The following scenario was discussed by those attending the evening meeting on Discipleship Sunday, 30 January 2011:

An 84 year old gentleman with end stage dementia is in a nursing home. He sometimes recognises his wife but not often and rarely recognises anyone else. Physically, although frail he has kept quite well. His wife has been called in because he has had a severe stroke that morning. He is unconscious and so unable to eat or drink.

When he was first admitted to the home, a discussion was held as to whether or not the family would want him transferred to the hospital if he became unwell. Having discussed this with her two sons, both of whom live abroad, the decision had been made not to transfer him to hospital but for him to be cared for still at the nursing home. This decision was made on the basis of wanting to cause him the least distress possible. Change of placement or routine upset him and the nursing care on the elderly care wards was felt not to be constantly reliable.

His wife is distressed to see him and her main concern is that he does not suffer pain or indignity. If he remains unconscious he will become dehydrated and death will inevitably occur. It is possible that even though unconscious he may become distressed by the dehydration. The home is unable to give fluids except by mouth and the only way to prevent the dehydration is to transfer him to hospital. He has already been unconscious for 4 hours and shows no sign of waking. There is no way of knowing if he will regain consciousness or make any sort of recovery.

His wife doesn’t know whether she should change her decision and transfer him to hospital for treatment or whether she should request the home to continue TLC only. She is unable to reach her sons to discuss the problem.

What are the issues involved?

What are the ethical principles?

What would your advice be?

Are there any circumstances that would change your opinion?

What support would you offer?

The Salvation Army’s Positional Statement on Euthanasia (dated 1986)

The term ‘euthanasia’ is used to describe any act which is taken with the primary purpose of deliberately accelerating the death of a patient, whether or not at the patient’s request, in order to relieve distress.

Advocates of euthanasia insist that under certain conditions, any competent person should be permitted to ‘choose to die’. They are anxious to avoid dying in conditions of pain, dementia or loneliness, or with loss of dignity, and fear the use of inappropriate life-sustaining measures made possible by modern technology.

Whilst recognising such anxieties, The Salvation Army believes that people do not have the right to death by their own decision, whether procured by their own act or by the commissioning of another. Only God is sovereign over life and death.

The Christian faith puts death into proper perspective as the transition from earthly life to life eternal, and it is the experience of Christians that the grace of God can sustain through any ordeal or adversity. However, it is our conviction that anyone in need should be offered compassionate, comprehensive and effective care to the end. In so doing, dignity and self-worth are maintained for the patient and positive feelings are encouraged in those who will be bereaved by their passing.

It has been demonstrated that, in spite of safeguards, euthanasia is associated with gross abuses; and distrust is fostered within families and between patients and their doctors. For many reasons coercion occurs and patients feel guilty if they do not comply. The ‘right to die’ becomes a ‘duty to die’.

We share the genuine anxieties and abhorrence that people have concerning inadequate care, unrelieved suffering and inappropriate treatments, but maintain that these can be overcome without resort to euthanasia. The hospice movement has shown that pain can be eliminated or considerably eased in all cases with the proper administration of drugs and other treatments. Sophisticated palliative skills are also available.

For these reasons, The Salvation Army opposes any proposal to legalise euthanasia.

We urge therefore that resources be invested to meet the mental, physical and spiritual needs of all patients and their loved ones. Research into pain control and other aspects of palliative care for the chronically and terminally ill is paramount. The provision of skilled nursing is an essential part of the management of serious illness. Development of home-care facilities and the hospice programme is a requirement for providing the necessary support for patients in need, and would allay present fears.

These resources should be available to every person according to his or her medical condition.

(Source: Major (Dr) Eirwen Pallant – 30 January 2011)

Major (Dr) Eirwen Pallant