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TEXTS OF THE CONGRESS

THE ACCEPTANCE OF THE PATIENT'S LIVING WILL
FROM THE CHRISTIAN POINT OF VIEW,
AN ANSWER TO ACTIVE EUTHANASIA
R. GIERTLER
President of the German Association of Catholic Doctors
Catholic Hospital St. J. Nepomuk, 99096 Erfurt, Germany

In Europe, two countries, the Netherlands and Belgium, have recently legalized euthanasia. Patients suffering a terminal illness, severe pain or other symptoms can now demand the termination of their lives with the active assistance of a doctor. In Belgium this is also possible for people with psychological illnesses. Although euthanasia is controlled by strict legal regulations, which I will not further discuss in this paper, this practice is neither reconcilable with medical ethics nor with our Christian philosophy on life. On the other hand, however, questionnaires on the subject show that approximately 60% of the population support euthanasia in certain circumstances.

I believe, that we as Christian doctors, have to take these opinions expressed by the general public very seriously indeed and ask ourselves what the reasons for these are. The causes are without doubt of a very complex nature and they reflect the wide-spread hedonistic and materialistic way of life in the western world. Death and suffering do not make sense and thoughts about such matters are avoided because they make life more difficult. Only death can end senseless suffering quickly and painlessly. Man has the key to his own self determination which allows him to both decide how to live his life and die his own death. Christian thinking is no longer representative for how the majority of people see the world and respect for life has become very selective indeed, so much so that abortion, embryo research and euthanasia can be seen to be a part of this selective approach.
On the other hand, patients experience illness and suffering, pain and helplessness and the fear of being left alone when dying and of not being able to decide over their own fate as a threat. The desire not to be left to suffer endlessly and the hope that their autonomy and intended will be respected are for this reason legitimate expectations of the patient. While palliative medicine attempts to accompany the patients during their time of suffering, in intensive care units, decisions often have to be made about whether to discontinue mechanical life-support therapy. A living will or a durable health care power of attorney can be of great help in such cases. Unfortunately there is much uncertainty both on the side of doctors and patients when dealing with such documents.

It is for this reason that the German Conference of Bishops and the Evangelical Church Council in co-operation with doctors and legal consultants drew up a "living will" which should act as a point of reference for patients and as a guide for doctors making decisions on this matter. This Christian "living will" is dedicated to the Christian belief that life and the dignity of people is to be respected as an inviolable gift from God in life as in death. It is the aim of pain-killing therapy and palliative care to make life worth living until the moment of death and it is for this reason that a lot of attention is given to special patient care with patients receiving spiritual help as well as having contact to others. At the same time, the individual desire of patients not to receive treatment which could extend their life expectancy is to be respected, if such treatment would only mean a small extension of life expectancy or would simply mean an unacceptable prolongation of the patient's suffering.
The Christian "living will" wishes to guide the way between both an unacceptable lengthening and an irresponsible shortening of a patient's life. In cases where patients are no longer able to express a will, a living will can be added to or replaced by a durable health power of attorney.
Because life is a gift from God and because God is sole lord over life and death, euthanasia is to be strictly rejected. Euthanasia in Germany is forbidden and punishable by law.
The Christian doctors of Germany support the living will because it increases the responsibility of patients as well as their autonomy and can contribute to a dignified self-determination where life and dying are not compromised to an unacceptable extent.

If the fear of dying painfully as well as the fear of a prolongation of suffering brought about by the use of life preserving treatments are removed then the desire for active euthanasia usually ceases to exist. It is in such a way that the living will, which may oblige the doctor to use palliative treatments and make critical use of medical and technical possibilities, can serve as an alternative to Euthanasia.