Is physician-assisted suicide ethical?

April 17, 2019

When I was a child, one of my relatives developed a debilitating disease that attacked the nervous system. He gradually lost his abilities to speak and to dress himself, and fits of choking seized him at every attempted meal. As a fiercely brilliant man who prized his self sufficiency, over time his loss of independence fractured his spirit. One morning he took his own life. In a letter on the kitchen table, in a shaky scrawl that remained emblazoned upon my mind years later as I donned my white coat, he wrote the words, “Support Kevorkian.”[1]

Over the ensuing years, as I witnessed suffering well up from every corner of the hospital, I would remember that letter and wrestle with the idea of physician-assisted suicide (PAS). In PAS, now widely called “medical aid in dying,” physicians prescribe a lethal dose of medications for a terminally ill patient to self-administer. Proponents of PAS argue that compassion mandates we honor requests for a peaceful death. Compassion for Choices, the oldest nonprofit organization in America that advocates for PAS, explains, “Our vision is a society where people receive state-of-the-art care and a full range of choices for dying in comfort, dignity, and control.”[2] The practice is legal in seven states, offering one in 5.5 people in the U.S. the option to end their own lives with the approval of a doctor.[3]

While few could argue against “choices for dying in comfort, dignity and control,” PAS warrants debate. The American Medical Association condemns PAS in its code of medical ethics, stating, “Physician-assisted suicide is fundamentally incompatible with the physician’s role as a healer, would be difficult or impossible to control, and would pose serious societal risks.”[4] Skeptics warn that the imbalance of power between physician and patient risks coercion of the dying.[5]

Even in the public sector, PAS generates uneasiness. In a 2012 Gallup survey, 64 percent of respondents agreed that doctors should painlessly end a terminally ill patient’s life upon request.[6] However, when the phrasing of the question was changed to include the term suicide, support dropped by 10 to 15 percent.[7] This jarring change of opinion with substitution of a single word captures the ethical dubiousness fundamental to its debate.

Compassionate, but unbiblical

Anguish afflicts those with terminal illness, and we must minister to our dying neighbors in tenderness (Matt. 22:39; John 13:34–35). But Scripture points us to the sanctity of mortal life, and to our imperative as God’s image bearers to protect life and commit our days to his glory (Gen. 1:26; Exod. 20:13; 1 Cor. 10:31; Rom. 14:8; Acts 17:25). Compassionate intent doesn’t change the fact that in cases of physician-assisted death, demise is artificially—and intentionally—hastened. This is true even while terminal illness broils in the background, and even when death’s purpose is to alleviate suffering.

Advocates for PAS uphold individual autonomy as the greatest good. The human right to self-determination, they reason, includes control over how we die. In the Bible, however, true freedom comes not from individualism, but from using all we have and are to glorify God. In his first letter to the Corinthians, Paul reminds us that while we remain free in Christ, the cross must temper our conduct (1 Cor. 6:19–20). Furthermore, from Colossians 3:17: “Whatever you do, in word or deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.” While God endows all of us with free will, our identity in Christ compels us to exercise our autonomy in faith, as an instrument of service. Our God-given ability to make individual choices doesn’t justify the active taking of life through PAS.  

Options in suffering

The emergence of PAS in courtrooms and clinics signals our failure as a society to support the dying, particularly as illness disables us. The most common reason that people cite for pursuing PAS is not intractable pain, but rather loss of independence. A review of data in Oregon from 1998–2016 revealed that 79 to 92 percent of people who committed suicide with physician assistance cited loss of autonomy, inability to engage in activities that make life enjoyable, and loss of dignity as their motivations for ending life.[8] The intractable pain we might assume at the end of life was a factor in only 25 percent of cases.[9] These alarming statistics suggest not a solution in PAS but rather a gross failure on the part of our society to uplift people with progressive and debilitating illness.

As believers, we need to offer our dying neighbors better than the end so many face, a dwindling existence bereft of joy, confined to a medicalized institution. We’re called to care for those afflicted with severe illness (Matt. 25:36–40). We need to advocate for hospice and palliative care, and most importantly, to freely offer Christian love. In Christ we cleave to the assurance of a new heavens and a new earth, when disease no longer cripples our bodies. As we face death, reminders of this truth can offer light and air when the grief descends. Through such support, we grasp his grace. Through such compassion, we may escape the lie that suicide is the best option.


  1. ^ Dr. Jack Kevorkian was an American pathologist who staunchly advocated for euthanasia in the 1980s and 1990s. He personally assisted in the deaths of over one hundred people, and in 1999 was convicted of second-degree murder for administering a lethal injection to a patient with amytrophic lateral sclerosis.
  2. ^ Compassion and Choices, “About Compassion and Choices” (2016), accessed January 8, 2018,  https://www.compassionandchoices.org/wp-content/uploads/2016/02/About-Compassion-and-Choices-Brochure-FINAL-4.05.16-Approved-for-Public-Distribution.pdf.
  3. ^ United States Census Bureau, Population Division, “Annual Estimates of the Resident Population for the United States: Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2016,” United States Census Bureau (December 2016), Accessed January 8, 2018, https://www2.census.gov/programs-surveys/popest/tables/2010-2016/state/totals/nst-est2016-01.xlsx.
  4. ^ American Medical Association, “Chapter 5: Opinions on Caring for Patients at the End of Life,” American Medical Association Principles of Ethics (2016), accessed January 8, 2018, https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-5.pdf.
  5. ^ Ewan C. Goligher, E. Wesley Ely, et al., “Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues,” Critical Care Medicine 46, no. 2 (2017): 149–55.
  6. ^ Emaniel et al., “Euthanasia and Physician-Assisted Suicide,” 81.
  7. ^ Ibid.
  8. ^ Charles Blanke, Michael LeBlanc, and Dawn Hershman, “Characterizing Eighteen Years of the Death with Dignity Act in Oregon,” Journal of the American Medical Association Oncology 3, no. 10 (2017): 1403–6.
  9. ^ Ibid.

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