By / Jul 13

In 2016, California’s assisted suicide law called the “End of Life Option Act” was passed which allows terminally-ill patients who meet specific criteria to request lethal drugs from their physician to end their life. The law requires patients to receive clearances of mental competency and terminal status from two doctors and undergo a waiting period before acquiring the drugs. The 15-day waiting period was shortened to only 48 hours by a 2021 revision to the law. 

A lawsuit brought by a collection of disability rights groups and two individuals with disabilities alleges that California’s assisted suicide law discriminates against people with disabilities and minorities, who often fail to receive proper diagnosis and medical treatment. The petitioners in the case explain that the law “steers people with terminal disabilities away from necessary mental health care, medical care, and disability supports, and towards death by suicide under the guise of ‘mercy’ and ‘dignity’ in dying.”

What is the case against California’s assisted suicide law about?

Ingrid Tischer was born with muscular dystrophy, which has required her to seek medical attention her entire life. Unfortunately, Tischer contracted pneumonia in 2021, leaving her especially weak. When she requested therapy to regain her strength, the doctor denied her request saying, “Well, I mean, look at you, there’s nothing we can do for you. And you’ve known this is coming for a long time. So why are you surprised?

Tischer is just one victim of what the plaintiffs call “steering,” the effect on disabled and terminal patients who have difficulty receiving the care they need. The result may compel people to seek assisted suicide to reduce their perceived “burden” on their families, doctors, or the healthcare system. While the doctor did not directly recommend assisted suicide to Tischer, his response implied she was untreatable and unworthy of any other assistance.

The other individual plaintiff, Lonnie VanHook, has quadriplegia and requires around-the-clock care. VanHook says he could not get the necessary hours of medical assistance he needed, which left him depressed, even considering assisted suicide. VanHook is a victim of “attendant deficiency diagnosis.” Medical care was the solution to VanHook’s depression, not suicide.

Proponents of California’s assisted suicide law say that safeguards are in place to prevent non-terminal patients, like VanHook, from accessing lethal drugs to end their life. However, some have challenged this notion, citing the 2021 revision to the law that reduced the waiting period from 15 days to 48 hours and the eradication of other protections as leaving more people vulnerable.

The lawsuit claims the End of Life Option Act violates equal protection and due process laws in the 14th Amendment and the anti-discrimination provisions in the Americans with Disabilities Act and the Rehabilitation Act. The disability rights groups argue that while the coercion is not explicit, the healthcare system’s shortcomings for people with disabilities can implicitly push them toward choosing assisted suicide. 

What is assisted suicide?

The term “assisted suicide,” or “physician-assisted suicide,” is the act of ending one’s life through prescribed lethal drugs to cease the suffering caused by a terminal illness or incurable disease. 

It was first introduced in the United States in Oregon when the 1997 Right-to-Die law was enacted. Since then, 10 states and the District of Columbia have implemented laws allowing assisted suicide. Canada has also legalized what they call, “Medical Aid in Dying,” or MAID, a superficial term for assisted suicide that dilutes the gravity of the undertaken action.

What is the issue?

Assisted suicide laws create significant life and human dignity issues that reflect our society’s larger disregard for the value of life. Genesis 1 tells us that we were created by God and possess inherent worth. With such a respect for life, we have been commanded, “Thou shalt not murder” (Exo. 20:13). The Hebrew word “ratzah,” translated as “murder” in the passage, includes death caused by carelessness and negligence. While assisted suicide is not direct murder, individuals involved are intentionally assisting in taking a dignified life created by God. 

Doctors are sworn to the Hippocratic Oath to “do no harm,” but what greater harm is there to a living patient than to help them end their life? Individuals with disabilities and those experiencing mental health crises should be met with care and compassion—not with encouragement to end their life.

A former lawsuit against the law filed by a coalition of Christian doctors protected them from assisting in the suicide of patients because of their deeply held religious beliefs. While the religious liberty of these doctors should be protected for valuing the lives of their patients, the existence of this law continues to devalue the life and dignity of terminally ill individuals and those with and disabilities.

What happens next in the lawsuit against California’s assisted suicide law?

The lawsuit was filed in the U.S. Central District Court of California at the end of April and creates a potential avenue for sweeping changes to assisted suicide laws around the country. This challenge would likely spend a long time in the court system because of the appeals process. The ERLC will be closely watching this important case.

Why is this important to Southern Baptists?

As Southern Baptists, we recognize that every person is created in the imago Dei, possessing immeasurable worth and requiring the utmost dignity. This principle applies equally to every person, regardless of sex, race, ethnicity, or even quality of health and ability. We are called, as Christians, to advocate for the vulnerable like those who are told they are better off ending their lives than living through severe and terminal health complications.

Proponents of assisted suicide erroneously refer to it as “dying with dignity.” However, they fail to see that preserving the individual’s dignity is best achieved by showing them the value of their life amid their trials. Our circumstances do not dictate our worth; it is etched into every individual through God’s design.

In our efforts to care for the vulnerable, we should work to improve the healthcare system so that it provides ethical means of relieving suffering and dignity to those nearing the end of their lives. This does not mean aiding and abetting thoughts of suicide induced by wanting an end to suffering. James 1:2-4 says, “Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.” While persevering through trials can feel like an unendurable challenge, we should come alongside those in their suffering and show them their worth in Christ. 

As pro-life advocates, we commit to promoting all life from conception to natural death. We must advocate for vulnerable individuals who are preyed upon by a society that tells them their lives have no worth. We strive for a day when the dignity of every individual is recognized by a society that embraces a culture of life.

By / Mar 3

Last month, the government of Canada introduced legislation to extend the temporary exclusion of eligibility for medical assistance in dying (MAID) where a person’s sole medical condition is a mental illness until March 17, 2024. The legislation (Bill C-39) passed the House of Commons and has been introduced in the Senate.

Here is what you should know about Canada’s law that allows for voluntary euthanasia.

What is Canada’s MAID law?

MAID is the acronym for Canada’s medical assistance in dying law. The laws allows physicians and nurse practitioners (in provinces where this is allowed) to help a person commit suicide by either directly administering a substance that will end their life or prescribing such as substance so that it can be self-administered.

The law provides exemptions from the criminal law concerning suicide and provides protection from liability to pharmacists and pharmacy technicians/assistants, healthcare providers who help physicians or nurse practitioners, and family members or other people who have been asked to participate. They are able to assist in the suicide process without being charged under criminal law as long as they follow the legal requirements. 

This legal right to voluntary euthanasia has been in effect since March 17, 2021. Prior to that, the Supreme Court of Canada had ruled that a prohibition on medical assistance in dying violated the Canadian Charter of Rights and Freedoms.

What should Christians think about medically assisted suicide?

Medically assisted suicide is a form of euthanasia, the intentional act of taking a human life for the purpose of relieving pain and suffering. Christians should reject euthanasia because it denies the inherent dignity that God has given human beings and seeks to take the place of God in determining the end of life.

While those seeking MAID and those participating in the practice may want to eliminate suffering, what they are doing is actually undermining the objective value of life. Although the Bible does not speak about euthanasia directly, it teaches that we must regard life as belonging to God and approach issues of suffering with a critical and biblically-based approach. As Mary Wurster has written, “The value of human life in all its forms and at all stages is the central theme of the gospel, for it is the very purpose of Christ’s birth, death, and resurrection. To fail to respect human life at any point mocks the very essence of Christ’s mission to humanity.”

See also: How would you counsel someone interested in assisted suicide?

How many people are being legally euthanized under Canada’s MAID law?

In the five years since the law was adopted, there have been 31,664 medically assisted suicides. As the Canadian government notes, “annual growth in MAID provision continues to increase steadily each year.” In 2021, the total number of MAID deaths increased by 32.4% (2021 over 2020), compared to 34.3% (2020 over 2019) and 26.4% (2019 over 2018).

In 2021 there were 10,064 MAID related suicides, an average of 28 per day. MAID suicides account for 3.3% of all deaths in Canada. Across Canada, fewer than seven deaths were from self-administered MAID.

What is the reason people in Canada choose MAID?

According to the Canadian government, the most commonly cited intolerable physical or psychological suffering reported by individuals receiving MAID in 2021 was the loss of ability to engage in meaningful activities (86.3%), followed closely by the loss of ability to perform activities of daily living (83.4%).

Who is eligible for medically assisted suicide under MAID?

To qualify under MAID, a person wanting to take their own life must satisfy all the following criteria:

  • Be eligible for government-funded health insurance in Canada.
  • Be 18 years of age or older and have decision-making capacity.
  • Have made a voluntary request for MAID that was not a result of external pressure.
  • Give informed consent to receive MAID after having received all information needed to make this decision, including a medical diagnosis, available forms of treatment, and options to relieve suffering (including palliative care).
  • Have a “grievous and irremediable condition,” meaning they have a serious illness, disease, or disability (excluding a mental illness until March 17, 2023), be in an advanced state of decline that cannot be reversed, and experience unbearable physical or mental suffering from an illness, disease, disability, or state of decline that cannot be relieved under conditions that the person considers acceptable.

Does a person have to have a terminal illness to qualify for medically assisted suicide?

No. The diagnosis has to be considered “serious” but not necessarily “terminal” (i.e., a condition that cannot be cured and is likely to lead to someone’s death).

Does a person with a mental illness qualify for medically assisted suicide?

If the sole underlying medical condition is a mental illness, they are not currently eligible for MAID. However, this exclusion is only in effect until next March, at which time it will be automatically repealed.

This exclusion also only applies to conditions that are primarily within the domain of psychiatry, such as depression and personality disorders, and does not include neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities. For instance, a person who has dementia, Alzheimer’s, Huntington’s, or Parkinson’s are all able to receive medical assistance in their suicide. In 2021, 12.4% of MAID deaths were for neurological conditions.

Are medical practitioners able to refuse to participate in Canada’s MAID law?

The MAID law does not itself compel doctors or physician assistants to participate in the medical killing of another person. However, various Canadian provinces have issued guidelines that “strongly encourage” medical practitioners who are unwilling to provide MAID to refer their patients to other institutions or providers.

Some provinces violate the conscience rights of doctors and physician assistants by requiring transfer of care or referral  to a medical provider who will participate in the suicide. For example in the province of Ontario, objecting providers must make an “effective referral” to an available, accessible physician or agency willing to facilitate a request for assisted dying. 

By / Feb 1

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:

  • What is the condition that threatens my loved one’s life? 
  • Why is the condition life threatening? 
  • What is the likelihood for recovery? 
  • How do my loved one’s previous medical conditions influence his/ her likelihood for recovery? 
  • Can the available treatments bring about cure? 
  • Will the available treatments worsen suffering, with little chance of benefit? 
  • What are the best and worst expected outcomes? 

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). 

  • 1
    Danielle 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.
By / Jul 10

Decisions had to be made. He was a proud man, active and strong. He would not have wanted to live like this. What is his quality of life? How can we afford his care? How will we care for him? These were only a fraction of the questions that raced through our minds as dad lay unconscious.

End-of-life decisions are not vague abstractions for my family. Within a 36-month period, we were confronted with the death of two parents—both suffering from illness. We all had to decide how they would handle suffering. Therefore, as I consider the arguments for the death with dignity legislation, specifically in New York where I live, I do not approach this as spectator in the cheap seats. I have been up close to end-of-life decisions.

Nobody wants to suffer, and nobody wants to watch a loved one suffer. Amidst all of the joy and beauty in life, suffering is a sober reminder that the world is broken. Nevertheless, the death with dignity movement is troubling for several reasons: 

First, death is not dignified; it is dehumanizing. This is why death is such a haunting enemy. Death changes the state of the human body—the body releases fluids, all movement stops, and the flesh decomposes. Death is ugly, and there is nothing humans can do to change this.

I have seen death firsthand in multiple venues. I have watched people die quietly in hospital beds, and I have watched them die peacefully in their own home. I have been up close to a violent death at a public shopping center, and I have seen people die in auto accidents. There is nothing dignified about death, regardless of the circumstance.

Second, it assumes that humans can dictate the terms of our own suffering. The German philosopher Friedrich Nietzsche argues that the ultimate act of humanity is the power to create. According to Nietzschean philosophy, the power to create is interwoven with the power of choice. In his worldview, human dignity and value are entwined with one’s ability to make choices. It is no wonder Nietzsche concluded that God is dead. If individual choice is transcendent, then there is no need for a transcendent God. Consequently, the power of individual choice takes on God-like qualities.

The argument for death with dignity possesses several concealed problems. First, when individual choice takes on transcendent-like qualities, what criteria are used to determine suffering? For instance, if someone struggles with depression, anxiety, or fear of big pink elephants, might they not be able to choose death to escape suffering? I have counseled many people who would do anything to get out of the black cloud of depression. Of course, I realize that this legislation (for now) only applies to terminal illness. But if the premise is based on one’s individual choice and their autonomy to decide how they will suffer, how can we infringe upon one’s choice to stop suffering of any form?

Others will contend that the family physician and the state will determine what suffering qualifies for terminating life. But does this not undermine the entire concept of individual choice itself? If the final decision lies in the hands of the family physician, then how does the individual have the power of choice? One’s doctor (or worse yet, the state) is the final arbiter. Moreover, what if prescribing a death pill violates the religious conscience of the doctor? Will doctors be coerced to take one’s life because the patient demands it? Placing the decision of who lives and who dies in the hands of humans is always a treacherous endeavor.

Finally, it romanticizes death. When death is perceived as an escape from life suffering we promote a society that diminishes life. Our culture already has an unhealthy fascination with death. Death consumes our video games, television screens, and music. Our fascination with death has become so normalized that we can watch the metamorphosis of the language of suffering in this legislation. It was once called doctor-assisted suicide, then it progressed to Right to Die, and now the language takes on a more positive and upbeat tone in death with dignity. A society that idolizes radical autonomy and death sets itself up to slide the scales of life and death toward unthinkable horrors.

To be clear, the death with dignity legislation purposed is not the same as ending treatment when a person is terminally ill. There may come a point in our lives when it is painfully clear that using extraordinary means to forestall death is futile. When a person no longer chooses to accept treatment, they are not actively taking their life, they are merely accepting the natural process, and this process is one that will inevitably come to all of us.

However, the goal of the death with dignity legislation is to allow people to calculate and control the timing and conditions of their own death. And this is quite different than ending a treatment plan when it no longer can provide hope for life. There is a vast difference between allowing nature to take over and actively reaching for godlike actions.

End-of-life decisions are emotional, complex, and sorrowful. While technology has done wonders to extend life and improve our quality of life, it has also complicated the process of ending life. I hope our elected officials will not make this decision based on pragmatism and politics. Instead, I pray they will consider a vision that promotes life across all spectrums of society.

This article originally appeared here.

By / Jun 20

In my experience, I think most believers who are in end-of-life dilemmas or are thinking about them want to respond faithfully—we want to honor God, and we want to make sure we're being biblical in our approach. The problem I find, though, is that the context is so foreign, and we don’t know how.

When you look at the Bible as a whole—what it teaches us about life and death and God’s work in it, and our redemption through Christ—there are four key principles that arise from Christian bioethics that can practically help us. In our own emotional turmoil, we’ll cling to one principle, but when we adhere to any one of these principles without considering them as a whole, it can steer us down a dangerous path. Here are each of the principles:

1. Life is sacred

The first, which is the one that people think of most readily, is that our mortal life is sacred. It’s a gift from God. This harkens back to Genesis where God breathed life into Adam and we were then part of that lineage of being his image bearers with inherent dignity. The 10 Commandments teach us that we’re to cherish life, and we’re not to murder, because life is a gift from him and because the purpose of our lives is to serve God. We are to protect life. This is the tenet that steers us toward protection of the unborn. It also inspires us to protest against physician-assisted suicide. And when we’re considering end-of-life care, the sanctity of moral life should persuade us to consider accepting treatments with the potential to cure.

2. God is sovereign

The second point—which I think tends to get overshadowed by the first and can confuse or overwhelm people so that they don’t consider it entirely—is that even though we are called to preserve life, God is ultimately sovereign over our life and death and has authority over our days. While we might stalwartly try to preserve life at all costs, when we do that, we ignore that death comes to everyone. It is inevitable because the wages of sin is death.

When we refute that truth, we deny the great power of the resurrection that death does come to us all, but we have a greater hope than this. So it’s important that when death approaches, we accept it. When it becomes inevitable, we realize that God can work through all things—even and including our death—for the good of those who love him.

3. Care for the afflicted

The third is that we are called to love one another. We are called to love our neighbors as ourselves. We’re called to love one another as Jesus loves us. We are called to act justly, and love mercy, and walk humbly with our God. What that means is that we need to be attentive to suffering. We need to be empathetic and we need to care for the afflicted.

This matters in end-of-life care because intensive-care measures cause suffering. CPR chest compressions—that deliver oxygen-rich blood to the brain when the heart stops—break ribs when you do them properly. Mechanical ventilators, which are required to continue to give the body oxygen, require sedation to tolerate because they’re so uncomfortable. Even psychologically, patients who have endured ICU care for a long period of time report psychological trauma. They have nightmares, potentially for years afterward, of waking up in the ICU confused, panicked, tethered to a bed, not knowing what’s going on, and not being able to breathe on their own.

If these measures preserve life, it’s worth it, but there are times when the disease process at work is not recoverable. When we compel people to undergo these types of measures, we are causing unnecessary suffering. We’re failing in our call to be empathetic. God does command us to preserve life, but he does not mandate that we doggedly chase after interventions that are brutal without any hope for cure.

4. Hope in Christ

The fourth one is that our hope resides in Christ, which is the most important tenet considering any of these issues. Even though we may fear death, death is an end but it is not the end. Through the cross, God transforms death from an event to be feared in its entirety to an instrument of grace. Even when we consider these issues—as much as they may frighten us and as much as they may dishearten us—we have hope that it is not the end. We have hope in God’s love for us through Christ.

The saving gospel of Jesus Christ transforms our view of dying. Even as we wrestle with decisions about ventilators and chest compressions, and even as we consider our final moments, we need not fear death! “For this light momentary affliction is preparing us for an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen” (2 Cor. 4:17–18). Christ has vanquished sin. Through the gospel, fear of our transient earthly death withers before the assurance of renewed life.

As Christians, we share an immaculate hope unrivaled by any in human history. We rest assured of Christ’s promise by faith alone: “Whoever believes in me, though he die, yet shall he live, and everyone who lives and believes in me shall never die” (John 11:25–26). Christ’s resurrection transforms death from an event to be feared into an instrument of God’s grace as he calls us home to heaven. Although we die, we are alive in Christ.

This article originally appeared here. Read Kathyrn Butler’s new book, "Between Life and Death," which aims to equip Christians facing end-of-life decisions by simplifying confusing jargon and exploring biblical principles families need in order to navigate the transition from this life to the next.

By / Apr 17

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.

Notes

  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.
By / Dec 12

In November 1999, my husband Craig and I received the glorious news that we were expecting our first baby. We couldn’t have been more excited. Of course, we immediately notified our family and friends and sprung into full baby preparedness mode.

Amazed by life

My pregnancy was textbook. I felt wonderful and was continually amazed at the life that was growing inside my womb. Once we learned the sex, we quickly settled on the name Maddison Grace. We were surrounded by wonderful Christian community in our neighbors, co-workers, family, and church family. As this was our first child, we were abundantly showered with everything we needed. Our baby girl was so loved, welcomed, and wanted before she even arrived.

The nine months passed quickly. My due date came and went with no signs of impending labor.  The doctor ordered a precautionary stress test. The baby was healthy, and I felt great. A friend of ours was an OB/GYN and happened to check in during my test.  I jokingly told him I wasn’t leaving the hospital until our sweet baby girl was in my arms. Apparently he passed along my wishes, so I was admitted and induced. We called everyone to let them know it was show time!

Labor progressed nicely. It wasn’t long before I was able to push. After a few pushes, Maddi’s head was crowning. The hospital staff began to prepare for her arrival. As I focused on the final push, everything suddenly changed. In an instant the monitor lost her heartbeat. The nurses became somber and began frantically relocating the sensors to no avail. In what seemed like a split second, I was in the operating room undergoing an emergency cesarean section. Thankfully, I had already received an epidural which allowed them to make the incision immediately to save our daughter. They quickly put me under with anesthesia.

Anguished by loss

My next memory was coming out of the anesthesia in the recovery room. As I opened my heavy eyes, I could vaguely make out my husband and pastor standing over me. Though they said nothing, I knew, in my heart, that Maddison did not make it. The first words out of my mouth were, “How do people survive moments like these without the Lord?” During the final push, my placenta detached from the uterine wall. Our precious baby girl was without her lifeline for too long to be resuscitated.

The nursing staff navigated the difficult circumstance with such care. They cleaned our baby girl, swaddled her, and kept her in an incubator until we were ready to see her. While this may sound morbid to some, it was a beautiful time with this gift from God we had anticipated for the past nine months. We were able to finally see her perfectly formed features and count all of her fingers and toes. We captured a few photos. They are likely my most treasured possessions on earth.

The next few days were a blur as my husband had to contact family, purchase a cemetery plot, and plan a funeral, all while taking care of me in the hospital. This is something no young couple ever plans to encounter. My initial grief was over the fact that he had to navigate this virtually alone as I was still heavily medicated. However, he exhibited such strength and courage through it all. He prepared a poignant speech to share at Maddison’s funeral. I knew it only came from Christ in him.

Sustained by our Father

While we never anticipated or pondered whether we could survive this, we had full trust in our good, good Father. His very real presence surrounded us through his Word and his church. Friends did our laundry and brought paper goods and meals. One prayed for God to burden her with some of our grief. Others planted a tree in Maddison’s memory. A neighbor mowed our lawn. Strangers wrote letters of babies they lost decades ago. We saw a grown man sob over her tiny casket and later repent for not spending more time with his family. Our names were on prayer lists across the country. Our small group came to the funeral home early so they could pray over us. We will never forget the kindness we were shown; it was overwhelming and undeserved. It was all a perfect picture of the love Christ shows to his people.

To this day, people still talk about our Maddison Grace. She was created on purpose and with purpose, no matter how brief her time. I can testify that God can and will use all things for our good and his glory. His mercies are truly new every morning. He is my Sustainer, my Comfort, my Peace. He has led me to share his goodness with many as a result of Maddi’s death. He has brought me alongside those who have suffered the same devastating loss. He tuned my heart to the gift of motherhood and called me to stay home with my subsequent children. He has allowed me platforms to be a voice for life. He has turned my sadness to joy, unspeakable joy. For that, I am eternally grateful, and I long for the day I see my beautiful daughter in the presence of my Rescuer and Redeemer.

From the tiniest unborn life to the elderly at the end of life, from immigrants and refugees to those trafficked against their will, all life matters to God. Join the ERLC in Washington, D.C. on January 17-18, 2019, for Evangelicals for Life, one of the largest gatherings of pro-life Christians in the country. Speakers include Russell Moore, J.D. Greear, Steven Curtis Chapman, Keith and Kristyn Getty, and more. Register now to join us.

By / Dec 11

It’s a sobering reality when we realize that the parents who raised us need us to care for them because of advanced age. As Christians, it’s unacceptable to turn our backs on those who are needly and vulnerable. Lindsay Nicolet, Dan Darling, Susie Hawkins, Debbie Bethancourt, and Benjamin Mast recently talked about how to best care for the elderly around us.

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By / Oct 29

American culture has a conflicted relationship to death. Maybe that’s because most Americans don’t have to think about it very often.

Death is less visible than it used to be. It comes most often to people in their 70s or 80s. It typically happens in sanitized, professionalized institutions most people rarely visit. You might live well into adulthood, even most of your life, without an up-close-and-personal encounter with death.

This buffer between the average American and the prospect of death is an illusion, of course. Death is no less inevitable now than when life expectancy was in the 30s and everyone died in their own beds. But precisely because it is often ignorable, when death does impose itself the common responses are confusing and even contradictory. It’s common to fight off death with everything we can muster, on one hand. Then once a death has occurred, it’s common to shrug off death as if there’s nothing to see here.

Fighting off death

Americans invest a staggering amount of resources in the attempt to hold death back. In Being Mortal, surgeon Atul Gawande reflects on how the incredible capabilities of modern medicine shape the way we think about, confront, and ultimately experience death. Doctors are trained to approach diseases as problems to be solved, to throw everything they have at what isn’t yet curable, and to extend life however possible. They’re so good at solving these problems that doctors and patients alike cling to the hope that there is always something more to be done. Some new experimental drug to try out. A new surgical procedure to perform. Another specialist to weigh in.

As a result of this hope, Gawande says, “we’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win” (Being Mortal, 171-72). In fact, one quarter of Medicare spending goes to “the 5 percent of patients who are in the final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit” (Being Mortal, 153).

This common approach to end-of-life care points to the cost we’re paying for all the benefits we’ve received from medicine’s ability to make life longer and more comfortable. Our success in treating a wide variety of once-fatal problems has blinded us to the fact that you have to die of something. Every time we cure one disease another will eventually rise to take its place. Because death is no disease to be eliminated. It’s the inevitable end to every human life.

Shrugging off death

So on one hand in American culture there’s a tendency to fend off death at all costs. On the other hand, when someone actually dies, there’s another tendency that pulls in the opposite direction. Sometimes we shrug death off as if it’s something less than a devastating tragedy. Just one of those things. Nothing to see here.

For example, think about the way many American funerary customs blind us to the ugliness and finality of death. In 1963 investigative journalist Jessica Mitford published The American Way of Death, a satirical send-up of the American funeral industry. Studying trade magazines with names like Mortuary Management, Mitford found a startling range of products for the dead marketed with qualities desired by the living. Whether burial clothing, caskets, cemetery plots or whatever else, “the emphasis is on the same desirable qualities that we have been schooled to look for in our daily search for excellence: comfort, durability, beauty, craftmanship.”

In American culture, it’s normal to put clothes on our dead as if they are alive. It’s normal to place our dead in soft and sturdy coffins for comfort and protection as if they are alive. It’s normal to manipulate their bodies and cover them in makeup and even set their faces with pleasant expressions so they look like they’re alive. But underneath the appeal to comfort and preservation is a denial of the fundamental separation that has taken place. Behind the quest for a lifelike appearance is an attempt to deny the deathly reality.

Facing up to death in Christ

These books on end-of-life care and funerary practices offer just a couple examples of a much wider phenomenon. Ours is a culture in denial. This denial leads to disorientation when death comes close. And in that confusion Christians have a powerful opportunity for a clarifying witness.

As Christians we face what we face in Christ. He is our orientation to the world. We view death as we view life—looking to his example, listening to his words, hoping in his work.

That means we know we should know better than to shrug death off as if it’s not terrible, even through some sort of solidarity with the promise of heaven. Yes, of course, it’s right that a Christian who has died in faith is in a better place. Paul tells us that to die is gain (Phil. 1:21), that to be absent from the body is to be present with the Lord (2 Cor. 5:8). This is true and wonderful. But this same Paul also called death our final enemy (1 Cor. 15:26) and told us we’re still waiting till that enemy is made a footstool for Jesus’ feet.

Even more to the point, think of Jesus’ own posture toward death when he approached the grave of his friend Lazarus. He didn’t tell Mary and Martha to remember he’s in a better place. He didn’t come to Bethany for a funeral “celebration.” Jesus wept. The text says he was deeply moved, even angry. He knew he would give Lazarus life again, but still he experienced the truth about death. Jesus’ example gives us permission to grieve this awful reality and absolutely no incentive to suppress any of it.

Facing death in Christ also means we should know better than to try to fight it off ourselves. I’m not saying we shouldn’t seek medical interventions where we can. Thank God for what modern medicine has done to make our lives longer and more comfortable. By all means, use this gift. But the Bible tells us to be honest with ourselves and with each other. We’re told to remember that all flesh is like grass. At our most glorious, we’re like flowers in a field, blooming brilliantly just before we wither and fall (Isa. 40:6-8). We’re told to number our days as the path to wisdom (Psa. 90:12). No medical intervention can change what it means to be mortal in this fallen world.

In Christ, all our focus hinges on the only intervention that brings any true comfort in life and in death: Christ has died, Christ is risen, Christ will come again.

It’s all in Hebrews 2: “Since therefore the children share in flesh and blood, he himself likewise partook of the same things, that through death he might destroy the one who has the power of death, that is, the devil, and deliver all those who through fear of death were subject to lifelong slavery” (2:14-15).

We have no chance to fight off death for ourselves. In Christ we don’t have to try. This battle is not ours to fight. He has made our enemy his enemy, and he has conquered for us.

In Christ we’re set free to speak with clarity into our culture’s confusion about death. And the truth about death gives us a rock-solid platform from which to offer the hope of the gospel. Yes, death really is terrible. No, there’s nothing you can do to stop it. But Jesus and all in him is yours for the taking.

By / Jul 27

For centuries, physicians have adhered to the sentiment as described by the Hippocratic Oath. One of the clauses included in the historic commitment is this: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” Those who subscribe to the oath promise to refrain from participating in two actions now known as euthanasia and physician assisted suicide.

Euthanasia is the intentional act of taking a human life for the purpose of relieving pain and suffering. This can occur actively or passively. Active euthanasia involves an intentional act on the part of the physician toward a patient that causes death. Passive euthanasia involves withholding treatment with the intent to cause death. Physician assisted suicide, “PAS”, is a type of voluntary euthanasia in which a doctor either intentionally provides information to a patient about how to commit suicide, or prescribes the means that allow the patient to commit suicide.

There are three primary arguments in favor of euthanasia and PAS: autonomy, minimizing pain and suffering, and the idea that there is no morally relevant difference between taking steps to hasten death and allowing the dying process to occur. Even though a physician intentionally ending the life of a patient was considered unthinkable for centuries, western sentiment seems to be changing. In fact, both euthanasia and PAS are sometimes referred to as “death with dignity.” But the Bible teaches that euthanasia and PAS are actually enemies of dignity. Let’s consider what the Bible might have to say about these arguments.

Mercy killing

Those who advocate euthanasia and PAS do so for largely understandable reasons. They wish to take away the suffering of terminally ill individuals, and they may even claim that there is a moral obligation to do so. In fact, in Canada, if a physician refuses to participate in euthanasia or PAS, he is legally required to refer patients to a physician who will. But the Bible teaches that suffering is not necessarily something that should be avoided at all costs. Romans 5:3 teaches us to “rejoice in our sufferings, knowing that suffering produces endurance.” Similarly, James teaches this: “Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing” (James 1:2-4).

For most people, including Christians, rejoicing in our sufferings is not easy. A dying person screaming in pain or weeping in loneliness in a hospital bed does not want to be told to be joyful in his suffering; and indeed, he generally shouldn’t be. But Christian ethicist Gilbert Meilaender said, “We should maximize care rather than minimizing suffering, which might include eliminating the sufferer.” Likewise, the authors of Always to Care, Never to Kill in the journal First Things concluded, “Although it may sometimes appear to be an act of compassion, killing is never a means of caring.” Inspired by Meilaender and the authors of Always to Care, Never to Kill, Stephen Phillips, an Indiana professor and physician once thoughtfully suggested that sometimes, true care is holding someone’s hand and suffering right alongside him. It is not taking his life or suggesting that he take his own.

Freedom of choice

Others in favor of euthanasia and PAS cite personal autonomy and freedom of choice. Everyone, they argue, has a right to die when and how they choose, and in fact, human dignity includes this. But consider the words of Job: “A person’s days are determined; you have decreed the number of his months and have set limits he cannot exceed” (Job 14:5). Euthanasia and PAS “assert a desire to be infinite” and reject a dependence on God, the author of life and controller of death.

Withholding treatment: A morally relevant distinction

Advocates would insist that there is no relevant difference between euthanasia or PAS and withholding life-saving treatment from a dying individual. They claim that since withholding medical treatment can be permissible, euthanasia or PAS must also be permissible, because  the end result, the death of a person, is the same in either situation. Therefore, there must be no difference between any of these actions. This, however, is simply not the case.

Allowing to die involves withholding treatment without an intent to cause death. This is a form of beneficence, or preventing harm to a person. Examples might include removing a ventilator from a grandmother with no hope of recovery, or choosing to refrain from potentially fruitless chemotherapy. The authors of Always to Care, Never to Kill explain it like this: “It is permitted to refuse or withhold medical treatment in accepting death while we continue to care for the dying. It is never permitted . . . to take any action that is aimed at the death of ourselves or others.”

God commands, “You must not murder” (Ex. 20:13). Jesus also commands us, “love your neighbor as yourself” (Mark 12:31). Allowing someone to die by withholding treatment may combine these two sentiments, because the intention is to care for a person in the best way possible, rather than to cause death. The morally relevant distinction between euthanasia or PAS and allowing someone to die involves intention and benevolent care.

Enemies of dignity

“So God created human beings in his own image. In the image of God he created them; male and female he created them” (Gen. 1:27). Human beings are created in the Imago Dei—the Image of God. This alone gives us inherent dignity and a value to our lives. At some point, determining that our lives are not worth living fundamentally rejects this dignity.

Euthanasia has been legal in Belgium since 2002. Thousands of individuals in this country alone are euthanized each year. Countries like Belgium, the Netherlands, Luxemburg, and others are perfect examples of how opening the door to voluntary euthanasia leads directly to the practice of non-voluntary euthanasia, which is the killing of sick individuals who are incapable of consent, and even involuntary euthanasia, which is the killing of sick individuals against their will. These practices, although abhorrent, become normalized when a society deems certain lives not worth living.

Euthanasia and PAS reject the inherent dignity that God has given human beings. Participants seek to eliminate suffering, but they instead eliminate the objective value of life. Although the Bible does not speak to either euthanasia or PAS directly, Christian thought demands a critical and biblically-based approach to the subject. The value of human life in all its forms and at all stages is the central theme of the gospel, for it is the very purpose of Christ’s birth, death, and resurrection. To fail to respect human life at any point mocks the very essence of Christ’s mission to humanity.

References

https://www.dutchnews.nl/news/2017/04/number-of-official-cases-of-euthanasia-rise-10-in-the-netherlands/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/

https://www.firstthings.com/article/1992/02/006-always-to-care-never-to-kill