Since the first half of the 17th century, scholars have debated “euthanasia” as a voluntary termination of life with the goal of avoiding useless suffering. However, the term “euthanasia” was not always related to what today would be called “physician-assisted suicide.” In fact, Francis Bacon became the first writer to use it in such a way.[1] The goal of the present essay is to reclaim the forgotten Christian meaning of euthanasia. As will be seen below, throughout the ages, Christian writers have thought of ways to prepare for a pleasant death, for euthanasia. Following this historical survey, a discussion of how such ancient wisdom may be applied today will be provided.
In older Christian books on moral theology or ethics, the usage of the term euthanasia was common. However, these works interpret it in a fashion entirely different from how it is currently employed. The word euthanasia is a Greek composite term (eû + thánatos) meaning nothing but “good death,” “beautiful death,” or “pleasant death.” Accordingly, older Christian textbooks presented “euthanasia” as a Christian preparation for death. But what exactly was meant by that?
Since the period of the early church, the Christian preparation for death represented an important topic and was closely related to the counseling of the dying. For instance, Augustine understood it as a final act of friendship to comfort the dying so that they might have a “good death”—that is, that they obtain eternal salvation. He based his argument concerning this final act of friendship on passages such as Matthew 25:36 (“I was sick and you visited me;” ESV) and the commandment to love your neighbor as yourself (Matt 22:39).
The publication Admonitio morienti (“A reminder of death”) from the 11th century, likely written by Anselm of Canterbury, became a highly influential work on how to prepare for a good death during the middle ages. This booklet contains two parts. While both sections contain questions which a priest was supposed to ask of a dying person, the first part deals with questions for a monk and the second part questions for a layman.[2]
During the 14th and 15th century, when the European West fell into a deep crisis because of natural disasters, epidemies, and ecclesial schisms, artists crafted drawings depicting a danse macabre,[3] a ”dance of death” in which a personified death invites people to accompany him to the grave, while priests gave sermons on useful preparations for death.[4] Additionally, writers provided textbooks on how to mentally prepare for death by exploring the question of how a Christian can withstand temptations during the final moments of life and, thus, find a “good death.”[5]
From this comparatively large number of publications,[6] a work by Johannes Gerson should be noted by way of example. The chancellor of the Sorbonne and chief advocate for reforms at the Council of Constance (1417) published his book De arte moriendi (“Concerning the art of dying”) in 1408.[7] It represented a seminal work for the entire 15th century, both in its structure and its content. The book consists of four parts. The first part deals with topics such as humble subordination under God’s mighty hand, grateful acknowledgement of divine beneficence, and patient bearing of pain and death as repentance for sin and complete devotion to God.
The second part follows the six questions found in Anselm’s Admonitio. In order to die a good death, the dying person is called to answer the following questions: Do I stand firm in the Christian faith? Do I wish to die in obedience as a faithful son of the church? Do I desire God’s forgiveness of my sins? Do I intend, in the case of my recovery, to live better than before? Am I aware of one or more unconfessed deadly sins? Do I still intend to confess them and do I make the decision, if still possible, to make amends? Have I forgiven everyone who has injured or insulted me in my life? The third part contains preformulated prayers to God, Mary, the angels, and the saints (patrons). Finally, the fourth part provides instructions regarding the taking of the sacrament and argues that others should read pious martyr legends or the ten commandments to the dying person.[8]
Right at the beginning, Gerson summarizes the intention of his work: Friends of a dying person should care for his bodily, frail, and decrepit life. However, for him, it is even more important to care for the spiritual and eternal salvation of a dying person than to care for perishable things. True service of friendship means to pray with a terminally ill man, to comfort him, and to exhort him so that he despises the present world and yearns for the eternal world.
About a century later, another significant work about the good death was published by Johannes von Staupitz, a famous figure in church history because of his role as confessor of Martin Luther. In 1515, Staupitz wrote the booklet: Von der Nachfolge des willigen Sterbens Christi (Concerning the imitation of Christ’s voluntary death).
According to Staupitz, God neither created death nor does he rejoice in man’s perishing. Quite contrary, he created everything in such a way that man was able to live an earthly life without fear of death. He was supposed to live in abundance and with unrestricted health. However, (unlike the angels) it was not impossible for man to die as his immortality was dependent upon a life of obedience towards God. Adam’s rebellion against God affected him like deadly poison resulting in a trifold death for Adam: the death of the soul, the death of the body, and the eternal death.[9]
Because of the death of the soul human life is determined by the opposition of the flesh, the inability to do good, the ignorance of truth, the desire for evil, and, not least, the bitterness of death. In order to escape this deficient life, man has to orient himself towards God and obey him. In this way, he is able to reverse the death of his soul and makes it possible for new life to form within him.
Specifically, man can respond to death in three different ways:
In order to achieve this attitude, a Christian is called to understand Christ’s death on the cross as a paradigm for his own death, teaching him how to righteously bear suffering, overcome temptation, and die a good death. Specifically, Christ’s words on the Cross serve as an example. Christ’s prayer “Father forgive them” teaches that evil angels have to step aside with their accusations and need to make way for good angels coming to help Christians during the time of death. “Today you shall be in paradise with me” promises that one can die in hope if one is not an unrepentant person, if one acknowledged his own injustice, if one does not cling to perishable things, if one desires to flee temporal pain, and if one longs for eternal life. The saying “Woman, behold your son, son, behold your mother” teaches that one overcomes the flesh by emotionally letting go of close relatives and friends as he bids them farewell in a blessing manner. Christ’s call “I am thirsty” teaches, according to Staupitz, that nothing is more beneficial to humans than to desire heavenly refreshment, that is, to thirst after living water. The cry “My God, my God, why have you forsaken me” calls us to serenity: “Leave, oh noble soul, all things and yourself for the one who left all things for your sake.”[10] Hence, Staupitz teaches that a good death consists in following the death of Christ. His little booklet providing comfort for the dying probably marks the climax of late medieval mystical spirituality on the topic of the good death.
Only four years after the publication of Staupitz’ book, Martin Luther also authored a writing on the good death: Ein Sermon von der Bereitung zum Sterben (“A sermon on the preparation for death”). Unlike Staupitz, who called for a mystical imitation of Christ’s death, Luther emphasized the connection between Christ and a Christian which is established solely through faith in the forgiveness of sins on the basis of Christ’s complete work on the cross. Christians have a living hope beyond death because of the righteousness of God which was established on Golgotha. It is from this perspective that Luther answers of what constitutes a good death.[11]
Luther argues that a Christian is called to bid farewell to the temporal world. He must make efforts to put temporal things in order (and, hence, not to despise them). It is important that he orders his personal relationships. He must both grant forgiveness and desire forgiveness so that “the soul may not remain afflicted with any matter on earth.” The dying man must turn “to God alone” and understand the coming death as a “new birth”: “The narrow gate begins here, the narrow path to life. Everyone must confidently prepare for it. For it is narrow but it is not very long. It is similar to a child being born out of the small apartment of its mother’s womb, with dangers and fears, into this wide heaven and earth, which is our world.”[12]
A dying Christian has to be aware of the fact that powers will rise up against him. Luther specifically mentions the “frightening image of death, the horrible multilayered image of sin, and the unbearable image of hell and eternal damnation. These occasionally rise up in front of a person in a terrible fashion.” The dying Christian should not feel threatened by these images but instead focus on “death in eternal life,” “sin in grace,” and “hell in heaven.”[13]
In all of this, it is helpful to remember the temptations Christ faced on the cross:
Like us, He [Christ] was tempted with the image of death, sin, and hell. They held up the image of death before his eyes . . . the image of sin before him . . . they drove the image of hell towards him. . . . We see how Christ remains silent in the face of all these words and terrible pictures. He does not fight them. He acts as if he does not see or hear them. He does not answer a single one of them. Rather, he focuses on the beloved will of his father alone. . . . In the same fashion, we want to let the images fall and descend and only think about the fact that we are dependent upon the will of God, which is that we cling to Christ and believe that our death, our sin, and our hell, is overcome for us in him and cannot harm us, so that Christ’s image alone may be in us.[14]
Luther recommends a desire for and a celebration of the sacraments so that the dying Christian does not doubt but realize that he is not alone. Additionally, the love of family and worship of God on one’s deathbed are a great support in dying a good death.
In a way, Luther understood the hour of death to be the climax of a life of faith which is grounded in Christ’s work: temptation of sin and distance from God can only be overcome by trusting the complete work of Christ.
In the following decades, up until the period of pietism and puritanism, a plethora of writings on the topics of the “good death” and the “good dying” were published. At times, such publications took the shape of abbreviated laypersons’ dogmatics that emphasize the knowledge of sin and highlight gospel-centered repentance for which faith in God’s mercy in Christ is central. The only point of discussion was whether the process of dying should be celebrated as the Art of dying (ars moriendi; common in Pietism)—one might think about Johann Sebastian Bach’s cantatas—or understood as a minor transition (for instance by A. Bengel) which should not receive much attention.[15]
In sermons on ethical issues, Bible passages were often used like guardrails (for instance, in answering the question of how one should behave in relation to political authority, preachers commonly used Roman 13:1–8; regarding divorce, Matthew 19:1–12 was popular; regarding suffering, the book Job). In accordance with this practice, preachers often used the death of Jacob (Gen 47:29–30) and Joseph (Gen 50:24–26) to teach the church about a “good death.” Two things can be learned from Jacob’s (and Joseph’s) death: First, this man did not passively accept his death but became active on his deathbed (Gen 47:29). He called for his son and his grandchildren and provided instructions regarding his funeral. In the same fashion, a Christian should not passively endure the dying process but should call for his family, his progeny, and take care of his temporal affairs. Second, Jacob and Joseph changed their focus: away from Egypt where they lived, towards the promised land of Canaan. In the same way, a Christian is called to reorient himself towards the land of Canaan which is promised to him (Gen 47:29–30 and 50:24–26; Ex 13:19; cf. Hebr. 11:21–22).
During the modern era, the question of the “good death” gradually disappears. People increasingly viewed the dying process from a medical perspective. Care for the dying became an irreligious service designed to delay death as much as possible through medication and machinery. At the same time, there was an attempt to psychologically care for the dying by strengthening their identity through making them aware that they can understand their temporal life as a “fulfilled life”. They were comforted on the basis of their own works: life was not meaningless because they had success and loved other human beings. To summarize: during the modern era, the topic of the good death which was so dominant in the Christian West for centuries lost most of its relevance. The word “euthanasia” ceased to carry its previous meaning.
What of these older considerations regarding the “good death” is relevant for a Christian today? In my opinion, it is, first of all, necessary to think about the problems related to dying a “good death” as a Christian in our current secularized society. On the one hand, the media depict death unscrupulously both in the news and also, and that to an even greater extent, in a never-ending stream of (crime) movies entertaining through murder and homicide. Numbness in the face of death is an unsurprising result.[16]
On the other hand, we live in a time in which death is largely banned from the public sphere and outsourced into specialized institutions such as hospices and hospitals. Often, death only appears as a more or less irritating disruption of societal economy. Otherwise, death is commonly ignored in an Epicurean fashion: “Let us eat and drink for tomorrow we will be dead” (1 Cor 15:32).
Preparing for a good death in a society which focuses on the temporal world is not easy for a Christian. On the contrary: it is a struggle. Professionals attempt to relieve the dying from pain, to feed him artificially, and to give him breath with a ventilator. While it is commendable that medical advances are utilized, a tension may arise between the necessary medical procedures and the need for counseling at the end of life. For instance, in order to pray with the dying Christian, to read Scripture with him, and to talk to him about the imminent journey in a confident manner, undisturbed privacy is necessary.
Having discussed these divergences, there are five essential aspects we can receive from both the aforementioned considerations and Scripture to prepare for a “good death.”
Whether it is helpful to speak of an “art of dying” (ars moriendi) dependends on its definition. In any case, Scripture does not teach a celebration of one’s death. On the one hand, in the process of dying, one should not scoff death (as the Amalekite Agag did: “Truly, death’s bitterness has left me” 1 Sam 15:32). On the other hand, excessive sentimentality is not suitable for a Christian either.
Bodily deterioration and grave illness might cause the final months or weeks to be almost unbearable. In many cases, this period is overshadowed by anxiety and horror (Ps 39:5–6; 55:4ff). However, it is good that one experiences his own finitude. The Bible verse “Lord, teach us to number our days that we may get a heart of wisdom” (Ps 90:12) still applies today. It is possible that a dying person lives out his last days more earnestly in the face of directly experienced finitude than he or she did during previous periods of life.
When people today speak about a good death, they usually envision a quick death involving as little suffering as possible. Hence, a good death becomes an unexpected death which surprises the person. The Epicurean pleasure-society favors heart attacks, quick deaths on the road, or emergency operations resulting in the death of the patient.
It is quite telling that eras dominated by Christianity understood a quick death to be tragic. Often relatives are left with questions: Should they have talked about something? Should they have told their son, husband, wife what they meant to them?
In contrast a dying process during which one was able to settle his personal affairs was understood to be a good death. Such personal affairs may include an advance directive, an appointment of healthcare proxy, or arrangements for the funeral. However, on one’s deathbed, it is of primary importance to discuss important issues with one’s spouse, children, and close relatives so that quarrels, strife, or other doubts regarding personal property do not rise up among the survivors.
Last but not least, bidding farewell to this world and its affairs is important. This means that it is important to say goodbye to one’s loved relatives. Undoubtedly, this is not easy. It causes pain. There is the temptation to avoid saying goodbye and to argue that things will become better despite better knowledge. But this is not appropriate in light of the sincerity of this moment. It is dishonest.
It is possible that a dying person who is surrounded by or hooked up to medical machines asks the question: What am I actually afraid of? Of the pains or of dying? Whatever the answer is, a Christian is called to put his trust in God in the dying process. Precisely during this time, he needs to seek comfort and hope in his faithful savior Jesus Christ. During this phase, it can be helpful to remember that God himself participates in a human body (Col 2:9): Jesus Christ became a man. Not only did he turn towards the sick and dying, he also suffered an incomparably more painful death.
Given the face of eternity, reconciliation with one’s neighbor and the knowledge that one will soon stand before one’s judge (Heb 9:27) and savior (Phil 1:21–23) indispensably belong to a “good death.” If the relationship between a dying person and a surviving person is burdened, this is the final possibility for reconciliation and forgiveness in the face of approaching death.
Undoubtedly, it will also be important to order one’s own life before God and to ask for his forgiveness of sin and guilt. Christian churches use known rites for this, such as the anointing of the sick, the final anointing, the celebration of the Lord’s Supper on one’s deathbed, or the blessing on one’s deathbed. We shall not engage this matter much further. A handed down blessing for the dying may read as follows:
God, the Father, bless you
who created you according to his image.
God, the Son, bless you
who redeemed you by his suffering and death.
God, the Spirit, bless you
who called you to life and sanctified you.
God, the Father, Son, and Holy Spirit,
accompany you through the darkness of death.
He shall be gracious in judgement and give you peace
and eternal life. Amen.[17]
Talking about a “good death” would be charade if it did not happen in awareness of eternal life. For the Christian, a “good death” does not consist in a “death with dignity.” For him, death is not merely the end to biological existence. Death is not something natural that “belongs to life” but a judgement instituted by God because of Adam’s fall into sin (Gen 3:19; Rom 5:12; 6:23) which extends to all people (Ps 89:49), even all of creation (Rom 8:20). That death is also a judgement for concrete singular sins is not impaired by that (Prov 11:19; 1 Cor 11:30; Rev 18:8).
Death is not only God’s judgement on us, it is also our enemy. It is not only our enemy, it is also the enemy of God (1 Cor 15:26; Rev 20:14). God does not only lead into death, he also brings out of death (1 Sam 2:6). God is the savior from death (Matt 4:16; 2 Cor 1:9–10;). Since Christ’s resurrection, death is a defeated enemy. Christ destroyed its power (1 Cor 15:55) and brought life and incorruptibility to light (2 Tim 1:10). Now, death cannot separate anyone who believes from the love of God (Rom 8:38–39). Christ holds the keys of death (Rev 1:18). Through his death, Christ has freed us from our fear of death (Heb 2:14).
In other words: death does not have the final word. It is not ultimate but the bridge on the path to glory. It is the departure for the city which is built by God (Heb 11:14–16). In contrast to those “who have no hope,” a Christian has this hope (1 Thes 4:13). The word which the prophet Hosea once pronounced as a word of judgement (“Death where is your sting? Where is your victory?” Hos 13:14) is transformed into joyful rejoicing on basis of the resurrection of the Son of God (1 Cor 15:55). Therefore, the most important preparation for a “good death” consists in not losing sight of eternal life and the resurrection of the dead and in holding fast to the work of Christ in faith. Only in looking at Christ overcoming death is it possible to speak about “good dying” and a “good death”—that is, euthanasia in the true sense of the word.
[1]The concept is already found in his 1605 work De dignitate et augmentis scientarum (“Concerning the dignity and advancement of the sciences”) in which Bacon discusses Sueton’s report of Augustus’ death. Cf. Francis Bacon, The Advancement of Learning (Oxford: Clarendon Press: 1963).
[2]This book by Anselm of Canterbury represents an indispensable source for late medieval writings. Cf. “Ars Moriendi,” in Lexikon der Kunst, Malerei, Architektur, Bildhauerkunst, ed. Wolf Stadler (Erlangen: K. Müller Verlag, 1992), 1:272. A discussion and German translation of the Admonitio morienti et de peccatis suis nimium formidanti can be found in Adolph Franz, Das Rituale von St Florian aus dem zwölften Jahrhundert: Mit Einleitung und Erläuterungen (Freiburg: Herdersche Verlagsbuchhandlung, 1904), 196-200. According to Franz, the priest asked the dying person whether he or she believes the teachings of the church, whether he or she is glad to die in the Christian faith, whether he or she confesses to have insulted God heavily, whether he or she repents of this and promises to do better, if he or she stays alive, and whether he or she believes that he can only find salvation through the merit of Christ.
[3]Kurt Fassman, “Ars moriendi,” in Kindlers Malereilexikon, ed. Helmut Kindler (München: Dtv,1984), 6:87; Karin Hahn, “Ars Moriendi“ in: Lexikon der christlichen Ikonographie, ed. Engelbert Kirschbaum SJ (Freiburg: Herder, 1968), 1: column 188.
[4]E.g. the sermon held by the Florencian preacher Girolamo Hieronymus Savonarola regarding the “art of dying”; Wilhelm von Langsdorff, ed., Hieronymus Savonarola. Ausgewählte Predigten (Leipzig: Richter, 1890), 126ff.
[5]Peter Jezler, Himmel, Hölle, Fegefeuer, Das Jenseits im Mittelalter. Katalog zur Ausstellung (Zürich: Neue Zürcher Zeitung, 1994), 398.
[6]Cf. “Ars Moriendi,” in Lexikon der Kunst, Malerei, Architektur, Bildhauerkunst, ed. Wolf Stadler (Erlangen: K. Müller Verlag, 1992), 272.
[7]The Latin text of Gerson’s De arte moriendi can be found in Johannes Gerson, Opus tripartitum de praeceptis decalogi, de confessione, et de arte moriendi (Cologne: Ulrich Zell, 1470). For a discussion of Gerson’s publications on the art of dying see Allen Verhey, The Christian Art of Dying: Learning from Jesus (Grand Rapids: Eerdmans, 2011), 85-88.
[8]Cf. Alois M. Haas, Todesbilder im Mittelalter: Fakten und Hinweise in der deutschen Literatur (Darmstadt: Wissenschftliche Buchgesellschaft, 1989), 176–177.
[9]Text: Johannes von Staupitz, “Das Büchlein von der Nachfolge des willigen Sterbens Christi” in Johannes Staupitz. Luthers Vater und Schüler. Sein Leben, sein Verhältnis zu Luther und eine Auswahl aus seinen Schriften, ed. Alfred Jeremias (Berlin: Hochweg, 1926), 133–159. See also Albrecht Endriss, “Nachfolgung des willigen Sterbens Christi: Interpretation des Staupitztraktates von 1515 und Versuch einer Einordnung in den frömmigkeitsgeschichtlichen Kontext” in Kontinuität und Umbruch: Theologie und Frömmigkeit in Flugschriften und Kleinliteratur an der Wende vom 15. Zum 16. Jahrhundert, ed. Josef Nolte, Hella Tompert, and Christof Windhorst (Stuttgart: Clett-Cotta, 1978), 93–141.
[10]Johannes von Staupitz, “Das Büchlein von der Nachfolge des willigen Sterbens Christi” in Johannes Staupitz. Luthers Vater und Schüler. Sein Leben, sein Verhältnis zu Luther und eine Auswahl aus seinen Schriften, ed. Alfred Jeremias (Berlin: Hochweg, 1926), 155.
[11]Martin Luther, “Ein Sermon von der Bereitung zum Sterben” in Martin Luther: Ausgewählte Schriften in sechs Bänden, ed. Karin Bornkamp and Gerhard Ebeling (Frankfurt: Insel, 1982), 2:15–34.
[12]Martin Luther, “Ein Sermon von der Bereitung zum Sterben,” in D. Martin Luthers Werke: kritische Gesamtausgabe, ed. J.F.K. Knaake et al. (Weimar: Hermann Böhlau, 1883-2009), 2:685f.
[13]For all these phrases see Martin Luther, “Ein Sermon von der Bereitung zum Sterben,” in D. Martin Luthers Werke: kritische Gesamtausgabe, ed. J.F.K. Knaake et al. (Weimar: Hermann Böhlau, 1883-2009), 2:685-697.
[14]Martin Luther, “Ein Sermon von der Bereitung zum Sterben,” in D. Martin Luthers Werke: kritische Gesamtausgabe, ed. J.F.K. Knaake et al. (Weimar: Hermann Böhlau, 1883-2009), 2:691-692.
[15]Oscar Wächter, Johann Albrecht Bengel: Lebensabriß, Character, Briefe, und Aussprüche (Stuttgart: Verlag von Samuel Gottlieb Liesching, 1865), 272.
[16]Cf. Hans Schwarz, Eschatology (Grand Rapids: Eerdmans, 2000), 4.
[17]This is the so called “Valet Blessing;” Cf. Jochen Arnold, Theologie des Gottesdienstes: Eine Verhältnisbestimmung von Liturgik und Dogmatik (Göttingen: Vandenhoeck & Ruprecht, 2004), 456.
Cite As: Jürgen-Burkhard Klautke, “Dying a 'Good Death' by Preparing for Eternity: Reclaiming the Forgotten Meaning of Euthanasia,” Dignitas 25, no. 3 (2018): 10–13.
