A statement made by a former archbishop of the Church of England in July 2014 caused quite a stir among Christians, not only in his own denomination, but also among others. Retired archbishop George Carey commented on how his views about physician assisted suicide (PAS; or “assisted dying” as Carey called it) had changed. He wrote, “The fact is that I have changed my mind. The old philosophical certainties have collapsed in the face of the reality of needless suffering.” That this statement came from Carey, considered an evangelical, was a surprise to many.
Carey’s arguments for his changed views had to do with the nature of God’s love and the reality of immense suffering (which he now considers to be meaningless suffering) of many terminally-ill patients. According to him, the loving God would not allow such meaningless suffering and would accept and endorse such patients choosing to end their suffering. Carey said that his previous arguments of the “slippery slope” (the argument that allowing PAS would open a can of other problems) and potential abuse by powers have become less convincing. Carey’s position was supported by the liberal archbishop Desmond Tutu. What Carey said brought some degree of confusion, so much so that the incumbent Church of England archbishop issued a statement to clarify the church’s unchanged position on the matter. 
The Situation Today
We now have increasing public discussions on dying, a topic that is usually not the subject of normal social conversations. But two things have changed that. Firstly, the rapid development of medical science and technology poses novel dilemmas for patients, and their families and physicians, when life can be prolonged, even in its terminal stages, through medical technology. Secondly, the erosion of long-held moral foundations and the rise of individualistic ideas of right and wrong have introduced intense debates on how society should proceed in this “brave new world.” There is an increasingly popular view that personal happiness is the summum bonum (highest good) of life, thus absolutising the freedom of choice and personal autonomy. It is, therefore, argued that each patient has the right to choose to die when suffering with terminal illness that is considered meaningless and unbearable. Theologians such as David Wells address this morally confusing ideas by showing that we live in an age when our understanding of ourselves as moral beings has been eclipsed by extreme forms of individualism and consumerism that have resulted in people becoming “moral illiterati” and “morally vacant”.
The noble task of medicine is to find cures for illnesses that patients suffer. However, when one is diagnosed to suffer from an incurable and terminal illness, there are people who will find every means possible to find a cure or to prolong their life. Some desperately hold on to life, clutching at every straw offered. They travel and try whatever “cure” is available whether by doctors or charlatans until their deteriorating medical condition stops them. Commercialised medicine and the development of a wide range of untested alternative medicines do not help the situation. At the same time, doctors attempt to prolong the patient’s life using new tools and techniques. With increasing costs of medical treatment, this can be a grossly expensive but futile business.
It is for this reason that there are some people who are horrified by the thought of having their lives prolonged unnecessarily by extraordinary medical means – in a situation when death is imminent and unavoidable. Along with this, there are also others who, in the context of the pain and hopelessness of terminal illness, prefer to end their lives earlier through euthanasia. They consider it their individual right to make such a decision.
Euthanasia is “the intentional killing by act or omission of a dependent human being for his or her alleged benefit.” The word “intentional” is emphasised here. If death is not intended, it is not an act of euthanasia.
Euthanasia can be voluntary (where the patient makes the decision) or involuntary (where others make the decision for the patient). It can also be active (for example, by giving lethal injections) or passive (for example, the withholding of food and water and customary care). When it is voluntary, it can be carried out directly by a physician (by, say, giving a lethal injection). Alternatively it can be achieved through PAS, when the doctor makes available to the patient the means by which he can take his own life. Voluntary euthanasia can also be carried out by acts of omission, as mentioned above. Such acts can also be involuntary, when the medical staff withhold food and medicines. This would be considered as euthanasia as the intention is to speed up the death of the patent, that is, to kill the patient.
While euthanasia and PAS seek to shorten life, an Advance Medical Directive (AMD) seeks to prevent the unnecessary prolonging of life through extraordinary medical measures, which are heroic in their efforts but futile. Therein is the difference between euthanasia and AMD. In AMD, while heroic medicine is withheld to a dying patient, palliative care is not – which means that food and water are given, along with painkillers and other symptomatic medication to relieve the suffering of the patient. For these various reasons, from a Christian perspective, AMD is morally acceptable while euthanasia is not.
What does the Bible Say?
Our moral compass to deal with such a difficult and sensitive issue as the needs and rights of a dying patient must be found in the Bible, which has an authoritative place for faith and practice. What does the Bible say? What follows is a meditation on a Bible text that can help us to elucidate some important theological principles that can guide us in our thinking and actions. The text comes from a book in the Old Testament that deals with inexplicable and intense suffering (from our human perspective) in the life of a man called Job. The poor man does not have the advantage of listening to the dialogue that takes place between God and Satan. All he experiences is blow after blow in his life and the sudden and rapid deterioration in his personal circumstances. In many ways, his situation is akin to a patient who is suddenly struck with terminal illness, and whose world crashes in on him or her.
The key text is Job 2:3-10.
God Owns Us (Possession)
In this text, God has a wager with Satan. Initially, in an earlier wager (Job 1), God had allowed Satan to take away all of Job’s children (and therefore future), and possessions. But in spite of his devastating losses, Job was still faithful to God. He “did not sin by charging God with wrongdoing” (Job 1:22). God was pleased with Job’s unshakeable faith, and made it known to Satan, which leads to the second wager.
Satan said, “A man will give all he has for his own life. But stretch out your hand and strike his flesh and bones, and he will surely curse you to your face” (Job 2:4). He claimed that Job’s faith would change when his own body is struck and when he has to physically suffer. Confident of his servant Job’s steady faith, God gave permission to Satan to strike Job with illness and physical pain. But there was one condition. God limited what Satan could do to strike Job’s body with illness by telling him, “but you must spare his life” (Job 2:6). Why did God set this limit?
Satan is always slipping errors and falsehood in his speech. In this instance, he refers to Job’s “own life” (Job 2:4). But does Job’s life belong to him? The answer is No.
God created man and owns his life.
God created us in His image (Gen 1:27). He breathed His breath of life into the form of man he made from the dust, and man became a living being (Gen 2:7). When we die, our spirit returns to God (Ecc 12:7 – the dust returns to the ground it came from, and the spirit returns to God who gave it). The fact that God made us in His image and that we are “fearfully and wonderfully made” (Ps 139:14) means that we have a God-given dignity and our lives are precious.
Here in the book of Job, these truths that God is our Creator and the One who has given us life is reiterated. In Job 1:21, we read: “The Lord gave and the Lord has taken away.” God is the giver of life, and also the taker of life. He alone possesses that right and power. The book also acknowledges that “The Spirit of God has made me; the breath of the Almighty gives me life” (Job 33:4; this statement was made by Elihu, one of Job’s counsellors).
For the Christian, God’s ownership is a double ownership – He owns us as our Creator and as our Saviour. We are therefore to honour God with our whole lives, including our bodies, because we have been purchased and redeemed by Christ. Thus we read in 1 Cor 6:19-20, “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies.” We do not belong to ourselves, but to God. He alone has the right to give life and take it away.
This truth is further emphasised when we read Rom 14:7-8 NIV – “For none of us lives for ourselves alone, and none of us dies for ourselves alone. If we live, we live for the Lord; and if we die, we die for the Lord. So, whether we live or die, we belong to the Lord.” No one stands alone on his own, claiming absolute rights over his life and death. Because we are related to God (as Creator and Saviour), because we belong to Him, we do not have the right to take our own lives, or to take someone else’s life. Any discussion of personal autonomy must also deal with the important question of responsibility, especially relational responsibility. We are accountable to God because we are related to Him as His creation.
Our days are numbered by God.
Amid his inexplicable suffering, Job patiently and wisely spoke to God, “Man’s days are determined; you have decreed the number of his months and have set limits he cannot exceed” (Job 14:5). He acknowledged God’s authority over his life and God’s pre-determination of his life span, which means that God has also determined when and how his life would end. The psalmist declared the same truth when he told God, “My times are in your hands” (Ps 31:15).
This knowledge that God has already set our days is further expressed in Ps 139:16 – “All the days ordained for me were written in your book before one of them came to be”. In this great psalm, God’s intimate involvement in the creation of life is acknowledged. God is not a distant power who is not interested in all the details of our life. Rather, He is always present, from whose presence we cannot really escape. Such an intimate involvement in our lives on the part of God means that even our death is a matter of personal concern to Him. He had already determined how and when we will die, even before we were born. The time of our death is decided by God. It is He alone who has the authority to put to death and bring to life (Deut 32:39).
Job, therefore, refused to follow his wife’s rather heartless and insensitive advice: “Are you still holding on to your integrity? Curse God and die!” (Job 2:9). She was asking Job to commit suicide for he was in much pain and in a terrible condition. There is nothing said about she caring for her husband and seeking to alleviate his pain. She does not pray to God for help. Perhaps she became cynical when she saw how terribly Job suffered. So she considered that death would be better than for Job to suffer. But the man did not seem to die easily, in spite of his severe physical condition (we must remember that God had forbidden Satan to take Job’s life. Only God had that authority).
Job was told by his wife to curse God, and therefore to stop trusting God, for in her mind God was not going to do anything about Job’s suffering. She asked job to die. How would he do that? She was asking him to end his life (commit suicide) and bring his suffering to an end. But Job considered her suggestion foolish. “Shall we accept good from God, and not trouble?” (Job 2:10). He saw God’s hand even behind his sufferings. He respected God’s sovereignty, and thus “did not sin in what he said” (Job 2:10).
The way God has created us, we are meant for relationships – with God and others. Even in death, these relationships remain important. Our relationship with God is paramount and our choices must recognise His sovereignty, presence, and grace.
God Forbids Murder (Prohibition)
Euthanasia, in whatever form, involves murder and suicide. It is not only taking into our hands the right that belongs to God, but it is also a contravention of God’s moral Law. The sixth commandment declares, “You shall not murder” (Ex 20:13). That the taking of another person’s life is morally wrong is clear. Bible scholars would also consider this commandment as prohibiting the taking of one’s life. It is for this reason that suicide was considered in the church as an act against divine Law.
Is suicide wrong?
There are seven cases of suicide in the Bible: a. Abimelech (Judg 9:54), b. Samson (Judg 16:29-31), c. Saul and his armour bearer (1Sam 31:3-6), d. Ahithophel (2Sam 17:23), e. Zimri (1Kgs 16:18); and f. Judas (Mt 27:5).
All of them (except Samson) are presented in negative light. These were ungodly men acting in desperation and disgrace. Samson’s case may have been seen differently as an act of martyrdom and self-sacrifice. Thus, though he is not a model of godly living, he makes it to the list of heroes of the faith in Heb 11:32. Suicide is thus quite consistently seen in Scripture as morally wrong.
For this reason, suicide has been considered by the church as sinful. In some periods, suicide was in fact associated with “the unpardonable sin” leading to the idea that one who commits suicide is disqualified from heaven (because unlike a murderer, he would not have any opportunity to repent of his sinful action). However, over time, the church has come to see suicide not as the unpardonable sin, and more sensitivity and pastoral care has been extended to families of those who tragically commit suicide. But this in no way diminishes the Bible’s serious view of suicide, for such an act offends God by denying God the right over our lives and death, and it breaks God’s prohibition.
This is one key reason why Christians have made known their opposition to euthanasia and PAS. Moreover, the medical profession has also generally spoken against euthanasia and PAS because it goes against the doctor’s Hippocratic oath, promising that the physician will never do anything to deliberately bring harm to his patients.
In God’s Hands, No Suffering is Meaningless (Providence and Purpose)
One of the arguments, and it is a powerful argument, used by those who seek to legitimise euthanasia and PAS, is the great suffering that some terminally ill patients suffer. This is all the more poignant when the suffering patient pleads to be put to death so that their misery can end. Hence, some argue that their request should be met through “mercy-killing”. It is called that because killing the patient is seen as a merciful act.
It is indeed extremely unsettling to see a patient suffer intense agony when in the throes of impending death. Should his death be speeded up so that his sufferings can end? Would this be a merciful act? Our previous reflection on the truth that God created us and owns us, and has determined our days, and that He is present and concerned for us would help us to think more deeply about this problem. We also need to reflect on the reality of suffering, and how we should view it and handle it.
Suffering and Ultimate Meaning
There is no doubt that Job suffered greatly, more than we can imagine. He was desperate to find some meaning in his suffering. His friends tried to explain it but their explanations did not satisfy Job; they in fact became accusatory in nature and made his suffering worse. Sometimes suffering is inexplicable. We may be able to explain suffering in a broad general sense, but it is often difficult to explain an individual’s particular suffering.
In Job’s case, God finally spoke above all the human voices. He did not give any specific answer or explanation for Job’s sufferings – which reflects how we often experience suffering and God’s relative silence in it. The book of Job, however, gives the reader a bird’s eye view of things. The reader is made aware by the narrator of the story of the heavenly scenes and can hear the dialogue and wager between God and Satan. There is a heavenly drama to which the sufferer, Job, is not privy to. While we can see the full picture, Job suffers in the darkness of inexplicable loss and agony. But at the end, God steps in and puts an end to Job’s misery, blessing him more with far more than what he had before his excruciating trial (Job 42:12).
We may not be able to explain why someone suffers in a particular way, but we also know that God allows suffering for purposes best known to Him at that time, but the wisdom of which will be made known in the future when it will be explained how that suffering was redemptive and how “in all things God works for the good of those who love him, who have been called according to his purpose” (Rom 8:28). This does not mean that we do nothing to relieve the sufferings of others. Christian love demands that we do all we can to alleviate human suffering. The parable of the Good Samaritan told by Jesus (Lk 10:25-37) shows the lack of concern on the part of the religious professionals who do nothing to help the dying man on the road. It is the Samaritan traveller who shows Christian love by helping the wounded man.
How can we apply this in the case of a terminally ill patient? If the person is suffering much, we must acknowledge it and empathise with him. Trying to explain why he is suffering in that particular way is often unhelpful, a lesson we can learn from the blundering efforts of Job’s friends. Neither do we have the right to put an end to the patient’s suffering by terminating his life. Neither the patient nor we have that right. But we can still do something to bring relieve to the person’s suffering by caring for him. There are various things through palliative care that the patient can be helped – from medical alleviation of the pain to providing human company and dignity to the person. While we may not be able to explain why the person is suffering in that way, we can still help to mediate God’s presence.
Suffering and God’s Presence
Jesus suffered greatly when He died on the cross. It was not only physical in nature (for he was brutally beaten and crucified) but also social and spiritual. His death was a public event; He was stripped and hung in humiliation, and felt abandoned by God. In the depths of His sufferings, He cried out to His Father in heaven, “My God, my God, why have you forsaken me?” (Mt 27:46). Was there any ultimate meaning in His suffering? Yes, because He suffered for us, to save us. In having suffered, He also offers us His wounded hands, His precious company, especially when we suffer.
The apostle Paul suffered much for the gospel – from painful beatings to near death experiences. In all of it, he was confident that his sufferings could be explained by an overarching principle. Though we may lose control in our suffering, God does not. He allows suffering for His own purposes, though we may not see it in a given moment of suffering. Paul therefore, could write, “we rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope” (Rom 5:3).
More than seeing ultimate purpose, Paul enjoyed Christ’s presence especially in times of suffering. Writing from the restrictive conditions of a Roman prison, he opened his heart to say, “I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death” (Phil 3:10). Paul enjoyed the sweetest fellowship with Jesus when he suffered.
For a dying patient, what we can do to help is to mediate God’s presence. We can encourage the patient to experience the comforting presence of God. This is often experienced when God’s community gathers around the suffering person.
Suffering and God’s Community
We cannot use suffering as a reason to kill someone (an idea that is present in the suggestion made by Job’s wife). But we can do something to relief someone’s suffering. As a community, we can ensure that no one suffers alone, and without comfort and help. The Christian community ought to gather around the dying person. There are also hospices, where dying patients can be cared for and helped to die as comfortably as possible and with dignity. Modern medicine can also help sufferers find some relief from pain.
When King Saul was critically wounded in battle, he asked his armour bearer to kill him, but he refused. Saul was obviously in great pain, but he was more fearful of being abused by his enemies (1Sam 31:4). Saul then committed suicide. It was a miserable end for the king, who died alone. There was no community to help him.
We saw earlier how the good Samaritan helped the wounded man who was left to die on the road (Mt 22:37-40). The Samaritan brought the man to an inn to be cared for, and “took care of him” (Lk 10:34). It is a little detail that is often missed. We can imagine the Samaritan sitting by the bedside of the badly wounded man, consoling him and attending to his needs throughout the night. He had the heart of a care-giver. He could not do it alone, and therefore recruited the innkeeper to be part of the caring team. Because he had to attend to other matters, he told the innkeeper to “Look after him” (Lk 10:35). Thus a community of caregivers was formed for the poor traveller who was left half dead on the road.
How Do We Go Forward?
Euthanasia is wrong because it contravenes God’s law and challenges His sovereignty. It will produce societal decline and loss of human dignity. We have no right to legitimise or practice it. There are two fallacies that it is based on.
Firstly, it has to do with the “cure or kill” ideology.
This ideology can be described so: Try to cure the patient using medicine, but if the patient cannot be cured, then it is acceptable to kill him (or let him take his life). If this way of thinking is allowed to take root, it will grow into other monstrosities, the signs of which are already emerging where euthanasia or PAS are now legalised.
Society should instead cherish a “cure or care” mindset. That is to say, if we are unable to cure patients, then we must care for them compassionately. Even in terminal illness, patients can be cared for through palliative medicine. Most people become depressed in such situations because of their pain or loneliness. However through caring palliative medicine (which can help the patient in his pain), and loving care provided by caregivers, a person in such conditions can die with dignity and hope. When euthanasia becomes an easy way out, then it can become a convenient way of “disposing” terminally ill patients whom society and families may not have the compassion or time to care for. That would be disastrous for any society. American philosopher Daniel Callahan aptly observes, “Euthanasia … is an act that requires two people to make it possible, and a complicit society to make it acceptable.” The kind of society that legalises euthanasia would be one that would threaten human dignity and create the loss of trust and mutual respect. Moreover, those who are elderly, seriously ill or disabled would eventually face the threat of coming under the shadow of euthanasia, as it is expanded in its application.
The second ideology is that death is better than suffering.
The motive for this is: Avoid suffering at all costs. Such an ideology fails to understand the redemptive effects of suffering (cf. 2Cor 4:16-18). We should not put ourselves or others to death just because we are suffering. Moreover, in terminal illness, palliative medicine exists that can assist patients who are suffering.
In the strong grip of his personal illness and agony, Job utters words of hope against the depressing circumstances that he was in. He declared, “I know my Redeemer lives” (Job 19:25). This truth is further elaborated in the New Testament and in the testimonies of countless believers who had approached death and suffering with the unshakeable faith of the gospel of Jesus. The ultimate hope of escape from pain is not death but resurrection (Rev 21:4).
No one should be allowed to die alone or with pain that can be reduced through medicine and loving care. But we have no right to take their life. Neither should they take their own. We do not have that right because our lives belong to God.
The term “euthanasia” means “good death”. It leads us to ask the question, “What is a good death?” A good death is to die in God’s hands. When Jesus gave up His life, He prayed, “Father into your hands I commit my spirit” (Lk 23:46), a habit adopted by His followers (Acts 7:59). In the history of pastoral care, especially in the uncertain times of medieval days when plagues and sudden death were common, the primary aim of pastoral care was to help people to die well. It follows that knowing how to die well will help one to also live well. A good death comes from a life lived in seeking to know Christ and to become like Him in death (Phil 3:10).
Bishop Emeritus Dr Robert M Solomon (PhD, Edinburgh) served as Bishop of The Methodist Church in Singapore from 2000-2012. He had served previously as a medical doctor, church pastor, principal of Trinity Theological College and president of the National Council of Churches of Singapore. Dr Solomon has degrees in medicine, theology, intercultural studies, and a PhD in pastoral theology from the University of Edinburgh. He has contributed many articles to books, theological dictionaries and journals and authored 20 books, including ‘The Race’, ‘The Conscience’, ‘The Enduring Word’, ‘The Virtuous Life’, ‘The Sermon of Jesus’ and ‘Apprenticed to Jesus’. He now has an active itinerant ministry of preaching and teaching in Singapore and abroad.
 “Lord Carey: I support assisted dying”, Telegraph, 12 July 2014, http://www.telegraph.co.uk/news/religion/10963195/Lord-Carey-I-support-assisted-dying.html.
 “Archbishop of Canterbury criticises George Carey’s support for ‘right to die’”, The Guardian, 15 July 2014, http://www.theguardian.com/society/2014/jul/15/archbishop-canterbury-george-carey-right-to-die.
 David F. Wells, Losing our Virtue: Why the Church must Recover its Moral Vision (Leicester, England: Inter-Varsity Press, 1998), 13.
 R. K. Sharma, Concise Textbook of Forensic Medicine and Toxicology, 2nd edn. (New Delhi: Elsevier, 2008), 162.
 See Roland Chia, The Right to Die? A Christian Response to Euthanasia (Singapore: Genesis, NCCS, 2009), 28-29 for a discussion on the principle of double effect, where a medical intervention (such as giving increasing dose of morphine to alleviate a patient’s pain) may result in his death. As the intention was not to kill the patient but to relieve his pain, his unfortunate death is morally acceptable. It is different from euthanasia where the aim is to speed up the death of the patient.
 Roland Chia has rightly maintained that “the removal of the feeding tube from a PVS [persistent vegetative state] patient is a form of passive nonvoluntary euthanasia. Roland Chia, The Right to Die?, 27.
 Views vary among scholars as to the character and faith, or lack of it, of Job’s wife. She may have lost faith in God and saw no hope for Job. The only recourse was for him to die. Perhaps she asked him to curse God as “an indirect way of committing suicide”. Francis I. Andersen, Job, The Tyndale Old Testament Commentaries (Leicester, England; Downer’s Grove, US: Inter-Varsity Press, 1984), 93.
 St Augustine of Hippo was influential in his views that suicide was “self-murder” and was morally as reprehensible, if not more than murder. See Augustine, The City of God, trans. Marcus Dods (New York: Modern Library, 1950), Bk 1:24, 25.
 The traditional Hippocratic Oath, originating in classical times, says: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy. In purity and holiness will I guard my life and my art.” See Kevin V. Ergil, Ancient Healing: Unlocking the Mysteries of Health and Healing through the Ages (Lincolnwood, IL: Publications International, Ltd.: 1997), 76. The World Medical Association has consistently expressed its opposition to the legalization of euthanasia and PAS through repeated statements. Its most recent statement in 2015 reiterates its position: “Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.” See its website, http://www.wma.net/en/30publications/10policies/p13/.
 In his encyclical Evangelium Vitae, Pope John Paul II points out that what may be termed “mercy killing” may not really be merciful. “In reality, what might seem logical and humane, when looked at more closely is seen to be senseless and inhumane.” See John Paul II, The Gospel of Life (New York: Random House, 1995), para 64, 116.
 See John Breck, The Sacred Gift of Life: Orthodox Christianity and Bioethics (New York: St Vladimir’s Seminary Press, 2000), 216. Breck offers several spiritual benefits of suffering: it creates humility before God, dependence on Him, sanctifies us, and helps us to share in the mission of Christ.
 Stanley Haeurwas, Naming the Silences: God, Medicine, and Suffering (Grand Rapids: Eerdmans, 1990). Hauerwas, a Christian theologian and ethicist, asserts that trying to explain suffering, especially in the case of children suffering terminal illness, is a pursuit in vain. Though we may not agree with all his conclusions, his argument that modern medicine’s “noisy” technological interventions in the face of suffering and death is a denial of the mystery of suffering and a distortion of reality that leads people to look to modern medicine as a god who would provide answers or solutions, is surely a point well worth reflecting on.
 There are many Christian books that have come out of hospice ministries. Two examples are Sheila Cassidy (a doctor), Sharing the Darkness: The Spirituality of Caring (London: Darton, Longman and Todd, 1988) and Deborah Howard (a nurse), Sunsets: Reflections for Life’s Final Journey (Wheaton: Crossway Books, 2005).
 See Robert Solomon, “A Good Death?” ETHOS Institute, http://ethosinstitute.sg/a-good-death/.
 In Belgium, children “in great pain” can be legally euthanised since early 2014. See “Belgium’s parliament votes through child euthanasia”, BBC News, 13 Feb 2014, http://www.bbc.com/news/world-europe-26181615. Also a prisoner suffering from “mental anguish” was given permission by a national legal body to pursue physician assisted suicide in Sept 2014. His doctors eventually refused to provide such assistance, and he was referred to a psychiatric institution. See “Belgian rapist Van Den Bleeken refused ‘right to die’”, BBC News, 6 Jan 2015, http://www.bbc.com/news/world-europe-30699780.
 Daniel Callahan, “When Self-Determination Runs Amok”, in Bioethics: An anthology, 2nd edn., Helga Kuhse and Peter Singer, eds. (Malden, MA: Blackwell Publishing, 2006), 381–5.
 The Netherlands was the first country to legalise euthanasia and PAS. Studies and official reports show that doctors have contravened rules and procedures and euthanized thousands of patients without their consent. See John I. Fleming, Euthanasia, the Netherlands, and Slippery Slopes, Southern Cross Bioethics Institute, Adelaide, South Australia, Bioethics Research Notes Occasional Paper No.1, June 1992, http://www.bioethics.org.au/Resources/Online%20Articles/Other%20Articles/Euthanasia%20the%20netherlands%20and%20slippery%20slopes.pdf.