Veelkantige besinning oor eutanasie

Abstract

Die debat oor eutanasie kan benader word vanuit ’n etiese, teologiese, sosiologiese en regsfilosofiese perspektief. Deel van die haakplekke in die debat is die bestaande verwarring ten opsigte van oorvleuelende terminologie. In hierdie studie word ’n bespreking van moontlike definisies aangebied alvorens daar oor die waarde van die lewe en die dood besin word. Definisies van wat die dood konstitueer, word bespreek. Die verskillende vorme van eutanasie word uitgelig, naamlik vrywillige aktiewe, nie-vrywillige en gedwonge. Vrywillig en nie-vrywillig is onderskeidings vanuit die perspektief van die pasiënt wat sterf, terwyl aktief en passief onderskeidings is vanuit die perspektief van die persoon (bes moontlik ’n dokter) wat ’n ander persoon bystaan om te sterf. Bybelse perspektiewe op die waarde van die lewe en moontlike argumente teen eutanasie word bespreek. Die slotsom is dat daar geen ondersteuning vir of teen eutanasie in die Bybel gevind word nie. Daar is geen etiese uitspraak wat eutanasie aanmoedig of ontmoedig nie. ’n Bespreking van die huidige Suid-Afrikaanse wetgewing wat eutanasie reguleer word aangebied aan die hand van ’n refleksie oor die Stransham-Ford-hofsaak. Die filosofie van die Duits-gebore politieke filosoof Hannah Arendt (1906–1975) word vervolgens krities ingespan om aan te dui dat dit wat reg en verkeerd is, eties beredeneer kan word en dat onnadenkende, klakkelose naspreek van geykte formules geen bydrae tot die debat oor eutanasie lewer nie. Vir Arendt lê die waarde van etiese vraagstukke nie soseer in die vasstel van wat reg en verkeerd is nie, maar in die proses wat gevolg word op soek na ’n antwoord. Uiteindelik sluit hierdie besinning af deur oorweging te skenk aan die bybelse opdrag om lief te hê as kriterium waarvolgens Christene oor eutanasie besin. Die slotsom is dat eutanasie vanuit ’n Christelike oorweging ’n uitdrukking van genade is om met die dood om te gaan.

Euthanasia has over centuries been a highly evocative and much discussed topic. There are different approaches to the debate as set out in ethical, theological, sociological, legal and philosophical perspectives. Although etymologically the origin of the word euthanasia can be traced back to its Greek roots (eu = good, and thanatos = death), there still seems to exist substantial uncertainty as to the precise dimensions and meanings of the concept. Ever since the historian Suetonius used the expression euthanasia to describe the manner in which the emperor Augustus died as peaceful and dignified, and therefore a good death, the term has been used with many different nuances. Terminology and assigned meanings overlap to such an extent that it is not always clear what people actually refer to when speaking of euthanasia.

There is consensus that euthanasia may be differentiated into three categories, namely willing and active, unwilling, and forced. The notions of willing and unwilling refer to a differentiation from the perspective of the dying patient, whilst the notions of active and passive euthanasia describe the perspective of the person (most probably a medical practitioner) assisting the patient in an activity resulting in death.

This contribution critically investigates and evaluates biblical references to cases which can potentially be interpreted as involving euthanasia. References from the Old as well as the New Testament are cited and discussed, leading to the conclusion that there is no conclusive evidence from the Bible in support of nor arguments against euthanasia. Although the perspectives as set out by early church fathers, such as Thomas Aquinas and St. Augustine, emphasise the ultimate value of life, these are not clear in indicating how to think about euthanasia. The cultural environment in which the Bible and early church found itself condoned taking one’s own life under certain conditions. Archbishop Desmond Tutu recently pleaded that the right of dying and suffering patients to request their own death be respected.

This contribution then continues to present the legal arguments regulating South African legislation regarding euthanasia. The legal debate reflects in particular on the court case of Robin Stransham-Ford and the consequences of the final verdict in his court case. In 2015 Stransham-Ford applied to the court for permission that a medical doctor should be allowed to assist him, as a dying cancer patient, in applying treatment that would end his life. He also applied for a decision that the doctor involved be exempted from any prosecution. The verdict delivered in 2015 was in favour of the applicant, but was only delivered after the applicant had already died of natural causes. Judge Fabricius, in delivering the verdict, indicated that according to existing South African legislation, assisted suicide and willing and active euthanasia is illegal. Stransham-Ford’s arguments in support of his request were based on the constitutional and democratic rights of the individual, as expressed in chapter 1 (section 1a) of the South African Constitution, as well as the guarantee of human dignity as stated in chapter 2 (section 10) of the Constitution. The freedom of the individual (chapter 2, section 12.1 and 12.2) emphasises the right a person has over his or her own body. South African legislation does not as yet reflect a thorough consideration and representation of these constitutional values.

Upon the verdict delivered by Judge Fabricius, the Minister of Justice appealed the verdict and in an appeal case in 2016 the verdict was overturned, reenforcing the current South African legal position against assisted suicide and willing and active euthanasia.

The next section in this contribution turns to philosophical arguments reflecting on what is right and what is wrong when considering euthanasia. The philosophical reflections of the German-born political philosopher Hannah Arendt are applied to the discussion of euthanasia. For Arendt, the value of ethical considerations and debate does not lie in determining what is right and what is wrong. True value, according to Arendt, lies within the process of reaching a solution. How did we go about reaching an answer? To her, that is a more important consideration.

In her publications (1958; 2003a; 2003b; 2006a; 2006b), Arendt comments on the evil acts committed during the Second World War. She tries to clarify for herself as well as for others what exactly happened during the war and why it was allowed to happen. Why war, why discrimination, and why did so many innocent people have to die in such violent ways? In her deliberations, she addresses the matter of good and evil. Her analysis of collective evil, as evident during the Second World War, is relevant to a society that collectively tries to address the issue of euthanasia.

Arendt may be just the right person to assist in the debate on euthanasia as she is not a theologian. In the evaluation of the post-war legal cases addressing war crimes committed by Nazis, and specifically the case of Adolf Eichmann, Arendt (2006a) is astonished to hear about the violence and evil people committed. She describes Eichmann as a normal-looking, even weak person who does not appear to be able to commit evil. Arendt reaches the conclusion that ordinary people are capable of indescribable violent and evil deeds (see Mahoney 2018:43).

What Arendt finds disturbing, is the way in which Eichmann justifies, without reflection, his acts of cruelty as the obedient performance of tasks assigned to him as a government official. His acting without reflecting on his acts is upsetting. The banality of evil performed is related to unreflective acting, without considering the consequences of the actions. The ignorance displayed by Eichmann is an expression of his inability to place himself in the shoes of others. According to Arendt it is ignorant behaviour if one is incapable of original thought and unique expressions, and then resorts to clichés (Mahoney 2018:18–28). Evil acts are not always motivated by evil thoughts – evil can be performed even with good and innocent intent (see Mahoney 2018:28).

In the case of euthanasia, the question will inevitably be this: Who is acting with evil intent – the one collaborating to take a life or the one refusing to take a life? What, in this context, can be regarded as the most extreme evil – to end a life of suffering, or to allow a life of suffering to continue? In light of the insights from Arendt, it is important not to resort to ignorance by not reflecting on the consequences of the planned actions. Even though South African legislation prohibits euthanasia, the meaningfulness of the plea for euthanasia may still be considered and reflected on. Moral thought makes it possible to reflect on evil (Mahoney 2018:83).

What does this say about a society where evil is allowed? In the case of euthanasia, evil can refer to either the refraining from bringing about death or the continuation of a life of suffering. Both can be viewed as evil. A balance is necessary: protect life, but do not prevent death at all costs. What should weigh more heavily – the right to live or the right to die? A balance between being correct (applying the letter of the law) and to express love (to show empathy with those suffering) is necessary. This contribution wants to emphasise that Christian love must consider the possibility of ending a life of suffering as an expression of love.