February 01, 2016
By Christopher Bogosh
In November of 2014, Brittany Maynard revived debates on the national scene about a person’s right to end suffering via physician-assisted suicide, in so doing she became the poster child for the right-to-die advocacy group Compassion & Choices and was the inspiration behind the assisted suicide bill recently passed in California. The twenty-nine year old suffered from a brain-tumor resistant to treatment. After doctors gave her a six-month prognosis, Maynard desired to end her suffering by committing suicide but, at the time, in her home state of California physician-assisted suicide was illegal, so Maynard moved to nearby Oregon where it was not. On November 1, Maynard ingested a lethal dose of a medication prescribed by her doctor, Compassion & Choices praised her actions, and legislators in California passed the Aid in Dying bill.
Compassion & Choices is a non-profit organization in Denver, Colorado, seeking to advocate for and expand choices for those with a terminal illness. The group has 400,000 plus supporters and with a recent victory in California’s Aid in Dying bill connected to publicity from Maynard, Compassion & Choices reports that “momentum is at an all-time high.” While Compassion & Choices provides several services for those facing a terminal illness, its most vigorous advocacy is at the state and federal levels where the group promotes laws permitting self-determined euthanasia. Compassion & Choices does so under the banner of compassion, believing that one of the best ways to ameliorate suffering connected to a terminal illness is to control it by ending life.
This seems compassionate—mercy killing. In fact, about 70 percent of the American population believes physician-assisted suicide should be a choice for terminally ill people. After all, the argument goes, they are suffering and they are going to die anyways, why not allow them the choice to end their misery in a clean and painless way? The arguments for “Physician Aid-in-Dying” in medical institutions usually stem from a person’s right to refuse life-sustaining treatment and to receive medication to treat suffering that may have the untoward effect of hastening death. If a terminally ill person has the right to refuse treatment and has the potential to cause death by aggressive pain management, argue pro-choice medical providers, then why not permit the right to commit suicide in a prescribed manner? While all of this seems compassionate to the world, for the Christian desiring to love God and his or her neighbor, it is not a compassionate answer to suffering at all.
Suffering as a Vocation
The question is not will I suffer and die; it is how will I suffer and when will I die? According to Holy Scripture, Adam’s self-autonomy and sovereignty invited suffering and death into the world (Gen. 3; Rom. 5:12). Thus, suffering and death are inevitable. Further, Scripture also teaches that ultimately, suffering and death are not physical problems with naturalistic solutions, but they are spiritual aberrations with physical manifestations requiring the suffering, death, resurrection, and second coming of the Second Adam to fix (Rom. 5; 1 Cor. 15)—a supernatural-incarnational-redemptive solution. In a Christian worldview, committing suicide to eliminate suffering misunderstands the cause of suffering and death and it repudiates their answer. For the Christian, suffering and death take on their fullest meaning in the Second Adam, “who for the joy that was set before him endured the cross,” and who succeeded where the first Adam had failed (Heb. 12:2; Rev. 2:7).
A teaching largely lost in the Church today is suffering as a vocation, which is tied to cross bearing (Matt. 16:24). This is a tough concept for some Christians, especially those embracing the idea that the less we suffer the happier we will be. By suffering as a vocation, I do not mean acts of self-mutilation or enduring excruciating pain without treating it. What I mean is persevering in the midst of suffering as one looks to the Second Adam and seeks to follow him and his example in loving obedience. For example, a Christian diagnosed with a terminal illness in excruciating pain will not seek relief by committing suicide but will seek to persevere like Jesus to love God and others in the midst of suffering.
The Monastics have a large body of literature about suffering as a vocation. According to them, suffering, if correctly understood and applied, will humbles us, motivate us to find persevering strength in the means of grace, and cause us to exercise love toward others to address it. Suffering is a painful reminder of the havoc our self-autonomy and sovereignty brought into the world, so we should not rejoice in them. Suffering forces us to look away from ourselves and to Christ and his suffering on our behalf to receive grace from the Word, sacraments, and prayer in order to rid ourselves of self-autonomy and sovereignty and to experience selfless love. According to the Monastics, we truly experience God’s love when we forget about our personal suffering, and when we give ourselves to others to suffer vicariously on their behalf, whether through intercessory prayer, giving, or practical acts of mercy. This is the teaching of the Monastics on suffering as a vocation, and it is the clear example of Jesus in the midst of his suffering (cf. Phil. 2:1–8).
The idea of suffering embraced by Compassion & Choices and the pro-suicide states of Oregon, Washington, Vermont, and California is akin to Stoic philosophy. Stoics believed the meaningful life was one free from “passion.” By passion, among other things, they meant suffering. Thus, the goal was to pursue what they saw as the passionless life which was the rational life, and when the passion of suffering prevented this goal, suicide was one of the answers they turned to. Stoicism runs into a contradiction at this point, however. The motivation to escape suffering is rooted in the passion caused by suffering and this is a violation of reason. It is not rational to terminate suffering by committing suicide because reason does not motivate the decision, suffering does, and this is irrational and unreasonable. Thus, it is impossible to make a rational choice if suffering directs it, so this does not meet the standard of “mentally capable” that Compassion & Choices adheres to, and pro-suicide states require as a criterion to use physician assistance to commit suicide.
The following is also worth mentioning. According to the University of Washington School of Medicine, in order for “Physician Aid-in-Dying” to occur in that state, a doctor needs to “evaluate for depression or other psychiatric conditions” before teaming up with the suicidal person to assist in developing a plan. Statistics in the United States indicate that 90 percent of the people who commit suicide actually have an underlying mental disorder. In a 2002 article, “Contact with Mental Health and Primary Care Providers before Suicide: a Review of the Evidence,” in the American Journal of Psychiatry, found that 45 percent of those who committed suicide were examined by medical providers within thirty days of the event. Further, in a 1997 article from the New England Journal of Medicine, “Psychiatry and Assisted Suicide in the United States,” psychiatrists specializing in mental conditions concluded that one session, even with a psychiatrist, would not be enough to determine if an underlying mental condition was driving the decision for a terminally ill person to commit suicide. All of this shows that a large percentage of those committing suicide have psychiatric problems; are not adequately screened; and cannot possibly be cleared of an underlying mental condition during one evaluation, even by a psychiatrist. In all cases, people commit suicide because suffering in life has become too much to bear. Terminally ill or not this is not rational or “mentally capable” thinking, it is suicidal thinking with an ideation, plan, and, now, a willing professional accomplice.
Suicide in the Bible
There are six episodes of suicide mentioned in Scripture: Abimelech (Judges 9:54), Saul (1 Sam. 31:1–4), Saul’s armor-bearer (1 Sam. 31:5), Ahithophel (2 Sam. 17:23), Zimri (1 Kings 16:18), and Judas Iscariot (Matt. 27:3–5; Acts 1:18–20). A woman dropped a millstone from a wall onto Abimelech’s head, still alive but suffering and ashamed; he requests the assistance of a solider to kill him. After a major defeat by the Philistines, Saul falls on his spear and is unsuccessful in committing suicide. With his spear protruding from his back, he looks to his aide, and instructs him to finish the job. The aide assists in Saul’s suicide and commits suicide himself. Ahithophel sides with Absalom in the rebellion against King David. After giving counsel to Absalom on how to defeat David, Absalom rejects it. Anticipating doom, Ahithophel sets his house in order and hangs himself. Zimri, a rebel chariot commander murders his king, usurps the throne, and after an uprising against him, he burns himself alive in the palace he stole from the king. Judas Iscariot turns Jesus over to the authorities for thirty silver coins. After leading the soldiers to Jesus and marking him with a kiss of greeting, guilt floods his soul. Judas hangs himself. Samson is often included the list of those who committed suicide in the Bible (Judges 16:28–31), but technically he did not commit suicide. He was fighting the Lord’s enemies. Although Samson was a rebel most of his life (see Judges 13—16), at the end of it he was a hero. He makes the ultimate sacrifice fighting against the Philistines, which is why the writer of Hebrews mentions him among the heroes of faith (Heb. 11:32). Samson prayed, “O Lord LORD, please remember me and please strengthen me only this once, O God, that I may be avenged on the Philistines for my two eyes” (Judges 16:28, ESV). God answers Samson’s prayer. He receives supernatural strength, he pushes the support pillars apart in the pagan temple, and the roof crashes down on him and the Philistines. Unlike the other biblical characters mentioned that committed suicide to escape suffering, whether do to excruciating pain, shame, potential for exploitation, or overwhelming guilt, Samson persevered in the midst of suffering and sought to honor God by fighting against his enemies.
The Doctrine of Double Effect
The account with Samson illustrates an important concept for Christians when seeking to address suffering—the doctrine of double effect. Thomas Aquinas most famously articulated this principle, which essentially says, an action may have the side effect of causing harm to others or ourselves but the act itself seeks to accomplish a higher purpose. For Samson this was vengeance in the name of God upon his enemies and the side effect was his death. The higher purpose in a Christian worldview is to love God, first, and one’s neighbor, second (Deut. 6:5; Matt. 22:37–39). Forever mindful of St. Paul’s words, “For if we live, we live to the Lord; and if we die, we die to the Lord . . . whether we live or die, we are the Lord’s” (Rom. 14:8, NKJ).
God condemns suicide because it is an unloving act toward him. It is seeking to control and destroy the life he created and governs, and it is a deep disrespect for his image. According to the sixth commandment (Exo. 20:13), it is wrong to murder a human being (suicide is a type of self-murder). More than this, human life has even greater value than other forms of life because it bears God’s image (Gen. 9:6). If a person in his or her “right mind” has the audacity to murder the image of God then, according to God, he or she deserves to die, not only in this life, but also ad infinitum (Dan. 12:2–3; Matt. 18:50; 25:46; Mark 9:48; John 5:28; Rev.2:11; 14:10; 20:6, 14–15; 21:8). Love for God requires that we respect the life he created, honor his image stamped upon it, and follow his revealed will to govern it.
Throughout the Bible and church history, there is no principle more highly evident than living life in obedience to the revealed will of God, even at the cost of great suffering and death. This is what it means to love God with all of one’s heart, soul, mind, strength, and being. Christian martyrs illustrate this principle, and, of course, the example par excellence is Jesus Christ. While the Bible condemns suicide as a solution to end life, it also censures the pursuit of treatment at all costs to prolong it (see Bogosh, C. Compassionate Jesus: Rethinking the Christian’s Approach to Modern Medicine. Grand Rapids: Reformation Heritage Books, 2013). Self-autonomy and human sovereignty govern both of these choices. Vertical love requires that all decisions conform to principles in line with the revealed will of God, and fundamental to this is loving one’s neighbor—horizontal love.
I noted above the principle “suffering as a vocation” and I said that this has for its end the experience of God’s love. Thus, I wrote, “we truly experience God’s love, when we forget about our personal suffering, and when we give ourselves to others to suffer vicariously on their behalf, whether through intercessory prayer, giving, or practical acts of mercy.” Suffering vicariously means bearing the burden of others (Gal. 6:2). When it is not about us, our suffering, our self-determining powers, then it is about others, especially those close to us. This is the experience of God’s love in us and it is the expression of it to others.
Loving horizontally may mean taking and giving medication to manage suffering, even though there are potential risks involved. This focuses on the higher purpose of compassion (Pro. 31:6). It may also mean treatment with awful side effects to prolong a life of misery, in order to help a spouse or child come to terms with a terminal diagnosis and impending death. On the other hand, in order not to burden loved ones financially or with ongoing care needs, loving horizontally may mean refusing treatment so that others do not suffer because of our decision to try to prolong life. Whatever the case may be, loving horizontally is not about us—our lives, our suffering, our terminal condition—it is about experiencing God’s love and communicating his selfless to others.
Loving horizontally most definitely means warning the world about God’s view of physician-assisted suicide—he hates it. Committing suicide does not respect the life he created, honor the image he stamped upon it, and it challenges his right to govern it. Of the four state bills in America legalizing physician-assisted suicide, the title to the one in Vermont should be the most offensive to Christians, “Patient Choice and Control at End of Life Act.” Self-determined choice and control—these terms are completely antithetical to Christianity! Self-autonomy and human sovereignty are the culprits behind suffering and death in the world, not their answer. The only way ultimately to escape suffering and death is to renounce self-autonomy and sovereignty; to embrace Jesus Christ by faith and his victory over them; and to experience God’s love in the midst of them. Loving horizontally for the Christian means speaking this message in love, especially to those suffering with a terminal illness and contemplating suicide—there is compassion and there is a choice for those suffering with a terminal condition, it just not with Compassion & Choices and death-dealing doctors.
Almighty God, who hast created man in thine own image;
Grant us grace fearlessly to contend against evil. Amen.
By Christopher W. Bogosh
Informing, transforming, and reforming medical care