Ethics: Aid in Dying

By Victor Lee Austin

The term “aid in dying” refers to assisted suicide, and legally often refers to a physician being able to prescribe upon request, without prosecution, lethal drugs for dying persons to self-administer. Generally the person must be terminally ill and capable of making the decision and consuming the medicine autonomously. The death remains self-administered (thus, literally, “suicide,” killing oneself); the physician’s “aid” does not directly bring about the death, although that is of course its aim.

Euthanasia (literally, “good death”) can be understood as a logical extension of “aid in dying.” Terminally ill persons might fear reaching a state of debilitation where they would no longer be able to self-administer the lethal drugs; euthanasia would allow their autonomous choice still to be carried out. Furthermore, such autonomous choice to die under specified conditions seems hindered if it is limited to the ongoing presence of communicative capacities.

“Aid in dying,” both in its strict sense as assisted suicide and in the broader sense of euthanasia, commends itself to our innate human desire to mitigate one another’s pain, and to honor human dignity.

We may distinguish euthanasia from many other forms of killing. A judicial execution, a deadly military assault, a police officer using lethal force to stop a terrorist in a public school: none of these actions is euthanasia. Advocates also wish to distinguish euthanasia from murder, understood as the wrongful killing of an innocent human being. This, however, is a difficult line to draw. In the film “The Giver,” a very loving man euthanizes a baby who is not up to standards. He is cradling and talking to the baby as he does it. He does not know what he is doing, although we who watch the film do.

“Aid in dying” involves active procedures that aim at the death of a person. They are different from withdrawing medical assistance (or refusing medical assistance) that is of minimal benefit at best, or whose possible benefit is far outweighed by its side effects. Gail Godwin’s novel The Good Husband begins with a brilliant and lovely professor who has just learned she has advanced ovarian cancer. When her doctor “told her what her chances were . . . or, rather, weren’t,” she told him: “In that case, I’d prefer to spend the time I have left studying for my Final Exam, rather than studying my disease.” Hers is not a decision for suicide.

Similarly, the administration of morphine, carefully increased only as needed to control a dying patient’s pain and fear of being unable to breathe, is not euthanasia, because it does not aim at the patient’s death.

In my judgment, Christian faith entails that both euthanasia and assisted suicide are morally wrong. Christians should oppose the normalization of such aids in dying as social practices or legal options.

The root theological problem is that “aid in dying” misconceives our life as something we own. That’s a widespread cultural error, pervasive all through life and not just at the end. But in fact my life is not my possession. My life is a gift; I am a steward of that gift, not an owner; and I am responsible for my stewardship. This is true for every human person. The fact that life is gift, not possession, is a truth that opens into a sense of awe over the depths in which we are connected one to another.

Hence everyone’s first moral task is to give thanks. We may want more than what we have; we may want something different; but we cannot ask for more or different apart from thanksgiving. Rejoice always, says the apostle Paul, “and again I say, Rejoice. . . . In every thing by prayer and supplication with thanksgiving let your requests be made known unto God” (Phil. 4:4,6; emphasis added). No matter how severe the need that draws forth our pleading, there is a container of thanksgiving that needs to surround it. As Anglican clergy have said at the Eucharist for centuries, “It is very meet, right, and our bounden duty, that we should at all times, and in all places, give thanks unto thee.”

Now one might think that in extreme conditions one could still give thanks to God while deliberately bringing a life to an end. One might think that in a particular case the pain is so great, the alternatives so limited, that administering aid in dying is the best choice. Yet even if that were the case, we should not deliberately bring a life to an end, because of our connections one with another. If I end my life, I have harmed others. My deliberately chosen death makes it easier for others to feel that maybe they too should choose death. In the end, in this as in so much else, pressures “to end it all” would be felt particularly by the poor.

The Oxford ethicist Nigel Biggar draws out, in his book Aiming to Kill, the deleterious social consequences of acceptance of these practices. For the good of humanity, we need to keep the prohibition, social and legal, of euthanasia and assisted suicide.

Nonetheless, Christians should become enthusiastic practitioners of the art of dying. There is much Christian wisdom about dying and we should aim to articulate it and help one another in it.

Being thankful for our lives, we have a duty to be courageous in the face of illness, aging, and death. We should study, exercise, practice good hygiene, and not shun such surgery as can prolong or promote our health. But we do not have a duty to extend our lives at any cost. In fact, we have a duty to develop such virtues as will help us to die well.

“I was sick, and ye visited me,” says the Lord at the last day (Matt. 25:36). We need to be with people who are approaching death, to include them in our communities. We need to learn how to walk beside, helpfully, a frail person. We should remind each other that, for instance, there is nothing undignified in wetting one’s pants. Dementia, too, is no indignity. We can acquire wisdom to be present with people in loving ways.

The Christian motto should be: Even though you are dying, we will not abandon you.

And let us not be bashful about the substance of Christian hope. After death, it seems we sleep with Jesus. Whatever that is, it’s not forever. Then comes “a yet more glorious day” (Hymn 287, st. 7) when bodies rise from the dead and joyful, fulfilled human beings join in praise of God. Good theology is sung when “For all the saints” is a hymn at a burial.

Let us encourage one another with the loose ends of life. There are people to thank, apologies to make sincerely, goods to let go of. And when we visit persons near the end, perhaps we should read Scripture to them (even if they seem asleep). I would like the Psalms read to me, from the 1979 Book of Common Prayer, if you can. And the prayers — some of the most powerful collects are at the end of the burial office (BCP pp. 487–9, 503–5) and these could be repeated aloud. We need not be silent at the approach of death. We can recognize its inevitability, and learn why we pray that God deliver us, not from death itself, but “from dying suddenly and unprepared” (Great Litany, BCP p. 149).

Such would be a truly Christian practice of aid in dying.

The Rev. Victor Lee Austin is theologian-in-residence for the Episcopal Diocese of Dallas and Church of the Incarnation, Dallas.


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