October 4, 1978
A notion making the rounds in certain Christian circles today goes something like this:
“Medical care costs so much these days, and with taxes and other expenses being what they are, when it comes time for me to die I just want to die ‘naturally,’ without being hooked up to any machine. After all, I have a responsibility to my family not to cost them a fortune as I die. And besides, who wants to live like poor Karen Quinlan anyway?
“Therefore, I’ll sign a statement which will tell the doctor that when I become critically ill, when there is no more hope, he should not try to sustain my life with extraordinary procedures.”
This notion, I believe, is not only destructive to the family fabric but also patently anti-Christian.
Christian families are being faced daily with the specter of a slow death in their family and with the consequent question: “What should we do?”
Much of the public attention to this agonizing question stems from the celebrated case of Karen Quinlan. While her situation does not involve a legal document called a living will, the desire not to duplicate her situation has caused many Christians to embrace the “death with dignity” type of thinking.
Advocates of the “death with dignity” movement are promoting the so-called living will which basically stipulates that when death is “imminent” or life is “hopeless,” in the opinion of the attending physician, then the physician is to withhold life-sustaining procedures in order to allow the patient with the living will “to die with dignity.”
Bills instituting this concept have already passed in California and in one house of the legislatures of most of the other states. Indeed, in virtually every state legislature a living will law has been proposed.
I strongly oppose these bills and this concept; and I counsel other Christians – and seek to persuade legislators – that this philosophy ought not to be accepted. For many basic reasons I oppose the concept of a living will, but before I get to those reasons let me quickly address some comments to the Karen Quinlan type of situation:
Once life-support treatment is begun on a dying patient, to remove that treatment in order to hasten death is tantamount to premeditated homicide. If that seems harsh, it seems harsh only if one forgets the intrinsic value of biological life (Gen. 1:26), or if one forgets the alternative to life-support treatment — no life-support treatment at all.
If one wants to die “naturally” then one ought not to be put on the artificial machines in the first place. Once hospital personnel are Involved, the freedom of choice is automatically curtailed. Other individuals are caught up in the patient’s physical predicament, and he has no moral right to bind those Individual consciences to the thinking of the patient.
The classic Biblical example of an immoral attempt to bind another’s conscience is King Saul’s euthanasic request of another Hebrew (I Sam. 31), but fortunately that Hebrew knew God’s law.
I oppose the concept of a living will as being anti-Christian for the following reasons:
In the first place, the document ought not to be called a living will, but rather a “death will” (Isa. 28:15; Jer. 8:3), since it legalizes one’s wish to die, not to live. Clearly, this is against Scriptural teaching (Deut. 30:19-20). The Bible uniformly teaches that the personal, deliberate taking of one’s own life — regardless of the method or circumstances surrounding the killing — is found only in a context of God’s judgment, whether the Scripture Is referring to Samson (Judg. 16:30), King Saul (2 Sam. 1), Ahithophel (2 Sam. 17:23), Saul’s armor bearer (I Sam. 31), Judas (Matt. 27:5), or anyone else.
Indeed, the Scriptures speak of two of God’s most favored people enduring great pain and suffering In their pursuit of life and resistance of death: Job (Job 2:7, 9, 13, 7:16, 9:21) and Paul (2 Cor. 11:23-33; Phil. 1 :21-24).
Jesus commands us to love ourselves as a prerequisite for loving others (Matt. 22:39), so to kill ourselves by a death will is morally as evil as killing our neighbor (Lev. 19:18; Gal. 5:14).
The difficulty with the Idea of the death will concept is that medical judgments can differ. Medicine, at the “imminent death” stage, is an inexact science because the criteria for “imminent death” are hazy and imprecise; this will always be the case with the death of a human being.
Simply put, the death of the Individual parts does not necessarily equal the death of the whole person. A mistake in medical judgment at this point in one’s life is hardly coffee table!
For Instance, in some “terminally” III patients, blood transfusions, antibiotics or intravenous feeding would be considered “life-sustaining treatment.” Furthermore, what are now considered extraordinary medical procedures will be quite ordinary a decade from now. But the value of life will be the same always — priceless.
These death wills inject the courts and legal profession into what has historically been a personal relationship between the physician and the patient. The medical profession has long made decisions, usually in conjunction with the patient and family, to allow death by withholding treatment. See I Corinthians 6 for a principle applicable at this point for secular courts and Christian practice.
These wills no doubt will put into our legal system a concept which opposes the sanctity of life clearly taught in the Bible (Gen. 9:6).
An underlying assumption behind these death wills is that life is a possession, and the possessor may do what he wants with it. This assumption also runs counter to the Bible’s teaching that life is a gift and that there are restrictions on what one does with that gift (Job 1 :21, 12:10). Moses taught that possession does not equal ownership (Lev. 25:23; Deut. 1:8).
Another assumption underlying these wills is that we can “dignify” death if we delete suffering, pain and deformity from the dying process. Somehow anguish has become Inhuman and completely alien to our species. Biblical writers, however, do not see suffering and pain in the same unacceptable light (2 Cor. 12:7-10; Jas. 5:10-11).
The Christian responsibility for the sick person is not benign neglect — if neglect can ever be benign — but rather an active effort to relieve pain, suffering and sickness (Matt. 25:34¬36; Jas. 2:14-17). The Scriptures teach that to fight against sickness and death is a holy war against sin itself (Matt. 9:35; 1 Cor. 15:54-56).
The biggest problem with the so-called living will concept, however, Is that it codifies Into legal statute what is meant to be a family decision, or at the very minimum, a patient-physician decision. To bring the law courts into such a delicate and private situation can only result in confusion, abuse and denial of personal rights (2 Cor. 6).
The ethical tension surrounding Saul’s death (I Sam. 31) clearly shows what happens when the state (King Saul) makes demands on private citizens to contravene God’s fundamental value system. To bring the state into private moral matters is always risky for the Christian citizen.
In light of what has been said, what can your family do in the face of a slow family death, instead of using the living will? First, you must understand that no moral problem arises when family members decide in advance what they want to do in case of terminal Illness in that family.
Indeed, I would highly recommend such family conferences and even putting the conclusions down in writing for periodic review and discussion. As a Christian alternative to these living wills, I suggest that a family use something like the “Christian Affirmation of Life” available from the Catholic Hospital Association, 1438 South Grand Blvd., St. Louis, Mo. 63104.
Unless the Christian family faces the specter of death In that family before it happens, the family members will be forced into difficult decisions in the midst of great sorrow when there is little time for contemplative study of Scriptures, reasoned discussion among family members and friends, and thoughtful prayer to life’s great Sovereign.
Second, I would urge the Christian citizen to lobby against “death with dignity” legislation which attempts to make legal and formal the living will. This political activity would involve working for politicians who believe that government ought not to manipulate the family In Its own decisions.
Third, I would suggest you study the subject of death and the manner of death given in the Scriptures. This could most profitably be done in a small study group. The group might also want to study some good Christian books dealing with this, such as The Right to Live; The Right to Die by C. Everett Koop (Tyndale). In short, get your church Involved in the discussion because many in the congregation will be facing this dilemma in the future.
Nothing is going to make the death of a family member an easy thing to watch or accept, even for those who have put their trust in Christ. However, some of the principles discussed in this article will make the process of dying more consistent with Biblical principles. These thoughts may provide a stimulus for clear and sober reflection by the Christian family.