sound, cleverly catching the energy and righteousness of the ‘right to life’, the right to die is not an opposite of the right to life. To continue living (or naturally dying) requires no specific intervention. The opposite of the right to life is the right to die naturally, not the right to kill myself or have myself killed, because these require interference.

But the right to die in turn comes to mean the right to kill, to act to terminate life. This false logic of euthanasia campaigners has often been exposed, including by legal judgments such as that of the European Court of Human Rights in 2002.

But the autonomy approach shows further lack of logic because it denies the obvious truth that ‘no man is an island’.

I won’t repeat what I have said before, but as those made in God’s image we exist as relational beings. We are not human islands existing in splendid isolation who can live as we please without affecting anyone else. The idea is absurd, yet often unchallenged.

Autonomy should not have primacy in our decision making. Our decisions and actions always involve others. This biblical truth, embedded in our imageness, should be embraced as we make all our decisions, especially the most important ones about life and death.

Autonomy is important, but so are our relationships. Ironically, the reality that we exist in relationships, and that euthanasia (by whatever name) has devastating implications for others around us, was exposed inadvertently by one of its famous campaigners (or more accurately by his wife).

Some years ago, at a major medical conference in the Netherlands, there was a debate on euthanasia (though I don’t think they called it that) and a colleague was speaking against it. When making his case for why people with dementia should be given this option, one of the Dutch proponents quoted from the best-selling novelist Terry Pratchett, who by then had made headlines about his desire to be allowed ‘to die with dignity’ (that is, kill himself or have himself killed).

What this doctor had missed were the comments from Mrs Pratchett. Someone confounded this Dutch speaker by quoting Mrs Pratchett, in opposition to her husband, saying in effect, ‘What about me?’

She wanted more time with him and didn’t want him to deny her this. Nor did she want him to leave her with the bitter legacy of having chosen to kill himself rather than to live longer with her. Her point was the biblical one we have been making: that we exist in relationships and our decisions affect others, most of all those closest to us.

This important truth is embedded in our status as humans made in God’s image who therefore exist in relationships. We were created as individuals, accountable for our own actions, and autonomy picks up on this. But crucially this must be balanced by the fact that, like God himself, we are never alone and our decisions and actions always involve others.