How would you counsel someone interested in assisted suicide?

February 28, 2018

Imagine you are a pastor of a local church and a man who comes infrequently to your church has requested an emergency meeting with you. In your meeting, he tells you that his father is dying of brain cancer. It is painful for this man to see his father suffer by slowly losing control of his physical and cognitive abilities. The father wishes to die because he wishes to no longer be in pain. Because the state where your church is located just passed an assisted suicide law, this man—who you do not believe is a Christian—is asking you whether it would be appropriate for this man's father to exercise his "right to die" in accordance with the state's new law. How would you answer him?

On the one hand, it is understandable why someone of advanced age with a terminal illness might view euthanasia as an attractive “medical” option. The person ostensibly has not long to live, and that short bit of life will likely be overwhelmed with physical and emotional pain. It will seem as though the less painful, frightening thing to do is terminate one’s life in advance so as to avoid going through trauma in the first place. Why live through several months of intense pain and suffering, the assumption goes, when you die at the end anyway and could just as well avoid it all?

Still, other factors are sometimes cited to support euthanasia. The costs of palliative care are a major one, casting euthanasia as a cost-saving measure, especially for the bereaved family. This same family can become a forceful second factor, where the person believes seeking euthanasia unburdens the family of time, money, energy, and attention necessary to company them through death. A surprisingly large number of euthanasia seekers have cited this reason in particular, since it is one of the few reasons that seems somewhat altruistic.

Above all, however, it is the avoidance of unnecessary pain and suffering that constitutes the most compelling reason cited by euthanasia seekers.

Suicide is never okay

Now, just because it is understandable why someone might think the above are good reasons for seeking euthanasia, that does not mean the reasons really are good. This is especially true at the end of life, when existential pressures can impair judgment and foster self-deception. Nor should the language of “euthanasia” (which translates literally as “good death”) soften or alter the fact that what is being opted for is suicide. In the case of the congregant’s terminally ill father, there are several reasons why deciding to terminate his own life is morally wrong.

On the personal level, as it relates to the congregant’s sick father, there is first and foremost the moral prohibition never deliberately to kill oneself. There are older, classical traditions, of course, like the Stoics, who felt suicide the most valiant form of courage. This was mistaken; in part because true virtue seeks some higher end, but in the case of suicide this possibility is formally cancelled out. Suicide serves no final or higher good. Suicide is thus an end in itself, not some praiseworthy demonstration of a life bravely lived.

The common contemporary assumption that all pain and suffering should be avoidable is mistaken.

Secondly, the common contemporary assumption that all pain and suffering should be avoidable is mistaken. For one, we often live with diverse forms of pain and suffering on an almost permanent basis. We diet, we exercise, we labor, we have hard conversations, we make sacrifices, etc. Some degree of pain and suffering is unavoidable in this life. This fact does not become untrue as one approaches death, but differently true. The person approaching death faces a new, threatening pain; a deep pain both of physical and emotional anguish. His pain appears not to serve any further purpose because he will soon die. This is mistaken. Pain, as C.S. Lewis once memorably put it, is powerfully formative, and often in ways that escape our perceptions. The most intense forms of pain may seem questionable in their capacity to accomplish some greater good, but the soul’s lament cries out for relief, and this cry, too, is important. It is pointless only if there is nothing after this life.

The prohibition of killing codified in the Decalogue encompasses the taking of one’s own life (Ex. 20:13). Killing is prohibited because human beings bear the image of God; they have value and worth. Human beings do not get to determine the terms of their birth and likewise do not get to determine the terms of their death. Not even Job, whose life-situation was full of tragic loss and excruciating pain, contemplates taking his own life, only of surrendering to death. Lastly, both Jewish and Christian traditions have taken the first clause of Genesis 9:5–”and for your lifeblood I will require an accounting”–as applying to suicide. Preserving life is a high human responsibility, even one’s own life.

Our lives belong to God

The Christian moral tradition, by contrast, has stressed the importance of “bodily integrity.” Human beings should in principle live whole, productive, and loving lives. That was Augustine’s emphasis, for example. Each of us has a duty to self-love and to love others (‘love your neighbor as yourself’). Love of self is natural and can be ordered or disordered. Only love of God leads to a properly ordered love of self and others. On this Christian theological basis, suicide is impermissible because it denies the fact that our lives belong to God and therefore are not ours to take. God alone brings final integrity.

Without love of God, self-love remains disordered. If the congregant’s father does not profess belief, then of course he will not understand his life as belonging to God. The theological rationale will not have strong purchase for him. The question then becomes whether there exists some common or universal rationale opposing euthanasia, a question that brings us to the social reasons why euthanasia is morally impermissible.

Secularists will wish to affirm autonomy as the normative guide for end of life decisions. That is very likely the basis the congregant’s father makes his own decision. The idea is that terminally ill patients should be entitled to reach their own decision whether to continue living or to take their life with the help of a physician. It is even the person’s decision as to whether pain is purposeless. Autonomy is the guiding criterion.

In one sense it is important for end of life decisions to fall to patients themselves. The congregant’s father would have at some point been confronted with the question of whether to try other exploratory treatments, or to discontinue treatment and transition to palliative care. Forced treatment is a bad idea and a violation of the patient’s dignity. It should be their call. If they decide to forego treatment, their eventual death is not wrong or in any way morally troubling. No one is at fault for dying of ailment.

The ethics of dying

This moral distinction is crucial: there is a world of difference between allowing to die and direct killing. At some point omission of care is not a fault, but a courtesy to the patient. Euthanasia, by contrast, asks the physician to prescribe chemicals for the purpose of directly killing the patient.

Euthanasia is often misleadingly referred to as “death with dignity.” Physicians agreeing to prescribe the relevant chemicals (in the states where it is legal) describe their “care” as merciful. But this mistakes what it means to have, and so to perish, with dignity. It is a simple, indefinable attribute. Dignity describes something all human beings have to some degree or other, which no one can take away, and has something to do with mastering one’s existence and displaying that mastery. This is not to suggest that everyone should see excruciating pain at the end of life as chance for moral achievement; that’s not it. But it does suggest a strong connection between how we bear pain, proceed toward death, and bear our dignity before others. Not an achievement, but an endeavor.

The church’s social witness

The case we’re reflecting upon is particularly difficult because both the person asking advice and their father do not profess Christian belief. Terms of persuasion are slightly different. But one last approach might be persuasive: no one has a right to do what is wrong. A state crafting some statutes granting permission for patients to take their own lives—event under specific, terminal circumstances—does not make an immoral act moral. Any binding law must have a moral basis and so carry moral authority. Taking one’s own life breaks the moral law, state laws allowing for the practice does not suddenly make it right. That is what Augustine meant when he said that an unjust law is illegitimate: a law that lies is without authority.

Bearing in mind all that’s been said so far, the only faithful answer to give to this man who has come for advice is that it would be wrong. Direct taking of one’s own life constitutes a moral wrong. No matter how much it may feel as though euthanasia offers much preferred relief and mercy, in reality, it does not. And who knows, perhaps the prolonging of life, however brief, may result in the father’s conversion. God has certainly met people under odder circumstances.

Editor’s Note: This article is a part of a monthly series sponsored by the Research Institute written by its Research Fellows that focuses on difficult ethical issues facing Christians in the local church.

Matthew Arbo

Matthew Arbo has a Ph.D. in ethics from the University of Edinburgh, currently serves as a research fellow in Christian Ethics at the ERLC, and has taught at Southeastern, Midwestern, and Southern Seminary in Christian Ethics and Public Theology. He has formerly held a bioethics fellowship at the Paul Ramsey … 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