On Human Dignity, Compassion, and Physician-Assisted Suicide

October 20, 2015

On September 11, 2015, the California State Legislature approved a bill called the End of Life Option Act, which would allow doctors to prescribe medicine to help terminally ill patients end their lives.   Currently four states—Oregon, Washington, Montana, and Vermont—allow some form of physician-assisted suicide, or “aid-in-dying,” as supporters call it.  As the New York Times reports, advocates hope that the addition of California will represent a significant turning point for the movement.1 That deadly possibility makes this an ominous Act.

Liberty and the Right to Die

While SCOTUS has denied a constitutional right-to-die,2 the Court has left open the possibility that states could permit physician-assisted suicide, and states that have made such provisions have accepted right-to-die arguments.  Proponents appeal to the highest of American values, individual liberty and autonomy, which are presented as essential to human dignity.  Suffering, extreme pain, and disease that rob patients of their autonomy represent an attack on human dignity, and compassion demands that we help to end the suffering of those who wish to die.  Physician-assisted suicide laws testify to the desperation experienced by those facing suffering and death, who see no better option than to choose death before death chooses them. At least then they are in control, and the choice represents to them “death-with-dignity.”  But is it?

The Death of Dignity

It is certainly a terrible thing to suffer, and to have a disease take away our independence, little by little.  Having learned to prize autonomy, to be in control of our lives, it is a devastating thing to lose. It seems undignified to become once again like a child, dependent on others.  This explains why polls tell us that almost 7 in 10 Americans agree that doctors should be permitted to help a patient commit suicide if the patient requests it. Such numbers suggest that there will be more victories for “death-with-dignity.”

This is tragic, for the victory of death is the defeat of dignity for those who are suffering and facing the end of life.  The argument for autonomy is grounded in the fiction that we must be, or can be, or are in control of every aspect of our lives.  Indeed, suffering and the approach of death are vivid reminders that we do not possess such control. Christians understand that as human beings we are not our own.  Life is a precious gift from God, and while God has given us great freedom, the truth is that we are finite and frail beings from conception until death, dependent on one another and dependent on God for life and breath.  Human dignity and meaning is grounded not in our autonomy, but in our relations with God and one another. To assert absolute autonomy is not dignity or liberty but bondage to deception.

The Death of Compassion

One of the most influential organizations backing “aid-in-dying” is Compassion and Choices, which suggests that death-with-dignity links compassion with the freedom to choose death. However, we should be suspicious of a dignity and a compassion that wills death.  Like other virtues, compassion can be distorted into a vice.  Killing or assisting in death is not compassion. However well intentioned, it is abandonment: those who are suffering need comfort and care, not confirmation that their only or best options are despair and death. This denies rather than affirms their dignity, reinforcing their fear that they are a burden.

Compassion is the virtue that moves us to suffer alongside those who are hurting, and to seek to lighten their burden.  Jesus had compassion for and ministered to those who were weak, sick, hungry, and helpless (e.g., Mt 9:36, 14:14, 15:32; Lk 7:13).  We ought to have compassion for those who are suffering and in great pain. We ought to care for them and comfort them as much as possible.  But we ought not to kill them, or affirm or defend their killing.  Compassion that is rightly ordered to human dignity will not promote or tolerate such a view, but will instead seek to comfort and care for those who are suffering because they matter to us, and they have immeasurable value as human beings made in the very image of God.  Their value is not lost because they are increasingly dependent on us, and are no longer “useful” to us.  By contrast, Dr. John Wyatt cites a slogan of the hospice movement, “not only will we help you to die in dignity, but we will help you to live before you die.”3

It is sometimes said that if we have compassion on animals, which we mercifully “put to sleep” when they are suffering, why would we not have the same compassion for human beings?  In response, it may simply be noted that human beings are different from animals, and we treat them differently in countless ways.  It may also be said that we do not wait for animals to request aid-in-dying; rather, we make the judgment on their behalf. Should we take seriously, then, the suggestion that humans be treated like animals?

The Death of a Profession? 

One of the ominous aspects of the passing of California’s End of Life Option Act is the implicit endorsement given to it by the California Medical Association.  The CMA has long been a vocal opponent of physician-assisted suicide, which has kept many lawmakers from supporting such a bill.  A significant reason that the law was able to pass is that in May, 2015, the CMA dropped its opposition, adopting a neutral position, and calling the matter a personal decision for doctors and patients to make.4   As R. Albert Mohler points out, the CMA’s policy change is an act of cowardice in the face of pressure, for it is not merely taking a neutral stance, but it amounts to support for physician-assisted suicide, since the CMA knew that their change would contribute to the bill’s passing.  Indeed, their opposition was dropped in order that the bill could pass.5

This is an astonishing abdication of professional and moral responsibility, and of one of the most basic moral commitments held by physicians for over two millennia.6  Physician-assisted suicide is not merely a matter of personal liberty, for it requires the assistance of a physician—who by profession is committed to healing and caring, and sworn not to kill or assist in the death of a patient. This, as Archbishop of Canterbury Justin Welby argues, crosses “a fundamental legal and ethical Rubicon.”7

It is interesting to note that while the California legislature passed the assisted suicide bill, the British parliament soundly rejected a similar measure, which was modeled on laws in Oregon and other states that have legalized assisted suicide.  The reasons for the British rejection of such a measure include the protection of people who are vulnerable, and a belief that it is better to focus on palliative care and comfort.8

A Dangerous Path

One of the concerns about legalizing physician-assisted suicide is the unintended consequences, a slippery slope that endangers the most vulnerable and leads to a duty-to-die for those who have become a burden to society.  Many defenders of a right-to-die dismiss the slippery-slope argument as fear-mongering.  But, in talking about many of the dubious consequences that may accompany the “right-to-die,” Archbishop of Canterbury Justin Welby rightly asserts that “some slopes are indeed slippery.”9

The slope in the case of “right to die” is indeed slippery, as it has been observed in several European countries.10  Once it is acknowledged that there is a right to die, and that doctors can and should assist patient-dying, there is subtle coercion for those who are suffering to choose death rather than to burden their loved ones.  Safeguards to ensure against such coercion are undermined by the clear message that at some point the choice of death is the best option, the means of preserving dignity.

Once in place, the “choice” of death may also be a way of containing health care costs.  As preposterous as this sounds, in the New York Times article cited earlier, this concern is raised by Dr. Aaron Kheriaty, who points to the case of Barbara Wagner in Oregon, “a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for ‘physician aid in dying.'”

Care, Compassion, and Dying Well

Is it possible that the idea that a chosen death is a good death—a “death with dignity”—is fueled in part by not knowing—or forgetting—what it is to die well, and to care well for those who are suffering?  Is it possible that the fear of suffering and death is driven by a fear of other things, such as the loss of autonomy, the loss of dignity, and isolation? That such fears may be especially acute with diseases such as Parkinson’s and Alzheimer’s, with their “death before death,” is no surprise, for the losses are magnified.  Further, those fears are also reflected in “the social deaths created by the sequestration of the elderly” in institutions that many people would like to avoid.11  We need to relearn how to express true compassion and to care well for those who suffer and fear suffering. We need to relearn how to die well, and with true dignity, and to resist the enemy who delights in death.  Otherwise we ought not to be surprised to find that more people will seek to take control of their dying and to make an early exit their final act of self-expression.

We need not do everything possible to keep someone alive, but “letting die” is not the same as choosing death. There comes a time when we recognize that treatment is futile and death has won a temporary victory. Death is thereby acknowledged but not chosen.  Yet, we must train medical practitioners who are fully committed to healing and caregiving, who refuse to become killers.  Otherwise doctors will merely be purveyors of medicine and equipment that is used at times for life and at times for death, not according to whether they advance life, but whether the life in question is worth advancing.

Kenneth Magnuson

Magnuson joined the faculty of Southern Seminary in 1999. Magnuson teaches on a wide range of topics in Christian ethics and theology, and has presented conference papers and published articles on topics such as sexual morality, marriage, infertility and reproductive technologies, contraception, capital punishment, and war and pacifism. In addition … 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