Years ago I read a short story about an old man alone in a city. His aloneness extended beyond the fact that he was walking by himself. His family had died or moved away, his friends were all dead, and so he had no one but himself. Then a well-lighted and attractive storefront caught his attention. He had seen it before, but this time he decided to go inside. The Orwellian name in neon lights did a poor job of concealing the fact that this was a suicide parlor.
Inside, friendly, attractive, smiling young women urged, encouraged, and cajoled him into signing the necessary papers. Then in a comfortable recliner under low lights, with soft music in the background, they bid him goodbye and gave him a lethal injection. This tale was meant, I believe, as a horror story about euthanasia, that is, “good death,” for that is precisely what it was, a horror story that is, nonetheless, a distinct possibility.
Consider that in four years the first of 77 million baby boomers will begin to retire. And while attention in Washington has been focused on the problematic future of Social Security, those numbers pale when compared with the ballooning cost of Medicare and Medicaid. Add the fact that the greatest medical costs are incurred in the last years of life and you have a sense of why a “right to die” (morphing into a “duty to die”) has such a wide hearing in our culture. Oregon already has a “physician assisted suicide” law and in the wake of the Terri Schiavo case it appears that many Americans—including many Christians—support some form of assisted suicide, reasoning, “I wouldn’t want to live like that.”
We Fear Suffering, Yet It is Inevitable
Fear of suffering grips us as a people. We fear personal suffering and the suffering of others. Personal suffering includes both physical pain and the loss of autonomy. The suffering of others includes personal, emotional, and financial burdens due to the care of an invalid. Yet promised suffering is a prominent feature of the cursing of Adam and Eve (Genesis 3:16-19), and a belief in human autonomy caused the curse.
The mystery of suffering is that though it is part of the Curse, suffering—the suffering of Christ—is what saves us. Suffering also betrays the lie of autonomy, and when we see another suffering it stirs us to compassionate love for our fellow human. Some conclude that compassionate love will mean ending another’s suffering by death.
Thomas Aquinas addressed a similar question, “Whether it is lawful to kill the innocent?” His response applies to the weak and the sick as well as the innocent: The one who kills such a person commits a grievous sin “ because he injures one whom he should love more, and so acts in opposition to charity.” The Scripture is filled with commands to care for the weak and the sick (Psalm 41:1; 82:3-4; Acts 20:35; 1 Thessalonians 5:14; James 5:14, to cite a few). Moreover, Jesus promises that when we care for the sick, we are looking after Him (Matthew 25:36). The sick and particularly the dying deserve our best care, and this is precisely where the difficulties arise.
Georgia was in her seventies. Five years earlier she suffered a stroke that left her wheelchair-bound with a host of complications. When she buckled over with abdominal pain, she was rushed into surgery. Her intestines had knotted and a long section had to be removed. She never regained consciousness. I visited Georgia just before the doctor “pulled the plug.” No gut-wrenching decision had to be made by the family. Her body and, by then, her brain had ceased to function. Within minutes of being disconnected, she was gone.
Contrast that to another stroke victim. Dan, about the same age as Georgia, was one of those “I’ve never been sick a day in my life” sorts. His stroke was serious, but not severe and certainly not life threatening. The paralysis and slurred speech would be overcome by therapy. He would not be “as good as new,” but he would be well.
Instead, a week later he lay unconscious, unfed, un-hydrated, and on morphine laboring to breathe. “I’m ready to go,” he had said to his daughter. Rather than recognize his words as a natural grief response to his new, limiting circumstances, she called hospice. Soon after, Dan was dead.
We Do Not Choose to Die. We Choose How to Live.
When is it permissible to “pull the plug,” that is, to refuse treatment that could prolong life, and when is it not permissible?
Gilbert Meilaender, professor of theological ethics at Valparaiso University wrote in the September 2004 First Things, “The answer of our medical-moral tradition has been the following: we may refuse treatments that are either useless or excessively burdensome. In doing so, we choose not death, but one among several possible lives open to us. We do not choose to die, but, rather, how to live, even if while dying, even if a shorter life than some other lives that are still available for our choosing.”
Georgia had reached a point in her life where additional treatment was useless. Her bodily systems had shut down. Withdrawing treatment was the moral choice. Don was just moderately sick. His capabilities may have been diminished, but his life did not need to be. He was not, in fact, dying at all. Cutting off food and water and prescribing morphine, a drug that depresses breathing, was not a refusal of useless or burdensome treatment. The aim was death and the commandment not to kill was violated. As the PCA’s position paper on “heroic measures” affirms, “To intend the death of a patient as a means to relieving suffering … is morally wrong.”
With those clear examples in mind, consider the case of Ben. Thirty years ago Ben had cancer. It was a tough road, but he beat it—or so it seemed. Last year the cancer returned, this time in his esophagus. After surgery to remove the tumor, he and his wife made a decision: no radiation and no chemotherapy. The burden of the surgery nearly killed him. The burden of radiation and chemotherapy in light of a poor prognosis was both useless and excessive.
In this Ben is not choosing to die. He is choosing the life he will live in this final phase of his earthly life. Meilaender writes, “We may reject a treatment on grounds of excessive burden. But if I decide not to treat because it seems a burden just to have the life this person has [or that I currently have], then I am taking aim not at the burdensome treatment, but at the life.” The PCA heroic measures position paper makes it clear that burdensome expense is also a valid consideration.
Bearing Witness to Human Dignity
While decisions should be made prayerfully by individuals and families consulting elders and physicians, the issue extends to government and public policy. Christians are to work for the common good and thus need to see to it that suicide parlors do not open up in our cities or our hospitals.
First, Christians must affirm the inherent value of all human lives. As Thomas Aquinas argued, our being is the gift of God and it precedes every human action, including thought. The crux of the “right to death” movement is that some lives, because of physical pain, emotional anguish, or physical or mental handicaps, are not worth living. Whether that unworthiness is in the judgment of the person himself or in the judgment of others, the result is the same: death. As Princeton professor Robert George noted, “What we must avoid, always and everywhere, is yielding to the temptation to regard some human lives, or the lives of some human beings in certain conditions, as lebensunverten Lebens, lives unworthy of life. Since the life of every human being has inherent worth and dignity, there is no valid category of lebensunverten Lebens. Any society that supposes that there is such a category has deeply, morally compromised itself.” And we are called to bear witness to human dignity and worth in just such a deeply, morally compromised society.
Second, the state alone may “bear the sword” (Romans 13:4). Only legitimate states may put someone to death. The right to yield lethal force is a great and terrible responsibility that is not to be delegated by the state for private use. Russell Hittinger, chairman of the Department of Philosophy and Religion at the University of Tulsa writes, “… the state’s monopoly on lethal force, as well as the constitutional constraints upon the way the state uses that force, cannot be an option for individuals. .... The fact that federal judges, as well as many citizens, perceive no danger in private franchises to use lethal force tells us much about our society. It tells us that people have forgotten what to fear.”
There is good reason for saying that we live in a “culture of death.” While we do not have suicide parlors in suburban shopping malls where the old, sick, or just plain tired can go to step aside for the young, healthy, and strong, we are headed in that direction. The challenge for the Church is to speak into that culture not merely with words, but by caring with compassion for the sick, the disabled, the weak, and the dying. In this way we bear witness to the truth that each life has value, each man and woman has dignity regardless of his or her condition, prognosis, or stage of life.
Jim Tonkowich is the managing editor of Breakpoint, a teaching elder in the PCA, and a member of Grace D.C. (PCA) Church.
