Editorial : Faith and Reason - Reflections on a debate...

Michael McCabe
Issue 10, August 2003

In July 2003 the New Zealand Parliament voted 60 to 57 against a Private Member's Bill, "The Death with Dignity Bill" that sought to legalise euthanasia, or more correctly, physician-assisted suicide. The seemingly close vote contained a number of Parliamentary members who, while against the Bill, wished it to go to a Select committee to allow further public debate.

This year staff at The Nathaniel Centre have spent considerable time and resources critiquing this Bill from the perspective of both faith and reason. In communicating this analysis through a variety of written and oral presentations we both complemented the work of other church, medical and hospice groups who opposed euthanasia and gained considerable insight into this debate.

We also strove to promote critical analysis on the presuppositions that drive the call for euthanasia. This call is built upon a belief that suffering is meaningless, that increasing isolation of the elderly is inevitable, and, that self-determination and personal autonomy are not subject to the common good.

In the process of critical reflection faith is as essential a component in the search for truth as is reason. Both are required, and together, because, as Pope John Paul II writes in Fides et Ratio, faith by itself leads to a type of fundamentalism and reason by itself ultimately leads to disappointment.

Nevertheless, to think in terms of both faith and reason is not necessarily straightforward, particularly in the field of bioethics and certainly not on the topic of euthanasia.

In speaking to various audiences on euthanasia different responses to the interconnection between faith and reason are evident. Some audiences seem to be averse to the scientific and the rational while others are dismissive of attempts to draw on the faith or spiritual implications of physician-assisted suicide. Both of these extreme positions make moral reasoning and ethical reflection unbalanced and confined and inevitably result in people talking past each other.

In its acknowledgment that pain and suffering are multi-dimensional the hospice movement in New Zealand implicitly recognizes that the community draws on both sources - faith and reason - in its search for truth and in coming to terms with terminal illness. The community in turn has a deep appreciation that its sources of strength and meaning are understood and respected and are an integral part of the holistic care offered by hospice.

This reassurance led a retired medical specialist to make the following observation in a recent letter of thanks to The Nathaniel Centre:

"The vote in the face of powerful media promotion is striking. The Sunday Star Times openly espoused Euthanasia. The defeat was, of course, due to the Hospices and their remarkable community penetration – South Auckland Hospice, for example, has only 9 beds, 250 patients under care at any one time and 450 volunteers – Arohanui Hospice in Palmerston North has 230 volunteers. Community financial support is astonishing. Perhaps it is better to own the community than the media...?"

Doubtless the debate as to how we as a community should care for the terminally and chronically ill will continue particularly as the population continues to age. This debate is healthy especially if it includes all the wellsprings of wisdom within the community. It is also valuable because it raises the profile of palliative and hospice care and its comprehensive focus on the needs of the dying as outlined in the National Palliative Care Strategy Document.

Consequently, a further lesson from the recent debate is that there is a clear need to close the gaps in Palliative Care. This is particularly necessary in the care of those dying from diseases other than cancer. Such a process would enable better access to hospice care - a need underscored by the World Health Organisation which recommends that governments not consider the legalization of physician-assisted suicide and euthanasia until they have demonstrated the full availability and practice of palliative care for all citizens.

The influence of the hospice movement on the community has been profound. Such an influence is easily underestimated, particularly when one considers the more celebrated cases that were given an unbalanced profile by the media. In these cases it was suggested that there is very little respite care for families who are at the end of their tether and therefore the only option was euthanasia.

To those who may suggest that the care of the dying is too difficult and too daunting it is perhaps timely to remember that the profound influence of hospice in New Zealand has only ever been built by tending to one patient's needs and his or her family's needs at a time. With such care hospices have built upon the inspiration of their charismatic creators since the founding of New Zealand's first hospices in 1979. In making patients and their families the focus of their care, they have helped people who are especially vulnerable negotiate the very real roller-coaster of exhaustion and grief. Central in such a process has been the role played by volunteers who help to bind the dying into the community of the living. In the use of their myriad skills and in their gift of time and presence they strengthen hospices' recognition of the relational nature of community.

The debate also underscored the pivotal role that the medical profession plays in the network of community relationships. The strong opposition to "The Death with Dignity Bill" by The New Zealand Medical Association reminded the community of the deeply reflective approach that doctors have to their traditional role as healers and of the respect that the community has for this role. This insight was strongly expressed by the previously quoted correspondent:

"To my surprise, the argument from within the medical profession, that killing by doctors would destroy the ethical Hippocratic healing basis of medicine, was counted as a highly relevant cogent point. A group of doctors seeking to explain the high road of true patient service is a truly potent force."

The narrow margin by which this Bill was defeated is a warning. Even though this legislation cannot be presented again before this Parliament there is no doubt that the advocates of euthanasia will accelerate their campaign for physician-assisted suicide. While we give thanks that faith and reason have prevailed in this debate we do so knowing that much work remains.

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Rev Michael McCabe, PhD
Director
The Nathaniel Centre