November 11, 2016
The Image of God: Why life is worth defending against Physician-Assisted Suicide
The article below was originally published in FOCUS Magazine, Christian Medical and Dental Society (Spring 2011), 8-13. I present it here with the hope that it may be helpful to readers wishing to think carefully about physician-assisted suicide, now euphemistically called "physician-assisted dying" (I say euphemistically because we all want physicians to assist us as we die by giving us clean sheets, morphine, and comfort care, whereas the actual topic at hand, which the euphemism hides, is whether they should kill us). On the topic of biblical reasons against suicide, see the section "Bible vs. Suicide." Of course, not everyone takes the Bible seriously, so concerning secular reasons against physician-assisted suicide—reasons aimed at the public good—see the section "Respecting the image of God in the secular physician-assisted suicide debate."
The Image of God:
Why life is worth defending against Physician-Assisted Suicide
By Hendrik van der Breggen, Ph.D.
Associate Professor of Philosophy
Providence University College, Otterburne, Manitoba, Canada
In April 2011 the B.C. Civil Liberties Association, along with a woman who arranged to have her ill elderly mother commit suicide in Switzerland with the help of medical professionals, announced a lawsuit to legalize physician-assisted suicide in Canada. The Globe and Mail reports: "In a notice of claim filed in B.C. Supreme Court, the parties argued that Criminal Code provisions against physician-assisted death are unconstitutional because they deny individuals the right to control their physical, emotional and psychological dignity."
Canadians must now ask: Does the right to control one's physical, emotional, and psychological dignity entail the right to kill oneself (whether with a physician's assistance or not)? But this question presupposes an answer to a more fundamental question: Is human dignity actually a matter over which one exercises control? We must be careful here. The question is not: Can we choose to treat each other with dignity, whether that dignity is understood physically, emotionally, or psychologically? Surely we can. Nor is this the question: Can I choose to treat myself with such dignity? Surely I can. The question is this: Is human dignity per se actually under our control?
As a response to this question in the context of what no doubt will be an important public discussion about physician-assisted suicide (PAS), I will set out three arguments. First, I will argue that, according to the biblical Christian worldview, human dignity is an essential part of human nature—i.e., a built-in reflection of God. This means that human dignity per se is not under our control. Second, I will argue that Christian Scripture condemns suicide and, by implication, PAS. This means that the life of those who suffer is not theirs to end according to their choice, whether with or without a physician's assistance. Significantly, Scripture also teaches us to provide physical, emotional, and psychological care for those who suffer. Third, because most readers of this publication live and work in a secular society, I will set out an argument that casts secular doubt onto the wisdom of legalizing the choice for PAS. This doubt, which is substantial, should encourage our secular society to respect true human dignity—by rejecting PAS.
Image of God: The non-negotiable basis for human dignity
Whether understood wholly literally or not, the biblical account of God's creation of humankind makes it clear that human dignity is part of human nature, i.e., a built-in reflection of God, and therefore human dignity per se simply is—and so is not under our control. According to Genesis 1:26-27, God created humans, male and female, "in his own image." According to Genesis 2:7, "the LORD God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature." Subsequently, according to Genesis 2:18-23, God took a rib from the man, "and the rib that the LORD God had taken from the man he made into a woman." Interestingly, according to Genesis 1:30, the various beasts and birds also have "the breath of life"; significantly, however, humankind has such breath uniquely. An ESV Study Bible commentator explains: "God breathes life—physical, mental, and spiritual—into the one created to bear his image...While human beings have much in common with other living beings, God gives them alone a royal and priestly status and makes them alone 'in his own image.'"
Disability advocate Joni Eareckson Tada and bioethicist Nigel M. de S. Cameron add some helpful insights:
"[I]n Genesis 1 we read of God making the various 'kinds' of animals and birds and sea creatures. They reproduce 'after their kind.' The implication is that humankind is made 'after God's kind.' We are made within the confines of space and time to image—to mirror, to model—the nature of God. That decides our view of human nature. All human beings are created equal, and equally precious, in the sight of God...Every member of our species, Homo sapiens, are image bearers of God and thus reflect the dignity of God."
To further drive home the significance of the moral status of humankind, Genesis also tells us that just before humans come onto the scene, God proclaims that the creation is good (Genesis 1:25), and then immediately after humans are on the scene, God proclaims that the creation is very good (Genesis 1:31). Although the creation contains many and various living creatures that all have worth, Genesis clearly informs us that, unlike the other creatures, humankind is unique in its worth: because humans are made in God's image, humans are the moral pinnacle of the creation.
But there is even more. On the Christian view, as Eareckson Tada and Cameron point out, because God took on human flesh in the man Jesus, "God has twice placed his stamp on human dignity."
The biblical bottom line: Each and every member of the human species has real dignity—real intrinsic moral worth—which is non-negotiable. We do not control human dignity itself, because each human life is sacred, period. And so we should treat every human being with respect.
Bible vs. Suicide
But what about suicide? So far I have established that, biblically, human beings are unique in that they are made in the image of God and thus there exists a theological basis for the great respect we should give human beings. But perhaps the Bible allows us to respect human dignity via suicide? The answer seems very much to be No.
Here is a list of seven reasons for thinking that the Bible condemns suicide (and, by logical implication, physician-assisted suicide).
1. That God is the highest good, that humans are created in God's image, and that God's image is a reflection of this good—these facts logically imply that the deliberate destruction of God's image is an evil. The deliberate destruction of the highest good is an evil, suicide is the destruction of a being made in God's image, i.e., a being that reflects the highest good, so suicide is an evil.
2. The sixth commandment says, "You shall not murder" (Exodus 20:13). It is reasonable to think that this command applies to human persons who are innocent, that the individual considering suicide is a human person who has not committed a capital offence, and hence that the command prohibits self-murder.
3. The facts that God reveals Himself most clearly in Jesus (the incarnation of God), that Jesus' teaching in word and deed provide us with a moral standard, that Jesus taught that we ought to care for others by feeding, healing, clothing, and sheltering them—not by encouraging them to self-destruct—these facts logically imply that suicide is wrong. Moreover, Jesus commands us to love others as we love ourselves (Matthew 22:37-39). Implicit is the assumption of self-love. Christ's acts of love show that they are acts for the betterment of the individual, not the individual's destruction. Therefore, self-love is not self-destructive. 
4. The facts that God advises Joshua to be strong and courageous in the face of danger and difficulty (Joshua 1:6-9), that Joshua carries out this advice not by self-destructing but by working hard in the face of the danger and difficulty, and that God very apparently approves of Joshua's response to God's advice—these facts logically imply that we ought to be alive to do God's work on earth, that doing God's work is right, and that suicide is not only morally wrong but also an act of cowardice.
5. Paul's life and teaching also logically imply that suicide is wrong. According to Paul, we are to spend our lives in service to others (Galatians 6:9-10). Clearly, Paul's example shows that this requires us to be alive as we serve others. Paul suffered immensely (see 2 Corinthians 11), and he wished to be with Jesus (i.e., be physically dead), yet he continued to serve without committing suicide.
6. Referring to Jonah, philosophers Francis Beckwith and Norman Geisler observe: "even the most desperate believer in the Bible who desired death never considered suicide a morally valid option. Take for example Jonah's prayer: 'O LORD, please take my life from me, for death is better to me than life' (Jonah 4:3 NASB...)."
7. Beckwith and Geisler also point out that "the Bible records five cases of suicide: Abimelech (Judg. 9:50-56); Saul and his armor bearer (1 Sam. 31:1-6; 2 Sam. 1:1-15; 1 Chron. 10:1-13); Zimri (1 Kings 16:18-19); Ahithophel (2 Sam. 17:23); and Judas (Matt. 27:3-10; Acts 1:15-19)." Significantly, as philosopher Robert Wennberg points out, "in each case of suicide recorded in Scripture, death represents a tragic end to a life that did not (at least in its latter stages) meet with God's approval." In other words, the Bible merely describes suicide; the Bible does not prescribe it.
Thus, it is reasonable to believe that the Bible morally condemns suicide, whether assisted by a physician or not. Moreover, the examples and teachings of Jesus and Paul make it clear that instead of encouraging suicide, we should work to enhance the physical, emotional, and psychological well being of those who suffer.
At this juncture, Christians should pause and ask: Does the biblical case against suicide mean that there are never circumstances in which a suffering, terminally-ill person should simply be allowed to die? The biblical answer seems very much to be No. Ethicist Scott Rae explains:
"[T]he Bible also affirms that death is a normal and natural part of a person's life 'under the sun,' or on this side of eternity (Eccl. 2:14-16; 2:19-21; 5:15-16; 9:1-6). Death is seen as both an enemy and a normal part of life, due to the pervasiveness of sin in the world. But from the perspective of the cross and resurrection of Jesus, for the Christian, death is also a conquered enemy, having been vanquished by the death and resurrection of Christ. Thus, since death for the Christian is a conquered enemy, it need not always be resisted."
In other words, the Bible condemns suicide, but, as Rae rightly points out, the Bible also recognizes that earthly life is "a penultimate good," whereas the ultimate good is "eternal fellowship with God." There is a time for death.
Respecting the image of God in the secular physician-assisted suicide debate
Of course, Canada is religiously pluralistic, and so many (most) Canadians do not look to the Bible for moral guidance—and so public discussion of PAS requires arguments that appeal to a secular, publicly accessible common ground. Significantly, for the Christian, this is not problematic. Such a common ground exists and consists of God-given knowledge concerning human worth plus reasoning that can promote this knowledge (or at least refute faulty ideas that thwart this knowledge). On the Christian view, whether or not one explicitly acknowledges the reality of God, these facts remain: general moral knowledge has been written by God onto the human heart, and the human ability to reason is part of our constitution as God's image-bearers.
Here, then, are seven secular reasons for casting doubt onto the wisdom of PAS.
1. To think that we face an option only between PAS and a painful death, and so we should legalize PAS, is to commit the false dichotomy fallacy (the mistake of limiting our options when more options are available). John Scott, a palliative care specialist, explains:
"We are being told [by the media] that the only real choice facing a person with terminal illness lies between a quick and easy death by assisted suicide or a slow, painful, and meaningless death by disease progression…. Canadians who support some form of physician-assisted death do so only because they believe that significant numbers are being forced to face death in unrelieved pain."
Scott quickly adds, however:
"In reality, there is solid evidence that: [a] the pain of advanced disease can be relieved with existing drugs and techniques; [b] the other psychological and physical problems of dying can be well managed by palliative care; [c] the dying are not being kept alive, by means of tubes and machines, against their wishes; [d] most deaths occur gently without agitation or distress."
In other words, PAS is not needed.
2. In those rare cases wherein suffering terminally ill patients do not respond to standard palliative care, instead of deliberately killing the patient, there is palliative sedation. Physician Erin Brender explains:
"Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life."
If it turns out that, foreseeably, palliative sedation hastens death, it is important to realize that palliative sedation need not be judged unethical. Just as death is not the intended effect in a high risk surgery (needed to relieve pain), and so such surgery is not immoral if death occurs, so too if death is not the intended effect in high risk pain management, yet death occurs, then such pain management is not immoral either. In other words, there remains an important moral difference between engaging in a procedure with the intent to kill (e.g., PAS/euthanasia) rather than not (e.g., palliative sedation).
Again, PAS is not needed.
3. Contrary to public opinion, termination of life support by withdrawing or withholding extraordinary, burdensome, or medically useless treatment from a terminally ill patient and thereby allowing the patient to die of his/her illness is both a legal and ethical part of palliative care—and does not require PAS. Rae correctly observes:
"Physicians need not always 'do everything' to stave off death, especially when it involves no more than simply delaying an inevitable death. In general, when the dying person's prognosis is very poor and further treatment is futile or more burdensome than beneficial, death can be welcomed as the 'doorstep to eternity.'"
Indeed, as Scott explains, "Choices about CPR, respirators, and intravenous procedures in the last weeks of life should not be viewed as choices for death....One can affirm and treasure life to the last moment without frantically trying to prolong the days."
Again, PAS is not needed.
4. The call for PAS misinterprets the plea for death. Scott explains:
"Yes, the cries 'Let me die,' 'Help me die,' or 'I wish I would die,' are real and deep, but they can be interpreted only in the context of lamentation [i.e., the expression of sorrow/grief; weeping]. Bedside doctors and nurses frequently care for patients who yearn to discuss their highly ambivalent feelings about death. These patients need a place of safety in which to pour out their total pain. For us to interpret such a cry as a request for a lethal overdose is to miss the mark completely. Lamentation is a call for support and relief, a search for meaning, and an invitation for relationship. It is a cry of life."
PAS, then, misinterprets patient need.
5. PAS tends to weaken a society's respect for human life. Life no longer is society’s default position. This is a fundamental shift of attitude in a less life affirming direction. In view of the general life-affirming foundations of civilization, such a shift should be questioned.
PAS, then, runs counter to civilized society.
6. Following closely on the heels of the previous reason, PAS imposes a terrible burden on the most vulnerable members of society. Because life will no longer be the default position, the most vulnerable members of our society—the elderly, terminally ill, and disabled—will feel a need to justify their continued existence. This is an awful weight to place on someone’s shoulders when that someone is already in a weakened state. Surely, legal policy that imposes such a weight on the weak is wrong—morally wrong.
PAS, then, is morally wrong.
7. Also, there is a logical-legal slippery slope argument that looms large. Philosopher Paul Chamberlain sets out an argument that hinges on the notion of patient autonomy coupled with the crucially important observation that reasons for one action sometimes also justify other actions which are unintended. In the context of legalized PAS, patient autonomy becomes understood in terms of the following fundamental principle: the sufferer has the right to choose PAS to end his/her suffering. Significantly, accepting PAS as a legal right on the basis of this fundamental principle opens up and justifies a host of new situations in which persons suffer and may request PAS. These situations include not only the terminally ill but also the non-terminally ill, the elderly, the disabled, the parent suffering the loss of a child, the person suffering chronic back pain, the depressed teenager, and so on.
Yes, we can set up so-called legal safeguards against abuses of PAS, but our courts will do what courts do—promote consistency. But consistency demands that all of the above-mentioned suffering persons, if they request PAS (and if they hire a good lawyer), can be quite reasonably seen to have the right to PAS too. Indeed (or so the argument would go), if we have already accepted "patient autonomy" as a legal justification for PAS, how can we deny them PAS?
Yes, the new situations are different. But their differences are incidental, if not irrelevant. At the core of each of these new situations we have a sufferer who requests PAS. And consistency requires that PAS's fundamental justifying principle—that the sufferer has the right to choose PAS to end his/her suffering—will carry more legal weight than the situational differences.
Clearly, the legal acceptance of PAS puts us on a non-fallacious slippery slope that embraces death as a solution. But medical, social, and psychological problems require medical, social, and psychological solutions—not killing.
PAS, then, is dangerous.
In sum, we have strong secular reasons for thinking PAS is definitely not needed, PAS misinterprets patient need, PAS runs counter to civilized society, PAS is morally wrong, and PAS is dangerous.
Therefore, we can reasonably conclude the following: (1) Human dignity is grounded in the image of God and thus not under our control, personally and legally; (2) Christian Scripture condemns suicide and, by implication, physician-assisted suicide, plus tells us that we must strive to enhance the physical, emotional, and psychological well being of those who suffer, instead of assisting them in their choice to die; (3) there are strong secular reasons not to legalize the choice for physician-assisted suicide.
Contrary to what the B.C. Civil Liberties Association would have us believe, physician-assisted suicide is not a good idea. Biblical and secular wisdom tell us that we should reject the choice for suicide—and choose life instead.
(Hendrik van der Breggen, Ph.D., is assistant professor of philosophy at Providence University College, Otterburne, Manitoba, Canada.)
Sunny Dhillon, "B.C. civil liberties group sues to legalize euthanasia in Canada," The Globe and Mail, April 26, 2011; http://www.theglobeandmail.com/news/national/british-columbia/bc-civil-liberties-group-sues-to-legalize-euthanasia-in-canada/article1999454/ [accessed May 2, 2011].
Unless indicated otherwise, Scripture references are to the English Standard Version (ESV).
ESV Study Bible (Wheaton, Illinois: Crossway Bibles, 2007), 53.
Joni Eareckson Tada and Nigel M. de S. Cameron, How to be a Christian in a Brave New World (Grand Rapids, Michigan: Zondervan, 2006), 51-52.
Eareckson Tada and Cameron, How to be a Christian in a Brave New World, 53.
Whether one cannot be forgiven for this sin, since it is difficult to repent afterward—at least in this life—is another issue. I believe God is just and merciful and gracious. Ultimately, of course, the forgiveness decision is up to God.
It may be helpful to keep in mind that Jesus' death by crucifixion was not a suicide. Although Jesus had the resources of heaven at His disposal and foresaw His death, the fact remains that Jesus was unjustly tried and murdered.
Francis J. Beckwith and Norman L. Geisler, Matters of Life and Death: Calm Answers to Tough Questions about Abortion and Euthanasia (Grand Rapids, Michigan: Baker Book House, 1991), 159. See also Job 3.
Beckwith and Geisler, Matters of Life and Death, 159.
Robert Wennberg, Critical Choices: Euthanasia, Suicide, and the Right to Die? (Grand Rapids, Michigan: Eerdmans, 1989); cited in Beckwith and Geisler, Matters of Life and Death, 159.
Scott B. Rae, Moral Choices: An Introduction to Ethics, 3rd ed. (Grand Rapids, Michigan: Zondervan, 2009), 218.
Rae, Moral Choices, 221.
Admittedly, our moral knowledge and our reasoning abilities are fallible and non-exhaustive. Nevertheless, I submit, we have some moral knowledge and we can reason quite well (if we are honest and careful).
John Scott, "Fear and False Promises: The Challenge of Pain in the Terminally Ill," in Euthanasia and Assisted Suicide, Ian Gentles, ed. (Toronto: Stoddart, 1995), 101.
Scott, "Fear and False Promises," 101.
Erin Brender, Alison Burke, and Richard M. Glass, "Palliative Sedation," The Journal of the American Medical Association , Vol. 294, No. 14 (October 12, 2005): 1850. JAMA Patient Page: http://jama.ama-assn.org/content/294/14/1850.full [accessed May 2, 2011].
This example is from MGill University law professor Margaret A. Somerville, "Euthanasia is never necessary," Citizen, Focus on the Family, Vol. 8, No. 5 (June 1999), 6.
This is an appeal to the principle of double effect, which Norman L. Geisler describes more generally as follows: "When an act has both good and bad consequences, it can be preferred if (1) the act is good or indifferent, (2) a good effect also follows from the act, (3) one intends the good effect and only tolerates the evil effect, and (4) the good effect is at least equal to the evil effect." (Norman L. Geisler, Christian Ethics: Contemporary Issues and Options, 2nd ed. [Grand Rapids, Michigan: Baker Academic, 2010], 187-188.) For more on the principle of double effect, see Chuck Colson and Robert George, Doing the Right Thing: Participant's Guide (Grand Rapids, Michigan: Zondervan, 2011), 55-57. See too Rae, Moral Choices, 230-232.
Rae, Moral Choices, 221.
Scott, "Fear and False Promises," 100.
Scott, "Fear and False Promises," 103.
Yes, many slippery slope arguments are fallacious: e.g., if you play cards, you’ll next be dancing, then you'll be drinking alcohol, and soon you’ll be a drug addict. But not all are fallacious: e.g., if you light a campfire directly under a tree in a dense dry forest, the tree will probably catch fire, which will probably cause the neighbouring trees to ignite, which will probably set the whole forest aflame.
What follows is a summary of pages 108-126 of Paul Chamberlain’s Final Wishes: A Cautionary Tale on Death, Dignity, and Physician-Assisted Suicide (Eugene, Oregon: Wipf & Stock, 2009).
For further reading I recommend Chamberlain's Final Wishes and Rae's Moral Choices. I also recommend viewing "What Does It Mean to Be Human?" which is Part 4 of the DVD series Doing the Right Thing: A Six-Part Exploration of Ethics with Chuck Colson and Robert George, moderated by Brit Hume (Washington, D.C.: BreakPoint Inc., 2011).