Late last year, Washington D.C. mayor Muriel Bowser signed into law the Death with Dignity Act of 2016. It permits D.C. residents who suffer from a terminal disease with a life expectancy of less than six months (and who do not have a psychiatric diagnosis of depression) to request and receive a prescription of lethal medicine from their physician, which will cause death within three hours.
The Death with Dignity Act is a Physician-Assisted Suicide (PAS) law patterned after a similar measure that became law in Oregon two decades ago. Within the past few years, a number of states—Washington, Vermont, Montana, Colorado, and California—have enacted similar programs. While other states have voted against PAS, the assisted suicide agenda continues to have momentum across the country.
It’s helpful to note that physician-assisted suicide and euthanasia are not the same thing. Physician-assisted suicide refers to the practice whereby a doctor writes a prescription for a lethal drug or combination of drugs, which the patient ingests on his or her own, without the doctor present. Euthanasia refers to a physician directly administering a lethal drug to a patient. Unlike physician-assisted suicide, this procedure is legal in the U.S. and Europe and is becoming legal in Canada. In both instances, the explicit intent of the physician is to cause death. These practices should be understood to be absolutely distinct from the ethically and legally permissible practices of end-of-life care, whereby patients may forego or request discontinuation of high-tech, life-sustaining measures when these are deemed to be futile. In these latter situations, palliative care or hospice programs are available and effective; they are designed to improve the quality of life, not end it.
While most Christian traditions condemn the practices of PAS and euthanasia, there are several prominent Christian figures (among them, former Archbishop of Canterbury George Carrey and Archbishop Desmond Tutu), who have endorsed the practice. Christianity Today recently published poll data indicating that a significant minority (possibly as many as 40 percent) of self-described evangelical Christians believe that it is morally acceptable for a terminally ill patient to request—and for a physician to participate in—assisted suicide.
The history of PAS is complex and multifaceted; spatial limitations prevent me from doing it justice here, so a brief sketch must suffice. PAS, along with abortion, was commonly practiced in the ancient world. The philosophy of medicine established by the ancient physician Hippocrates (the Hippocratic Oath) set in place a hitherto unknown high moral code of conduct for physicians, which included accountability to “the gods.” The Hippocratic Oath’s proscription of both abortion and assisted suicide, then, was considerably countercultural. As the oath was incorporated into and refined by Judeo-Christian ethical thought, PAS became increasingly marginalized and condemned by mainstream medicine—no doubt practiced, but practiced surreptitiously and illegally.
Over the course of the next two millennia, the culture of medicine (along with society) shifted dramatically. The concept of patient autonomy was increasingly held as the highest moral imperative in guiding medical decision-making. Man was (and is) no longer regarded as an image-bearing creature with innate value; he was (and is) a self-creating producer whose value is directly associated with his conception of himself and the material benefits he provides for society. If there is no divine mandate that makes self-destruction morally prohibitive, then why shouldn’t someone choose to end his own life? As a result, physicians (most notably, Dr. Jack Kevorkian) began facilitating suicides for terminally ill patients. Before the arrival of the Internet, the Hemlock Society provided mail-order recipes and instructions to anyone who asked on how to commit suicide. More recently, the patients’ rights advocacy group Compassion & Choices (an outgrowth of the Hemlock Society) has taken up the cause of patients’ “entitlement” to make autonomous choices about the time, method, and location of their own deaths.
In 2014, Brittany Maynard, a young woman with advanced brain cancer, made international headlines when she died as a result of PAS under undisclosed circumstances. People magazine heralded Maynard as a hero. Compassion & Choices, riding the publicity wave generated by her death, has spearheaded the PAS movement across our land, deploying Maynard’s widower via Skype to debates and public hearings as a figurehead of their agenda. Furthermore, Compassion & Choices’ legal advisor has published PAS guidance in medical journals. Similarly, the practice in some European countries of procuring transplantable organs from patients who have died as a result of euthanasia has made its way into American transplant medical literature. There is a strong sense that the respective agendas of PAS/euthanasia and organ procurement will eventually intersect.
My heart goes out to Brittany Maynard and her young family, and to the myriad patients I have encountered over the years in my medical practices whose travail is great and suffering unknowable. Like Job, some may even long for death and be tempted to end it all (Job 2:9; 3). There is no sin in wishing for a release from pain and sorrow. That’s precisely why Christians uphold the virtue of compassion—the suffering alongside or with someone—as one of the hallmarks of loving our neighbor. Brittany was not defined by her suffering; her life was not made worthless or worthwhile by her health alone. (I understand that her perception of her life’s worth may be such that she didn’t feel that living in that state would be meaningful, but that is a different discussion.) Instead of making it easier for her to end her own life, society’s efforts (and the efforts of all Christians everywhere) should be focused on making her life (however long or short it may be) better. The transition from life to death should be eased through the love and care of family members, well-trained medical practitioners, and legislation that makes hospice and palliative care financially feasible, not abruptly terminated with a lethal prescription. The embrace of PAS and euthanasia by society and by the profession of medicine indicates that both have lost their way, and that the embrace of these practices by Christians signals a failure of the educational and pastoral care ministries of the church.
In addition to these concerns, it can be argued that PAS is dangerous to the community at large, as it lacks safeguards against abuse. Notification of a patient’s next of kin or power of attorney regarding such a critical decision is optional in the D.C. bill, effectively removing the counsel of trusted family and friends. PAS places the most vulnerable—the elderly and the disabled—at risk of coercion. Most terminally ill patients are too sick and weary to assert their rights, and they are dreadfully worried about becoming an emotional or financial burden on their loved ones. The “right to die” can become the “duty to die.” There are no accepted standards of practice, board certifications, or external oversight that govern this procedure. The physician (and, in some instances, the insurance carrier) can exercise considerable influence over the patient to advise whatever course of action he or she feels is best. This is not to say that the critical, hospice, or palliative care industries are above reproach—abuse and neglect are legitimate concerns.
The remedy, then, is to reform and improve these programs (and to reexamine the value we as a society place on human life), not to make physicians complicit in suicide pacts. Physicians are to be healers and counselors, not mediators of death. Even if these concerns were to be met—if there were greater regulation overseeing PAS procedures, or reforms to healthcare that made hospice or palliative care more financially feasible—they wouldn’t address the false premise that human beings are self-creating creatures with an absolute right to decide when to end their own lives. Physician and ethicist Edmund Pellegrino writes,
In ethics generally and medical ethics in particular, autonomy, freedom, and the supremacy of private judgment have become moral absolutes. On this view, human freedom extends to absolute mastery over one’s life, a mastery which extends to being killed or assisted in suicide so long as these are voluntary acts…. For the Christian, this is a distorted sense of freedom that denies life as a gift of God over which we have been given stewardship as with other good things.
Humanity is created in the image of God as the pinnacle of creation (Gen. 1:27) and declared as such to be good. Life is sacred. Death from the beginning was an aberrancy, the curse that Adam incurred for his autonomy-driven sin of disobedience. All proscription of the taking of innocent human life, beginning in Genesis 9:6 and codified in the sixth commandment, is predicated upon the sacredness of human life. In contrast to the mantra of “My life, my death, my choice!” Paul admonishes, “Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you are bought with a price. So glorify God in your body” (1 Cor. 19–20).
To assent to PAS is to reject the clear teaching of Holy Scripture and to reduce to mere sentiment the emotion of compassion, rather than to uphold the love and self-sacrifice required by true compassion. Jesus Christ, in his loving and sacrificial compassion, came alongside humankind—all of whom are afflicted with a terminal condition and death sentence—not to affirm or dignify death, but to defeat it and restore true and everlasting life to all who are in him. Death is the last enemy (1 Cor. 15:29). The debate over PAS is deeply emotional on both sides, and is in many cases driven by painful experience and awful fear of the future. Christian physicians are to come alongside those who are in such distress and use their education, expertise, and wisdom to alleviate this suffering. Christian stewardship is a stewardship of life. The way of the cross is to suffer alongside of those who suffer; to mitigate the effects of the curse, not help them deliver themselves up to it. Christ holds the keys to death and Hades in his hands, and we can comfort our brothers and sisters who succumb to the enemy’s assault with the certainty of their resurrection, so that even “as we go down to the dust, yet even at the grave we make our song: Alleluia, alleluia, alleluia.”
Allen H. Roberts II (MD, MDiv) is professor of clinical medicine and chair of the Ethics Committee at Georgetown University Medical Center, where he practices Critical Care Medicine.