Open access peer-reviewed chapter
Abstract
One of the biggest current issues of European society is the dramatic decrease of the natality rate in most countries. Comparing these low natality rates and the increased mortality rates, we can conclude that in a not too distant future, the European demographic fund will differ greatly from the current one. In this context, the biotechnological industry is looking for a way to extend life for as long as possible. The paper analyses the way in which the two categories – people who want to extend their life and people who want to bring it to an end – report to the transcendental relationship. The questions for which an answer is sought are: Can we, in the light of immanence, reach the truth? Which are the answers of medicine, bioethics, and theology?
Keywords
- quality of life
- immanent
- transcendent
- biotechnology
1. Introduction
The concept of “quality of life” has several traits that have been analysed by researchers to assess human life in society [1]. Without the intention of analysing this phrase exhaustively, we want to show how this concept should be understood in the light of the notions of
The term
The concept of “quality of life” leads us to the crucial question “What is life?” whose answer, from a scientific-rational perspective, is ambiguous, since there are as many answers as various schools of thought are or will be. No real consensus has been reached. From the point of view of Christian theology, there is only one answer to the question “What is life?”, namely “I am the Way, the Truth, and the Life” (John 14, 6). Any other answer part from the words of Jesus Christ has a limitation, since human thought cannot raise beyond certain limits and only what comes from beyond these human limits is real. The problem is for us, as human beings, to accept that we are limited and to acknowledge that Someone is above our comprehension and wishes the best for us.
Studies [2] show that life has meaning only if a state of wellbeing, comfort, health, and satisfaction is reached, a contentment with what the individual wants to have in this world. In the
These are just a few questions on the quality of life in certain contexts of wellbeing and health or less wellbeing and health that can affect the concept of “quality of life” itself.
2. The quality of life from a medical perspective
The goal of medicine is to care for and treat patients, seeking to ensure good and long health for them. As Hippocrates states in his Oath, medicine should do everything “
However, these needs rather define the concept of “quality of health” than “quality of life”. There are voices who state that the definition of the concept of “life” cannot neglect the emotional states. If we dissociate the body from the soul, as it is attempted in the definition of the concept of “quality of life”, then, obviously, we find ourselves in a very limited area, without any possibility of analysing that there still is something that exceeds us, beyond our “logical” thinking. On the contrary, if we talk about Socratic thinking [4], according to which only the soul has value in the detriment of the body, which is considered evil in itself, we are once again far from determining the true meaning of the concept of “quality of life”. Therefore, there are three types of concepts related to the “quality of life”: 1. The one that relates only to the body. 2. The one that relates only to the soul and 3. The one that relates to the life which comprises both body and soul. This last concept on the quality of life is accepted by Christian Orthodox theology, since it asserts that this truth was sent by God through the Revelation. Thinking this way, human suffering is approached in a whole new perspective, stating that the medical act can help to alleviate bodily pain, but it cannot decide or determine if an individual can have a better or worse quality of life following this act.
When a decision is taken for an embryo to be destroyed because it is suspected of a certain malformation (for instance, trisomy 21 – Down syndrome), it is omitted that the embryo has a “soul” and that it can have, in the future, a superior quality of life compared to another embryo which is perfect from the perspective of its body. When they develop and grow, these children may have a different quality of life. The one with physical health issues may have a better life quality by replacing the body’s damage with a morally superior life. On the contrary, the child without any malformation may, for various reason, develop in its ontogeny a poor quality of life.
Therefore, the medical act may improve the quality of health, but not necessarily the quality of life. The one that suffers, being in a terminal cancer stage, does not necessarily have a poor life quality, but rather a poor health quality. With such an individual, when treated in a holistic approach, the idea of sufferance is changed, no longer being seen as a disaster but as a difficult trial followed by joy, peace.
2.1 The temptation of immortality
Is it possible for humans – each individual – to live forever? Confronted for millennia with the reality of a short life, people have always dreamt of living longer, sometimes taking this aspiration to an extreme, the desire to live forever. As evidence we have countless legends and writings on human being willing to find deathless life, the elixir of youth, the secret of endless life. 10.000 years ago, people did not hope to live for more than 30 years and only 100 years ago, the average lifespan was only 50. Incredible progress has been made, especially in the last century and, due to the scientific discoveries, most probably the series of revolutionary modifications and inventions on the way we live and die will continue. Thus,
With the evolution of medical science and biotechnology, cryogenised human bodies may be unfrozen, healed, and then restarted by means of such devices. The same category counts the methods of genetic engineering, which can transform senescent cells into young cells by their ex vivo telomerisation, namely by the reconstruction of their chromosomes’ heads which shorten every time a cell divides. This is physical immortality.
The right way regarding the interpretation of immortality can only be found when we will be concerned more about what we live behind, in the collective memory, more about the spirit and less obsessed by physical immortality. When the great values and virtues of mankind will be acknowledged and acquired, then our role on Earth will have been found and we will know immortality.
3. The perspective of bioethics
With the extraordinary development of state-of-the art technology, medicine has turned into a “public interest enterprise that creates a stringent necessity of moral orientation, which the existing medical deontology – preoccupied more with the relationships among the medical personnel – cannot satisfy”. [5]. It is in this context that
Nonetheless, to be able to use bioethics, we should know the moral it is based on. For instance, for Christian bioethics, abortion is forbidden (with rare exceptions), while for secular bioethics, the ban on abortion is a “forced imposition of the pregnancy, which violates a woman’s fundamental rights” [6]. These are fundamental notions related to life and death, to good and bad and to right and wrong.
At the moment, a social marginalisation of Christian moral theology is in place, as well as a development of a “global secular cosmopolite culture, and this theology is presented as belonging to the past, to the Middle Ages, being no longer able to cope with the requirements of the modern individual [6].” The current problem is that secular bioethics cannot have a vision that exceeds the immanent and leads towards the transcendent. Being stuck in their immanence, individuals cannot go “beyond” the limit of rational knowledge and that is why there arise laws in “His image and likeness”, of a being that considers itself autonomous in relation to the transcendent. The tragedy of the immanent human being is that they consider themselves too proud to establish a contact with the transcendent, as they are “the measure of all things” and therefore need no help.
Therefore, the following question arises:
The full connection between the immanent and the transcendent can be made by a Christian theology, which asserts that it has kept unaltered the divine truth; that is why it is the only way that can lead to the transcendent. Sufferance, diseases, infirmity, and death are allowed by God for a well determined purpose: to save humans. “By placing the experience of sufferance and death inside a life that aims at transcendence, the immanent preoccupations, and concerns, including those related to medical assistance, are radically relativized. As a consequence, the traditional Christian approach to these problems – such as the continuation or discontinuation of the treatment, the acceptance of medically assisted suicide or euthanasia – acquires another significance that powerfully contrasts with their meaning presented as certain and safe inside a secular moral” [6].
We need, therefore, to enter the “realm” of religion. It is necessary to see the relationship between bioethics and religion (if any) or whether it should be considered. If the relation of bioethics – and of medicine, in general – with religion is not considered at all, then the data change. As Romanians, with an orthodox tradition of over 2000 years and currently reporting to this religion, we are bound to analyse the relationship between medicine and religion, between bioethics and religion. From this perspective, when an individual lives under the immanence of their action, without reporting to the transcendent, it is impossible for them to see that life on Earth does not end with death but that it lasts forever. Without thinking about immortality and living with the eyes fixed only on the finitude of telluric life, individuals act and relate to this desideratum: live your life as well as you can on Earth, by any means, because death is waiting and there is nothing else after it. In this context, it is understandable that humans, severed from the transcendent, attempt to fulfil their dreams and pursue happiness only in relation to their immanent thinking.
This thinking is not novel, but a 1200 years old, when the European human rationality split from the thinking of the Saint Fathers and all sorts of rationalistic concepts appeared, looking for the truth in immanence, and refusing to relate to the transcendent. A new theology was defined as a theology that evolves and adapts to the times, leading to a rethinking of the cult unit, prayer and Christian life in the eyes of human rationality, which in turn led to a multitude of opinions that tore Christianity to pieces. A divided Christianity became incapable of holding a unitary vision regarding moral guidance and a new global moral came to birth in this void of morality, the secular moral. This secular moral separated itself from theology, aspiring to the status of global moral that should bind people as they weaken their ties with the ethnical roots, cultural traditions, and religious constraints.
The 17th century hails the
The current thinking supports loudly the “upgrade” (aggiornamento) of Christianity to cosmopolite liberal culture. Edward Schillebeekx confirms it: “
This reinvented Christianity has led to the secularisation of Christianity. The 20th century makes millions of victims in the name of a new secular future, allegedly better: that of justice, equity, and human rights. Human life has been channelled to attempts of bringing “heaven on Earth” (for instance, national-socialism and communism) but instead, they brought hell instead of heaven [7].
Orthodoxy states that the divine teaching came to us through individuals inspired by God, who prepared themselves in fasting and prayer before conceiving laws for people. Due to human pride and vanity, the European started making laws for humans that adapt to the times, without considering the laws given by God to humanity through
3.1 Christian or secular bioethics
Christian bioethics argues that life begins at conception and that starting with the zygote, there is a human being in the making, which needs to be treated as such. Reporting human life to eternity, Christian bioethics defends the embryo, acknowledging its soul. Christians do not “raise the problem of the embryo just for fun but reach it starting from the resurrection” [8] but still, they are different in thought. Tristam Engelhard was wondering, “which Christianity is better for a Christian bioethics?”, answering that “we should see Christianity from a historical perspective, in the sense that it is at the basis of the historical roots of contemporary Christianities, or that we should see it not like something from the past, old and obsolete, but as something present, animated and alive” [6]. In the West, theology went towards aggiornamento, meaning that the accent transferred on the “accommodation” with the world, while in the East, orthodox Christianity kept the tradition, the accent being placed on sanctification of the world. The aggiornamento of theology has decisively influenced bioethics, which in turn became “accommodated” with the worldly, immanent interests to the detriment of the transcendent. There arises thus a dispute between bioethics built on the grounds of the transcendent Divine Revelation and bioethics built on the grounds of immanent human rationality.
In the context of secular moral there also appears the
4. The quality of life from a theological perspective
Sufferance leads to a crucial question: is there life after death? Does sufferance have any meaning in relation to the transcendent? Even if medicine argues that sufferance can be controlled and death postponed, eventually death wins. Supporting euthanasia these days is like Seneca’s pagan stoicism expressed in his letters on suicide: “One death involves pain, another is simple and easy, why not take the easy one?” [9]. It is known that Seneca, to avoid being captured and tortured by Nero, commits suicide together with his wife. In the current secularised society, which encourages self-determination in an exacerbated way – with individuals no longer observing any moral principle – the intention is that religion should encourage active voluntary euthanasia and medically assisted suicide. In other words, Christians should be encouraged to avoid sufferance and choose death as great dignity. This is how the commercials that encourage these suicidal acts have appeared: “The Death Club: leave this life with the same spark you have lived it”, “The last journey: experiment death that you have always wanted! Leave in dignity, pleasure and style!” or “Executive death: for those who have always been in control” [6].
Through biotechnology, the life expectancy has increased but the 21st century’s individual “lives a spiritual crisis, namely a crisis of significance because they want to maximize happiness in this earthly life, seeking to transform the biological in the search for perfection” [10]. The Church expressed its concern that genetic research is not closely monitored and regulated to ensure the protection of the community [10]. The Romanian Orthodox Church has initiated an action, by setting up in 2001 certain Bioethics Committees that debate litigious themes where the faith in life’s Sacrality is expressed, as well as in human dignity and its individuality [11]. There needs to be an open dialogue between researchers (laic people) and the representatives of the Church regarding the implications of genetic technologies: “The determination of a relationship between science and religion should seek common points in time to observe the gap between metaphysics and epistemology. Hence, the importance of initiating a dialogue between religion and science by means of Bioethics” [11].
The influence of evil on those in pain is often remembered in theology. Thus, in the case of St. Martyrs Timotheus and Mavra who were in the ordeals of death, the devil showed to them under an angel’s face to allegedly save them from sufferance; however, his presence was meant to take from them the crown of martyrdom [12]. Although individuals suffer with their body, the temptation addresses the soul, because the “soul is the vital principle of the body – the one that gives it life, structures, puts it into motion and keeps it alive [13]. Unfaithful people are afraid of death while the faithful see death as a “gate to eternal life” [14], death “not being evil in itself, what would be bad is to die badly” [15] as St. John Chrysostom says, namely unprepared for eternity. “The world, in its entirety, as well as each thing created by God, has a rationality, they were created for a reason and towards a certain finality” [16]. “The physical world, aware or not of God’s love, is created as a means of His love for humans” [16]. Christian theology speaks about the
4.1 Case study: euthanasia versus palliative care
The “treatment” through euthanasia or medically assisted suicide is expressed using various euphemisms, such as “to put down out of mercy”, “gentle death”, etc. which brutally enters a human being’s life (body and soul), putting an end to the body’s pain but failing to consider spiritual values. Several factors account for the patient’s sufferance, such as the emotional, physical, and emotional factor. Euthanasia only “solves” the physical factor. With an honest palliative therapy, that approaches all determining factors (including the psychic and spiritual ones), the patient’s emotional state is modified, and the quality of life acquires a whole new meaning. The justification of euthanasia starts from the following premises: the individual has a right to die and the value of human life is measurable, human life can be approached as animal life, sufferance cannot have any beneficial function, the request for euthanasia is always rational and trustworthy, the medical diagnosis and prognosis are always certain, the degree of an individual’s sufferance can always be realistically appreciated, the efficient alternative methods to alleviate sufferance are nowhere to be found and euthanasia is a justified duty of the doctor. If we study the premises for the practice of euthanasia, we see they have a doubtful value, especially those of a medical nature. Initially, euthanasia was approached only in case of incurable patients, to put a stop to their suffering, but it then took a turn for the worse, when the old, the handicapped, invalids, chronic patients, depressive patients, children and newly-born with malformations became vulnerable. Three out of four paediatricians are trained in euthanizing children and newly born [19].
Euthanasia has been made legal in many states, but the law is extremely unclear and imprecise in the countries that accept it. As an example, the term “terminal suffering” is not clarified. The word “terminal” is not mentioned, and euthanasia can be applied in non-terminal cases, as well. That happens in 15% of the cases. Only physical and psychic sufferance are stipulated. Since the law is unclear, it has come to be applied in a larger and larger context. Furthermore, it has been assessed that euthanasia is delegated more and more often to nurses, while normally only the doctor is allowed to carry it out. It has been assessed that the effect of the law is not to provide people with enough support in life. People are suggested to resort to euthanasia, although that was not their initial thought. Euthanasia can be asked by people with poor sight who do not want to wear glasses, because the law allows it. To practice euthanasia is, by excellence, a problematic act. In Netherlands, but in other states as well, euthanasia no longer applies to people in terminal cancer or with Alzheimer, but simply to anyone who “has had enough of life”. It came to be used in case of children, which is particularly serious. This “service” can pe performed “at the client’s address”. It may be asserted that, once legalised, euthanasia can no longer be kept under control. The law stipulates that any euthanasia should be reported with the authorities, but those who carry it out argue that it is a “waste of time” and “boring bureaucracy”. The introduction of the presumed consent is being attempted. These events trigger a movement
Euthanasia is too radical. It destroys a problem instead of solving it. By putting an end to the patient’s life, it deprives them of any hope and of any possibility of regret or change of hearts.
Euthanasia has not ethical justification. There is an ethical principle of totality that allows the sacrifice of a part for the sake of the whole. There is no reverse principle – to sacrifice the whole for the sake of a part. Certainly, that would be illogical and non-ethical.
Euthanasia is difficult to put in practice. The various schemes of euthanasia suggest that euthanasia will be performed by doctors. Nevertheless, doctors are trained to preserve life, not to destroy it. Probably there will not be too many doctors who want to be known as the executioners of their patients, since that would undermine their doctor-patient relationship.
Euthanasia becomes less and less necessary. When the ideas supporting euthanasia were launched, the concept and practice of palliative medicine were unknown. The doctors had no practical guides and no experience in analgesics and in eliminating other unpleasant symptoms caused by incurable diseases. With an efficient approach of several bothering symptoms, with the development of psychiatric facilities and healthcare units, the necessity for euthanasia has drastically lowered.
Oncologist David Cundiff shows in his book,
Now, there is a better solution than euthanasia, and that is caring for the human being. Palliative care is the active and global medical care for patients for whom any other treatment fails to work. It is important to bring attention to the fact that the end of life usually occurs slowly and naturally. A palliative care covers all, from a dying child to family, brothers, sisters, all those involved in their life, because after a child dies, the others remain here.
Palliative care should be the answer to the question why euthanasia should not be resorted to, because this care implies bioethics, psychology, theology, etc. There is research which show that a significant percentage of those requesting euthanasia give it up once they sign up for a palliative care program. Certainly, the family plays the most important role [21] but together with the other actors of the palliative care, hope can be reached, a chance given for the patient’s life to change, even if terminally ill. A lived hope may prove determining [22].
The first International Conference for Palliative Medicine Research (May, 1998, Bethesda, Maryland) organised by Dr. Russell Portenoy, the President of the “Pain Medicine and Palliative Care” Department within the Medical Centre Beth Israel in New York and by Dr. Eduardo Bruera, Director of the palliative care program within the “Grey Nuns” communitarian hospital (with the participation of 268 experts in palliative medicine from 22 countries) constituted the event that defined palliative care as a real an efficient alternative to euthanasia. In Romania, at Brasov, there is an organisation – The Medical Foundation Hospice „House of Hope” and a Centre for Palliative Care Medicine. These have organised Courses of Palliative Care in collaboration with the National Association of Palliative Care, which took the form of plenary presentations and workshops. Due to this activity, 43 institutions or sections of palliative medicine (public and private) were set up in the country.
The Christian orthodox church is against the legalisation of euthanasia. Still, the Christian orthodox church has a special prayer for those on the deathbed, which looks like a theological “euthanasia”: “
5. Conclusions
In a holistic approach, the quality of life means the relationship between the body and the soul, which only together can determine an individual’s existence. According to this approach, separating and ignoring the value of the soul means to mutilate the individual, to wrong them, since joy and pain belong both to the body and to the soul. When the body is in excruciating pain, the soul is the one that comes to substitute this want of the body, strengthening and supporting it. But the soul can only do that if it receives help and this help can come from family and from society but, above all, the greatest help comes from Divinity, which is immanent and transcendent at the same time in relationship with His creation. It is transcendent by the fact that it cannot be known in Its being, but also immanent through the actions performed in the world, especially in the quality of humans’ life. In the Christian orthodox theology, God help human through the soul to overcome these sufferings, offering them a happy living in His kingdom eventually. If God’s work is ignored in the world, suffering really becomes atrocious and the individual, unable to take it anymore, commits suicide with the help of medicine, which should cure instead of murdering. That is why to legalise euthanasia under the pretext of the quality of life puts enormous pressure on the sick, the old and the disabled, who come to see themselves as a burden for the others and thus to feel morally constrain to accept death. The psychic sufferance of these individuals is fierce, as they feel useless and unloved, an economic burden for the relatives who must pay for an expensive treatment. On the other hand, by legalising euthanasia, social distress would be created, and there will be great changes in the social attitude towards sickness, infirmity, death and old age, in parallel with root modifications of the role of the medical profession. Human values, such as patience, compassion, solidarity, and commitment become void. Killing becomes a “treatment option”, beside surgery, radiotherapy, chemotherapy, the treatment of pain or antidepressant medication. Palliative care may be undermined, and the doctor-patient relationships will be deteriorated. Modern medicine has the capability of reducing pain, even in the worst cases. Meanwhile, those who intent to extend their life by means of biotechnology want, in fact, to build a sort of earthly heaven for them, inventing all kinds of doctrines and utopias to believe that humans alone, without God, may achieve a perfect quality of life, here on Earth. The wellbeing and worldly riches they long for have nothing in common with the true quality of life, which also involves the soul. Instead of immanence versus transcendence, we opt for immanence together with transcendence.
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