Physician-assisted suicide (PAS) is now legally available in 13 U.S. states and Washington, DC, and to the more than 100 million residents of those jurisdictions. Following the removal of residency requirements from eligibility criteria in Oregon and Vermont in 2023, anyone who has the means to travel to those states can potentially receive PAS. More pointedly, all of your parishioners or fellow congregation members who could qualify can now receive PAS, regardless of which state your church is in. Till now, Christians have resisted PAS by working to keep it illegal or to slow its political and legal advance. Christians must reconsider what continued Christian resistance to PAS looks like.
One of the problems presented by the legalization of PAS is that it makes PAS thinkable.[1] When PAS is a legally available option, it forces us to justify the continuation of our existence. This observation has been made by J. David Velleman[2] and Martha Minow,[3] and it is a common argument against PAS from those within the disability community.[4] When PAS is not an option, then no one ever has to explain or justify their desire to continue to live. The desire to live is simply taken for granted. When PAS is an option, however, then every day anyone who can qualify must consider whether or not her continued living merits the medical, economic, physical, and emotional burden that her continued living carries or that it imposes on others.
I don’t wake up every day feeling a need to justify my desire to continue living. I am young, healthy, able-bodied, and able-minded. There are many people who love me and whom I love in return. There are people who depend on me for their livelihood and well-being. I have meaningful and fulfilling family and work lives. I don’t see doctors very often, nor do I use any prescriptions. I have no medical bills, good health insurance, and adequate financial resources. I have no reason but to expect to enjoy many more years during which I will wake up every day, and the question won’t occur to me whether or not my continued existence is justifiable.
The burden of having to justify one’s desire to continue to live is unequally borne by those who are sick, disabled, or dying. Someday I may bear this burden, as many already do. The story of a human life is one that is always proceeding towards illness and disability. Unless I die suddenly in some tragic accident, it is inevitable that both my body and my mind will decline and cease to function as they once did, that doctor appointments will more frequently fill my schedule, and that the medical costs of my life will increase. This is called aging, and I will be blessed if I get to enjoy it. Whether by aging, disease, or accident, we are all likely to find ourselves in a condition of life where our continued living carries and imposes burdens that will make PAS thinkable. To continue to resist PAS, we have to make it unthinkable again.
I. Why People Choose PAS
Pain and other difficult physical symptoms are not really the reasons that push people to choose PAS.[5] Oregon collects data on the reasons for which patients choose “Death with Dignity,” as it is called in Oregon state law.[6] Since it was first practiced in Oregon in 1998, a minority of patients who have chosen PAS have done so out of concerns about pain and symptom management. Only about 30 percent of all patients who have died by PAS in Oregon chose to do so out of a concern about “inadequate pain control at the end of life.” Forty-five percent cited a concern about “the loss of control of bodily functions, such as incontinence or vomiting.” Palliative care and hospice are very good at responding appropriately to pain and other symptoms in order to manage them well, and these reports reflect that a majority of people trust that medicine has the means and ability to keep them comfortable as they die.
There is another reason why we can conclude that pain and other symptoms are not really the reason why people choose PAS. People have great ability to endure pain and physical suffering when they have a clear purpose for doing so. Viktor Frankl makes this point in his book Man’s Search for Meaning, which is in part a memoir of his time as a Jewish prisoner of the Nazis during World War II. Quoting Friedrich Nietzsche, Frankl writes, “He who has a why to live can bear with almost any how.”[7] Frankl raises this quote while considering how survival in a concentration camp could be possible. It became his mission while in the prisons to protect his fellow prisoners from suicide by helping them to identify their own why so that they could endure the hardship of their imprisonment. People today who face the prospect of pain and difficult symptoms while dying can endure through them in order to live if they have a why. We see an instance of this in Atul Gawande’s PBS Frontline documentary “Being Mortal.”[8] The documentary tells the story of Jeff’s decline from cancer into death. Jeff goes onto home hospice care, which permits him to experience his final days at home surrounded by family and friends while receiving excellent treatment of his pain and other symptoms. Some of Jeff’s final words are recorded on camera only hours before his death. Jeff says, “In the last couple of weeks, I have been surrounded by family and friends, and it has been terrific. Some of the best days of my life, I must say. . . . I felt great during that time and my body was in rapid decline. Since then, my mind has been in rapid decline. I get confused. But I’m still a happy guy.”[9] Jeff’s family and friends were the why that enabled him to happily endure his decline into death.
The concerns that make PAS thinkable are spiritual and existential: The patient has lost grasp of the why for his continued existence. PAS is made thinkable by a loss of meaning, purpose, and hope. In order to make PAS unthinkable again, we need to take a page from Viktor Frankl and help one another to have a firm grasp of the why.
II. Receiving Love Is Giving Love
Participation in relationships of love in which one still has something to offer can be one source of the kind of meaning, purpose, and hope that make PAS unthinkable. Receiving love and care from others provides an important sense of why one’s life is worth living. However, a sense of an imbalanced relationship in which one is always receiving and never giving can create an uncomfortable sense of unfairness or injustice. This presents an especially difficult challenge to people who experience significant changes in their bodies and modes of living, such that they cannot give love in the ways to which they have normally been accustomed throughout their lives.
There is one very important sense in which ill, disabled, and dying people are able to give love. It seems paradoxical, but being completely vulnerable to others in order to receive their love and care is a form of giving love.[10] A beautiful example of this is described by Maggie Karner in her YouTube video “A letter to Brittany Maynard.”[11] Karner was a Christian who, in 2014, was dying of the same form of brain cancer as Maynard at the same time that Maynard partnered with Compassion & Choices to advocate for expansion of PAS across the country. In the video, Karner describes what it was like to care for her own dying father.
And during those months, our family had precious time just soaking up the presence of my dad. He couldn’t do anything except talk. And quite frankly, I never had that kind of candor and intimacy with my dad before those days. My brothers and sisters and I, we learned more about ourselves and each other than we ever could have in any other way. We grew as a family, and we learned about sacrifice and love. Each of us became wiser and better people through the whole experience. So, really, in essence, it was a gift that my dad gave to us.
Karner’s dad gave love to his family by making himself available to them as a recipient of their love. It seems paradoxical and unfamiliar, but receiving love is giving love. With this perspective, ill, disabled, and dying people can enjoy reciprocal relationships of love with others without feeling a burden to them, and these relationships can provide the sense of meaning, purpose, and hope that makes PAS unthinkable.
III. A Congregational Culture and Life That Makes PAS Unthinkable
The idea that receiving love is giving love seems paradoxical and unfamiliar because it is so contrary to the dominant culture of our contemporary American society, which values and emphasizes autonomy, individuality, self-sufficiency, strength, youth, and vitality. In order to make sense of the idea that receiving love is giving love, we have to pursue and elevate other values: interdependency, communality, fidelity, fragility, weakness. To resist PAS and to make it unthinkable, Christian congregations need to pursue and establish a culture in which those who are weak, sick, disabled, dependent, needy, and dying are valued, welcomed, and loved as important members of the community. The general principle that I want to encourage is that churches ought to be communities in which every member enjoys satisfaction and happiness from living life together with their fellow congregation members, and that this satisfaction and happiness needs especially to be extended to people who are sick, disabled, aging, and dying. When all members of a congregation enjoy a full life of love that is shared within the church, then PAS will be less thinkable or perhaps unthinkable for those people. Christian congregations can continue to resist PAS by working toward the goal of the realization of this culture and this community. I’ll conclude with some practical considerations regarding how a congregation might ensure that sickness, disability, aging, or dying excludes no one from enjoyment of the church’s life of love.
Christian churches cannot allow illness, disability, and aging to isolate a church member from the congregation. The church is a gathering. To be part of the church is to be one with the assembly of the people of God. Illness, disability, and aging present real obstacles to an individual’s ability to physically gather with the assembly. Of special concern are shut-ins, for whom isolation from the church appears permanent. Isolation breeds loneliness, which can be a great motivator to PAS. When a sick, disabled, or dying person is unable to come to the assembly, then the assembly needs to go to him. Congregation members should visit those who cannot join the assembly due to sickness or disability. Visitors should pray and worship with them. They should enjoy the opportunity to participate with them in a relationship of love. Read the paper together. Watch a baseball game together. Tell stories and reminisce about the past. Bear one another’s burdens and fears about the future. Visiting congregation members can help with household tasks and, when appropriate, with physical care. However the time together is spent, what matters most is presence and togetherness nourished by mutual Christian love. Such visits should not merely be a responsibility of the pastor or of some particular members of the congregation. Ideally, all members of the congregation would develop and delight in this habit.
It is especially important that young, healthy, and able-bodied Christians develop this habit and practice it throughout their lives. Developing this habit will help them to understand sickness, disability, and dying as normal parts of human life that they will be ready to accept when their own lives enter these stages. They will become accustomed to receiving and enjoying the love that sick, dependent, and dying people have to give. When they become sick and dependent themselves, they will be ready to give love by receiving love. Having been on the other side of that relationship, they will understand the goodness and value of the love that they have to offer.
Unfortunately, congregation members can be made into shut-ins simply because they cannot confidently enter and navigate the church building. Congregations should assess their buildings and other spaces for accessibility in order to ensure that people with limited mobility or disabilities can enter into the places where the assembly gathers together. Many concerns could here be raised related to stairs, hearing assistance devices, designated areas for wheelchairs in the sanctuary, and more. Investing in our buildings in order to rectify this problem is a necessary way of loving and elevating the place of sick, disabled, and aging people in our congregations. Changing our buildings so that these members can be fully participating members of the congregation demonstrates our desire for their participation in the assembly and our commitment to them as sharers in a life lived together. Such investment is necessary for making PAS unthinkable.
Finally, a dying person should have their congregation with them as they die. Many desire PAS because they believe that a fast, easy, clean, medically controlled death offers the dying person more dignity than death naturally offers. The final days and hours of a person’s life are the final opportunity for the dying person to give love by receiving love. A congregation can love its dying member by being with them through these final hours at the bedside or in the hospital room. As the person dies, the congregation ought to keep vigil by praying, singing, and worshipping Jesus for the gift of resurrection and eternal victory over death. Pastors can do these things as representatives of the congregation, but it is good for every member of the church to experience and participate in the death of a fellow Christian in these ways. Doing so contradicts the notion that dying deprives one of dignity. When the church gathers like this around a dying person, it recognizes the dying person’s inherent dignity and responds to it with honor, gratitude, and love.
IV. Conclusion
The church must intentionally extend its life of love to its members who are weak, fragile, and dependent. Visiting the sick and shut-ins, ensuring the accessibility of church buildings, and being with dying members are examples of how congregations can do so. Such actions demonstrate that the community values the contributions of these members, including the contributions of presence and of giving love by receiving love. There are other possible actions that congregations can take. Christians should consider their own unique congregational context in order to identify how best to enjoy the church’s life of love with those whose conditions of life may otherwise make PAS thinkable. Establishing the kind of culture that makes PAS unthinkable is a long-term, generational project. If, by the grace of God, congregations succeed in establishing a culture and a congregational life that values and incorporates the participation of those who are sick, disabled, aging, and dying, then such people will be given a why by which they will know how to endure the very real challenges that they experience on a daily basis. They will be freed from having to think about the option of PAS; they will be free to continue to desire to live and enjoy their relationships of love.
References
[1] There are many more problems with PAS than this. Because I do not have the space to engage them in this essay, I must presume that the reader knows both the secular and Christian arguments against PAS, which I take for granted. Christians have no choice but to be opposed to PAS. It is intrinsically contrary to Biblical morality and it is irreconcilable with Christian faith. This is among the most important ethical issues facing Christians today, and churches and pastors have a responsibility to be discussing PAS with their congregation members. Two books that present valuable arguments against PAS and that can helpfully inspire faithful discussion and reflection on the topic are Ewan Goligher’s How Should We Then Die? A Christian Response to Physician-Assisted Death (Lexham Press, 2024) and Charles Camosy’s Living and Dying Well: A Catholic Plan for Resisting Physician-Assisted Killing (Our Sunday Visitor, 2025). Goligher presented his arguments against PAS during a plenary address given at the 2025 conference of The Center for Bioethics and Human Dignity, which can be viewed on YouTube: Ewan Goligher, “How Should We Then Die? A Christian Response to Physician-Assisted Death” (plenary address, The Center for Bioethics & Human Dignity’s 32nd Annual Conference, Living in the Biotech Century: The First 25 Years, Deerfield, IL, June 28, 2025), https://www.youtube.com/live/XdJa0L5VWjA.
[2] J. David Velleman, “Against the Right to Die,” The Journal of Medicine and Philosophy 17, no. 6 (1992): 665–81, https://doi.org/10.1093/jmp/17.6.665.
[3] Martha Minow, “Which Question? Which Lie? Reflections on the Physician-Assisted Suicide Cases,” The Supreme Court Review 1997 (1997): 1–30, https://www.jstor.org/stable/3109738.
[4] For example, Paul K. Longmore, “Policy, Prejudice, and Reality: Two Case Studies of Physician-Assisted Suicide,” Journal of Disability Policy Studies 16, no. 1 (2005): 38–45, https://doi.org/10.1177/10442073050160010601.
[5] Goligher and Camosy both make this same point.
[6] The reasons here reported are the prescribing physician’s beliefs about the reasons that motivated the patient’s choice to die by “death with dignity.” Oregon Health Authority, Public Health Division, Center for Health Statistics, “2024 Oregon Death with Dignity Act Data Summary,” Oregon Health Authority, March 27, 2025, https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year27.pdf.
[7] Viktor Frankl, Man’s Search for Meaning (Washington Square Press, 1984), 97 (emphases original).
[8] Tom Jennings and Atul Gawande, “Being Mortal,” WGBH/Boston, PBS, February 10, 2015, https://www.pbs.org/wgbh/frontline/documentary/being-mortal/.
[9] Jennings and Gawande, “Being Mortal,” 46:44.
[10] Annette Geoffrion Brownlee, “The Dark Night of Hope,” Journal of Religion & Aging 1, no. 2 (1985): 9–25, https://doi.org/10.1300/J491v01n02_02.
[11] FICLIVE, “A letter to Brittany Maynard,” October 29, 2014, 4:29, https://youtu.be/1ZR-qB3HaQY?si=WAkWvlVxQJj0lcJz.