Wednesday, July 8, 2009

An Evangelical Christian Ethic for Life (ECEL), V: Euthanasia

Now we will discuss the topic of euthanasia. Euthanasia is from the Greek for “good death”: it is the act of what some would call mercy killing—an attempt to painlessly end a life.

There are essentially four categories of euthanasia:

• Passive Euthanasia: Passive euthanasia is the act of withholding common treatments (such as chemotherapy, blood transfusion, etc.), even though it will result in death. A special case of passive euthanasia is administering a pain medication like morphine to relieve pain, even when it is known that application of the drug will bring about death.

• Non-Active Euthanasia: Non-active euthanasia is the removal of life support (such as feeding tubes and breathing apparatus).

• Active Euthanasia: Active euthanasia is the purposeful application of medical methods to induce death, such as by lethal injection or the use of a euthanasia machine.

• Assisted Suicide: Assisted suicide is a special case of active euthanasia in which the individual applies the active euthanasia to themselves, with the assistance of another person (such as a physician).

In order to determine what is allowable and what is not, we must first understand what Christians have said regarding suicide and withholding of treatments; following an understanding of suicide we may discuss medical treatments, the nature of death, and finally draw our logical conclusions.

Christian Scripture does not discuss the morality or immorality of suicide explicitly at any point, which is quite surprising when one considers that suicide and mercy-killing has been commonplace since the dawn of man.

In Scripture, however, there are a number of suicides which occur, and three are discussed in detail: King Saul, Samson, and Judas Iscariot. In both of the Old Testament cases, the Scripture almost seems accepting of the suicide—Saul is given a war hero’s burial and traditionally Christians have concluded that Samson’s suicide is required as a result of God’s commandment.

The lone New Testament example is that of Judas Iscariot, who commits suicide following his betrayal of the Christ (Matt 27). Though Scripture clearly condemned Judas for the betrayal, it passes no judgment either positive or negative on the act of Judas’ suicide, rather simply relaying its actuality.

Therefore, we cannot draw any strong conclusion from Scripture as to whether suicide is morally acceptable.

Early Christian Fathers
Though Scripture is fairly silent, most of Christian history is on the same page as consistently anti-suicide. The two most important theologians of the medieval church, Augustine and Thomas Aquinas, both concluded that suicide was a sin and (in Catholic theology) an unforgivable sin. Throughout most of history, Christian burial was denied to those who commit suicide, and ancient Christian synods likewise condemned suicide.

Lactantius (c. 304-313 AD), stated that committing suicide was an act of murder—that it is irrelevant whether the man you kill is yourself or someone else, for you still kill a man. He also argues that if you kill yourself as a punishment for some sin, you commit two sins—murder (of yourself) and the vengeance for wrongdoing (which belongs to God alone).

This basic concept lasted throughout most of Christian history; famed writer G.K. Chesterton (1874-1936) wrote that suicide was worse than murder, for a murderer wishes to kill one man while a suicidal person wants the entire world to cease to exist to him.

We can from all of this conclude that Christian history has been consistently anti-suicide, though silent in the Scripture.

So What About Euthanasia?
All of that is interesting, but…suicide is not euthanasia. I began with a discussion of suicide so that we could define some basic boundaries, and from this point, continue on our argument.

What Christian tradition shows us is that it is not acceptable for a Christian to undertake actions that result in one’s own death. So the “suicide” extreme has been discussed.

But what of the other extreme—if a medical device or procedure is available to extend our life, does the dignity of human life require us to use it?

I do not believe that we are required to use methods to extend a life which is dying naturally. Death is presented as the inevitable end to life (Ecc 12:7; Psa 104:29), the result of the sin-infused world in which we live (Rom 5:12), and occurs to all of us (Gen 3:19, Rom 5:12). Furthermore, despite the numerous spiritual laws in the Old Testament regarding the sanctity of life, there are no laws which require the application and/or acceptance of medical intervention if someone is dying of natural causes. Furthermore, we are somewhat to look forward to death, as our transition into the next life (1 Cor 15:55-57, Phil 1:21).

So I think we may safely conclude that we are not required to use medical advances to prolong our lives, but that we are allowed to do so (physicians were quite common and acceptable throughout the Scripture).

General Rules
Thus, I conclude that we have two general rules provided us by logic, Scripture, and tradition:

1. Christians do not have the right to take active measures to end their lives prematurely.

2. Christians are not required to accept medical attention to avoid a natural death, but are allowed to do so as they choose.

These two rules both fall in line with the general thrust of Scripture, which establishes God as both the proper giver and ender of life.

Therefore, using these rules, we draw the following conclusions.

Passive Euthanasia
Passive euthanasia—the refusal of medical attention for a terminal condition—is completely acceptable. If a person chooses to allow natural sickness or injury to run their course, they are committing no moral sin.

Non-Active Euthanasia
Non-active euthanasia—the removal of life support from a terminal patient—is likewise acceptable. To make such a decision obviously must come from the appropriate legal guardian or living will, and should be done after much prayer and consideration: after all, life is precious and should be treated as such. However, there can be no sin in allowing nature to simply run its course, and thus non-active euthanasia also cannot be considered sinful.

In both of the above cases, to argue that it is sinful to allow an illness to run its natural course would be to argue that God committed a sin in inflicting them with the illness to begin with.

Things change, however, as we move into the next two categories.

Active Euthanasia
Active euthanasia as defined herein is the application of a lethal procedure to another person. There is a significant difference between passive euthanasia (which simply allows an illness to run its course) and active euthanasia (which commits euthanasia to avoid the inevitable death which will one day result from an illness). These are crucial differences. While it is acceptable to simply deny medical attention and allow nature to run its course, it is a quite different scenario to actively induce death in order to avoid the natural death which will one day result. Therefore, we cannot accept active euthanasia; it is an act of murder to take another person’s life, even if you do so in an attempt to be merciful. Therefore, a “mercy killing” or coup de grace (death blow) to shorten a dying person’s life is not an acceptable act for a Christian.

Assisted Suicide
Assisted suicide is no different from unassisted suicide, which we demonstrated earlier is out of touch with the long history of Christian tradition and thought on the subject.

Thus, we conclude that it is acceptable for a Christian to refuse medical treatment for a disease and therefore condemn themselves to death (passive euthanasia); likewise is it acceptable for a legal guardian or a physician via a living will to remove life support and allow death to occur naturally (non-active euthanasia). However, we must conclude that any active form of euthanasia or assisted suicide is wholly unacceptable, as the inducement of unnatural death to any person (including yourself) is the taking of a human life and is strictly forbidden.

(For a great article on how we as Christians should treat those affected by suicide, see Kennedy, 2000