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17 septembre 2007 1 17 /09 /septembre /2007 06:33
The Church of England (C of E) has and does consistently and officially oppose euthanasia in all its forms (as does the Anglican Communion as a whole, agreed at the Lambeth Conference of Anglican Bishops in 1998).
This opposition has been both stated and acted.
•    It has been stated through publications (including jointly with the Roman Catholic Bishops of England & Wales), resolutions of General Synod, official evidence to the Parliamentary Select Committees considering the matter (and participation thereon by a senior Bishop), speeches by the Archbishop of Canterbury and others, and contributions to debates  as well as votes by the 26 Bishops who sit in the House of Lords.
•    It has been positively active through the work of the Anglican chaplains in each hospital and health authority of England, through encouragement for the development of the speciality of palliative care, and above all through the late Dame Cecily Saunders (a practicing member of the C of E) who founded the hospice movement, which has been the major source of developments in pain control and care for the dying and the creation of the specialty of palliative care.
The C of E rests its opposition on the dignity of the human person, and the common good. It has successfully involved other faith groups (notably Jewish and Muslim) in this campaign.
None the less, in England as elsewhere in Europe the public mood is in favour of euthanasia, spurred on by the support of leading and influential journalists, and often (but not always) inspired by fear and ignorance. In 2004 Lord Joffe introduced an assisted suicide Bill in the House of Lords (on a private basis) which was narrowly defeated earlier this year. It is certain that there will be further attempts.
Philosophically the church has also been seeking to reclaim the Kantian concept of responsibility from the postmodernist aberration of absolute autonomy which is the very often the philosophical basis for the support of euthanasia.

1.    Social background
The C of E has a unique position within English society when speaking on issues of moral significance. This derives in part from its established status. The Monarch is, since the Reformation, the Supreme Governor of the C of E; in her name Bishops (and many Deans as well as almost 10% of parish clergy)are nominated for election by the Prime Minister (which cannot be refused by the Cathedral Canons (electors) under pain of imprisonment in the Tower of London), and the 26 senior Bishops sit in the House of Lords. All hospitals, prisons, units of the armed services and police forces have a C of E chaplain, and senior members of the Church are routinely invited to represent the “Christian” position on Parliamentary Commissions etc.
On the subject of euthanasia the C of E has, unusually, been clear and determined in its opposition, seeking to influence the direction of debate (although it rightly cannot, of course, impose its views).
The general position of public opinion has been in majority in favour of euthanasia (whether assisted suicide or voluntary, but not involuntary). Opinion has been greatly influenced by leading public figures, especially in the media. Support is strongest amongst intellectuals and those who are used to having control of their lives.
In 2004 Lord Joffe, a Liberal Democrat (centre left) peer, introduced a private member’s bill in the House of Lords to permit assisted suicide. A widespread campaign against this, in which the churches played a leading role, resulted in its defeat. C of E Bishops were consistent in voting against it in the House of Lords.
The reality is that despite the advances in palliative care, and the hospice movement (see below), the cultural tide is against the Christian view, and it is certain that more legislation will appear, with a high risk of success. The cultural tide is driven by a number of influences.
First, fear of pain and suffering, loss of independence and indignity. This fear is despite the clear research demonstrating that with proper palliative care such indignity and pain is avoidable (1-4% pain, 1-2% nausea, 0-6% confusion etc ). Secondly, popular culture demonstrated above all in TV and film presentations, including the most popular “soaps”. Thirdly, leadership of articulate and well respected figures in the media above all, whose writing and arguments chime with the human desire to be in charge of one’s own destiny. Fourthly, philosophical ideas as applied to medical ethics and practise (see below).
Swimming against this tide is the more or less united opinion of the three Abrahamic religions, with a common voice expressed by the two established churches (C of E and the presbyterian Church of Scotland), and the Catholic Bishops.
2.    Philosophical Approach 
The key philosophical influence on issues of patient care in the English National Health Service (NHS) is the official doctrine of the autonomy of the patient. The move to the patient as part of the care team, or patient centred care, has been a significant change in doctrine in the last 10 years. It is in many ways beneficial. The patient becomes a dignified human being with whom treatment decisions are shared, and no only longer someone to whom things are done. Good doctors and the hospice movement have always followed this idea.
Taken to its logical conclusion, though, it makes the (by definition, unwell) patient the dominating factor, to whom everyone is responsible, but without reciprocal responsibilities to relatives and the clinical team. The wishes of the patient may also be hard to discern, even in the case of a living will (a directive as to future care given in advance by a patient who expects to become incapable of expressing their choices, Liverpool pathway 72). In popular terms, those in favour of euthanasia say “it is my life, and I will choose when and how to end it, requiring the services of the State if necessary”, or as Frank Sinatra almost sang, “I’ll do it my way”.
The hospice movement is careful to maintain the benefits of patient centred care and patient autonomy. However, starting with a commitment to the dignity of the human person, hospices seek to treat the whole patient, dealing with symptoms, but also with distress and spiritual needs. Communication with relatives and the patient is a high value, with training for staff in listening skills and in how to ensure that information is heard properly. Both in the Liverpool pathway and hospice practise, the role of spiritual advisers and carers is built into the system but only with the consent of the patient.
Much attention is given to pain and symptom control, and the ethics of treatment or its withdrawal. The Doctrine of Double Effect (DDE) is the accepted ethical approach to giving pain relief that may hasten death. This says that the intention is critical; if it is to relieve symptoms, this is not euthanasia. Research shows that the DDE is relevant in less than 5% of cases, and that proper use of opioids almost always deals with the question without needing the defence of the DDE. In other words the accepted C of E (and English legal) position is that properly administered pain relief with beneficial intent (i.e. not to kill) in medically accepted doses, is not murder.
It is interesting that the pro euthanasia groups seek to dismiss the DDE and blur the distinction between administering opioids intending to cause death, and to some extent speeding death by administration with the intent of relieving pain.

3.    Action & Words 
a.    The Hospice Movement 
The hospice movement began with Dame Cecily Saunders. A practising Christian of the C of E, she began professional life as a nurse. The experience of nursing a terminally ill Polish patient led to her retraining as a doctor and developing (as a pioneer) the speciality of palliative care. Frustrated by the incapacity of hospitals to deal well with the dying, she founded a hospice, and there are now more than 100 in the UK, including hospices without residential facilities offering care in the home. The C of E has always been closely involved in this area, and most parish priests have direct links to a hospice. There is also almost always a chaplain from the C of E (in England). As time has gone by the speciality of palliative care and pain control has developed, with many hospitals having consultant specialists. The NHS now helps some hospices, but the vast majority rely mainly or entirely on charitable donations.
b.    Palliative Care (and the Liverpool Care Pathway)
The Liverpool pathway is a good example of the development of palliative care. Clinical pathways are a common feature of care in many areas, for example with heart attack. The Liverpool pathway has been featured on the BBC, and seeks to ensure that there is consistent and effective care of the terminally ill patient in the last period of their illness.
c.    Statements and Voting 
The C of E has opposed euthanasia in three main ways. First, considered work and articles by Archbishop Rowan Williams  and the relevant commissions of the C of E, and his speech to the House of Lords in May 2006 . Secondly reports to and debates of the General Synod . Thirdly, consistent voting and speeches in the House of Lords.
d.    The Importance of Ecumenical and Interfaith Positions 
Finally, with the Cardinal Archbishop of Westminster, there has been significant effort to ensure that there is a common and often interfaith position on the issue. Archbishop Rowan has been very instrumental in this, with the Christian churches especially, but also, above all through the very remarkable Chief Rabbi with whom he has a close personal friendship.

Can the line be held? It is possible. At present the balance of opinion is in favour of euthanasia, but not inescapably so. A powerful combination of clear argument, strong positions and the provision of active alternatives remains the best strategy, and the most faithful course of action.

Revd Canon Justin WELBY
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