Euthanasia, Another Wave Sweeping Across Europe

A petition with more than 1.2 million signatures was delivered to the Italian Supreme Court last October 8, calling for a referendum with the aim to legalize euthanasia. Of these almost 400,000 were gathered online. The referendum aims to repeal the regulation in the criminal code that prevents the introduction of legal euthanasia in Italy.

If the referendum is successful, assisted euthanasia would be allowed in the forms provided for by the Law on Informed Consent and Living Will, subject to certain requirements. It would remain punishable if euthanasia involves a person incapable of understanding what is involved, or t a person whose consent has been extorted by violence, by threat, or involves a child under 18.

The current legal system prohibits assisted euthanasia, both in the direct form, where the doctor administers a lethal drug to the person who requests it (Article 579 of the Criminal Code), and in the indirect form, where a person prepares the lethal drug, which is then taken independently by the same  person (Article 580).

Forms of passive euthanasia practiced in the form of omission, that is, refraining from intervening to keep the sick patient alive, are already considered lawful, especially when the   withdrawal of treatment is intended to avoid “therapeutic obstinacy.”  

Cardinal Gualtiero Bassetti, president of the Italian Episcopal Conference – during the 27th National Congress of the Association of Italian Catholic Doctors, October 8, 2021 – entered into the “restless public debate,” and affirmed that “the prospect of a referendum to decriminalize the murder of consenting persons arouses grave disquiet.” He added , in front of doctors, that above all today “it is necessary to reiterate that there is no expression of compassion in helping people to die, but it reflects the prevalence of an anthropological and nihilistic conception in which neither hope nor interpersonal relations have any room.”

Bear in mind that in Holland in 2020 there were 6,938 reported deaths by euthanasia, the highest number since 2002 when the law came into force, with an increase of 9 percent over the previous year. In 2003 euthanasia interventions on request numbered 1,815, representing 1.28 percent of deaths in the population, while now they are 4.5 percent, if we exclude those caused by Covid-19. The euthanasia option is gaining strength in the agendas of the various European countries where legislation on the subject has already been in force for several years.

What is happening in Europe is also happening in various other countries in the world, including Colombia, New Zealand and Canada. We find ourselves before a complex situation, where it is not surprising that new countries are entering a state of affairs that opens questions at various levels and that can generate consequences difficult to control. Moreover, the problem has implications and internal dynamics that need to be carefully analyzed, since, alongside Covid-19, it is one of the great ethical, political, social and health issues of our time.

In this debate the positions of the Catholic Church have been clear: “the greatness and preciousness of human life” must be defended without compromise.[1] On this point the Letter of the Congregation for the Doctrine of the Faith Samaritanus Bonus reiterates how the Church is opposed to therapeutic obstinacy, and reaffirms as “definitive teaching” that “euthanasia is a crime against human life.” There is also full convergence at the interreligious level as well, as shown, for example, by the “Joint Declaration of the Abrahamic Monotheistic Religions on End-of-Life Issues,” signed at the Vatican on October 28, 2019, which records the agreement of Catholics, Jews and Muslims on statements such as this: “Euthanasia and physician-assisted suicide are inherently and consequentially morally and religiously wrong and should be forbidden with no exceptions. Any pressure upon dying patients to end their lives by active and deliberate actions is categorically rejected.”[2]

From the Catholic perspective, this view is based on Sacred Scripture – Genesis and Exodus [3] and various passages of the Gospels are taken as references[4] – on the Magisterium and on Tradition. We find it reaffirmed from the Second Vatican Council onward, in texts such as Gaudium et Spes (GS),[5] the declaration on euthanasia Iura et Bona from the Congregation for the Doctrine of the Faith, and the encyclical Evangelium Vitae,[6] among others. Obviously, it resonates clearly with St. John Paul II’s incisive denunciations of the “culture of death.”

We must remember that this position is not intended to be at odds with concern for the suffering of people for whom pain and personal decline have become a genuine existential abyss. It is this aspect, in fact, that leads many citizens to look favorably on the possibility of euthanasia. It should not be forgotten that there is a great deal of popular support for this, and no argument should be avoided in this regard, as it is the sensitivities and, above all, the lives of people that are at stake.

In this article we will try to approach the problem of euthanasia and the perception of the end of life from a different perspective,[7] one which is not based solely on outright condemnation nor on the desire to alleviate the suffering of thousands of sick people. Above all, we will try to analyze which phenomena in European society, politics and culture are such as to lead politicians, citizens and the media to defend such a complex set of arguments as those in favor of euthanasia.

This is not merely a political accident, but rather the convergence of multiple processes of change which weigh more than they appear to at first sight. For this reason, when we speak of euthanasia in its various forms, we mean to refer to the tip of an iceberg in which various dynamics of society converge.

Medicine as a consumer good

There is no doubt that one of the great achievements of European states during the 20th century was their public and universal health systems. This is all the more true if we compare them to what happened in earlier eras and what is still happening in other parts of the world. Nonetheless, for some decades now, in order to ensure their viability, the private sector has been playing an important role, and in some cases has improved the system. But as a result this area has become an attractive business for some companies and health professionals. So the market has made its way into the field of disease and has offered a range of health and wellness services, which have achieved remarkable changes , such as, to give a few examples, radical weight loss, vision correction and amazing surgical solutions.

The gradual privatization of the health system favors the creation of new services. This is not a bad thing in itself, but it does pose a problem: the perception of health care and health care workers is changing. The work of the latter is no longer seen only as a guarantee of health care. It is being reoriented in terms of the interests of the citizen and of maximum well-being. Patients are seen as clients, and illness becomes an opportunity for profit. Gradually, the perception of health is altered, and so  health intervention is no longer aimed at the patient’s needs, but at satisfying their desires. Therefore, in the Faculties of Medicine, a growing number of students are inclined to set aside the prestige and service vocation of their profession, because they consider it as a way to serve “customers” rather than treat “patients.”

In the case of euthanasia, this vision has serious consequences, because it cannot become just another service of the health care system: it breaks the trust in the protection of life, in care and concern for the patient in all its forms, transforming doctors and nurses into engineers of people. Euthanasia transforms health care professionals from guarantors of life into judges who decide who should fall within the model of “dignified” death provided by law, and then go so far as to apply the “sentence.” This seems to conflict with the spirit of some basic principles of Medicine, well defined in the Hippocratic Oath[8] and in the Code of Medical Ethics.[9] Finally, we can learn much from the current situation, in which we have seen how much our societies need to be able to count on people with a vocation to care and capable of fighting for life at any cost. No measure aimed at breaking that trust will ever be able to supplant that need.

‘Omnipotent’ science

The great scientific and technological developments of our time have brought well-being to billions of people around the world. Images such as the man on the moon, the creation of the Internet, or the new forms of communication still linger in our eyes and memories. We can add the discovery of the human genome, the great advances in transplant techniques made in recent decades and, recently, the success of vaccines against Covid-19. However, to this spectacular tally we must add the atrocious development of military armaments, the cloning of living beings and the transhumanism project, and these are not the only blots that have  appeared.

Following conquest after conquest, science has taken its place in contemporary thinking, so that for some it has become a veritable “religion.” Its possibilities are so great that it has earned the attribute of “omnipotent.” Beyond the benefits attainable for human beings as a species, these prodigious developments have reduced discernment to mere feasibility, leaving aside the value of the good, the truth and the dignity of every human life. The fine line between good and evil has been supplanted by the can-do and can’t-do of science, and with it new scenarios have emerged, without any prior discernment of possible consequences.

It is clear that the practice of euthanasia does not require much scientific development. But in fact the problem does not lie with science as such, but with the power it has been granted. Science, however much progress it may make, curiously enough must continue to recognize that the line between good and evil remains in force, although this struggle sometimes takes place only in the individual conscience. History contains a large catalogue of examples where the confusion between what is permitted and what is possible has led to unexpected and dramatic consequences, and every scientific advance is a potential time bomb. The experience of Belgium and the Netherlands shows that euthanasia laws can gradually enter  a slippery slope, i.e. they are extended to more ambivalent situations, so that what were initially isolated cases later become commonplace in society.

And to this we must add, among other possible negative elements, the atrocious development of nuclear weapons, the cloning of living beings and the transhumanism project.

An empty vision of progress

In 1989 we witnessed the fall of the Berlin Wall. That event expressed, more than the simple reunification of Germany, the collapse of the USSR and, with it, of the bloc that embodied the vision of the socialist world competing for world hegemony in the 20th century. As a result, economic neoliberalism was regarded as  the only viable model for democracies, uniting all powers around it, with the exception of China, which followed a different path. On the other hand, the reality of climate change and the past economic crisis, as well as the one now being announced, remind us that resources are limited and that this neoliberal system can lead us to collapse just like the previous one, sweeping away another political utopia.

Beyond political changes, our societies have undergone very profound transformations. The new forms of liberalism have fossilized the feeling of solidarity. And while during the 19th and 20th centuries the issue of the condition of the working class  was associated with the idea of progress and the amelioration of an unjust situation, the current nature of jobs – more specialized and less physical – means that fewer people identify as workers and feel that they belong to a distinct, clear and defined social class. Too many citizens watch in isolation as technology and the economy improve, but not their own precarious condition. This reality, therefore, calls into question an idea of progress understood as the improvement of the lives of people and peoples and imposes new categories in this regard. Here it finds in euthanasia the best of allies.

As we know, various politicians who defend euthanasia associate it with the idea of progress, using the simple equation between euthanasia and an increase in civil rights, that is, proposing the argument that this new scenario will improve the lives of individuals and peoples. This phenomenon reveals a collective problem: the absence of meaning that accompanies the progress of our societies and, on the other hand, the difficulty of thinking deeply about what it means to improve the lives of peoples and, above all, of g people who suffer the most. We should not consider euthanasia as part of progress, because it is nothing more than the failure of a society that does not know how to offer inclusion, support and hope to those who need it most.

Current political events without debate

In the 20th century the average politician’s profile probably coincided with that of a wise man of advanced years, who saw politics as an act of loyalty to the nation and to legitimate values. Compared to this simplistic generalization, we now see different profiles: the average age has fallen considerably; image counts for much more than before; experience is more specialized and global; and equality is a reality in most parliaments. Change is taking place both at the electoral level and in the way politics is done.

The pervasiveness of social networks means that parliament and society as a whole carry less and less weight in the dialogue about what matters. It is no exaggeration to say that most laws are agreed upon in party offices well in advance, and that parliamentary sessions turn into events, where MPs make their speeches thinking more about the votes to be won in the elections than about convincing society as a whole. Politics resembles less and less a debate and more and more a spectacle and, in this way, makes the necessary dialogue almost non-existent and almost completely abolishes the confrontation of ideas.

In the case of euthanasia, this political model has direct consequences. It seems paradoxical that, in the case of France, this sensitive issue has begun to be addressed in the midst of this unprecedented crisis, with the nation’s health system under immense pressure, making meaningful debate within and outside of parliaments impossible. In the case of Spain, for example, the Ley de euthanasia continued its course without taking into account the unfavorable opinion unanimously expressed by the experts of the Bioethics Committee. Politics understood as a “Game of Thrones,” as a political game, and not as a debate of ideas, means that laws of this kind go through as part of the strategy, entrusting only to a chance majority the task of defining the very delicate line between what is legal and what is not.

States in the 21st century

The changes that states have progressively undergone, global interdependence and the influence of economic powers, have imposed limits on the capacity of the various public institutions to act. The recent pandemic has become perhaps the clearest example of this: various governments had serious difficulties in assisting, coordinating and controlling an unprecedented health situation, becoming in some cases mere financiers, subcontractors and managers of freedoms. At the same time, more protection and assistance is being demanded of the state.

In the 21st century we have also seen various communities come to the fore that were minorities and marginalized in other times and places. In some cases their struggle for justice has been accompanied by resentment against a system that was deemed unjust, and the state and other traditional powers have been targeted and blamed for many ills, more or less consciously and more or less rightly. This attitude turns the state into a scapegoat, and this feeling of disapproval infects a large sector of society.

The confusion of the state with the establishment and the reduction of its ability to maneuver mean that some of the new problems that arise are resolved by granting alleged rights and avoiding proposals, duties and responsibilities. In the case of the end of life this is evident. In fact it is much easier to offer certain people a chance to die than to fight for the conditions necessary to humanize death and ensure that no one wishes to die.

How much is a life worth?

One of the great challenges facing most European countries is the ageing and loneliness of the population, with the associated increase in health and social expenditure, which, together with pensions, require adjustments necessary to ensure the functioning of the system. On the other hand, the utilitarianism with which the capitalist model is imbued leads to the evaluation of each individual person on the basis of cost-benefit with respect to the citizens as a whole, and thus the temptation arises to evaluate each person not on the basis of their dignity, but on the basis of their economic capacity. This temptation leaves no room for reflection, and makes the elderly and the sick the most vulnerable and least visible communities.

For some time it has been known that the great alternative for reducing the suffering associated with the termination of life, on which science and bioethics agree, is the practice of palliative care. This is a humanizing possibility, which continues to make progress and offers satisfactory results for health care workers, families and patients, and proposes to accompany pain and make people feel reconciled within themselves, with loved ones and with the world. But today, people with serious illnesses – such as amyotrophic lateral sclerosis, for example – complain that they do not have sufficient resources, and society’s abandonment drives them to desperate decisions.

Some politicians are not interested in the option of palliative care because it seems too expensive compared to euthanasia, and again the existence of many people is being subordinated to economic criteria. Along similar lines, it is clear that if the door to euthanasia is opened, a number of patients will choose it as a way of ending desperate economic, family and social situations, but these would not occur if they were well protected and supported. One of the lessons we could learn from the current pandemic crisis is that economic criteria can never take precedence when it comes to health and, above all, that the state must do all it can to alleviate the suffering of the weakest.[10]

Freedom ‘leading’ its people

One of the philosophical currents that has had the greatest influence on present-day culture has undoubtedly been existentialism, which had in Jean-Paul Sartre one of its principal representatives. It is a proposal that supports the unique and decisive role of the “I,” capable of deciding what it is and what it wants to be beyond any given reality.[11] For the French philosopher, existence precedes essence, so that each person decides to live as they want, because that person is the origin of their own existence. As early as the Enlightenment, freedom was regarded as a fundamental element of Europe, because it was a necessary requirement for the development of democracy. Nevertheless, when freedom is idolized, liberty is devalued.[12] Placing freedom on a throne makes us forget that it is not there to be worshipped, but to be lived to the full and to make us better, and for that it must be combined with equality, fraternity and other values, such as life and dignity.[13] Any way of understanding freedom that is incompatible with life will inevitably fall into error.[14]

The religion of emotion

Finally, we must remember that we live in the world of emotions. We compulsively follow TV series that make us cry and laugh in the space of a second; we are passionate about sports; we seek out anything that sends out dopamine and “positive vibes”; we are moved by images on Instagram and we pour out our indignation on Twitter. In addition, mindfulness, self-help books, psychologists and life coaches gradually become more influential in our lives, simply because we want to control our inner selves in a balanced, healthy and natural way.

At the same time we can see that religion is losing ground on the public and private levels, so that people pursue their desire for transcendence in other forms. Among the causes of the rejection of the religious element is the denial of death, morality and sacrifice as necessary components of life. Nevertheless, there are few existential alternatives capable of bridging the abyss of suffering and death as religions do. The fact is that the abandonment of religion leaves the human being alone in the search for the meaning of life.

Nor is it an exaggeration to say that the reason many people are in favor of euthanasia is a mix of emotion and compassion for the pain of others. This empathy, in principle, is positive. However, we cannot ignore the fact that in human life suffering is inevitable – which is not to say that it should be sought – and that, in addition to alleviating it, it is appropriate to seek meaning in it. Compassion, true compassion, moreover, refers to the sharing of pain. This problem cannot be tackled on the basis of emotion alone, because feelings are ephemeral and would lead us to a confused and probably mistaken view of reality.[15]

Conclusions

Years ago, at the site of Atapuerca (Burgos, Spain), a fossil of the species Homo heidelbergensis was found, which the discoverers renamed “Benjamina.”[16] According to archaeologists, those human remains belonged to a 10-year-old girl with a cranial deformity that showed a severe disability. But the most important thing for us is that others had cared for her all her life. Anthropologists took this as evidence of the mutual care of human beings, thus setting a milestone. We cannot ignore the fact that concern for other members of one’s own species is inherent to humanity. Therefore, in addressing the issue of euthanasia, we cannot help but apply the humanizing paradigm of the “culture of care” to this 21st century.[17] It is a way of relating to reality that opens us to others and leads us to recognize the dignity of each person.

This is what Pope Francis has invited us to consider: “Even if we know that we cannot always guarantee healing or a cure, we can and must always care for the living, without ourselves shortening their life, but also without futilely resisting their death.”[18]

DOI: La Civiltà Cattolica, En. Ed. Vol. 6, no.1 art. 10, 0122: 10.32009/22072446.0122.10

[1].    Cf. John Paul II, Evangelium Vitae (EV), No. 2.

[2].    The point of departure for the three religions is the origin of human dignity, which is put to the test when a disease becomes serious or terminal: “Care for the dying is both part of our stewardship of the Divine gift of life when a cure is no longer possible, as well as our human and ethical responsibility toward the dying (and often) suffering patient.” This same dignity, rooted in God, inspires and imposes the ability to stop whenever clinical interventions – today made ever more invasive by medical technology – go beyond the point of balance with respect for life itself, which does not need to be preserved at all cost. The document proposes a shared approach: “We, as a society, must assure that patients’ desire not to be a burden does not promote in the feeling of being useless and the subsequent unawareness of the value and dignity of their life, which deserves care and support until its natural end.” To achieve this, the signatories “commend laws and policies that protect the rights and the dignity of the dying patient, in order to avoid euthanasia and promote palliative care.” Finally, some commitments were made on the cultural level: “To engage our communities on the issues of bioethics related to the dying patient;” “to acquaint them with techniques of compassionate companionship for those who are suffering and dying;” “to raise public awareness of palliative care through education;” “to provide succor to the family and loved ones of dying patients.”

[3].    Cf. Gen 4:9-15; Exod 2:17.

[4].    Cf. Luke 12:6-7; Matt 25.

[5].    Cf. Second Vatican Ecumenical Council, Gaudium et Spes, No. 27.

[6].    Cf. EV 65.

[7].    The ethical reflection on euthanasia that we make here is largely based on “Informe del Comité de Ética de España sobre el final de la vida y la atención al proceso de morir”, in Reflexiones en torno a la proposición de ley sobre eutanasia aprobada por el Congreso by the Bioethics working group of the UNIJES – Universidades Jesuitas, and on the article by B. Sant?t, “Loi pour l’euthanasie: désolé, ça ne passe pas!”, in La Croix, April 5, 2021.

[8].    We refer to the version that was adopted as the Geneva Declaration by the World Medical Association (WMA) in 1948, then revised and amended on several occasions (1968, 1983, 1994, 2005, 2006 and 2007). The text approved in October 2017 in Chicago is as follows: “As a constituent of the medical profession, I solemnly swear to devote my life to the service of humanity; the health and well-being of my patient shall be my primary concern; I will maintain the utmost respect for human life.”

[9].    “The doctor, even at the request of the sick person, must not carry out or favor treatments aimed at causing his or her death” (Code of Medical Ethics, art. 36).

[10].   Cf. Francis, Fratelli Tutti (FT), No. 22.

[11].   Je suis de trop, donc j’existe, one might say, paraphrasing Jean-Paul Sartre.

[12].   Cf. EV 19.

[13].   See FT 103.

[14].   “Freedom consists in being able to do everything that does not harm others” (Declaration of the Rights of Man and of the Citizen, 1789, Article 4).

[15].   “Compassion for those who ask to die because of the extreme situation in which they find themselves is a virtue and a high human quality, but it should not make us forget that fulfilling that request may bring consequences on other human beings and, even, affect the future of the most vulnerable people” (“Informe del Comité de Ética de España sobre el final de la vida e la atención al proceso de morir”, op. cit., 6).

[16].   See A. Rivera, “Atapuerca cuidó de Benjamina”, in El País (elpais.com/diario/2009/03/31/sociedad/1238450407_850215.html), March 31, 2009.

[17].   Cf. Francis, The Culture of Care as a Path to Peace. Message of the Holy Father for the 54th World Day of Peace, January 1, 2021.

[18].   Id. , Message to Participants at the European Regional Meeting of the World Medical Association on End-of-Life Issues, November 16, 2017.