August 2021 Pulse
In 2017, Victoria became the first state in Australia to legalise physician-assisted dying when MPs voted in its favour after more than 100 hours of debate across both houses of Parliament. Speaking to reporters, Victoria’s Premier, Daniel Andrews, said that the landmark legislation signals a historic day for Australia. ‘This is a day of reform, a day of compassion, a day of giving control to those who are terminally ill’, he said.
In an article published by Evolution News and Science Today, Wesley Smith reported that since the Supreme Court legalised euthanasia in Canada in 2016, doctors and nurses indicated that they have killed almost 4,000 patients. In an article published by BioEdge in September 2018, Michael Cook disclosed that the Canadian government was also exploring legalising euthanasia for ‘mature minors’ and people with mental illness.
In January 2019, on the 46th anniversary of Roe v. Wade, Democratic governments in New York and Virginia were revising existing laws to allow abortions during late pregnancy, up to the point of birth. The governor of New York, Andrew Cuomo, described the bill as ensuring ‘a woman’s right to make her own decisions about her own personal health.’ He adds that ‘women in New York will always have the fundamental rights to control their own body.’
We are witnessing in modern society the emergence what some writers have been calling the ‘medicalising of death.’ ‘By medicalisation,’ writes Gennaro Bruno, ‘we mean a process of encroachment by a scientific discipline, i.e., medicine, aiming to swamp its boundaries.’ In so doing, he adds, ‘it no longer defines itself as the art of healing, or as that process and capacity of organising the knowledge and practices needed to manage and cure an individual’s maladies.’
The medicalisation of death therefore refers to the use (or abuse) of medicine – its knowledge and techniques – to intentionally cause the death of the patient instead of his healing and restoration. In this sense, it is the betrayal of medicine, the perversion of the purposes and goals of this noble science and art.
One of the chief reasons why life and death are medicalised in our day is the way in which we have come to answer the question about our own nature. What does it mean to be human? This is a question that nags in every era in the history of civilisation, and the answers that are thrown up at any particular period depend very much on its metaphysical commitments. In our time, there has been a seismic shift from a dualist to a materialist or physicalist account of the human being.
According to this view, the human is simply a material or physical being. The so-called meta-phenomena that have been recognised as distinctively human behaviour and abilities – intellect, moral conscience, and free choice – are nothing more than the products of the body, especially the brain. The spiritual aspect of the human being such as the soul has been dismissed, not only by many philosophers and neuroscientists today, but also by some theologians.
As Marcella Colbert has rightly pointed out, ‘With the loss of recognition that human beings have such spiritual faculties as intellect or the will, man seems only to be a very clever animal. He is no longer a personal subject’. Then she adds (and here’s the rub): ‘Man is objectified and has value only in what he possesses. He has no intrinsic worth.’ With this estimate of the human being, the medialisation of life and death is not at all surprising. And when a utilitarian ethics is added to the mix, we have a deadly cocktail that sees prematurely causing the death of the sick by medical technology as an answer to one of society’s burdens.
This approach, however, is inimical to the nature of medicine and the purpose of medical practice. It is at serious odds with the ethic of medicine expressed in the Hippocratic Oath, and the Judeo-Christian tradition that have informed and shaped medical practice for centuries. In the Hippocratic Oath, we find this pledge, which should guide every doctor and healthcare professional: ‘I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.’
Based on this premise, the physician should never perform any ‘medical’ procedure that would deliberately cause the death of the human being. Both euthanasia (or PSA) and abortion are mentioned explicitly in the Hippocratic Oath: ‘I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman abortive remedy. In purity and holiness I will guard my life and my art.’
Commenting on this statement, Leon Kass writes: ‘Healing is thus the central core of medicine: to heal, to make whole, is the doctor’s primary business.’ The core moral responsibilities that have guided healthcare, asserts Arthur Dyck, are the responsibilities to rescue, nurture and protect life, and to respect all human beings. ‘For medical professionals’, he adds, ‘this core includes the commitment to treat everyone who has a health need they can beneficially meet, in ways that never intend the death of the patient.’
The lofty ideals of the Hippocratic Oath are in many ways dwarfed when we reflect on the even profounder basis for the motivations and goals for the practice of medicine supplied by the Judeo-Christian tradition. Physicians as healers both mirror and participate in the redemptive work of God himself, who in Jesus Christ has come to save and heal a broken world.
No one has put this across more elegantly and powerfully than the great Roman Catholic moral theologian Bernard Häring who in his three-volume work on theological ethics writes:
The whole redemption is a work of healing; therefore the whole of theology, but particularly of moral theology, has an essential therapeutic dimension. Christ the Saviour is also the Healer. He came to heal the individual person in his or her relationships, but he also proclaimed an all-embracing kingdom and therefore a healthful world to live in. Christians are, in Christ, healers. They have a mission to heal themselves, to heal each other and to join hands to create a healthier world.
The medicalisation of life and death in modern society sadly shows that medicine and the cultural and societal forces that cradle and nurture it have lost their way. It shows that the practitioners of this noble art have been beguiled by the hegemony of science and technology, the heady rhetoric on rights and autonomy and the tacit but pervasive devaluation of life. Consequently, instead of being the promoter of life medicine and health care have been slowly pulled into the vortex of what Pope John Paul II has called ‘the culture of death’.
In medicalising life and death, medicine has not only betrayed itself. It has also failed the very portion of humanity it exists to serve: the sick, the dying, the disabled, the unborn and the vulnerable.
Dr Roland Chia is Chew Hock Hin Professor at Trinity Theological College (Singapore) and Theological and Research Advisor of the Ethos Institute for Public Christianity.