When can Christians withdraw life-sustaining medical treatment?

May 3, 2018

The case of Alfie Evans, a terminally ill British infant who died several days after being taken off ventilation, has raised troubling concerns about the state’s authority to intervene in parental rights. But it also has caused some to wonder what they would have done if they were Alfie’s parents.

We often aren’t prepared for the questions that arise in such situations. For example, when should life-sustaining treatment be withdrawn? Do Christians have an obligation to delay death as long as humanly possible? What should we do if we disagree with medical providers about continued treatment of a dying relative?

Such questions are complicated, and the answers often depend on the individual context. But there are certain principles and considerations that can help guide our decisions about withdrawing life-sustaining medical intervention.

Withdrawal is allowable when the fatal condition is irreversible

A primary consideration when determining whether treatment should be withheld or withdrawn is whether the fatal condition is reversible or irreversible.

When a person suffers a potentially fatal threat to their health (e.g., disease, injury), their impaired condition may be either reversible or irreversible. If the condition is reversible, appropriate medical intervention and treatment exists that may possibly restore a person to a state where they are no longer in imminent danger of dying. Medical intervention that restores health and reverses the dying process is known as curative care and should be the first option.

However, if no effective intervention or treatment is possible, the condition is irreversible (i.e., terminal) and the impaired condition will lead to death. This is what is meant when we say that a person is dying, or has entered the dying process.

We can’t always know whether a person’s condition is reversible or irreversible. In most cases, the best we can do is rely on expertise that is based on the collective experience of the medical community. But when the probability is that the condition is irreversible, we are under no moral obligation to continue life-sustaining interventions we believe will be futile.

Withdrawal of treatment should not cause or hasten death

Whether death is imminent or non-imminent, our first consideration for dealing with people in the dying process is that we take no action with the intention of hastening the end of their life. As bioethicist Gilbert Meilander explains, “‘Allowing to die’ is permitted; killing is not. Within these limits lies the sphere of our freedom.”

Withdrawal of treatment is not the same as withdrawal of care

If curative care is not possible because the condition is fatal and irreversible, we still have a duty to provide one of three other types of care:

Symptom care – In some situations, a person may be in the non-imminent dying process. They may suffer symptoms such as shortness of breath that requires medical intervention, such as artificial respiration. Out of respect for life and to prevent unnecessary suffering, all necessary symptom care—a form of palliative care—should be provided until death become imminent.

Comfort care – People in the dying process should not suffer needlessly. When death becomes imminent, palliative care should shift from symptom care to comfort care. The main distinction is that comfort care focuses on providing direct relief from the stress and pain of dying. Comfort care is provided to make the last state of dying as comfortable as possible.

Respect care – The dying process often leads to deterioration of the body. Because a person is often unable to care for their own bodies, they may feel a loss of control. Our duty is to provide such care for people unable to take care of themselves in a way that restores their sense of dignity. We should, for example, ensure that their bodies are adequately cleaned and that they afforded a level of decorum and privacy from unnecessary exposure. No matter what stage a person is in the dying—or living—process, respect care should be provided to all who are in need.

Withdrawal of nutrition or hydration should be a last resort

If food and liquids can be administered through oral means and are capable of providing either comfort or nourishment, we have a moral obligation to provide them as a form of care (Matthew 25:31-45). To actively withhold nutrition or hydration to hasten death is evil. However, there may be situations where artificial nutrition and hydration can cause discomfort, pain, or complications and the most loving form of comfort care would entail withholding nutrition or hydration.

Disagreement should be respectful

Health care workers are under no moral obligation to provide treatments they believe are likely to be futile, harmful, or wholly ineffective. While we may disagree with their judgment, the principle of charity requires that—unless we have evidence to the contrary—we assume their refusal to continue treatment is rooted in concern for the patient. As Christians, we must be careful about unfairly maligning health care providers over disagreements about the best methods of treatment.

That does not mean, of course, that we must always submit to a specific expert opinion. Doctors and nurses are fallible, and there is not always a consensus about whether treatments are effective. If another group of health care providers is willing and able to take on the case, transfer of care is a legitimate option.

Parental authority should be respected, but it is not absolute

In a recent article on the Alfie Evans case, Andrew Walker and I argued that the state much respect the rights of parents:

Parental authority over children is explicit in Scripture (Deut. 11:19; Eph. 6:4). The parent-child relationship is one of divine origin and design, accomplished through the one-flesh union of a mother and father. Scripturally speaking, parents are tasked with raising children. For this reason, the mother and father of a child ought to retain primary authority over the child. This is grounded on the basis of an innate link between parent and child—whether biological or adoptive—and right of the parent over the child. This is both commonsensical and appeals intuitively to our sense of justice.

Although children are a gift to parents from God, all children ultimately belong to God. Parental authority is a sub-authority, ordained and limited by what God allows. Just as parents do not have a the authority to abuse or neglect their child, they do not have the authority to hasten their untimely death.

While parents should be given wide latitude in making medical decisions for the child, healthcare workers have an obligation to oppose parental decisions that may significantly harm their children.  

All healing comes from God

Whether God works within the natural laws he has established for health or provides miraculous intervention, we should recognize that all healing comes from God.

“Sometimes it is clear that scientific principles are used to facilitate that healing; sometimes the connection with known science is not so clear,” says the Christian Medical and Dental Association. “We need to give God the credit at all levels of healing, whether we understand the science behind it or not.”

We must also, however, trust God has a purpose for withholding healing and remember that physical death is the expected outcome of human life (Hebrews 9:27). As the Apostle Paul says, “For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord” (Romans 6:23).

Our love ones have no reason to fear either death or the eternal consequences of their sin, though, when they believe in Jesus (John 3:16). That is why the most important step an individual can take when preparing their loved one for death is to ensure they know Jesus as their Lord and Savior.

Joe Carter

Joe Carter is the author of The Life and Faith Field Guide for Parents, the editor of the NIV Lifehacks Bible, and the co-author of How to Argue Like Jesus: Learning Persuasion from History’s Greatest Communicator. He also serves as an executive pastor at the McLean Bible Church Arlington location in Arlington, Virginia. 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