The end of life can be a difficult and challenging time for individuals and families, particularly with respect to medical issues and concerns. The articles in this section address ethical issues that arise surrounding end-of-life care including withholding and withdrawing of treatment, terminal sedation, determination of death, DNR (“do not resuscitate”) orders, artificial nutrition and hydration (“feeding tubes”), euthanasia, assisted suicide, as well as the availability and opportunities associated with palliative medicine and hospice care. CBHD also provides an advance directive form in both English and Spanish.
Culture is so easily influenced by the entertainment industry. This is why I am sounding an alarm about a very dangerous message in a film released earlier this summer. It’s simply titled Me Before You.
In 2015, while serving as President of the Evangelical Theological Society (ETS), I took the opportunity in the annual presidential address to raise what I think are some of the most pressing issues facing the church today in medicine, particularly at the edges of life. What follows are thoughts adapted from my presentation. In my experience, churches are undereducated when it comes to ethical issues raised by advances in medicine and technology, a neglect that is critical because these issues are not just academic ones but touch people’s lives in very tangible and deep ways.
In times of pain, suffering, and loss of control, appeals to compassion and autonomy can make the “right to die” seem reasonable and attractive, and PAD seem forgivable—or even sanctioned. Despite the appeal of PAD, believers can be trusted to discern its wrongness when we make loving and impassioned appeals to historical Christian theology. Every believer can wield a sanctified moral reasoning that cuts carefully and humbly through the noise and appeal of popular notions of love, compassion, and autonomy.
We live in a Western culture in which we find ourselves caught between two opposing secular medical responses to the reality of suffering and death: 1) Suffering and death are the ultimate human foes and must be fought—and conquered—at all costs (often resulting in the over-treatment of patients); or 2) Suffering produces a diminished “quality of life,” so death should be hastened (often resulting in the under-treatment of patients).
[T]he progress that has been made, combined with this hype of decontextualized and often exaggerated claims by the media, continue to fuel the hope of medicine and technology: “If we could only accomplish a little more . . . .” But more is never enough. And hope, commingled with the fear of death (Heb 2:15), can fuel an attitude of “taking and keeping” (the “agency”), one that grasps at and clings to the technological hope of immortality. From here one can easily (and subtly) fall prey to worshipping technology and progress as gods.
Bills to change the law to allow euthanasia and physician-assisted suicide continue to be presented to parliaments throughout the western world, on a wave of overwhelming public support for “the right to choose and have a dignified death.” While it is unlikely the debate will go away, we can still hope for a more honest one.
Having been a pastor and professor for a couple of decades, I’ve heard (and spoken) my share of funeral sermons. At times, quite ironically it seems, death is almost personified and praised as the great deliverer, the one who relieves our loved ones of unbearable pain and suffering. And while I understand the “blessing” of death to cease suffering, I can’t help but think of the New Testament portrayal of death as “the last enemy” (1 Cor. 15:26; cf. 2 Tim. 1:10; Rev. 20:14; 21:4). The story of Jesus’s response to the death of his friend Lazarus in John 11 brings not only comfort and hope but much-needed wisdom and perspective.
Given our secular culture’s confusing responses to suffering and death—death is either the ultimate human foe to be conquered at any cost, or is preferable to a “diminished quality of life”—many believers are co-opting a worldview that runs contrary to historic Christianity. While we are most appreciative of the fine and informative work of ministries such as The Center for Bioethics & Human Dignity, the “think tank” cannot replace the local parish as the center of Christian education. In other words, bioethics (especially issues of death and dying) must be mainstreamed from the academy to the pulpit and pew. This will obviously require a fair bit of intentionality.
In the 23 years since the passage of the Americans with Disabilities Act (ADA), I have watched its most celebrated ideals erode and crumble under a double standard. I had the honor of serving on the National Council on Disability when the ADA became law, and ideally, it was intended to guarantee the basic rights of Americans with disabilities. Many saw the ADA as a law which would help move society beyond the premise that one is “better off dead than disabled.” I am amazed, however, at how much people’s fears of disability have eroded the most basic of human rights, especially now that so many more people are surviving disabling conditions. And when society’s fundamental fear of disability provides the framework to legislate policy, the outcome can only result in a double standard.
When an idea or concept needs a push in popular culture, Hollywood often makes a movie about it. With the power of emotional drama and a film score designed to tug at the heart, Hollywood has the power to advance ideas that we would otherwise reject on moral grounds. Its most recent attempt uses the book-to-movie love story Me Before You to create sympathy for and acceptance of euthanasia and Physician-Assisted Suicide (PAS).
Bioethical dilemmas are being explored everywhere. Moral questions embedded in the application of medical technology are not reserved for elite medical roundtables. Rather, ethical decisions are the prevailing substance of entertainment. Stories do touch our souls.
The prevailing cultural narrative, woven into routine dialogue and highlighted throughout the entertainment industry, turns on how the individual alone must define what is good using one’s internal moral compass. The frame of reference for making optimal moral choices is exclusively located within the uniqueness of the autonomous person, who applies private and personal criteria to achieve happiness, wholeness, and significance.
I have intentionally titled this series, “Death and the Church.” Given the highly individualistic character of Western culture, many complex human issues are viewed as personal concerns to be dealt with in a manner that keeps friends, neighbors, and even family at a distance. The well-known expression “It is none of your business,” epitomizes an isolationism that has become a core value of American culture.
In Edwards’ early modern world, people usually died at home, spending their final days surrounded by friends and family. Evangelicals thought intently about the way that they should die. Deathbed scenes were public spectacles, remembered for posterity. They testified to the Christian faith and character of the deceased. It should come as no surprise, then, that Edwards died surrounded by a group of close companions, people hanging on the words he whispered painfully to them through his contagious, swollen throat.
In our death-denying culture (including the evangelical church), it is very rare to hear sermons on Christ’s resurrection except at Easter. Even then, many messages tend to be apologetic in nature, namely, how the empty tomb vindicates Christ’s claims to deity. While I have heard many pastors sermonize on Paul’s “resurrection magnum opus” in 1 Corinthians 15, too little time has been spent on the extensive treatment that the Apostle gives to its implications for believers facing the reality of even untimely earthly death (cf. vv. 35–58). This existential absence has, in my opinion, only exacerbated a secular-like trust in the achievements of modern medicine in the Christian community.
As I have reflected on those conversations, two aspects stand out: 1) their questions represent the public, secular views about death and dying popularized in American culture; and 2) they were more interested in avoiding physical pain than in thinking Christianly about the problem. I want to briefly describe the view they seem to have absorbed, and the consequences we already see from legalization of both euthanasia and physician-assisted suicide (PAS).
One of my favorite parts of getting around Washington, D.C. is the Metro system. The zzzip of the Metro fare card that opens the turnstile, the flashing lights that announce the incoming train, and the garbled announcements of the upcoming station create a vivid collage. Even more, the long entrance/exit rides, such as on Rosslyn station’s 270-foot escalator, induce a bit of vertigo. The wide stainless steel divider might tempt brash or drunk riders to emulate their childhood prowess on the playground slide, but large discs mounted at strategic intervals along the divider deter all but the most foolhardy. It is dangerous to descend that slippery slope.
In older Christian books on moral theology or ethics, the usage of the term euthanasia was common. However, these works interpret it in a fashion entirely different from how it is currently employed. The word euthanasia is a Greek composite term (eû + thánatos) meaning nothing but “good death,” “beautiful death,” or “pleasant death.” Accordingly, older Christian textbooks presented “euthanasia” as a Christian preparation for death. But what exactly was meant by that?
Only four years after the publication of Staupitz’ book, Martin Luther also authored a writing on the good death: Ein Sermon von der Bereitung zum Sterben (“A sermon on the preparation for death”). Unlike Staupitz, who called for a mystical imitation of Christ’s death, Luther emphasized the connection between Christ and a Christian which is established solely through faith in the forgiveness of sins on the basis of Christ’s complete work on the cross. Christians have a living hope beyond death because of the righteousness of God which was established on Golgotha. It is from this perspective that Luther answers of what constitutes a good death.[i]
Preparing for a good death in a society which focuses on the temporal world is not easy for a Christian. On the contrary: it is a struggle. Professionals attempt to relieve the dying from pain, to feed him artificially, and to give him breath with a ventilator. While it is commendable that medical advances are utilized, a tension may arise between the necessary medical procedures and the need for counseling at the end of life. For instance, in order to pray with the dying Christian, to read Scripture with him, and to talk to him about the imminent journey in a confident manner, undisturbed privacy is necessary.
In a previous article in this forum, I wrote about how COVID-19 could serve as a jumping-off point for raising issues of bioethics in the church, issues that extend far beyond the current pandemic. Two examples I gave were of issues related to vaccines/public health and healthcare disparities. However, there is another topic that is just as easily raised and is perhaps even more pressing for the church today: facing death.
In this essay, I want to provide some practical ways in which Christians can approach the end of their lives both individually and as a believing community. Some of these will be relatively easy to implement; others will both require and lead to drastic changes in our thinking. Once again, these recommendations are largely drawn from Rob Moll’s excellent book The Art of Dying: Living Fully into the Life to Come.
The Good Place is a popular comedy show that follows four humans and their experience in an imagined afterlife where people accumulated points based on their good and bad actions on earth and were then sent to either “the good place” (effectively heaven) or “the bad place” (hell) depending on how they lived. As the main characters experience all that the afterlife has to offer, the show consciously addresses a number of moral and philosophical questions revolving around what it means to be a good person and how one can live a moral life.