A Christian Response to Physician-Assisted Suicide
"I just can't handle it anymore. It's been six months now since I've slept for more than an hour at a time I can't eat solid food anymore, and I live in excruciating pain. My family will be forced to watch me wither away. Money which could be used to send my children to college or pay for their weddings will be spent to keep me in this hospital. My doctor mentioned that a number of people in my position have 'died with dignity' with the help of a physician. I am planning on requesting a physician-assisted suicide. I know it will be best for everyone." How does one respond to such a statement? What would you say if a friend or loved one said this to you?
Were the practice of physician-assisted suicide (PAS) advocated solely by non-Christians, perhaps an article on the topic might not seem all that relevant. After all, non-Christians do many things which violate what God has revealed both in nature (natural law) and in scripture. In recent years, however, a number of Christians have begun to advocate PAS as a legitimate practice for Christians who no longer wish to live. Arguing on such grounds as "the right to die with dignity," "human autonomy," and "mankind's God-given dominion over all creation" (which includes one's own life), some Christians have attempted to make the case that PAS is not a violation of the sixth commandment, and argue instead that Christians may be supported in their desire to end their lives with the help of a physician.
Thou Shalt Not Murder...
Genesis 4 recounts the story of the first murder in history. In his jealousy, Cain rose up and killed his brother Abel. When the Lord confronted Cain, Cain was unable to deceive the Lord and was "cursed from the ground" (Genesis 4:11) because of his sinful act. Immediately following, Cain expressed his concern that there would not be justice for him on the earth and that the inhabitants would respond to his sin by killing him. This implies that Cain understood that everyone simply knew murder to be wrong and would therefore seek vengeance on him. The Lord made an oath to Cain, however, that there would be justice in the world, even toward him, a murderer.
After the flood, God made a covenant with every living creature (Genesis 9:10, 12, 15-17). A central element is found in Genesis 9:5-6:
And for your lifeblood I will require a reckoning: from every beast I will require it and from man. From his fellow man I will require a reckoning for the life of man. Whoever sheds the blood of man, by man shall his blood be shed, for God made man in his own image.
Though one may find instances of legitimate killing throughout the Scripture, the unjust taking of life is always condemned as something sinful.
"Thou shalt not murder," is perhaps the key passage when considering the sanctity of life. After all, when Jesus described unrighteous anger as murder (Matthew 5:21-22), he did not quote from the Noahic covenant, but from the decalogue. In the case of this commandment, however, we are privy to God's rationale because of Genesis 9:6. Jochem Douma notes that murder is wrong because in taking one's life "we would be acting as if a person's life and reputation are of little or no value" (The Ten Commandments: Manual for the Christian Life, trans. Nelson D. Kloosterman [Philipburg: Presbyterian & Reformed Publishing Co., 1996], 211). He argues: "Among all God's creatures, people are unique. They represent God on earth. God wants to live in them and have His own power radiate through them in this world. Man was destined to be God's temple" (pg. 210). After all, "plants and animals are called creatures of God, but only people have been created in the image of God..." (pg. 210). God's commandment is given because humans image Him and He, as their creator, is the only one who has control over life and death. Louis Berkhof concludes: "The crime of murder owes its enormity to the fact that it is an attack on the image of God" (Systematic Theology [Grand Rapids: Eerdmans, 1977], 204). Unjust killing defaces the image of God.
The Bible's condemnation of murder must also condemn suicide as a form of self-murder. After all, in suicide, the image of God is defaced just as it is in murder. Not everyone, however, is convinced by this argument. In a paper advocating the legalization of PAS, Lawrence E. Hoist argues that though five suicides are mentioned in the Bible, "the Bible makes no comment about these recorded suicides, and neither condones nor condemns them. Historically, the strong condemnation of suicide has been post-biblical" ("Do We Need More Help in Managing Our Death? A Look at Physician-Assisted Suicide" in Journal of Pastoral Care 47, no. 4 : 341).
When one considers the five suicides mentioned in the Bible (six if one includes the Suicide of Saul's armor bearer), one hardly finds the text silent concerning the suicides. In the cases of Saul (1 Samuel 31:4/1 Chronicles 10:4) and Zimri (1 Kings 16:18), the text shows that they were wicked men whose ultimate defeat in battle was the result of their sin against the Lord. Ahitophel was an ally of Absolom and an opponent of King David. David, in fact, prayed that Ahitophel's counsel would be turned to foolishness (2 Samuel 15:31). Though Abimelech did command his armor bearer to run him through (his command making this essentially suicide), he had already been dealt a fatal blow. The narrator describes this saying: "Thus God returned the evil of Abimelch..." (Judges 9:56). Judas, rather than repenting of his sin, killed himself (Matthew 27:5). Acts 1:20 cites Psalms 69:25, saying that the camp of God's enemies shall be left desolate. In each of these cases, those who committed suicide are not model citizens simply "dying with honor."
Although the case of Samson may be a bit more ambiguous (after all, God granted Sampson the strength he needed to push down the pillars and Hebrews 11:32 lists Sampson among the "heroes of faith"), his entire life was one of disobedience to God, culminating in his suicide which was not in defense of God's honor, but was done in order to avenge his two eyes (Judges 16:28)! Conversely, it is interesting to note that the Bible does actually record the prevention of a suicide. Paul and Silas cried out for the jailor not to harm himself! Douma explains: "Biblical condemnation of those who took their own lives is possible only by taking into account their entire lives" (pg. 224). From the way Scripture records these cases of suicide, one can see that the Bible is not silent on the matter, even though not explicit in its condemnation of it.
Does the Apostle Paul Contemplate Suicide?
Arthur J. Droge attempts to muster Paul's words in as an example of the Bible speaking favorably of suicide. He argues that Paul himself (in line with Seneca, the Roman Stoic who was an instructor of Caesar Nero, and the Socratic principle which allowed for one to commit suicide once God had sent a "necessity" upon him) indicated that suicide was a decisive choice that a Christian could legitimately make provided that he had completed the task to which God had called him. In Philippians, Paul writes: "For to me to live is Christ, and to die is gain ... My desire is to depart and be with Christ, for that is far better" (Philippians 1:21, 23). Droge interprets this (and similar verses in 2 Corinthians 5) to be Paul's expression of a longing for suicide and, in fact, he argues that though it is not known how Paul died, "given his statements in Philippians 1:23 and 2 Corinthians 5:8, the possibility of suicide cannot be ruled out" ("Suicide," in Anchor Bible Dictionary, ed. David Noel Freedman [New York: Doubleday, 1992.], 6:229).
Droge's interpretation of Paul's words, however, presupposes that Paul does, in fact, hold the same position as does Seneca (and Socrates). In a scholarly article published in Novum Testamentum, Droge attempts to connect the views of Paul with Seneca's stoic position ("Mori Lucrum: Paul and Ancient Theories of Suicide," Novum Testamentum 30, no. 3 : 278-85). Unfortunately for Droge, the only passage which might allow for a pro-suicide reading of Paul is Philippians 1:23. Even within this passage in Philippians, however, Droge's alleged link between Paul and Stoicism is exclusively lexical (i.e., they use the same words). Though he proves that Paul used some vocabulary which Stoics used in their defense of suicide, he does not show that Paul uses it in the same way as them. J.N. Sevenster, though writing almost thirty years prior to Droge, nevertheless offers a cogent and destructive critique:
It is plain that fundamental differences emerge between Seneca's estimation of suicide and Paul's preaching of the Gospel. No immediate comparisons can of course be made, since Paul nowhere speaks of suicide or the possibility of it. At the most those places can be compared where Paul writes of a desire to depart ... But how vastly different are these texts (2 Corinthians 5:8, Philippians 1:23) from Seneca if we read them both in their setting! Even the quoted passages testify to the fact that death is only desired in so far as it holds forth a prospect of being at home with the Lord. Hence Paul does not really long for death; he longs to be with Christ. But if Christ can still use him here on earth, he will of course choose life.Paul and Seneca [Leiden: E.J. Brill, 1961], 58.
Since the Bible both prohibits murder and explains the reason for this prohibition (i.e., humans are created in God's image), it is clear that unjust taking of human life (in all forms) is forbidden by the Bible. Hoist's suggestion that suicide only violates a "traditional interpretation" of the sixth commandment fails to see that the traditional interpretation is the Biblical interpretation! Although, one can find the legitimacy of war (which of course involved killing) and the legitimacy of the magistrate's "bearing of the sword," in each of these cases killing is rightly done as an act of divine justice, being accomplished through the means of his chosen emissaries. The Bible's own implicit condemnation/disapproval of suicide further gives us good reason to apply the sixth commandment to the matter of suicide. This proposed application, in light of the exegetical evidence above, falls clearly within the intent of the commandment.
But Aren't Humans Autonomous?
Lauris C. Kaldjian, in offering a theological response to PAS writes: "Philosophical arguments in favor of PAS rely heavily upon a principle of respect for patient autonomy" ("A Theological Response to Physician-Assisted Suicide," Theology Today 56, no. 2 : 203). To be autonomous literally means to be "self-governed" or to view oneself as the ultimate source of law, not subject to anyone other than oneself. Holst, in his case for PAS, assumes that humans are autonomous, even appealing to this when he defends that physicians cannot be forced to assist in a suicide. He writes: "Neither's autonomy transcends the other's" (pg. 344). It comes as no surprise that non-Christians would argue a case. Greg L. Bahnsen notes:
The non-Christian thinks that his thinking process is normal. He thinks that his mind is the final court of appeal in all matters of knowledge. He takes himself to be the reference point for all interpretation of the facts.Always Ready: Directions for Defending the Faith., ed. Robert R. Booth
[Nagogdoches: Covenant Media Press., 2006], 46.
Christians, on the other hand, are called to recognize that they are anything but autonomous. This is not to say that humans, who are intelligent, accountable, and moral creatures, do not possess a true form of freedom.
The Bible certainly does not proceed from the assumption that the divine decree is inconsistent with the free agency of man. It clearly reveals that God has decreed the free acts of man, but also that the actors are none the less free and therefore responsible for their acts, Genesis 50:19, 20; Acts 2:23; 4:27, 28pg. 106
This freedom, however, cannot properly be called autonomy. Because Christians recognize that it is God who is sovereign, upholding everything according to the purposes of his will, they live according to what he has said, something Cornelius VanTil described as "the acceptance ... of the ultimately self-determinative will of God" (Christian Theistic Ethics, in Defence of the Faith, vol. III [Nutley: Presbyterian & Reformed Publishing Company, 1977], 35.).
The Call to Suffer
The Apostle Paul affirms the reality of suffering and interestingly does not describe it as something that is optional for the Christian: "For it has been granted to you that for the sake of Christ you should not only believe in him but also suffer for his sake" (Philippians 1:29). Here Paul compares the surety of our suffering with the surety of our election. He also exhorts Timothy: "Share in suffering as a good soldier of Christ Jesus" (2 Timothy 2:3; cf. 1:8, 4:5). While many people have sought to avoid suffering, Paul has called Christians to face it willingly. Hoist, however, disagrees: "While we can, and should, lift up the sanctifying values of suffering, we dare not impose them on everyone. To acknowledge that growth may occur through suffering is different than insisting it must occur" (pg. 342). Hoist understands suffering as something that may shape Christians into the kind of people they want to be. The New Testament, however, indicates that suffering does shape Christians into the kind of people God wants them to be.
Ultimately, one must consider suffering in light of the one who suffered to the utmost, Jesus Himself. In His incarnation, Christ began His suffering — the eternal Word became flesh in the form of a tiny and helpless baby. On the cross, Christ endured the most excruciating suffering imaginable. He suffered the derision of men, but more horribly, He suffered the wrath of God against sin. Though Christ's suffering differs from Christian suffering in that only His suffering actually atones for sin, Christ and His followers both really and truly suffer. Horton explains: "His suffering was redemptive, whereas ours is a participation in that already-accomplished victory. But our cross bearing is still real" (Too Good to be True: Finding Hope in a World of Hype [Grand Rapids: Zondervan, 2006], 46.). Though Christ dreaded His suffering, He nonetheless embraced it (Luke 22.42), and in this suffering He accomplished the greatest feat imaginable, victory over sin and death.
Adele Stiles Resmer describes how Luther's "Theology of the Cross" is the proper lens through which to understand human suffering. She writes:
On the cross, God participates in the brokenness, despair, and death that is part of human existence. God is not the great knight who comes to save us from our human experiences. God does not deny the dreadfulness of many of our experiences. Rather, God is a humble companion who accompanies us in and through the worst of it all..."Physician-Assisted Suicide: What Is the Pastoral Task?"
in Word & World 16, no. 1 : 35-36
Not only does Paul call Christians to suffer, he says that he rejoices in his sufferings (Colossians 1:24). This is because Paul teaches a full-orbed "theology of suffering." Though for Hoist suffering is something that has only subjective value insofar as it can help people become the kind of people they want to be, suffering for Paul has both subjective and objective elements, making his theology of suffering far more substantial.
Paul praises God as the "God of all comfort" (2 Corinthians 1:3). He argues that when we are afflicted, then too we are also comforted. The key phrase in his argument is in v. 5: "For even as we share abundantly in Christ's sufferings, so thus through Christ we share abundantly in comfort too." Paul's use of the Greek terms translated "even as" and "so thus" strengthen the force of his argument all the more. To share in Christ's sufferings is to also share in comfort.
The second strand of Paul's theology of suffering goes beyond the subjective element of comfort, however, and becomes much more objective. In Philippians 3:8-11, Paul counts everything he accomplished to be rubbish, and instead counts it gain to be found in Christ.
That I may know Him and the power of His resurrection, and may share in His sufferings, becoming like Him in His death, that by any means possible I may attain the resurrection of the dead.Philippians 3:10-11
The Greek participle, translated by the English phrase "becoming like him" (literally: while being conformed to him), shows that as he is sharing in Christ's sufferings, he is also participating in Christ's death. This is good news, Paul argues, because it also means participating with Him in His resurrection. Paul makes this explicit in Romans 6:5:
For if we have been united with Him in a death like His, we shall certainly be united with Him in a resurrection like His.
Paul clarifies this all the more in Romans 8:16-17:
The Spirit Himself bears witness with our spirit that we are children of God, and if children, then heirs — heirs of God and fellow heirs with Christ, provided we suffer with him in order that we may also be glorified with him.
Suffering leads not only to resurrection, but to glorification!
Paul's theology of suffering is clear. Not only are Christians called to suffer with Christ for the comfort they will receive, but they suffer in order to be conformed to Christ in His death, united to Him in His resurrection, and ultimately to be glorified with Him. Christians who are suffering intensely are not simply encouraged to hold fast so that they might experience a subjective form of accomplishment or pride, but are called to hold fast because here, in this excruciatingly difficult time, they are being conformed to the image of their savior, Jesus Christ. For a Christian to use PAS as a way out is not only to refuse to share in the same sufferings which Christ endured for their sake, but is also to refuse to trust God that this suffering is truly accomplishing the end for which He has ordained it.
This is not to say, however, that the pain of suffering is somehow to be minimized When a member in Christ is weighed down under immense physical pain and suffering, our response must be that of a grieved friend, one who weeps with them, longs along with them for the age to come when God "will wipe away ever tear from their eyes, and death shall be no more, neither shall there be mourning nor crying nor pain anymore..." (Revelation 21:4). It is tragic that many who suffer feel compelled to take their own lives because they fear dying alone. They believe that controlling the time of their death will somehow minimize this isolation. If we are convinced that God's word forbids PAS as a legitimate way for a Christian to end his sufferings, however, we must not simply admonish them to refuse PAS. Instead we must come alongside our suffering brother, sit with him, talk with him, pray with him, be with him in his darkest hours, read scripture with him, and above all, remind him time and time again that God has not rejected him. He is not being punished for his sin because Christ has already been punished in his place on Calvary. Instead we must reassure him that even in the midst of this seemingly unbearable time, God is shaping him into the person He would have him to be. God is conforming him to Christ's sufferings so that he will be united to Christ in his resurrection and ultimately in order that he will be united to Christ in glorification. Though the tunnel looks as though it cannot get any darker, there is not only a light at the end, there is the eternal light, the light of God's heavenly glory. While we are to encourage one another to cherish life by refusing PAS, we must also encourage one another to set our sights on eternal life in our heavenly promised land. There we will find complete freedom from pain and suffering because, as the Apostle John writes, "the former things have passed away" (Revelation 21:4).