The mission of Issues in Perspective is to provide thoughtful, historical and biblically-centered perspectives on current ethical and cultural issues.

I had addressed the subject of assisted dying in an edition of Issues on 25 January 2025.  But what is occurring in Quebec, Canada is alarming.  Hence, I want to return to the topic of assisted dying in this edition of Issues in Perspective.

A new law adopted in the province of Quebec, Canada on 31 October 2024 permits patients to request what Canadians call medical assistance in dying (MAID) long in advance of the debilitation or deterioration associated with terminal illness . As The Economist reports, “It represents a significant expansion of Canada’s federal laws on assisted dying, which require patients to provide consent immediately before they receive a set of lethal injections. In Quebec, patients with an illness that will eventually render them incapable of granting that consent can now make arrangements for MAID months or even years in the future, long before their condition deteriorates . . . Slightly over 1,000 Canadians opted for a doctor-assisted death in 2016, the first year in which it was permitted. By 2023 that number had risen to 15,343, 4.7% of the 326,571 deaths in Canada that year. No country that permits assisted dying has seen faster growth in the practice. (The Netherlands has allowed assisted dying for more than two decades, and it accounts for a higher share of deaths there than in any other country, 5.4% as of 2023.)”

The Economist continues:  “Nowhere in Canada has adopted MAID faster than the French-speaking province of Quebec. The share of deaths in the province that were doctor-assisted reached 7.2% in 2023. Michel Bureau, who heads a commission on end-of-life care that reports to the provincial legislature, says there is little doubt that the province carries out the highest number of doctor-assisted deaths in the world relative to its population. He says that Quebeckers now see MAID as a fundamental part of their medical system. Surveys suggest that three-quarters of Canadians support MAID. In Quebec that number is 86%. Dr. Bureau says the number of people in Quebec choosing MAID will keep rising, now that consent may be given in advance.”

“That pleases Georges L’Espérance, a retired neurosurgeon who runs the Quebec Association for the Right to Die with Dignity. He says he has helped hundreds of people end their lives, and has noticed a rise in requests for his services since the law was changed in October. His relationships with patients seeking MAID tend to be very different from those shared with patients awaiting brain surgery. He usually met people going under the knife for a single consultation before surgery. Applying for MAID is a multi-step process that requires repeated meetings with patients and can run over several years.  Dr. L’Espérance says MAID patients know there is no hope their lives can be improved, but that ‘people are smiling 15 minutes before they know they are going to die. They talk, share a glass of wine, and tell their family members how much they are loved.’ He stays with family members for at least an hour after patients die. He answers all their questions. Often they embrace him. ‘I never had that experience as a surgeon,’ he says.”

Additional points from The Economist article:

• Opponents of MAID’s expansion in Canada say that too few of the doctors recommend traditional palliative care as an alternative. Dr. L’Espérance and others point to statistics suggesting that 78% of those who opt for MAID have tried palliative care first. Opponents also worry that some patients choose MAID because Canada’s strained, publicly funded health-care system has failed them.
• A report published in October by the coroner from Canada’s most populous province, Ontario, stated that 116 people who were given MAID in 2023 (2.5% of the 4,644 in total) were struggling with disabilities, but not dying. One man in his late 40s who suffered from severe ulcers, multiple mental illnesses and chronic suicidal thoughts ended his life with the help of a doctor. The report found that people who opted for MAID tended disproportionately to have lived in areas with poor access to housing and labor markets, though it notes that this could simply be because old and disabled people tend to live in those areas. The coroner also found that people opting for MAID lived disproportionately in white neighborhoods.
• The federal government [of Canada] has deferred until 2027 a decision on allowing mentally ill patients to apply for MAID. But although it could have challenged Quebec’s expansion of the practice, it has chosen not to. Canada’s health minister, Mark Holland, cited the torment his grandmother endured in her final years with Alzheimer’s in his decision to allow Quebec to go ahead.

Over the last decade, Western Civilization has embraced and in many cases legalized  various forms of euthanasia.  [Assisted dying is a neutral, less threatening name for euthanasia.]  How has this occurred?  What legal justification has emerged to justify or condone assisted dying as a medical procedure in many parts of the West?   For American civilization, I would begin with a 1992 Supreme Court decision.  In the 1992 Supreme Court case of Planned Parenthood v. Casey, Justice Anthony Kennedy penned his famous “mystery passage:”  “At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life.” Robert Bork called the phrase indicative of “New Age jurisprudence”; William Bennett derided it as an “open-ended validation of subjectivism” that paves the way for drug abuse, assisted suicide, prostitution, and “virtually anything else”; George Will said it was “gaseously” written; Michael Uhlman labeled it a “thing of almost infinite plasticity”; the editors of First Things called it the “notorious mystery passage.”

What seems clear is Kennedy’s underlying conception of human beings as autonomous individuals, choosing their own values and mapping out their own life courses.  Is human autonomy at the heart of liberty?  Does autonomy define the essence of personal freedom and liberty?  As Matthew Reynolds observes, “the fact remains that most human beings—frail, dependent, and sinful as we are—experience it more as a burden than a blessing. After all, with an absolute freedom to determine who I’m supposed to be and how I’m supposed to live comes an absolute responsibility to realize these goals.  The liberating truth, for believers, is that we don’t have to determine who we’re supposed to be and how we’re supposed to live. At a core level, these are questions God has already answered for us.”  Thus, the proposition of absolute freedom, of personal autonomy is a dangerous lie.  Indeed, as the Heidelberg Catechism puts it, “I am not my own, but belong with body and soul, both in life and in death, to my faithful Savior Jesus Christ.”

How should we think about this growing panacea to embrace assisted dying?

First of all, The Economist summarizes several concerns:

• “If assisted dying becomes common, will old people who require round-the-clock care feel more social pressure to choose death? Many already worry that they are a burden on their children or care givers.  Some may feel additional guilt if continuing to live is seen as an individual choice, rather than the blind workings of fate. This is a genuine concern.
• The trickiest questions arise when an individual’s capacity to make an informed choice is in doubt. Some people with mental disorders have suicidal thoughts that come and go. For them, the bar should be very high. Doctors must be sure they can distinguish between a temporary mental-health crisis and a sustained, considered wish to die. If in doubt, they should offer treatment aimed at helping the patient to live.
• Dementia poses the hardest problem of all. Someone diagnosed with the condition may make a living will, asking for an assisted death when it becomes severe. But they may change their mind. Such a document should never be used to kill someone against their wishes, and if those wishes are unknowable, they should be left to live. Assisted dying should be only for those who can make an informed decision at the time they take the drugs.”

Second, does the Bible speak to the issue of assisted dying, a form of euthanasia?

1. There are two important biblical passages to consider:
   • Exodus 20:13:  You shall not murder (see also Matthew 19:18; Romans 13:9).  Is assisted dying a form of murder?
   • 2 Samuel 1:1-16 (The account of Saul, gravely wounded, begged an Amalekite man from his camp, to kill him).   As Wayne Grudem notes, in this passage we some similarities to modern euthanasia:
     • Saul (the patient) appeared to be terminally injured, with no reasonable hope of recovery.  (He had fallen on his sword in an attempted suicide, 1 Samuel 31:4-5).
     • The patient was in extreme pain and, if he did not die, faced the prospect of even more suffering.
     • The patient clearly requested, even begged, that someone would put him to death.
     • This request, from the head of the government, was ordered by King Saul.
     • David declared that the Amalekite who had killed Saul (carried out euthanasia) was guilty of murder and was worthy of capital punishment.
2. There is a critical difference between killing and letting a person die.
   • Killing is actively doing something to a patient that hastens or causes his/her death (i.e., the cause of death is an action actively taken by another person).
   • “Letting die” is passively allowing someone to die from other causes, without interfering with that process (i.e., the cause of death is the disease, injury or the aging process that has already been occurring in the person who dies).
   • To clarify this however, two points are necessary:  We should intervene and try to help the person recover and not passively allow the person to die, when [1] there is a reasonable human hope of recovery and [2] we are able to help.  If there is no reasonable hope of recovery (a “situation of futility”), and it is the patent’s wish to die (e.g., via a living will) and we are unable to help, then it may be ethically right to allow the person to die.  This could involve not starting a medical life-support system to stopping a life-support system.   It is important to remember that a believer need not fear death (Philippians 1:20-22 and 2 Corinthians 5:8).
3. Additional observations about euthanasia:
   • Euthanasia is a slippery slope which leads to the teaching of an “obligation to die.”  This is now a topic of discussion where the elderly have an obligation to die due to the rising medical care costs and other entitlements, which are becoming too costly for society to bear.
   • Increasingly, we are seeing the horrors of involuntary euthanasia.  In the Netherlands, in 2020, over 7,000 people were euthanized through a mix of sedatives and a lethal dose of a muscle relaxant.
   • Doctor-assisted suicide is the norm in much of Europe and Canada.  It is growing in the US.
   • Infant euthanasia is also a growing practice in Europe (e.g., 2005 the Netherlands announced the intention of expanding its euthanasia program to permit doctors to end the lives of infants with the parents’ consent.  Belgium has also passed a similar law).

A culture of death is growing in Western Civilization where we see the erosion of the protection of human life, all along the continuum from prenatal life to the elderly.  It is flouting the idea of the sanctity of all human life, so central to God’s Word.  God is not honored by such a development and, at some point, He will vindicate His view of the infinite value of all human life.

See The Economist (18 January 2025), p. 32; The Economist (13 November 2021), pp. 62-64; James P. Eckman, Christian Ethics, pp.  35-41 ; Wayne Grudem,  Christian Ethics, pp. 587-605; Matthew Reynolds, “The Lie of Self-Ownership” in CT Books (26 October 2021) at www.christianitytoday.com; and Clifford R. Goldstein, “Justice Kennedy’s ‘Notorious Mystery Passage’” in Liberty Magazine (July/August 1997).