Science in Christian Perspective
Toward a Scriptural View of Euthanasia
David J. Martinez
Darien, Illinois 60559
From: JASA 34 March 1982): 35-37.
Euthanasia is an issue in medicine today that is gradually becoming less controversial, and more acceptable. Judicial precedent and sentiment is growing with very little dissent. The decision to "no code" a patient, at one time passed quietly to the staff, is now out in the open. As Christians, we need to understand where these decisions are leading and understand the reasoning behind them. This reasoning must then be examined based on scriptural teaching.
The main arguments for euthanasia are the easing of suffering and utility. In cases where the pain is great and constant, and there is no hope of a cure, euthanasia is thought to be desirable. The suffering does not have to be for the patient alone, but also for his family. A petition from Protestant and Jewish ministers in New York sums up this idea: "We believe in the sacredness of human personality, but not in the worth of mere existence or 'length of days.' We no longer believe that God wills the prolongation of physical torture for the benefit of the soul of the sufferer. For one enduring continual and severe pain from an incurable disease, who is a burden to himself and his family, surely life has no value."1
The argument from the point of view of utility comes from both the family and society. The delivery of medical care necessary for life support is expensive. Even with insurance the cost can overwhelm the family. On the larger scale, can society justify the use of our resources, private or public, to maintain or prolong "unsalvageable" lives, while throughout the world millions of children are starving and health care is inadequate? It is a question of stewardship of both monetary and health care resources.
The efforts of physicians, legislators, and judges to define brain death have not been totally successful. Karen Quinlan showed us the dilemma. She continued to live after the plug was pulled (passive euthanasia), leaving those around her perplexed at what to do. The next step in the progression would be to act to end her life (active euthanasia).
Euthanasia should be opposed by Christians on the basis of scriptural principles and other reasons.
The understanding of "the image of God" in man is the first and main principle. It is the key doctrine of Scripture that places value on any human life, and differentiates us from being just smarter animals. In some way God gave of Himself into each one of us, not in an "indwelling" way which is reflected when someone accepts His greatest gift, but in some way intrinsic to what we are we have part of God in us. In the beginning we were commanded to go out and subdue creation. We were to master it, become lord over it. Not so much in an exploitive sense, but to be beneficent rulers for our own good, and for creation's. In this way we reflect the image of God. We create things, and order them. We strive to know all, do all, and to find order in the universe. One of the high points of this are the scientific method and the technological applications of the knowledge found.
The abilities to reason and create do not complete the image of God in man. Research into animal intelligence, especially in the use of language, leads many to think that man is not so unique after all, though this is disputed by the behavioralists. It is hard to dispute the objective evidence of a chimpanzee using a tool (a twig) to gain a specific end (a termite), but even the most ardent "animalist" is forced to accept that there is a quantum difference between man and the most intelligent of animals.
Personality has been cited as being part of our uniqueness. Certainly this is part of it, but alone is not enough as any pet owner can tell you.
The completing factor to the image of God in man is twofold. The first part is that we are loved by God. This is not a new idea. Thielicke stated it well in The Doctor as Judge of Who shall Live and Who shall Die. "The basis of human dignity is seen to reside not in any immanent quality of man whatsoever, but in the fact that God created him. Man is the apple of God's eye. He is 'dear' because he has been bought with a price: Christ died for him. Thus man stands under the patronage of an eternal benevolence and is sacrosanct. Whoever touches man has to do with God himself."2 It is God's love that gives the ultimate source of meaning to existence. Man is special, whether he wishes it or not.
A step down in scale, and certainly less absolute is the value a life is given when it is loved by another person.
Even being loved is not enough. It takes the ability to return or initiate love to complete the circle. This implies a choice, a freedom to accept and return love or refuse it. It is the risk of refusal that substantiates love (see Romans 5). It is the possibility of interpersonal relationships with God first, and then others which makes man unique in creation. Bernard Ramin affirmed this in a 1974 article in the Journal ASA on bioengineering by stating that the true humanity of man, as laid out Genesis I and 2 is realized in the male-female, husband-wife, and parent-child relationships.3
Thielicke, following Heidegger's view that self-consciousness is the distinguishing factor between human and other biologic life states that "This consciousness of self has reference particularly to knowledge about what lies ahead, and hence also to knowledge about death. Man's anxiety and hope have reference to the future, whereas the animal, not having a consciousness of self, remains a prisoner of the present moment."4 This self-consciousness and knowledge reflect themselves the decisions and the relationships that are effected by the decisions.
In summing this idea up, the image of God in man consists of three parts: (1) Man's intellect, will, rationality, creativeness, selfconsciousness, etc. (2) The value given to our lives because we are loved, first by God, and then by others. (3) The affirmation of our humanity by returning God's love, and returning and initiating love towards others.
God has given human life a very high standing. It is because of this intrinsic value that murder is a sin (Gen. 9:6). Is euthanasia any different in its end result? The act of euthanasia is uncreative, denying the image of God. It places man at the same level as animals.
The patient who chooses euthanasia is committing suicide. He kills himself when he no longer wishes to live and be useful (creative, loving, receptive of love, etc.) The problem, aside from the image of God within us, is that in choosing death, the patient refuses the will of God. A Christian's life is no longer his own, but is under a new lordship. Whether he lives or dies, it is not for him to choose. If it is God's judgement that in suffering and dying he may be of use, then so be it. We all have heard of many cases of people with only short periods of time left to live who accomplished much good in that time. The witness of dying godly men has ever. been a fruitful means of adding to God's family. It would seem that euthanasia is a lack of trust in God's love, and a rebuttal to His grace being sufficient.
The issue here is the Christian doctrine of suffering. The whole book of Job is about a man who should have ended it all, yet he believed in God's guidance in his life. Christ suffered horribly to accomplish our salvation. Paul rejoiced in his suffering for Christ and the Gospel (Col. 1:24, Phil. 3:8), and commanded us to "exult in tribulation" (Rom. 5:3 NAS). All of this is not just because God wants his people to be masochists, but to accomplish His will in each life: perseverence, proven character, hope, and faith. Indeed, James tells us to count it all joy when we encounter various trials and testings because they produce faith and endurance to make the Christian complete.
The point of this is that suffering is not an evil to be avoided, but something to be expected in each life to make us "perfect and complete" (James 1:4). Both Viktor Frankl, a psychiatrist who survived the concentration camps of World War 11 and Thielicke agree that life finds its meaning in suffering: No matter what the situation, the freedom of choice remains. The choice is one of attitudes, of how to accept the suffering. Frankl said, "The way in which a man accepts his fate, and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity--even under the most difficult circumstances-to add a deeper meaning to his life. It may remain brave, dignified, and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forego the opportunity of attaining the moral values that a difficult situation may afford him."5 Thielicke refers back to the presence of selfconsciousness. It is because of this that man is able to react to suffering. It is the reaction to suffering that gives meaning to life.6
Medically, much more can be done to suppress pain than in the past. Research has produced many compounds over the last thirty years that help relieve pain.7,8 In some cases the use of drugs may not be desirable due to the side effects, but in such cases surgery to relieve pain may be effective.9 It is in cancer victims that euthanasia is highly advocated, even though pain is not a major factor in more than half of the fatal cancers.10 Pain from cancers metastatic to the bone may often be treated effectively with radiation.11
Psychologically, pain can be very tricky. It can be exaggerated. Personality can greatly effect how pain is perceived. The dynamics of the situation must also be looked at closely. Great care would have to be taken to determine whose suffering was being relieved, the patient's or the relatives12."
The final argument against euthanasia has been cited by many, including Schaeffer and Koop in Whatever Happened to the Human Race? It is known as the wedge effect. It is a gradual, subtle, and erosive decay in the attitudes surrounding death, occurring sequentially that would allow great changes to take place in smaller, less noticeable steps. Thus far our society has gone from one that respected life to one that allows babies to starve in the nursery because they are deformed; to one that allows abortion as a form of birth control; to a society that would wish for an easier way to handle the elderly and the terminally ill. If the dying can choose their time of death, and doctors and/or family choose death for the unconscious "hopeless", the extension of this to the deformed, mentally retarded, psychotic, deformed infants, and senile aged cannot be too far off. It is assumed that the quality of these lives is so low as to merit the release of death.
The idea of stewardship of resources or "triage" is powerful, and it must pose an even greater dilemma in less fortunate areas. Euthanasia as an act because the family is going broke is vile and abominable. It is a sad commentary on our society that this is a consideration at all. I understand it. The materialishi of our society traps us all in many ways. For what length of time should life be prolonged while reducing the family to poverty?
The difference between ordinary and extraordinary means of life support is becoming less distinct. Even smaller community hospitals are getting highly sophisticated systems that were once found only in large medical centers. What was once a "modern medical miracle" is now an everyday occurrence.
I have read that the good doctor is aware of the difference between prolonging life and prolonging the act of dying. The decision to discontinue aggressive treatment is sometimes arrived at with difficulty, and sometimes quickly. It is my hope that it never becomes too easy.
1Norman St. John-Stevas, Life, Death and the Law, Bloomington, Indiana: Indiana University Press, 1%1. pg. 269.
2Helmut Thielicke, The Doctor as Judge of Who Shall Live and Who Shall Die, Philadelphia, Pa.: Fortress Press, 1976. pg. 27.
3Bernard Ramm, "An Ethical Evaluation of Biogenetic Engineering," Journal of the American Scientific Affiliation, Vol. 26, #4, Dec. 1974. pg. 140.4Thielicke, pg. 16.
5Viktor E. Frankl, Man's Search for Meaning: An Introduction to Logotherapy, New York, N.Y.: Pocket Books, a division of Simon and Schuster, Inc., 1963. pp. 106-107.6Thielicke, pp. 16-17.
8John A. Bevans, ed., Essentials ofPharmacology, Hagerstown, Maryland: Harper and Row, 1976. pg. 234.
9George W. Thom, et. al., editors, Harrison's Principles of Internal Medicine, 8th edition, New York, N.Y.: McGraw-Hill, 1977. pp. 19-20.
10St. John-Stevas, pg. 273. "Thorn, et. al., pg. 1763.
11St. John-Stevas, pg.
Claude E. Frazier, editor,
Is it Moral to Modify Man?,
Charles C. Thomas
Wayne E. Oates, The Revelation of God in Human Suffering, Philadelphia, Pa.: Westminster Press, 1946.