By / Jul 28

In the first seven months of 2023, four states have liberalized their assisted-suicide laws. Vermont and Oregon have dropped the requirement that people who receive a lethal prescription must be citizens of the state, thereby allowing “suicide tourism.” Washington and Hawaii have expanded those eligible to prescribe a fatal dose from physicians to other healthcare providers. 

Responding to recent developments in state laws, Miles Mullin, ERLC vice president and chief of staff, commented to Baptist Press,

Life is precious from conception to natural death. It is a travesty that some political leaders think that making suicide easier and more accessible is an acceptable answer to the pain and suffering of their citizens. It is the state’s job to protect life, not encourage taking it. Politicians should do the hard work of coming up with better solutions that will support life. . . . [The ERLC] will stand for this Christian ethic, work to cultivate a culture of life and stand against a culture of death that encourages vulnerable, suffering people to seek their own death.

Here is what you should know about the practice of medically assisted suicide in the United States.

What is medically assisted suicide?

Medically assisted suicide refers to the process where a licensed medical professional provides a patient with the means (typically in the form of lethal medications) to end their own life. The patient then administers the lethal agent to themselves. 

Usually, before a patient can be provided with the means for assisted suicide, they must meet specific criteria, including:

  • A terminal diagnosis with a prognosis of six months or less.
  • Mental competence to make and communicate healthcare decisions.
  • Multiple requests over a specific timeframe, indicating a consistent desire.
  • Consultations with at least two physicians who confirm the diagnosis and prognosis.
  • Once these conditions are met, the physician can prescribe a lethal dose of medication, which the patient takes on their own, without the medical professional’s assistance during the act of ingestion.

This practice differs from voluntary euthanasia, wherein the medical provider directly administers the lethal agent. The federal government and all 50 states prohibit euthanasia under general homicide laws. State laws legalizing assisted suicide also violate the Americans with Disabilities Act.

How does medically assisted suicide differ from physician-assisted suicide and “medical aid in dying”?

Physician-assisted suicide was the common term used when lethal medications for suicide were provided solely by doctors. But over the past decade, some states have eased the requirement to allow other medical health providers who are able to write prescriptions, such as nurse practitioners and physician assistants, to provide the lethal dose. For this reason, the term ​​medically assisted suicide is often more accurate. 

However, the phrase “medical aid in dying” has been promoted to obscure the fact that the procedure is a form of suicide. Suicide has always been defined as the act of deliberately killing oneself. But because of the negative connotations associated with the term suicide and the general opposition to having the medical community involved in suicide, the euphemism has been offered to remove the stigma. Some medical organizations such as the American Academy of Hospice and Palliative Medicine and the American Academy of Family Physicians now use the the term “medical aid in dying.” 

In which states is medically assisted suicide legal? 

The locations within the U.S. where medical assisted suicide is legal includes:

  • California,
  • Colorado,
  • Hawaii,
  • Maine,
  • Montana,
  • New Jersey,
  • New Mexico,
  • Oregon,
  • Vermont,
  • Washington,
  • and Washington D.C.

However, Vermont and Oregon do not have a state residency requirement, which means that patients can travel to those states and receive a legal lethal prescription to take their own life. (It’s been reported that Vermont allows the procedure to be done remotely, but currently, travel to the state appears to be required to obtain the prescription.)

What should Christians think about medically assisted suicide?

Medically assisted suicide is the intentional act of taking a human life for the purpose of relieving pain and suffering. Christians should reject suicide 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 medically assisted suicide 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 the practice 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 Kathryn Butler has written,

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.”

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

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 / Jul 22

Every person reading this is a human being. But what does that actually mean? “Human dignity” is a term used by Christians (and non-Christians) in policy conversations about a vast array of topics including poverty alleviation, humanitarian aid, abortion, and euthanasia. As Christians, we believe that God creating humankind in his image means that every person possesses an inherent and inalienable dignity. In other words, every human life is precious because every life belongs to a person who bears God’s image. Because of the value and preciousness of each life, it is vital that we develop a clear biblical understanding of what a human is and what the image of God implies. 

What is a human?

Our culture has wrongfully placed the responsibility of defining personhood onto individuals instead of our Creator, who, as “the Alpha and the Omega, the First and the Last, the Beginning and the End” (Rev. 22:13), has the rightful authority to define our being. Claiming false authority over personhood has led to broken families, distorted views of sexuality, and heinous acts such as abortion in our society. Thankfully, through the creation account, the Bible helps us understand specific ways human beings are set apart from the rest of creation. Though faithful scholars differ in certain respects about exactly what it means to be made in God’s image, below you’ll find three characteristics about humanity that are clearly implied by the opening section of Genesis. 

1. Humans are relational

“Then God said, “Let us make man in our image, after our likeness. And let them have dominion over the fish of the sea and over the birds of the heavens and over the livestock and over all the earth and over every creeping thing that creeps on the earth” (Gen. 1:26)

When God created mankind, he did so as a Trinity of three persons: the Father, the Son, and the Holy Spirit. God created us to live in community with him and with one another, reflecting his relational nature. As one God in three persons, God is relational by nature. Similarly, humans are made to operate in relationships. This is precisely what God emphasizes when he creates Eve to live in union with Adam and says, “It is not good for man to be alone” (Gen. 2:18). 

Through the blood of Jesus, God invites us into fellowship with the divine Trinity. John writes in 1 John 1:3, “Indeed our fellowship is with the Father and with his Son Jesus Christ.” God’s heart for relationships is further revealed in the New Testament when he establishes the familial nature of the church, encouraging believers throughout the New Testament to “devote themselves to fellowship,” to “have one heart and one mind,” to “bear one another’s burdens,” and to “love one another with brotherly affection” (Acts 2:42; 4:32; Gal. 6:2; Rom. 12:10).

2. Humans are distinct/unique

So God created man in his own image, in the image of God he created him; male and female he created them” (Gen. 1:27). 

In creating us, God not only gave us the ability to love and enjoy companionship with one another and himself, but he also made us distinct in two ways. First, as mentioned above, mankind is made in God’s image. And from Genesis, we learn that human beings are distinct because we are the only part of God’s creation that he specifically made in his image. 

Second, God made us distinct in terms of biology. As Genesis 1:27 tells us, God designed us as either male and female. These distinctions in biological sex are apparent in many ways, including our DNA and external features. Each sex is unique, and various aspects of God’s nature are displayed in both men and women. Ultimately, these distinctions are an important part of the mystery of the gospel, particularly when they are on display in a one flesh union between a husband and a wife. 

As the New Testament explains, the male and female marriage relationship is a picture of Christ’s love for the church. Paul writes of the mysterious, holy complexity of the marriage relationship in Ephesians 5:32: “For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh. This mystery is profound, but I am speaking about Christ and the church.” Long before Christ’s incarnation, God purposefully created humanity as male and female and designed the marriage union to display truths about himself. 

Biological sex in every individual is one aspect of God’s design that proclaims his creativity and gives us a clearer picture of his image. The distinct features each human bears remind us that no life is ever interchangeable, replaceable, or worthless.

3. Humans are commissioned

God blessed them and said to them, “Be fruitful and multiply, and fill the earth and subdue it; rule over the fish of the sea and the birds of the air and every creature that crawls upon the earth” (Gen. 1:28). 

Every person has a designated role as a steward and cultivator over the earth. God gave Adam a job: to have children, to subdue the ground, and to rule over the other living creatures. Each of us can subdue, or tame, the earth through all kinds of vocations, but this command reveals that God has designed a place and a purpose for each of us (Eph. 2:10). God has included in our makeup the ability to procreate, desires and determination to care for and protect our families — with specific callings designed for husband and wife — to produce things that are good and useful, and to assert leadership in various settings. In order to preserve ourselves and care for loved ones, we employ different gifts and talents that add value to the world and subsequently seek the good of our neighbors. 

God sets his image-bearers above creation and other created beings in giving us vocations. Adam Smith’s The Wealth of Nations is widely taught and accepted, observing the phenomenon of trade as an obvious outlier from the way animals relate. Smith is merely observing what has been woven into creation — God has uniquely commissioned his image-bearers to work and care for his good creation, and even the marketplace puts his creative design on display.

Conclusion

The special care God took in setting humans apart from other created beings is why a Christian understanding of human dignity is important when considering issues of justice. Slavery, genocide, abortion, and exploitation of all kinds are tragic displays of treating other humans as utilities. But God’s unmistakable genius in each of our bodies, minds, hearts, and personalities denies any attempt to devalue a human’s worth. These practices are considered “inhumane” because they treat people as a means to an end, more like subordinate animals than respected brothers and sisters.

As Christians, we must defend the vulnerable on the grounds that humans are image-bearers; there is no amount of privilege or power that makes a man or woman more or less valuable. Physical distinctions are often a barrier to relationships and an excuse for sinful and exploitative uses of authority, but the Bible makes no distinction when it comes to a person’s value; every person bears the imago Dei, and every person matters.

When God finished creating heaven, earth, and us, he called his masterpiece “very good” (Gen. 1:31). Long ago, God defined our worth so sinful humans wouldn’t be responsible for determining the value of a life. From conception to death, humans have dignity, eminence, and significance because we are the only creatures God made in his image. We may not understand the full picture of the imago Dei until we are face to face with God in heaven, but we do see God’s image reflected in how humans are relational, distinct, and commissioned.

By / Nov 29

“You shall not murder.” That’s the entire sixth commandment. In Hebrew, it’s actually even shorter—just two words, in fact: lo, the negation (“not”), and ratsach, “murder.” It seems like an obvious, uncontroversial commandment. If any command could go unstated, any that we as human beings and good neighbors would simply assume, perhaps it would be this one. Surely people from all times and places could agree that we shouldn’t murder.

Let me highlight three related areas that are particularly relevant (and sometimes controversial).

The sixth commandment prohibits suicide

There is almost no topic more painful than suicide for those who have experienced it with family or friends. Suicide is a sin—not the unforgivable sin, but a sin. Of course, that’s not what I would lead with as a pastor going to visit a family who just lost a loved one to suicide. I’m not talking about my pastoral care strategy at the moment, but giving you the doctrinal foundation.

There may be extreme cases where a suicidal person has clearly lost control over his or her faculties, such as certifiable dementia or closed head injuries. Such a person doesn’t have any sort of capacity for rational decision making. But in the majority of cases, we are right to see suicide, as tragic as it is, as a morally culpable and blameworthy choice. For centuries the church has consistently viewed suicide as a violation of the sixth commandment, since self-murder is still murder.

There are five instances of suicide in Scripture: Judges 9:50– 57; 1 Samuel 31:1–7; 2 Samuel 17:23; 1 Kings 16:15–19; and Matthew 27:3–10. All these suicides are in the context of shame and defeat. Likewise, when more noble characters ask God to take their lives (such as Jonah or Job), God clearly views their self- destructive requests unfavorably.

We hear far too often of famous movie stars, athletes, or entertainers who have committed suicide. Many people were understandably upset and saddened by Robin Williams’s death. There was much conversation and punditry, and people said things in perhaps an unhelpful way or with unhelpful timing. But one of the recurring themes was a lack of moral responsibility: “We all have our demons. We all have to face this. We shouldn’t put any sort of ethical blame on one who commits suicide.”

Initially that sounds compassionate—but it isn’t. Listen to a woman named Julie Gossack, who wrote for the Journal of Biblical Counseling ten years ago. She’s a wife and a mother who has suffered through the suicides of five family members. I can scarcely imagine that. She said this:

Suicide is not a genetic trait nor is it a family curse. Suicide is a sinful choice made by an individual. This statement is neither unloving nor disrespectful. It is the truth. I dearly loved my family members that committed suicide, but their choices were sinful and not righteous.[1]

She adds that she intends her words to be loving, so that other people in a dark place who might be considering taking their lives would, if there are no other restraints, perhaps be restrained by the law of God. Suicide might feel like the only way out, but Scripture tells us that God will never lead us into a situation where violating his commandments is the only option.

We do not help struggling saints by refusing to tell them that suicide is displeasing to God. Lovingly spoken, in the right time, that may be one way in which God jolts the suicidal soul back to better, saner, more righteous thinking. Your life is precious to God, even when you have concluded that it’s pointless.

The sixth commandment prohibits abortion

“For you formed my inward parts; / you knitted me together in my mother’s womb” (Psa. 139:13). The psalmist is speaking here of the nascent life (which is truly life) within the mother. I already mentioned. If you read the context [of a law from Exodus 21: “Eye for eye” (v. 24)], it has to do with injuring a woman’s baby while still in the womb. There were punishments for doing so, because that life was considered life.

Until very recently the church has universally opposed abortion. The Didache says, “Do not murder a child by abortion or kill a newborn infant”—two practices that were common in the ancient world. It was chiefly in [the worldview] in the early church that children were valued and considered to need protection. Commenting on Exodus 21:22–25, John Calvin writes:

For the fetus, though enclosed in the womb of its mother, is already a human being, and it is almost a monstrous crime to rob it of the life which it has not yet begun to enjoy. If it seems more horrible to kill a man in his own house than in a field, because a man’s house is his place of most secure refuge, it ought surely to be deemed more atrocious to destroy a fetus in the womb before it has come to light.[2]

Life begins at conception. That’s a scientific fact. Any embryology book will tell you that the life of each one of us traces back to the zygote—to the moment of conception. We didn’t become something different. We’ve all been formed from that original life, which is still us.

The only way to think that ending life in the womb is appropriate is to think that personhood begins at some time other than the beginning of biological life. And yet the Bible assumes—and, until very recently, everyone in the Western world agreed—that there is a profound and organic unity between body and soul, such that personhood exists wherever biological life exists.

The ancient heresy Gnosticism posited a dualism whereby the physical body and the soul did not exist in organic unity. One was trapped inside the other and needed to be set free. But we understand from a biblical anthropology that, though they are two things, the body and the soul have an organic union. When your biological life begins, you also exist as a person made in the image of God, created to honor God, and with a life that deserves to be protected.

The sixth commandment prohibits euthanasia

Assisted suicide laws continue to make headway in America and in the rest of the Western world. Legal and medical experts point to a number of problems with the laws themselves. Some of these laws don’t require notification of family members. They don’t specify which kind of doctor must diagnose you. They also allow you to pick up your suicide drugs at your local pharmacy and administer them on your own. And that’s to say nothing about doctors getting their terminal diagnoses wrong.

Just as important are the ethical problems with these laws. How can we try to prevent suicide among teenagers and young people and encourage it among the sick and elderly? I often see signs in high schools that read, “Say No to Suicide,” or, “Thinking about Suicide? There is help.” How can we promote that message to students and then put forward a very different message to the elderly? We are to do what we can to preserve and protect all innocent life.

We must not let foggy definitions of compassion cloud our thinking. This is the key distinction: we are not talking about the termination of treatment, but the termination of life. Sometimes people hear that spiel about suicide and say, “Look, I don’t want to be put on a respirator. I don’t want to have a machine do my life for me.” That’s not what euthanasia laws are about.

My grandfather passed away a couple of years ago at ninety-one years old. He went downhill very quickly. When he was in hospice care, he was told, “There are some things we can do. We can force you to get up and move around and give you some further treatments, and it might preserve your life for another four or five months. Or we can keep you comfortable, give you palliative care, and you can rest in your bed. You may not live more than a week or two.” He said, “I’m ninety-one. I’ve lived my life. I want to rest. I don’t need to do all that to preserve my life for four or five more months.” Many of us face those decisions, and we know loved ones who’ve had to face them. Those decisions are not wrong. He was choosing to end treatment, not to end his life.

Assisted-suicide laws have consequences most people don’t think about on the front end. The Netherlands was the first nation to allow legal assisted suicide, and over time they’ve seen the voluntary become involuntary. When it becomes an option for you to end your life, insurance companies say, “Well, we aren’t going to pay for that treatment to extend your life another six months or a year. You can just take these pills and end your life.” You become a burden to insurance providers, to the state, and to your family.

More and more requests for assisted suicide in the Netherlands are coming from family members, not from the patients them- selves. During the Nazi occupation of the Netherlands, Dutch physicians refused to obey orders by Nazi troops to let the elderly and the terminally ill die. In 2001 Holland became the first country to give legal status to doctor-assisted suicide. As Malcolm Muggeridge noted, it took only one generation to transform a war crime into an act of compassion.[3] Blessed are those who have regard for the weak (Psa. 41:1).

Every human life is precious. Unborn life is precious. Children with special needs are precious. Aging parents are precious—even when they don’t remember because they’re suffering dementia, they’re still made in the image of God. Nonverbal children or parents, those in a wheelchair, and those who are completely dependent upon others or doctors are precious. All of life matters to God. If we have our eyes open, we can see this in even the most surprising places in the Bible, like in the lex talionis of the Mosaic law. You see it in imago Dei. You see it in the incarnation, when God entered the world as a helpless babe.

Defend, honor, and give thanks for life—yours, your children’s, and your parents’. The sixth commandment means to protect it.

*Content taken from The Ten Commandments: What They Mean, Why They Matter, and Why We Should Obey Them by Kevin DeYoung, ©2018. Used by permission of Crossway, a publishing ministry of Good News Publishers, Wheaton, Il 60187, www.crossway.org.

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!

Notes

  1. ^ Julie Gossack, “Life after the Suicide of a Loved One,” January 2, 2006; Journal of Biblical Counseling, vol. 24, no. 1 (Glenside, PA: Christian Counseling & Educational Foundation), n.p.
  2. ^ Calvin’s Commentary, vol. 3, Harmony of Exodus, Leviticus, Numbers, Deuteronomy (repr. Grand Rapids, MI: Baker, 1993), n.p.
  3. ^ Edmund P. Clowney, How Jesus Transforms the Ten Commandments (Phillipsburg, NJ: P&R, 2007), 79.
By / Jan 11

In this series we’ve been covering three broad areas of bioethics categorized as “making life” (beginning of life issues, such as reproductive technologies), “taking life” (end of life issues, such as abortion and euthanasia), and “faking life” (the melding of human biology with machines or other species).

Each category comes with a dizzying array of terms, some that are technical and some that are common but whose meanings differ from normal usage. Since understanding the ethical issues requires understanding how the terms are used, we need to develop a glossary of terms for each area.

The following are common terms related to “taking life.” Whenever the meanings of terms are generally disputed, I’ve relied on the common understanding used by the majority of evangelical Christian bioethicists:

Abortifacient — A chemical or drug that causes embryonic death by either killing the child directly or by preventing implantation in the uterine lining. (See also ‘chemical abortion’)

Abortion — The deliberate termination of a human pregnancy that results in the death of a child either in the embryonic or fetal stages of development.

Brain death – The irreversible loss of all functions of the brain, which usually determines that a person is dead both legally (i.e., for the purposes of the law) and clinically (i.e., for the purposes of medicine).

Chemical abortion — A method of abortion in which chemicals (i.e., an abortifacient) is used to terminate the life of a child in the womb. Also known as a “medical abortion.”

Dying or dying process — An impaired condition that eventually leads to death. May be either reversible (i.e., health can potentially be restored through medical intervention) or irreversible (i.e., no medical intervention can change the process). A person is considered “terminal” when they have entered an irreversible dying process.

Embryocide — The intentional killing of a human at the embryo stage of development (i.e., from fertilization to 8 weeks).

Emergency contraceptive — A method of contraception that is taken after sexual intercourse with the intention of preventing pregnancy. Although the purpose of the contraceptive is to prevent ovulation, it can prevent an embryo from attaching to the uterine lining, thus causing an abortion. Sometimes also known as the “morning after pill.”

Euthanasia — The intentional taking of a human life for the purpose of relieving pain or suffering. Euthanasia may be either voluntary (i.e., at the request of and with the consent of the individual who will die) or involuntary (i.e., request and/or consent was not given), and either passive (i.e., removing medical intervention that results in the person entering the dying process) or active (i.e., causing death through direct action or intervention, such as providing a lethal dose of medication).

Fetuscide — The intentional killing of a human at the fetal stage of development (i.e., from 8 weeks until birth).

Infanticide — The intentional killing of a human being at the infant stage of development (i.e., from birth to 1 year).

Mortality — The number of deaths in a given population during a given period of time or from a particular cause.

Partial birth abortion — A method of abortion, also know as “dilation and extraction” or “intact D&E”, in which the child in the fetal state is partially extracted from the birth canal before being killed. The “dilation” refers to the dilating of the woman's cervix, which allows the child’s feet to be pulled from the birth canal. With the head remaining inside, a sharp instrument is used to puncture the brain. The skull is then crushed to make is possible to “extract” the child’s body in a relatively intact state from the birth canal.

Physician-Assisted Suicide — A type of voluntary passive euthanasia in which a doctor provides information about how to commit suicide or proscribes means that allow the patient to terminate their own life.

Right-to-Die — The concept and political movement that claims individuals have the right to terminate their own lives either through suicide or euthanasia.

Selective abortion — A type of abortion that is usually performed because the child in the womb has unwanted characteristics, such as the child has a birth defect, is of the wrong sex (e.g., a girl when a boy was desired), or is of the wrong number (e.g., the killing of one or more children when the woman is carrying twins, triplets, etc.).

Suicide – The intentional taking of one’s own life.

Surgical abortion — A method of abortion in which the child in utero is dismembered and his or her body parts are removed by suction (aspiration) through a thin tube inserted into the uterus. This method is also known as an aspiration abortion or suction abortion.

By / Jan 5

(Note: This is the second in a two part series. Part one can be found here.)

Over the past few decades the Dutch have expanded the scope of protected physician killing to include children. With their parent’s permission, a child between the ages of 12 to 16 years old may request and receive assisted suicide. (Initially, minors could obtain an assisted death even if their parents objected, but after domestic and international criticism, the law was changed to require parental consent.) Even before the Parliament made it legal to euthanize young children, doctors in the Netherlands took it upon themselves to end the life of infants and others who do not have the free will to agree to end their own lives, but whose existence doctors or parents deemed them “unfit.”

In October 2004, the Groningen Academic Hospital officially proposed a government policy—dubbed the Groningen Protocol—which would allow doctors to legally euthanize children under the age of twelve for conditions in which suffering was “so severe that the newborn has no hope of a future.” The hospital even admitted to administering a lethal dose of sedatives to four newborns in 2003. In the previous three-year period, fourteen other cases had also been reported by various hospitals to the Justice Ministry. No legal proceedings were ever taken against either the hospitals that condoned the practice or the doctors who carried out the killings.

The lack of prosecutions is hardly surprising considering the Dutch people’s attitude toward killing those deemed unworthy of life. A survey by the NIPO Institute in 1998 found that 77 percent of the populace favored non-voluntary euthanasia while only 76 percent favored voluntary euthanasia. Although the one percent difference falls within the margin of error, it may also be attributable to the false belief that non-voluntary killing is considered only as a last resort while voluntary euthanasia can be administered for almost any reason. As reported in one Dutch documentary, a young woman in remission from anorexia was concerned that her eating disorder would return. To prevent a relapse, she asked her doctor to kill her. He willingly complied with her request.

Death for those ‘suffering from life’

The anorexia example is horrifying, but at least in that instance an actual physical illness was involved. As the most recent legislative proposal shows, some advocates of the practice consider the presence of a debilitating illness or physical suffering as too stringent a prerequisite for permitting euthanasia.

The Dutch Voluntary Euthanasia Society (DVES), for example, was generally pleased with the relaxation of euthanasia laws, but it was disappointed that the law continued to forbid the killing of people who are simply tired of living. “We think that if you are old, you have no family near, and you are really suffering from life,” said DVES spokesperson Walburg de Jong, “then [euthanasia] should be possible.”

Days after the change in the law, Dutch health minister Els Borst admitted in an interview that she had no problems with providing “suicide pills” for elderly citizens who were simply “bored sick” with living. (The public now seem to agree: A study in 2013 found that more than one in five Dutch people believe that euthanasia should be allowed for elderly people who are "tired of living.") And another poll in 2015 found that Dutch doctors would willingly euthanize anyone who was, “tired of living, with medical grounds for suffering but in the absence of a severe physical or psychiatric disease.”

Perhaps the most significant shift in the public acceptability of voluntary euthanasia occurred in the summer of 1991, crystallizing around another important legal case. Psychiatrist Boudewijn Chabot treated a woman whom he gave the fictional name of “Netty Boomsma.” The woman was suffering from grief over the loss of her youngest son to cancer at the age of twenty. Her eldest son was also dead, having killed himself two years earlier after being rejected by his girlfriend. Boomsma, who had a long history of depression, approached Chabot with the understanding that he would assist her suicide if she did not change her mind about wanting to die.

Although the crushing grief over losing a child can last for years, Chabot treated Boomsma for only two months before fulfilling his promise. Four months after the loss of her youngest son to cancer, Chabot gave Boomsma the lethal agent she needed to kill herself. While listening to the sounds of the same Bach flute sonata that had played at her son’s funeral, the grieving mother took the medication and asked the psychiatrist: “Why do young kids want suicide?” Thirty minutes later she was dead.

With the aid of the psychiatrist, the mother was able to end her life and fulfill her desire to be buried between the graves of her two sons. In his defense, Chabot insisted that Boomsma was not depressed, nor even a real patient. She was, he claimed, simply a grieving woman who wanted to die. Many Dutch therapists insist that there is an obligation to assist in the suicide of a patient with suicidal ideation if treatment has not succeeded.

But Chabot provided only minimal treatment: The despairing patient became her own diagnostician, and the doctor simply acted as the deadly pharmacist. After reporting the case to the coroner, Chabot was prosecuted for violating Dutch law, but the case was appealed to the country’s supreme court, which upheld the precedent set by the Leeuwarden criminal court in 1973 that pain relief that runs the risk of shortening life is acceptable when helping a patient suffering from a terminal condition.

The court found that Chabot was guilty of not having provided an adequate psychiatric review of the patient’s case before assisting with the suicide. However, the court imposed no penalty on Chabot, and the legal ruling established the precedent that physical illness was not a requirement for providing “pain relief” that ends a life when the request is voluntary, well-considered, and reviewed by a second physician. Suicidal depression became a terminal disease; psychic distress became a legitimate ground for doctor-assisted death.

While the Supreme Court’s decision was hailed as a victory by euthanasia supporters, it took more than ten years before the medical community openly agreed that neither a terminal illness nor physical suffering should be necessary for ending a patient’s life. After a three-year investigation, the KNMG concluded in January 2005 that doctors should be able to kill patients who are not ill but who are judged to be “suffering through living.”

Jos Dijkhuis, the emeritus professor of clinical psychology who led the inquiry, said that it was “evident to us that Dutch doctors would not consider euthanasia from a patient who is simply ‘tired of, or through with, life.’” Instead, the committee agreed on the term “suffering through living,” because a patient may present a variety of physical and mental complaints that can lead them to conclude that life is unbearable. “In more than half of cases we considered, doctors were not confronted with a classifiable disease,” said Dijkhuis. “In practice the medical domain of doctors is far broader . . . . We believe a doctor’s task is to reduce suffering, therefore we can’t exclude these cases in advance. We must now look further to see if we can draw a line and if so where.”

No boundaries on dealing out death

Over a period of forty years, the Dutch have continued the search for where to draw the line with euthanasia, shifting from acceptance of voluntary euthanasia for the terminally ill, to voluntary euthanasia for the chronically ill, to non-voluntary euthanasia for the sick and disabled, to euthanasia for those who are not sick at all but are merely alcoholics or “suffering through living.”

While the initial impetus may have been spurred by a desire to give expanded rights to the person who faces extreme suffering or imminent death, the effect has been to concentrate power into the hands of state-sponsored medical professionals. And while the justification for assisted death is usually the supposed well being of the suffering patient, the Dutch have redefined natural dependency into an unacceptable or unwanted social burden.

This increasing acceptance of euthanasia in the Netherlands is inversely proportional to the decline of Christianity in the country. In the mid-1960s, about 65 percent of the nation was Christian. Today, that same percentage (67 percent) claim no affiliation. Slightly more than 25 percent of the Dutch people are atheists while only 17 percent believe in the existence of God.

The Dutch sought autonomy from God, which led to a radical embrace of autonomy for the individual. Not surprisingly, the rejection of the Author of Life has led to a Culture of Death in the Netherlands. Faced with the many pains, heartaches, and disabilities that eventually afflict most of us in one form or another, and having no ultimate Redeemer to turn to, the Dutch are resorting euthanasia to quell their distress.

Euthanasia came to Europe through the agnosticism and atheism of the Netherlands. The experience on that continent should serve as a warning that when a nation ceases to believe in God, they embrace collective suicide carried out one person at a time.

By / Dec 29

“I will give no deadly medicine to any one if asked, nor suggest any such counsel.”

For centuries, the Hippocratic Oath, which included this admonition against assisted suicide and euthanasia formed the core of Western medical ethics. Over the past few decades, though, the Hippocratic ideal has been eroding. Euthanasia—both voluntary and involuntary—and physician-assisted suicide have become increasingly common in Europe.

North America has been following the lead of European nations. Canada recently legalized physician-assisted suicide, as have five states in the U.S.—California, Oregon, New Mexico, Washington, and Vermont. Currently, one in six Americans lives in a state where a doctor can prescribe a lethal dose of drugs to a patient. That may soon increase, though, since nine other states have pending PAS legislation: Kansas, Massachusetts, Michigan, Minnesota, New York, New Jersey, North Carolina, Oklahoma, and Pennsylvania.

The fact that the death ways of Europe soon become accepted here in the states has some medical professionals concerned. The American Psychiatric Association, in concert with the American Medical Association, recently issued an official position statement that a “psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”

What seems to have U.S. psychiatrists concerned is the first documented case of a doctor in the Netherlands performing euthanasia on a patient who suffered from chronic alcoholism.

While this case is unique, it’s the logical extension of the Dutch policy of allowing euthanasia for “treatment” of mental illnesses, including severe depression.

How Euthanasia Came to the Netherlands

The story of how euthanasia, once condemned by all physicians, began to be acceptable begins in the Netherlands. Since the end of World War II the most direct challenges to life and human dignity came from the Netherlands and the nation’s cultural and legal acceptance of the “right to die.” The medical community and broader citizenry have so embraced the right to choose death that even parents of gravely ill children can now have doctors speed up their death.

In almost any other country on earth such a policy might be considered radical and shocking. But in the Netherlands—the country that first legalized euthanasia—the legalized killing of alcoholics and sick children merely decriminalized a practice that has been occurring for decades. An examination of how this formerly conservative, tradition-bound culture could adopt what the modern Hippocratic Oath refers to as “therapeutic nihilism” is useful for understanding how other nations—including the United States—will likely begin to accept euthanasia in the near future.

The Liberalization of Sex, Drugs, and Death

As occurred in many Western countries during the 1960s, the people of the Netherlands began to reject traditional authority structures in favor of increased individual freedom. While the change led most visibly to a liberalization of attitudes toward sex and drugs, it also carried over into the role of doctors and patients, particularly in the expansion of patient’s rights and patient autonomy.

In 1969 the influential physician J. H. Van den Berg published Medische macht en medische ethiek (“Medical power and medical ethics”), which argued that medical technology was making doctors more powerful. According to Van den Berg, doctors, when bound by Hippocratic ethics, are morally required to keep patients alive as long as possible (a dubious interpretation of the oath and its meaning). But in the age of advanced medical technology, he argued, the ancient creed posed new ethical problems. On the basis of this revised ethical code, Berg argued not only for voluntary euthanasia but also for the involuntary killing of individuals who suffer from reduced quality of life, such as elderly patients suffering from dementia.  

After the release of Van den Berg’s book, end-of-life issues began to be included in the debates on patient’s rights. But while public sentiment was evolving rapidly—becoming much more tolerant of assisted suicide and euthanasia—the law was slower to conform. Despite legal prohibitions against euthanasia and assisted suicide, which had been part of Dutch law since the Dutch Penal Code replaced the French Code Penal in 1886, euthanasia become increasingly common.

A Doctor Kills His Mother

A turning point occurred in 1973 when Dr. Geertruida Postma was convicted of killing her elderly mother, but on such grounds and with such limited punishment that the conviction had the practical effect of giving public protection to physicians engaging in certain forms of euthanasia. In this landmark case, the criminal court ruled that it was possible to administer pain-relieving drugs leading to the death of the patient provided the purpose of treatment was the relief of physical or psychological pain arising from an incurable terminal illness. Because Postma’s primary goal was to cause the death of her patient, she was found guilty and received a one week suspended sentence and one year’s probation.

The ruling marked a notable shift in the law, allowing the formulation of conditions under which life could be deliberately shortened by doctors. The minimal punishment and light sentence also sent a clear signal that cases of euthanasia would be treated mildly by the judicial system. The result was that the publicly popular practice, while not yet decriminalized, began to be carried out more regularly and routinely, but without a studied understanding of its prevalence or the circumstances under which it was administered.

Euthanasia and ‘Matters of Murder’

In 1990, the Dutch government set up a Commission, chaired by Attorney General Jan Remmelink, to investigate and quantify what was happening in the shadows of the law. Using the narrow definition of euthanasia as “active termination of life upon the patient’s request,” the Remmelink report concluded that 2,300 instances of euthanasia were carried out during 1990. And while the Royal Dutch Medical Association (KNMG) had established in its Guidelines for Euthanasia that terminating a life without a patient’s request is “juridically a matter of murder or killing and not of euthanasia,” the Remmelink Commission found, through interviews with randomly selected physicians and mailed questionnaires, that over 20,000 life-ending actions had been taken in 1990 without the patient’s express consent.

These “matters of murder” do not include, as the report notes, the unknown numbers of disabled newborns, children with life-threatening conditions, or psychiatric patients who may have been killed involuntarily but were not included in the survey.

Rather than being disturbed by the findings, the Commission glossed over these instances of involuntary killing by claiming that “active intervention” was usually “inevitable” because of the patient's “death agony.” In 1993, the Dutch Parliament responded not by tightening controls on doctors but by implementing the Commission’s recommendation to establish in statutory form the report physicians who practice euthanasia should file with the local medical examiner. Euthanasia shifted from being a punishable criminal offense to being a matter of bureaucratic form-filing.

Voluntary Euthanasia Increases while Involuntary Euthanasia Stays in the Shadows

According to the Dutch Ministry of Justice, of the 135,675 deaths recorded in 1995, 3,600 (2.4 percent) were the result of a doctor-assisted termination of life while another 238 (0.3 percent) were cases of assisted suicide. In 2014, that number had increased to 5,306 assisted deaths, including 41 assisted deaths for psychiatric reasons and 81 assisted deaths for dementia.

As Dutch ethicist Theo Boer wrote earlier this year, “For no apparent reason, beginning in 2007, the numbers of assisted dying cases started going up by 15 percent each year. In 2014 the number of cases stood at 5,306, nearly three times the 2002 figure.” Boer also notes the increase in non-voluntary killing:

On top of these voluntary deaths there are about 300 nonvoluntary deaths (where the patient is not judged competent) annually. These are cases of illegal killing, extracted from anonymous surveys among physicians, and therefore almost impossible to prosecute. There are also a number of palliative sedation cases—the estimate is 17,000 cases yearly, or 12 percent of all deaths—some of which may involve shortening the life of a patient considerably.  

While it is assumed that these cases consisted of terminally ill patients with no chance of survival, no one in the Netherlands knows for certain. Although the government passively accepted the practice for decades, doctors are still legally susceptible to prosecution if a disgruntled family member disagreed with the killing of their relative. Legislation to decriminalize euthanasia, which had been repeatedly proposed since 1984, was finally passed on April 10, 2001. A criminal liability exclusion was added for doctors who willingly reported their actions and demonstrated that they have satisfied the criteria of “due care.”

However, doctors in the Netherlands know that no penalties will be incurred by simply ignoring the law. Prosecutions for guideline violations are exceedingly rare and no doctor has ever been imprisoned or substantially penalized for noncompliance. Even when the government is made aware of cases of non-voluntary euthanasia, legal action is rarely if ever taken and convictions for such crimes are all but nonexistent.

(Note: This is the first of a two part series. Part two can be found here.)

By / Jun 21

On more than one occasion, I have found myself leading a family in prayer while holding the hand of a dying man in hospice care. At this point, the family simply wanted the relief of knowing that the suffering had ended and that the man was finally at rest with Christ. On other occasions, I have found myself making frequent visits to an assisted living facility in order to ministers to church members who were plagued with dementia. With each month that passed, I grew less and less recognizable to my members, spending the majority of my time simply reintroducing myself to them. At this point, the pastoral care was palliative. Apart from miraculous intervention, the people that I was visiting were not going to recover. Death was certain. In fact, funeral plans occasionally occurred at the behest of the family in the very presence of their dying family member. There was no denying the impending “covering of death that is cast over all people” (Isa. 25:7). It is in situations like these that a pastor’s theological mettle really gets tested. Pastoral care beside the death bed is holy ground. For, it is here, in the face of certain death, that all of our white ivory tower theorizing about eschatology looks us in the eyes and asks, “Are the dead really raised?”

As pastors attempt to shepherd their terminally-ill sheep to “the river’s edge,” a growing number of people in the world are suggesting a solution to death that they claim is “peaceful, humane, and dignified.”[1] Instead of suffering for months on end with an incurable disease, Death with Dignity (DWD, hereafter) advocates appeal to humanity’s rather natural desire to avoid pain and suffering. The proposed solution is straightforward enough. As an “end-of-life” option, advocates seek to allow “certain terminally ill people to voluntarily and legally request and receive a prescription medication from their physician to hasten their death.” Such advocacy efforts have already resulted in Oregon, Washington, and Vermont passing legislation that allows “physician-assisted dying,” while California’s law takes effect on June 9, 2016. These states alongside DWD advocates promise those with a terminal illness a “dignified” death. A “dignified death,” according to advocates, is one that affords those with a terminal illness the opportunity to die with a sense of self-respect, self-determination, self-control, and self-awareness. In other words, instead of passively and slowly being subdued by death, “certain” patients actively and willingly enter into it. The solution is often proposed as a merciful and compassionate solution that alleviates a loved one’s suffering. So how should Christians respond to such DWD solutions? How can pastors shepherd their sick sheep well through the valley of the shadow of death?

Admittedly, it is hard to know where to start with answers to such questions. One could begin by pleading for Christians to stop trivializing death. Death first appears in the Bible as a consequence of mankind’s rebellion against God and according to Paul, “spread to all mankind.” It is a universal reality. Funeral jokes and awkward colloquial phrases about how “God just needed another angel” are not real solutions for combatting the ubiquity of death. They are mere distractions from the finality and impending judgment that follows death (Heb. 9:27). Of course, such a move away from the trivialization of death would require the embrace of a robust theology of death. With the vast majority of DWD advocates addressing death from an anthropocentric perspective, Christians must recognize that death is ultimately theocentric. The apostle Paul wrote, “For if we live, we live to the Lord, and if we die, we die to the Lord” (Rom. 14:8). As Christians, we do not have the authority to make death about ourselves. Yes, we will die; but our death is unto the Lord. Medical expediency, scientific ability, and twisted distortion of mercy and compassion must not be allowed to shape the conscience on these matters. Our perspective about death must be shaped by the eschatological trajectory of death itself.

Ultimately, though, while taking death seriously and developing a theology of death are vital aspects of one’s response to DWD arguments, there is an even more urgent problem that Christians must face directly. DWD proposals attempt to undermine the continuing significance of the work of Christ. Most people are rightly and understandably fearful of death. Even I will admit that I have left my share of assisted living facilities and thought to myself, “Lord, please don’t let me suffer when I die.” It is in such a moment that the false gospel of DWD promises a “peaceful, humane, and dignified death.” No need to worry about someone feeding you, bathing you, or cleaning up after you. No concerns about being a “burden” to others in your family. No fear of forgetting the names of your spouse, your children, or your grandchildren. No financial burden on your surviving family. No unbearable pain or sleepless nights. No loss of control. Just a prescription, a seat in your favorite spot at home, and then you’re gone. What a compelling offer for the one that is fearful of death and all of its accompanying uncertainty! What a gospel for the terminally-ill, right? While DWD advocates certainly propose this scenario as good news for the dying, the sad reality is that in all these promises of peace, compassion, and dignity, the perpetual comfort of Christ in death is lost.

When Christians speak about the death of Christ, they tend to focus on the forgiveness and freedom from guilt that it provides for those who have trusted in Him. And rightly so! Yet, to relegate the significance of Christ’s death to the believer’s past is to neglect its continuing power in their present life. Christ died to set believer’s free not only from the condemning power of sin, but also from the enslaving power of the fear of death (Heb. 2:14-18). If a barbiturate cocktail could bring peace in death, then Christ died in vain (Gal. 2:21). He himself is the believer’s peace (Eph. 2:14), promising all who believe in Him that “though they die, yet shall they live” (John 11:25). DWD advocates promise peace, compassion, and dignity in death, yet dignity speaks of a state or quality of being that is worthy of honor and respect. For the Christian, such dignity is found in dying in the hope of Jesus’ fear-destroying death and resurrection. The hope for all people who face a debilitating terminal illness is found in Christ alone, who has disarmed the sting of death and conquered the grave (1 Cor. 15:50-58). We do not lose heart in our suffering. Though our outer self is wasting away with terminal illnesses, our inner self is being renewed day by day. The light momentary affliction of things like dementia and cancer, while intended by our enemy to break us, are sovereignly allowed by God to prepare for us an eternal weight of glory that is beyond comparison. Therefore, we do not look to the things that are seen, but to the things that are unseen. For the things that are seen are transient, but the things that unseen are eternal (2 Cor. 4:16-18).

Christians must discern the deadly poison in DWD’s promise-wrapped pill. Humanity’s search for peace and compassion in death is a deeply theological quest, which ultimately ends with finding the One who will wipe away our tears, end our pain, and destroy death forever (Rev. 21:4).

[1] FAQS – Death with Dignity, last modified May 20, 2016, https://www.deathwithdignity.org/faqs/.

By / Oct 20

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.

By / Jul 29

The cover story of the June 29, 2015 weekly edition of The Economist reads “The right to die: Why assisted suicide should be legal”. In the article, the popular and influential British newsmagazine gives a number of arguments why physician assisted suicide should be decriminalized. One such reason the author cites is that “evidence from places that have allowed assisted dying suggests that there is no slippery slope towards widespread euthanasia.” Simply, this is not true.

Physician-assisted suicide is the act of a physician providing a death-causing means, such as prescribing a lethal dose of barbiturates to a patient designed to end their life. The patient then fills the medication at a pharmacy and self-administers it at their leisure. In most contexts, no healthcare professional need be present. This is currently legal in Colombia, the Netherlands, Luxembourg, and Switzerland, as well as the US states of Oregon, Montana, Washington, and Vermont. This is differentiated by voluntary euthanasia, which is the practice of a physician ending a life, typically by administering a lethal injection to the patient. It is important to note that neither term applies to a patient’s refusal of life-sustaining technology, such as a respirator or artificial nutrition. Neither do the terms apply to a patient’s request that these be withdrawn, for these have had ethical and legal sanction nationally for years.

In the past year, the push within the US by the pro-assisted suicide camp has been enhanced by the highly publicized case of Brittany Maynard, the 29-year-old woman who, after being diagnosed with brain cancer and given a grim prognosis, moved from her home state of California to Oregon in order to attain a legal right-to-die. Maynard’s story, and those similar, elicit sympathy and compassion from those on both sides of this issue. As one who is against allowing patients the right to seek a lethal prescription from their physician, I can still have compassion on those in the midst of agonizing suffering. However, I do not believe that the answer to this problem is legalizing assisted dying. One reason for this is it has been well documented (contrary to the article cited above) that in those countries where physician-assisted suicide or euthanasia has been legalized, a slippery slope gradually occurs.

April 1, 2002: The Netherlands’ “Termination of Life on Request and Assisted Suicide Act” takes effect, making it the first country to enact such legislation. Conditions of the original law included that the providing physician must be convinced that it concerns a voluntary and well considered request, and must be convinced that it concerns unbearable and hopeless suffering of a patient. Further, certain age requirements had to be met. The original law applied to competent adults, though some caveats for minors existed. If the minor patient is between sixteen and eighteen years and may be deemed to have a reasonable understanding of his interests, the physician may carry out the patient’s request for termination of life or assisted suicide, after the parents/guardians have been involved in the decision process. If the minor patient is aged between twelve and sixteen years and may be deemed to have a reasonable understanding of his interests, the physician may carry out the patient’s request, provided always that the parents/guardians agree with the termination of life.[1]
May 28, 2002: The Belgian Parliament legalizes voluntary euthanasia and physician-assisted suicide. Those wishing to end their lives must be under “constant and unbearable physical or psychological pain”. Additionally, only adults may seek assistance in dying.[2]
September 2004: The Groningen Protocol is created by the University Medical Center Groningen in Groningen, Netherlands. It stipulates criteria under which physicians may perform the euthanasia of “severely ill newborns with a hopeless prognosis and unbearable suffering” without fear of legal prosecution.[3]
June 2010: A study appears in the Canadian Medical Association Journal that discovered that out of 208 physician-assisted deaths studied in Belgium, 66 (31.7%) were administered without an explicit patient request.[4]
February 2014: Belgium becomes the first country in the world to lift all age restrictions on euthanasia. For children who request euthanasia, they must have a terminal and incurable illness, near death, and suffering great pain. Parents and healthcare professionals must agree to the choice.[5]
April 2014: An 89-year-old retired art teacher utilizes assisted suicide to end her life at a Swiss clinic after becoming disillusioned with the curses of modern life from emails to fast food. Though suffering from ill health in recent years, she was neither terminally ill nor seriously handicapped.[6]
May 2014: The Swiss organization “Exit” that helps people take their own lives officially votes to extend its services to elderly people who are not terminally ill.
February 2015: In a study published by the Journal of Medical Ethics, approximately one in three Dutch physicians would be prepared to help someone with a psychiatric disease, early dementia, or patients who are simply “tired of living” to die.[7]
March 19, 2015: An article appears in the prestigious New England Journal of Medicine revealing that in 2013, Belgian doctors hastened the death of patients “without an explicit request” at the rate of 1.7% of all deaths in the country. This equates to more than 1,000 patients each year that are euthanized without explicit request.[8] Moreover, from 2010 to 2013, the number of reported euthanasia in Belgium has almost doubled (an 89% increase) in the four-year period. Additionally, a great amount of people have asked to be euthanized when their death was not expected in the short term (13% of euthanasia).[9]
June 2015: Dutch Pediatric Association says country should follow Belgium in changing law on euthanasia and scrapping age limit for children in unbearable suffering.[10]

This is merely a small sampling to illustrate how, gradually, assisted suicide and euthanasia laws become increasingly relaxed and open to a greater amount of people for increasing reasons. What begins as only allowing for death in the case of competent, terminally ill adults, spirals into euthanasia without request and allowing children to seek their own termination. Legal scholar and Georgetown University Professor of Christian Ethics has affirmed:

Once a doctor is prepared to make such a judgment in the case of patient capable of requesting death, the judgment can, logically, equally be made in the case of a patient incapable of requesting death…If a doctor thinks death would benefit the patient, why should the doctor deny the patient that benefit merely because the patient is incapable of asking for it? If denying assistance in suicide to those physically incapable of committing it, and for whom death is thought a benefit, amounts to discrimination, why does denying euthanasia to those mentally incapable of requesting it, and for whom death is thought a benefit, not amount to discrimination? The logical “slippery slope” argument is unanswerable.[11]

Similarly, Ezekiel Emanuel, former Chief of the Department of Bioethics of the US National Institutes of Health and current Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, writing in the Atlantic Monthly, has stated:

The Netherlands studies fail to demonstrate that permitting physician-assisted suicide and euthanasia will not lead to the nonvoluntary euthanasia of children, the demented, the mentally ill, the old, and others. Indeed, the persistence of abuse and the violation of safeguards, despite publicity and condemnation, suggest that the feared consequences of legalization are exactly its inherent consequences.[12]

The evidence from those countries that have legalized physician-assisted suicide or euthanasia is overwhelmingly in favor of a slippery slope. In our own country where we are already seeing invigorated pushes to decriminalize physician-assisted suicide, we need to approach the issue with a clear view of what it is we are asking for. Legalizing physician-assisted suicide or euthanasia would be a step in the wrong direction in comparison to our current situation. If proponents of assisted dying are going to make a strong case, they must come to terms with the facts of what has happened in those countries where it has been legalized, for glossing over the gradual liberalization is not helpful to the conversation, nor is it honest.

For the church, physician-assisted suicide and euthanasia is a very pressing issue, and the big debates loom just over the horizon. We must affirm to our churches what it means not only to have a good life but a good death. A good death is able to minimize suffering when possible, and it affirms the inherent dignity of the person. In a profound, true sense, one cannot evade all forms of human suffering. I am not arguing, of course, that people should simply accept every kind of suffering. However, the opposite position that one must intervene to alleviate all suffering, or even intervene before the suffering begins, is an extreme one. Suffering was not part of God’s original design for his creation. It is the result of the fall, just like death. However, God can use these to accomplish his greater purposes in the world. The notion of suffering and its ability to produce character and make possible a deeper experience with God is littered throughout Scripture. This is a point that opponents to our position will not be fond of, yet it is one that Christian tradition and Scripture stand upon and must not forfeit. The Christian church would do well to recover a robust ars moriendi and stand ready to articulate their position on assisted dying, lest culture attempt to redefine it for us.

[1] “Termination of Life on Request and Assisted Suicide (Review Procedures) Act,” http://www.eutanasia.ws/documentos/Leyes/Internacional/Holanda%20Ley%202002.pdf(accessed July 5, 2015).

[2] “Belgium legalises euthanasia,” http://news.bbc.co.uk/2/hi/europe/1992018.stm(accessed July 5, 2015).

[3] A.B. Jotkowitz and S. Glick, “The Groningen protocol: another perspective,” Journal of Medical Ethics, 32, no.3 (2006) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564470/(accessed July 5, 2015).

[4]Chambaere, Kenneth, et. al., “Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey,” Canadian Medical Association Journal, 182, no. 9 (2010), http://www.cmaj.ca/content/182/9/895.full (accessed July 6, 2015).

[5] “Belgium passes law extending euthanasia to children of all ages,” http://www.theguardian.com/world/2014/feb/13/belgium-law-extends-euthanasia-children-all-ages (accessed July 5, 2015).

[6] “It’s adapt or die — she couldn’t adapt,” http://www.thesundaytimes.co.uk/sto/news/uk_news/Society/article1396979.ece(accessed July 5, 2015).

[7] Eva E. Bolt, et. al. “Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living?” Journal of Medical Ethics (2015), http://jme.bmj.com/content/early/2015/01/30/medethics-2014-102150.short?g=w_jme_ahead_tab (accessed July 6, 2015).

[8] Kenneth Chambaere, et. al., “Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium,” http://www.nejm.org/doi/full/10.1056/NEJMc1414527 (accessed July 6, 2015).

[9] European Institute for Bioethics, “Belgian Euthanasia Increases by 89% in four years,”

http://www.ieb-eib.org/fr/document/belgian-euthanasia-increases-by-89-in-four-years-382.html (accessed July 5, 2015)

[10] “Dutch paediatricians: give terminally ill children under 12 the right to die,”

http://www.theguardian.com/society/2015/jun/19/terminally-ill-children-right-to-die-euthanasia-netherlands (accessed July 5, 2015).

[11] John Keown, “A Right to Voluntary Euthanasia? Confusion in Canada in Carter,” Notre Dame Journal of Law, Ethics & Public Policy, Vol. 28, No. 1 (2014), p. 23, http://scholarship.law.nd.edu/ndjlepp/vol28/iss1/1/ (accessed July 6, 2015).

[12] Ezekiel J. Emanuel, “Whose Right to Die?” The Atlantic, March 1, 1997, http://www.theatlantic.com/magazine/archive/1997/03/whose-right-to-die/304641/ (accessed July 2, 2015).