End of Life: Euthanasia and Physician-Assisted Suicide

End of Life: Euthanasia and Physician-Assisted Suicide Philip Thompson Professor of Bible, Harding University Preacher, Rose Bud Church of Christ

The “Problem” of Medical Technology “Condemned to Life” The ability to prolong life (or to delay the dying process) in increasingly poor quality of life circumstances

Euthanasia Euthanasia = “Good death,” which for proponents of euthanasia means death without pain and suffering From a biblical perspective, what is a “good death”? Is a “good death” necessarily or merely a death without pain and suffering?

Homiletic Hint • Use biblical illustrations to show that a “good death” is not necessarily one free of pain and suffering, but one that glorifies God—even in the midst of pain and suffering—by exhibiting trust and submission to the very end. • Example of Jesus (Matt. 26:36-46; Jn. 12:23-33) • Example of Paul (1 Cor. 15:25-27; 2 Cor. 4:16-18; 5:1-10; Phil. 1:21-26; 1 Thess. 4:13-18; 2 Tim. 4:6-8) • Example of contemporary Christians(Pam J).

Homiletic Hint • Be sure to distinguish pain and suffering. • Pain: a consequence of a particular biological situation – physical pain • Suffering: one’s interpretation of situation • Emotional – grief • Social – isolation • Spiritual – meaning • Financial – poverty

Voluntary, Non-voluntary, Involuntary Voluntary:at the patient’s request Involuntary: against the wishes of the patient Non-voluntary: without the knowledge or consent of the patient

Active Euthanasia “Acting to cause death” Intentionally and directly causing death; typically by a lethal injection of drugs The patient is killed by the direct action of the physician. Currently illegal in all 50 states in the U.S.

Passive Euthanasia Better terminology: “Letting die” or “choosing not to prolong the dying process" Withholding or withdrawing life-prolonging technologies in order to allow the patient to die naturally. The underlying disease or injury is the medical cause of death.

Active versus Passive Distinction • That there are morally relevant differences between active euthanasia and passive euthanasia (“letting die”) has been upheld by: • The Supreme Court • Many non-Christian and Christian ethicists • A large majority of medical professionals

Two Morally Significant Differences between Active and Passive Euthanasia • Intention: Is the intent to cause the immediate death of the patient? Or is the intento avoid prolonging the dying process and allow the patient to die naturally? • Cause of death: Is the medical cause of death the lethal act of the physician or the underlying disease or injury?

Principle of Double Effect • Bequeathed by Natural Law ethics • Rejected by Utilitarian ethics • Almost universally accepted in clinical medicine

Principle of Double Effect • If an inherently good act has two effects, one good and one bad, a person can act morally in doing that act provided • only the good effect is intended • the bad effect is not the means to the good effect, and • the good effect is at least equal to the bad effect.

Principle of Double Effect • Active euthanasia fails at least the first two criteria. It intends death and achieves the good effect (relief of suffering) by means of the bad effect (death). • Passive euthanasia or “letting die” is morally right, however, in cases that meet the following criteria: • Death is inevitable and imminent. • The death is caused by the disease or injury. • The intention is to care for and relieve suffering, not to kill.

Does being “pro-life” require the acceptance of vitalism? Vitalism:The belief that doing everything possible to squeeze out every minute of life – regardless of the medical circumstances – has value and is required. When cure is no longer possible, is it permissible for a Christian to surrender to the disease, back away, and allow death to run its natural course? My Mother

Homiletic Hints Helping listeners to differentiate active euthanasia and passive euthanasia (“letting die”) may be the most critical task in preaching on end of life issues. A sermon titled “Is it Wrong to Let Go?” could bring clarity to the difference between VAE/PAS and vitalism.

Currently Being Debated: Voluntary Active Euthanasia (VAE) At the patient’s request, a physician directly and intentionally administers a lethal dose of medication. This act is the medical cause of death. VAE is illegal in all 50 states in the U.S. VAE is legal in the Netherlands, Belgium, and Luxembourg.

Currently Being Debated: Physician-Assisted Suicide (PAS) The physician provides a medical means (a prescription for a lethal dose of medication) by which a patient can take his own life. Death is caused directly by the lethal medication and not by the underlying disease or injury. PAS is legal in Oregonand Washington(Ballot) Montana (Court), and Vermont(Legislature).

Oregon’s “Death with Dignity” Act • Since the “Death with Dignity” Act was passed (1998 – 2011): • 935 patients have had DWDA prescriptions written • 596 patients have died from ingesting medications under DWDA

Concerns of Patients under Oregon’s and Washington’s DWDA in 2011 Decreasing ability to engage in activities making life enjoyable – 90% (OR); 89% (WA) Loss of autonomy – 89% (OR); 88% (WA) Loss of dignity – 75% (OR); 79% (WA)

Homiletic Hint • Be clear about the operational differences and the ethical similarities between VAE and PAS. • Address the expressed the end of life concerns of patients opting for PAS. • Loss of meaningful activities • Loss of autonomy • Loss of dignity (control)

The Case for VAE and PAS: Argument from Mercy • Response: • What constitutes an ethically appropriate way to respond out of mercy? Does mercy allow killing? • Why disallow an incompetent patient, who cannot exercise autonomy, to be denied relief from suffering? • Difference between pain and suffering. Suffering is the interpretation of pain. From a Christian standpoint, suffering can be redemptive.

The Case for VAE and PAS: Argument from Mercy • Response: • Proper pain management • Principle of double effect • Theology of suffering • Job • Lament • 2 Cor. 12:7-10 • Phil. 1:21-26

The Case for VAE and PAS: Argument from Autonomy • Response: • Assumes human autonomy is absolute. What is the biblical perspective? • If the “right to die” is grounded in personal autonomy, why limit expressions of autonomy to only terminally ill patients?

The Case for VAE and PAS: Argument from Autonomy • Response: • What do we mean by saying we have a “right to die”? • All will die. • Rather, we’re saying we have a right to determine when, how, and under what circumstances we will die. • The timing of death belongs to God.

The Case against VAE and PAS God’s role in life and death: God determines the beginning and end of life. Sanctity of human life: Human beings are imagers of God

The Case against VAE and PAS • Suffering may be redemptive • Preferring death but deciding to live (Phil. 1:21-26) • Suffering helps produce steadfastness on the way to “perfection” (James 1:2-4) • Suffering helps prepare the sufferer for eternity (2 Cor. 4:16-5:10) • Slippery slope • The “right to die” becomes the “duty to die.” • Distortion of doctor-patient relationship

Biblical Principles The human being as the image of God: Gen. 1:26-27; 5:1-2; 9:6 God determines the beginning and end of life: Heb. 9:27 Self autonomy and determination – Our bodies are not our own: 1 Cor. 6:19-20

Biblical Principles Responding to suffering: 2 Cor. 4:7-12; 12:7-10; Phil. 1:20-24; James 1:2-12 Preferring death but deciding to live: 2 Cor. 5:6-9; Phil. 1:20-24 Longing for the redemption of the body: Rom. 8:22-25; 1 Cor. 15:42-44, 53-57; Phil. 3:20-21; Rev. 21:4

Biblical Principles • Suffering and death may serve to bring about a good end, when they are mingled with faith. • Romans 8:28-39 • 2 Corinthians 12:7-10 • Hebrews 12:3-13 • James 1:12-18

Biblical Principles • Sickness, pain, suffering, and bereavement can contribute to our growth as Christians. • “Suffering so unbolts the door of the heart, that the Word hath easier entrance.” (Richard Baxter). • Makes us bitter or better • Can shape, temper, and mold us (Rom. 5:1-5) • Can engender compassion and empathy (2 Cor. 1:3-11)

Homiletic Hint These principles furnish the main substance of sermons on VAE and PAS. For example, a sermon that stresses one principle: “Life and Death are in God’s hands.”

Key Theological Reflections Life as gift and death as a conquered enemy Living (and dying) with an “eschatological horizon” in view

1 Corinthians 15:12-26 • “The last enemy to be destroyed is death.”… “Death is swallowed up in victory.” (15:26, 54) • “ With what kind of body?” (15:35) • Imperishable • Immortal • Glorious • Powerful • Spiritual

2 Corinthians 416-18; 5:1-10 “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day…an eternal weight of glory…what is unseen is eternal.” (4:16-18) “Now we know that if the earthly tent we live in is destroyed, we have a building from God…” (5:1-10)

Hebrews 2:14-15 “…he too shared in their humanity that by his death he might destroy him who holds the power of death—that is, the devil—and free those who all their lives were held in slavery by their fear of death…” (2:14-15) “Instead, they were longing for a better country—a heavenly one…” (11:16)

1 Thessalonians 4:13-18 “Brothers, we do not want you to be ignorant about those who fall asleep, or to grieve like the rest of men, who have no hope…”

Philippians 1:20-26; 3:20 “…so that now as always Christ will be exalted in my body, whether by life or death. For to me, to live is Christ and to die is gain…I desire to depart and be with Christ, which is better by far; but it is more necessary for you that I remain in the body…” (1:20-26) “But our citizenship is in heaven…” (3:20)

Lament • Sharing the voices of lament • The form of lament: • Invocation/address to God/cry of distress/ remembering God’s past deeds • Lament /complaint/protestation of innocence • Prayer of confidence/confession of trust • Petition for help • Words of assurance/motivations (reasons for God to act) • Vow of praise/thanksgiving/testimony

Lament and the story of Jesus • Jesus suffered on the cross • Mute suffering – three hours of silence • The voice of lament • Psalm 22 • In Matthew and Mark, the lament of Psalm 22 are the only words of Jesus on the cross • A voice of one’s own • “Father, forgive them…” (Luke) • “Father, into your hands I commit my spirit.” (Luke) • “It is finished.” (John)

Lament and the story of Jesus Lament belongs to the whole story of Jesus Compassion as discipleship

Attending to Suffering • Eric Cassell: • Suffering is both universal and particular • We are “storied”

W. H. Auden: Three Features of Suffering • The simultaneous identification with and alienation from the body • Sufferers experience isolation • The sufferer’s loss of voice

Attending to Suffering • Warren Reich: Three Stages of Suffering • First stage: mute suffering • Second stage: the voice of lament • Third stage: a voice of one’s own

End of Life: Euthanasia and Physician-Assisted Suicide