Lifes Living toward Dying: A Theological and Medical-Ethical Study

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Should the appeal to the conviction that God Almighty is Lord over life and death rather be interpreted as the argument that only God controls and may control human life, one has to be careful not to fall in the trap of crude determinism.

Such crude determinism is at work when some evangelical churches teach that the doctrine on God's special providence implies that Christians should accept with resignation everything that overcomes them, including terminal illness and unbearable suffering, as the outcome of God's will. The logical conclusion that they should therefore also do nothing on their side to avoid serious illness or to overcome such illness and the suffering it involves, is seldom drawn.

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The refusal of conservative Reformed Christians in the small town of Staphorst in the Netherlands in the sixties to inoculate their children against polio is such an example. One can, of course, try to avoid such crude determinism by arguing that belief in the Lordship of God over life and death does not so much imply a denial of the responsibility we indeed have for our own lives and those entrusted to our care, but only the denial of any responsibility on our side to decide on such a crucial issue as when and how we or others should die.

Making such a distinction does not, however, help much in a situation where medical practitioners on a daily basis make decisions that have a direct impact on when and how patients die. The decision to resuscitate a patient who had a serious heart attack could avoid her certain death at that particular point in time and could add many more happy years to her life. It could, however, also have the result that her heart starts to beat again, but she remains in a coma due to brain damage caused by a lack of oxygen during the period in which her heart stopped.

If a ventilator is used to help keep the patient in the coma alive medical practitioners and family members are then again faced with the decision on whether and when the 'plug should be pulled' to bring about the death of the patient. In rare cases the patient may keep on living even after the ventilator has been unplugged. New decisions then await those involved on whether artificial nutrition should be continued or rather discontinued to allow the patient in the 'persistent vegetative state' to die of hunger and thirst.

The same applies to many other cases medical practitioners have to deal with on a daily basis. The conclusion is unavoidable: we are already on a large scale taking the responsibility to decide on when and how seriously ill persons will die. And there is no reason to morally condemn those who take such a responsibility on them.

The ethical issue is not so much the responsibility to decide on when and how a seriously ill patient should die, but rather whether this responsibility may include in certain circumstances the decision in favour of medically assisted suicide or voluntary euthanasia. In the context of this article the ethical issue could be defined even narrower: 'May the responsibility of the Christian to take care of his or her own life and those of other persons, include in the case of the terminally ill Christian the decision to request medically assisted suicide or euthanasia?

Autonomy is also for Christians the final arbiter in deciding. In the previous section we have argued that the issue of the moral acceptability of medically assisted suicide and euthanasia cannot be foreclosed by appealing to an absolute prohibition based on the sixth commandment and the belief in God's Lordship over life and death. Christians cannot avoid the responsibility to thoroughly reflect and decide on the acceptability of these two practices in particular situations.

Does that now, however, mean that they may elevate their own autonomy to final and sole arbiter when deciding on the matter?

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In Western liberal democracies the right to autonomy plays a central role in the debate on the legalisation of medically assisted suicide and euthanasia. Autonomy as moral value to which this right relates is highly regarded as the core of human dignity, which in turn is seen as the foundational value of human rights. Although they are in the minority, a number of Christian ethicists can be found, who also argue in favour of the named practices by appealing to autonomy as central value. The Dutch theologian Harry Kuitert is a clear case in mind. Autonomy needs not be interpreted as a synonym of arbitrary self-determination, of doing whatever you wish to do.

For Immanuel Kant the autonomous legislation of the will entails the free and rational recognition of a general moral law. The autonomy of the individual is thus conditioned by the moral law, which applies to everyone Kant ; cf. However, it cannot be denied that today autonomy is often understood as pure self-determination.

Especially in debates on the ethical acceptability of medically assisted suicide and voluntary euthanasia protagonists of these two practices often in a rather abstract way elevate the self-determination of the patient to final arbiter. Whenever a patient wishes, for whatever reasons, to be medically assisted in suicide or in euthanasia - the argument goes - a moral obligation rests on medical practitioners and family members to grant the wish. By implication it is taken for granted that the wish of the patient is always morally acceptable. Kuitert starts off his endorsement of the principle of self-determination as final arbiter when it comes to end of life issues with a number of qualifications.

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He asserts: 'Self-determination thus definitely does not mean that I only do what I wish, that no one else has a determining influence on my life, even that nobody may have such a determining influence. It rather means that there are limits to the power they have to determine my life and that I may come up for these limits' Kuitert , tr. Kuitert is strong in emphasising that no one, including medical practitioners, may take life and death decisions on behalf of patients.

In response one cannot but agree with him that when it comes to such decisions moral limits must be respected, including the moral guideline that the informed consent of the patient must be obtained. Kuitert is, however, not so strong in pointing out what the moral limits are that would prevent the patient's self-determination from deteriorating into arbitrariness, a futile attempt to retain total independence, or a panicky flight from a difficult situation. These moral limits in his opinion clearly do not come from the religious beliefs of Christians. In his discussion of the question: 'Is there anything in the Christian faith, which makes euthanasia … impossible for Christians?

Christian beliefs regarding life as a gift from God and the meaning of death and suffering are, in his opinion, of no consequence when the content of such moral decisions is at stake. They have, at the most, a certain motivational role to play Kuitert I agree with Nigel Biggar that from a Christian ethical perspective it is unacceptable to equate autonomy with a self-determination that denies the validity of moral values that are independent of my will.

It lies not in sheer autonomy, but in responsibility first to God and therefore also to one's human fellows' Biggar When it comes to deciding on the request for medically assisted suicide or euthanasia, the responsibility of Christians would include reflecting on the ethical implications of the message of the Bible and their personal vocation from God.

They would also have to take into consideration the prevalent moral consensus within the Christian church and the society in which they live and consult family members and fellow Christians. And finally, they should try to ascertain to the best of their ability what the foreseen consequences of a request for medically assisted suicide or euthanasia for family members and for the moral fibre of society at large would be cf.

Bedford-Strohm The moral implications of relevant Christian beliefs. The conclusion drawn in the discussion in the previous section has been that the message of the Bible does not entail an absolute prohibition against medically assisted suicide and voluntary euthanasia. However, this does not mean that Christians have to fall back on their own autonomy as highest arbiter when making decisions in this regard, as if their religious beliefs do not provide any moral guidance.

Some of these beliefs do have ethical implications for their decisions on life and death, and their internalisation of these beliefs through participation in the practices and rituals of the church do cultivate in them basic moral attitudes or virtues that provide guidance when confronted with the option to request medically assisted suicide or euthanasia. In the last part of this article I am discussing the moral implications of these relevant Christian beliefs. Respect for the sacredness of human persons.

On account of the message of the Bible, Christians believe in the sacredness of human persons. Although the Bible teaches that humans have a calling to be stewards of all of God's creation and should have a certain respect for plants and animals, it certainly teaches that the respect we should have for the lives of human beings is special. This is a respect we should have for the lives of all persons, irrespective of their gender, race, class, age, sexual orientation, appearance or mental capacity.

The reason is not that persons earn such respect on account of some admirable characteristics or some valuable contribution to society. If this were the case we would have been justified in having more respect for the lives of meritorious persons than for the lives of persons who in our opinion are less meritorious.

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The reason is rather that the Bible teaches that God bestows on each and every human being a special dignity or sacredness. This is the person who walks humbly on the earth as the image and likeness of the Creator who made him … H e is, with all his gifts and in spite of all his sins, the sacred person among all other valuable living creatures' Smedes Respect for the sacredness of persons entails a certain awe and humility which compels us to keep a certain distance, to maintain a certain circumspectness and carefulness when we are taking decisions that could impact significantly on our own lives or those of others.

It is prone to cultivate in us a strong moral prejudice against the killing of human persons, including committing suicide, or requesting medically assisted suicide or euthanasia. This does not mean that this prejudice cannot be overridden by other considerations. It does, however, mean that such considerations must have more moral weight than the strong moral prejudice against the killing of human persons.

Should I and the loved ones I consult not be convinced that considerations in favour of the request for medically assisted suicide or euthanasia morally outweigh the moral prejudice against killing human persons we have to refrain from it. Gratefulness for life as a gift from God.

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On account of the message of the Bible, Christians believe that their lives are gifts from God. In the past, theologians and philosophers often argued that this belief entails a clear-cut moral prohibition against suicide: because life is not simply our property, but a gift or a loan from God, we have no right to damage or destroy it. Against this argument the counter-argument has been made that if a gift is genuine, then the donor has relinquished his or her rights of control. If life is really a gift from God to the individual, the individual has the moral right to do with it as he or she chooses cf.

Biggar In my opinion both the argument and counter-argument are based on a misunderstanding of the core meaning of this Christian belief. The argument does not sufficiently take into account that a gift is only a genuine gift when it is given with no strings attached.


It should especially not be equated with a loan that reduces the receiver to a debtor faced with the obligation to pay back the loan. The counter-argument does not sufficiently take into account that an attitude of 'I can do with the gift whatever I like' is not a fitting attitude for the receiver of the gift. It should rather be one of gratitude, joy and humility on account of the undeserved, unconditional nature of the gift.

When the gift is as precious as life itself an attitude of cherishing and care is also fitting. In his book on gratefulness the Dutch philosopher Paul van Tongeren argues that gratefulness for life should be seen as a virtue that can be cultivated, rather than as a duty we have to fulfil Van Tongeren When we believe that life is a gift, and when we have regular experiences of life as a gift, gratefulness for what we experience in life, even for life itself, needs not be something that we only occasionally experience.

It can over time develop into a disposition that, in turn, enables us to, on a more continuous basis, experience life as a gift.

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If the major key in which we live our lives becomes gratefulness, it is possible to even in difficult situations, when we are sick and are suffering, experience life as a gift. Van Tongeren observes that in religion and in art the experience of beauty and goodness and of thankfulness over against God in the midst of suffering and evil, has often been recorded. Trust in the sustained care and support of God. Earlier in the article I critically discussed the appeal to the Lordship of the Almighty God to ground an absolute prohibition of medically assisted suicide and voluntary euthanasia.

In such an appeal the Almighty God is equated with an authoritarian ruler who jealously controls everything and everyone and leaves little room for human beings to exercise responsibility. However, the dominant picture provided by the Bible of the Almighty God is different. He is the God who restricts his own omnipotence in more than one way. He creates human beings as free beings, which also includes the freedom to choose evil and to turn against Him. He does not destroy humanity and the world in wrath when human beings rebel against Him, but rather faithfully continues to sustain his creation.

He does not force human beings to leave their sinful ways, but rather appeals to them to repent their sins, and forgives them when they do so. Through the incarnation and death of his Son he identifies in the strongest possible manner with the plight of human beings and the world. He cares for the sick and the poor and promises to support them even in the hour of death. He thus exercises his rule over the world by means of the power of his love. On Christians in the terminal phase of illness this belief in the faithful presence and support of God in their suffering can, and often does, have a strong comforting and empowering impact.

As the German theologian Wolfgang Huber puts is: they may trust that even in death they will not fall deeper than the hands of God Huber The moral significance of trust in the sustained care and support of God when it to comes to medically assisted suicide and voluntary euthanasia thus consists in providing hope and comfort to believers and strengthening their inner resilience against death seeking despair.

The responsibility to remain true to one's vocation as Christian.

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Christians believe that each one of us has a unique vocation from God to fulfil in this life. One may even say that it is this unique vocation that in the first instance constitutes die dignity of the human individual. Award Winners. Biblical Studies. Dead Sea Scrolls. Second Temple Ju Hermeneutics and T Grammars and Exege Old Testament Studies Criticism. Apocrypha and Pseu New Testament Studies John Studies.

Life's Living Toward Dying: A Theological and Medical- Ethical Study