Au In the beginning was the Word

1. -      The Italian female Eluana Englar, 38 years old, dies after being disconnected from the probe that had maintained her vegetative life for 17 years. Before the accident that left her prostrated, Eluana had not written a vital testament, but she had manifested her will. “In the family, the three of us had left our position clear. We had talked many times about it”, “we do not need to listen litanies neither cultural, nor religious or political”, says his father. In 2008 the Court of Milan allowed the interruption of the watering and the artificial feeding. The office of the public prosecutor argued that the irreversibility of the persistent vegetative situation had not been proved with enough objectivity. The Supreme Court settled the question, protecting the family’s request.

2. – Thirty years ago a group of the science and the culture personalities wrote a Manifesto on euthanasia: “It is immoral, they said, to tolerate or to impose the suffering. We believe in the value and the dignity of the individual. This implies to treat him with respect and to give him freedom in order to be able to decide reasonably about his own fate”, “it is necessary to provide the means to die sweetly, easily to those who undergo an incurable illness or irremediable injuries and have reached the last stage. It is cruel to demand that a person be maintained alive against his will”, “all individual has the right to live with dignity and to die with dignity” (The Humanist, July 1974).

3. -   Euthanasia fact and name are strange to the biblical world. When the newly born Cristianisme reaches the Greco-Roman world, it confronts the problem of a practice that is defended in the ancient philosophy. The term euthanasia has in the ancient times an etymological sense of good death or death in peace, with no pain, even with lucidity. Philosophers like Plato or Aristotle, allow the practice of a willingly induced death in the case of sick people considered like unrecoverable. The stoics consider suicide like a consequent alternative to an excessively grievous and senseless existence.

4. -            According to Plato (about 427  - 347), model society should be formed by sane people: “That who is not able to live developing his own missions should not be receiving any care, since he is useless for himself as much as for the society” (Republic, 407). Aristotle (384 – 322) writes about infanticide: “as far as the exposure and nursing of the children, it should be disposed that anyone defective should not be nursed, but no one should be exposed because of delivering too many children, in the case that the rules imposed by the habits forbid to exceed certain limits; in effect, procreation must be constrained, but if someone continue their sexual relations further than the established time and conceive children, abortion must take place before the awareness and the life is produced in the embryo,  since the lawfulness or unlawfulness of the abortion will be defined by the awareness and the life” (Politics, 1335).

5. -      One of the most representative authors of the stoicism, Seneca, writes in his letters: “ the wise man will apart himself from life due to very well founded reasons: to save the patria or the friends, but also when he is burdened with too cruel pains, in case of mutilations or a incurable sickness”, “he will not be put to death, if the case is a sickness that may be cured and does not hurt the soul; we will not kill anyone because of the pains, but only when the pain prevents anything he lives for”; “I prefer to kill myself to feel how I progressively lose my strength and become dead being alive”. On his part, the physicians must deliver remedies to the sick, but to those who cannot extend their life, “they will facilitate a tolerable death”.

6. -      Roman historian Suetonius affirms that emperor Augustus was abettor of the euthanasia: “as soon as Caesar Augustus heard that someone had died quickly and without any pain, he asked the euthanasia, using this word, for himself and for his family”. (The life of twenty Caesars, L, II) “It is clear that the text is referred to the persons who cannot be cured and that, due to this, have entered the hopeless phase. Such is the reason for the roll of illnesses elaborated by Pliny, in which the doctors may accelerate death. In the classic literature, euthanasia and ouster are correlative terms”, “it is understandable that when the European culture wanted to approach the classicism ideals, the relationship between medical ouster and euthanasia always appear. Such thing happens, for instance, in the Renaissance”, comments Diego Gracia, Medicine History teacher in the Madrid Complutense University. See Javier Gafo (ed.), The euthanasia and the art of dying, UPCM, Madrid, 1990, 13, 32.

7. -      We find this text during the Renaissance in the Englishman Thomas Moro (1478-1535) Utopia: “If the illness not only is incurable but also a torment and a continuous martyrdom, then the priests and authorities say to such person that he is a burden for the rest and unbearable for himself… and he should not doubt to join death, since life is a torment for him”. And the Englishman too, Francis Bacon (1561-1626) affirms: “I estimate that the medical profession duty is not only to restore health, but also to diminish the sickness pains and torments; and not only when such pain mitigation, like that of any other pathologic symptom, helps and drives to the recuperation, but also when, being nonexistent any recuperation hope, helps to leave life more easily and equitable. Since it is not a small happiness the one which moved Caesar Augustus to ask for the euthanasia; it is similar to the one seen in the death of Antoninus Pius, who it looked that he did not died but he fell in a deep and pleasant sleep… But in our times, doctors assume like a scruples and religion case to be near the patient when he is dying. But, in my opinion… They should acquire the skills and to pay attention to the way by which the dying could abandon life more easily and silently. I call to these the investigation upon the external euthanasia or the body easy death (to distinguish from the euthanasia that looks for the soul preparation)”. (Science advance, IV, 2).

8. -            According to Professor Diego Gracia, “it does not look a risk to say that the doctors have traditionally practiced the passive euthanasia (oustering their patients when they see the process like incurable) and even the active euthanasia, in those cases in which the sickness characteristics (process incurability, possible contagion, very tragic and painful end) made it advisable. The typical example of the last case is the hydrophobia, which met the three characteristics. In these cases medicine treaties advised the practice of the so-called loose bleeding, which ended with the patient pains and with his life at the same time. This explains that in 1810 a law was promulgated in France, saying this: To strangle, asphyxiate, bleed to death or to kill by any other method to those suffering rabies, hydrophobia or any other illness causing spasms, convulsions, agitation and dangerous madness is forbidden under death penalty”. In some South American countries the practice known like to dispain has existed, strangling applied to illnesses with a terrible end.

9. -    The christianism adopts a position against the euthanasia. It sticks to the Decalogue commandment saying: You shall not kill (Ex 20.13). Life is a gift received from God. No one may dispose of it. Only God is the master of life and death: God holds the life of every creature and the breath of all mankind (Job 12, 10). Yahweh is Lord of life and death (1S 2,6; Dt 32, 39). Nevertheless, there are situations that can overcome people. Because of this the believer prays: Give me neither poverty nor riches; Give me as much food as I need lest, satisfied, I deny you and say: Who is Yahweh? (Pro 30, 8-9). The Bible does not judge Saul’s death, who, wounded in the war against the philistines, asks his squire to kill him to avoid falling in enemy hands; the squire does not want to do it, so Saul drew his own sword and fell upon it. (1S 31, 4-5). Other suicide cases: Samson (Jdg 16, 28-31), Eleazar (1Mc 6, 43-47), Razis (2 Mc 14, 37-46), Judas (Mt 27,5). Although in many cases takes place, the Christian is not obliged to accept the pain only because of the pain. It is bad to be sick and this is the reason why Jesus goes by healing (Acts 10, 18).

10. -    One of the first Christian writers, Lactancius, says about those who today we call terminals: “they are useless for men, but useful for God, who keeps their life, gives them the spirit and gives them the health”. When the christianism expands through Europe, suicide and euthanasia practices are relegated.

11. -    During the XVI century the theologians begun asking themselves: In which cases wouldn’t be suicide to allow the own death? In which cases wouldn’t be an assassination to allow the death of others?. Francisco de Victoria, in his theologian relessons (1557), says that if a person is so sick and depressed that to eat could become an enormous burden, this person does not sin if he does not eat. About the medicines it says: “since rare times is certain the curative effect, it is not compulsory to use them, although it is very sick”. Victoria’s followers develop the distinction between ordinary and extraordinary measures. The later are optional

12. -    In 1826, one of the fathers of the modern ethics, Karl Friedrich Marx, defends in the Gotinga University a doctoral thesis about the medical euthanasia, in which he shows the need to teach the doctors how to take care technically and humanly of the sick that are in the terminal phase of their life. The doctors must learn the science of the euthanasia, since they cannot give their patients the athanasia, id est, the immortality.

13. -    In 1895, German jurist Adolph Jost publishes a book, titled The right to die, in which he defends that control over the death of the individual should rest, in the last stage, into the social organism, the State. In 1920 the philosopher and jurist Karl Binding and the doctor-psychiatrist Alfred Hoche publish a book on the permission to destroy lives lacking any vital value. Like lives lacking any vital value the authors understand not only those of the terminal sick individuals, but also those of most part of the mental sick individuals, psychical handicapped and the deformed and retarded children. To destroy life with no vital value, they say “in a healer treatment” and an “hygienic work”.

14. – In the XX century the practice of the euthanasia was dramatically the focus of attention as a consequence of its legal acceptance by the Third Reich. Nazi doctors undertook the extermination of 200.000 psychiatric and chronic patients, and actively collaborated in the most ample program of social extermination we have news of.  

15. -    In our times, more than in others, patient’s will is taken into account in the practice of the euthanasia. In Spain the Law of Patient Autonomy Regulation (14-11-2002) acknowledges the rights of the patents and their guardians to request the interruption of a medical treatment. Any person has the right to accept or reject the medical treatment proposed.

16. - The direct euthanasia is punished in almost all the legislations. In the Spanish Criminal Code (article 183) the euthanasia under request is punished with a minor penalty, between 18 months and 3 years in prison. The suicide is not penalized, but it is punished the collaboration with it with a prison penalty from 2 to 5 years. At present, legislation revision for certain circumstances is under deliberation.

17. -    Other views product of our times are: life expectative has increased due to the advances of the medicine; years have been added to life, although not life to the years: “Life prolongation provokes many people to die out of life and out of the society, when they have already been fully segregated long time before” (A. Tornos).

18. -    At the same time, the process of pain control, acute or chronic, has suffered a spectacular progress. “Most of the problems associated with acute pain can be adequately controlled with medicines, inhalator anaesthetics, nerves blockade or other treatment”, “persistent pain is one of the malign progressive illness most feared aspects”, “therapeutic modalities and the medicines we presently count on, are effective to alleviate most of these sick people pain”; nevertheless, “some sick, with severe and untreatable pain, are desperate to the point of committing suicide”. (J.L. Madrid).

19. -    The II Vatican Council denounces euthanasia with all that attempts against human life: “any kind of homicides, genocides, abortion, euthanasia and even the deliberated suicide”, “any of these practices and other similar are infamous in themselves, they degrade human civilization, dishonour more to their authors than to their victims, and are totally against the honour due to the Creator” (GS 27)

20. – The Congregation for the Doctrine of the Faith in its Declaration about the euthanasia (1980), affirms: “Today it is very important to protect, in the moment of the death, the human person dignity and the Christian conception of life against some kind of technicality undergoing the risk to become abusive”. It is accepted “the right to die with all serenity, with human and Christian dignity”, which does not include “the right to obtain the death oneself or from others in the desired way. The Declaration distinguishes among proportioned or disproportioned means. To evaluate the quality of proportionate or not of a therapeutic mean it is necessary to consider “the type of therapy, the difficulty and risk degree that it takes with it, the expenditures needed and the possibilities of application, with the results that can be expected, taking into account the sick person condition and his physical and moral strength”. To avoid a costly or risky therapy “is not equivalent to suicide”. Before the imminence of an unavoidable death  in spite of the means used, it is licit in conscience to take the decision to renounce to some treatments that would only give a precarious and painful existence extension, without interrupting, nevertheless, the usual cures due to the sick in similar circumstances” 

21. -    The Catholic Church Catechism (1992) presents the euthanasia as follows: “Those which life is diminished or debilitated have the right to a special respect. The sick or diminished people must be taken care of, so that they can reach a life as normal as possible” (n. 2276). “Being any the motives and the means, the direct euthanasia puts an end to the life of diminished, sick or moribund persons. It is morally unacceptable. Therefore, an action or omission that, in itself or in the intention, provokes the death in order to eliminate the pain, constitutes an homicide gravely against the dignity of the human person and to the respect of the living God, his Creator. The judgement mistake in which in good faith some may have fallen does not change the nature of this homicide act that must be always rejected and excluded”. (n. 2277)

22. -    “The interruption of grievous, dangerous, extraordinary or disproportionate medical treatments may be legitimate. To interrupt these treatments is to reject the therapeutic cruelty. With this, to provoke death is not intended; it is accepted not to be able to prevent it. The decisions must be taken by the patient, if he has competence and capacity for it or by those who have the legal rights, in other case, respecting always the patient reasonable will and his legitimate interests” (n. 2278), “although death is considered imminent, ordinary care due to a sick person cannot be legitimately interrupted. The use of analgesics to alleviate the moribund suffering, the risk of decreasing his days included, may morally conform human dignity if death is not intended, neither as an end nor as a mean, but only foresee and tolerated as unavoidable. The palliative cares constitute a privileged way of impartial charity. Due to this they must be encouraged” (n.2279)

23. – Let us go back to Eluana. His father has been called “assassin”.  There was a lack of comprehension and respect. We should remember what the theologian Francisco de Victoria said: “If a person is so ill and depressed that to eat could become a heavy load, this person does not sin if he does not eat”. Eluana situation could not be foreseen in the XVI century. The medicine has created “situations that do not exist in nature”, pleads the father. Tackling this subject, we read the psalm assigned to this day, which says: “They all look to you for their food in due time. You give it to them, and they gather it up” (Ps 104). It also says: “You take away their breath and they return to dust”, “when you send forth your spirit, they are created, and the face of the earth is renewed”

24. – “The heart of the ethical and moral discussion is to discern what we consider an ordinary mean in the care of a patient in a final state”, “when nutrition by enteral or parenteral tract is prescribed, the period of time that this mean will be needed is taken into account, as well as the fact that it is a measure to bear the sickness and to favour the recuperation, but it is not a curative treatment in itself. When this mean is installed we do not think that it can condemn a person to live in vegetative conditions for indefinite time. To give up eating in the process of an irreversible sickness is a natural part of the evolution. When a patient goes into coma this situation may revert or, as it happens in many instances, extend in the time without any hope of recuperation. But then, who decides that a measure initially ordinary has become, with any previous notice, in a extraordinary measure?”, “I cannot defend the administration of means provoking death, I did not study medicine for it, but I shall defend the proportionality of the medical activities allowing a worthy life and not a vegetative life” (Mar).


*  Dialogue on diverse positions:

-         life is a person property

-         life is a God’s gift, who says: You shall not kill

-         there are situations that can overflow the person

-         therapeutically cruelty is rejected

-         proportionate means are used

-         any person has the right to accept of to reject the proposed treatment

-         the decision must be taken by the patient or by those who have the legal rights

-         palliative care must be encouraged

-         the euthanasia must be penalized/ must not be penalized

-         the euthanasia must be legalized / must not be legalized