Elective Death: Euthanasia and Physician Assisted Suicide
Baptists affirm the special significance of human beings in Gods creative activity. Death can never be taken lightly and is ever accompanied by a sense of tragic loss. At the same time, many Baptists have been unwilling to turn this belief into an absolute aversion to death.
The term euthanasia has a long and complex history. In its original usage, meaning reflected etymology; “good death” referred to efforts to keep terminal patients free from pain. In current usage we distinguish types of euthanasia. Passive euthanasia mirrors the early meaning of allowing to die as comfortably as possible. Double effect euthanasia denotes potentially lethal acts primarily intended to relieve suffering. Active euthanasia means causing to die, including cases in which the patient participates in deliberations and freely chooses to die, i.e., physician-assisted suicide.
Many Christians have made clear their opposition to any form of euthanasia, including physician-assisted suicide. Elective death as a health care option is perceived as a nemesis to the sanctity of human life. The Bible is understood to prohibit any procedure or decision, which could be construed as elective death.
Other Christians approach this issue from a different vantage point, stressing quality of life. Once death is imminent and inevitable, they emphasize that the right course of action is to minimize suffering, even at the cost of hastening death.
In light of disagreement over this issue, dialogue among Christians regarding death and dying is crucial. Baptists have some positive contributions to make to the dialogue. First, Baptists both affirm and temper self-determination in moral decision making. Second, Baptists affirm a biblically based reverence for life.
Each side in the elective death debate can cite long–standing ethical principles to support their positions. Both sides; however, face some troubling difficulties should their positions be set in stone as social policies. An extreme expression of autonomy in which patients could choose death according to their unchallenged wishes could violate the convictions of those who feel compelled to carry out elective death decisions. On the other hand, strict prohibitions against terminating life prolonging therapies could lead to forced, extended suffering for patients who would choose to let death take its course.
Baptists affirm the special significance of human beings in God’s creative activity. Death can never be taken lightly and is ever accompanied by a sense of tragic loss. At the same time, many Baptists have been unwilling to turn this belief into an absolute aversion to death.
We are formed, after all, by the story of Jesus’ suffering and death in our behalf. In this context suffering and death are not evil, but are in fact central to God’s redemptive purposes. We are called in baptism to identify with Christ’s death and resurrection and in discipleship to follow the way of the cross. We remember with awe and honor the martyrs of Christian history. In this memory and with this calling we are able to contemplate the possibility of our own suffering and death.
Neither suffering nor death is the ultimate enemy. Because Jesus is our Lord, we approach suffering and death in the sure hope of God’s loving purposes. Prevalent throughout the New Testament, this acceptance and theological interpretation of death is exemplified in Paul’s reflection on his own mortality:
But we have this treasure in clay jars, so that it may be made clear that this extraordinary power belongs to God and does not come from us. We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be made visible in our bodies. For while we live, we are always being given up to death for Jesus’ sake, so that the life of Jesus may be made visible in our mortal flesh. So death is at work in us, but life in you….
So we do not lose heart. Even though our outer nature is wasting away, our inner nature is being renewed day by day. For this slight momentary affliction is preparing us for an eternal weight of glory beyond all measure, because we look not at what can be seen but at what cannot be seen; for what can be seen is temporary, but what cannot be seen is eternal.
For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens. For in this tent we groan, longing to be clothed with our heavenly dwelling–if indeed, when we have taken it off we will not be found naked. For while we are still in this tent, we groan under our burden, because we wish not to be unclothed but to be further clothed, so that what is mortal may be swallowed up by life. He who has prepared us for this very thing is God, who has given us the Spirit as a guarantee.
So we are always confident; even though we know that while we are at home in the body we are away from the Lord–for we walk by faith, not by sight. Yes, we do have confidence, and we would rather be away from the body and at home with the Lord. So whether we are at home or away, we make it our aim to please him. (II Corinthians 4:7-12, 4:16-5:9)
While Paul affirms the importance of terrestrial life, he is realistic about its transience. Christians should be good stewards of our lives, even as the Spirit grants us the realization that we are on our way to eternal life with God. This understanding of terrestrial life is not peculiar to Paul, but endemic to scripture. The prospect of clinging to the crumbling shell of earthly existence through the application of heroic medical technologies contrasts sharply with biblical teaching.
Part of the significance of being made in God’s image is the ability to understand spiritual and moral matters and the responsibility to act upon that understanding. Baptist convictions interpret this ability and responsibility. Our understanding of soul competency is threatened by external moral authorities, which issue unilateral pronouncements and prohibitions and thereby deny the believer’s obligation to seek God’s guidance in matters affecting their own lives. Yet, believers cannot claim that in making self-determining choices we are unaccountable to others. Every perception, choice and action is made in the context of a believing community.
The Moral Dilemma of Elective Death
Informed by these convictions–reverence for life tempered by a sensitivity to suffering, soul competency tempered by accountability to the community and confidence in God’s purposes rooted in the Christ event–Baptists can take a closer look at death and dying without dread. On the one hand, believers must live this life as a wondrous gift from God. On the other hand, believers can come to terms with death and act responsibly when confronted with the suffering that often precedes death. One theologically sound place to begin this responsible action is the acceptance of death as part of God’s will. Finitude is a God-given characteristic of human existence.
In some circumstances, the unrelenting opposition to the dying process may be as contrary to God’s will as the unfaithful taking of life.
We face an inescapable moral predicament. There are circumstances in which no choice can guarantee the avoidance of tragedy. Tragedy is here understood in terms of unintended negative consequences. This dilemma should come as no surprise to Baptists. The Bible says that we are sinners in perception, reason, and action. There is no calling, degree or position that enables us to see with the perfect vision of God. No loyalty to an abstract principle can free us from the taint of sin and its tragic outcomes in the exercise of moral discernment.
Neither allegiance to sanctity of life nor self-determination eliminates the vulnerability, anguish and grief of dying. Dying is a messy process. This messiness cannot be eradicated by laws prohibiting elective death or enforcing patient rights. There are circumstances; therefore, when we are forced to "play God" with life and death decisions even though we are theologically under-qualified.
An unfortunate and crucial element of many elective death cases is isolation. The patient who is suffering the physical anguish of disease or the mental anguish of an anticipated disease process is often separated from a supportive, informed Christian community. Several factors account for this alienation. One factor is the regrettable avoidance of death and dying by churches as legitimate topics of discussion. We have more to say about the heaven and hell we have never seen than the death and dying that daily surround us.
Another factor is the propensity of some Christians to use pronouncements and rules to resolve the moral dilemmas of end-of-life situations. Patients and families facing elective death choices may wonder if their particular circumstances create an exception to the historical Christian opposition to hastening death. If the only message such persons have ever heard at their church on the topic is “we are against it,” they will avoid sharing their questions and doubts with others. What a tragedy! Fellow church members are among the most important people to stand beside the patient and family facing death and dying. Despite all its resources, the health care community cannot replace the faith community.
Another factor is the lack of experience many Christians have in moral discourse. We know that people die and often suffer greatly before death. But we struggle when we attempt to integrate our theological beliefs with end-of life decisions. For example, one common response when asked about euthanasia is to condemn it outright. In moral vocabulary; however, euthanasia simply means ‘good death’. Who can condemn the desire for a good death? What does it mean to have a good death? What is the meaning of suffering? In an age of advanced medical technology, when do we cross the line between saving a life and causing a ‘bad death’?
Reflections on “Good Death”
We should recognize that in end of life situations maximal treatment is not always optimal care. As William F. May puts it:
Sometimes it makes sense not only to withhold but also to withdraw treatment. A physician does not always have the duty to fight pneumonia if such fight has become acceptable to the patient in preference to imminent death by irreversible cancer. To sure, the commandment states, “Thou shalt not kill, ” but there is, after all, a time to live and a time to die, and a fitting time to allow someone to die…. At some point, treatment becomes futile, but, while we cease to treat, we do not cease to care.
This recognition should not drive us toward active euthanasia:
[Active] euthanasia goes beyond the middle course of the right to die and insists on the right to be killed. It solves the problem of runaway technological medicine with a final resort to technique. It opposes the horrors of a purely technical death by using technique to eliminate the victim. It insufficiently honors the human capacity to cope with life once terminal pain and suffering have appeared. It tends to doubt that dying itself can be suffused with the human.
Avoiding both the prolonging of suffering and the move toward active euthanasia entails changes in public policy. We must work toward a more just health care delivery system. The prospect of horrific medical costs to prolong life drives some people to consider the cheaper option of seeking death. While we should avoid investing exorbitant resources to delay imminent death, we should also strive to change the present system which makes life-sustaining technologies available to those who have wealth and access to insurance coverage and effectively denies these technologies to those who do not.
A second policy step is to make the option of foregoing life-prolonging treatment more available to those who face the final stages of terminal illness. Some patients seek active euthanasia to avoid getting trapped in a bureaucracy, which insists on keeping them alive. The system must accommodate the wishes of terminal patients to be allowed to die.
A third step is to establish programs, which provide genuine care for dying persons:
Many times euthanasia appears the only option for those who have been abandoned to pain and neglect. The only way out of their loneliness appears to be death. A genuine caring ministry will rescue these people from their desperate plight and limited choice. Our care should be wide-ranging in its dimensions and its providers. Caring is not the exclusive or even the primary responsibility of the physician. Families, friends and especially faith communities should overcome their uneasiness in the presence of death and suffering so that they can provide the caring presence that will witness to the truth that life can be worth living.
A Resolution Process
Christians can come together to deal with death and dying situations through communities of moral discourse. These are groups in which we grapple with the specific circumstances of moral dilemmas, calling on common beliefs and experiences along with the best available insights from a variety of resources. Such a group requires a high degree of internationality and focus. Moral discussion is hard work. It requires careful thinking and communication. Participants must be willing to analyze critically not only the conclusions of others but also their own perceptions, values, and beliefs. Most importantly, such discourse necessitates enough trust in God’s grace and guidance to risk changing one’s mind about particular cases and issues.
How might Christians develop such groups? A structure already exists in the tradition of Bible study meetings. Keeping Bible in hand, these groups can engage in a process of moral discourse in order to seek God’s purposes in a variety of situations. There is no cookbook outline, which guarantees comfortable unanimous resolutions. There is; however, a four-dimensional process, which can be utilized in search of greater insight and constructive action: data collection, open dialogue, participation and continual reflection.
The collection of data is foundational. Without adequate attention to relevant information, moral responses reflect biases more than genuine understanding. Data collection involves research through Bible study, relevant reading and focused conversation. Physicians, intensive care and hospice nurses and members of hospital ethics committees are good sources for data collection. The input of others facing terminal disease and prolonged suffering can also be helpful. Data collection helps groups avoid both simplistic clichés and a sense of despair in the face of complexity.
Open dialogue occurs during and after the collection of data. Open dialogue is crucial to processing diverse beliefs and values both within the group and the wider community. Fear of conflict must be overcome by creating an open forum in which any statement or question is valued while every assumption or perception is open to discussion. This kind of dialogue affirms the Baptist understandings of finitude and sin. No person has unlimited knowledge, and sin is capable of distorting everyone’s values and perceptions. The aim of open dialogue is not a majority vote or the development of all-inclusive rules, but the discernment of God’s purposes in the given situation.
Participation emphasizes that we are not mere spectators in facing moral dilemmas, but are called to be good stewards of the Spirit’s leadership. Participation builds on the human capacity for intentional, innovative involvement while maintaining a balance between human possibilities and limitations. Christians must stand courageously between the extremes of indifferent relativism and self-righteous certainty.
In end-of-life dilemmas, participation involves a sense of awe and reverence, which leads to humility. Suffering and dying are deeply intimate and personal experiences. Any attempt to intervene in decision-making processes must be free of arrogance. Seldom will the consequences of an intervention be certain. The circumstances which lead persons to consider elective death possibilities are gut wrenching.
Continual reflection entails the group’s reflection concerning its own research, decision-making, and intervention activities. No matter how well intentioned the group, they remain limited human beings who cannot see with the eyes of God. Continual reflection is a self-critical filter through which the group’s activities pass. Is the group more interested in discerning God’s purposes or in winning a power struggle? Did the group’s interventions make things better or worse? By wrestling with such questions, the group confesses its dependence upon God and its need for God’s mercy. When formulating advice to a person facing death, we all must rely on God’s abiding patience and grace.
“Elective Death: Euthanasia and Physician Assisted Suicide” is one of fourteen articles in the Getting Well: Christian Perspectives on Health, Sickness, and Ministryseries. Getting Well deals with major health and biomedical issues.
Christian Life Commission