Program / Course 22: Christian Ethics / Lesson 6.3
What you will learn
- Distinguish palliative care, withdrawing or withholding treatment, assisted suicide and euthanasia.
- Explain the Christian distinction between ordinary and extraordinary means and the role of double effect.
- State the Catholic, Orthodox and Protestant teaching on these questions and the range of views among Christians.
- Present the arguments of those who support and those who oppose legal assisted dying.
The big idea
Christian traditions hold that the dying are to be cared for, not abandoned and not killed. They distinguish three things: relieving pain and caring for the dying, which is encouraged; declining or stopping treatments that are burdensome or futile, which is permitted; and intentionally causing death by euthanasia or assisted suicide, which the main churches reject. Supporters of legal assisted dying appeal to compassion and autonomy, and opponents appeal to the dignity of life, the risks to the vulnerable and the alternatives of good palliative care. The debate is serious on both sides.
Key terms
- Palliative care
- Care aimed at relieving pain and other symptoms and supporting patients and families, without attempting to cure or to hasten death.
- Hospice
- A program of palliative care for the dying, often at home or in a special facility. The modern hospice movement, begun by Cicely Saunders, grew from Christian roots.
- Ordinary and extraordinary means
- A traditional distinction: ordinary means are those that offer reasonable hope of benefit without excessive burden, while extraordinary means are overly burdensome, costly or futile.
- Euthanasia
- An action or omission that by its nature and intention causes death in order to end suffering. Voluntary euthanasia is done at the patient’s request.
- Assisted suicide
- Providing a patient with the means to end his or her own life, such as a lethal prescription.
- Advance directive
- A document stating a person’s wishes about treatment in case of incapacity, or naming someone to decide.
- Medical assistance in dying (MAID)
- The term used in law in some countries, such as Canada, for euthanasia or assisted suicide carried out by medical professionals.
Background
The Bible treats death as an enemy that Christ has overcome (1 Corinthians 15:26), and treats the dying with care. Job’s suffering and the Psalms of lament show that suffering can be honestly cried out to God. The Bible reports cases of self-killing, such as Saul and Judas, without approval. The early church condemned suicide, and Augustine argued in City of God (Book 1) that it is a violation of the commandment against killing. Aquinas gave three reasons: it is contrary to natural self-love, it harms the community and it usurps God’s authority over life.
Modern medicine changed the situation. People now can be kept alive by machines for long periods and many die in hospitals. Doctors can ease pain far better than before. Questions arose: when should treatment stop? When is pain relief that risks hastening death permitted? Should patients be allowed to choose death? In 1997 Oregon allowed assisted suicide under conditions, the Netherlands and Belgium legalized euthanasia in 2002, Canada introduced medical assistance in dying in 2016, and various other jurisdictions have followed. Churches have taken part in the debate throughout.
Step-by-step explanation
Step 1: Caring for the dying
All the major traditions affirm care for the dying as a duty. This includes pain relief, nursing care, companionship, prayer and the sacraments: the anointing of the sick and viaticum (Communion for the dying) in Catholic and Orthodox practice, and pastoral visits and prayers in Protestant practice. The hospice movement, founded by Cicely Saunders, an Anglican, in London in the 1960s, was shaped by Christian conviction that no one should die alone or in unrelieved pain.
Medicine for pain raises the question of double effect. Catholic teaching and others hold that using strong painkillers to relieve suffering is permitted even if it may shorten life, provided the aim is to relieve pain and not to cause death. Pope Pius XII approved this in 1957. Many clinicians note that, when drugs are used properly, they seldom hasten death. The moral line is drawn at intention: relieving pain is good, and killing the patient is not.
Step 2: Withholding and withdrawing treatment
The tradition does not require preserving life at all costs. Catholic moral theologians since the sixteenth century have taught that one need not use extraordinary means, those that are very burdensome, painful, costly or offer no reasonable hope. The Declaration on Euthanasia (1980) restated this and added that a patient may refuse treatments that only secure a precarious and burdensome prolongation of life. The decision is based on the benefits and burdens of the treatment, not on the value of the life.
Debates continue about artificial nutrition and hydration. In 2004 Pope John Paul II said that giving food and water by tube is, in principle, ordinary care and a moral obligation, as long as it achieves its purpose, and the case of Terri Schiavo in the United States in 2005 became a flashpoint. Some Catholic ethicists disagree about how this applies. Other traditions, such as Protestant and Orthodox, usually allow withdrawal of such treatment when it is burdensome or when death is imminent, while insisting on basic comfort care. The concept of brain death is also debated: most Christian bodies accept it as a sign of death, while some theologians and a number of Orthodox and Protestant writers question it.
Step 3: Euthanasia and assisted suicide
The Catholic Church teaches that euthanasia is gravely wrong, a violation of the law of God, and Evangelium Vitae (1995) declared it so. The Orthodox Church likewise rejects euthanasia and assisted suicide, and teaches that suffering can be spiritually fruitful when borne with faith, while calling for compassion and pain relief. Most Protestant bodies, including the Southern Baptist Convention, the Lutheran Church-Missouri Synod and the Presbyterian Church in America, oppose them. Some mainline Protestant churches and individuals have voiced concern but also compassion, and a few have been open to legal assisted dying in limited cases. In Canada and parts of Europe, there have been disagreements within churches about the question.
Christian arguments against include: life is a gift and the right to end it belongs to God; the intentional killing of an innocent person is always wrong; the request for death often arises from depression, fear or lack of support that can be addressed; legalization puts pressure on the old, disabled and poor; and the practice changes the role of the doctor. Some Christians who support the option argue from compassion, from respect for conscience and from the view that in extreme cases God’s mercy does not require suffering to the end. They are in the minority among church bodies.
Step 4: The wider debate
Supporters of legal assisted dying, many of them secular, argue that competent adults who are terminally ill should have the right to decide the manner and time of their death, that suffering is sometimes unbearable even with good palliative care, and that allowing death is not morally different from killing in some cases. The philosopher James Rachels argued that the distinction between killing and letting die does not itself make a moral difference. Opponents answer that the distinction matters: killing and allowing death differ in intention and causation, and that safeguards in laws have not always been kept, citing the experience of some countries where eligibility has widened.
Evidence is contested. Studies in Oregon show that most patients who use the law cite loss of autonomy and enjoyment of life more than pain. Critics worry about disability and about cases in other countries involving mental illness or lack of care. Supporters point to the stable use under strict rules in some places. Christians who oppose legal assisted dying often join with disability advocates and some secular physicians, and those who support it argue that law should not impose religious beliefs. All sides agree that better palliative care and support are needed.
- Is the act intended to relieve suffering, to refuse a burden or to cause death?
- Is the treatment ordinary or extraordinary, that is, does it offer benefit with reasonable burden?
- Who is deciding, and is the decision free and informed?
- What alternatives of care and support have been offered?
- What does the view say about the dignity of a life that is dependent, in pain or unconscious?
- What would be the effects of making a practice legal, for the vulnerable and for medicine?
Examples
Pain relief at the end
A hospice nurse gives increasing doses of morphine to a man with cancer who is in severe pain. His family asks whether this will kill him. The doctor explains that the dose is set to control pain and that this is accepted practice, and that the aim is comfort. A chaplain prays with the family. Catholic and most other Christian ethics agree that this is permitted. (A constructed example.)
Stopping a ventilator
A patient with advanced lung disease is on a ventilator. After weeks, the doctors say there is no hope of recovery and that the machine only prolongs dying. The family, with the chaplain’s support, agrees to remove it and focus on comfort. The traditions generally allow this, as the treatment is burdensome and not curative, and the death is from the disease. (A constructed example.)
A request for assisted dying
A woman with terminal illness asks her doctor for a lethal prescription, saying she does not want to lose control. Her pastor listens, takes her fear seriously, and asks whether she has been offered hospice care and pain control. Whether the request should be honored is the subject of the debate, and the pastor’s task is to remain with her whatever her decision. (A constructed example.)
Different perspectives
Catholic
The Catholic Church teaches that euthanasia and assisted suicide are grave wrongs, that patients may refuse disproportionate treatment, that pain should be relieved even at the risk of shortening life and that the dying must not be abandoned. Catholic hospitals and hospice programs apply this teaching, and the church urges care of those who suffer, offering the Anointing of the Sick and Viaticum.
Orthodox
Orthodox teaching rejects euthanasia and assisted suicide as taking life that belongs to God, and holds that suffering can be borne with spiritual meaning but should be relieved. Orthodox ethicists accept the refusal of futile treatment and stress prayer, confession, Holy Communion and the Anointing as the proper care of the dying.
Protestant
Most Protestant churches oppose euthanasia and assisted suicide, citing the sanctity of life and God’s sovereignty over life and death, while accepting the withdrawal of burdensome treatment. Some mainline bodies are more divided or open to legal choice in limited cases. Karl Barth, Paul Ramsey and others reasoned that the dying should be cared for and not killed, and Ramsey wrote of the duty of caring presence.
Secular and scholarly
Secular views divide. Some support legal assisted dying on grounds of autonomy and compassion, and others, including many palliative care physicians and disability advocates, oppose it on grounds of risk to the vulnerable and medical integrity. Law varies widely across countries. Empirical research on safeguards and outcomes is ongoing and disputed.
Why it matters
Almost everyone faces the death of loved ones and eventually their own. Understanding the distinctions among comfort, refusal and killing helps people make hard decisions with clearer conscience, to support families, and to take part in debates about law. It also reminds Christians that the first duty to the dying is presence and care.
Common misunderstandings
Misunderstanding: Christian teaching requires keeping people alive by every means.
Correction: The traditions allow refusing treatments that are burdensome or futile, and teach that dying a natural death is acceptable. What they reject is intentionally causing death.
Misunderstanding: Pain relief that risks shortening life is the same as euthanasia.
Correction: The difference is in intention and in the means. Relieving pain properly is accepted by the traditions, while giving a lethal dose to end life is not.
Misunderstanding: Opponents of assisted dying simply want people to suffer.
Correction: They hold that suffering should be relieved by care, not by killing, and often support hospice and palliative care. Critics argue that care is not always enough, and the debate is about whether killing is ever the answer.
Misunderstanding: All Christians agree on end-of-life issues.
Correction: There is wide agreement on the wrongness of euthanasia in the main churches, but views differ on feeding tubes, brain death, and legal policy, and a minority of Christians support legal assisted dying.
Knowledge check
What is the difference between ordinary and extraordinary means?
Ordinary means offer a reasonable hope of benefit without excessive burden, and are generally obligatory. Extraordinary means are overly burdensome, painful, costly or futile, and may be refused. The judgment concerns the treatment’s benefits and burdens, not the worth of the patient’s life.
How does the principle of double effect apply to pain relief?
It permits giving strong painkillers whose foreseen side effect may shorten life, provided that the intention is to relieve pain, the death is not the means of relief, and the dose is proportionate. The aim of comfort makes the act different from giving a drug in order to kill.
What do the main Christian traditions teach about euthanasia?
The Catholic and Orthodox churches and most Protestant bodies teach that euthanasia and assisted suicide are wrong, because life is a gift and the intentional killing of an innocent person is forbidden. They support palliative care and the refusal of burdensome treatment. A minority of Christians and a few church bodies are more open to legal assisted dying.
State one argument for and one against legal assisted dying.
For: competent adults should have the right to decide on their own death when suffering is unbearable, and compassion may call for it. Against: legalization may put pressure on the vulnerable, killing differs morally from allowing death, and better palliative care can address most suffering.
Think it through
- What would you want for yourself at the end of life? What would you want your church to offer?
- Is there a morally significant difference between letting die and killing? Why or why not?
- How should a Christian respond to someone who asks for help to die?
- What does a community owe those who are dying and those who care for them?
Independent assignment
A conversation about the end of life
In your notebook, write 400 to 600 words. Write what you would want to be considered in your own care at the end of life, using the distinctions in this lesson, and describe in a paragraph how a Catholic, an Orthodox and a Protestant source would advise on one decision, such as stopping a ventilator. Add a paragraph stating the best argument against your own view. Consider talking with family about an advance directive, but do not send this assignment to anyone or post it anywhere.
Further study
- Catholic Church, Catechism of the Catholic Church Read the paragraphs on euthanasia and suicide in the section on the fifth commandment.
- Augustine of Hippo, The City of God Read Book 1, chapters 17 to 27, on suicide.
- Thomas Aquinas, Summa Theologiae Read Question 64, Article 5, on suicide.
- C. S. Lewis, The Problem of Pain Read for a reflection on suffering.
- Psalm 23:4 Though I walk through the valley of the shadow of death.
- 2 Corinthians 1:4 The God of all comfort.
- Romans 14:8 Whether we live or die, we are the Lord’s.
- 1 Corinthians 15:26 The last enemy is death.