Limited Reproduction Rights Granted · the book Choosing Death: Active Euthanasia,Religion, and the...

Copyright © 1995 Christian Faith and Life Area, Congregational Ministries Division,PC(U.S.A.)

Limited Reproduction Rights Granted � Chapters, sections, and pages of this book maybe reproduced for congregational, group, and individual use if appropriate credit is given.

Reviewers may quote brief passages in connection with a review in a magazine or anewspaper. Resale of any reproduction of this book is prohibited.

Where indicated, scripture quotations are from The Holy Bible, New InternationalVersion.

Copyright © 1973, 1978, 1984 International Bible Society. Used by permission ofZondervan Bible Publishers.

Produced by Presbyterian Publishing Corporation.

Additional copies of this book may be ordered fromPresbyterian Distribution Services (PDS)

100 Witherspoon StreetLouisville, KY 40202-1396

800/524-2612

PDS 70-420-95-100

Cover art: Ruf des Todes (Call of Death), by Kathe KollwitzCourtesy of Philadelphia Museum of Art.

In Life and in Death We Belong to God:Euthanasia, Assisted Suicide, and End-of-Life Issues

A Study Guide

Christian Faith and Life Area, Congregational Ministries Division,Presbyterian Church (U.S.A.)

Introduction��iii

Session 1Moral Discourse in the Christian Community��..1

Session 2It�s a New Day�or Night��.4

Session 3Whose Life is It, Anyhow?��..�.��7

Session 4Good Death, Bad Death��..10

Session 5Scriptural Perspectives on Suffering and Death��.12

Session 6The Experience of Sufferers: A Personal Encounter��.15

Session 7The Experience of Sufferers: What We Learn��..17

Session 8Christ�s Suffering��...19

Session 9On the Possibility of Knowing That One�s Time Has Come��.22

Session 10Responses of Caring��.��..�24

Session 11Public Policy: Striving for a Better World��..��..27

Session 12Conclusion��.��.�30

Appendix 1Glossary of Terms��.��.32

Appendix 2A Sermon and a Response��.��.33

Appendix 3Prior Denominational Statements on Euthanasia�..�.��.��...40

Appendix 4A Commitment to Caring��.��..53

Appendix 5Selected Bibliography��.��...55

Response Form��.57

INTRODUCTION

Why has the denominationprepared this study guide? The 202nd General Assembly (1990) ofthe Presbyterian Church (U.S.A.)directed the Theology and WorshipMinistry Unit (now called the Offices ofTheology and Worship) to prepare astudy document examining thetheological issues that emerge from aconsideration of the public debate ofeuthanasia and assisted suicide. Whileprevious General Assemblies havetouched on the topic of euthanasia (seeAppendix 3), it has not up to now beenthe subject of a full-scaledenominational study.

As part of its effort, the Office ofTheology encouraged a number ofcongregations and other grassrootsgroups throughout the denomination toengage in study of these issues, and toappraise preliminary study materials.

On the basis of what it learned fromparticipants in these groups, as well asfrom a group of professors in one of ourdenomination�s theological schools, theOffice of Theology supervised thepreparation of this second and finalstudy guide, working with a task force ofthirteen persons, many of whom hadparticipated in the grassroots studies.

What does the study guideinclude?Each of the twelve sessions includes:

• Goals• A list of resources• Suggested Scripture

readings

• Critical issues (asummary statement ofbasic theological issues)

• Questions of groupdiscussion

• Suggested prayers• Suggestions for group

process Study participants may wish to preparefor each session by reading the goals, thesuggested Scripture, and the criticalissues. The other resources that arelisted can also be read in advance or canbe used as material for further reflectionat the end of the study.

While it is possible to structurediscussion around the �Questions forGroup Discussion,� the task force andthe Office of Theology believe that thestudy will have greater value if it takesplace in communities characterized byprayer and mutual accountability. The�Suggestions for Group Process�indicate ways to give significantattention to the community�s commonlife. Note that each session includesmore suggestions than a study group willprobably use. Participants areencouraged to modify sessions to meetthe needs of their particular groups.

It is possible to condense the study intofewer sessions. The Office of Theology,however, encourages groups to use asmany sessions as possible. (A possibleeight-session study would utilizeSessions 1 through 4 and Sessions 9through 12.) Personal, self-directedstudy of each session is also possible.

The appendices include a glossary ofterms, a brief bibliography, and portionsof prior denominational statements that

touch on euthanasia. In addition, asermon and a response are included as amodel for the kind of discussion that cantake place in congregations.

At the end of the study, participants areasked to return a response form (pp. 57-59) to the Office of Theology. Yourcomments will help the Office ofTheology determine whether to takeadditional steps to address issues relatingto euthanasia, assisted suicide, and end-of-life decisions. A summary ofresponses will be shared with theGeneral Assembly and GeneralAssembly Council.

Who can lead a group? Any minister or member who has alively interest in helping others exploreand understand euthanasia, assistedsuicide, and end-of-life issues can helplead the study. In some cases, it may bepossible to form a leadership team ofpastors, physicians, nurses, and attorneysfrom within a congregation.

What assumptions shape the studyguide? The study does not promote a particularchurch policy or legislative agendarelating to euthanasia or assisted suicide.It does encourage participants toconsider a wide spectrum of views andexperiences.

Persons will come away from this studyhaving wrestled with the gravity of theseissues for themselves. They willencounter the Christian moral tradition,address questions of faith, and listen tothe wisdom of others who have engagedin similar reflection.

As the task force explored issuesrelating to euthanasia and assisted

suicide, it concluded that they point tobroader issues of suffering and dying.The study�s overall goal, therefore, is tohelp Christians consider what is at stakefor the faith when people face end-of-lifeissues, including euthanasia and assistedsuicide. Basic to the study are questionsof Christians� response to those whosuffer and die.

While the study suggests no neatresolution of the issues, it will encourageparticipants to wrestle with ambiguities,to respect one another�s perspectives,and to model ways of effectivelyconsidering controversial topics. Theauthors hope that, when the studyconcludes, participants not only willhave learned new information but willhave also grown in faith.

This growth in faith may embody acertain tension. On the one hand, thestudy encourages open conversation. Asa community of moral discourse andaction, we can learn as a church thatcontroversy need not tear us apart. If agroup meets in a spirit of respect andunderstanding, it can find its commonlife stronger in the end, despite people�sdifferences.

On the other hand, the study identifiesScripture, confessions, and personalresources that can help participants makedecisions, identify boundaries, clarifytheir own positions, become aware ofdifferent cultural perspectives, and knowwhat God requires both of them and ofthe church as a whole.

Session 6, �The Experience ofSufferers: A Personal Encounter,� willrequire special preparation. This sessionasks class participants to engage inconversation with persons who have

faced end-of-life decisions, with personswho have actually considered the optionof euthanasia or assisted suicide, andwith health care professionals. Studyleaders will need to be in extendedconversation with physicians, nurses,chaplains, hospice workers, and others inorder to arrange this session.

An important supplemental resource isthe book Choosing Death: ActiveEuthanasia, Religion, and the PublicDebate, edited by Ron P. Hamel andpublished in 1991 by Trinity PressInternational. This book provides asummary of past and contemporaryChristian thought relating to euthanasia,assisted suicide, and end-of-life issues.Copies of Choosing Death may beordered from the publisher (Trinity PressInternational, 3725 Chestnut Street,Philadelphia, PA 19104). The study,however, is not of the book itself but ofthe theological issues that emerge from aconsideration of euthanasia, assistedsuicide, and end-of-life decisions.

Since reflection on Scripture will be animportant part of the study, participants

should bring a Bible to each session. Itwill also be helpful for each member ofthe group to have a copy of the studyguide.

Members of the Task Force Task force members included: RichardAllman, Villanova, PA; Eugene Bay,Bryn Mawr, PA; Margaret Cheesbrough,Prescott, AZ; Brian Childs, Decatur,GA; John Dalles, Pittsburgh, PA; BruceHumphrey, Prescott, AZ; PeggyLindamood, Paradise Valley, AZ;Michael Krech, Memphis, TN; LindaPeeno, Louisville, KY; Dell Richards,Iowa City, IA; Blake Richter, Iowa City,IA; and Polly Schrimper, Memphis, TN.

Joan McIver Gibson, Albuquerque,NM, and Herbert Hendin, New YorkCity, NY, offered the task force specialassistance.

John Burgess and Dick Junkin providedstaff support from the Offices ofTheology and Worship in the ChristianFaith and Life Area.

SESSION 1Moral Discourse in the Christian Community

Goals In this session, participants will (1) getacquainted with one another; (2) getoriented to the study as a whole,including what they will do, why theywill do it, and how they will do it; and(3) be invited to commit themselves tomaking the study a success.

Suggested Resources�The Church: A Community of MoralDiscourse,� James M. Gustafson, in TheChurch as Moral Decision Maker(Pilgrim Press, 1970)

A Brief Statement of Faith

Glossary of Terms (Appendix 1)

Suggested Scripture:Ecclesiastes 3:1-22Romans 8:28-39Romans 12:3-5

Critical Issues When Christians gather to reflect oneuthanasia, assisted suicide, and end-of-life issues, our principal goal in neitherto engage one another in debate not tosatisfy intellectual curiosity. Debate andsatisfaction of curiosity are good andhave their place, but Christians gatherfor another purpose. When Christiansapproach euthanasia, assisted suicide,and end-of-life issues, we seek to learnmore about ourselves, about our world,and about God. We seek to grow in ourcapacity to live with faith and joy, tocome nearer both to God and to oneanother, and to draw on our theologicaland moral tradition in order to relate it tonew challenges and situations.

As Reformed Christians, we believethat God generally speaks better throughall of us, as we engage each other, thanthrough the view of any one of usindividually. The church is and shouldbe a community of moral discourse andaction. A community of moral discourseand action is one in which peopleacknowledge their need for each other�swisdom and experience as they try toresolve basic questions of right andwrong. When the church is such acommunity, it allows people to speakfreely, to raise big questions, and tograpple with the fundamental issues ofhuman existence.

As we begin this study, it is appropriatefor us to think together about thecharacter of the church. In baptism, wedie and rise with Christ (Romans 6:1-4).We become a covenant peoplecommitted to realizing God�s purposes.Though we often fall short of thesepurposes, we cannot forsake themwithout forsaking ourselves. As theBrief Statement of Faith proclaims, �Inlife and in death we belong to God.� Itis this identity as God�s people thatmake us a community of moral discourseand action, and that makes discussion inthe Christian community distinctive.

Life in community with God and withone another contrasts with much ofcontemporary society and itscommitment to autonomy. (For adefinition of �autonomy,� see theGlossary of Terms, Appendix 1.)

Throughout the study, we will beasking ourselves how our being

Christians and members of a communityof moral discourse and action shapes ourunderstanding of these issues and ourresponse to them.

This study is both deeply personal anddeeply corporate. It is personal becauseit is we ourselves who are to betransformed and renewed in the depthsof our beings. The life of each of us ison the line. But we are also on the linetogether. We are not a gathering ofisolated individuals, but of brothers andsisters who learn from one another andwho are accountable to one another.Rightly undertaken, therefore, our studyinvolves mutual commitments and acommon discipline.

Questions for Group Discussion1. Why are we interested in

studying euthanasia, assistedsuicide, and end-of-life issues?What is there about our own livesthat makes the issues importantto us? How would we like to bedifferent as a result of this study?

2. What will it mean for us toapproach these difficult moralissues as persons who in life anddeath belong to God? What is(or should be) different about ourdoing this study together than ifit were being done by a group ofpersons without a common faithin Jesus Christ?

3. What do we owe one another aswe undertake this study? Howmight we become a communityof moral discourse? Whatcommitments might we make toone another that would help all ofus benefit from the study to thegreatest possible extent?

Suggestions for Group Process1. Read Ecclesiastes 3:1-22. Invite

participants to join in prayingtogether: Opening Prayer: OGod of every moment, we readyour Word, and so we believethat there is a time, a season, forevery purpose under heaven.And yet, when we face the toughissues of intractable pain oroverwhelming suffering, andwhen we know that we havetechnology to prolong our dying,what does it mean to say, �a timeto be born and a time to die�?These words sound so fitting, butthen out circumstances blur theirmeaning. When this happens, OGod, how can we know whetherit is a time to weep, or a time tomourn? Speak to us, we pray, sothat all we say and do togethermay be synchronized to yourtiming. In Jesus Christ our Lord.Amen.

2. Invite participants to mentiontheir names and to take a fewmoments to say why it is that, atthis particular moment of theirlives, they choose to invest theirtime and energy in this particularstudy.

3. Draw out stories fromparticipants based upon their ownexperiences with familymembers or friends in the laststages of life. Then, in pairs orthreesomes, ask participants toreflect on what obstacles mayexist for them personally or forthe entire group in discussing thistopic. Invite them to share some

of their concerns with the wholeclass.

4. Discuss with participants thegoals for the study and the wayyou are going to try to achievethem. As you do so, you mightwish to make such points as thefollowing:

a. You will be intentional inlooking at euthanasia,assisted suicide, and end-of-life issues not as justanyone might but aspeople who find theiridentity in Jesus Christ.

b. You will therefore beapproaching these issuesas people who live in acertain way: who praytogether, who share theirlives with others, whotake the concerns of theworld seriously and try tounderstand what ishappening in it, wholisten carefully toScripture, and who seekto know God�s will forthe community and to actupon it.

c. When this study is over,the most important thingwill be not what has beenlearned about euthanasia,assisted suicide, and end-of-life issues, but whetherthe participants havegrown in faith and in theircapacity to live their livesfaithfully.

d. While the content of eachof the sessions of thestudy will be related toeuthanasia, assistedsuicide, and end-of-life

issues, these issues willbe framed in such a wayas to draw attention toissues of a more generalnature, including ouridentity in Christ, therelationship of faith andculture, and the wayChristians makedecisions.

e. We are approaching thisstudy opportunity open toone another�s diverseviews, opinions, beliefs,and cultural traditions.

5. Invite participants to readtogether Romans 12:3-5 and todiscuss the commitments they areprepared to make both tothemselves and to one another asmembers of one body of Christ inorder to help make the study asuccess. (Such commitmentsmight include that of beingpresent at each session, carryingout any assignments, praying forthe class as a whole and for oneanother in particular, respondinghonestly and openly as issuescome up in the class sessions,and keeping a journal of thought,feelings, and reflections.)

6. Before concluding, tellparticipants that in the nextsession they will be discussingthe new challenges andresponsibilities presented byadvances in medical technology.

7. Conclude by reading Romans8:28-39 and inviting participantsto pray together:Closing Prayer: O God, oursource and sovereign, you chart

all of our journeys and everymoment of life is in yourkeeping. We praise you for younever-failing love in Jesus Christ,and we rejoice that you care forus without limit. You hold usclose through all circumstances,whether mountaintops of joy orvalleys of sorrow. O God, whenwe walk those valleys, may we

remember that we were not bornfor death but for life. Be with usand with all who cry out, �OLord, save my life.� When thewinnowing wind sweeps over us,may we learn to bend and yet notbreak. And though we are turnedabout, help out faith remain anever-fixed mark. In Jesus Christour Lord. Amen.

SESSION 2It�s a New Day�Or Night

Goals In this session, participants will (1) listthe concerns that make our era a newday (or night) in relation to euthanasia,assisted suicide, and end-of-life issues;(2) explore the social context of theseissues; and (3) reflect on what it meansto deal with these issues as Christians.

Suggested ResourcesHeidelberg Catechism, question 1

A Brief Statement of Faith

Glossary of Terms (Appendix 1)

Suggested Scripture:Genesis 11:1-9Psalm 141 Corinthians 13:8-13

Supplemental Scripture:Genesis 1-3Romans 3:10-181 John 1

Critical Issues The Gospels tell us again and again ofJesus� concern to heal people withphysical, emotional, and mentalafflictions. Jesus was deeply concernedfor the wholeness and well-being ofpeople. As Christians, we too seek thewholeness and well-being of others. Weare committed to healing the brokennessof the world and to helping people withillness and disease.

Yet issues of wholeness and healing arecomplex. We can celebrate the goodthat medical science offers: Morepeople are able to get well, and people

generally live longer. We can affirm ahealth care system that values andprotects our autonomy: We should havea right to receive and refuse treatment.Yet out technology had advanced sorapidly that we are experiencing a newday (or night) in our medicalcapabilities. Difficult, troubling issuesconfront us. We have reason to fear thatthe good we intend with our medicinecan become distorted. At what cost dowe prolong our dying after many goodyears of living? At what cost do weprevent those with multiple birth defectsfrom dying, even if their future �qualityof life� appears minimal?

These questions imply a number oflarger issues. One set of issues concernsour faith in technology. While the bestintent of the medical community is toheal, we know that we live in a world ofsinful human nature. Are we tempted tomake technology our god, seeking toprolong human life at any cost?

A second set of issues concerns thecomplexities of medical economics.What forces provide for, or preventaccess to, health care? How do weprovide for just allocation of resourcesfor healing? How do we deal withrealities of resource rationing both in ourown country and in a world context(where, for example, the cost of oneheart transplant may be equivalent to thecost of vaccinating thousands of childrenin the third world)?

Third, we face issues relating to thenature of suffering, especially sufferingat the end of life. What constitutes�quality of life�? How do we care for

the least of our brothers and sisters?What does it mean to be a child of God,dependent both upon God and uponothers?

Fourth, there is the danger that the costof medical treatment will undermine ourcommitment to compassion. What willhappen if a right to euthanasia convergeswith a situation of economic constraint?How do we guard against the possibilitythat people will choose death or bepressured to choose death in order tosave money?

Questions of euthanasia and assistedsuicide cannot be separated from largerissues surrounding suffering and dying.Twentieth-century medical andtechnological advances have created anew kind of crevice between life anddeath. In this crevice, we find thosewhose dying is a lingering twilight,those in a permanently unconsciousstate, as well as newly-born childrenwith such severe problems that their veryexistence seems more a biologicalmischance than a genuine life. Our lawsand our ethics have not yet managed tobridge this crevice.

These questions challenge our theologytoo. How might our Reformed faithaddress the needs of these living-dead,or dead-living? How might it respond tothose who wish to choose death, even ifthey are still relatively healthy? Whatdoes it mean to be a member of Christ�sbody? Are there limits to our freedom tochoose for ourselves?

Christians are called to address theseissues from a faith perspective, utilizingthe traditional resources of faith:engaging in personal and corporateprayer; reading and appealing to

Scripture as the basis for what webelieve and do; drawing on the bestwisdom of our tradition; engaging inministries of compassion; acting asfaithful stewards of God�s creation;seeking justice and living in obedienceto God�s Word.

The question narrowly defined appearsto be whether it is ever morallyacceptable and consistent with Christianpractice for people to kill themselves orto seek assistance in ending their liveswhen death is imminent or suffering isintractable.

Yet it is not entirely clear that thisquestion is the most important one for usto ask. As this and the remainingsessions of this study unfold, many otherend-of-life issues will emerge, includingquestions of withdrawal of treatment,alleviation of pain (even at the risk ofdeath), and quality of care. Asparticipants work together, they willconsider the possibility that issues ofeuthanasia and assisted suicide raise amore fundamental question: How do weshape a kind of medicine thatconcentrates not only upon curing butalso upon caring, and where medicalpersonnel and patients are more fullypartners in healing and decision-making?

Questions for Group Discussion1. What in your experience helps

explain why euthanasia, assistedsuicide, and end-of-life issueshave become topics of such greatconcern over the past century?

2. What current medical technologyhave you experienced thatreassures you? What do you findfrightening about it?

3. Which concerns in particular doChristians bring to a discussionof euthanasia, assisted suicide,and end-of-life issues?

Suggestions for Group Process1. Read aloud 1 Corinthians 13:8-

13 and the first question andanswer of the HeidelbergCatechism. Invite participants tojoin in praying together:

Opening prayer: O God of all, ourfortress and fountain, we celebratethe wonders of life and the goodnessof health and the authority of yourhealing power. We thank you, aswell, that you have given us ameasure of your own wisdom and aknowledge of how to work for thehealing of others. Yet, we admit thatour thankfulness sometimesoversteps appreciation and moves toan infatuation with medicaltechnology. Our trust twists awayfrom you to lesser purposes. Forthis, we are sorry. Be with us as weseek to understand how medicine canbe an instrument of your everlastingcare as will as a source of bodilycure. Through Jesus Christ our Lord.Amen.

2. As what, if anything, theparticipants have seen or heardsince the last session(newspapers, television, radio,art, etc.) that has reminded themof the concerns of this study.

3. Refer participants to the�Glossary of Terms� (Appendix1), and ask them to becomefamiliar with it.

4. Invite participants to discuss anypersonal experiences that help

account for why euthanasia,assisted suicide, and end-of-lifeissues are more of a concerntoday than a century ago. Youmay wish to ask them to considerways they have experienced (a)the ability of modern medicine tokeep people alive beyond whatwas possible in past generations,(b) the impact of suffering onquality of life, and (c) theunevenness in medical about howthey experience the technologyof modern medicine: Whatseems reassuring about it? Whatseems frightening about it?

5. Invite the participants in smallgroups to consider one or both ofthe following case studies:

Case AAlec is a Christian, a 35-year-oldman who has a history of heartproblems. He wears a pacemaker.He has also been diagnosed withmetastatic lung cancer. He has noblood relatives. A close friend hasagreed to be the decision maker forhim, but Alec has not yet signed adurable power of attorney statement.His illness has brought him to thehospital, where he learns thatchemotherapy will provide him, atbest, about six more months to live.As he talks with his physician, Dr.Pratt, in the hospital, Alec says thathe is tired of fighting his disease, thathe does not want to go on with thechemotherapy, and that he no longerwishes to receive morphine for hispain. He is not afraid of addiction;he wants the course of his disease toproceed naturally. Alec also saysthat he wishes Dr. Pratt to �zap� hispacemaker, to scramble its signal, sohe will die. Alec reasons with his

doctor that since he gave permissionto insert the pacemaker, he also hasthe right to request that it bedeprogrammed. Dr. Pratt, troubledby the role Alec is asking him toplay, consults the hospital�s ethicsdepartment. Among the concernsDr. Pratt wishes to discuss arewhether deactivating Alec�spacemaker will be considered alethal action.

Case B Della is a lifelong Presbyterian and63-year-old widow. Until her recenthospitalization three weeks ago, shehad lived alone in a first floorapartment and enjoyed herindependent living. She wasadmitted to the hospital for difficultyin breathing caused by her painmedication, which gave her relieffrom the pain of poor circulation inher legs and arms. Della is also adiabetic and has heart problems.Because of her circulatory problems,the doctors are recommendingmultiple amputations of her fingersand feet. They do not expect her tobe able to live alone and predict thatshe will need constant attention. Herdaughter and son-in-law want her tohave the operation, though they livein another part of the country andcannot take her into their smallhome. Della refuses to have theoperation. She says, �I have lived agood life. Why should we spendwhat I have on a nursing home? Mydaughter, son-in-law, and grandchildwould be better off with myinsurance money now, rather than gointo debt to pay some nursing hometo watch me die. If my heart doesn�tstop soon, why can�t my doctor helpme with the pain medication? That

would be the most loving thing eitherone of could do.�

Following the discussion in smallgroups, invite a member of eachgroup to describe in plenary theissues raised by the case theydiscussed, asking the group as awhole: �Is it morally acceptable andconsistent with Christian practice forpersons to seek assistance in endingtheir lives?�

6. Move into a general discussion.Invite people to discuss the wayChristians should think aboutthese issues. Remindparticipants of the affirmation inA Brief Statement of Faith that�In life and in death we belong toGod.� Ask them how thisaffirmation might affect the waythey think about these issues.(You may wish to use thesupplemental Scripture readingsto help move the discussionforward.)

7. Before ending this session, tellparticipants that in the nextsession they will be discussingissues of control, autonomy, andstewardship of our bodies andinvite them to prepare by readingchapter 3 of the book ChoosingDeath.

8. Conclude by reading Psalm 14and inviting the participants topray together:Closing prayer: O RighteousOne of Israel, we acknowledgethat we are your children. In lifeand in death we belong to youand are linked to one another byyour love. Help us be more

aware of how dependent we areupon you and howinterdependent we are with therest of your children, whocomprise our global family.Give us a greater measure ofmutual concern, and restore to us

a reciprocal joy in our service toone another. As we join in ashared quest for each other�swell-being, may we ever hold incommon a reliance upon yourgrace. Through Jesus Christ ourLord. Amen.

SESSION 3Whose Life Is It, Anyhow?

Goals In this session, participants will beinvited (1) to discuss why our lives arenot ours alone; (2) to explore issues ofpersonal autonomy and life incommunity; and (3) to determine, from aChristian perspective, whether or notthere is such a thing as a right to die.

Suggested ResourcesChoosing Death, chapter 3

Westminster Shorter Catechism,question 1

Suggested Scripture:Genesis 1:26-31Philippians 2:1-18

Supplemental Scripture:Genesis 23:4Exodus 20:13Deuteronomy 26:5Judges 21:25Isaiah 40:8Matthew 25:31-46Romans 14:7-91 Corinthians 6:20Ephesians 5:29Philippians 1:21

Critical Issues We often live as though life were ourown to do with as we please. We aretempted to act as if our lives go onforever and are completely under ourcontrol. When we experienceconstraints on what we wish to do, weprotest. We claim a right to choose whatis best for ourselves.

Yet none of us can escape nagginganxieties about the end of life. Ourdesire to be in control of our destinymerely underscores our fear that wereally are not in control, that powers andforces greater than ourselves will finallydictate both the way we live now and theway we will eventually die.

We may attempt to ignore theseanxieties or even to repress them. Wemay try to keep ourselves busy with thelives that we wish to make for ourselves.But again and again we experience limitsto our efforts. For all our talk aboutindividual rights, we know that we alsoneed others. We long for friendship andcommunity. We long for comfort in themidst of our own brokenness and in themidst of a broken world. We long forultimate assurance that we make adifference and that we are not entirelyalone.

As Christians, we understand life as agift that we hold in trust from God, ourCreator. Even when we succumb toanxious strategies either of trying tocontrol what we cannot or of refusing todo what we can (trusting God and eachother), we hear another voice among us,the words of Scripture and of Christiansof other times and places, reminding usthat we belong to God and that our chiefpurpose is �to glorify God and enjoy himforever� (Westminster ShorterCatechism, question 1).

When we understand that we hold ourlives in trust from God, we become allthe more aware that life is fragile,precious, and passes so very quickly,that we are therefore called upon to be

good stewards of life, both our own andothers�. We also become thankful. Wecome to mark our lives with dailygestures of gratitude, trusting that Godwill care for us through life and death,even when we are unable to make senseof them for ourselves anymore.

Yet living by this trust is not easy. AsChristians make decisions in the face ofsuffering and death, we find that thegood that we seek for ourselves does notnecessarily correspond to the good thatGod seeks for us.

In broad terms, �personal autonomy� isthe major concern here. If our life isGod�s gift in trust to us, and if death isthe end of our earthly life, how do we, asmembers of the Christian community ofmoral discourse and action, face death?If God cares for us, must we accept evenintractable suffering and a process ofprolonged dying? Does God ever ask usto end our life? How do we know, andwhat do we do when God appears to beabsent, giving us no clear answer? Whatare the limits to our decision-making? Ifwe decide to leave some things in thehands of God, how do we know whetherwe are trusting God or simply evadingthe responsibility that God gives us tomake decisions?

Personal autonomy also raises thequestion of accountability to theChristian community. As Christians, webelieve that we belong to each other.We are members of the one body ofJesus Christ. What does this communityowe each of us individually as we faceour deaths, and what do we owe it? Isthere any meaningful way in whichChristians can guide each other throughthe valley of the shadow of death (Psalm23)? How far can the Christian

community go in asking us to test ourdecisions against its larger wisdom?Can we ever become such a burden tothe community that it has the obligationto let go of us for the common good?

Christian moral tradition has generallybeen reluctant to allow for the possibilityof euthanasia or assisted suicide. It has,however, often justified the decision towithhold or withdraw treatment, even ifdeath results more quickly. The keyquestion has been whether or notmedical interventions are able to reversethe dying process.

One finds a similar tension in relationto pain. The Christian tradition has oftenallowed for the possibility thatalleviating pain through drugs mayinduce death. The key question has beenone�s intent in administering them.

As we noted in Session 2, we live in anew day. Medical technology putsChristians in a new situation. Becausewe wish to respond faithfully to thechoices that come at life�s end, we mustexamine the wisdom of the past anddetermine how it speaks to ourcircumstances today.

Questions for Group Discussion1. Is life really a gift? Why or why

not?

2. How do we as Christians respondto those who assert that we arefree to do whatever we pleasewith our lives?

3. Can faithful stewardship of thelife that we hold in trust fromGod ever mean the decision togive it back to God? Why orwhy not?

4. Is there a right to die or a right tobe dead?

5. Is there a difference betweenputting down a pet and humaneuthanasia?

6. How might a Christian reconcilethe tension between personalautonomy and life incommunity? To whom am Iaccountable? Are there limits toour freedom to choose forourselves?

7. What do we believe about thebiblical mandate of dominionover creation? Does it mean toexercise this responsibility overall of life, including those createdin the image of God? Whatresponsibility do we have to thesenile and comatose?

Suggestions for Group Process1. Read Genesis 1:26-31 aloud.

Invite participants to join inpraying together:Opening prayer: O God, ourmercy and our might, you givelife, and your purpose gives lifeits meaning. Yet, we avoid yourpurpose, and instead we carveour names for ourselves. In thecarving, we forget you, we forgetothers. How long, O Lord, untilwe learn the long-term effects ofinstant gratification? Ourconcern is self-worth; yet, whatwill become of us when, nolonger able to work, we ask, �AmI only valuable as long as I amproductive?� May we at lastreturn to you and discover life�smeaning in you and in your

charge to us to care for portionsof your creation, and to seek tosustain the very lives of ourbrothers and our sisters. In JesusChrist our Lord. Amen.

2. Ask what, if anything,participants have seen or heardsince the last session(newspapers, television, radio,art, etc.) that has reminded themof the concerns of this class.

3. In plenary, invite participants todiscuss the following quotationfrom Choosing Death: �It�s mylife do to with as I please, to liveout in accordance with mybeliefs, values, personality andstyle� (p. 30). Do we agree? Isthis life ours alone? Why or whynot?

or

In plenary, invite participants todiscuss whether there is adifference between the mercifulact of putting down a cherishedpet and human euthanasia. Ishuman life an absolute good? Isdeath an absolute evil? Do wehave �mastery� or �dominion�over life? Is there a right to die,a right to be dead?

4. In pairs or threesomes, readGenesis 1. Ask participants toreflect upon what it means to begiven dominion over God�screation. Ask each group towrite a summary statement andto share it with the whole group.

5. Ask participants to discuss thefollowing: To what extent is the

desire to die with dignity a denialof what it means to be created byGod? To what extent is thedesire to have doctors employ�heroic measures� to save us adenial of what it means to becreated by God?

6 . Ask members of the group toread aloud 1 Corinthians 6:20.(You may wish to include someor all of the other supplementalScripture passages: Genesis23:4, E x o d u s 2 0 : 1 3,Deuteronomy 26:5 , Judges21:25, Isaiah 40:8, Matthew2 5 : 3 1 - 4 6 , Romans 14:7-9,Ephesians 5:29 , Philippians1:21.) Then, consider how aChristian might resolve thetension between personalautonomy and accountability toGod and to the Christiancommunity when consideringeuthanasia, assisted suicide, andend-of-life issues.

7. Tell participants that in the nextsession they will be discussing

the meaning of �good death� and�bad death.� Ask then to readthe preface and chapter 2 ofChoosing Death.

8 . Conclude by reading aloudPhilippians 2:1-18 and invitingthe participants to pray together:Closing prayer: O God, ourShepherd and Savior, who inyour son Jesus chose to serverather than to be served and whocame to redeem the lost, grantthat we may follow you. Guideus in Christ�s way, so that we toowill put ourselves in the place ofthe least of our sisters andbrothers. There, may we lookbeyond our own self-interest tothe larger scope of human need.In so doing, may we ever knowthat our ties to one another andour ties to you are not limited bytime or circumstance, for in lifeand in death we belong to you.Through Jesus Christ our Lord.Amen.

SESSION 4Good Death, Bad Death

Goals In this session, participants will (1)share with one another what they regardas a �good death� or �bad death�; and(2) reflect on their fears and hopes whenthey think about dying.

Suggested ResourcesChoosing Death, preface and chapter 2

Suggested Scripture:Deuteronomy 34:1-81 Samuel 31:1-6Job 14:1-4Luke 2:25-35John 10:14-18John 14:25-27Acts 7:54-60

Supplemental resources:Phaedo, Plato (The death of

Socrates)The Death of Ivan Ilych, Leo

Nikolaevich TolstoyHow We Die, Sherwin Nuland

(chapter on accidents, suicide, andeuthanasia)

�Because I Could Not Stop ForDeath,� poem by Emily Dickinson

We Live Too Short and Die TooLong, Walter M. Bortz (chapter on �TheLast Passage�)

Critical Issues Our dying is the final, mostimpenetrable mystery of our lives.Many of us have a tendency to deny itsreality, to think about it as little aspossible, to live as if death did not, infact, await us at the bend of the road weare traveling.

When we do manage to contemplateour own mortality, it is natural toimagine the circumstances of our dyingand to hope for certain things and to fearothers. Having witnessed or heard aboutothers� deaths, we begin to projectourselves forward to our own bend in theroad and say, �May it happen like this,�or �May it not happen to me like that.�

In contemplating our anxieties aboutour own death, we come face to facewith the issue of our limits and finitudeas creatures of this earth. Our hopes andfears with respect to our dying reveal agreat deal about the values we hold withrespect to our living. They are,therefore, immensely valuable materialfor theological reflection. They are aprofound test case, helping usunderstand with greater clarity what weactually believe about the meaning oflife, about God�s providence, abouthuman freedom, and about out salvationin Jesus Christ. Needless to say, thereverse can also be true: To clarify ourbeliefs about life�s meaning and God�sprovidence and human freedom andsalvation can also be an opportunity toreshape our hopes and fears about ourdying.

Questions for Group Discussion1. How do we define for ourselves

�good death� and �bad death�?What is it that we hope for andwhat is it that we fear withrespect to our dying?

2. In what sense is what we hopefor (e.g., absence of pain) andwhat we fear (e.g., loss ofcontrol) also that which we hope

for and fear with respect to ourliving?

3. Does the fact that Jesus Christclaims our lives make it harder oreasier for us to die? Is it easier,since we trust that we will inheriteternal life? Is it harder, sinceGod may yet have a reason for usto be alive?

Suggestions for Group Process1. Read Job 141-4 together. Invite

the group to join in prayingtogether:Opening prayer: O God of eachof life�s passages, we confessthat our first reflex is to avoidthoughts of death�especiallyour own death or that of peoplewe love. Yet, we know thatdeath is part of our human life,and even when we are in thepresence of death, you are ourvery present help. Help us, then,to understand what it means totrust in you. Grant us a calmwith a depth of assurance,knowing that neither death norlife, nor things present nor thingsto come, nor heights nor depthsnor anything else can separate usfrom your love, a love morecontinuous than the starts. InJesus Christ our Lord. Amen.

2 . Ask what, if anything,participants have seen or heardsince the last session that hasreminded them of the concerns ofthis class.

3. If it seems helpful, participantsmay recall and renew thecommitments they made at thefirst session.

4. Explain to participants that theywill spend ten minutes in silence.During the silence, each personshould think about �good death�and �bad death,� preparing todescribe, in about five minuteseach (or however much time willbe available

5. After the few minutes of silence,invite all the group members toshare their thoughts.

6 . After all have spoken, spendsome time talking about whatparticipants have said. What dothey hope for with respect totheir deaths? What do they fearthe most? Do any of these hopesor fears also relate to what theyhope for or fear about theirliving?

7 . Invite participants to considerany differences in perspectivethat may result from culturaldifferences among them.

8. In plenary, ask the participants todiscuss the following: Does thefact that Jesus Christ claims ourlives make it harder or easier forus to think about our own death?Why is it easier? Why is itharder?

9. In plenary, ask participants howbeing a person of faith mightaffect what one hopes for or fearswith respect to death.

or

Have participants look upDeuteronomy 34:1-8, 1 Samuel 31:1-

6, Luke 2:25-35, John 10:14-18, Acts7:54-60. In each of these passages,is death �good� or �bad�? Why?

or

If your group is reading ChoosingDeath, you may wish to inviteparticipants to share any particularquestions or observations related tothe assigned reading in chapter 2.Note any questions for which theyhope to receive answers during theremainder of this study. How doesthe reading connect with the issue ofthe participants� hopes and fears inrespect to their deaths?

10. Before concluding, tellparticipants that in the nextsession they will be discussingthe suffering of Jesus.

11. Read John 14:25-27 together.Remind participants to be inprayer for all who are taking part.

As you close in prayer, suggestthat people bear in mind the fearsand hopes that have beenexpressed during this session.

Invite the group to join inpraying together:Closing prayer: O God, you arethe very soul of concern, andwhile the world is uncertain, youalone are ever sure. All of lifemoves to the fullness of yourtiming, and in life and death webelong to you. We pray forourselves and all persons that wemay not die alone, without ourfriends or family, nor in asenseless way. Yet, grant thatwhenever the time comes to die,you will tenderly gather us aspebbles in your holy stream,refresh us with your living water,and keep us in perfect peace, allsorrows ended, all loss restored.In Jesus Christ. Amen.

SESSION 5Scriptural Perspectives on Suffering and Death

Goals In this session, participants will (1)listen to different biblical understandingsof the meaning of pain, suffering, anddeath; (2) relate these differentunderstandings to their own lifeexperience; and (3) talk about what itmeans to be a part of a community thathas resolved to listen carefully toScripture in the fullness of its witness.


Suggested Scripture:Deuteronomy 30:15-20Job 42:2-3Psalm 20:6Psalm 22:1-21Psalm 44Ecclesiastes 3:2-8Isaiah 53:1-6, 10-12Amos 8:1-8Mark 8:31Mark 15:33-34John 9:2-3Romans 5:3-8Romans 8:18-222 Corinthians 4:7-12Philippians 2:4-11Colossians 1:24Hebrews 2:10, 14-182 Timothy 1:8, 12

Critical Thinking Christians listen to Scripture. Scripturehelps us unlock the mysteries of humanexistence. While it is important to knowthe historical context of particularscriptural passages, our primary concernis to listen to Scripture as God�s Wordfor us today.

One approach to Scripture would be toline up all the passages that seem tospeak for or against euthanasia. On theone hand, the Bible affirms life andprohibits murder. On the other hand, theBible records several stories of suicidewithout appearing to condemn it.

Yet this approach may be too narrow.For euthanasia, assisted suicide, andend-of-life issues raise basic concernsabout our understanding of pain,suffering, and death. Here Scripture hasa great deal to say.

When we inquire of Scripture withrespect to the meaning of pain, suffering,and death, we discover several strands ofthought, a variety of insights andemphases. In some of these strands,pain, suffering, and death are the resultof human sin. They represent divinepunishment. In other strands, there is noclear reason for pain, suffering, anddeath. They defy explanation; we areleft with the mystery of God�s ways,perhaps even a fear of divine neglect.Elsewhere, Scripture sees suffering ashaving redemptive possibilities; it maydeepen our faith. God may even ask usto suffer on behalf of others. YetScripture also recognizes that someforms of pain, suffering, and death arethe consequence of human oppressionand human evil. God asks us to resistthe sources and causes of such pain,suffering, and death. Finally, Scripturerecognizes that pain, suffering, and deathare part of the human condition; theyreflect our finitude.

Listening to the whole of Scripture isno easy matter when we have to sort outthese different strands and apply them tothe complex circumstances that surroundeuthanasia, assisted suicide, and end-of-life issues. As Christians, we believe,nonetheless, that it is in the whole ofScripture that God meets and speaks tous. Our challenge is to take all ofScripture seriously and to find a way tolive within its tensions.

Some may ask, �What do I do with abook filled with tensions, even seemingcontradictions?� Perhaps our task is notto deny the various strands, but to viewthem as pieces of a whole fabric ofunderstanding about suffering. Becausehuman suffering has many facets, it isnot surprising that Scripture speaks to itin different ways.

Questions for Group Discussion1. What points of view do we find

in the Bible, with respect to themeaning of pain, suffering, anddeath? How should the Christiancommunity respond to sufferingor death that is perceived in oneway or another?

2. How do we understand the factthat Scripture appears to offerdifferent points of view, differentstrands of thought? Is this facttroubling to us or comforting?

3. What does it mean to take thewhole of Scripture seriously?How do we live within thetensions created by the existenceof different strands of thought?How do we take seriously thevariety of witness about pain,suffering, and death?

Suggestions for Group Process1. Read Romans 5:3-4 together.

Invite the group to join in prayertogether:Opening prayer: O God, speakto our hearts and minds. Tell usof your authenticity that isbeyond our humanunderstanding. Help us hear youand by your insight know that thevoices of human suffering defyany particular time or nation.They are our sisters and brotherswho cry out; their experience ofsuffering is universal to ourmortal life. O Present Help, bewith us, and with them, with allwhose cross seems too great tobear. Help us to place allburdens upon you and to know,even in the midst of turmoil, thepeace that you alone can give. InJesus Christ our Lord. Amen.

2. Invite participants to shareanything relating to the issues inthis study that has come to theirattention since the last session.

3. Divide participants into smallgroups. Distribute the followOld Testament texts: (a)Deuteronomy 30:15-20; (b)Psalm 22:1-21; (c) Isaiah 53:1-6;(d) Amos 8:1-8; (e) Ecclesiastes3:2-8. (Or use some of the othersuggested Scripture passages.)Note that each of these passageshas a different understanding ofsuffering. Ask each group toread it assigned text or text, totalk about what might be inferredfrom each about the meaning ofsuffering, and to call to mind apersonal experience of sufferingthat the text suggests.

4. In plenary, have someone fromeach small group report, sharingwhat text was read, whatperspective on the meaning ofsuffering they heard in it, andwhat personal experience ofsuffering (if any) the textsuggested. After each smallgroup has reported, invite peoplefrom other small groups tosuggest other ways each textmight be heard. Finally, inviteparticipants to discuss how thecommunity of faith should relateto anyone who might beexperiencing the kind ofsuffering described in each text.(The way the communityresponds to those who sufferoppression will be different fromthe way it responds to those whosuffer because of disease.)

5. Ask participants to listen to thefollowing texts from the NewTestament: (a) Mark 15:33-34;(b) 2 Corinthians 4:7-12; (c)Hebrews 2:10, 14-18; and (d)Philippians 2:4-11. (Or usesome of the other suggestedScripture passages.) Again askthem to identify the meaning orsignificance of suffering in eachpassage.

6. Part of our Christian identity isthat we take all of Scriptureseriously. Is it possible to do soeven if there appear to be voices

and viewpoints that are in tensionwith one another?

7. Before concluding, tellparticipants that in the nextsession they will be visiting withpersons who have eitherconsidered euthanasia or assisteddeath for themselves, or havebeen close to persons who haveconsidered such an option.Explain that the purpose of thesession will be to clarify theissues from the perspective bothof health care providers and ofsufferers.

8. Read Isaiah 53:2-12 together.Invite the group to join in prayertogether:Closing prayer: O mercifulGod, you have given us yourWord and shown us in Jesus ourSavior that when we suffer, yousuffer alongside us, that our painis your pain, our despair is yourdespair. Hear our cry forcomfort in time of distress!Come quickly, O God, and meetour every need, extending yourbrokenness as our source ofwholeness, your torment as oursource of relief. In all times andplaces, may we remember that inyou we live and move and haveour being, and may we hold fastto the truth that in life and indeath we belong to you.Through Jesus our Lord. Amen.

SESSION 6The Experience of Sufferers: A Personal Encounter

Goals In this session, participants will (1)listen to the stories of persons, includingpersons of faith, who have contemplatedeuthanasia or assisted suicidethemselves, or who have known orworked professionally with persons whohave contemplated one or the other, orwho have grappled with other end-of-lifedecisions; (2) become aware of some ofthe factors that lead people to considerthe option of euthanasia or assistedsuicide; and (3) hear how health careworkers and patients think about pain,suffering, and death and about thepossibility of effectively relieving painand suffering.

Suggested ResourcesSuggested Scripture:

Psalm 42:111 Peter 3:12-14

Critical Issues It is possible to discuss pain, suffering,and death as theoretical issues. Theyare, however, anything but theoretical.Together they constitute a major portionof human experience.

One way to convince ourselves of theissues under discussion is to deliberatelyput ourselves in contact with personswho are struggling with them. Suchcontact provides us an opportunity toincrease our awareness of thecomplexity of the issues and to test thereality of whatever ideas we have aboutthem.

Listening to the experience of sufferersmay help us face complex issues that we

would often rather avoid. To come face-to-face with the pain, suffering, anddeath of others may also be the �meansof grace� that allows us to face our ownpain, suffering, and death.

Special Instructions for PreparingThis Session In preparing for this session,participants are asked to discuss amongthemselves whom they might invite tospeak our of their own life experience asit relates to these issues. While groupsmay feel some hesitancy about invitingsuch people, especially from within thecongregation, forming such a panel canalso be an opportunity to bring membersto a deeper appreciation of each other�sstruggles and perspectives.

Guest speakers could include legal andmedical professionals, family membersof persons who are sick, parents ofchildren with terminal illnesses,chronically ill persons, and/or persons ondialysis. In virtually every congregation,there will be persons who have facedend-of-life decisions for themselves orwith others.

Also, most congregations will access toagencies that care for persons withterminal illness (cancer, AIDS) as wellas agencies that advocate a particularposition on euthanasia and assistedsuicide, such as the Hemlock Society orthe American Suicide Foundation.

Participants may need to consider otheroptions if no one in the local communityis available to serve as a guest speaker.Persons in the group might be invited tofocus on their own personal experiences

where end-of-life decisions had to bemade and the question of euthanasia orassisted suicide came up or could havecome up. Whether the guest speakersare from within or beyond the localcongregation, be sure that there arepeople present to facilitate the discussionand to support the persons who shareinformation. If it is helpful, consideradding another session or two to thestudy in order to have several meetingswith guest speakers.

Another option is to utilize videos. TheNational Bioethics Resource Center hasa good library of such videos.

Suggestions for Group Process1. Read Psalm 42:11. Invite the

participants to join in prayingtogether:Opening prayer: O God ofstorm and stillness, we offer youour thanks and praise, for you arewith us in all times and throughall circumstances. We ask yourblessing upon all who are in painthis day, and for whom the futureholds little hope for recoveryfrom illness. We pray that youmight surround them with yourtender mercies and bless them inways beyond our earthly art orscience. We pray as well for allwho work with those who arefacing death, or who help to meetthe needs of those whose dailyrealities include terrible anguishof body, mind, or spirit. Help usto minister unto them and to seehow they minister to us, astogether we seek wisdom. InJesus Christ our Lord. Amen.

2. Introduce the guests andparticipants to each other.

Explain to the guests thatparticipants are involved in astudy of euthanasia, assistedsuicide, and end-of-life issuesand that they are trying to learnhow to think about these issuesas people of Christian faith.Explain that as a part of the studyit will help participants to hearthe personal stories of some whohave contemplated euthanasia orassisted suicide, or who haveactually been involved withending life in one way oranother, whether by euthanasia,assisted suicide, or other end-of-life decisions, such as withdrawalor withholding of treatment.

3. Then invite the guests to sharetheir stories. Afterward,participants in the study arelikely to have questions, and theguests may well have questionsthat they would like to put to theparticipants. Encourageparticipants in the study to writedown any new insights.

4. Before concluding, remindparticipants to read chapter 5 ofChoosing Death for next time.

5. Conclude by thanking the guestsfor their help. Then read 1 Peter3:12-14 and invite guests andparticipants to join in prayingtogether:Closing prayer: O God, ourword and our source of wisdom,we thank you for the witness ofthose who share their stories withus. Because they have openedtheir life journeys to us, we canbegin to sense the wide range offeelings present when we

consider suffering and pain.Help us, by hearing them, todiscern ways in which we andyour church can more faithfullyserve you by serving them,

remembering that in life and indeath we belong to you.Through the action of the HolySpirit and in the love of JesusChrist. Amen.

SESSION 7The Experience of Sufferers: What We Learn

Goals In this session, participants will (1)think together about insights that theyhave gained from the guests� personalstruggles with euthanasia, assistedsuicide, and end-of-life decisions; (2)examine which of their insights andexperiences helped us better understandthese issues and which raised newquestions; (3) discuss ways in which ourChristian faith might help any who aredealing personally with euthanasia,assisted suicide, and end-of-lifedecisions; and (4) discuss the differencebetween pain and suffering.

Suggested ResourcesInsights offered by guests in Session 6

Choosing Death, chapter 5

Suggested Scripture:Judges 16:23-312 Samuel 18:9-33Job 1 & 2:1-10Psalm 139Matthew 27:5Luke 19:41-42John 1:1-5John 9:11-122 Corinthians 12:7-10(also see the passages listed forSession 5)

Supplemental resources:Medical Nemesis, Ivan IllichThe Nature of Suffering, EricCassell

Critical Issues The guest speakers from the previoussession may have made us aware in new

ways of the complexities of the debaterelating to euthanasia, assisted suicide,and end-of-life issues. Particular guestsmay have given us insight into legal,moral, or medical dimensions of theseissues. Others may have shared eitherexplicitly or implicitly their ownstruggle to resolve their questions abouteuthanasia and assisted suicide.

As we listened to any guests whodescribed their suffering, we may havelearned that it is difficult to determinejust what constitutes pain. Whilepatients� descriptions of pain may be sovivid and intense that we feeloverwhelmed, medical science has noadequate way to measure or gauge pain.Within the medical community, peopledebate whether or not there exists paintoo severe for medicine to alleviatewithout inducing death.

Another consideration may be thedifference between pain and suffering.Some mistakenly think that if wediminish the pain, the suffering too willdecrease. But pain and suffering are notidentical. Even when one�s pain is undercontrol, one�s suffering, one�s sense ofbeing burdened, can continue.

Yet another consideration may be thearray of emotions expressed by peoplewho contemplate assisted suicide andeuthanasia regret, remorse, sorrow, guilt,embarrassment, pain, loneliness,estrangement, abandonment. Persons offaith may be called upon to helpsufferers recognize and address theseemotions.

Finally, those who suffer have an effecton those around them. When onecontemplates or indeed chooseseuthanasia or assisted suicide, familymembers, close friends, concernedneighbors, and the community in generalexperience many feelings�includinganger and anguish. Again, thecommunity of faith may be able to helppeople deal with these feelings.

Questions for Group Discussion1. What aspects of the guests�

information and experienceadded to our understanding ofeuthanasia, assisted suicide, andend-of-life issues?

2. What aspects of the guests�information and experiencechallenged us to think in newways about euthanasia, assistedsuicide, and end-of-life issues?What, if anything, disturbed us?

3. What might our Christian faithsay to these particular guests,who shared what it means forthem to have contemplated thequestions surroundingeuthanasia, assisted suicide, andend-of-life decisions?

4. What are the differences betweenpain and suffering?

Suggestions for Group Process1. Read Psalm 139 together. Invite

the participants to join in prayingtogether:Opening prayer: O God, ourroot and vine, we pray for allwhose lives are intertwined withthose who are facing death. Bewith them all: those who standbeside loved ones in the valley of

the shadows; those who waitupon others in a ministry ofpresence and prayer; those whocarry in their hearts bittermemories, painful regrets, harshremorse, or the anguish of brokenrelationships. Comfort thelonely, be with all who are leftbehind, and by your presence,ease their melancholy. In JesusChrist our Lord. Amen.

2. Ask what, if anything,participants have seen or heardsince the last session that hasreminded them of the concerns ofthis class.

3. Ask participants in pairs orthreesomes to discuss which ofthe comments made by the guestsin Session 6 were helpful to theirunderstanding of euthanasia,assisted suicide, and end-of-lifeissues. Similarly, inviteparticipants to discuss which ofthe comments made by the guestsraised questions or concerns.

or

In pairs or threesomes, askparticipants to list on newsprintor a chalkboard the feelingsexpressed by the guests inSession 6 (e.g., anger, anguish,pain, remorse, embarrassment,guilt, regret, fear ofabandonment). How might werespond to each of thesefeelings?

4. Ask persons in the class to keepin mind the comments of theguest speakers while readingaloud several of the passages of

Scripture that appeared inSession 5: (a) Deuteronomy30:15-20; (b) Psalm 22:1-21; (c)Isaiah 53:1-6; (d) Amos 8:1-8;(e) Ecclesiastes 3:2-8; (f) Mark15:33-34; (g) 2 Corinthians 4:7-12; (h) Hebrews 2:10, 14-18; and(i) Philippians 2:4-11. (Or usesome of the other suggestedScripture passages.) Askparticipants to consider, in aperiod of silence, which of thetexts help them better understandwhat is happening in the lives ofthe guests and which do not.

5. Following the period of silence,invite participants to share theresults of their personalreflections. Which of the textshelp make sense of suffering andwhich do not? Why or why not?

6. Ask participants to reflect uponthe experiences of the guestspeakers with regard to pain andsuffering. Encourage them toidentify the difference betweenpain and suffering.

7. Tell participants that in the nextsession they will be discussingthe meaning of suffering. Askthem to read chapter 4 inChoosing Death.

8. Conclude by reading John 1:1-5and inviting the participants topray together:Closing prayer: O God, whoselife all life conferred, if we butknew how, our aim would be tosoothe the bodily pain of thosewhose lives are broken, and togrant a solace to those whoseminds are assailed by anguish.We would, as well, seek to liftthe spirits of all who aredownhearted. In your greatmercy, help us to help others intheir distress. We pray yourblessing for all whose misery isbeyond our ability to grant relief,or whose sorrow is beyond ourgift of consolation. In their woe,O God, be their ever-presentcomfort. Surround them with theassurance that in allcircumstances, in life and indeath, they belong to you. InJesus Christ. Amen.

SESSION 8Christ�s Suffering

Goals In this session, participants will (1)consider a portion of the witness ofScripture that speaks of the suffering anddeath of Jesus Christ; (2) think aboutwhat it means to be a people who findtheir identity in Christ and are enjoyed to�have the same mind� as he had; and (3)as persons who find their identity inChrist, relate their thinking abouteuthanasia, assisted suicide, and end-of-life issues.


Job 42:2-3Psalm 20:6Psalm 22:1-21Psalm 44Deuteronomy 30:15-20Ecclesiastes 3:2-8Isaiah 53:1-6, 10-12Amos 8:1-8Mark 8:31-9:1, 9:30-32, 10:32-34Mark 15:21-41John 9:2-3Romans 5:3-8Romans 8:18-222 Corinthians 4:7-12Philippians 2:1-11Colossians 1:242 Timothy 1:8, 12Hebrews 2:10, 14-18

Critical Issues Christians acknowledge that theiridentity and the very meaning andpurpose of their lives is found in JesusChrist. To know ourselves in Christ,however, we must first listen carefully toScripture�s witness to him.

At the very heart of the biblical witnessto Jesus is a story that includes pain,suffering, and death. Jesus is the onewho relieved the suffering of many withwhom he came into contact, and he isthe one who called back to life a friendwho had died. But he is also the onewho, when his own time had come,entrusted himself into God�s hands andendured suffering and death for the sakeof the life of the world.

For people of faith, Christ�s witnessstands as a profound challenge to ourculture�s assumptions that the �gooddeath� is easy and painless, while the�bad death� is hard and painful. If evera death was �good�, it was that of Jesus,for it is to that death that we owe our lifein God. But, if ever a death was �bad,�in terms of suffering and pain, it wasalso that of Jesus.

What a challenge Scripture gives us,therefore, when it enjoins us to �have thesame mind� Christ had, or when it tellsus that we are to take up our cross andfollow him. On the one hand, Jesus�suffering and death do not necessarilygive us any clear guidance for ourdecisions in the face of suffering anddeath. Jesus died at the hands of sinners;most of us will die of disease or perhapsin a tragic accident. Jesus understoodGod to require him to suffer on behalf ofa sinful world; our suffering may appearto have no intrinsic value. For us tohave the same mind as Christ is for us tofocus first of all on his ministry, not toequate our suffering and dying with his.

On the other hand, we may findmeaning in our own experience of pain,suffering, and death as we contemplateJesus� crucifixion. The one who hasgone before us has plumbed the depthsof human experience. We are not aloneas we face the mystery of our own end.

This tension challenges us to exercisegreat care in relating Christ�s sufferingto our own. Rather than being a sourceof comfort, Christ�s suffering mayactually remind us that we too often seekto escape the kind of suffering that Jesusendured. Yet Christ�s suffering alsotestifies to God�s compelling power inhuman life. In contemplating themystery of Christ�s suffering, we maybecome aware in a new way of God�spower to sustain us and to call us to newlife even in the midst of our sufferingand dying.

Perhaps of equally great consequencesfor our understanding of suffering anddeath is Jesus� resurrection. By virtue ofour baptism, we share in thatresurrection. We trust that our livesbelong to God. Sin and death do nothave the last word; they cannotultimately rob our lives of meaning.How, then, do we live as a resurrectionpeople as we face suffering and death?How does our confidence in sharing in�life everlasting� free us to takeresponsibility for whatever decisionspresent themselves to us in our finaldays and hours?

Here too are dangers. We easilytrivialize the resurrection, seeking toavoid the reality of suffering and death.We may try to forget that suffering anddying also bring moments of despair.Jesus� own words from the cross remind

us that he himself felt forsaken in hissuffering and dying.

Both the cross and the resurrectionteach us not only of God�s presence, butalso of the experience of God�s absence.A life of faith does not save us frommoments of doubt and protest. We canbelieve even now, however, that Christhas claimed us as his own, regardless ofthe struggles and questions that we facein moments of intense suffering and inour final hours.

Questions for Group Discussion1. In what sense can it be said that

the most important thing aboutthe life of Jesus Christ was hisdeath?

2. What do we learn about pain,suffering, and death from Jesus�life and ministry? From hisdeath?

3. How does the scriptural witnessabout the life and death of Jesuschallenge or affirm our ownnotions about �good death� and�bad death�?

4. With respect to our own deaths,what might it mean to followJesus, to have the same mind hehad? What would it not mean?

5. In what respect was Christ�ssuffering unique and notapplicable to our own?

Suggestions for Group Process1. Read Mark 15:33-39 together.

Invite the group to join in prayertogether:Opening prayer: O God ofmystery and meaning, we cannot

sufficiently understand yourlimitless love. You care for us tosuch an extent that you acceptedundeserved ridicule, and anunthinkable death on our behalf.Yet, we know all we need toknow, that you did it, and thatyou did it for us. We can do nomore and no less than thank you,love you in return, and pledgeourselves to you. We know thata part of human life is suffering.And while we would recoil fromneedless, irrational suffering,help us not to shrink when youcall us to bear crosses for thesake and in the name of JesusChrist our Lord. Amen.

2. Ask what, if anything,participants have seen or heardsince the last session that hasreminded them of concerns ofthis class.

3. Write on the chalkboard ornewsprint the following OldTestament texts: (a) Job 42:2-3(in which Job resigns himself tothe undeniable, yet bafflingwisdom of God); (b) Psalm 44(which assails God violently forneglecting the people); (c) Psalm20:6 (which suggests suffering isdivine education by which thepeople will return to God); and(d) Isaiah 53:10-12 (whichaffirms that God suffers insolidarity with humanity).(Alternatively, participants couldrevisit the Old Testament textslisted in Session 5). Suggest thatparticipants read each text insilence, imagining themselves tobe Jewish followers of Jesus whoare trying to make sense of his

suffering and death in the daysfollowing his crucifixion. Askthem to decide which texts helpthem understand what happenedto Jesus and which do not.

4. Following the period of silence,invite participants to share theresults of their personalreflections. Which texts helpthem make sense of Jesus�suffering and death, and whichdo not? Why does each help ornot help?

5. Ask participants to listen to theseNew Testament texts: (a) Mark8:31-9:1 (in which Jesus explainsthat he must suffer and die�alsosee 9:30-32 and 10:32-34); (b)John 9:2-3 (in which Jesus seessuffering not as a consequence ofsin, but as an opportunity forGod to work); (c) Romans 5:3-8(in which Paul says that sufferingcan teach Christians endurance);(d) Romans 8:18-22 (in whichPaul sees suffering as relativelyunimportant in the full context ofGod�s plans and purposes); (e) 2Corinthians 4:7-12 and/orColossians 1:24 and/or 2Timothy 1:8, 12 (which speak ofthe suffering that the church mustbe prepared to endure).(Alternatively, participants couldrevisit the New Testament textslisted in Session 5). After eachtext has been read, inviteconversation. Which passageshelp participants understand thesuffering and dying that theymay someday face?

or

Read the story of Jesus� deathin Mark 15:21-41. Talk togetherabout what you have heard. Wasit a �good death� or a �baddeath�? On what grounds wouldone call it either?

6. Invite participants to talk withone another about what they haveheard during this session andabout what they think and feelabout what they have heard. Is itimportant to listen to Scripture inthis way? Do we really want tobe persons who have in ourselves�the same mind that was inChrist Jesus?� If we do wish tobe such persons, what can we doto help make it happen?

7. Ask the participants to discussthe following:

a. Did Jesus choose to endhis life? If you believethat he did, do you seeparallels to peopleconsidering euthanasia orassisted suicide? Why orwhy not?

b. How was Christ�ssuffering unique and notcomparable to our own?

8. Tell participants that in the nextsession they will be discussingthe possibility of knowing whenone�s time has come.

9. Read Philippians 2:1-11together. Invite participants tojoin in prayer together and toremember all those Christiansthroughout the world who arealso praying to be conformed tothe mind of Christ. If they wish,participants may voice briefprayers, then close by prayingtogether:Closing prayer: O God, ourcounselor and comfort, our livesare lived in the light of yourpresence. In life and in death webelong to you. Yet, to each therecomes a time when life and deathcollide, with a dimming of thelight and a drawing-down of theblinds. While our every instincttells us to rage against the dyingof the light, we know that inJesus our Lord is light and lifeeternal. Help us cherish thistender grace you give us, hear thesound of your still voice, andtrust your love which never fails.In Jesus Christ our Lord. Amen.

SESSION 9On the Possibility of Knowing That One�s Time Has Come

Goals In this session, participants will (1)discuss the possibility of knowing that�one�s time has come�; (2) discuss howone might determine whether his or hertime, or the time of another, had come;and (3) discuss how the suffering anddeath of Jesus Christ help us reflect onthe question of knowing one�s time.


Exodus 13:21-221 Kings 19:9-13Mark 8:31-33, 9:30-32, 10:32-34Luke 9:51

Supplemental Scripture:1 Kings 21Job 38:4, 42:2-3Ecclesiastes 3Isaiah 55:8Luke 2:25-35John 2:4John 12:27-33John 13:1John 14:16Acts 13:1-3Acts 15Romans 8:26Galatians 4:4

Critical Issues Some persons at some point in theirlives decide that their �time has come.�They conclude that they have livedenough, have accomplished enough,have loved enough. They are ready,perhaps even eager, to die. Death forsuch persons becomes a friend. By thesame token, it is not uncommon for suchpersons to discover later that they were

mistaken. The mystery is that manytimes we do not know and cannot predictwhen death may be near. (Indeed, athird of all deaths are sudden andwithout forewarning.)

The theological issues are complex.For instance, what is it that one �knows�if that one�s time has come? Does oneknow that God is ready for a given lifeto end, or does one know only that Godis permitting one to exercise her or hisfreedom to allow death to come?

Second, how does one come to knowsuch a thing? Is it a privatedetermination that requires noconfirmation from the community offaith? What is there to ensure that thedecision is not simply a reaction out offatigue or depression in the aftermath ofmuch pain and suffering?

And third, is it really possible thatdeath, the �last enemy� (see 1Corinthians 15:26) can finally beregarded by a person of faith as a friend?How should a Christian view death?And what about those whose familiesinclude those of other faiths, or of nofaith?

Jesus himself seemed to know that histime had come. Yet his death for the lifeof the world, after persecution and at thehands of sinners, is a calling few of usexperience. What may we learn fromJesus� experience and what should wenot learn, we who one day may wish toknow whether our time or the time ofanother has come?

Questions for Group Discussion1. Is it possible for us to know that

our time has come? That thetime for another has come? Howwould we know?

2. How might we faithfully test oursense that our time or the time ofanother has come?

3. What do we learn about oursuffering and dying from Jesus�way of approaching his sufferingand dying?

Suggestions for Group Process1. Read Exodus 13:21-22 together.

Invite the group to join in prayertogether:

Opening prayer: O God of cloudand fire, God of all wisdom andknowledge, all certainty rests uponyour truth and all flawless insightcomes from you. It is youdiscernment that we seek so that wemay comprehend the circumstancesof our lives. We are so grateful thatby grasping your truth we may beginto perceive what is right, and that byfollowing your counsel, we may startto understand what we are to do. Weask your perfect guidance in all oflife, and especially when we seek toidentify the end of life. Help uswatch the signs so that we mayrecognize your voice calling ushome. And when our time comes,may we ever remember that in lifeand in death we belong to you.Through Jesus Christ. Amen.

2. Invite participants to shareanything relating to the themes ofthe class that they have heard,seen or thought since the lastsession.

3. Tell the group that in this sessionwe will be thinking aboutwhether or not it is possible to�know that one�s time hascome,� and if so, how one canknow such a thing. Inviteparticipants to spend a fewmoments in silence reflecting ona time when they knew that theirlives were reaching someimportant turning point. Howdid they know? In retrospect,how confident are they that theirknowing was accurate? Askthem to reflect upon a time whenthey did not now that they werereaching some important turningpoint. After a few moments ofsilence, invite a few persons toshare their stories if they wish.

4. Invite participants to share storiesabout persons they have knownwho thought their time had come.What led those persons to believethat their time had come? Was itin some way tied to a medicaldisclosure? Have any of theparticipants thought that theirown time had come? Is itpossible to will one�s self to die?How might we faithfully test oursense that our time or the time ofanother has come? You maywish to include some or all of thesupplemental Scripture passagesto augment this discussion.

5. Read the following texts: Mark8:31-33; 9:30-32; 10:32-34;Luke 9:51. Did Jesus know thathis time had come? How did heknow? How did he act on hisknowledge, or not act? Wouldhis example help us to know

whether our own time or the timeof another had come? Why, orwhy not?

6. Tell participants that in the nextsession they will be discussingissues of caring for the sufferingand dying.

7. Read 1 Kings 19:9-13 together.Invite the group to join in aprayer together:

Closing prayer: O God, whospeaks through fire, wind, andearthquake, help us ever to listen for

your still, small voice! When ourlife circumstances become extremeand it seems that we alone are left tocope with illness, degeneration, andpain, bring to us, we pray, yourtimely message of direction andpertinence. Even as you hear everyearnestly whispered prayer, help us,as we call to you, to know yourtiming for our lives and to trust you,even when it is time for us to die.For in you we live and move andhave our being, and ever and alwayswe are yours, O God. Through JesusChrist our Lord. Amen.

SESSION 10Responses of Caring

Goals In this session, participants will (1)discuss ways in which the church can bea community of caring andcompassionate action as people confronteuthanasia, assisted suicide, and end-of-life issues; (2) identify obstacles thatkeep the church from being this kind ofcommunity; (3) discuss ways in whichwe can share the love and grace of JesusChrist with persons in crisis; and (4)seek ways to pray for each other.

Suggested ResourcesDescent Into Hell, Charles Williams(chapter on �The Doctrine of SubstitutedLove�)

Suggested Scripture:Psalm 231 Corinthians 13:4-7Galatians 6:21 John 4:7-8

Supplemental Scripture:Genesis 1Ruth 1:16-17Matthew 7:12Luke 6:31, Isaiah 53:4Romans 12:17Romans 14:7-9James 2:8-26

Supplemental Resources:The Death of Ivan Ilych, LeoNikolaevich Tolstoy

�Whose Participation and WhoseHumanity? Medicine�s Challenge toTheological Anthropology,� BrianChilds, in The Treasure of EarthenVessels: Exploration in Theological

Anthropology, ed. Brian H. Childsand David W. Waanders

Hope Springs from Mended Places:Images of Grace in the Shadows ofLife, Diane M. Komp

Critical Issues In the face of pain, suffering, and death,doctors seek cures that will restore us tohealth. This concern for healing hasdeep roots in the Christian tradition. TheChristian community has often been atthe forefront of establishing andsupporting hospitals and clinics and oftraining people to enter medicalprofessions.

At the same time, the church hasunderstood itself to be concerned withmore than curing. As a company of thefaithful, we also seek to become acommunity of caring, a community ofcompassion. Caring includes measuresto cure disease and illness but goesbeyond them.

When we care for each other, we seekto be present to each other. Even whenwe cannot cure another, we can stand byhim or her. Our very physical presencemay bring comfort. A loving touch maybe as powerful as words. Or we mayfind ourselves simply listening,encouraging those in distress to tell usthe best and the worst of all they areexperiencing. Even when others can nolonger recognize our care, our standingby them in the presence of death mayoffer us privileged moments ofremembering and experiencing God�smysterious grace.

Yet such caring is not easy. Those whoare suffering and dying may resist it.Despair, on the one hand, and a desirefor control and autonomy, on the other,especially in those moments when onefeels least in control, can wrap a band ofisolation around a person. In such asituation, Christians are challenged notto impose their presence on others, butalso not to abandon them.

Caring is also difficult because theChristian community itself is imperfect.We find ourselves with busy schedules.Individual caregivers may reach pointsof exhaustion. They may findthemselves torn between the needs of theone who is suffering or dying and theneeds of his or her family or friends whofeel unable to deal with the situation. Inother cases, communities may find theirresources of money and energy depleted.Moreover, there is concern aboutintruding into other people�s lives. Andthose who are suffering and dying maymake us feel uncomfortable, evenanxious, if we find ourselves thinkingabout our own dying.

It is also important that we examine ourown motivations if offering care. Wemay be tempted to believe that we cando more than we really can. In pridingourselves on our commitment to care forothers, we may fail to recognize thatthere is a time to let go.

Yet the Christians discipline of caringis all the more important in a world inwhich many fear that their suffering anddying will put them at the mercy ofmachines and experts. The very cry foreuthanasia and assistance in dying mayreflect people�s fear of abandonment andof becoming a mere object of futile

efforts to �cure� them in their last daysand hours.

Public interest in a �right to die� mayalso reflect a fear of death, a sense ofpowerlessness and depression in the faceof death. As Christians, weacknowledge that any of us may one dayutter, like Jesus, �My God, my God, whyhave you forsaken me?� Yet we believethat even in the darkest moments ofdespair, such a cry also conveys anenduring hope that God will hear. Wewish, therefore, to be present to othersand to comfort them.

Such caring continues even whenmedical treatment reaches its limits andis only futile. Such caring may includehonest words that the time has come towithhold or even withdraw treatmentthat can no longer restore life. Suchcaring may require the Christiancommunity to take initiative indeveloping and supporting new modelsof car, such as hospice. Such caring alsochallenges the Christian community tofind ways to support and assist medicalprofessionals to deepen their owncapacity to integrate caring and curing.

Within the Christian community itself,prayer will have a special place asChristians minister to those who aresuffering and dying. Through prayer,the Christian community seekswholeness and healing for those in need.Christians cannot promise that prayerwill cure people. They pray not becauseit guarantees a better �success rate,� butbecause it opens the possibility of ourrecognizing God�s Spirit moving amongus, caring for us in life and in death, aspeople who belong to God.

Questions for Group Discussion1. How might the church be a

community of caring andcompassion for all those whoface end-of-life issues, includingdecisions relating to euthanasiaand assisted suicide?

2. What obstacles prevent thechurch of Jesus Christ frombeing this kind of community?

3. How might Christians bettershare the love and grace of JesusChrist with persons in crisis?

4. How might Christians better praywith persons facing life-and-death decisions andpredicaments? For what mightone pray? Why?

Suggestions for Group Process1. Read 1 Corinthians 13:4-7 and

invite the group to join in prayertogether:

Opening prayer: O compassionateand caring God, you alone granthealing, and all you touch receivescomfort. Thank you for listening toour concerns with infinite patienceand love. We would satisfy theneeds of others as Jesus did, waitingwith those who wait, weeping withthose who weep, in a personalencounter, with a calm and peace togo beyond words or understanding.Help us press forward into all placesin an attitude of prayer, so that indiminishing isolation and increasingcommunity, we may represent youand your church. Fashion us asagents of your peace. We ask inJesus� name. Amen.

2. Ask participants to shareanything relating to the issues inthis study that has come to theirattention since the last session.

3. Read Psalm 23 aloud together.

then

In small groups, invite participantsto discuss ways in which the churchcan be a community of caring andcompassion for those who areconfronting end-of-life issues andmay even be considering euthanasiaor assisted suicide. Haveparticipants list these ways on chartpaper and share them with the entiregroup. Help participants becomeaware of any resources that may beunfamiliar to them, such as hospicecare.

or

In plenary, have participantsidentify particular individuals in theircongregation who are presentlyfacing these kinds of decisions. Askparticipants what the congregationmight be doing to minister to thesepeople. Try to be specific andconcrete about your strategies forcaring for them.

4. In plenary, consider whichobstacles keep the church frombeing a community of care.

5. Ask members of the group toread aloud from the supplementalScripture passages.

or

Read together excerpts from thechapter entitled �The Doctrine ofSubstituted Love� in British novelistCharles Williams� book, DescentInto Hell and Galatians 6:2.

then

Ask the group to think of ways wemight try to express the love andgrace of Jesus Christ toward personsin crisis (such as being present, usingtouch, listening, becoming aware ofothers� emotions, speaking a word oflove, praying).

6. Share a time when prayer hasmade a difference in your life orin the life of someone you know.As a group, discuss ways inwhich prayer opens us to God�spresence.

7. Tell participants that in the nextsession they will be discussingways in which Christians and thechurch might respond to public

policy relating to euthanasia,assisted suicide, and end-of-lifeissues. Ask them to readChoosing Death, chapter 6.

8. Read 1 John 4:7-8 together.Invite participants to conclude inprayer together:

Closing prayer: O God ofencounters, who meets us in allphases of life and who challenges usto live the adventure of the unfoldingof time, may we seek for others thewholeness we would like forourselves. Gather us from whereverwe have wandered; confront us withour responsibilities to our neighbors,our sisters and brothers, all who areyour children. Greet us with anassuring word that overcomes ourevery fear. Answer us in ourthundering doubts; satisfy us in ourunquenchable fearsome place. Maywe be thankful, now and always, thatin life and in death we belong to you,O God. In Jesus Christ our Lord.Amen.

SESSION 11Public Policy: Striving for a Better World

Goals In this session, participants will (1)discuss the role of Christians in effectingchange in society; (2) consider ways inwhich this study might influence theiroutlook on public policy relating toeuthanasia, assisted suicide, and end-of-life issues; and (3) seek to identifyprojected action for the future.


The Confession of 1967

Suggested Scripture:Isaiah 65:17-25Amos 5:24Matthew 25:31-46Acts 3:1-10, 4:13-141 John 5:19Revelation 21:1-4

Critical Issues The General Assembly overture thatcalled for this study of euthanasia andassisted suicide noted that thePresbyterian Church (U.S.A.) could �nolonger remain aloof from this importantdebate� if it were to �be responsible tothe mission and ministry of JesusChrist.� Since the Assembly�s action,several states have considered ballotinitiatives to legalize euthanasia and/orassisted suicide under certaincircumstances. It seems clear that theseissues will remain on the legislativeagenda in the days ahead.

As Christians, we profess Jesus notonly as our Savior but also as our Lord.This Lord claims us not only for

salvation but also for service. From theago of John Calvin onward, wePresbyterians have stressed our callingto order society in ways that reflectGod�s will. As we confront issues ofeuthanasia and assisted suicide, we againfind ourselves called to help shapepublic policy.

Yet those questions of euthanasia andassisted suicide are complex. In callingfor the study of euthanasia and assistedsuicide, the General Assembly explicitlydirected the Office of Theology andWorship to prepare study materials, nota denominational position paper.Moreover, the task force that met toprepare these materials found its ownthinking evolving to include broaderissues of care for the terminally ill.

The church will have to decide whetherto support, reject, reframe, or ignoreparticular proposals for public policyand legislation relating to euthanasia andassisted suicide. But these are not theonly public policy questions and are notnecessarily the most important publicpolicy questions. While the publicdebate of euthanasia and assisted suicideis sometimes posed in terms of �right�language, something more may be goingon. The public interest in euthanasia andassisted suicide may, in fact, reflectpeople�s fear that they will be abandonedin their times of suffering and dying andbecome objects of an impersonalmedical establishment.

Both as a community of caring (seeSession 10) and in its commitment tojust public policies and legislation, theChristian community can speak to this

fear. First, the Christian community cansupport public policies that informpatients of their right to refuse treatment.The Christian moral tradition allows forthe possibility of withholding orwithdrawing treatment when it can nolonger restore life. People should nothave to fear that others willunnecessarily prolong their dying.

Second, the Christian community canwork to guarantee health care to allpeople. In a society without universalhealth care, the legalization ofeuthanasia and assisted suicide couldimplicitly pressure the most vulnerableto choose death rather than to burdensociety with the expenses for theirtreatment. People should not have tofear that their lives are worth less thanothers�. Nor should they choose deathout of a temporary depression that maybe treatable and reversible�a majorissue of concern, since some studiessuggest that the overwhelming majorityof people seeking euthanasia or assistedsuicide are in fact suffering fromtreatable forms of depression.

Third, the Christian community cansupport public establishment of hospiceand similar programs that help relievepeople of the fear of dying alone and outof control. Similarly, the Christiancommunity can support public policiesthat encourage research into painmanagement and that educate health careprofessionals in pain management, sothat no patient has to choose death out offear of intractable pain.

Fourth, the Christian community cansupport the establishment of publiccommissions and panels that provide forour nation�s best minds to discuss end-of-life issues and to consider strategies

that we do not yet have or have not yetadequately implemented. Questions ofeuthanasia and assisted suicide belong tothis larger context.

Fifth, the Christian community can helpengage society in consideration of thelarger implications of legalizingeuthanasia and assisted suicide. It isimportant to note that hard cases do notnecessarily make for good law. Somewho support the possibility of euthanasiaand assisted suicide under certaincircumstances, nonetheless argue againstlegalization. The Christian communitywill be concerned about ways in whichlaws shape public morality and aboutlegalization of euthanasia and assistedsuicide if it further devalues life in asociety in which violence is rampant andnot all members of society feel valued.

Christ calls us to risk involvingourselves in the world. The question ishow we can be most faithful God and toeach other as these debates continue.Perhaps we still need time for consensusto emerge both in the church and insociety on issues of such complexity.Perhaps it is right to continue our studyof these issues, seeking to be thoughtfuland prayerful, until such consensusemerges.

Questions for Group Discussion1. Do Christians have an obligation

to help shape public policy?Why or why not?

2. Which public policy questionsdoes the euthanasia/assistedsuicide debate raise?

3. Should Presbyterians nowdevelop a position paper oneuthanasia and assisted suicide,

seeking to influence legislationone way or another? Why orwhy not?

Suggestions for Group Process1. Read Isaiah 65:17-25 together.

Invite the group to join in prayertogether: Opening prayer: O PerfectOne of Israel, we live in animperfect world. We are animperfect people, an indistinctreflection of your flawlessdesign. So too, our hospitals andmedical abilities, wonderful asthey may be, nonethelesscomprise an imperfect system ofhealing efforts, all toounderdeveloped and all tooinaccessible. You are unlimitedpower and purpose; may we beyour representatives as we workto transform public policy, untilthe long awaited day when all ofyour children may receivewithout restriction the fullmeasure of healing you intendfor them. In Jesus Christ ourLord. Amen.

2. Invite participants to shareanything that has come to theirattention since the last session.

3. Distribute Part III (�TheFulfillment of Reconciliation�)from The Confession of 1967,emphasizing the following:

God�s redeeming work in JesusChrist embraces the whole ofman�s life; social and cultural,economic and political, scientificand technological, individual andcorporate�With an urgencyborn of this hope the church

applies itself to present tasks andstrives for a better world. It doesnot identify limited progress withthe kingdom of God on earth, nordoes it despair in the face ofdisappointment and defeat.

Then, invite discussion withrespect to the role of the churchas a community of moraldiscourse and action by posingthis question: Do Christianshave a responsibility to shape thelife of the greater society? Whyor why not?

4. Divide the participants into fivesmall groups. Assign each groupone of the five positions onpublic policy in chapter 6 ofChoosing Death (MargaretMurphey, Robert Moss, Don C.Shaw, Albert R. Johnson, AlbertW. Alschuler). Invite each groupto develop a plan for action in thearea of public policy based on itsassigned viewpoint. In plenary,request each small group toreport their action plans. Notesimilarities and discrepancies andhighlight areas of agreement.

or

Read Isaiah 65:17-25 again (orone of the other suggestedScripture passages). Beforereading, ask participants to listento the text with ears sensitive tothe issues that they have beendiscussing over the last weeks.Then, invite conversation aboutwhat the participants heard in thereading that suggests how thechurch could strive for a betterworld where pain, suffering, and

the threat of death will lose theirdehumanizing power.

5. Inquire if any participants believethat the group as a whole shouldundertake initiatives in the areaof public policy. If so, ask if anyparticipants would like to workon the development of theseinitiatives.

6. Remind participants that the nextsession will be the final sessionand that they will be discussinghow any of their perspectiveshave changed over the course ofthe study.

7. Conclude by reading Revelation21:1-4 and inviting theparticipants to pray together:

Closing prayer: O Word of Life,you have called us to speak to oneanother your good news. Yet, in somany corners of our communities,the news is not good. Make us boldto speak your truth, so we may say tothe medical community your word ofjustice for all. May we speak to ourdehumanizing social structures yourwill for equities in service anddignity. May we speak to thefavoritism still present in our judicialsystem your spirit of impartiality thattranscends the letter of narrow laws.Until that day, O God, may we notrest our voices in the cry for truth!This we ask in Jesus� name. Amen.

SESSION 12Conclusion

Goals In this session, participants will (1)review the study as a whole; (2) sharewith one another ways in which theyhave grown in faith; and (3) identifywhat they have learned about dealingopenly with a complex and controversialissue.

Suggested Resources�A Commitment to Caring� (seeAppendix 4)

Suggested Scripture:Ecclesiastes 3:1-22Romans 14:7-9

Critical Issues See the statement under �CriticalIssues� for Session 1.

Questions for Group Discussion1. Was the study a success? Why

or why not? What were the highpoints of the study and why?What sessions were the mostdifficult or disturbing and why?

2. What key questions haveemerged? (Responses mightinclude such issues as autonomyand accountability; therelationship between the Creatorand the created; suffering, bothredemptive and meaningless;access to health care.

3. How have we been changed?How are we different at the endof this study? Do we knowmore? Is our faith stronger? Arewe living our faith in new ways?

Has this study prompted (orcould it prompt) new or furtheroutreach toward meeting theneeds of persons facing end-of-life decisions? Has our studybeen (or could it become) theoccasion for other initiatives onour part (educational, publicpolicy, etc.)?

4. What did participants learn abouthow a group of Christians candeal openly with a complex andcontroversial issue? How hasthis study impacted us? In whatways has this study been helpfulin providing material for ourdenomination in developingpublic policy?

5. How did you feel about the topicof euthanasia/assisted suicidewhen this study began? How doyou feel about it now? Do youthink that euthanasia or assistedsuicide can be a faithfuldecision? Why or why not?How does your understanding ofwhat we owe God and each otheraffect your response?

6. If you do see euthanasia/assistedsuicide as an option, under whatconditions and with whichsafeguards? If you do not see itas an option, what are thealternatives?

7. Should the church take a stand onthe legalization of euthanasia andassisted suicide? Why or whynot? If we close the discussion,are we better off or not as a

society and a church? Who arethe winners and the losers ifeuthanasia and assisted suicideare legalized?

Suggestions for Group Process1. Read Romans 14:7-9 together.

Invite the group to join in prayertogether: Opening prayer: O God, assistus in sharing what we havelearned, so we may pass it on theothers who face these issues.Make us alert to the many waysin which we can work to changeinequities in out healthcommunity. Give us minds offaith and hearts of compassion toprovide comfort for all whosuffer and experience pain. Evenas you are working out yourpurposes, O God, make uspersons of open minds andwilling hearts, so we do not shyfrom difficult issues, not resistthe transforming wind of yourHoly Spirit. Even as you promptus, may we respond by joining inthe pursuit of righteousness forall people, and by entering intothe enterprise of fulfilling yourplan for all creation. ThroughJesus Christ our Lord. Amen.

2. Invite participants to tell aboutanything new they have heard,seen, or thought since the lastsession in relation to the themesunder discussion in this study.

3. Share with participants thestatement under �Critical Issues�in Session 1 of this study guide.

or

Explain to participants thepossibility of participating in aCommitment to Caring as oneresponse to this study. Readaloud the Commitment to Caringstatement (Appendix 4).

then

Invite discussion on the study asa whole in light of the �CriticalIssues� or the Commitment toCaring. How, if at all, have thefaith and life of the participantsbeen affected by this study?What, if anything, might theywish to do in response?

4. Invite participants to respond toany and all of the �Questions forGroup Discussion� listed forSession 12.

5. Invite participants to fill out theresponse form on pp. 57-59.Please return forms to the Officeof Theology. Your commentswill help the Office Theologydetermine whether to takeadditional steps to address issuesrelating to euthanasia, assistedsuicide, and end-of-lifedecisions. A summary ofresponses will be shared with theGeneral Assembly and GeneralAssembly Council.

6. Read Ecclesiastes 3:1-22together. Invite the group to joinin prayer together: Closing prayer: O matchlessGod, we have gathered trustingone another and trusting you aswe seek to understand end-of-lifeissues, including concernssurrounding euthanasia and

assisted suicide. The questionsare so many! Like pieces of anunformed quilt, they have attimes confounded us. Yet, wehave looked at the many hues ofthe affected lives and the manyshapes of the arguments pro andcon and in between. In thelooking, we have tried to see thepattern of your hand amid thecrazy-work. We have searched,as well, for a way in which to put

together the pieces in a designfavorable to others and pleasingto you. We know that, in thisstudy, our work has only begun.Still and awed, we pray it wouldform a motif for the future, forourselves, and for our church,until we realize the full potentialof our calling, remembering thatin life and in death, we belong toyou, O God. In Jesus Christ ourLord. Amen.

APPENDIX 1Glossary of Terms

With acknowledgement to Tom L.Beauchamp, J. Fletcher, Robert George,Richard M. Gula, Steven Miles, EdmundD. Pellegrino, and LawrenceSchneiderman.

Assisted Suicide: See suicide.Assisting in suicide entails one�s being anecessary and relevant condition ofdeath, but not a sufficient condition.Assisting in suicide requires affirmative,assertive, proximate, direct conduct suchas furnishing a gun, poison knife, orother instrumentality or usable means bywhich another could physically andimmediately inflict some death-producing injury upon himself or herself.Such situations are far different than themere presence of a doctor during theexercise of a patient�s constitutionalrights to refuse treatment.

Autonomy: Rule of the self. To beauthor of one�s life plan.

Euthanasia�Mercy Killing: Death isintended by at least one other personwho is either the cause of death or acasually relevant condition of the death.The person who is to die is either acutelysuffering or irreversibly comatose (orsoon will be), and this alone is theprimary reason for intending theperson�s death.

Futility: Inability to achieve goals of anaction, no matter how often repeated; anexpectation of success that is eitherpredictable or empirically so unlikely

that its exact probability is incalculable;interventions that are physiologicallyimplausible or are statisticallyimprobable, unproven, or of no value tothe patient as a person.

Involuntary Euthanasia: Seeeuthanasia. Carried out without thepatient�s consent when it could havebeen obtained. Also includes euthanasiaperformed against the patient�s wishes.

Nonvoluntary Euthanasia: Seeeuthanasia. Performed when consentcannot be obtained, as in the case ofcomatose, profoundly demented, orretarded persons.

Passive Euthanasia: Thought by mostscholars not to be a useful concept.Withdrawing or withholding treatmentthat the patient does not want becausethe relief afforded by it would notoutweigh the burden resulting from it.Confuses euthanasia with the well-established and acceptable practice ofwithholding or withdrawing uselesstreatment.

Suicide: Acts or omissions thatintentionally bring about one�s death.

Voluntary Euthanasia: Seeeuthanasia. Done with the patient�sconsent. An active or direct means toend the life of a dying person whorequests another to terminate his or herlife in the name of mercy.

APPENDIX 2A Sermon and a Response

I.THE CHRISTIAN FAITH AND

EUTHANASIAA sermon from the pulpit of

THE BRYN MAWR PRESBYTERIANCHURCH

Bryn Mawr, PennsylvaniaNovember 7, 1993

ByDr. Eugene C. Bay

Readings: Genesis 1:26-31Romans 14:1-12

Text: So then, each of us will beaccountable to God (Romans 14:12).

Earlier this fall, I said that anycongregation that is serious aboutChristian nurture has to be ready andwilling to explore the complex and oftenambiguous issues with which people areconfronted today. I am devoting thismorning�s sermon time to one suchmatter. It involves decisions that somewithin this congregation have alreadyhad to make. Many more will likely beinvolved with such questions in thefuture.

Let me say, at the outset, that thissermon is not intended as any kind offinal word. My purpose is not to stopconversation, but to get it started.Whether or not you agree with medoesn�t matter. That you think aboutthese issues from a Christian perspectivedoes.

I should also say that my topic is moreinclusive than the sermon title mightsuggest. The word �euthanasia� is a

combination of two Greek wordsmeaning �a good death.� These days,the word refers to the taking of the lifeof a terminally ill or dying person forreasons of compassion�either by doingsomething to cause death, called �activeeuthanasia,� or by not doing somethingthat might prolong life, called �passiveeuthanasia.�

The topic, as I conceive it, has manydimensions: physician assisteddying�of which Dr. Kevorkian is themost prominent, if also one of the leastethical, examples; the freedom to refusemedical treatment, or to stop treatmentonce it has begun; the responsibilities ofphysicians, nurses, hospitals, andnursing homes; the involvement offamily members; the role of the courts;and the question of how, as a society, weshould allocate health care resources. Inother words, I have in mind the broadrange of issues concerning what issometimes called �the right to die.�

So far, I have been talking about thesematters in an abstract and impersonalway. But these issues come to ourattention because they involve realpeople. It�s time to meet a few of them.

Dr. and Mrs. Henry Pitt VanDusen, forexample. Some of you may recallhearing, some twenty years ago, abouttheir double suicide. Dr. VanDusen wasa Presbyterian minister and a formerpresident of Union TheologicalSeminary in New York. At the time oftheir suicide, he and his wife were bothelderly, both physically enfeebled, andboth intellectually alert. They left aletter saying that their infirmities had

become intolerable, and that theirdecision to end their lives was anexpression of Christian stewardship,thoughtfully and prayerfully made�What do you think? Is it possible forsuch a decision to be called �Christian�?

Another, �for instance.� Diane wasdiagnosed as having acute leukemia.After exploring her options with herphysician and her family, she not onlydecided to refuse treatment, but askedher doctor if he would help her end herlife when she determined the time hadcome to give it up. After manydiscussions with Diane and much soul-searching, the physician gave Diane aprescription for barbiturates, exactingfrom her a promise to consult him beforetaking enough of them to commitsuicide. Months later, the two of themmet for what was to be the final time.Of that encounter, the physician writes:��It was clear that (Diane) knew whatshe was doing, that she was sad andfrightened to be leaving, but that shewould be even more terrified to stay andsuffer�� Two days later her husbandcalled to say that Diane had died.1

�What do you think? Should Diane�sdoctor be condemned or commended?

Charles Lukey was a pastor. He died afew years ago of a rare disease that, asone man describes it, involves �agalloping degeneration of the nervecells.� When the crisis came, Lukeywrote a letter to his friends. �What,� heasked, �does the Christian do when hestands over the abyss of his own deathand the doctors have told him that thedisease is ravaging his brain and that hiswhole personality may be warped,twisted, changed?� Then, does theChristian have any right to self-destruction, especially when he knows

that the changed personality may bringout some horrible beast within himself?Answering his own questions, Lukeysaid: ��it comes to me that, ultimatelyand finally, the Christian has always toview life as a gift from God, and see thatevery precious drop of life was notearned but was a grace, lovinglybestowed on him by his Creator, and it isnot his to pick up and smash.

�And so,� Lukey went on, �I find theposition of suicide untenable, notbecause I lack the courage to blow outmy brains, but rather because of my deepabiding faith in the Creator who put thebrains there in the first place. And nowthe result is that I lie here blind in mybed and trust in the loving, sustainingpower of the great Creator who knewand loved me before I was fashioned inmy mother�s womb. But I do not think itis wrong to pray for an early releasefrom this diseased and ravagedcarcass.�2

This is a courageous and profound stateof faith! �What do you think? Couldsomeone else have made a differentchoice and been equally faithful in doingso? Or did Lukey make the onlypossible Christian decision?

A final example. Elizabeth is twenty-eight and suffering from severe cerebralpalsy. She is a quadriplegic and whollyunable to care for herself. She alsosuffers from degenerative arthritis and isin continuous pain. She wants to die.The guess is that by force-feeding her,Elizabeth could live another fifteen ortwenty years. Right-to-life advocatesbelieve she has a duty to live. Elizabethhas gone to court to secure permission toforego medical treatment or life supportthrough mechanical means.3 What do

you think? Does Elizabeth have theright to say when her life no longer hasquality or meaning? Or, is she obligatedto wait until her body revolts against themedical technologies that are keepingher alive?

Time was when questions such as thesehad neither to be asked nor answered.Life and death decisions were made forus, not by us. The tragedy was thatmany people died before their time,prematurely.

Today, the situation is different. Somechildren and young people will diebefore their time, as some in thiscongregation know only too well. Butnow there are many older people whofeel that they have lived beyond theirtime. Medical technology is able toprolong life and cure disease, but it canalso keep �alive� those who are severelybrain damaged, or the comatose, orthose, like Elizabeth, who no longerwant to live.

The result is that, today, what peoplefear, sometimes, is not the approach ofdeath, but its postponement�they fearthat their dying will be prolongedbeyond what is reasonable, or that theirlives will be extended when their dignityand purpose have long sincedisappeared. It�s because of this newsituation that we are facing the issued ofeuthanasia and the related questions Imentioned earlier.

The question is how, given this newsituation, we can make wise,compassionate, faithful moral choices.As Christians, what should we keep inmind as we encounter these new anddifficult dilemmas? As I have thought

about it, here are some things I havecome to see as important.

First, we need to remember the biblicalwarning about human frailty and humansinfulness. We are limited in wisdom.We are imperfect people, with mixedmotives and hidden agendas. So, asregards these life and death decisions,caution is called for, not recklessness.Ethicists are right to worry about �theslippery slope��a way of saying thatonce we start down a certain path,something like gravity will pull usfurther along. Applied to euthanasia, theworry is that once we allow physicians,or others, to end the lives of people likeDiane or Elizabeth, it won�t stop there,and before long we will be interveningto end the lives of the senile, say, or ofhandicapped newborns, or the lives ofthose whose care is judged to be tooexpensive.

This cautionary note is important, butfor me, at least, it doesn�t end thediscussion, or relieve us from theresponsibility and burden of deciding inindividual instances. So what otherguidance is there?

There is, of course, the biblicaladmonition to �choose life,� along withthe commandment not to kill. But, at thetime when Moses urged his people to�choose life,� the definition of life wassimple: if you were breathing onlybecause he or she is hooked up to amachine? Again, is the command not tokill absolute? What about killing in self-defense? What about war? What aboutcapital punishment? In these cases,many Christians make exceptions to therule. Is euthanasia another possibleexception? These biblical injunctionsare important, but they don�t end the

discussion either, they don�t relieve usfrom the burden of decision-making.

So where are we? With regard to theselife and death dilemmas, where we are,and where we will always be, I think issomewhere between two poles of atheological kind: one we might call�finitude� and the other, �freedom.�

At the one end, near the pole labeled�finitude,� the emphasis is onacceptance, on playing the hand that lifedeals you, not complaining about thequality of the cards, but playing them tothe best of your ability�in other words,accepting whatever comes, be it good orbad, joyful or sad, and seeking in andthrough your acceptance to honor God.Of the people we met earlier, CharlesLukey heroically represents thisresponse.

At the other end of the spectrum, nearthe pole labeled �freedom,� the emphasisis on taking responsibility. The passageread earlier, from Genesis, seems toencourage this response. For there it issaid that human beings are created inGod�s image and are given �dominion.�When, in other words, we takeresponsibility for our lives, we are notusurping a divine prerogative, but onlyassuming our God-given power andresponsibility. The VanDusens arerepresentatives of this response.

Somewhere along this spectrum,between finitude and freedom, betweenacceptance and responsibility, Christianswill take their place as they areconfronted by these life and deathdecisions. Rarely will we confront aclear moral choice. Most of the time thechoice will be ambiguous. And mycontention is that there may well be

more than one acceptable decision froma Christian perspective. As a Christiancommunity we should, of course,support a Charles Lukey when hechooses to live out his life, come whatmay. But should we not also respondcompassionately to a Diane or anElizabeth, not condemning, but valuing adifferent kind of courage andfaithfulness?

Which is where the lesson read earlier,from Romans, comes into the picture.The issue Paul was dealing with seemstrivial when compared with thequestions we are thinking about. But hiswarning against making one�s owndecisions normative for everybody else,applies nonetheless. Each of us, saysPaul, is accountable to God. But eventhough we all are equally serious aboutour accountability, we may not all arriveat the same decision. And Paul pleadswith us to refrain from easy judgmentsabout the difficult decisions others make.

One final thought: I am persuaded thatthis new situation in which we findourselves should cause us to re-examineour understandings of both life anddeath.

Those who oppose �the right to die,�for example, are often heard to speak ofthe �sacredness� of life. Life is aprecious gift, to be received withgratitude and treated with utmostrespect. But, while life is precious, forpeople of faith it is not the only thing ofvalue in this world. Something moreimportant can cause us to put our liveson the line. It is clear teaching of theNew Testament that something moreimportant caused Jesus to put hisobedience to his heavenly Father. �Noone takes my life from me,� Jesus said.

�but I lay it down of my own accord.�The question is, may people like theVanDusens, or Diane, or Elizabeth alsolay down their lives if and when theydecide that their lives have becomeunbearably painful and withoutmeaning? My own answer is yes, thatcan be a faithful decision. And as apastor, I have supported people inmaking such a decision.

We also need to think anew aboutdeath�about how to define or recognizeit. A hospital chaplain by the name ofGerald Oosterveen, writes: �It is timefor the Christian community to see deathin a broader context than mere biologicalor brain death�A human being is morethan the total of his or her functions,more than heartbeat and breathing andbrain flow combined. Life isrelationships with God and humanbeings.� He goes on: �As the evidencemounts that a loved one will never againhave a meaningful relationship withanother human being on earth, is thatperson not dead? �Have we, ascommitted Christians, the right to bringto the bedside every possible machine,drug or procedure that cannot change theultimate outcome but only prolongs thedying process? If,� Oosterveenconcludes, �we truly believe that �thisworld is not our home, that we are onlypassing through,� how can we justifydelaying the going-home of a dyingperson? Do we,� he asks, �love ourloved ones enough to let go? And do wetrust God enough to let our loved onesenter into God�s presence?�4 I wouldadd: As Christians, should not ourperspective on these matters be differentfrom those who hold onto life becausethey have nothing else to hold onto?

We are faced today with choices ourgrandparents did not have to make. It�sobvious that I cannot offer you a feweasy solutions on how to deal with thesequestions, something to laminate inplastic and carry in your wallet. Asregards those two poles I talked aboutearlier, I myself gravitate�not withoutfear and trembling�to the responsibilityside. But you will have to determineyour own position. What I want to do,above all, this morning, is remind youthat you are not alone as you make theselife-and-death decisions. Whether youare deciding for yourself or another,whether you are patient or physician,family member or friend, attorney orpastor, God is with you in your struggle.Be confident of that. Do the best youcan. And know that God�s grace andmercy surround you.

II.MEMORANDUMDATE: June 20, 1994

TO: Gene BayFROM: Rich Allman

SUBJECT: THE CHRISTIAN FAITHAND EUTHANASIA

Thank you for your willingnessthoughtfully and courageously to addressa vexing issue which engages ourconcern as professionals and asChristians. I am pleased to accept yourinvitation to use what you have said as abeginning of dialogue. Areas ofcommon ground exist; areas ofconfusion should be clarified; areas ofirreconcilable difference summon ourneed for mutual respect. You arefamiliar with my position, oftenstated�you might say overstated!

I believe euthanasia to be badmedicine, misapplied compassion, and

socially destructive. My views, if notvery original are deeply felt, hopefullycoherent, and open to what I know willbe your spirited rebuttal.

Regarding euthanasia, no matter howmerciful the intent, the result is still thedeliberate killing our patients distortsand perverts the purpose of medicine,which is to facilitate healing. Notice Ididn�t say curing, which is often, andultimately always impossible, but ratherI said healing. The good of healing canand must be achieved by means otherthan killing patients. We cannot healand improve our patients� lives byending those lives. We can improvetheir lives as Stanley Hauerwas writes byembodying fidelity in our commitmentto be partners in a caring community andby being present to those we cannotcure.5 In a single act of mercy, ordesperation, or exasperation, orannoyance, or faulty judgment, todeliberately end the life of a patient is awrong turn on the road to human dignity.It deprives dying persons of theopportunity for the proper relational andspiritual closure that will occur for thosewhose symptoms are controlled andwhose care givers are the presenceHauerwas demands. At a time whenmedicine stands accused of atechnocratic, impersonal approach topatients, sanctioned killing is a wrongway back to improved doctor-patientcommunications. Even if onegeneration�my generation�ofphysicians would carry out euthanasiawith awe, respect, fear and trembling,the routine would soon become rote andmechanistic and simply anothertreatment choice. It would undermineand abort the genuine progress we havemade in patient self-determination andhigh touch, as opposed to high tech end-

of-life care. The prohibition of medicalkilling has been a genuine impetus todevelopments in palliative care. Weshould take further steps in improvingour patients� dying rather than taking thewrong step and simply kill them.

What ought we to think of a societythat conspires to work out way to killpatients before it has provided a decentminimum of health care for 37 million ofits citizens? A related question is: Willeuthanasia become a tool for resourceallocation? In any inevitable multitieredhealth care system, will those with morerobust levels of coverage getcomprehensive medical care? Will thosewith more limited coverage morefrequently be economically compelled toopt for euthanasia? A further societalconcern is: When in human history hasmoral progress occurred when thecircumstances for sanctioned killinghave been expanded? I know fromconversations that you share some ofthese concerns.

After hearing, reading, and rereadingyour sermon, I was disturbed by howmuch I agreed with much of what yousaid. I even feared that my mind mightbe changed! Paraphrasing, but hopefullystaying true to your thoughts, I shareyour rejection of the idolatry ofbiological life. Physical conditions thatare gravely burdensome do exist,certainly in the opinion of those whosuffer such torments. Life without thepossibility of any human interaction isno life at all. The preservations of suchlife violate the standards of goodmedicine, evoked as early asHippocrates, who admonished doctors torecognize when patients wereovermastered by disease. I ampersuaded that such pointless and

meddlesome therapy violates soundtheological practice as well.

Those faithful people in your sermonwho chose to end their lives all hadmoving narratives. Most suicides are inthe context of depression and thus arenot truly autonomous or rational, butsome are. Statistically, fewer than 2percent of suicides are for the kinds ofsituations you have so movinglydescribed. Rather than to condemn orcommend, I prefer to wonder if thechoice taken was the only way to facewhat was happening in their lives. I amuncomfortable with endorsing suicidewhen the statistical odds are sooverwhelming that the act is neitherautonomous nor rational, althoughadmitting it may occasionally be.Similarly, I am fearful of a retreat frommedicine�s, society�s, and hopefully thechurch�s commitment to the preventionof suicide. Yale Psychiatrist PatriciaWesley has properly wondered howDiane would have responded had Dr.Quill as an act of human nurturing said�no�but� to her request for barbituratesand, instead of referring her to theHemlock Society, had referred her to acancer support group and suicideprevention society.6

Where I come down in the face ofprogressive disability and decline is tosupport, comfort, be a presence, and tryto render healing that is neitherbiological cure nor medicalized assaultwith unwanted burdensomeinterventions that provide no benefits tothe patient as a person. Good carerequires attentiveness to medical needsand symptom control, even if thatsymptom control runs the risk,acceptable I believe, of shortening lifeby suppression of respiration. Vigorous

pastoral care and the interactive andnurturing techniques we can learn fromyou and your colleagues are vitaladjuncts to the care of the dying. Youcan do something that as a physician Icannot do, that is, to help the sick anddying understand the meaning of theirsuffering and of the presence of God andGod�s servants in the face of inevitabledemise. You can also serve as valuedintermediaries in helping the dying, theirloved ones, and their care givers toestablish treatment goals that meet theirneeds and life plan at penultimatemoments. Ventilators, intravenous lines,dialysis machines, and feeding tubes arepoor substitutes for the humanity Godwants us to provide. Intensively kind,supportive end-of-life care ought not tobe confused with intensive care andmechanical life support. The morally, asopposed to technically, heroic care Irefer to must be medically andtechnologically restrained,unencumbered by the idea that ifsomething can be done, it must be done.

In your sermon, you set out to thinkabout euthanasia, but what youaccomplished was to present in aChristian context a catalogue ofalternatives to euthanasia, some ofwhich, like assisted suicide trouble me,others of which such as honoring patientwishes for withholding of treatment orwithdrawal of burdensome and futiletreatment, as a physician, I demand. Inour own faith tradition, Bonhoefferwrites that where death is only one ofseveral plausible choices, it is the choicethat always must be rejected.7

This from a man who paid with his lifefor the conviction�correct, Ibelieve�that the only way out of themoral sewer that was Nazi Germany was

by the assassination of Hitler. The kindof intervention and nonintervention youdescribe and directly or inferentiallyendorse provides a rich menu ofalternatives to that which would take usas health professionals and Christiansonto a pernicious path of medicalizedkilling of persons.

You framed end-of-life decision-making on a continuum between theextremes of finitude and freedom. Iprefer to think of two separate continua.One has as its polar extremes finitudeand infinitude. The other continuum hasas its polar extremes enslavement and atthe opposite end hubris and license. Themidpoint of this continuum is freedom.Where medicine gets into trouble iswhen we deny the finitude of biologiclife and of our resources to preserve thatlife, however burdensome or poor itsquality. If we as physicians deny thefinitude of human existence, we willacknowledge no limits to what we cando and no limits to how much ofsociety�s resources are to be used in suchan elusive quest. At the end of thismisbegotten journey, human death anddecline still await. Human finitude, if Imight quote a prior sermon of yours thatstill resonates, demonstrates to us who isGod, and who is not. I perceive that theopposite of finitude is God, who thoughincomprehensible except in the person ofJesus, is the only infiniteness I canimagine. The other continuum is onemore grounded in values. Enslavementto pointless technology and hubristicnotions of control by acts such aseuthanasia and other acts that assumemedicine can control everything are thepolar extremes. Patient choices abouttreatment options, within proper moralboundaries, coincide with the virtuousmidpoint of that continuum at a place

called freedom. Such freedom excludesthe impulse to euthanasia, which wouldbe the Janis Joplin freedom�justanother word for nothing left to lose.Finding the moral locus of freedom isbetter than asking an old and honorable(though admittedly flawed) profession totake on a role it has historically rejected.This would grant to physicians aresponsibility society heretofore has onlygiven to soldiers, police, andexecutioners, that of killing persons.What would we call mistakes?Malpractice? Homicide?

Gene, your ministry is a constantblessing and gift in the lives of myfellow congregants, my family, andmyself. One of the reasons why this isso is because of the seriousness withwhich take your ordination vows. As aphysician, on the day I graduated frommedical school, I too swore an oath to allthat I hold holy to live my life in acertain way. Whether one swears theoath of Hippocrates, or of Maimonides,or of the World Health Organization, aconstant element of those oaths is thatwe will not, even if asked, kill ourpatients. This moral precept has stoodour profession in good stead for two anda half millennia. I hope the church willalways hold my colleagues and me tofidelity to the oath. Within the confinesof that prohibition has developed a richmatrix of palliative, comfort care; paincontrol; and end-of-life care. If anurgency exists in our society, it is tomake that care available to all��to theleast of these��rather than to add a newand grotesque dimension such as killingby physicians or physician-assistedsuicide. If a place for such activityexists, it is neither historically, uniquely,nor properly medical. Anyone withaccess to a knife, a gun, a poison, a rope,

a club, or a live electrical wire could dothe deed.

As a moral profession, medicine at itsbest responds to prophetic voices, bothwithin and beyond the institutionalreligious community. Sometimes thosevoices arise within our professionalcommunity. Leon Kass raises such avoice. He writes:

People who are for autonomy anddignity should try to reverse thisdehumanization of the last stages oflife, instead of giving dehumanizationits final triumph by welcoming thedesperate goodbye-to-all that iscontained in one final plea forpoison�

�Should doctors cave in, shoulddoctors become technical dispensersof death, they will not only beabandoning their posts, their patients,and their duty to care; they will setthe worse sort of example for thecommunity at large�teachingtechnicism and so-called humanenesswhere encouragement and humanityare both required and sorely lacking.On the other hand, should physicianshold fast�should doctors learn thatfinitude is no disgrace and that humanwholeness can be cared for to thevery end, medicine may serve notonly the good of its patients but also,by example, the failing moral healthof modern times.�8

As a Christian physician, I can only tryto hold to such high standards. End-of-life care still has itspurpose�enrichment of whateverlimited and compromised life remains.The British AIDS hospice physician,Robert George, in his �quest�fordignity, hope, freedom, and healing forour patients as they pass through death,�9 quotes a more familiar prophetic voice,Isaiah:

The Spirit of the Sovereign Lord is onme, because the Lord has anointed meto preach good news to the poor. Hehas sent me to bind up the brokenhearted, to proclaim freedom for thecaptives and release from darknessfor the prisoners, to proclaim the yearof the Lord�s favor and the day ofvengeance of our God, to comfort allwho mourn, and provide for thosewho grieve in Zion�to bestow onthem a crown of beauty instead ofashes, the oil of gladness instead ofmourning, and a garment of praiseinstead of a spirit of despair. Theywill be called oaks of righteousness, aplanting of the Lord for the display ofhis splendor. (Isaiah 61:1-3, NIV)

This is how I believe good doctors,good patients, and a good societyachieve their freedom in the face offinitude. To take up your summons, it�sthe best I can do. And thanks for theassurance that God�s grace and mercysurround me as a person and as aphysician. 1 Timothy E. Quill. M.D., �Death andDignity��A Case of Individualized DecisionMaking,� The New England Journal ofMedicine, (March 7, 1991): 691-694.2 James W. Crawford, Worthy to Raise Issues(Cleveland: Pilgrim Press, 1991), p. 41.3 Howard Moody, �Life Sentence,� Christianityand Crisis (October 12, 1987).4 Gerald Oosterveen, �Decisions at Life�s End,�Presbyterian Survey (November, 1993): 19.5 S. Hauerwas and R. Bondi, �Memory,Community, and Reasons for Living: Reflectionon Suicide and Euthanasia,� in S. Hauerwas,Truthfulness and Tragedy (Notre Dame, IN:University of Notre Dame Press, 1977).6 P. Wesley, �Dying Safely,� Issues in Law andMedicine 8 (1993): 467-85.7 D. Bonhoeffer, Ethics, trans. N. H. Smith (NewYork: MacMillan, 1995), pp. 160-6.8 L. R. Kass, �Neither for Love Nor Money:Why Doctors Must Not Kill,� Public Interest 94(Winter 1989): 25-46.9 R. George, �Euthanasia: The AIDSDimension,� in Death Without Dignity, ed. N.Cameron (Rutherford House, 1990), pp. 176-195.

APPENDIX 3Prior Denominational Statements on Euthanasia

I.EXCERPTS FROM �THE

NATURE AND VALUE OFHUMAN LIFE�

A Paper Adopted by the 121st GeneralAssembly (1981) of the Presbyterian

Church in the United States andCommended to the Church for Study

pp. 16-19

Euthanasia. The topic of euthanasia iscomplicated by the fact that one term isoften applied to quite different kinds ofcircumstances. Therefore it is importantat the outset to make a fundamentaldistinction between taking life(sometimes referred to as �activeeuthanasia�) and allowing to die(sometimes referred to as �passiveeuthanasia�). Our consideration of eachof these matters will be carried out interms of the framework utilized in thediscussion of abortions.

(i.) Taking Life. �Active euthanasia� isa question that arises in situations ofmedical extremity where it is thoughtthat an individual is beyond the reach ofmedical care. Some have at least posedthe question of whether the most humanetreatment might be to terminate life.However, the dominant value of respectfor human life and its accompanyingobligations to do no harm and to protectfrom harm establish a clear prejudiceagainst such direct taking of life. Theonly relevant question for us is whetherthere is a conceivable conflict betweenthese obligations. Once again it is alsonecessary to formulate a judgment about

which obligation is more expressive ofrespect for life if conflict is seen to exist.

Perhaps cases of intense andunrelievable pain furnish the mostdifficult examples. Because humanbeings are finite creatures, we know thatthere are definite limits to the amount ofpain that anyone can bear without havingthe relational quality of their lifecompletely consumed by the relentlessbattle with pain. It is not terriblydifficult to imagine some suchcircumstance where we would beinclined to perceive the obligations to dono harm and to protect from harm asbeing in direct conflict. The harms alsowould appear to be proportionate to oneanother since uninterrupted, intense paincan probably destroy the ability to enjoyrelationships as fully as can physicaldeath. Thus the judgment called for atthis point in the process would be thedesignation of which obligation is moreconsistent with respect for life in thissituation. It might be argued thatcontradiction of its meaning and purposeand causes such palpable harm to theperson in question, that greater respect isshown for life by giving priority to theobligation to protect from harm.

Happily extreme situations of suchintense and unrelievable pain are lessand less likely in the context of modernmedical services, especially with theavailability of pain relieving drugs.Therefore, the conflict of obligations justdescribed can often be reduced throughdrug therapy. While human life mightbe less than ideal under such treatment,it does not present us with a directconflict between the obligations of doing

no harm and protecting from harm.Nonetheless, there may be circumstanceswhich have no access to such medicaltreatment and which would continue topose a situation of conflict. Moreover,there may be other circumstances thansheer pain which could present us with aconflict of obligations. Thus it is usefulto illustrate the procedure of determiningwhether a conflict exists and whichobligation best satisfies the concern forrespect for life. It reminds us as wellthat certain tragic choices do confront usat the boundaries, for which we do wellto have a clear procedure to guide ourconsideration.

If and when we are confronted by suchboundary choices, caution andconsultation are important ingredients ofour deliberations. From our earlierconsiderations on the moral character ofhuman life, we recall our proclivity to letour self-interest cloud our judgments onimportant matters. From our analysis ofthe finite character of human life we alsorecall limitations on our knowledge andthe importance of being aware of allrelevant knowledge. Thus we should notencourage hasty decision-making, norshould we abandon patients, families,and doctors to make such monumentaldecisions with the collaboration of otherexperts. Here too there is a need forrelatively disinterested helpers in thedecision-making process, so thatjudgments satisfying the moral claimsdescribed in this study might be reached.

�Active euthanasia� is extremelydifficult to defend morally. There are,however, extreme circumstances inwhich we may have to at least raise thequestion of a fundamental conflict ofobligations. There is an analogybetween such cases of �active

euthanasia� and abortions, questions thatare based on the circumstances of thefetus. There is an accompanyingprejudice against the taking of life inboth cases, since the conflict betweendoing no harm and protecting from harmhas reference to one and the sameindividual. The ambiguity of thissituation serves to reinforce what hasalready been said about cautious andconsultative decision-making.

(ii.) Allowing to Die. �Passiveeuthanasia� presents a somewhatdifferent picture from �activeeuthanasia.� Whereas the latter assumesthat death cannot be expected to followfrom the person�s medical condition, theformer assumes that death is predictable.The question is basically whethermedical interventions should be made orcontinued, or whether the person shouldbe allowed to die as a result of themedical condition.

The moral question posed here is notwhether two obligations are in conflict.It is rather the question of whatconstitutes the fulfillment of theobligation to protect from harm. Inallowing to die, one is not active butpassive. It follows that the activity ofdoing harm cannot be attributed to thepassive procedure of not intervening.Thus we are not confronted with aconflict between obligations to do noharm and to protect from harm. Rather,we are confronted with the question ofwhat our obligation to protect from harmmeans in such circumstances.

In one sense, every medicalintervention represents a decision not toallow a person to die. Therefore, itwould appear that normally we assumethat the obligation to protect from harm

means that we do not allow people to dieif we can do something about it. Yet afurther distinction is relevant just at thispoint. When we speak of not allowing aperson to die, we usually mean that weare prolonging their life. However, thereis a difference between prolonging lifeand prolonging dying. If the effect of agiven intervention is not to prolong life,but to prolong dying, then we cannotclaim that we have protected human lifefrom harm by the intervention. Ourearlier discussion of the finite characterof human life makes plain that death isnot always to be understood as a harm.Where ding is judged imminent andinevitable, death is not a harm fromwhich we can conceivably be protected.Hence, there can be no obligation toprotect from this event.

Thus the fundamental judgment thathas to be made in the matter of �passiveeuthanasia� is whether the person inquestion is dying or not. This is not thesame thing as asking whether a patient isterminal. A person with a certain formof cancer may clearly be terminal, butthis does not necessarily mean that theindividual is confronted by impendingdeath. The dying condition obtainswhen it becomes apparent that noavailable medical treatment will reducethe disability or improve the capabilitiesof a terminal patient facing impendingdeath. The effect of medical treatmentin this case cannot be to prolong life, butat most to prolong dying by marginallyforestalling impending death. Thedetermination of the condition of dyingis fundamentally a medical judgmentthat will need to be rendered by qualifiedmedical personnel. Once the judgmentis made, the situation can be analyzed interms of our obligation to protect fromharm.

In such a situation the obligation toprotect human life from harm does notrequire us to treat the condition that isleading to death. On the other hand, itdoes require us to accompany and carefor persons in every relevant way.Certainly it obliges us not to abandonpersons, leaving them to die alone.Instead, protection from harm means thatwe will remain with them, offeringcompany and support as they confrontthe inevitable implication of their ownfinitude. Additionally, medicaltreatment designed to relieve pain andmake persons more comfortable wouldcontinue to be very much in order.Entailed in this commitment toaccompany dying patients is a readinessto undertake medical treatment that willprolong dying if requested by patients,assuming their competence. Perhapsmost often in the situation of dying, theperson will be unable to make judgmentsor requests of this sort. Here, wheredoctors and guardians are necessarilyentrusted with the decision, no moralobligation to treat the dying patientexists. However, if a patient is able toand does make a request for so-called�heroic� medical measures, even againstthe best medical judgment, it would be afailure of readiness to support andaccompany to refuse such a request.

Obviously this response assumes thatthe requested treatment does not portenda more harmful result for the patient thanalready experienced; nor doesresponsiveness to such a requestpreclude careful review with the patientof the medical judgment and even thetheological implications to enable thepatient to better grasp the rationale fornot prolonging dying. Nevertheless, themedical judgments involved are human

and therefore fallible. With dueexplanation and discussion, it would notbe appropriate to refuse request fortreatment from the patient.

It should go without saying that shouldthe medical indications suggest that theperson is not in a condition of dying,then the obligation to protect includesthe obligation to treat medically to themaximum extent possible. Such asevere, even terminal, but non-dyingmedical condition does not change thenormal implication of out obligation toprotect from harm. Here not to intervenemedically constitutes a clear violation ofthe obligation to protect.

Just as �active euthanasia� requires aprocess of moral reasoning that isdeliberately cautious and collaborative,so �passive euthanasia� requires thesame ingredient. While we are notconcerned in �passive euthanasia� with aconflict between the obligations to do noharm and to protect, very difficultjudgments, especially of a medicalnature, need to be made. It is especiallyimportant that people deeply involved inthe situation are helped to ask andanswer the question of whether thecondition is one of dying, then thoseinvolved medically and familially mustbe assisted in determining how they cancontinue to care for and accompany theperson as death is confronted.

(iii.) Acknowledging Death. While nottechnically part of our consideration ofeuthanasia, the matter of determiningwhen death occurs is an importantrelated issue. There are circumstances inwhich taking life or allowing to die canbe confused with acknowledging death,as when the use of a respirator for acomatose patient is discontinued. The

act could constitute taking life, allowingto die, or acknowledgingdeath�depending upon the condition ofthe patient. If it were either of the firsttwo possibilities, it would be subject toanalysis in terms already provided. Herewe need to indicate what is involved ifthe third possibility, acknowledgingdeath obtains.

To determine when death occurs is asubtle admixture of medical andphilosophical or theological judgment.On the basis of our earlier discussion ofthe relational character of human life,our theological judgment is that deathoccurs where the capacity for suchrelationships is irretrievably lost. Therelated medical judgment is that suchcapacity is lost when cerebral function islost. Traditionally, the most readilyevident signs of lost cerebral functionhave been lost heart and lung function.Modern medical technology complicatesthe picture, however, since heart andlung function can sometimes besupported by the use of a respirator. Insuch a situation, the question is whetherany determination can be made aboutcerebral function. Through the use ofelectroencephalogram and possibly othertests of responsiveness and reflexes,judgments about whether cerebralfunction is present or not can be made.If judged to have been irretrievably lost,the individual is properly determined tobe dead.

There are important considerations forcertain difficult cases. It is important toinsist that removal of life supportsystems is such a circumstance is neithertaking life, not allowing to die. It isacknowledging death. Thus itconstitutes no failure of the obligations

to do no harm or to protect from harm, totake such action.

(iv.) Summary and Conclusions. Whatgoes under the label �euthanasia� can beusefully distinguished as �activeeuthanasia� and �passive euthanasia.�The former, which is the act of takinglife directly, can only be raised as amoral possibility in situations where weexperience a conflict between out two-fold obligation not to harm another andto protect that person as well. To justifysuch action morally requires thedemonstration that the conflict is real,cannot be reduced, and that the action ofprotecting for harm is more consistentwith respect for life. Each of theseconditions is extremely difficult tofulfill. In any event, the inherentambiguity of such a decision requiresthat it be [made] thoughtfully andprayerfully, in collaboration withknowledgeable persons not emotionallycaptured by the situation.

�Passive euthanasia� or �allowing todie� is indistinguishable from �activeeuthanasia� if the person is not in acondition of dying. If, however, thepatient is determined by appropriatemedical indications to be dying, thematter becomes one of a rightunderstanding of the obligation toprotect from harm. Protecting personsfrom harm involves caring for them andaccompanying them, but not medicalinterventions which can only prolongdying. Decision-making requires expertmedical consultation as well as otherconsultation that enables affected partiesto distinguish meaningfully betweenprolonging dying and prolonging life.Of special importance is continuing tocare for and support the person who isallowed to die. It is also important to

acknowledge the fact of death whenevercerebral function, which makes possiblehuman relationships, is irretrievably lost,distinguishing it from both taking lifeand allowing to die.

II.EXCERPTS FROM �THE COVENANT

OF LIFE AND THE CARINGCOMMUNITY�

The 195th General Assembly (1983)Received the Report and Adopted the

Policy Statements andRecommendations

pp. 20-24, 29-30.Chapter 5: Decision-Making at the End-of-Life

Do not seek death. Death will find you.But seek the road which makes deathfulfillment. (Dag Hammarskjold)

Never harm (primum non nocere), curesometimes, comfort always! (MedicalMaxim)

The primary focus in decisions aboutlife or death should be the individual�swishes and needs, but decisions of thismagnitude ought also to occur within thecontext of community. Since individualsdiffer in their understanding andacceptance of death, their decisionsregarding care at the end of life will alsodiffer. Those views must be considered.In Christian perceptions the believingcommunity is the body of Chris, so wemust be concerned with the whole bodyand also with the individual members.As a body sensitive to corporate as wellas personal needs and desires, theChristian community should provide amodel to guide others in society. Butthis is no easy task since individualsdiffer, as is illustrated by the followingcase studies.

Fourteen-year-old Tim Clark said good-by Wednesday night to his friends

during a prayer meeting at AbbotsCreek Baptist Church. Weary of threeand a half years of dialysis treatmentsand three unsuccessful transplantattempts, Tim finally chose to diehaving received a sign from God to�come home� to live. Mrs. Clark saidTim had discussed going off dialysis formore than a month. �On Tuesday nightafter reading his Bible and saying hisprayer, I heard him say, �God, if youwant me to come home and live withyou, give me a sign.� A little later, Iheard him get up and he came down thestairs. He was aglow. He showed mehis arm. It was bleeding where thedialysis needles had been nine hoursbefore. He interpreted this as a sign thatGod wanted him to come home.�1

When Jane Gahagan, a young womanfrom Evanston, Illinois, read the story,she was not moved. Having struggledwith dialysis treatments for 8 years,��I thought of all those who arestruggling to hang on, who fiveeverything they�ve got to be alive.�Gahagan wrote an open Christmas letterto her fellow dialysis patients. �Lifereally begins when we know we mightlose it. Suddenly, all the little thingsbecome important again, as they werewhen we were children. The sun on thelake, the flow of the seasons, the stingof wintry air on our faces, the sound ofleaves falling�Most of us know thattime in the middle of the night when weare very much alone. That hour oftruth, the one in which we have novoice but our own echo�Still, thatmoment becomes a triumph. There isalways rising an instinct toward anotherday and the desire to make it count.And that is life, burgeoning in the midstof death, defiantly saying, �I will notgive in.��2

The vignettes above briefly describetwo inspiring and courageousperspectives on chronic illness and waysof accepting death: two theologies ofdeath and eternal life. These two storiesframe the single human experience thatmost invites, indeed mandates, that

biomedical and theological reflection bejoined: that of dying and death. Ourattention now turns to biomedicaldevelopments that affect the end of lifeand then to theological and ethicalanalysis of those developments.

A. The Biomedical Assault on Death

Life expectancy has changeddramatically in the last forty years due tothe discovery and use of vaccinationsand antibiotics, in addition toimprovements in sanitation. In thetypical deathbed scene of the nineteenthcentury, the physician looked onhelplessly as infection carried the personaway. At the present time infectionsremain a frequent cause of death,especially in the developing countries;but in Western culture, other factorssuch as renal failure, toxemia, orcardiopulmonary collapse are morelikely to be its cause.

A major changeover. The past fiftyyears have brought a major change in theplace where death occurs. Today thisevent takes place more often ininstitutions, namely, in hospitals andmedical centers. In 1937, 37 percent ofAmericans died in hospitals; in 1958, thepercentage had increased to 73 percent.Today over 80 percent of deaths occuraway from home in hospitals or otherinstitutions. This statistic underlies twoprimary characteristics of death in themodern world: (1) Death most oftenoccurs in the presence of powerfultechnology. (2) Death most often occursat a time, place, and manner outside ofone�s control.

Most people die in centers whereadvanced technologies capable ofprolonging life, and thus the dying

process, are available and often used. Ina clinical consultation at a universityteaching hospital, the question wasraised whether emergency dialysisshould be used for a patient who wasrefusing therapy. �Of course,� thedialysis team claimed, �that�s whatwe�re here for.� When the services areavailable and highly trained teams are onhand to initiate these efforts, it isvirtually assumed they will be used.This is also true for resuscitation effortsand a wide range of emergencymeasures. The modern hospital is wellequipped with a number of specialtyteams who are always on call to do allthey can to stave off inevitable death.

As a result, many persons now die ininstitutions under intensive care, at amuch older age, surrounded by animpressive battery of devices andmachines. Under these circumstances,dying takes much longer and costs farmore. Our technology may be capableof rescuing an individual from death butmay not be able to save the person fromexistence in a vegetative state with highsocial costs. Severely ill or injuredpersons are often stabilized in conditionsof permanent impairment, which raisesquestions about the long-range efficacyof these technological efforts.

Modern technology has forced us toreexamine the question, �When doesdeath occur?� This questioning has beenmade more urgent by economic andorgan transplant considerations. Theolder definitions of death: �when aphysician declares death,� or �whenheart and lung function cease,� have inrecent years yielded to the criterion ofcessation of brain function as thedecisive factor in determining death.The Harvard ad hoc committee�s

definition of irreversible coma (or somemodification thereof) has been widelyaccepted as the best objective standardby which to determine death and hasbeen adopted into legislative statutes andhospital policies.3

The great Puritan physician, SirThomas Browne, summarized the plightof modern society seeking both toassault death via biomedical skill and yetto retain the grace of acceptance, evenvictory, in the face of the inevitable.

With what shifts and pains we comeinto the world, we remember not; but�tis commonly found no easy matter toget out of it. Many have studied toexasperate the ways of Death, but fewerhours have been spent to soften thatnecessity.4

Many people today fear that they willlose control over their lives when theyapproach death; that things will be doneto them that they would not want; andthat they will not be given a choice toaccept or refuse contemplated therapies.This fear has given rise to twomovements in public policy that haveimport for our consideration of death anddying, particularly as the churchcontemplates its own policy and itscounsel to the secular society on theseissues. Some persons have signed a�living will.� This is a document thatattempts to clarify a person�s wishesabout time, manner, and condition of hisor her own death and what he or sheinsists not be done.5 It is limited in itsusefulness because of its lack ofspecificity. Various religious bodieshave formulated versions of a livingwill. The Roman Catholic affirmation oflife and Sissela Bok�s �PersonalDirections for Care at the End of Life�6

are more specific and thus are helpfulexamples. Both are included in the

appendix along with text examples fromthe Euthanasia Educational Council(name now changed to Concern ForDying).

The �living will� movement is bothtragic and encouraging. It is tragic inthat it is necessary. Individuals andfamilies should, under optimalconditions, have discussed these issuesfully and made their wishes clear tophysician, family, and designated agentsbefore the final days of life. In an earliertime, when one�s pastor, physician,lawyer, and mortician were personalfriends, these convictions could bevoiced and arrangements made, so thatformal documents were unnecessary.Now, one may die in unfamiliarsurroundings in the presence of strangerswhere one�s wishes are not known.People are therefore beginning to takeinitiatives so that guidance is given toloved ones in the event that he or shelapses into coma or in some other way isunable to control medical decisionsthrough personal consent. Thus, proxyjudgments can be made according to thepatient�s desires. This, of course,confronts the proxy with newresponsibility and burden as a maker ofmoral decisions.

An increasing number of states haveenacted in law �natural death acts.� Thistype of legislation seeks to give legalauthority to a person�s wishes and at thesame time protects health professionalsand institutions from litigation arisingout of an accusation that they failed todo all that could be done to prolong life.An interesting philosophical andtheological concept underlies these laws.They suggest that there are �natural� and�unnatural� ways to die and that ethicaland legal sanctions should apply to

safeguard persons from unnatural deathsand assure that their rights to �naturaldeaths� are sustained.

The experience of death has notchanged dramatically since the dawn ofhuman history. It is terrifying because itis either the end of everything, or it leadsto the unknown. In theological languageit portends salvation or damnation. To alarge measure death remains out ofhuman control. As Sissela Bok, theHarvard philosopher, has argued, it isnot the fear of being dead that bringsdread to modern people; it is the fear ofdying, fear of long and hard sufferingand pain, fear of losing contact withloved one, and fear of �physicaldebilitation, senility�the loss offreedom and the loss of knowing what�sgoing on.�7

How does theology reflect on thesedevelopments in the experience of deathand what ethical wisdom does thattheology present?

B. The Christian Theology of Life,Death, Eternal Life

We seek good deaths, natural deaths,explainable deaths in the same way thatthe ancients did. In his study ofprimitive cultures, Frazer shows that allpeople stand in awe of death, seek toavoid it, and propose all manner ofrationalizations and escapes from it.8

Death was sometimes likened to a dreamin which a person enters another world.Reverence for the dead is evident at theprehistoric burial sites in Africa, theNear East, and Europe. This reverencein part arose from the belief that the deadstill had contact with and could influencefor good or ill the lives of the living.

Whether death is seen as natural (a partof life) or unnatural (provoked by evilspirits) by primitive persons is disputedby the anthropologists. It is likely thatpeople from earliest times saw death asit is seen today�with a mixture ofemotions. On the one hand, it is natural,a part of life and inevitable. On theother hand, it is unnatural and anintrusion, an evil to be explained, aproblem to be solved. The earlyChristians were divided over thequestion whether death was part of theoriginal creation. Would our progenitorshave died even if they had not disobeyedGod? Or is immortality the primalnatural state? In some culturesinfanticide and senilicide are practiced inorder to hasten facilitate naturaldestruction. In other cultures childhoodand old age are revered and protectedfrom assault. The seeds of the modernimpulses of both accepting and fightingdeath seem to have existed since thebeginning.9

The Hebrews in biblical times began toreflect on death in a new way. Takingthese primitive precedents, they foundseveral explanations of the meaning ofdeath. On the one hand, death wasnatural. Death was the normal end oflife. When a human life, like a fruit, isfull grown, it is harvested (Job 5:25).�Full of years,� one is gathered to one�speople (Genesis 15:15). We are like thegrass that flourishes, then dies, our daysare a fragile breath that will soon be over(Psalm 39). In another understanding,life continues through the offspring intothe next generation. Thus, to die withoutchildren was to be completely dead.Also there is the question of the fullnessof one�s life. Jepthah�s daughter weptabout her unfulfilled maidenhood (Cf.Judges 11). The prophetic tradition

found a primal transgression as the rootcause of human death. Thus even at thisearly intuitional stage, death wasseparation from the source of life.

In the first tradition, death is merely thecessation of life. Vital power (nephesh)is exhausted from the body when breathleaves, and the body lapses intocorruption and impurity (Numbers 9:6).In the complementary tradition, death isa force controlled by God. Prematuredeath was seen as a punishment allowedby God but delivered by a hostile power.This strain in Hebrew thought becamethe basis of Paul�s doctrine that death isthe �sting� which is the just wage of sin(Romans 6:23).

Superseding both of these notions, inwhich death is seen either as natural oras evil, is the confidence that Godcontends against death with humanity.God snatches believers from the hand ofdeath (Psalm 18:6, 116:3). Godaccompanies persons in the valley ofdeath and allays their fears, sustainingthem forever (Psalm 23). God holdspower over death. For those who haveturned against God, death is theinstrument of isolation andcondemnation. For God�s own, death isan instrument of deliverance andsalvation. Thus the meaning of death,like the meaning of life, is determined bythe covenant relationship.

The essential Christian teaching thatbears on death is centered in the deathand resurrection of Christ. In Christ�scrucifixion, God has decisivelyconquered the powers and dominions ofthis world, especially the power of death(Acts 2:24, I Cor. 15:45-46, Rev. 6:8).The �last enemy,� whose fate is sealed inChrist�s atoning death, is death itself. In

its fellowship with the living Christ, theChristian community has already beentransported in anticipation to the otherside of death. New life in Christ, whichis resurrection, can look back at deathfrom beyond (Colossians 3:2, cf. Col. 2).The Gospel of John uses eternal life asboth experience and promise forChristians (Cf. John 5-6).

To set the stage for an ethical responseto the biomedical issues of dying anddeath, it is necessary to review brieflythe evolution of Christian thought aboutdeath and resurrection. Early Christiansbelieved, as did the Jews of the firstcentury A.D., that a universal bodilyresurrection of the dead was forthcomingin the messianic age. This beliefinformed their understanding of thedestiny of Jesus, then dead, now vital totheir faith. This resurrection belief wasfurther intensified by the experiencewith Jesus. The earliest Christian burialcustoms and tests, and the abandon withwhich first and second century discipleswent to their deaths, exemplify inbehavior their faith in bodilyresurrection. It is clear that the apostoliccommunity knew that Jesus, alive andpowerful, was with them. Theyexpected his imminent return, whichwould mark the final victory over thegrave. Thus, there was watchful waitingand a call to be faithful unto death.

In the first and second centuries a greatstruggle ensued over the manner andmeaning of Christ�s death andresurrection. Generally, HellenisticChristians, especially Gnostics,emphasized a spiritual resurrection andthe derivative doctrine of theimmortality of the soul, while JewishChristians ordinarily held a moreapocalyptic belief in the resurrection of

the body. These two ideas framed thetheology of human death in earlyChristian history and were crucial asindividual persons and the communitycame to terms with physical death.Oscar Cullmann writes:

Only he or she who apprehends with thefirst Christian the horror of death, whotakes death seriously as death, cancomprehend the Easter exultation of theprimitive Christian community.�Belief in the immortality of the soulis not belief in a revolutionary event.Immortality, in fact, is only a negativeassertion; the soul does not die, butsimply lives on. Resurrection is apositive assertion: The whole person,who has really died, is recalled to lifeby a new act of creation by God.Something has happened�a miracle ofcreation! For something has alsohappened previously, something fearful:Life formed by God has beendestroyed.10

The biomedical implications of thetheology of death and eternal lifereflected in contemporary theologiansare several: (1) We fight with Godagainst the power of death; (2) we hopefor a time in history when disease anduntimely death will be overcome; (3) weaccept death as a part of life experience;(4) we do not live under the dominion ofdeath but live toward the promise of life;(5) we trust the details to God; and (6) inlife and death we are with God.

C. The Ethics of Life and Death

Reformed theological ethics lift upseveral points about death that are moralissues of life and living.

(1) The direction of biblical ethics isagainst taking the life of another, evenfor benevolent reasons. Persons shouldnot be deemed worthless, too old, too

weak, unproductive, sociopathic, or aburden, thereby justifying some act ofpositive �mercy killing,� or the morefashionable slow killing by neglect.When persons fall into deep sickness,pain, suffering, unconsciousness; whenthey life helpless under deep sedation orat the brink of danger in intensive care,they must know that they will not beabandoned.

While the direction of biblical ethics isagainst taking the life of another, it in noway claims that it is necessary toprolong the life�or the dyingprocess�of a person who is gravely illwith little or no hope for cure orremission. Persons who are terminallyill must be able to trust that their dyingwill no be prolonged by unrequestedtechnological interventions. Astheologian Paul Ramsey has stated, �Weneed�to discover the moral limitsproperly surrounding offers to save life.We need to recover the meaning of onlycaring for the dying, and thejustification�indeed the obligation�ofintervening against many a medicalintervention that is possible today.�11

The existence of specific medicaltechnology does not require that it beused.

Admittedly, it is often difficult to knowor to acknowledge when a person isdying. It is equally difficult to stopaggressive, curative types of treatmentsand therapies or to say that ordinarytypes of therapy have becomeextraordinary. Sometimes the personwill know that he or she is dying, will tryto communicate that knowledge tofamily and caregivers who prefer not tohear and keep busy trying to cure, ratherthan sitting quietly by, showing care andconcern. Ramsey admonishes readers to

be aware of �the duty only to care for thedying, simply to comfort and companywith them, to be present to them.�12

(2) Most discussions of ethics in healthcare address the issue of autonomy (i.e.,a person�s right to make�or at leastparticipate in�decisions related to his orher own body), primarily whendiscussing death and dying. The popularclichés related to this issues are: �theright to die,� �death with dignity,� andthe �right to refuse treatment.�Although cases (Quinlan, Fox,Saikewicz) that have been prominent inthe mass media and that have focused onthese extraordinary issues are moredramatic than commonplace, they stillnecessitate a moral response. In apluralistic society where people havedifferent beliefs about life and death,basic Christian respect for personsdemands that a person�s decisions aboutdeath be honored in most instances.

The choice of whether or not toundergo further treatment, whether ornot to consent to experimental therapy,or to donate tissue should be a personaldecision. Since the atmosphere ofcritical care medicine is highly chargedwith values such as medical authority,vested interest, and patient submission,care should be taken by the physician toconverse freely and candidly with thepatient. The patient ought to know theoptions, the pros and cons of eachoption, the thoughts of the attendingclinicians, and then be encouraged tomake his or her own decision. This viewholds that it is unkind or unreasonable toinvite the patient into the debate overoptions (and that the physician knowsbest), and so the physician proceeds tomake proxy decisions for the patient.The second unfortunate course sets the

options and scenarios before the patientlike a computer. It gives theprobabilities and statistics and then says,�There you are, now decided!� Both ofthese approaches shrink from the painand reward of cooperative judgment.The best course is one that involvescoming to a thoughtful medicaljudgment, sharing this with the patient,reviewing the alternative courses, andinviting the patient�s response. Thetragedy of patient refusal�orthoughtless acceptance�of proceduresand the increased possibility of legalaction often arise from failures to respectthe patient�s humanity and enter intoresponsible dialogue with him or her.

Another variation on paternalisticdecision-making involves the externallyimposed judgment about a patient�squality of life. If a patient�s quality oflife is deemed unsuitable or intolerableby members of the health care team,treatment may be terminated�or notinitiated�and the patient allowed to die.This judgment about a person�s qualityof life made by someone other than thepatient is far different from anindividual�s making such a decisionabout his or her own life quality. Whilemembers of the health care professionsare called upon to make quality-of-lifedecisions at many levels�and it isunrealistic to deny that such decisionsare not necessary�a word of caution isin order to those who make suchdecisions and to all who may be patientsat some point in time. We must takegreat care not to denigrate the worth orlife of others and impose a judgment ofpoor quality that might providejustification for stopping treatment oravoiding the patient.

For the time being, given thecomplexity of the modern medicalcenter, the anonymity of doctor-patientrelationships, the tendency to do thingsto and for other people, and conflictinginterests, it is best to safeguardautonomy in medical decision-makingby whatever means. Patient reviewboards, hospital ethics committees,institutional review boards for researchprotocol, patient advocates, and a patientbill of rights all serve the function ofsafeguarding personal freedom. None ofthese can take the place, however, ofhonest, fair, and compassionate humanrelations and communication.

(3) The real, almost inevitable dangerof reducing human lives to statistics ormechanical processes must beacknowledged. The influences ofeconomic factors, often unspoken, loomlarge. The efforts to place economicvalues on patients� lives or determinehow many treatments an individualdeserves, while reprehensible,nonetheless occur. If medical care mustbe rationed (e.g., no dialysis after 60years of age), policies should be madefollowing public deliberation so thatthose affected will have had a chance toparticipate.

Impulses to quantify or stage theexperiences of moving toward death orbeyond death should be stifled. Thethought of nurses or others withhandbooks trying to assess whether thepatient is in the �denial� or �acceptance�stage of dying is frightening. To reducea person to a stage, a disease (�the ulcerin Room 210�), or a statistic is to wishthat person dead. The awesome mysteryand unpredictability of life and living, tosay nothing of an enduring respect for

persons, should be sustained in I-Thourather than I-It relations.

(4) There is the danger and temptationto idolize bodily life by making retentionof physical life the only good andprimary goal. Jesus touches this subjectwhen he says that �Whoever would savehis life shall lose it.� Too much effort todefend one�s own life, to bury it in a safeplace like the one-talent man, to refuseto give life away, or to fail to use it upgoes against the grain of Christiancalling. It is indeed idolatrous to try tokeep a person�s body alive no matterhow to empty that life may be. Humanbeings are transcendent creatures. Reallife comes from beyond bodily function.Jesus asks: �Is not life more than food,and body more than clothing?�(Matthew 6:25b). Often hospitals andmedical personnel are simply engaged ina contest to preserve �life,� with littleconcern for quality or expectation.Sometimes they win the battle, but thepatient loses. Clinging to life rather thanreaching out to life compounds thetragedy.

(5) The affirmation about eternal lifethat is woven into the Gospel accordingto John should be emphasized. Eternallife is here and now. According to theapostle Paul, the light of promise shinesin the present moment. Eternal life, notdeath, is the ultimate reality. Thatassurance keeps Christians from livingall of life being afraid of death. ForChristians the adventure is never towardan end but toward new beginnings.Elizabeth Kubler-Ross has written thatdeath is the final stage of growth; itwould be more appropriate to affirm thatdeath is another stage of becoming. ForChristians, death can be understood as

the next chapter in the surprising story oflife.

(6) Decision-making is never sure;deciders are seldom secure. Persons areambivalent about whether to approachdeath with dread or hope, whether toresist or to accept. Possibly thisambivalence comes from the built-inwill to live and the corresponding will todie. Whatever its origin, ambivalence iswoven into the fabric of being itself, anddecisions of life and death are met with akind of frustrating ambiguity. Since life-death decisions can rarely be made withcertainty, even when all the evidence isin, decisions must be made with humilityand with a posture of seeking God�sforgiveness and acceptance.

(7) Finally, the church is in the world tobe an example, not to impose values orbeliefs. By its life and its attitudetoward life, it can and should bearwitness to the faith. The church in thisarea, as in many others, must be thecommunity of care, protection, andnurture. In this way, the church can be amodel in a pluralistic society for howthese decisions ought to be made whilepreserving and enhancing human dignityand worth.

Decision-Making at the End-of-Life

1. Many members of the PresbyterianChurch (U.S.A.) will face health caredecisions toward the end-of-life thatthey could not have anticipated, andmany of those decisions will requirejudgments that relate to values held

by the patient. Therefore, the 195th

General Assembly (1983) calls uponits members to:

a. Select their physicians with regardnot only to the skillfulness of themedical care that they can providebut also for their values regardinghuman life and community,whenever such a choice is available.

b. Take time to reflect on their ownvalues and discuss these with familymembers, close friends, and theirclergy.

c. Speak with their physicians abouttheir concerns regarding care andbecome educated about theirconditions in order to permitinformed decision-making.

d. Provide instructions (and designatetwo agents to carry out instructions)with regard to extraordinarytherapies and treatments to prolonglife.

2. The church should be a place whereindividual and families can makeplans about death, manner of death,living wills, etc. Therefore, the 195th

General Assembly (1983) calls uponthe church to:

a. Request the Program Agency tomake available information andstudy tools for use by congregationsregarding options available at theend-of-life and means of informinghealth care professionals of thesewishes.

b. Hold seminars utilizing theaforementioned materials and

qualified resource persons wheneverpossible.

c. Advocate that human need andbenevolence replace the opportunismand exploitation that so oftensurround the death experiencepresently.

3. Harmony and integration should besought between intensive care,curative hospitals, and hospices sothat end-of-life care can be free fromjurisdictional conflict and thattherapeutic and palliative care areavailable to all.

Appendix A

Directions for My Care

I, _____________________, want toparticipate in my own medical care aslong as I am able. But I recognize thatan accident or illness may somedaymake me unable to do so. Should thiscome to be the case, this document isintended to direct those who makechoices on my behalf. I have prepared itwhile still legally competent and ofsound mind. If these instructions createa conflict with the desires of myrelatives, or with hospital policies orwith the principles of those providingmy care, I ask that my instructionsprevail, unless they are contrary toexisting law or would expose medicalpersonnel or the hospital to a substantialrisk of legal liability.

I wish to live a full and long life, butnot at all costs. If my death is near andcannot be avoided, and if I have lost theability to interact with others and haveno reasonable chance of regaining this

ability, or if my suffering is intense andirreversible, I do not want to have mylife prolonged. I would then ask not tobe subjected to surgery or resuscitation.Nor would I then wish to have lifesupport from mechanical ventilators,intensive care services, or other lifeprolonging procedures, including theadministration of antibiotics and bloodproducts. I would wish, rather, to havecare that gives comfort and support,which facilitates my interaction withothers to the extent that this is possible,and which brings peace.

In order to carry out these instructionsand to interpret them, I authorize_________________, to accept, plan andrefuse treatment on my behalf incooperation with attending physiciansand health personnel. This personknows how I value the experience ofliving, and how I would weighincompetence, suffering, and dying.Should it be impossible to reach thisperson, I authorize _________________to make such choices for me. I havediscussed my desires concerningterminal care with them, and I trust theirjudgment on my behalf.

In addition, I have discussed with themthe following specific instructionsregarding my care:

(Please continue on back.)

Date ______________

Signed ____________________

Witnessed by _____________________and _____________________

(Source: Sissela Bok, �PersonalDirections for Care at the End-of-Life,�

New England Journal of Medicine 295(August 12, 1976), 367-369.)

Appendix B

Christian Affirmation of Life[1]

To my family, friends, physician,lawyer, and clergyman:

I believe that each individual person iscreated by God our Father in love andthat God retains a loving relationship toeach person throughout human life andeternity.

I believe that Jesus Christ, lived,suffered, and died for me and that hissuffering, death, and resurrectionprefigure and make possible the death-resurrection process which I nowanticipate.

I believe that each person�s worth anddignity derives from the relationship oflove in Christ that God has for eachindividual person and not from one�susefulness or effectiveness in society.

I believe that God our Father hasentrusted to me a shared dominion withhim over my earthly existence so that Iam bound to use ordinary means topreserve my life but I am free to refuseextraordinary means to prolong my life.

I believe that through death life is nottaken away but merely changed, andthough I may experience fear, suffering,and sorrow, by the grace of the HolySpirit, I hope to accept death as a freehuman act which enables me tosurrender this life and to be united withGod for eternity.

Because of my belief:

I request that I be informed as deathapproaches so that I may continue toprepare for the full encounter of Christthrough the help of the Sacraments andthe consolation and prayers of my familyand friends.

I request that, if possible, I be consultedconcerning the medical procedures thatmight be used to prolong my life asdeath approaches. If I can no longertake part in decisions concerning myown future, and there is no reasonableexpectation of my recovery fromphysical and mental disability, I requestthat no extraordinary means be used toprolong my life.

I request, though I wish to join mysuffering to the suffering of Jesus so Imay be united fully with him in the actof death-resurrection, that my pain, ifunbearable, be alleviated. However, nomeans should be used with the intentionof shortening my life.

I request, because I am a sinner and inneed of reconciliation and because myfaith, hope, and love may not overcomeall fear and doubt, that my family,friends and the whole Christiancommunity join me in prayer andmortification as I prepare for the greatpersonal act of dying.

Finally, I request that after my death,my family, my friends, and the wholeChristian community pray for me andrejoice with me because of the mercyand love of the Trinity, with whom Ihope to be united for all eternity.

Signed _______________________

Date _________________

Appendix C

A Living Will

To My Family, My Physician, MyLawyer, My Clergyman: To AnyMedical Faculty In Whose Care IHappen To Be; To Any Individual WhoMay Become Responsible For MyHealth, Welfare, Or Affairs:

Death is as much a reality as birth,growth, maturity, and old age�it is theone certainty of life. If the time comeswhen I ___________________ can nolonger take part in decisions for my ownfuture, let this statement stand as anexpression of my wishes, while I am stillof sound mind.

If the situation should arise in whichthere is no reasonable expectation of myrecovery from physical or mentaldisability, I request that I be allowed todie and not be kept alive by artificialmeans or �heroic measures.� I do notfear death itself as much as theindignities of deterioration, dependency,and hopeless pain. I, therefore, ask thatmedication be mercifully administered tome to alleviate suffering even thoughthis may hasten the moment of death.

This request is made after carefulconsideration. I hope you who care forme will feel morally bound to follow itsmandate. I recognize that this appears toplace a heavy responsibility upon you,but it is with the intention of relievingyou of such responsibility and of placingit upon myself in accordance with mystrong convictions, that this statement ismade.

Signed ____________________

Date _______________

Witness ____________________

Witness ____________________

Copies of this request have been given to

______________________

______________________

______________________

______________________

Appendix D

Form or Declaration under theVoluntary Euthanasia Act 1969

Declaration made _______

[and re-executed _______]

by ___________________________

of ___________________________

I DECLARE that I subscribe to thecode set out under the following articles:

A. If I should at any time suffer from aserious physical illness orimpairment reasonably thought inmy case to be incurable andexpected to cause me severedistress or render me incapable ofrational existence, I request theadministration of euthanasia at atime or in circumstances to beindicated or specified by me or, if itis apparent that I have become

incapable of giving directions, atthe discretion of the physician incharge of my case.

B. In the event of my suffering fromany of the conditions specifiedabove, I request that no active stepsshould be taken, and in particularthat no resuscitatory techniques beused, to prolong my life or restoreme to consciousness.

C. This declaration is to remain inforce unless I revoke it, which Imay do at any time, and any requestI may make concerning action to betaken or withheld in connectionwith this declaration will be madewithout further formalities.

I WISH it to be understood that I haveconfidence in the good faith of myrelatives and physicians, and feardegeneration and indignity far more thatI fear premature death. I ask andauthorize the physician in charge of mycase to bear these statements in mindwhen considering what my wisheswould be in any uncertain situation.SIGNED ______________________[SIGNED ON RE-EXECUTION]

WE TESTIFY that the above-nameddeclarant [2][signed][2][was unable towrite but assented to] this declaration inour presence, and appeared to appreciateits significance. We do not know of anypressure being brought on him to make adeclaration, and we believe it is made byhis own wish. Insofar as we are aware,we are entitled to attest this declarationand do not stand to benefit by the deathof the declarant.

Signed by _____________________ of_______________________

Signed by _____________________ of_______________________

[Signed by _____________________ of_______________________ on re-execution]

[Signed by _____________________ of_______________________ on re-execution]

ENDNOTES:

Chapter 5: Decision-making at the End-of-Life

1 �Boy Needs �Signs,� Makes Choice toDie,� Chicago Tribune, Thursday, June 22,1982, p. 1.2 �Her Choice: Don�t Give in to Death,�Chicago Tribune, Friday, July 30, p. 4., Sec.1.3 �A Definition of Irreversible Coma,�Journal of the American MedicalAssociation, 205, No. 6, August 5, 1968, pp.85-88.4 Sir Thomas Browne, Christian Morals,Part II, Sec. XII, Works IV, ed. S. Wilkon,London: William Pickering, 1835, p. 170.5 See versions of �Living Wills� in KennethVaux, Will to Live/will to Die, Minneapolis:Augsburg Press, 1978; Marvin Kohl, ed.Beneficent Euthanasia, Buffalo, NY:Prometheus Books, 1975; �Death,�Encyclopedia of Bioethics, New York:Macmillan Free Press, Vol. 1, 1978, p. 221.6 Sissela Bok, �Personal Directions for Careat the End-of-Life,� New England Journal ofMedicine, 295:7, August 12, 1976, pp. 367-369.7 Sissela Bok in �Death and Dying,� HardChoices, produced by KCTS/9, Seattle,Washington, p. 4.8 James George Frazer, The Belief inImmortality and the Worship of the Dead, 3Vols., London: MacMillan, 1913-1922.9 �Death: An Anthropological Perspective,�The Encyclopedia of Bioethics, op. cit. pp.225ff.

10 Oscar Cullman, �Immortality of the Soulor Resurrection of the Dead?,� inImmortality and Resurrection, ed. KristerStendalh, New York: MacMillan, 1965, pp.26-27.11 Paul Ramsey, The Patient as Person, NewHaven and London: Yale University Press,1970, p. 118.12 Ibid., p. 125.

APPENDIX 4A Commitment to Caring

God�s compassion toward humanity isshown in Scripture, in the history of thechurch, and most specifically in theperson and message of Christ Jesus.Although people seek to live forthemselves alone, God continually actsto set people free from selfishness,calling them into a community offaithful discipleship, and directing themtoward particular ministries of caring.

Responding to God�s compassion andguided by the Holy Spirit, the churchseeks to become an intentionalcommunity of caring to represent morefully the living Christ in faith andpractice. For this reason, the session of____________________ Church nowcommits itself to a covenant of caring.In fulfilling this commitment, we willengage in ministries of caring through:

WORSHIP�providing worship thatconveys the reality of God�s compassionto our congregation.

PRAYER AND BIBLESTUDY�encouraging members of ourcongregation to accept God�scompassion in their own lives and, bydaily prayer and openness to Scripture,to seek God�s compassion for today�sworld.

EDUCATION FOR CHILDREN,YOUTH, AND ADULTS�givingmembers of the congregation means tohelp them grow as caring persons intheir homes, their church, and theircommunity.

SERVICE�holding before thecongregation an urgency to work for

compassion in the public arena: toconfront apathy, insolation, and themarginalization of children, the poor, thehungry, the stranger, the homeless, thechronically and terminally ill, theprisoner, and others in need of care,knowing that even as we serve them, weserve the Lord Jesus. (Matthew 25:31ff.)

RECONCILIATION�demonstratingin our individual and corporate lives alove that is genuine, an abhorrence ofevil, a zeal for service, a joyfulhopefulness, patience in adversity, aconstancy in prayer, a generosity towardothers, and hospitality for all, so that themany may become one. (Romans12:9ff.)

ADVOCACY�standing with and forthose who cannot speak for themselves,as advocates of compassion in theirlives, to be a prophetic witness forremoving economic, social, andstructural obstacles to care in society,including care at the end-of-life.

RESPONSIBILITY�involving thecongregation in one or more acts ofcaring, such as: member-to-membercare-giving (e.g., Stephen Ministry);support for in-home health care (e.g.,hospice); establishing parish nurseprogram; organizing a bereavementcommittee; housing and/or supporting ahealth clinic; caring for, supporting,nurturing, and empowering professionaland volunteer care-givers.

The session will lead and support thecongregation in this caring response toGod�s compassion for us.

Moderator of Session, ______________

Date ____________________________

Clerk of Session, __________________

Date ____________________________

1. What is the Commitment toCaring?

The Commitment to Caring is a wayfor the session to state the intention thatthe church shall engage in a ministryfocused upon caring.

2. What value does making aCommitment to Caring hold for ourcongregation?

a. It may help a church grow in itsvision and understanding ofcompassion, until caring is aninherent part of the church�s life.

b. It offers members a pattern forplanning providing care in thecongregation. The Commitment toCaring implies that caring can be acomponent of much of the church�sministry, including worship, prayer,Bible study, education, and service,and acts of reconciliation,advocacy, and responsibility.

c. It gives direction to the churchleaders as they plan for the future.

d. It serves as a witness to others, bothmembers of the church and thelarger community, that an essentialcomponent of being Christian is tocare for others.

e. It offers a series of guidelines forassessing the church�s caringefforts.

f. It can become a vehicle fornetworking the ministries of care ofdifferent churches.

g. It can offer a congregation newenergy and initiative.

3. Does a congregation have to dosomething in all seven areas of theCommitment to Caring at one time?

No. Most congregations will seek totarget several areas initially. They mayalso find that they are already engaged incaring efforts in a number of these areas.It is hoped that eventually a congregationwill choose to be involved in all sevenareas. By adopting the Commitment toCaring, a congregation states its intent tobecome involved in all seven areas at apace consistent with its own resourcesand abilities.

4. What prompted the Commitment toCaring?

Since 1990, at the direction of GeneralAssembly, the Offices of Theology andWorship have been engaged inproducing a study guide for pastors andchurches about end-of-life issues,including euthanasia and assistedsuicide. As the task force met over thecourse of a year to plan this studydocument, it came to believe that theseissues are part of a much larger concern,that is, that our churches becomeintentional communities of caring. Inorder to highlight this need, theCommitment to Caring was created.

5. Caring has always been animportant aspect of the life of ourchurch. Why should our congregationmake such a commitment now?

Even though the church may assume itis caring community, a Commitment toCaring moves the congregation beyondassumptions to actions. By taking thesteps to adopt and then highlight theCommitment to Caring, a congregationmakes specific and intentional what mayhave been unspecified and haphazard inits approach to compassionate ministryin the name of Christ.

6. May we rewrite the Commitmentto Caring to make it more appropriate toour church�s vision of caring?

Certainly. It is expected and likely thatmany congregation will use theCommitment to Caring as is, but it isalso offered as a guideline for churchesto consider and to tailor to suit their owncircumstances and needs.

7. Why should the session be the bodyto agree to the �Commitment toCaring�?

Because according to our Presbyterianform of government the session is theprimary body of leadership in acongregation. Elders who have beenchosen, elected, ordained, and installedto direct the church have the properauthority to implement a new initiativesuch as is described in the Commitmentto Caring.

8. How might a session decide to adoptthe Commitment to Caring?

It could be presented by the clerk,moderator, or any session committee fora first reading and further study. Then, itwould probably be discussed at thefollowing meeting of session. Membersof session might be asked to note areasof the Commitment to Caring in whichthe congregation is already engaged.

9. Is there help available to ourcongregation as we inaugurate ourCommitment to Caring?

Yes. The study guide on euthanasia,assisted suicide, and end-of-life issuesaddresses many of the themes of theCommitment to Caring. For other,helpful resources, see the bibliography(Appendix 5).

APPENDIX 5Selected Bibliography

These are resources in addition to onespreviously listed. Choosing Death alsohas an excellent bibliography.

�Are Your Affairs in Order? APlanning Guide and Resource Book�(available from Bryn Mawr PresbyterianChurch, Bryn Mawr, PA, 19010).

A helpful, practical guide to puttingone�s affairs into order (includingfinancial, medical, and funeralplanning), so that one�s wishes foroneself and for others can best berespected when death comes.

Joseph E. Beltran, The Living Will (andOther Life and Death Medical Choices)(Thomas Nelson Publishers, 1994)/

A helpful, practical guide for individualswishing to make responsible medicalchoices for themselves. Medical, legal,and theological issues are considered.

Dan W. Brock, �Voluntary ActiveEuthanasia,� The Hastings CenterReport (March-April 1992): 10-22.

A thoughtful assessment of argumentsfor and against euthanasia. While theauthor argues for the possibility ofeuthanasia and assisted suicide, hedemonstrates the complexity of theissue.

Baruch Brody, ed., Suicide andEuthanasia: Historical andContemporary Themes (KluwerAcademic Publishers, 1989).

An important set of essays, providing anoverview of historical and contemporaryperspectives on the topic.

Howard Brody, �Care of theHopelessly Ill: Proposed ClinicalCriteria for Physician-Assisted Suicide,�New England Journal of Medicine(November 5, 1992): 1380-1388.

A significant article in the discussion ofassisted suicide.

Daniel Callahan, The Troubled Dreamof Life: Living with Mortality (Simonand Schuster, 1993).

An important investigation of whatconstitutes a life fully-lived. While theauthor opposes euthanasia, he raisesprovocative questions about how far weshould go in sustaining life in the face ofdeath.

Daniel Callahan, Gilbert Meilander,Christine Whitbeck, William Smith, M.Therese Lysaught, William May, andEric Cassell, �The Sanctity of LifeSeduced: A Symposium on MedicalEthics,� First Things (April 1994): 13-27.

A fine discussion centering on death anddying, euthanasia, religion, and publicpolicy. Virtually all points of view areexpressed.

Courtney S. Campbell, �ReligiousEthics and Active Euthanasia in aPluralistic Society,� Kennedy Institute ofEthics Journal (September 1992): 253-277.

A survey of various religious anddenominational perspectives oneuthanasia, with particular attention tothemes of sovereignty, stewardship, andthe self.

Eric J. Cassell, �RecognizingSuffering,� The Hastings Center Report(May-June 1991): 24-31.

An important essay on the nature ofsuffering, and on how we become awareof another�s suffering and moresensitive to it. Also, see his book TheNature of Suffering (Oxford, 1991).

Ezekiel J. Emanuel, �Euthanasia:Historical, Ethical and EmpiricPerspectives,� Archives of InternalMedicine (September 12, 1994): 1890-1901.

A clear historical and ethical approachto the issue, written for thenonspecialist. It is a valuable generalintroduction.

Stanley Hauerwas, Naming theSilences: God, Medicine, and theProblem of Suffering (Eerdmans, 1990).

A provocative set of reflections on thedistinctive character of the Christiancommunity, including its ability in faithto protest suffering.

Herbert Hendin and Gerald Klerman,�Physician Assisted Suicide: TheDangers of Legalization,� AmericanJournal of Psychiatry (January 1993):143-145.

A psychiatric perspective. The authorsargue that the majority of personsrequesting euthanasia or assistance indying are suffering from treatable formsof depression.

Leon R. Kass, �Is There a Right toDie?,� The Hastings Center Report(January-February 1993): 34-43.

An argument that there is no firmphilosophical or legal argument for a�right to die.� To speak of rights in thevery troubling matter of medicallymanaged death is ill suited both to soundpersonal decision-making and tosensible public policy.

Gilbert Meilander, �I Want to BurdenMy Loved Ones,� First Things (October1991): 12-14.

A provocative essay on Christianresponsibility in the face of sufferingand dying. The author argues for theimportance of our bearing each other�sburdens. Also, see relevant chapters inthe author�s book The Limits of Love:Some Theological Explorations(Pennsylvania State University Press,1987).

J.P. Moreland and David M. Ciocchi,Christian Perspectives on Being Human(Baker Book House, 1993).

Readily accessible to a lay audience.The author expresses a fairly traditionalevangelical point of view. Seeespecially Chapter 8, �Views of HumanNature at the Edge of Life.�

Timothy E. Quill, �Death and Dignity:A Case of Individualized Decision

Making,� New England Journal ofMedicine (March 7, 1991): 691-694.

An important and controversial essay.Quill relates a personal experience andargues for the right of physicians toassist patients in dying.

Response Form for Study on Euthanasia, Assisted Suicide, andEnd-of-Life Decisions

Your comments will help the Office of Theology determine whether to take additionalsteps to address issues relating to euthanasia, assisted suicide, and end-of-life decisions.A summary of responses will be shared with the General Assembly and GeneralAssembly Council.

Please type or print, and return to the address at the end of the form. Many thanks foryour participation and response.

PART I.

1. Name of Congregation (or if not congregationally based, a description of your studygroup): ____________________________________________________________

__________________________________________________________________

2. Location: ____________________________________________________________

3. Number of Study Sessions: ______________________________________________

4. Approximate Time Per Study Session: _____________________________________

5. Average Number of Participants Per Session: _______________________________

6. Name, Address, and Phone Number of a Contact Person: ______________________

____________________________________________________________________

____________________________________________________________________

PART II.

7. What were the high points of the study, and why? ___________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

8. What key questions or concerns emerged? __________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

9. Did you use the background book, Choosing Death: Active Euthanasia, Religion,and the Public Debate (ed. Ron Hamel)? (Circle one) Yes No

10. How did you feel about the subject of euthanasia/assisted suicide at the beginning ofthe study? (Choose one.)

a. I could contemplate it for myself and could support the legalization ofeuthanasia/assisted suicide, with certain safeguards.

b. I could not contemplate it for myself but could support the legalization ofeuthanasia/assisted suicide, with certain safeguards.

c. I believed that euthanasia/assisted suicide is wrong under all or almost allcircumstances but should be legalized, with certain safeguards.

d. I believed that euthanasia/assisted suicide is wrong under all almost allcircumstances and should not be legalized.

e. I had not given the subject much thought, or I had no opinion.

11. How do you feel about the subject of euthanasia/assisted suicide now, at the end ofthe study? (Choose one.)

a. I can contemplate it for myself and can support the legalization ofeuthanasia/assisted suicide, with certain safeguards.

b. I cannot contemplate it for myself but can support the legalization ofeuthanasia/assisted suicide, with certain safeguards.

c. I believe that euthanasia/assisted suicide is wrong under all or almost allcircumstances but should be legalized, with certain safeguards.

d. I believe that euthanasia/assisted suicide is wrong under all or almost allcircumstances and should not be legalized.

e. I have no opinion.

12. Should the General Assembly of the Presbyterian Church (U.S.A.) take a stand onthe legalization of euthanasia/assisted suicide?

a. Yes, for this reason: _______________________________________________

________________________________________________________________

________________________________________________________________

b. No, for this reason: _______________________________________________

________________________________________________________________

________________________________________________________________

c. I don�t know, here�s why: __________________________________________

________________________________________________________________

________________________________________________________________

13. If you answered �Yes� to Question 12, please answer the following:

What stand should the General Assembly take? __________________________

________________________________________________________________

________________________________________________________________

14. In your opinion, how important is it that the church does each of the following, inresponse to the public discussion of euthanasia/assisted suicide? (Answer each ofthe following.)

veryimportant

important somewhatimportant

not veryimportant

don�tknow/ noopinion

a. promote hospice care,both by offeringfinancial support tohospice programs andby making peoplemore aware of hospiceservices

b. work to ensure that allpeople have access tosufficient health care

c. work to ensure thatdoctors receive bettertraining in painmanagement

d. work to ensure thatthe church reaches outto people whoexperience isolation orfear as they facesuffering and/or dying

e. help to resolve�oneway or the other�theissue of whether or noteuthanasia/assistedsuicide should belegalized

PART IV.

Any other comments that you would like to direct to the Office of Theology andWorship:______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

PART V.

Results will be tabulated and shared with the General Assembly and the GeneralAssembly Council. If you wish to receive a copy of the results, please check here ( ___ )and provide your name and address if different from the contact person listed in Part I:

(Please print.)

Name: _________________________________________________________________

Address: _______________________________________________________________

______________________________________________________________________

Please send response form to: Charles Wiley, Office of Theology and Worship,Presbyterian Church (U.S.A.), 100 Witherspoon St., Louisville, KY 40202, phone: 502-569-5734.

Limited Reproduction Rights Granted · the book Choosing Death: Active Euthanasia,Religion, and the...

Documents

Transcript of Limited Reproduction Rights Granted · the book Choosing Death: Active Euthanasia,Religion, and the...