4 biblical principles for end-of-life dilemmas

February 1, 2021

In a recent ERLC film, Eric and Ruth Brown privileged us with the story of Pearl, their daughter born with severe congenital malformations. When doctors doubted Pearl’s survival outside the womb, the Browns clung to their faith, and chose life. In the poignant film, the Browns share the joy Pearl infused into their lives, and also their grief when she died after removal from a ventilator before her sixth birthday. God’s love, so clear to the Browns while Pearl was alive, seemed elusive in her absence, and they felt ill-equipped for the reality that children like Pearl often grace the earth only briefly. “I think,” Eric reflected, “we need to be equally as invigorated with learning how and helping each other know how to say goodbye.”  

In an era when intensive care medicine blurs the line between life and death, the dilemma of how and when to say goodbye pitches so many families like the Browns into anguish. Fifty years ago death occurred within homes and communities, where families could witness and understand it. By contrast, current medical technologies, although they’ve empowered us to save life in many circumstances, have also transformed death into a prolonged and painful process, steeped in unfamiliar jargon that confuses and unsettles us. 

Our faith clearly emboldens us to pursue life for the unborn, but when faced with a loved one dying on a machine, suddenly the path forward seems nebulous. We yearn to love our neighbor, but can’t discern how to proceed when care involves a mechanical ventilator, chest compressions, and feeding tubes. Such dilemmas can saddle us with guilt and despair long after we’ve said goodbye, with studies showing that a year after a loved one dies in the ICU, up to 40% of family members grapple with generalized anxiety, depression, post-traumatic stress disorder, and complicated grief.1Danielle R. Probst, Jillian L. Gustin, et al. “ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms,” Journal of Palliative Medicine 19, no. 4 (2016): 387-393; Mark D. Siegel, Earle Hayes, et al., “Psychiatric Illness in the Next of Kin of Patients Who Die in the Intensive Care Unit,” Critical Care Medicine 36, no. 6 (2008):1722-28. 

How do we honor God in such harrowing scenarios? How do we cherish life, and love our neighbor, and accept God’s will when dying involves ventilators and resuscitation? How do we know how and when to say goodbye?

Every situation is unique, and counsel from trusted physicians and pastors is essential with such delicate matters. Prayer, likewise, is paramount, as is immersion in God’s Word. When hard questions stir us to sleeplessness, reflection upon four key biblical principles can guide us through end-of-life dilemmas with peace and discernment:  

1. Sanctity of mortal life 

As beings created in God’s image, we each possess irrevocable value (Gen. 1:26), and stewardship of God’s creation requires special concern for human life (Gen. 1:28; 1 Cor. 6:19-20; Rom. 4:18). The Lord entrusts us with life and commands us to cherish it through the commandment, “You shall not murder” (Ex. 20:13). The sanctity of mortal life mandates that we advocate for the unborn and safeguard against physician-assisted suicide, and also requires that when struggling with an array of decisions about life-supporting measures, we consider treatments with the potential to cure.  

2. God’s authority over life and death 

Although God directs us to honor the life he has created, he also reminds us of its fleeting nature (Isa. 40:7-8). Death persists in this earthly kingdom as the wages of our sin (Rom. 6:23), and it overtakes us all (Rom. 5:12). When we blind ourselves to our own mortality, we ignore that our times are in his hands (Ps. 31:15), dismiss the power of his grace in our lives through Christ’s resurrection, and disregard the truth that the Lord works through all things—even death—for the good of those who love him (Rom. 8:28). Sanctity of mortal life does not refute the inevitability of death and God’s work through and authority over it.

3. Mercy and compassion 

Loving one another at the bedside requires attention to suffering. God calls us to love our neighbors as ourselves (Matt. 22:39), and especially to extend mercy toward the downtrodden and afflicted (John 13:34; 1 John 3:16-17; Luke 6:36). Mercy doesn’t justify active euthanasia or physician-assisted suicide, but it does guide us away from aggressive, painful interventions if such measure are futile. 

4. Hope in Christ 

So vast is God’s love for us, that in Christ nothing—not even death!—can pry us from him (Rom. 8:38-39). Even as we suffer, we rejoice that Christ has relinquished us from the permanence of death (1 Cor. 15:54-55). We savor the promise of the resurrection of the body and the hope of eternal union with God (1 Thess. 4:14). The gospel transforms our view of dying, and chases away our fear; although we die, we are alive in Christ (John 11:25-26)!

In summary, in end-of-life dilemmas the Bible guides us to seek cure when recovery is possible, but also to accept death when it arrives, and to alleviate suffering, all the while cleaving to our hope in Christ, our Redeemer. 

Preservation of life or prolonged suffering?

Distinguishing between these principles, which appear stark on paper, but tangled and messy at the bedside, depends on a key question: “Will life support in this scenario constitute preservation of life, or prolongation of death and undue suffering?” It’s crucial here to clarify that life-sustaining measures are supportive, not curative. Ventilators, dialysis, blood pressure support, and similar interventions don’t cure disease, but instead buy time, buoying organ function while physicians work to treat the underlying illness (with antibiotics for pneumonia, chemotherapy for cancer, coronary stents for a heart attack, etc). If the inciting disease is treatable, then life support is indeed “life-saving,” because it maintains our body systems long enough for us to recover. However, if the core illness is irreversible (e.g., end-stage emphysema or metastatic cancer without treatment options), life support prolongs dying, and can inflict suffering without ever ushering us to recovery. 

Questions about whether to pursue or decline life support for our loved ones, then, depend less on the technology itself, and more on whether the life-threatening illness is treatable. Asking a medical care team the following questions can provide insight:

When coupled with biblical principles, answers to the above questions can help us to discern when the Lord urges us to press onward, or when he beckons a loved one home. “When it seemed as though God was wanting Pearly to thrive, we supported her,” Eric Brown commented a few days after Pearl’s death. “And when it came time to send Pearl home, we had to support that, as well.” 

When the time comes to send our loved ones home, grief can cripple us. Yet even in our anguish, we rest in the promise that for those in Christ, death is a temporary parting, but not a farewell. By grace, we have been saved (Eph. 2:4). And nothing—not a ventilator, not an incurable illness, not even death itself—can wrench us from God’s love for us in Christ Jesus (Rom. 8:38-39). 

Kathryn Butler

Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma surgeon who is board certified in surgical critical care and served on the faculty at Massachusetts General Hospital and Harvard Medical School. After a decade of experience in surgery, she left clinical practice in 2016 to homeschool her … Read More

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24