Death is universal. Apart from the intervention of the second advent of Christ, every human being will die. But how humans should die is a point of keen debate in the history of ethics.

Christians and non-Christians have deeply disagreed over the ethical validity of “non-natural” means of human death, namely suicide, abortion, infanticide, capital punishment, war, and euthanasia. And even among Christians there have been deep disagreements over whether these means of human death are ever legitimate. Specifically, then, what should a Christian think about the surging interest in euthanasia in our largely non-Christian culture?

For a host of reasons including advancements in medical technology, the aging of America, and the increasing impact of the secularization of our society, the concept of “quality of life” continues to supplant the concept of “sanctity of life.” Not surprisingly, the practice of euthanasia, simply translated as “the good death,” is a topic of increasing interest and concern.

The stories of Karen Ann Quinlan, Dr. Jack Kevorkian, the Hemlock Society, and Terri Shiavo have filled the news. “Death with dignity,” “mercy killing,” “the right to die,” or “physician assisted suicide” identify some of the claims of the advocates of euthanasia.

To consider the issues surrounding euthanasia, or the alleged “good death,” it is essential to understand how we, as a society, have arrived at the point where legislators are discussing not how we are to live, but how we are to die.

The Advent of the Culture of Death

Euthanasia is not new. But its rise to the forefront of our social and political discussions can be seen as one outcome of the legalization of abortion in 1973. Claims by the critics of abortion that its legalization would naturally lead to infanticide and euthanasia were seen as scare tactics to keep women from exercising their “right to privacy” or “right to choose.” However, it was not long until these warnings were becoming realities. “Deformed” children were being starved to death or refused treatment and newborn infants were being discarded in trash bins.

Surgeon General of the U.S. Dr. C. Everett Koop responded to the euthanasia/infanticide by starvation of a Down syndrome child in a Bloomfield, Ind., hospital by writing an article in 1980 entitled “Slide to Auschwitz.” He explained that when the “quality of life” value system replaces the “sanctity of life” ethic, it is the first step to what the Nazi physicians at Auschwitz proclaimed—namely, that the unhealthy, the aged, the handicapped, the mentally incompetent, or the dying were lebensunwerten Lebens, or “life unworthy of life.”

Francis Schaeffer explained this emerging thinking when he described an article by author Charles Hartshorne in a 1981 article in The Christian Century entitled “Concerning Abortion, an Attempt at a Rational View.” Schaeffer wrote, “He [Hartshorne] begins by equating the fact that the human fetus is alive with the fact that mosquitoes and bacteria are also alive. That is, he begins by assuming that human life is not unique. He then continues by saying that even after the baby is born it is not fully human until its social relations develop (though he says the infant does have some primitive social relations an unborn fetus does not have). His conclusion is, ‘Nevertheless, I have little sympathy with the idea that infanticide is just another form of murder. Persons who are already functionally persons in the full sense have more important rights even than infants.’ He then, logically takes the next step: ‘Does this distinction apply to the killing of a hopelessly senile person or one in a permanent coma? For me it does.’ No atheistic humanist could say it with greater clarity.”

The high priest of mercy killing, Dr. Peter Singer of Princeton makes the thinking clear in his book Practical Ethics: “I do not deny that if one accepts abortion … the case for euthanasia … is strong. … euthanasia is not something to be regarded with horror. … On the contrary, once we abandon those doctrines about the sanctity of human life … it is the refusal to accept euthanasia which, in some cases, is horrific.” Thus the leaps from abortion to infanticide, to voluntary euthanasia, and ultimately to involuntary euthanasia are not leaps at all, but the natural consequence of stepping onto the slippery slope of morality apart from God.

The Unfolding Expression of the Culture of Death

To a society which no longer embraces the sanctity of human life, the natural extension of a woman’s “right to choose” is a person’s right to die at the time and under the conditions of their own choosing. Physician John M. Templeton, Jr., explains, “This right of personal autonomy regarding medical intervention can contribute to the concept of death with dignity. However, some persons have begun to try and push the concept of rights into extreme positions. In the words of Leon Kass, author of Death with Dignity and the Sanctity of Life, ‘We find people asserting a “right to die” grounded not in objective conditions regarding prognosis or the uselessness of treatment, but in the supremacy of choice itself. In the name of choice, people claim the right to choose to cease to be choosing beings. From such a right to refuse not only treatment, but life itself—that is, from a right to become dead—it is then a small step to the right to be made dead. From my right to die will follow your duty to assist me in dying, i.e., to become the agent of my death, if I am not able, or do not wish, to kill myself.’”

The ultimate expression of the culture of death is of course, the arbitrary killing of human beings based on some yet to be determined criteria, such as age, health, productivity, or cost to society. Philip E. Hughes writes, “given the evolutionist presupposition that the species is of far more consequence than the individual, that Man matters rather than man, it is far from fantastic to envisage the enactment of a law which, in the interest of mankind, would prescribe that on reaching, say, the age of 60, persons should be ‘put to sleep’—painlessly of course—by means of a pill, potion, or an injection.”

What role do physicians play in this new paradigm of the culture of death where they are called no longer to be life givers and sustainers, but instead to become managers of life and death? Templeton, in Death and Dying, writes, “The Dutch, in their research on euthanasia, found that many physicians acted with the initial intention of relieving pain and suffering, but also with the admitted ‘partial intention’ of hastening death. Now the Dutch parliament has lifted all restraints and has completely legalized active euthanasia, even in some cases without the patient’s consent.”

In the end, Peter Singer’s questions paint the road map for the culture of death. “For me, the relevant question is, what makes it so seriously wrong to take a life? Those of you who are not vegetarians are responsible for taking a life every time you eat. Species is no more relevant than race in making these judgments.” Singer posits the ultimate question, “But why should human life have special value?”

The Imago Dei

Why is human life precious and why is it wrong to take a life? For the Christian, the answer is clear. We are created by God; in fact, we are created in the image of God (Genesis 1:26-28.). But living out that answer is not always simple or easy. This understanding of the sanctity of life is undergirded by God’s moral law, summarized in the sixth commandment: “Thou shalt not kill.” J. Douma writes, “When we live and die in God’s presence, we do not exercise self-determination over ourselves. When God says that we may not kill, then we must not proceed stubbornly to put an end to our own lives. The wish for death can be a Christian desire, even outside of the dying stage of life (see Philippians 1:23). We may even pray for that; but that kind of praying itself presupposes that we must leave the realization thereof to God Himself.”

Professor J. J. Davis further clarifies how euthanasia is a violation of the sixth commandment: “Human life is sacred because God made man in his own image and likeness (Genesis 1:26-28). This canopy of sacredness extends throughout man’s life, and is not simply limited to those times and circumstances when man happens to be strong, independent, healthy, and fully conscious of his relationships to others. … The same God who lovingly is present in the womb can be present in the dying and comatose patient, for whom conscious human relationships are broken. The body of the dying can still be a temple of the Holy Spirit (1 Corinthians 6:19), and hence sacred to God. The euthanasia mentality sees man as the lord of his own life; the Christian sees human life as a gift from God, to be held in trusteeship throughout man’s life on earth: ‘You are not your own; you were bought with a price. So glorify God in your body’ (1 Corinthians 6:19-20). Determining the moment of death is God’s prerogative, not man’s (Job 14:5). Man does not choose his own death, but acquiesces in the will of the heavenly Father, knowing that for the believer, death is both the last enemy, and the doorway to eternal life. Because man bears the image of God, his life is sacred in every state of its existence, in sickness or in health, in the womb, in infancy, in adolescence, in maturity, in old age, or even in the process of dying itself.”

In a culture of death, Christians are called to be shining lights of hope to a forlorn and fallen world. When Christians choose life for themselves and/or others—offering to the suffering not deadly poisons, but rather Christ’s life-giving love in word and deed—they reflect the gospel hope of the eternal life promised by Christ’s resurrection.

Suffering Has A Point

If one adopts the biblical culture of life that flows from the concepts of the image of God and the sanctity of life, then one must also address the issue of human suffering. For euthanasia’s pragmatic appeal is in offering the “good death,” that is, a death that is without pain and suffering. What is a Christian to think of suffering since his rejection of euthanasia requires a commitment to face pain in a manner that glorifies God? The first thing to remember is that God is faithful (1 Corinthians 10:13). Suffering is never wasted in God’s economy, but always serves His purposes (Romans 8:28).

Professor William Edgar reminds us that suffering has a profound role in the Christian’s progress to the ultimate hope of the gospel of Christ. “In the school of suffering there are three great degrees, to be earned in sequence. The first is ‘perseverance’ (Romans 5:3). When we endure hardship for the sake of our Lord, we begin to learn what no other teacher can impart, the ability to endure. This virtue is notably absent from modern culture—we would rather have the easy pay-off and the pleasurable stimulus than the hard road of daily struggle. But as great athletes know, matches aren’t won in one move, but rather one point at a time. The second degree, once endurance is well in hand, is ‘character’ (Romans 5:4). The Greek word here signifies the ‘ability to pass a test.’ … Finally, the highest degree in the school of suffering is ‘hope’ (Romans 5:4-5). … when the New Testament speaks of hope, it means full assurance. And what is underscored in Romans 5 is a hope that does not have any shame or embarrassment attached to it. Furthermore, it is a hope that leads to the same kind of glad feelings that come with justification. ‘We rejoice in the hope of the glory of God’ (Romans 5:2).

The point here is that euthanasia sees pain as something to be avoided at any cost. For the Christian, pain is not to be sought, but when it comes it is to be grasped as a tool God has given to further restore the very image of God so tragically damaged in the fall of mankind. When hope triumphs over suffering, the first fruits of the resurrection and the eternal redemption of Christ have been tasted by the soul of faith.

The Problem of Pain

This understanding however, does not mean that physical pain is a goal to be sought or a required end to be endured without support. For example, C. S. Lewis wrote in The Problem of Pain, “I am not arguing that pain is not painful. Pain hurts. That is what the word means. I am only trying to show that the old Christian doctrine of being made ‘perfect through suffering’ (Hebrews 2:10) is not incredible. To prove it palatable is beyond my design.”

Although there are no easy ways to suffer, a Christian willingly embraces the blessings of the common grace gifts of medicine to address his pain and suffering. Yet he also learns to live by the apostle Paul’s words in Philippians 3:10-11 that describe his remarkable spiritual pursuit, “I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death and so, somehow, to attain to the resurrection from the dead.”

Death With Dignity In Christ

Our conclusion can hardly surpass the wisdom of Dr. Leon Kass in his article “Death with Dignity and the Sanctity of Life,” written in 1990. Dr. John M. Templeton, Jr. summarizes Dr. Kass as follows: “‘We should reject the counsel of those who, seeking to drive a wedge between human dignity and the sanctity of life, argue for the need for active euthanasia, especially in the name of death with dignity. For it is precisely the setting of fixed limits on violating human life that makes possible our efforts at dignified relations with our fellow men, especially when their neediness and disability try our patience. We will never be able to relate, even decently to people, if we are entitled always to consider that one option before us is to make them dead. Thus, when the advocates of euthanasia press us with the most heartrending cases, we should be sympathetic but firm. Our response should neither be ‘Yes, for mercy sake,’ nor ‘Murder! Unthinkable!’ but ‘Sorry, no.’ Above all, we must not allow ourselves to become self deceived: we must never seek to relieve our own frustration and bitterness over the lingering deaths of other by pretending that we can kill them to sustain their dignity.”

As believers, we are called to entrust our lives and the lives of our loved ones into the strong and loving hands of the only One who knows the end from the beginning. When we live in Christ with trust and when we die in Christ with hope, we can proclaim with Paul, “For to me, to live is Christ and to die is gain” (Philippians 1:21). This alone is the “good death,” the only true “euthanasia.”

Dr. Peter A. Lillback is senior pastor of Proclamation Presbyterian Church (PCA) and president of Westminster Theological Seminary.

SEVEN ETHICAL PRINCIPLES FOR FACING DEATH AND DYING

While we cannot pursue the following ethical considerations with any length, it is helpful to identify some of the basic issues guiding a Christian’s thinking as they face the death process.

1. Prolonging life versus stretching life: “We observe once again how important it is to avoid the phrase absolute ‘reverence’ for human life. We must respect human life. If we can expect a medical procedure to extend life for a meaningful time, then we have an indication that such a treatment is desirable. But if not, then we have an indication that our task here on Earth is finished. Life can be prolonged, but need not be stretched” (J.Douma’s The Ten Commandments).

2. The issue of terminating life versus terminating treatment. “For this reason it is important to distinguish between terminating life and terminating treatment. Perhaps death will follow quickly after a treatment has been terminated, although that is by no means always the case. If a patient undergoes no further medical treatment, he must still be fed and cared for. That is not killing him, but giving him up” (J. Douma’s The Ten Commandments).

3. When it is right to let someone die? John Frame, in his Medical Ethics, writes, “When may we let a patient die? In general I would say that we may let a patient die when we lack, in some way, the resources to save his life, whether those resources be time, technology, or skill. When a person is under medical care, we may let him die … when he is ‘dying.’” Davis adds, “The collapse of the distinction between killing and letting die could also open the door to the deliberate killing of other categories of persons: the senile, the comatose, and the economically burdensome.”

4. The distinction between the ordinary and extraordinary means in saving a life. Davis continues, “Ordinary means are all those medicines, treatments, and operations which offer a reasonable hope of benefit and which can be obtained and used without excessive expense, pain, or other inconvenience. Extraordinary means are all medicines, treatments, and operations which cannot be obtained or used without excessive pain, or other inconvenience, or which, if used, would not offer a reasonable hope of benefit.”

5. The difference between sustaining life and prolonging dying. Davis writes, “There is no moral obligation to prolong artificially a truly terminal patient’s irreversible and imminent process of dying. This is sometimes called employing ‘useless means’ of treatment.”

6. The compassionate control of pain and provision of comfort. Davis writes, “When a disease has advanced to the point where no known therapy exists and death is imminent despite the means used, then forms of treatment that would secure ‘only a precarious and burdensome prolongation of life’ may be discontinued or not instituted. … Only palliative care is indicated. … ‘Palliative care’ means therapeutic measures designed to increase the patient’s comfort and control pain, to provide food and water and normal nursing care, and to minimize stress for the dying patient and the family. To say that in certain cases palliative care alone is indicated is not to abandon the patient.” The advent of advanced pain treatments has largely eliminated the need for patients to suffer. The idea of “mercy killing” thus has a false basis.

7. Open and honest communication. A final important ethical consideration is excellent communication between the patient (if possible), the family, and the healthcare professional. There needs to be a team approach to making these difficult decisions.

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