Episode 158 - Euthanasia: How Should We Treat People At The End Of Life?

Audio

Transcript

While we often talk about how to defend the Christian faith and gospel and worldview, sometimes we also need to just be prepared to think through things Christianly or biblically for ourselves. To view the world in such a way that the Bible informs how we see and think about and interpret what's around us, what we see in the news and certain ethical issues. That's what we're going to talk about today. We're going to consider how we should treat people who are terminally ill, and by extension, how we should view human life in general. We've talked numerous times in the past about abortion and how from the moment of conception, really fertilization, until natural death, human beings are valuable because they're created in the image of God. Our worth is not found in our physical utility. It's not found in our size or our level of development. It's not found in our income or where we live or in our skin color or anything like that. Our worth is grounded in the fact of whose we are, of who created us, of who owns us. And I'll link to previous episodes about that topic.

But we haven't talked much about the other end of life. We've talked about the beginning with conception and abortion, but we haven't talked about how we view those who are elderly or how we view those who are terminally ill. If you've been paying attention in the news in recent months there have been a couple notable stories. There have been at least two children in the UK who have had ... at least they've been deemed to have terminal illnesses and the government has withheld care from them. And not just care, but in some instances food and water. So they have literally oftentimes tried to starve children to death. They've actually prevented parents from taking them to other countries where they could get care.

One of the most recent cases would be that of Alfie Evans, and before that, Charlie Guard. These were children whose parents desperately wanted to get them help and care, and yet it was determined by doctors and the courts in the UK that the children were not allowed to get that care. They weren't allowed to take them to Italy, even though in this case the Pope sent a helicopter to airlift the child to Italy, and Italy had granted the child citizenship. The government, the almighty government, of Britain said, "No, you cannot go. You cannot take your child." There are so many issues here related to parents' rights and all of those sorts of things, but what I want to focus on how we view those who are terminally ill?

We have these issues in our country. We have conversations about assisted suicide in our country, or mercy killings. Is it appropriate for a doctor to kill someone if they don't want to die or if they can't make that determination? Can they kill that person if they're in sufficient enough pain? Can someone decide for themselves that they want to kill themselves if they're in enough pain, or can they require or ask a doctor to kill them if they're in enough pain or discomfort?

Or as has happened in the Netherlands, can someone just simply say, "I don't want to live," and then someone has to provide them with help in killing themselves? In the Netherlands, it's interesting. Children as young as 11 or 12 can say, "I don't want to live anymore," and a doctor has to help them die. It's truly tragic. Words don't do justice to this. But we should think through this Christianly.

I say that this is important for us to think about because it's an issue where I think Christians are actually influenced by their culture. And you might say, "No, I don't think we should starve people to death," but you might be surprised at who that you're close to, when pushed or asked about a certain situation, would actually say that it's better for someone to be killed than to keep on living.

I had just finished speaking on abortion at a retreat with a church group and I was talking the next morning and some people actually said, "You changed my mind on some issues dealing with abortion." It's like, okay, that's good, even though I had taken for granted that we were all probably on the same page and I was just equipping them to defend those convictions better. I'm very happy to change someone's mind on that issue. But as the conversation over breakfast turned to end of life issues, it became apparent that we were not on the same page, that if we were to reason consistently for how we address the unborn, we would actually say that no, you can't just kill someone or kill yourself because you're in enough pain. Or you can't kill someone because their quality of life isn't to a certain degree. We weren't on the same page on that issue. And the reason is because we don't view life the same way, at least we don't view it consistently. And so when we asked the question of why abortion should be illegal and why it is wrong, the answer needs to be something about the unborn. It can't just be, well, we took a vote or we think. It actually needs to be grounded in the fact that life from fertilization to natural death is valuable because God created it, because God designed it, because God owns it.

Our value as people is actually a reflection of who created and owns us, much in the same way often that art or a collectible is valuable because of either who made it or who currently owns it. It's the same way in some ways, permit the analogy to do a little work here, with us. God created us. We bear his image. We are made to actively image him in the world, and therefore, for that and other reasons, we are valuable. That applies if you are a four-cell organism that is a human in your mother, or you are 95 in pain or not in pain even, in a hospital bed. And it applies if you're a toddler who has what's deemed to be a terminal illness. So life, all of human life, at every stage of development, is valuable because God created and owns us. He has a claim to us. In the same way that it would be wrong for me to just go over to my neighbor's house and kill his dog because it's not my dog, it's wrong for me to take someone else's human life without proper justification because that life is not mine to take.

We often tend to think, and I'll get to this in a minute, that no, it's not my life to take. It's their life. But biblically and scripturally speaking, it's God's life. God owns that person's life. He has a right to that person's life. He created them for a purpose. We are not actually created to live for ourselves.

So before I get too ahead of myself, I want to make one distinction and we'll move on, and that's the difference between active and passive euthanasia. Now what is euthanasia? Euthanasia is kind of the broad term that's given to this sort of consideration where it's assisted suicide or mercy killing or that sort of thing, and euthanasia literally means "good death." "eu" would be the Greek prefix for "good" and then the Greek word "thanatos," which means "death." So you put those together and you get the phrase "good death."

That's what is often referred to today when doctors have to help people die, or want to kill them to put them out of their misery or something like that. It's called euthanasia. Now some people have tried to make a distinction between active and passive euthanasia, where active euthanasia might be giving them an injection that actively kills them, and passive euthanasia might be taking them off a ventilator or breathing device. And I do think there is a difference in those two things. The problem here, and we're not going to have enough time to talk about this, is people do not define their terms all of the same way. So some of the items that someone would include in passive euthanasia I would say are ethically okay. So for instance, I don't think someone has to be kept on a breathing machine. If their lungs are trying to stop on their own permanently and they would have to be on a breathing machine for the rest of their life, I don't think it's ethically required to keep them on it. So I think you could take them off. The body is trying actively in that case to die, and we are propping it up artificially with modern medicine.

So that's one thing. But how would that relate to some people saying passive euthanasia is actually removing a feeding tube? It's actually withholding food and water. Those are very different things, because the person would keep on living if you gave them food and water. That would be a fact. That's not medical care. And this is a key distinction when it comes to the case in England recently and many around the United States. Food and water is not extraordinary medical treatment. I wouldn't even consider it to be treatment at all. It's just basic human decency and care. Food and water is not a medical type of treatment. So to withhold that is actually an active attempt to kill the person, because their body would go on indefinitely, we'll just stipulate to that in this circumstance, if you gave them food and water. But often people want to withhold that to kill the person for some other reason. So sometimes if someone's in a coma, it's said, well, it would be better for them not to be in the coma, so we will withhold food and water. So your solution to this person being in a coma is to starve them to death? Because that's literally what's happening. That is not an appropriate type of action. That is not a moral or ethical action.

So all of that to say, what we mean when we say active or passive euthanasia needs to be defined. If the goal in the activity is to bring death to the person, then that activity is immoral. That's perhaps the easiest way to think about it. If our intent is to kill the person, that is off the table for the Christian. That is an immoral, unbiblical action.

Now why is this even a consideration in our society today? I think because society has adopted, and culture has adopted, three driving ethical principles. The first is that of relativism, that we all decide right and wrong for ourselves. There's no transcendent standard. So what is true for me may not be true for you. We talked about this in the past.

The second is hedonism, that pain is bad and pleasure is good. And so if something is causing pain and suffering, it is bad. It must be done away with, and many times anything is on the table as an option as long as it gets rid of pain or increases pleasure. Now hopefully what you're seeing so far is both relativism and hedonism are not biblical moral principles. So biblically speaking, there is one right standard: it is God as revealed in His Word. So relativism is off the table. Hedonism, at least as it's understood in terms of human pleasure and pain, is off the table. The Christian life is actually marked by picking up a cross or it should be and following after Christ, of dying to self, of denying one's self for a greater good, that would be the kingdom of God. So hedonism, unless we're talking about Christian hedonism, which would be a topic for another day, is off the table. But the third principle that guides culture and how it thinks today oftentimes is that of personal autonomy, that I have the right to dictate what happens to me and my body. No one can trample on my autonomy.

So you put these three together and you end up where people are saying, "If I'm in too much pain at the end of life, that, according to the hedonistic principle, says that I should have the right to kill myself because of autonomy." So these three things often come together in overlapping ways. Sometimes people will say, "Someone else is in sufficient pain; I should be able to kill them to put them out of it." So there's this relativistic standard where I think this is right for me because they're in too much pain; there's the hedonism. And maybe that person isn't actually conscious to be able to exercise their own autonomy. So these three things often come into play together. Those are three principles that are popular today, but let's look at some biblical principles that should guide how we think and act on life and death matters.

Life is the Lord’s

The first is that life is the Lord's. He created it, He owns it, I am not my own. As a Christian there are two levels to that, but the first is that, simply, I was created by someone else for someone else. I am God's. All of human life, all of life, is God's. So I am not my own at a fundamental level. But the second is as a Christian, I am not my own. I was bought with a price. So Christians have a second order allegiance to God. It's not just that we're people created by Him in His image, although that would be enough, it's that also we have been ransomed to live for Him. He died for us, He died the death that we deserve, so we are to live for Him, not for ourselves. So autonomy, personal autonomy, exerting my right to the things I want, goes out the window for the Christian, especially in life and death matters. We should always be considering, how does my life, how do my actions, glorify God? Because that's what we were created to do. That's what we were purchased to do by Christ on the cross. So life is the Lord's, that's our first principle.

Pleasure is not the highest good

The second principle, and this kind of fits with it, is that pleasure is not the highest good. Contrary to relativism, life is the Lord's, contrary to hedonism, pleasure is not the highest good. Delighting and finding satisfaction in Christ, a Christ-centered pleasure, is certainly the goal, but we find that by living according to God's design, by trying to glorify Him. So when we live how we were created to, which is not for ourselves, but live for God, we actually find our most deep satisfaction and contentment. That's kind of how it's arranged. God created us to love him as the most beautiful, wondrous, holy being who is most worthy of love, and when we do that we actually find our greatest satisfaction. So pleasure is not our highest good.

Intention matters.

What is our intent when making a medical decision? So we're getting a little more practical here. There are some situations where someone might be in a lot of pain and you could administer a drug to help them manage their pain, and that is a term which desperately needs to be defined in many circumstances. But let's say the intent in giving a drug is that the dosage is only high enough to help the person not be in pain. But there is a secondary side effect where that might speed their decline and their death. Not like, “we gave them the shot and they died,” but maybe over time that it becomes hard for them to breathe. There are some palliative measures, measures to help manage and prevent pain that can do that.

If the intent, the prime intent, is to manage pain and not kill the person, I do think in many circumstances that can be a morally acceptable option. Now we can't just play games with words and say, well, we gave them a drug that ordinarily would kill them, but that's "managing their pain." That's not what I mean. So the intent cannot be to kill the person; it should be to help them be more comfortable as a natural end comes as naturally as possible. Yes, through a secondary effect, maybe that actually hastens their death somewhat, but if that's not the intent, nor is that a very real or present type consideration, I think it's morally acceptable.

Extraordinary treatment is not required

The fourth principle is that treatment that is extraordinary can be withheld or not pursued, but ordinary treatment or basic care cannot. So let's say you have cancer and there's some very experimental treatment that costs millions of dollars and is only available in Austria. I don't think it's morally incumbent upon you. I don't think you have to pursue that treatment. On the other extreme, if there's someone in front of you who's been cut and they're bleeding out and you're just like, "Eh, we're just gonna let them die." That's a different sort of thing. That's not extraordinary treatment, to help someone stop bleeding. That's just basic medical care. Now obviously there is a wide range in the middle, but as technology advances and as, in some cases, medical procedures become more affordable, what is extraordinary becomes less and less extraordinary over time.

But here's a basic principle, and like I said, we can get caught in that squishy middle ground, but here's a basic thing. Food and water are not extraordinary. They're not even a treatment. They're basic care. They're basic sustenance for the body. And so those cannot be removed because what you're effectively doing is starving a person to death or making them thirst to death. So that is not a passive type of means of euthanasia. That is an active form in some ways, and even if it were passive, the intent is to kill the person if you're removing food and water, so that is an immoral action. So you don't have to pursue extraordinary treatment, but ordinary treatment or basic care should always be provided to someone.

Comfort without killing

And our last principle is that you can comfort without killing. I kind of hit on this earlier for intention matters, but with modern medicine where it is, there are numerous palliative measures that can be taken to provide comfort to someone who otherwise would be in a lot of pain so that they are not ending their days in excruciating pain.

Now, the flip side of that is even if someone is in excruciating pain, there is not, biblical justification to allow for killing that person. Life is the Lord's. We don't suddenly get to where life is uncomfortable enough and then it becomes okay to kill someone. No, that's not biblically acceptable, but thankfully today, through the common grace of medicine, it is rarely the case that someone cannot be comforted who is in extreme pain, so we can comfort without killing.

Dying may not be better

The last and very last principle, and I'll wrap this up, is that dying may not be better. We often call it, in society, euthanasia. Good death. But doesn't that assume that death is actually good for that person? As Christians, we understand, as Hebrews 9:27 says, that it's appointed unto men once to die, and then after that comes the judgment. So for many people, hastening their death only hastens their judgment and their condemnation if they're not in Christ. That should be the reason, one reason, why we care about this, because one, life is the Lord's, but more than that, we are not necessarily sending someone to a better place if they are not in Christ, and even if they are, that doesn't make it acceptable.

So we've gone a little bit longer than usual today, but this is a really important issue for Christians to think through. To think Christianly about. That pleasure is not the highest good; that autonomy is not a governing principle for the Christian; that relativism does not work; that God sets the standards; that life is His, and those sort of things. And our intention in end of life issues matter, that we always are treating life as if it is God's and incredibly valuable, even if the person is defenseless, whether they're in the womb or in a hospital bed. We treat all life, at every stage of development, as if it is, because it is, an image-bearer of God.

I will talk to you next week on Unapologetic.