“When someone is in terrible pain is at the end of their life, why isn’t it the loving and compassionate thing to end their suffering?” I was confronted with this question, and variations on its theme, after a presentation I recently gave at a church on bioethics.
As I have reflected on our conversations in subsequent weeks, two aspects stand out: 1) their questions represent the public, secular views about death and dying popularized in American culture; and 2) they were more interested in avoiding physical pain than in thinking Christianly about the problem. I want to briefly describe the view they seem to have absorbed, and the consequences we already see from legalization of both euthanasia and physician-assisted suicide (PAS).
But first, here are some questions I wish I had asked them:
American culture and “the most loving thing.” The core of their question was that “the most loving thing” was to end the person’s life. This phrase brings to mind Joseph Fletcher’s situational ethics, and its core value of doing that which is most loving. The problem, of course, is that despite Fletcher’s efforts to define “love” as agape, it has become vulnerable to potentially idiosyncratic and subjective interpretations. Although Fletcher’s views are not widely accepted today, the idea of equating love with compassion and assisted suicide endures.
Arguments based on compassion appeal more to emotional response than to rational analysis. Brittany Maynard popularized support for PAS as a young, attractive 29-year-old victim of brain cancer who maximized social and mainstream media to generate sympathy for her decision to commit PAS, and who raised money for legalizing PAS. More admirable, but less adored by the press, was Lauren Hill, another young woman with inoperable brain cancer. She raised more than $1.5 million for cancer research, and did not conceal the disfiguring effects of steroids and other treatments. Her desire was to play one basketball game as a college freshman before she died, which she did, in a sold-out arena, weeks before her death at 19. Which woman demonstrated the more thoughtful and generous death?
The PAS slope is “slippery.” Physician-assisted suicide has been legal or permitted in the Netherlands, Belgium, and Switzerland for a number of years. Their experience serves as a warning that PAS cannot be confined to those who have a terminal illness and unmanageable physical pain. Patients who have requested PAS include those who are depressed, have a mental illness such as psychosis, have experienced sexual abuse, are disabled, are unhappy with their looks, are distraught over a sex change operation, or are bored with life. Couples who do not want to live apart have chosen to die together. Children are no longer protected, and have been euthanized even though they are not legally able to consent.
Although in 2001 the Dutch euthanasia law was inaugurated with safeguards such as a review committee, and expectations that the number of deaths would remain low, the reality quickly changed. Beginning in 2008, deaths increased by 15% per year. Professor of ethics at Protestant Theological Seminary in Gronigen Theo Boer, who sat on the review committee for over a decade, publicly admitted, “We were wrong—terribly wrong, in fact.”[1] The slippery slope he describes includes PAS as the ‘default mode’ for cancer treatment, and the impending option for everyone over 70.
The exception to normal patterns of dying is becoming the rule. Autonomous choice is morphing into coercion by doctors, and pressure from relatives. We are encountering that pattern in the U.S. as well. American philosopher John Hardwig reflects the growing trend that a “right to die” becomes a “duty to die” when one’s life is burdensome to others, or the patient is consuming a “disproportionate share” of medical resources. He argues that if you are not ready to die by the age of 75 or 80, this is a “moral failing, the sign of a life out of touch with life’s basic realities.”[2]
PAS in the United States. PAS is permitted in six states (in chronological order, Oregon, Washington, Montana, Vermont, California, and Colorado). Oregon has the longest track record, and its reports indicate a disturbing trend. The top five reasons that patients in Oregon have given for requesting a lethal prescription are not related to physical pain:
Unmanageable physical pain, which engenders high levels of sympathy for PAS legislation, did not even make the list. Yet, this is the ostensible core of most people’s support for PAS. Including Christians.
Christians and thinking differently. We reject conformity to the world’s standards, and desire the mind of Christ. We are to think differently! (Opinion polls reveal otherwise.)[4] We are called to live according to a higher standard, one that does not float on cultural currents. Not only in how we live, but also in how we die, we are called to do it all to the glory of God. John Dunlop’s book title captures it: Finishing Well to the Glory of God.[5]
As evangelicals, we hold the Bible in high regard, as our ultimate authority in all things, including ethical decisions at the end of one’s life. Although there is not an explicit prohibition of assisted suicide, Scripture is interwoven with applicable themes: God as creator and sustainer of all life; his sovereignty over his creation; his presence with us in our suffering; his promise of eternal life with him for those who believe in Jesus. We do find an explicit prohibition against murder (Exod 20:13), and choosing death. Moses urgently instructed the Israelites that in weighing their freedom to choose life or death, they choose life and blessing, rather than death and the curse (Deut 30:19). In the New Testament we are taught that our bodies are not our own, and that we were bought with a price (1 Cor 6:19–20). God, not we, has ultimate responsibility for our life.
Well-meaning support for PAS implies that our last days might be emptied of meaning, a bleak loss of hope. Yet, Christian faith finds hope when the world says there is no hope, because the object of our faith is not our physical well-being or material comforts, but life in Christ through the love of God. “And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit who has been given to us.” (Rom 5:5).
Mark Blocher writes:
More than anyone else, Christians have a major stake in what happens to people at the end of life . . . . If there exists a group of people a dying person should be able to count on to walk with him through the valley of the shadow of death, it is those who claim to belong to the Good Shepherd.[6]
Christians and compassion. Compassion is at the heart of Jesus’ ministry, and a core Christian value. Is helping someone to die in order to relieve their suffering an act of Christian compassion? Our tendency is to confuse emotional response or sympathy with being compassionate. Pope Francis said that assisted suicide gives us a “false sense of compassion.” We must ask the question: Is PAS an example of Jesus’ compassion? His ministry was characterized by paying attention to and healing the overlooked, the outcast, the hopeless, and yes, the privileged. How might that inspire expressions of compassion today, in our biomedically advanced society? Is an injection or lethal pill the best we can offer?
Suffering at the end of life is often not about physical pain. The patient may be struggling with other issues that need to be addressed: fear of dying; broken relationships; unconfessed sin; fear of loss of control; fear of an undignified death or a prolonged dying; or concern about being a burden to one’s family. Are people burdens, or do they have burdens? Genuine compassion encompasses caring for the whole person and their spiritual, psychological, and emotional needs, and not only their physical distress.
So, here is how I would answer the opening question: Alleviating suffering is good. Ending suffering through taking one’s life is out of bounds for the Christian, whether at the hands of the patient, physician, relative, or beloved friend. In the valley of the shadow of death, we fear no evil, because God is with us.
[1] Theo Boer, “Assisted Suicide: Don’t Go There,” EuthanasiaPreventionCoalition.org, July 16, 2014, http://alexschadenberg.blogspot.ca/2014/07/dutch-ethicist-assisted-suicide-dont-go.html (accessed March 27, 2017).
[2] As quoted in Wesley J. Smith, Culture of Death: The Assault on Medical Ethics in America (San Francisco, CA : Encounter Books, 2000), 157.
[3] “Oregon’s Death with Dignity Act—2013,” Oregon Public Health Division, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year16.pdf (accessed March 27, 2017).
[4] Polls show that about 83% of both Catholics and Protestants support physician-assisted suicide in certain circumstances. Craig McCartney, “When Is Killing Compassion?” ChristianWeek.org, February 4, 2015, https://www.christianweek.org/killing-compassion/ (accessed March 27, 2017).
[5] John Dunlop, Finishing Well to the Glory of God (Wheaton, IL: Crossway Books, 2011).
[6] Mark Blocher, The Right to Die? Caring Alternatives to Euthanasia (Chicago: Moody, 1999), 190, 192.
Paige C. Cunningham, “From the Director's Desk,” Dignitas 24, no. 1 (2017): 2–3.