We cannot decide the date and time we are born nor the date and time we die. The suicide and euthanasia argument centers around the patient’s decision in determining the time he or she chooses to die. Janet Adkins was fifty-four years old when she was diagnosed with early stages of Alzheimer’s disease. When informed about the course of the disease, she decided she did not want to live out the years in this progressive, deteriorating condition. She decided to kill herself but she wanted her death to be painless and dignified. She sought the help of Dr. Jack Kevorkian, a pathologist from Michigan, United States of America and fixed a date to die. On June 4, 1990 Dr. Kevorkian hooked her up to a heart monitor and an intravenous line. Janet Adkins pushed a button that released a lethal dose of medication, which killed her in 5 minutes. A murder charge was filed against Dr. Kevorkian but it was dismissed because the laws of the State of Michigan were vague against assisted suicide. Since then, the “Right-to-die” or euthanasia movement has been steadily gaining momentum.
On Wednesday, April 11, 2001, the Netherlands legalised euthanasia, becoming the first country in the world to allow doctors to end the lives of patients with unbearable, terminal illness. As of November 2017, human euthanasia is legal in the Netherlands, Belgium, Colombia, Luxembourg and Canada. Assisted suicide is legal in Switzerland, Germany, Japan, and in the US states of Washington, Oregon, Colorado, Vermont, Montana, Washington DC, and California. Euthanasia is often thought of as people who want to commit suicide because of various reasons, usually those suffering from incurable diseases. Euthanasia is actually wider than that. It also involves another party, usually a physician who will assist in the suicide, an act termed Physician Assisted Suicide (PAS). Physicians are healers not killers. Will they be forced to kill or assist in a suicide if their country legislated that euthanasia is legal? This is the dilemma facing the physicians in Canada today.
What is euthanasia?
Euthanasia is a Greek word meaning a “good death”. The present meaning of the word, euthanasia has come evolved to mean the intentional act of a person which causes the death of another that is terminally or seriously ill, often to end the latter’s suffering and pain. Commonly, euthanasia means mercy killing or assisted suicide. It implies that a doctor willingly, injecting or allowing someone to inject, a lethal dose of medication to kill a patient that is terminally or seriously ill to end his or her suffering. It is not euthanasia when doctors discontinue a treatment that is no longer effective and the patient dies.
The groundswell of support for euthanasia
Two strong cultural trends have arisen in the West and are currently globalised trends. One is the social construct of absolute autonomy. The other is the fear of pain. The concept of an individualised self is a recent one but has since become a powerful influence through this personal autonomy – ‘This is my body and I decide what I want to do with it and society has no right to interfere’. This movement of individualised autonomy is so powerful that it reforms modern medicine and empowers the issues of abortion, human sexuality, and euthanasia. Autonomy demands that people should have a say in when and how they die. This is closely related to the fear of pain and suffering. Society is full of distractions and other devices (including drugs) that minimise physical and emotional pain. It is this absolutised autonomy and fear of pain that provided the groundswell of support for euthanasia.
Modern medicine has not only prolonged life but it has also prolonged death. Efficient healthcare are enabling us to die by instalments. One of the fears many people have is to be in constant pain, whether from some disease or a cancer. This terrible pain occupies their whole life and there is no relief. Others fear that they may reach a point where they want to die in relative peace, only to find that they are forced to receive intensive and intrusive medical treatments that desperately attempt to prolong their lives. Yet others dread being bedridden for months or years, incapable of responding whatsoever to their families, relatives and friends. With the high cost of medical care, some fear that the medical bill for their terminal illness may put their spouse and children in debt for years.
Therefore, they want an option to be able to decide when they want to end their life. They want a ‘right-to-die’ and they want a doctor to help them to die painlessly. Some want to be allowed to make the decision to opt for euthanasia when they are dying while others want the option to instruct their doctors to end their lives when they, themselves are incapable of making the decision.
All these fears are real. Pain, incapacity, suffering and high cost of medical care are realities that confront us as our society become more developed and we live longer. We are now more likely to die from stroke, heart attacks and cancer than from accidents and infectious diseases. Stroke, heart attacks and cancer are often associated with high disabilities, pain, and suffering and expensive treatment modalities. Would it not make sense to have an opportunity to ‘check out’ if the going gets tough?
Perspective from Scriptures
Surprisingly, the Bible has little to say about euthanasia or mercy killing or assisted suicide. What about suicide? There are seven incidents of suicides in the Scriptures.
- Abimelech (Judges 9:52-54)
- Samson (Judges 16: 29-30)
- Saul and his armor bearer (1Samuel 31: 3-5)
- Ahithophel (2 Samuel 15:31b)
- Zimri (1Kings 16:18-20)
- Judas Iscariot (Matt 27:3-5)
Chronologically, the first mention of suicide in the Bible is Abimelech. After capturing the city of Thebez, he attacked a fortified tower in the center of the city. The Old Testament noted “ Abimelech went to the tower and stormed it. But as he approached the entrance to the tower to set it on fire, a woman dropped an upper millstone on his head and cracked his skull. Hurriedly he called to his armor-bearer, “Draw your sword and kill me, so that they can’t say, ‘A woman killed him’.” So his servant ran him through, and he died.” (Judges 9:52-54). Scripture neither approves nor disapproves of this act of assisted suicide. It was noted as a fitting end to an evil man. “Thus God repaid the wickedness that Abimelech has done to his father by murdering his seventy brothers.” (Judges 9:56). The next suicide, though it is arguable as there was a good cause and had divine sanction, was that of Samson. Samson pulled down the temple, killing himself and the Philistines (Judges 16: 29-30) Scripture regarded his act of suicide as a heroic act.
The suicide of Saul and his armor bearer elicit more comments. “The fighting grew fierce around Saul, and when the archers overtook him, they wounded him critically. Saul said to his armor-bearer, “Draw your sword and run me through, or these uncircumcised fellows will come and run me through and abuse me”. But his armor-bearer was terrified and would not do it; so Saul took his own sword and fell on it. When the armor-bearer saw that Saul was dead, he too fell on his own sword and died with him.”(1Samuel 31: 3-5). Even though Saul killed himself by his own sword, the chronicler noted that God himself killed Saul for his unfaithfulness. (1Chronicles 10:13-14). His armor-bearer chooses to die with his king, an example of suicide by identification. There was no comment on the suicide of Saul’s armor-bearer in the Scriptures.
Ahithophel was King David’s counselor. He became Absalom’s when Absalom rebelled against his father. David prayed that God would turn Ahithophel‘s counsel into foolishness (2 Samuel 15:31b). When Ahithophel found that his advice was ignored by Absalom, he hanged himself. (2 Sam 17:23). There was no comment in the Scriptures about this action.
Zimri came to the throne of Israel by assassination. The Israelites rebelled and besieged his city of Tirzah. “When Zimri saw that the city was taken, he went into the citadel of the royal palace and set the palace on fire around him. So he died, because the sins he had committed, doing evil in the eyes of the Lord and walking in the ways of Jeroboam and in the sin he has committed and had caused Israel to commit.” (1Kings 16:18-20). Here it was noted that his death was judgement for his sins.
Judas Iscariot was the only suicide mentioned in the New Testament. When Judas saw that Jesus was condemned, he was filled with remorse and tried to return the money. Then he went and hanged himself. (Matt 27:3-5)
It is interesting to note that in this brief survey of the seven suicides recorded in the Scriptures; the suicides of Abimelech, Saul and Zimri were recorded as direct judgement of God on their sins, even going as far as to say God killed Saul. The Scriptures were silent on the other four suicides though the ignoble context in each case speaks for themselves.
Therefore the Scriptures offered no specific guidelines on suicide, allowing each situation to speak for itself. Theologian Karl Barth noted in his multivolume Church Dogmatics that “a remarkable fact that in the Bible suicide is nowhere explicitly forbidden”. In addressing the issue of euthanasia we must look elsewhere in the Scriptures for guidance.
There are two Scriptural principles that can help us when we are confronted with the issue of euthanasia. The first is the sanctity of human life and the second is human autonomy and divine sovereignty.
Firstly, there are 4 inferences about the sanctity of human life that can be derived from the Scriptures. They are namely, human dignity comes from God, all human life has equal dignity, “Thou Shall not Kill” and, love your neighbour.
- Human Dignity comes from God. Human life are created in the image of God (Gen 1:26-27), so our dignity and God’s are closely related. “Whosoever sheds the blood of man, by man shall his blood be shed: for God made man in his own image” (Gen 9:6). Human life is a gift from God. In response, we should approach this life with gratitude, thanksgiving and deep responsibility.
- All Human Life has Equal Dignity. In Genesis 1:27: “So God created man in his own image, in the image of God he created him; male and female he created them.” Men and women bear the same dignity and this applies to all of mankind of all ages, sex, race and conditions. However incapacitated, mentally retarded, chronically ill, physically dependent or in a persistent vegetative state, they bear that dignity and have equal claims on us.
- “Thou Shalt not Kill”. The sixth commandment “Thou shalt not kill” (Ex 20:13; Deu 5:17) has its roots in the Creation’s narrative:- “Let us make man in our own image”(Gen 1:26) and in the Noahic Convenant’s “Whosoever sheds the blood of man, by man shall his blood be shed”(Gen 9:6). Man, being made in the image of God, is not to be intentionally killed. Ratsachis the Hebrew word translated as ‘kill’ in the commandment. It is similar to the Greek phoneuo, which means ‘murder’. Hence the sixth commandment forbids murder or ‘unauthorised, intentional or hostile killing of one human being by another’.
- Love your Neighbour. Jesus summarised the Commandments as ‘Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength’. The second is this: ‘Love your neighbour as yourself’. (Mark 12:30-31). Christians are called to love their neighbours. And this includes taking care of each other and looking out for each other. It does not include helping each other to die.
Secondly, there is the human autonomy and divine sovereignty principle. Human autonomy is the main argument for euthanasia. Christians must take the claims of autonomy with great seriousness. We are created in the image and likeness of God (Gen 1:26-27). An essential part of that image is our ability to make free choices. The Scriptural model for human autonomy, self-determination and human responsibility is portrayed in Genesis 2:19. As Hebrew scholars have noted, to ‘name’ something is not simply to label it; it is to give it a meaning and order it in the nature of things, Hence, Adam is called upon to continue the creation by bringing order into being, rather than simply replicating preordained orders. This is stewardship.
The fundamental distinction between the Creator and the created (His creation) sets limits to the freedom and scope of our stewardship. The limitations to human autonomy or self-determination is found earlier in Genesis 2:15-17. The story asserts a fundamental conviction of biblical faith that from the very beginning human freedom over life was limited or proscribed. God alone have sovereignty over life and death. The end of human life is not subject to a person’s free judgement. Our freedom does not extend to absolute dominion. Absolute dominion is an exclusively divine prerogative. The principles of divine sovereignty and human stewardship and responsibility argue against unlimited autonomy.
Therefore the Scriptural principles on the sanctity of human life and divine sovereignty and the limits of human autonomy argue against euthanasia which violates both these principles.
Alternative to Euthanasia
There must be viable alternatives to euthanasia if we are to face the realities of pain and suffering during terminal or serious illnesses. This is where Christians must be in the forefront of offering viable alternatives. Instead of an action to end life, the alternative to euthanasia is death with dignity.
There have been tremendous advances in pain control. Pain clinics are established in all government general hospitals. Advances in pain control medication have allowed better pain reduction with minimal side effects. Precision surgical procedure allows for disconnecting pain pathways. Church visitation groups can help in pain control by visiting and befriending the sick.
Palliative care or care of the dying have also made significant advances in the last few years. One of the changes is that patients are beginning to have more say in their treatment. With improved education and better access to information, patients may discuss with their doctors and spell out what treatments may or may not be given, when to stop when treatment fails and when extraordinary medical measures may not be taken. Extraordinary measures include putting a terminally ill patient on a ventilator when there is no hope for recovery. All these may be written down or spelt out in a ‘living will’ and/or a ‘medical directive’.
Medical costs will continue to escalate. There is need for better financial planning especially in medical insurance coverage. This will help alleviate the financial burden that a major illness imposes on the family.
A remarkable recent development is the modern hospice care. Hospice care enables helping terminally ill patients to die with dignity. The Hospice organization was founded in London by a devout Christian, Dr. Cicely Saunders at St. Christopher’s Hospice and rapidly expanded worldwide. Its rapid growth is a testimony to the urgent need of helping patients to ease their dying process as opposed to the use of medical technology to keep them alive. In Malaysia, Hospis Malaysia and a few other non-government organizations have a few centers around the country but there is a great need for the Church to be involved in setting up and running hospices.
Prayer is a powerful alternative to euthanasia and the Church is the best-equipped organization to offer it. It is one of the great mysteries of the universe that God will listen and act upon the prayers of his people. The Church has a God given role to pray for the sick (Jas 5:14-16) and those facing death. The Church will have failed in its mission if it does not pray for and with the sick and dying.
Death with Dignity
Euthanasia or mercy killing or assisted suicide is laudable because it is an action based on compassion. Unfortunately its basic premises are flawed as it goes against the Scriptural principles of the sanctity of human life and divine sovereignty and human autonomy. The Christian alternative of death with dignity is a better choice.