1. Introduction
2. Societal-Legal Problems with Kyle’s View
2.1. None of the American Medical Association, the American Psychological Association or the American Psychiatric Association endorse Kyle’s position. This undermines the credibility of Kyle’s claim that a fundamental right to PAS is “self-evident.”
2.2. The U.S. Constitution does not state or imply a right to PAS, as SCOTUS has ruled in two unanimous judgments that direct contradict Kyle’s claims. This further undermines the credibility of Kyle’s claim that a fundamental right to PAS is “self-evident.”
2.3. SCOTUS has signalled that the PAS issue is to be left to the States to be decided democratically. This undermines Kyle’s claim that it would be tyrannical for a State to prohibit PAS (unless democracy itself is tyranny).
2.4. The U.S. Constitution guarantees the right of private citizens and government officials to be guided by their religious convictions in forming their political positions and voting decisions.
2.5. The First Amendment’s Establishment Clause is no impediment to laws prohibiting PAS, since such laws clearly pass the Lemon Test.
2.6. Rev. Martin Luther King, Jr. is a shining example in American history of a private citizen extending his Christian religious values into the political sphere with positive results.
3. Moral-Theological Problems with Kyle’s View
3.1. Kyle uncharitably portrays religious opponents of PAS as indifferent to suffering. Nothing could be further from the truth.
3.2. Kyle’s position assumes that liberty is a more fundamental right than life itself—a self-contradictory notion, since life is a necessary condition for liberty.
3.3. Kyle focuses exclusively on the consequences of legalising PAS for the individual sufferer who requests it, showing no awareness of broader or longer-term societal consequences such as “slippery slope” effects and stigmatisation of people who have low “quality of life”.
3.4. Catholic moral teaching on end-of-life issues is genuinely pro-life and sensitive to suffering.
3.5. The Bible has little to say directly about suicide, but one should beware of arguments from silence claiming that God therefore leaves this moral issue up to individual judgment. Besides, the Bible does equate assisted suicide with murder in 2 Samuel 1.
3.6. There are numerous biblical principles that weigh against a "right" to commit PAS, including (1) the dignity of human life as created in God's image, (2) God's sovereignty over life and death, (3) God's ownership of each human person, (4) the commandment to love oneself, (5) the practice of godly people of deferring to God even when death seems desirable, (6) death as an enemy and not a friend, and (7) the mystery that suffering is meaningful.
4. Conclusion: A Culture of Life and a Culture of Death
1. Introduction
Recently I engaged in an
exchange of views on Facebook with Kyle Tucker on the subject of physician-assisted suicide (PAS) or what Kyle calls “the fundamental right to end our lives under medical supervision when pain or insufficient quality of life render living insufferable”. The discussion broadened to include the place—or lack thereof—of “religious values” in political discourse. In what follows I offer further commentary directed to Kyle and whomever else considers these issues to be as important as I do. In the first part of my response I will focus on the societal-legal side of the issue (in the context of American constitutional democracy) and in the second part I will focus on the moral-theological side of the issue from a Christian—specifically Catholic—perspective.
I have known Kyle personally for many years. He is a Christadelphian living in the United States, while I was raised as a Christadelphian in Canada, regularly attending Christadelphian functions and visiting family in the United States. I had the pleasure of sitting under Kyle’s teaching in youth sessions at Christadelphian Bible Schools, and later benefited from the spiritual “Thought for the Week” that he used to send out to an email list. Subsequently I left the Christadelphians, becoming an Evangelical and now a Roman Catholic. (Anyone interested in reading about my personal spiritual journey may do so
here.) Even as I grew increasingly disenchanted with Christadelphian theology, I continued to regard Kyle as bringing a helpful reformative perspective to the Christadelphian community—for instance, being more outward-looking (where an insular mentality sometimes prevails), and teaching a doctrine of the kingdom of God that incorporated both its present and future aspects (where Christadelphians have traditionally denied or minimised its present aspect). I have always looked up to Kyle as a man of principle and leadership (and an all-around nice guy). In view of this, Kyle’s comments on Facebook the other day struck me as out-of-character. At points in the dialogue I felt as though I were interacting, not with a lay Christian teacher, but with a secular humanist ideologue.
Kyle’s OP, posted to Facebook as a status update, read as follows:
We are allowed to give end of life directives (e.g. DNR) why not end of quality of life directives? It is bizarre to me that we don't have the fundamental right to end our lives under medical supervision when pain or insufficient quality of life render living insufferable. Why, for example, can't I put in place measures today in the event of say Alzheimer's Disease? We're kinder to pets than humans.
Make no mistake about the radicality of Kyle's proposal: the scope of the “fundamental right” that he asserts goes beyond anything that is currently legal in the United States, including in states that have passed legislation permitting PAS.
I initially misinterpreted the scope of Kyle’s comment. Knowing that he is a Christadelphian, and that Christadelphians eschew participation in politics (the most widely used Christadelphian statement of faith states, “We reject the doctrine – that we are at liberty to take part in politics”) I assumed that Kyle was making a theological statement directed at fellow Christadelphians or at least fellow Christians. However, his ensuing comments clarified that he was making a political statement directed at anyone and everyone. I will leave Kyle and his fellow Christadelphians to decide whether making public political statements is consistent with the Christadelphian doctrine of non-participation in politics. My concern is rather with the substance of Kyle’s post and his ensuing comments about the imposition of “religious values.” I bear Kyle no ill will and hope that my attack on his ideas will not be construed as an attack on him personally.
Because I initially interpreted Kyle’s OP as a theological statement, my initial comment asked whether his position was not contrary to the fundamental Christian value of enduring suffering patiently. Kyle’s response—which made it clear that his statement was politically oriented—was, “Should Christians dictate to everyone the right to determine whether they want to live in insufferable pain? Should anyone’s personal religious values determine another person’s choice in this matter?” Ensuing comments revealed Kyle's opposition to Christians who impose their "personal religious values" concerning PAS on others, which he views as symptomatic of a larger problem in the U.S., namely that Christians “wish to impose their morality on others”. According to Kyle, for religiously motivated people to politically oppose PAS is both immoral and unconstitutional. It is “immoral,” he declared, “to use religion to promote a policy which increases human suffering while not allowing that person [i.e. the suffering PAS candidate] any say in the matter.” It is unconstitutional, he maintained, “When people seek to impose religion through law which contradicts another’s religious conviction”.
Kyle apparently sides with those who envision religion as an essentially private affair that should be kept out of politics: “you should be able to practice your Christian virtue as a Christian but it is inappropriate to extend such a painful philosophy into the political sphere where now everyone must follow this.” It is legitimate for Christians to “fight for their right to practice their religion,” but not for Christians to “impose their religion on others even if it involves the suffering of others”.
Kyle stepped up his rhetoric when he declared that “the fundamental right to end one’s life” is “self-evident,” and that to deny this right would be “tyranny.” Kyle explained why this is tyrannical: “If your religion or politics forces me against my will to follow a practice I don’t agree with for no crime or misdeed and I suffer horribly as a result, that is the very definition of tyranny.” (This statement, of course, begs the question, since it assumes that PAS is “no crime or misdeed”—the very issue under debate!)
Kyle characterises the logic of “religious values” politics, which is “the very definition of tyranny,” thus:
1. I know better than you what is right for you.
2. I have the power to impose my will on you.
3. If you suffer horribly as a result, too bad.
His own stance on assisted suicide, which he regards as self-evidently correct, he expressed thus: “I prefer the simpler method of allowing me to make those calls regarding me and you make those calls regarding you.” His position thus makes self-determination the paramount value and dismisses the possibility that the People may have legitimate reasons (or even a moral obligation) to "impose" a prohibition on PAS.
In what follows, I will argue for a number of propositions in response to Kyle’s position on PAS and religious values in the political sphere, focusing first on secular legal aspects and then on moral-theological aspects. I must preface my remarks on the U.S. Constitution by acknowledging that I have no formal training in law and that I am not American. I do not think this disqualifies me from offering opinions on what is or is not constitutional (as Kyle also did), but I don’t claim to be an authority on the matter.
The American Medical Association is
opposed to physician-assisted suicide, opining that “permitting physicians to engage in assisted suicide would ultimately cause more harm than good” and that “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.” In fact, this ethical stance is not new to the medical profession, but is found in the Hippocratic Oath, which pronounces “twin strictures against abortion and euthanasia in uncompromising language”.:
I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a pessary to cause abortion. I will keep pure and holy both my life and my art.
The
American Psychological Association “takes a position that neither endorses nor opposes assisted dying at this time.” The
American Psychiatric Association, “in concert with the American Medical Association’s position on Medical Euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”
Bearing in mind that Kyle implicitly advocates for access to PAS for non-terminally ill persons (e.g., Alzheimer’s patients), what he calls a “self-evident” “fundamental right” is opposed by both the American Medical Association and the American Psychiatric Association and is not endorsed by the American Psychological Association. Can he really maintain that a practice that lacks the endorsement of such distinguished organs of the medical fraternity is self-evidently a fundamental right?
In two 1997 cases (Vacco v. Quill; Washington v. Glucksberg), the U.S. Supreme Court (SCOTUS) was asked to strike down state laws prohibiting assisted suicide in New York and Washington on the grounds that these laws violate the Fourteenth Amendment. In both cases SCOTUS upheld these prohibitions in unanimous 9-0 decisions. In view of the assumption of Kyle’s OP that there is an essential equivalence between DNR provisions and PAS, it is noteworthy that this argument was offered to the Court in Vacco v. Quill and that the Court rejected it, stating that “The distinction between letting a patient die and making that patient die is important, rational, and well-established: It comports with fundamental legal principles of causation…and intent…”
In Washington v. Glucksberg, the petitioners held that the liberties protected by the Fourteenth Amendment’s Due Process Clause include “a personal choice by a mentally competent, terminally ill adult to commit physician-assisted suicide.” They thus argued that Washington, by banning assisted suicide, was depriving people of a constitutionally protected liberty. The Court, again in a unanimous decision, ruled that Washington’s law prohibiting assisted suicide did not violate the Due Process Clause, because “the asserted ‘right’ to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause.” Once again, SCOTUS unanimously contradicted Kyle’s claim that PAS is a fundamental right, despite Kyle holding that such a right is “self-evident.” SCOTUS has, of course, not been averse in recent decades to "finding" dubious fundamental rights in the Constitution that conflict with traditional Christian morality (Roe v. Wade, 1973; Obergefell v. Hodges, 2015), so Kyle can hardly claim that the SCOTUS judgments on PAS reflect religious tyranny.
The 1997 SCOTUS judgments upholding state PAS laws did not rule that PAS is unconstitutional, only that it is not a liberty protected by the constitution. At the time, Oregon had already legalised PAS through its so-called Death with Dignity Act of 1994. This law would be effectively upheld by SCOTUS in a 2006 judgment (Gonzalez v. Oregon) by a 6-3 margin.
SCOTUS’s overriding concern in this case was that the authority to prohibit or permit PAS be left to the States to decide through democratic processes. SCOTUS had
held in 1997 that
Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in a democratic society.
In Gonzalez v. Oregon the judgment of the Court again referred the PAS issue to the States, rescinding the Attorney General’s attempt “to effect a radical shift of authority from the States to the Federal Government to define general standards of medical practice in every locality.”
If the States have the authority to decide whether to permit or prohibit PAS democratically (which in practice normally happens through ballot measures [referenda], the most direct form of democracy), how can it be tyranny when a State democratically decides to enact or preserve laws prohibiting PAS? Kyle construes this as “I have the power to impose my will on you,” but this is clearly not the case. The people have the power to impose their collective will on the people, and yes, individual persons must abide by the laws of their State. What Kyle calls tyranny is nothing other than a democratic society in which the rule of law is respected.
Kyle’s other objection to the PAS issue being decided democratically is what he regards as the inappropriate intrusion of “religious values” into the political sphere, which he considers unconstitutional. It is nothing of the kind.
The two provisions in the U.S. Constitution that explicitly concern religion are in the First Amendment, which reads:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; of the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.
The first clause, known as the Establishment Clause, places restrictions concerning religion on Congress (which in judicial interpretation has been broadened to mean any governmental organ), and not on “the people.” The Constitution places no restriction on the people’s right to freely exercise their religion; it explicitly protects this right in the next clause, the Free Exercise Clause. Now, the Free Exercise Clause is not absolute. SCOTUS precedents have placed constraints on it so that it cannot be used to justify all manner of otherwise unlawful practices on the grounds of religious obligation. However, the First Amendment in no way stipulates what ideological resources—religious or otherwise—people may or may not use to form their political consciences. To compel the people to keep their religious values private and personal and conform their politics to some secular ideological orthodoxy is to do violence to the First Amendment and impose precisely the kind of tyranny that Kyle claims he wants to avoid.
As for elected officials, they have the same religious freedoms as other citizens. Indeed, the Sixth Article of the U.S. Constitution stipulates that “no religious test shall ever be required as a qualification to any office or public trust under the United States.” To bar elected officials from being influenced by their religious convictions in their politics would blatantly impose a religious test.
Since 1971, the Establishment Clause has generally been interpreted under the “
Lemon Test” (from
Lemon v. Kurtzman, 1971), which stipulates that a law does not violate the Establishment Clause provided that it meets three conditions:
First, the statute must have a secular legislative purpose; second, its principal or primary effect must be one that neither advances nor inhibits religion; finally, the statute must not foster an excessive government entanglement with religion.
As far as I know, no significant legal challenge to State PAS prohibitions has even been mounted on the grounds that they violate the Establishment Clause. Such prohibitions obviously do not violate the Lemon Test. In terms of secular legislative purpose, SCOTUS itself, in its Opinion in the unanimous Washington v. Glucksberg judgment, identified no less than six State interests (i.e., secular legislative purposes) in laws prohibiting PAS:
The court identified and discussed six state interests: (1) preserving life; (2) preventing suicide; (3) avoiding the involvement of third parties and use of arbitrary, unfair, or undue influence; (4) protecting family members and loved ones; (5) protecting the integrity of the medical profession; and (6) avoiding future movement toward euthanasia and other abuses.
Kyle maintains that bans on PAS are unconstitutional because they “seek to impose religion through law which contradicts another’s religious conviction”. This is equivalent to claiming that PAS bans violate the second condition of the Lemon Test by advancing or inhibiting religion. However, a law banning PAS in no way advances, much less “imposes,” religion; it simply prohibits a particular activity that proponents and opponents all agree is secular (proponents classify PAS as medical treatment; opponents classify it as a kind of homicide). It would be ludicrous to claim that a law violates the Establishment Clause because it contradicts some people’s religious convictions, or because it is consistent with some people’s religious convictions. If the Lemon Test were applied in this way, very few laws would pass it! More to the point, state laws permitting PAS would be equally unconstitutional, since they too contradict some people’s religious convictions.
In our Facebook exchange, I asked Kyle whether he thought it was inappropriate for Dietrich Bonhoeffer to draw on his Christian convictions in opposing the Nazi euthanasia program. Kyle responded only that he was not very familiar with Bonhoeffer but was against Nazism. If Kyle is prepared to read up on Bonhoeffer, the question still stands. However, let us also consider an exemplary figure from American history: the Rev. Martin Luther King, Jr. Through his leadership in the Civil Rights Movement, Dr. King was instrumental in the racial desegregation of the southern states. But did Dr. King bracket out his Christian religious convictions when trying to influence public policy? Quite the opposite. Dr. King’s 1963 Letter from a Birmingham Jail, considered a key primary text of the Civil Rights era, was a letter from one clergyman to other clergymen, remonstrating with them about the moral, legal and theological justness of his political activities. Dr. King believed it was not merely appropriate but imperative for Christians to use their convictions to influence public policy. He pointed out how Christians had in the past “transformed the mores of society” and so put an end to “such ancient evils as infanticide and gladiatorial contest.” He lamented that the contemporary church is “so often a weak, ineffectual voice with an uncertain sound,” imprisoned by “the paralyzing chains of conformity”.
Consider further Dr. King’s historic I Have a Dream speech. Delivered in the nation’s capital during the March on Washington for Jobs and Freedom, its aims were overtly political, yet much of its language was religious. Rev. King cited several biblical passages and concluded by envisioning “that day when all of God’s children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual, ‘Free at last! Free at last! Thank God Almighty, we are free at last!’” By offering this vision to America, was Dr. King engaging in what Kyle considers tyranny—seeking to impose religious values on the non-religious? Or was he harnessing the intrinsic goodness of those values to overthrow tyranny?
Dr. King’s view on the role of religion in politics is captured by his classic statement on the church as the conscience of the state:
The church must be reminded that it is not the master or the servant of the state, but rather the conscience of the state. It must be the guide and the critic of the state, and never its tool. If the church does not recapture its prophetic zeal, it will become an irrelevant social club without moral or spiritual authority.
Dr. King has it exactly right. At its best, the church through history has been an agent for positive change by speaking truth to power with prophetic zeal. Regrettably, there have been times in history when the church behaved more like the master of the State. There have also been times when the church behaved more like the servant of the State, allowing herself to be silenced or even used to further ungodly political agendas. It is arguably this servile role into which much of the American church has retreated as right-wing propagandists use the romantic image of a Christian nation to peddle a gun-loving, anti-immigrant agenda that has no part with Christian morality. However, Kyle’s vision of a church that enjoys religious freedom in private, keeps out of the political sphere and preaches self-determination and moral relativism is equally servile (this time subject to a postmodern secularist-humanist agenda) and equally destructive of the church’s prophetic zeal.
We have established that PAS is not a self-evident fundamental right in an American constitutional framework, but rather a constitutionally ambiguous issue that the Courts have signalled is to be decided through democratic processes. We have noted that some major secular voices (e.g., American Medical Association and American Psychiatric Association) have weighed in against Kyle’s view, refuting any notion that opposition to PAS is solely on religious grounds. We have further established that, constitutionally speaking, religious people have every right to involve their religious values in the democratic process of political discourse. It is now time to hear a religious perspective on PAS. This perspective is mine, but more importantly it reflects the teaching of the Catholic Church.
Kyle depicts religious opponents of PAS as wishing to “impose their religion on others even if it involves the suffering of others,” and as saying to those whom it wishes to deny access to PAS, “If you suffer horribly as a result [of our religious imposition], too bad.” In other words, religious opponents of PAS are basically indifferent to the suffering of people who do not share their stance against PAS. In the case of my own religious affiliation, and probably most others, this is a manifestly inaccurate portrayal.
According to
The Catholic Association, the Catholic Church “founded the modern-day hospital system, manages approximately one-fourth of the world’s healthcare facilities, and is the largest non-governmental provider of healthcare worldwide and in the United States.” As of January 2018, the
Catholic health ministry comprised “more than 600 hospitals and 1,600 long-term care and other health facilities in all 50 states”. When the Catholic Church addresses ethical questions concerning care for the suffering and terminally ill, she does so with a vast wealth of experience on which to draw.
Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.
This differs starkly from Kyle’s depiction of the attitude of religious opponents of PAS, namely, “If you suffer horribly…too bad.”
Kyle implicitly makes self-determination and putting an end to suffering (or low quality of life) among the highest goods in his value system. These goods both operate at the individual level, and Kyle shows little interest in the effects of PAS at the macro, societal level.
There are, of course, many laws that restrict individual liberty—that “impose” on people, sometimes against their will and with adverse effects upon them. The State wants to tax my income; it does not ask me whether I agree for my income to be taxed, or of what goods I may be deprived by paying the tax. The State imposes this on me because it judges taxing me to be in the common interest, to serve a good greater than my personal liberty. Sometimes the State imposes rules on me that are primarily designed to serve my personal interest. By requiring me to wear a seatbelt or a motorcycle helmet, and fining me if I refuse, the State declares, “I know better than you what is right for you.” Clearly, then, self-determination is not an absolute good but is subject to the common welfare of society, including the welfare of each "self" within that society.
Kyle’s pro-PAS stance assumes that the right to self-determination extends as far as the right to self-destruction, at least under certain “insufferable” circumstances. This implies that the right to liberty trumps the right to life. Kyle offers no argument why liberty is a more fundamental right than life itself—he always returns to his claim that his position is "self-evident." Yet life is a necessary condition for liberty and death deprives a person of all earthly liberty. Therefore, the liberty to deprive oneself of life is nothing other than the liberty to deprive oneself of liberty—a contradiction in terms. A law that permits PAS safeguards one liberty—a self-contradictory one at that—at the expense of all others, whereas a law that prohibits PAS safeguards all liberties at the expense of one.
We mentioned earlier that SCOTUS has identified six State interests in prohibiting PAS:
(1) preserving life; (2) preventing suicide; (3) avoiding the involvement of third parties and use of arbitrary, unfair, or undue influence; (4) protecting family members and loved ones; (5) protecting the integrity of the medical profession; and (6) avoiding future movement toward euthanasia and other abuses.
The interests in preserving life and preventing suicide are self-evident. On protecting the integrity of the medical profession, one may refer to commentary on the American Medical Association’s and American Psychiatric Association’s respective positions on PAS. I would like to focus briefly, however, on protection of the vulnerable and avoiding future movement toward euthanasia and other abuses.
Kyle’s position advocates for restricted voluntary PAS based on two value judgments. The first value judgment is a high view of self-determination: a person’s right to control (including to kill) one’s own body. For Kyle, self-determination is not absolute, because he would restrict access to voluntary PAS to those with low quality of life (as measured by pain or lack of cognitive function). This restriction implies Kyle’s second (unstated) value judgment: that the worth of human life is proportional to quality of life. Consider two people who wish to access PAS. One is experiencing severe, irreversible pain and the other is physically and cognitively healthy (has high quality of life). Kyle apparently wishes to grant the first person’s death wish but not the second person’s. Why does Kyle want to protect the second person’s life, overruling the person’s own self-determination, but not the first person’s? It can only be that, in Kyle’s view, the second person’s life is intrinsically worthy of protection (because of its higher quality) while the first person’s life is not (because of its lower quality). In the words of Pope St. John Paul II:
How is it still possible to speak of the dignity of every human person when the killing of the weakest and most innocent is permitted? In the name of what justice is the most unjust of discriminations practised: some individuals are held to be deserving of defence and others are denied that dignity? (Evangelium Vitae 19)
A fundamental moral principle is that all human persons are equal in dignity and worth and thus all human life equally worthy of protection. A sliding scale in which the value of human life is proportional to quality of life is grossly immoral. Thus, if access to PAS is to be granted on the grounds of self-determination, it must be granted to everyone equally. Yet any reasonable person would consider it horrific to allow physically and cognitively healthy people to access PAS—e.g., a 47-year old father of three whose wife has just left him, or a 19-year old girl who has just been “slut-shamed” on social media, or a convicted murderer who has been sentenced to life imprisonment without parole. If we would deny PAS to such people, we must deny it to everyone.
The graph below shows the risk of a “slippery slope” in two directions once voluntary PAS is permitted under restrictive conditions such as those currently stipulated in Oregon and other states (the patient must be terminally ill in the judgment of two physicians). Some will advocate moving the graph to the right, i.e. making voluntary PAS more widely available on the grounds of self-determination and equality. If some have access to PAS, why not others? Who are you to tell me that your condition is insufferable and mine is not, just because yours is terminal? Who are you to tell me that physical pain is insufferable and psychological or emotional pain is not? Dutch euthanasia laws require that the patient and physician agree that the patient is experiencing unbearable suffering without prospect of improvement and that there is no reasonable alternative to euthanasia. However, the onward march of self-determination means that it is finally up to the patient to decide whether suffering is bearable, and whether an alternative to euthanasia is reasonable. As Dutch ethicist and euthanasia Evaluation Committee member Gover Hartogh
explains,
The patient suffers unbearably when he says he suffers unbearably and an alternative is not a reasonable alternative if the patient rejects it. In fact, these requirements then add little to the requirement of a voluntary and thoughtful request.
The Slippery Slope from Restricted Voluntary PAS toward Involuntary PAS and Unrestricted Voluntary PAS
As mentioned previously, Kyle is already further along the horizontal axis than any U.S. law, since he supports the right to PAS for non-terminal patients. It is difficult to see how he could argue successfully against unrestricted voluntary PAS given the stand he has taken for self-determination.
The other slippery slope concerns the movement from voluntary to involuntary PAS. Here, too, Kyle is already further up the curve than any U.S. law: he advocates for people to be able to give consent for PAS in advance, e.g. in case of dementia. This means he endorses the idea that a person can be killed who cannot at the time consent to this—already a serious compromise to the “voluntariness” of PAS which leads to scenarios such as
the following from the Netherlands:
In 2016, there were three reports of euthanasia of deep-demented persons who could not confirm their death wish. One of the three was identified as having been done without due care; her advance request could be interpreted in different ways. The execution was also done without due care; the doctor had first put a sedative in her coffee. When the patient was lying drowsily on her bed and was about to be given a high dose, she got up with fear in her eyes and had to be held down by family members. The doctor stated that she had continued the procedure very consciously.
If a cognitively impaired person can be killed on the basis of prior written consent, what about, say, a cognitively impaired young child, or a person who becomes cognitively impaired unexpectedly? Could the parents consent to PAS on the child’s behalf? (This is already an accepted, though nominally illegal, practice in the Netherlands under the
Groningen Protocol.) Could a next-of-kin consent to PAS on behalf of an unexpectedly cognitively impaired person? The view that the value of human life is proportional to quality of life makes such possibilities worthy of consideration, because the persons in question are regarded as typical PAS cases, and it is not that they refuse PAS, it is only that they are incapable of consenting to it.
Aside from explicitly involuntary PAS there is the issue of “voluntary” PAS of vulnerable persons under social or psychological pressure. Such pressure could be exerted by relatives, health care workers or the media who convey the message that PAS is the right thing to do for people with a certain condition or quality of life. People who express reluctance to request PAS could be made to feel like a burden on their families, on healthcare infrastructure or on society. Relatives and health care workers could add to the pressure by neglecting the patient’s needs, driven by the conscious or unconscious assumption that the patient’s life is unworthy of preservation. One Canadian ALS patient
was explicit that his decision to request PAS was motivated by poor care:
It’s not the illness that’s killing him, Rolland said in a series of emails with the Montreal Gazette. He’s tired of fighting for compassionate care. “The people here don’t understand ALS and can’t look after me. It is unbearable.”
As SCOTUS stated in its Washington v. Glucksberg judgment:
We have recognized, however, the real risk of subtle coercion and undue influence in end-of-life situations. Cruzan, 497 U. S., at 281. Similarly, the New York Task Force warned that "[l]egalizing physician-assisted suicide would pose profound risks to many individuals who are ill and vulnerable .... The risk of harm is greatest for the many individuals in our society whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, advanced age, or membership in a stigmatized social group." …If physician-assisted suicide were permitted, many might resort to it to spare their families the substantial financial burden of end-of-life health-care costs.
The State's interest here goes beyond protecting the vulnerable from coercion; it extends to protecting disabled and terminally ill people from prejudice, negative and inaccurate stereotypes, and "societal indifference." 49 F. 3d, at 592. The State's assisted-suicide ban reflects and reinforces its policy that the lives of terminally ill, disabled, and elderly people must be no less valued than the lives of the young and healthy, and that a seriously disabled person's suicidal impulses should be interpreted and treated the same way as anyone else's.
The weight of this social pressure would only increase as PAS became more common and move from “socially acceptable” to “socially normative” for people with long-term, incurable illnesses. The very euphemism “Death with Dignity” given to PAS suggests that terminally ill people who do not request PAS are dying without dignity. It follows that PAS is a way for the terminally ill to rescue their compromised dignity, making it comparable to "honour suicide" practices (e.g., seppuku in feudal Japan).
SCOTUS recognised in
Washington v. Glucksberg that evidence from the Netherlands added weight to slippery slope arguments against PAS. Even a staunch advocate of euthanasia in the Netherlands who calls himself a fighter for self-determination
says he is “now worried about the rate at which euthanasia is performed on demented and chronic psychiatric patients” and warns that the checks and balances within the Dutch euthanasia law are being “eroded.”
A non-negotiable, fundamental premise of Catholic moral theology is the dignity of the human person as the image-bearer of God (Gen. 1:26-27). Because of this intrinsic dignity, human life is always sacred and worthy of protection, care and support. Hence Catholicism is thoroughly pro-life. It is not merely for the life of the powerful and the healthy but of the most vulnerable human persons: the unborn, the physically or mentally disabled, the terminally ill, the poor, the immigrant, the convicted murderer, etc. For this reason, Catholic teaching holds that the commandment “You shall not kill” (Ex. 20:12) means that “no one can under any circumstance claim for himself the right directly to destroy an innocent human being” (
Catechism of the Catholic Church [
CCC] 2258). “Those whose lives are diminished or weakened deserve special respect.” Thus, “an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator” (
CCC 2276-77). Suicide likewise “is gravely contrary to the just love of self,” “offends love of neighbour because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations” and “is contrary to love for the living God” (
CCC 2281).
The Sacred Congregation for the Doctrine of the Faith made a
Declaration on Euthanasia in 1980 that declared that voluntary or involuntary euthanasia is a "violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity." This position was
reaffirmed by Pope St. John Paul II in 1995, who stated it to be "based upon the natural law and upon the written word of God, and...transmitted by the Church's Tradition and taught by the ordinary and universal Magisterium" (
Evangelium Vitae 65).
This stringent opposition to PAS does not mean that the Catholic Church is insensitive or indifferent to suffering. We have already noted that the Catholic Church is one of the world’s foremost providers of care to the sick and dying. We can add that Catholic teaching is sufficiently nuanced to allow for compassionate care to the terminally ill, based on the legitimate distinction between causing death and yielding to death. Hence, the Catechism states that one is not obligated to undergo “medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome”; “Here one does not will to cause death; one’s inability to impede it is merely accepted” (CCC 2278). Catholic teaching endorses as morally acceptable “The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days” provided that “death is not willed as either an end or a means”, and also encourages “Palliative care” as “a special form of disinterested charity” (CCC 2279). Catholic opposition to PAS must be viewed in the context of the Church’s preaching and practice in the area of compassion for the sick and suffering.
Nor does the Catholic Church take a judgmental stance concerning those who commit suicide or agree to be euthanised; the Church acknowledges that circumstances may reduce or completely eliminate their guilt and entrusts such persons to the mercy of God.
For Catholics, the judgment of the Church’s Magisterium (Teaching Office) against PAS decides the matter. Following the ancient example of the apostles and elders (Acts 16:4), the Church has “handed on for observance” to all local churches “the decisions reached” by her authoritative teachers. This will be of little consequence to Kyle and others who do not recognise the authority of the Catholic Church. It will be useful to consider the biblical basis of the Church’s position, especially for the benefit of those who employ a Sola Scriptura epistemology.
The Bible does not directly discuss physician-assisted suicide, or even medical ethics. There are, however, two biblical references to assisted suicide, both involving Saul. The severely wounded Saul asks his armour-bearer to kill him; the armour-bearer refuses, whereupon both Saul and the armour-bearer then kill themselves. An Amalekite later claims to have killed Saul at Saul’s request. The Amalekite portrays his action as justified because Saul had requested it due to his “great suffering” and because he saw that Saul “could not survive his wound” (2 Sam. 1:9-10). David judged the man guilty of capital murder, of having “put to death the LORD’s anointed” (2 Sam. 1:16). It is therefore difficult to avoid the conclusion that the special circumstances of assisted suicide—the victim having requested it, the victim being in great suffering or in a terminal condition—do not mitigate the guilt of a murderer under the divine law.
The Bible has little to say about suicide in general, and most of what it does say is in the form of narrative rather than commandments, statutes or precepts. Narratives of people committing suicide (e.g., Abimelech, Samson, Saul, Ahithophel, Zimri, Judas) do not provide clear guidance as to how God views such actions. However, rabbinic interpretation has placed the deaths of Samson and Saul in the category of Kiddush Hashem rather than suicide, while regarding suicide as forbidden by Gen. 9:5.
The lack of clear biblical teaching on suicide, however, presents a problem for Sola Scriptura epistemology. If the Bible is our only authority, and the Bible is silent, what are we to do? One might make an argument from silence that God does not have a position on PAS; the individual has freedom of conscience on this issue. This argument plays right to the biases of those who advocate “self-determination.” It is also fundamentally illogical—there are many behaviours that the Bible does not discuss (e.g., masturbation, plagiarism) or appears to tolerate (e.g., polygamy, slavery), but it would be very poor theology to argue on that basis that God is unconcerned with them or that they are morally neutral. There is a very real risk of misjudging God’s will in such areas and becoming
Those who call evil good, and good evil,
who change darkness to light, and light into darkness,
who change bitter to sweet, and sweet into bitter! (Isa. 5:20)
Other Sola Scriptura proponents may therefore want to dig deeper and infer God’s will concerning PAS from other relevant moral principles in Scripture. This approach is wiser but still problematic, since different people have different opinions on which passages are most relevant and on what these passages mean.
A further problem is specific to Christadelphians. As a religious group with no hierarchical or democratic structures capable of legislating on behalf of the group, there can and will never be any “Christadelphian position” on PAS (or other contemporary moral debates). There might be a position held by the majority of Christadelphians (though this would be difficult to ascertain), but this would not confer any formal legitimacy within the community. Consequently, even if the Christadelphians were inclined to exercise “prophetic zeal” à la Martin Luther King on moral issues such as PAS and euthanasia, they have no capacity for collective action. On an issue like PAS, there will inevitably be strongly held, diametrically opposed views. These opposing views will either lead to schism (fracturing the community) or will be mutually tolerated as legitimate differences of opinion, scuttling any possibility of a collective voice on the issue.
Several biblical principles weigh against a “right” to commit PAS, over and above the narrative of 2 Samuel 1. First and foremost is the dignity of human life, mentioned above. This principle is implicit in humanity’s status as God’s image-bearers (Gen. 1:26-27; 9:5-6; Jas 3:9), in God’s hatred of hands that shed innocent blood (Prov. 6:17) and in Jesus’ teaching that “Even the hairs of your head have all been counted…You are worth more than many sparrows” (Luke 12:7). Life is never worthless or meaningless.
Second is God’s sovereignty, as Creator and Judge, over life and death: “It is I who bring both death and life, I who inflict wounds and heal them” (Deut. 32:39); “The LORD puts to death and gives life, casts down to Sheol and brings up again” (1 Sam. 2:6). “The Lord gave and the Lord has taken away; blessed be the name of the Lord!” (Job 1:21). “In his hand is the soul of every living thing, and the life breath of all mortal flesh” (Job 12:10). “For you have dominion over life and death; you lead down to the gates of Hades and lead back” (Wis. 16:13).
Third, as a corollary of the above two principles, is that a person’s life belongs ultimately to God and not to the person: “Do you not know that your body is a temple of the holy Spirit within you, whom you have from God, and that you are not your own? For you have been purchased at a price. Therefore glorify God in your body” (1 Cor. 6:19-20). The same passage speaks of the possibility of sinning against oneself through sexual immorality. If “the immoral person sins against his own body” (1 Cor. 6:18), how much more the self-destructive person?
Fourth is the principle of self-love. What Jesus called the second greatest commandment, “You shall love your neighbour as yourself” (Lev. 19:18; Matt. 22:39), implies that one must love oneself. Paul makes the same presumption in commanding that “husbands should love their wives as their own bodies…For no one hates his own flesh but rather nourishes and cherishes it, even as Christ does the church, because we are members of his body” (Eph. 5:28-29). To hate and destroy our own bodies is to reject the principle of self-love and indeed to do violence to the spiritual reality of being part of the body that Christ nourishes.
Fifth is the principle of deferring to God in suffering. There are godly people in the Bible who expressed a death wish in times of intense suffering (emotional or physical). However, they expressed it not by acting on it but by appealing to God as the owner of all life. Thus Moses (Num. 11:14-15), Elijah (1 Ki. 19:4), Job (Job 6:8) and Jonah (Jon. 4:3) all appeal to God to kill them, but offer no hint of an intention to kill themselves. In Job’s case he rejects “foolish” advice from his wife to take action to cause his own death (“Curse God and die”), which earns him the narrator’s approval (Job 2:9-10). Jeremiah expresses extreme despair and a death wish (Jer. 10:19-21; 20:14-18), but remains unwilling to abandon God (Jer. 20:9) and rejects self-determination: “I know, O LORD, that no one chooses their way, nor determines their course nor directs their own step” (Jer. 10:23).
Sixth is the principle that death is an enemy, not a friend. To commit PAS is to make an alliance with death, to embrace it as a friend in order to escape from suffering, while at the same time bracketing out any question of postmortem judgment or punishment. However, Scripture is clear that Death is not a friend but an enemy (1 Cor. 15:26), an inimical power through which sin reigns (Rom. 5:21). While acknowledging that Protestants have dropped the Book of Wisdom from the canon, its warnings on this point are relevant:
Do not court death by your erring way of life, nor draw to yourselves destruction by the works of your hands. Because God did not make death, nor does he rejoice in the destruction of the living… It was the wicked who with hands and words invited death, considered it a friend, and pined for it, and made a covenant with it, Because they deserve to be allied with it. (Wis. 1:12-16)
Seventh and last is the principle that suffering is meaningful—what Pope St. John Paul II called "the mystery of suffering." James teaches that “the testing of your faith produces perseverance” and that “Blessed is the man who perseveres in temptation (or, ‘trial’)” (Jas 1:2, 12). The writer of Hebrews exhorts his readers to “Endure your trials as ‘discipline’… At the time, all discipline seems a cause not for joy but for pain, yet later it brings the peaceful fruit of righteousness to those who are trained by it” (Heb. 12:7, 11). Suffering is a prominent theme in 1 Peter, where we read “if you are patient when you suffer for doing what is good, this is a grace before God” (1 Pet. 2:19) and “those who suffer in accord with God’s will hand their souls over to a faithful creator as they do good” (1 Pet. 4:19). “Suffering for doing what is good” surely applies to those who, in reverence for the dignity of their humanity and God’s ownership of their lives, refuse to request PAS.
In my Facebook dialogue with Kyle, another participant, Dave Burke, distinguished between “Suffering patiently,” which “is a Christian virtue,” and “suffering needlessly,” which “is not.” This false dichotomy reflects a profound misunderstanding of the story of Job, the biblical sufferer par excellence. As already mentioned, Job suffered so severely that he longed for death. His suffering seemed needless to him, and when God finally answered his demands for an explanation, the answer only highlighted God’s sovereignty without explaining why Job’s suffering was necessary. Nevertheless, God rewarded Job for patiently enduring this apparently needless suffering in deference to God’s sovereign will (Job 42:7-10; cf. Jas 5:11). A terminally ill person may seem to suffer needlessly, but the story of Job tells us that there is no such thing as suffering needlessly. If we persevere in seemingly unnecessary suffering through faith in God’s sovereign yet mysterious wisdom, this is a virtue.
In his historic 1995 encyclical Evangelium Vitae (“The Gospel of Life”), Pope St. John Paul II exhorted all the members of the Church to be “the people of life and for life,” and to “work to ensure that justice and solidarity will increase and that a new culture of human life will be affirmed, for the building of an authentic civilization of truth and love.” In contrast to this positive vision, the pope warned of the emergence of a “culture of death” and a “conspiracy against life” that rests on “an idea of society excessively concerned with efficiency” and which therefore looks down upon persons with a low quality of life as “useless” (Evangelium Vitae 12).
As an example of this culture of death, the pope singled out the attitude toward “the incurably ill and the dying”. The reasoning that the pope identified as contributing to the spread of euthanasia included "misguided pity at the sight of the patient's suffering," "the utilitarian motive of avoiding costs which bring no return and which weigh heavily on society," "a cultural climate which fails to perceive any meaning or value in suffering," and "a certain Promethean attitude which leads people to think that they can control life and death by taking the decisions about them into their own hands" (Evangelium Vitae 15).
It is abundantly clear from Kyle’s comments that, whatever his exact motives, he has bought into (sold out to?) this “culture of death” to the point that he is actively, publicly promoting it. This would be regrettable coming from a secular humanist, but it is downright disturbing coming from one who claims to instruct others in the “word of life.” My advice to Kyle and any other person who advocates a right to PAS would be to reflect deeply on whether such a right truly coheres with the dignity, equality and genuine liberty of all human persons. My advice to Kyle and any other professing Christian who advocates a right to PAS would be to reflect deeply on moral theology, taking seriously the danger of “calling good evil and evil good.”
Footnotes
