Icon: enlarge
Photo: Stígur Már Karlsson / Heimsmyndir / Getty Images
Three Protestant theologians fueled the euthanasia debate with a newspaper article: Church institutions should offer advice and support to those willing to commit suicide, urged Ulrich Lilie, the president of Diakonie Deutschland, the ethicist Reiner Anselm and the theologian Isolde Karle.
There was no shortage of criticism: The EKD council chairman and dedicated euthanasia opponent, Heinrich Bedford-Strohm, warned of the consequences of a weakening of Christian ethics and the consequences for ecumenism.
The former EKD council chairman Wolfgang Huber and the ex-chairman of the German Ethics Council, Peter Dabrock, called the trio's attempt a "theological propaganda coup".
It is "somewhat weird" to recommend the charitable church houses as pioneers for "safer suicide".
The Federal Constitutional Court had overturned the ban on commercial support for euthanasia almost a year ago.
Federal Minister of Health Jens Spahn (CDU) was criticized because he still adhered to his instruction to the Federal Institute for Drugs and Medical Devices to reject applications from suicidal people for a lethal dose of the narcotic sodium pentobarbital.
Now a cross-party group of representatives in the Bundestag has presented a draft law according to which those willing to die should be given access to the drug, flanked by protective concepts.
The focus is on the free will of the individual.
The theology professor and co-signer of the evangelical initiative, Isolde Karle, is happy to have initiated the internal church debate - and hopes that the legal uncertainty in assisted suicide, which is harmful for all those affected, can soon be removed.
SPIEGEL
: You provoke with the statement that the dying should also determine their own death in church institutions.
Were you surprised by the harsh reaction from Protestants and Catholics?
Karle
: Yes, definitely.
But euthanasia is an emotional and difficult topic, and reactions are sometimes polemical.
First of all, it is a matter of perceiving people who want to die very precisely: Why do they want to die?
Is your decision self-determined or is it made under pressure from the social environment?
Are you afraid of dying and why?
It's about listening carefully and talking to those affected.
As a rule - this is the experience of many palliative care practitioners - their fears can be dealt with.
SPIEGEL:
Still, it applies to many in the Church
Suicide as sin.
Karle
: In pastoral care in particular, it is important to treat people who are willing to die without reservation, with appreciation and respect - without morally condemning their desire for suicide or judging them as sinful.
Only when a person who is willing to commit suicide feels that they are being taken seriously and that they are being taken into account is they possibly ready to reconsider their decision.
SPIEGEL
: Do you have personal experience with terminal care?
Karle
: I have accompanied several people as they die.
I know suicide accompaniment from the direct description of a relative.
In the absence of adequate suicide assistance, the person concerned decided to refrain from eating and drinking.
It was an extremely painful journey, as the family member told me.
SPIEGEL:
What would have been a better way?
Karle
: It's hard to say.
My aim is to acknowledge that people can get into a situation where they say: it is enough.
I look back on my life gratefully, but now I'm at a point where I can no longer, the suffering becomes too much for me or I don't want to walk the last stretch of the road anymore.
In such situations it can be an act of Christian mercy to acknowledge the wish to die.
The desire to end life can also be an expression of life affirmation.
Life also occurs in voluntary death and is accepted in all its breadth.
SPIEGEL
: Almost a year ago, the Federal Constitutional Court overturned the ban on commercial promotion of suicide and declared that it would interfere with the fundamental rights of people and associations who want to assist suicide.
Why are you fueling the debate right now?
Karle
: With our contribution, we are reacting to a legally uncertain situation.
The Bundestag has not yet developed a new law, as requested by the Federal Constitutional Court.
That is why there is still uncertainty in church care institutions such as diakonia.
We have made a suggestion to help clarify the conditions under which suicide assistance in diaconal institutions could be conceivable.
It is about a protection concept that should ensure that no pressure is exerted on the dying and that considerations of usefulness do not play a role.
SPIEGEL
: And what if the church decides to continue to categorically decline suicide assistance?
Karle
: Then she has to clarify what should happen as an alternative if, for example, a person in a diaconal care home expresses a suicide wish.
Will he be released then?
Will he be referred to an euthanasia organization?
I do not consider either of these to be helpful because the suicide-willing, in any case in great need, would be left alone and broken off established relationships.
"We can learn a lot from the Swiss"
SPIEGEL
: What could assisted suicide actually look like in a church context?
Should there be compulsory counseling, such as with abortions?
Karle
: Yes, there could be compulsory counseling and pastoral support.
At least two doctors should check the request in order to rule out external determination or a lack of judgment in the case of mental illness and dementia.
Just recently several intergroup bills were made public that go in this direction and at the same time try to prevent business-like death organizations.
SPIEGEL
: But isn't the dying process characterized by pain, great emotional fluctuations, and clouded awareness that make any rational decision difficult?
Karle
: Yes, that is why the wish to die must be persistent, i.e. continuous, that is, expressed several times and unequivocally.
In practice, assisted suicide is an absolute borderline and exceptional case.
Nobody wants such a procedure to become standard.
But there must be clear rules for exceptional cases.
The doctor-patient relationship would also benefit from this.
Then both could talk openly and confidently about worries, fears and death wishes and overcome them.
So far, doctors have often been afraid of it because there is no legal security.
SPIEGEL:
In Switzerland, the Protestant churches have developed pastoral practice in dealing with people who want to commit suicide.
What can Protestants in Germany learn from their neighbors?
Karle
: We can learn a lot from the Swiss.
The churches there encourage their pastors to accompany those who want to commit suicide in solidarity and to be there for them.
Some still celebrate the Lord's Supper with them.
As with us, the pastoral workers see their task above all in contributing to suicide prevention.
They try to get those who want to commit suicide out of their isolation and to restart the conversation with relatives, which has often become complicated.
It is often difficult for family and friends to come to terms with a suicide wish.
Some feel guilty, hurt, or angry.
Offers to talk to can help.
This even leads one or the other to revise the wish to die.
SPIEGEL:
The critics of suicide assistance repeatedly use the relationship argument - that ultimately loneliness and the feeling of being just a burden awakened the wish to die.
The chairman of the German Bishops' Conference Georg Bätzing and the council chairman of the EKD Heinrich Bedford-Strohm therefore want to promote the expansion of palliative and hospice support and a "culture of life".
So is it all just a structural problem?
Karle
: It is good to improve palliative care and enable even more hospice support.
But even with the best palliative care there will be people who want to die.
Then that must also be respected.
SPIEGEL:
Is the ecumenical movement endangered by your advance?
Or can the Catholic Church remain stolen from you?
Karle
: No, of course not.
I received both approval from Catholics and critical reactions from Protestants - there is a plurality of opinions in both churches.
Diakonie and Caritas both have to find a solution on how to deal with the judgment of the Constitutional Court.
There is no clear yes or no, right or wrong in this debate.
The question of assisted suicide is one of the gray areas in which we grope and search for acceptable ways.
"People who killed themselves were not allowed to be buried"
SPIEGEL:
The complicity of the Protestant diakonia with Hitler and his sterilization and euthanasia programs is an oppressive historical legacy that overshadows the debate.
Karle
: Absolutely.
But we also have a history of marginalization of people who have committed suicide.
People who killed themselves were not allowed to be buried and their relatives were met with the greatest suspicion.
In the gospel we find a God of mercy who loves his creatures.
It is therefore not our job to act as judges in precarious life situations and decisions.
SPIEGEL:
Would you want to make use of the possibility of assisted suicide yourself?
Karle
: There can be no question of wanting.
I hope I will have a more peaceful ending.
But who knows what to expect?
I can't rule out considering it.
Icon: The mirror