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

The Economist, a conservative British publication (in the historic British “liberal” tradition of Edmund Burke and Walter Bagehot), first made the case for assisted dying in 2015.  It argued that freedom should include the right to choose the manner and timing of one’s own death, while also cautioning that the practice should be carefully monitored and regulated to avoid abuses. “Since then, it has become more widely available. Assisted dying is now legal in one form or another in a dozen countries, and the trend seems likely to continue. [Recently] New Zealand enacted a euthanasia law for the terminally ill after 65% of voters backed it in a referendum. Th[at] same week Portugal’s parliament passed a broader law. Assisted dying is still illegal in Britain, but the House of Lords is debating a bill to allow it.”  The number of people who die this way is increasing, though still small. In the Netherlands it rose from roughly 1,800 in 2003 to nearly 7,000 in 2020, or 4% of all deaths.

What does the regulation of assisted dying look like?  “The Australian state of Victoria, for example, bars doctors from mentioning assisting dying to their patients. The aim is to avoid coercion, but the consequence is that many sufferers do not know that it is an option. In some jurisdictions only those with less than six months to live are allowed help to die. Thus, patients can be terminally ill and in intense pain, but unless a doctor estimates that the end is very near, they cannot end their own suffering. In some cases the diagnosis comes too late. In Victoria in the first six months of 2021 no cases were withdrawn because the patient decided not to proceed, but in 90 cases the patient died before receiving relief. Some countries, such as Spain and Colombia, have liberal laws in theory, but in practice health authorities are reluctant to let anyone make use of them . . . in Spain a desperate 83-year-old threw herself out of a window after her repeated requests for euthanasia were refused.”  Canada provides more leeway for individuals to make their own choices. Anyone whose suffering is unbearable can choose an assisted death. They do not have to be terminally ill. And, uniquely, “the question of what constitutes ‘unbearable’ suffering is for the patients themselves to decide, so long as they are of sound mind. There is a cooling-off period of 90 days for those whose deaths are not reasonably foreseeable, in case they have second thoughts.”

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.”

Finally, then, does the Bible speak to this 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.

1. 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).

1. 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 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.

See The Economist (13 November 2021), pp. 62-64; James P. Eckman, Christian Ethics, pp.  35-41 ; and Wayne Grudem,  Christian Ethics, pp. 587-605.