Round Table: Euthanasia
The 2016 film Me Before You stars Emilia Clarke as an awkward young woman who needs employment to help support her poor working class family. After losing her job at a local bakery, she applies to become a caretaker for the adult son of a wealthy family. The son, played by Sam Claflin, was an active and successful young man before being injured in a motorcycle accident that left him as a quadriplegic. The two main characters soon develop an unlikely romantic bond. Nonetheless, the son ultimately chooses to travel to Switzerland and end his life in a physician-assisted suicide facility. The movie, while not being a critical success, raises questions about a person’s right to end their life due to either chronic illness, old age, or a debilitating physical condition. These questions were brought to the forefront of the media recently when the 104-year-old Australian scientist, David Goodall, traveled to Switzerland to end his life.
For Christians, the issue of euthanasia raises many theological and ethical questions. Is it possible to reconcile the practice of euthanasia with a Christian worldview? If so, under what circumstances is it appropriate for a person to end their own life? Many Christian traditions allow persons to reject medical care or treatments that prolong life. What difference is there between rejecting medical care that extends life and the act of euthanasia that quickly ends life? Is there a difference between euthanasia and suicide? Finally, can euthanasia be considered an act of mercy and compassion? In the spirit of Christian charity, we have asked our regular authors and contributors to respond to these questions and other related topics from the perspective of their Christian traditions and their own personal convictions.
John Ehrett, Lutheran
As detailed at length by Edward Larson and Darrel Amundsen, the Christian tradition speaks with one voice against the practice of euthanasia. And it is no help to argue that euthanasia is, in some cases, obligatory as a matter of “Christian compassion.” Such an argument merely smuggles in the utilitarian premise that the highest moral good is the avoidance of pain. Yet this premise is diametrically at odds with most of Christian history.
And there are many problems with euthanasia beyond merely arguments from authority.
First, a regime of euthanasia entails the exercise of sovereign fiat regarding which lives are worthy of life. The traditional test case for arguments over euthanasia is that of a chronically ill patient who is in terrible pain and who will die soon, or perhaps a battlefield medic who administers an overdose of morphine to a fatally injured patient. But the logic of euthanasia has a tendency to drift outwards from edge-case scenarios, sparking more fundamental questions. Do severely disabled individuals have a right—or, as some might perversely argue, a duty—to die? Can situational depression justify ending one’s life? To authorize and systematize euthanasia is necessarily to answer those questions one way or another: how else can such a “treatment” be administered uniformly? And once traditional moral norms are jettisoned, it is difficult to discern a limiting principle.
More fundamentally, underpinning pro-euthanasia arguments is a profoundly toxic set of beliefs about what it is to exist—that is, what it is to live as a being created and sustained by God. Indeed, as Albert Camus famously wrote, “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest—whether or not the world has three dimensions, whether the mind has nine or twelve categories—comes afterwards.” One can answer Camus’ question in one of two ways, and the case for death is rife with ugly assumptions: that we are unable to experience the presence of our Creator in the midst of suffering; that we are incapable of responding with gratitude and love to the challenges of life; that our loved ones would be better off without us; and that we cannot enrich the lives of others while we ourselves are weak.
None of this is to deny the reality of difficult bioethical choices, particularly in end-of-life scenarios where a patient’s death is imminent. But an essential difference between the cessation of life-sustaining treatment and active euthanasia is that in the former case, the eventual decision to cease further treatment does not undermine the value of life as a “basic good” (to use Justice Neil Gorsuch’s terminology). The presumption remains that life is valuable and worth living. That presumption begins to erode when euthanasia is sanctioned.
And one can’t help wondering whether, in hard cases, euthanasia itself might become a medical “standard of care.” The recent case of Alfie Evans, while different in certain respects from a case of euthanasia, does not inspire confidence that today’s institutions will prioritize the lives of the weak.
Jeff Reid, Reformed
“To be, or not to be: that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?”1
When thinking about the question of euthanasia, Hamlet’s famous soliloquy came quickly to mind. As one might remember from high school English, Hamlet is faced throughout the play with the question of whether to believe that that his uncle murdered his father or not, and if so whether Hamlet should avenge his father. By the time Hamlet utters, “To be, or not to be,” he has begun to question whether suicide might be his best option—if the only way through the morass of his life is to end it and avoid trying to find a right answer where no right answer seems to be present. A similar set of moral and ethical issues faces Christians today when considering the topic of euthanasia. On the one hand, we have clear injunctions to not take life, while simultaneously we have injunctions to show mercy to those around us. When those two directions appear to come into conflict, which should win? Is there a point where life becomes so challenging that our best option is to end it—for ourselves or for others around us?
Foundational to this discussion is the sixth commandment: “You shall not murder” (Ex. 20:13).2 The principle—do not take life—is also backed up and affirmed through the rest of Scripture. The question which most people raise when applying this passage is, “What does murder mean?” After all, within the same law that prohibits killing, the death penalty is enacted; further on Israel will also be commanded to kill specific portions of the population of Canaan. Clearly, this command cannot mean a wholesale condemnation of killing whatsoever.
Calvin addresses this question in part by explaining what makes human life special, namely, “Scripture notes a twofold equity on which this commandment is founded. Man is both the image of God and our flesh. Wherefore, if we would not violate the image of God, we must hold the person of man sacred—if we would not divest ourselves of humanity, we must cherish our own flesh.”3 In effect, violence against other human beings is violence against both the Creator and humanity as a whole. The Westminster Larger Catechism expands on this by explaining, “The sins forbidden in the sixth commandment are, all taking away the life of ourselves, or of others, except in case of public justice, lawful war, or necessary defence; the neglecting or withdrawing the lawful and necessary means of preservation of life . . . and whatsoever else tends to the destruction of the life of any.”4 The interpretation of the sixth commandment that emerges is one which places a unique value on human life, and forbids violence except as a means to combat injustice. Especially to our point is the fact that the Catechism applies this command to suicide, indicating that death as a means of ending suffering is not allowable under the command.
As raised in the question, though, the removal of life support does provide one additional complication. After all, if one is going to say that at some point you can stop providing life support and thereby end a life, why can’t one also use a medical procedure to end a life, particularly when there are extenuating circumstances which would make the ending of a life merciful? To sort through this issue, it is helpful to return to Calvin’s reference to the image of God. Since humans are unique representatives of God, only God has the option to decide when those representatives will stop living. Euthanasia, as a proactive choice to end life, clearly disregards this fact. The ending of life support, though, or deciding not to receive treatment for terminal illnesses can sometimes be allowable since it is not acting to cause death, but rather allowing natural processes to run their course.
In the end, while there are several different complications to the question of killing, euthanasia ultimately runs afoul the sixth command because it is an attempt by man to make decisions which belong solely in God’s sphere of control. And, as good as the intentions are which prompt people to consider euthanasia, trying to make God’s decisions is idolatry—setting ourselves in the place of God.Show Sources
(1) William Shakespeare, “Hamlet: Entire Play,” shakespeare.mit.edu. Accessed 6/21/18. http://shakespeare.mit.edu/hamlet/full.html
(2) Scripture quotations are from The ESV Bible (The Holy Bible, English Standard Version), copyright 2001 by Crossway, a publishing ministry of Good News Publishers. Used by permission. All rights reserved.
(3) Calvin, John. Institutes of the Christian Religion, trans. Henry Beveridge (Peabody: Hendrickson Publishers Inc., 2009), 256.
(4) The Westminster Confession of Faith (Lawrenceville: Committee for Christian Education & Publications PCA Bookstore, 1990), 92-93.
Ben Winter, Roman Catholic
My response focuses on physician-assisted death. My argument against it is twofold: (1) Doctors, by definition, must care for patients. Killing can never be considered a “treatment” and is therefore beyond the purview of the medical profession. A doctor qua doctor cannot purposefully end the life of a sick person. (2) While a sick patient can refuse treatment, it is immoral for that patient to willfully end their own life or ask another to do so. This is because it is an offense against God’s providence (i.e. God’s agency over life and death) to intentionally end a human life.
(1) Care of the sick. Care of souls. These phrases describe the vocations of medical practitioners and priests. The burden of taking someone else’s life into your hands (both literally and spiritually) is serious, and involves dealing with difficult situations. The gravity of these callings—one could argue that they are the two most important and inclusive vocations related to “health”—demands a careful and nuanced approach when moral quandaries present themselves. As such, those called to these forms of service must abide by rigid principles that can never be compromised. For example, a priest must always be willing to absolve a penitent person. A doctor must always be willing to treat the sick, even if the sick person is a murderer or a member of a hostile military force. These vocations are defined by care and self-gift. As I mentioned above, it is not “care” at all to simply eradicate a sick person from this world, as if this would make things better or “easier” for all parties involved. End-of-life care is not easy.1 As such, doctors must do everything they can to treat illness. However, a patient can choose to forgo treatment, provided they do so in a manner that respects God’s providence.
(2) God is the author of life and death (see 1 Sam 2). Humans should not take matters into their own hands by willingly ending the life of another. As I have written elsewhere, I believe that Catholics can make a strong, unqualified argument against the use of lethal force. The same principle applies in matters of medicine. Removing an individual from treatment that is keeping them alive is not the same thing as willfully killing them. As Dr. Daniel Sulmasy puts it: “Treatments can be considered futile and terminated. But patients should not be considered futile and terminated.” The cessation of overzealous treatment is also allowed by the Church, for “here one does not will to cause death; one’s inability to impede it is merely accepted.”2 In fact, one can still hope that (and there are many examples where something “miraculous” has occurred) God will preserve life even without the aid of medicine. In other words, the decision to forgo excessive treatment does not mean that a person is “choosing death.” Instead, they are allowing nature to run its course; and Christians believe that natural processes are governed, in some mysterious way, by God’s providence. To instigate the death of one’s self or another bypasses that providence, and effectively sets a human being in the place of God.Show Sources
(1) For example, many who are suffering from terminal illness also suffer from depression. But should the response of doctors to a depressed person with suicidal thoughts be: “I respect your wishes, and will take the action necessary to end your life?” You would be hard-pressed to find someone advocating that doctors prescribe life-ending “medication” to the depressed. The same principle should apply to end-of-life care.
(2) As the Catholic Catechism explains: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.”
Jarrett Dickey, House Church
“But we have this treasure in clay jars, so that it may be made clear that this extraordinary power belongs to God and does not come from us. We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be made visible in our bodies (2 Cor 4:7-10 NRSV).”
At the core of the Christian faith is the assumption that suffering is redemptive (Isa 53). Christ’s death on the cross, while an act of cruel torture and extreme injustice, brings life and salvation to all (Rom 5). Popular Christian theology often speaks of Christ’s death for us, but the Apostle Paul speaks of Christ’s death as something we participate in (Rom 6:1-11). The good news is that Christ’s death is not God’s final word. If we share in Christ’s suffering and death, we will most certainly share in his life and resurrection. With this principle in mind, suffering is not a reality to be avoided in the Christian life. Paradoxically, believers embrace suffering in a spirit of joy and hope, knowing that trials and tests bring about spiritual growth (Jas 1:2-4). Taking a redemptive view of suffering, euthanasia becomes antithetical to a biblical vision of the Christian life.
Before proceeding further on the topic of euthanasia, it is good to clarify a Christian perspective of the human condition. In 2 Corinthians 4:7, Paul compares the human condition to a clay jar. Certainly this metaphor is based on God’s creation of Adam from the dirt (Gen 2:7). Adam, in and of himself, is only an earthy shell–fragile, weak, and mortal. Then God breathes life into Adam and he becomes a “living being.” Paul uses this metaphor drawn from the creation story to establish two important points: (1) The human condition is weak and temporary. (2) The weakness of human nature highlights the life and power of God. The good news is that God gives the Holy Spirit to believers to guide and sustain them through the difficult sojourn of this earthly life (2 Cor 5:5). Furthermore, we endure our present mortal condition knowing that at the resurrection we be will clothed in an imperishable spiritual body (2 Cor 5:1-4; 1 Cor 15:42-44).
With the above-mentioned points in mind, the active ending of one’s own life through euthanasia becomes wrong for two primary reasons. One, when euthanasia is used to eliminate some form of suffering, whether that be physical or psychological, it becomes a refusal to participate in the sufferings of Christ. Since we understand suffering to be redemptive, to reject suffering is to reject an opportunity for growth, refinement, and transformation. Furthermore, to reject Christ’s sufferings is to rejection his resurrection. For Christ there was no other way to new life than the route of suffering, torture, and death. Two, euthanasia disregards that life is ultimately a gift from God. All human life exists in a state of weakness supported by the life of God. If we end a human life simply because it seems especially weak, we deny a person the ability to experience the sustaining power of God even in the face of great difficulty.
Christians must remain adamant in these twin assertions—suffering is redemptive and human life is a gift from God. Yet, there are many questions about end of life care that do not involve an active rejection of either suffering or the gift of life. For example, many Christians choose to deny medical care for a variety of reasons. An elderly woman may decide not receive chemotherapy therapy, or an elderly man may opt to decline regular dialysis. In both cases, it is possible that such persons will actually suffer more by declining care. So this is certainly not an attempt to escape suffering. In both cases, it is possible that human life will continue for weeks, months, or even years after rejecting medical care. So this is certainly not a firm and final rejection of the gift of life. However, in other cases Christians choose to receive medical care—surgery, chemotherapy, organ transplant, and the like—that can possibly extend life. Although, there is never any guarantee that modern medicine will be effective. In both these situations, whether one receives or denies certain medical treatments, the power of life and death ultimately belongs to God. Euthanasia, by contrast, is a clear attempt to claim that power for ourselves.
While Christians should always be dogmatic in their affirmation of life and human dignity, I would propose a level of agnosticism when it comes to God’s ultimate judgment of those who actively end their own lives or the lives of others through euthanasia. Yes, this is a rejection of suffering and life, but we cannot comprehend how God, in his infinite wisdom and mercy, judges such a situation. For example, think of the battlefield medic who administers a high dosage of morphine to a fatally wounded soldier. The medic has clearly acted with a degree of compassion in the midst of the hell of war. The fatally wounded soldier, through no choice of his own, has been euthanized. If we, as humans, are capable of noting these moral and ethical complexities, does not God also take these factors into account at final judgment? Humans often attempt to grab control over life and death, but, when it comes to final judgment, that is a choice that is only ever the prerogative of God.
Jacob Quick, Anglican
I live in Belgium, which has some of the most, if not the most, liberal voluntary euthanasia laws in the world. Given Belgium’s laws, the parish which I attend must wrestle with the messy ethical and theological implications which accompany the freedom to end life. I know medical doctors who have administered the serum, enabling their patients to participate in voluntary euthanasia. My wife has interviewed elderly Catholic nuns, who have spent their entire lives on the mission field, who have opted for voluntary euthanasia. These encounters with euthanasia and its consequences have not led me to take a hard stance, but instead encouraged me to appreciate the elusive nature of clear answers when faced with matters of life and death.
Rabbi Dr Jonathan Romain insightfully notes that the debate surrounding euthanasia is not a debate between the secular and the religious. The debate is alive and well within religious communities, as it is in secular ones. This is clearly true within my own Anglican tradition. The Church of England is, officially, strongly opposed to euthanasia. Indeed, former Archbishop of Canterbury Rowan Williams and current Archbishop of Canterbury Justin Welby have voiced opposition to the legalization of physician-assisted suicide, on the grounds that it violates the sanctity of life. However, prominent Anglican figures such as Bishop Desmond Tutu and Lord Carey of Clifton, a former Archbishop of Canterbury, suggest that the legalization of physician-assisted suicide is the most compassionate option.
Lord Carey, while initially against euthanasia, changed his position after further reflection on the agony that individuals can experience before death. Lord Carey observed, “Even the most devout believers will find their faith tested by the sight of a dying person in torment – especially when modern medicine could swiftly bring the torment to a merciful end.” The challenge of agony is especially acute when considering the fact that, with modern medicine and technology, we can dramatically prolong life and, as a result, the anguish and suffering which accompany life that requires such an extension. I find Lord Carey’s observation compelling when he states that our absolute refusal to permit euthanasia can end up “sanctioning anguish and pain.” What does it mean to be pro-life if we are concerned primarily with the quantity of days instead of the quality of them?
Nonetheless, I also sympathize with Bishop James Newcome’s concern that euthanasia can easily be co-opted by consumerism, influencing society to consider “life as disposable, a commodity like any other in our consumer driven society to be thrown away when it has supposedly gone wrong.” In addition, euthanasia can be wielded toward horrible ends, such as offering a path for individuals who are already considered to be a “burden on society” to internalize discrimination by ending their lives.
As an Anglican, and as a Christian, I do not believe that euthanasia admits of any easy answers. And as a brief foray into the Anglican discussion shows, it’s possible to utilize Christian principles in order to voice arguments for and against certain forms of euthanasia. I believe that euthanasia should spur all Christians to carefully and compassionately consider the complex nature of life and death.
We invite your participation in charitable discussion of these viewpoints—and others—in the comments section.