In our part of the world MAiD or MAID refers to “Medical Assistance in Dying.” It possibly goes by a different name where you live.
Over the past few years I’ve been increasingly sharing my blog platform here, and especially at our sister blog with Ruth who is now an ordained pastor in a longstanding Canadian denomination. When she told me about this project, I offered to make it available to our audience here as well. Note that this is much longer than regular articles that appear on this site.
by Ruth Wilkinson
I have a friend who works at a hospice — a medical facility dedicated to the care of people who are dying. The hospice also provides support to people who choose to take this journey in their homes, with visitation, equipment, nursing, counselling. The purpose of palliative work is to allow people to die with as little suffering as possible, with the support they and their families need, and according to their own choice.
It can be argued that the purpose of MAiD is the same–support, dignity, the reduction of suffering. These two options (hospice and MAiD) lie before many of us as we age, or when we receive a diagnosis of terminal illness. As a pastor, if I am called to walk with people through their end-of-life decisions (insofar as they allow me), it is something I want to do well. And something I want to help them to do well.
Traditionally, the Church has condemned actions that end life before nature has taken its course. Intervention that speeds the process has been decried. Culturally, we’ve invested tremendous resources in extending life through treatment, medication, and equipment.
For many people, MAiD seems counter-intuitive. For some it just seems wrong. For those of us working through the question, I’ve put together this paper on the most common (in my experience) concerns and objections. These are questions that, I suggest, we would be wise to think through for ourselves, and to answer in community. I will include some quotes from other people, edited for anonymity.
These thoughts are not intended to answer the question, “Should I?” I hope instead to provide some resources for those trying to answer the question for themselves, or to engage well in conversation with others. This writing is neither prescriptive nor definitive. It is simply a tool for informing the conversation.
- Is MAiD suicide? Is it murder?
- “Does the Bible say we are not to take a life and our body is the temple of God?”
- “I think I believe it’s taking a life, which is ultimately murder. But it’s a tough one because I’ve seen patients that suffer so brutally…”
- “Only God has the power of life and death. When you choose to end your life, you’re breaking the Sixth Commandment “Thou shalt not kill.””
- “I’m ok with ‘pulling the plug’ but it seems different from MAiD.”
- “Does anywhere in the Bible tell us that this is wrong? I don’t consider it murder or suicide, it is a medical decision.”
- “Even the victims of crucifixion had their legs broken to speed death.”
Suicide and murder are strong language that evokes strong emotions.
If we define ‘suicide’ as “the act of killing oneself intentionally,” then it applies to MAiD. As the Canadian process stands at this writing, it is an option that can only be chosen by an individual for themselves. No one can choose MAiD for someone else. There are restrictions on who may assist the applicant in filling out the forms (an attempt at preventing conflict-of-interest, or undue influence). More than one medical confirmation of untreatable illness must be obtained. And the applicant must be (unless they specify the exception in legal documents) conscious at the time of administration, and therefore able to change their mind at the last minute. MAiD is not eugenics or non-voluntary euthanasia. It is a choice one makes for oneself to speed an acute and terminal illness to its end.
If we define ‘murder’ as “the crime of intentionally killing a person,” then legally MAiD is not murder, because it is not a crime. But crime and sin are not synonymous. Some things that are morally wrong are not illegal (for example, adultery). For doctors and nurses involved in administering MAiD, the act is seen as a medical treatment, chosen by the patient. One hopes that, from their perspective, the system is designed to prevent them from being pressured into unwillingly taking part. But medical professionals have, historically, often spoken out for the right of patients to make end-of-life choices, especially in cases of untreatable degenerative or terminal illness. One may legitimately ask whether it constitutes murder if it has been clearly, calmly, and unwaveringly requested by the recipient. For the one administering the treatment, the choice must be made according to conscience.
The distinction from “pulling the plug” should be considered, as well. If a patient is being kept breathing by a machine, removing them from the machine allows their body to exercise its own agency: to decide whether to keep going or not. In that case, often the greater question is whether we should be put on the machines in the first place. For families who have to decide to “pull the plug,” the choice is made on behalf of someone other than themselves, which brings its own challenges and trauma including dealing with disagreement between siblings, spouse, or children. But according to our definitions, it constitutes neither suicide nor murder.
(As an aside, I think it interesting to ask why we are more comfortable with scheduling the beginning of a lifetime (eg, C-sections and inductions) than with scheduling an ending? If God has power over life and death, I wonder whether that is an inconsistency.)
- What does the Bible say about suicide?
There is no simple, clear commandment that says, “Thou shalt not…” on this question. We look instead for the examples of people written about in the Bible. There are several who committed suicide. In chronological order:
Samson (Judges 16) – Samson was a judge in Israel, and filled with the Holy Spirit from his youth. He died by collapsing a building on himself and the enemies of God. Samson’s death was a complex act of humility, of repentance, and of hatred. As I understand it, in his self-sacrifice he sought to fulfill his calling and to seek atonement for his lack of faithfulness.
Abimelech (Judges 9) – Abimelech was one of Gideon’s many sons. He wanted to rule Israel, and tried to achieve this by killing his brothers. In the resulting civil war, Abimelech was fatally wounded, but commanded a servant finish him off so that “…they can’t say, “A woman killed [me].”” As I understand it, Abimelech’s choice was one fuelled by arrogance and made necessary by his own bad choices.
Saul, and his armour bearer (1 Sam 31) – King Saul chose death over defeat. His army was defeated by the Philistines, and Saul, critically wounded, fell on his own sword rather than be captured and tortured. His armour bearer, seeing Saul dead, did the same. In the former case, Saul died to avoid further suffering. In the latter, the man killed himself because all hope was lost. As I understand it, Saul’s capture might, arguably, have made things worse for Israel. A dead king is bad enough, but a tortured and humiliated king is different. His motives may have been mixed. The armour-bearer, who would have been with Saul in every battle and unquestioningly loyal, followed his king into the inevitable.
Ahitophel (2 Sam 17) – Ahitophel was a traitor against King David, supporting the insurgency of Absalom. When Ahitophel realized that his cause was lost and that David would regain the throne, he “saddled his donkey and set out for his house in his hometown. He put his affairs in order and hanged himself.” Ahitophel decided that his life was over, took the time to organize, and then killed himself. As I understand it, Ahitophel had gambled for power, and lost. In a game where the winner takes all and has the hold of life and death over the loser, he chose the manner in which he would pay the price. He didn’t see the possibility that David might forgive him, as he did another betrayer, Shimei.
Zimri (1 Kings 16) – Zimri was a short-lived king of Israel, having taken the throne by assassination. The people rejected his rule, naming Omri King instead. Zimri was besieged by the Israelite army and, rather than surrendering, he burned down the citadel of the royal palace with himself inside. As I understand it, Zimri’s death was a (perhaps accidental) consequence of his own evil actions and pride.
Judas (Matt 27) – Judas’ death is, I think, the most sad. Having betrayed Jesus to the authorities and seeing that the end result was likely to be Jesus’ death, Judas tried to atone by returning the money and declaring Jesus’ innocence. When his gesture was rejected, he hanged himself. Judas’ suicide was (like Ahitophel’s) premature. Neither considered the possibility of grace (Jesus forgave Peter, who had also betrayed Him). Like Samson’s death, Judas’ motives were mixed but coloured by repentance. As I understand it, Judas’ death was a tragic error.
We are created in the image of God. That imbues us with undeniable value. We are treasured by the one who created us, and who is the “giver of all good things.” A significant portion of Scripture is filled with lament and the reality of human suffering. God’s inspiration of the writers, and of those who compiled the authoritative body of the Bible, does not shy away from honesty around physical and mental suffering. But the examples of people in Scripture who took their own lives centre on questionable motives and a failure of hope.
From another perspective, one might consider the deaths of people like Paul and Peter, who chose death over the denial of their faith in Christ. For many, there are things more important than the next breath. For some people, that includes sparing their loved ones the sight of their suffering, or the roller-coaster ride of medical crises. Choosing to die is, I think, never easy. But for some it is the lesser of evils.
- If I choose MAiD, will I go to hell?
- “Growing up in a mostly Catholic culture, we were taught that suicide was a particularly heinous sin. People weren’t even buried in consecrated ground, because they died unshriven and guilty of the worst act–self-murder. Even though now I can’t find anything in the Bible to support that, I can’t shake the feeling that suicide might keep me out of Heaven.”
- “As [a friend receiving MAiD] said to me, “There’s no light at the end of this tunnel. I miss my wife and want to be in Heaven with her now.””
Many of us have, consciously or not, an uncertain understanding of how to “get into Heaven.”
Many believe that they will go to Heaven if they have lived a good life: one of more good done than bad. Of more innocence than guilt.
For one who, like myself, holds to a largely Evangelical theology, going to Heaven after death is instead a continuation of the relationship begun with Christ in this life.
Believers in other branches of Christianity have a theory of salvation that sees some sins as worse than others. Among the worst is the ending of life, and they might be concerned that if the last thing they do in this life is to end a life, there will be dire consequences.
But does sin keep us out of Heaven? Yes and no.
The sinfulness with which we are all born is a barrier to relationship with God. Whether one accepts the idea of ‘orginal sin’ (ie a congenital state of alienation from God) or not, there is little argument that human beings are incapable of living this life without breaking God’s moral or spiritual law. We are not capable of living a life that is pure. That sinfulness–that condition–if not dealt with through engaging with Christ’s forgiving work of dying on the cross to pay the cost, will keep us ‘out of Heaven.’
For the believer in Christ–the follower of Jesus–the cost of our sinfulness has been paid. Our relationship with God has been assured. If we, for example, tell a lie while talking on the phone crossing the street and get hit by a bus, that lie will not keep us ‘out of Heaven.’ God takes lying very seriously. Liars are included in the list of people who will not inherit eternal life, along with “the cowardly, the unbelieving, the vile, the murderers, the sexually immoral, those who practice magic arts, the idolaters” (Revelation 21:8). But our relationship status carries greater weight than any one act of sinfulness.
It’s true that even within our new identity within Christ’s family, we still do things that are wrong. But “… a person is not justified by the works of the law, but by faith in Jesus Christ. So we, too, have put our faith in Christ Jesus that we may be justified by faith in Christ and not by the works of the law, because by the works of the law no one will be justified” (Galatians 2:16). The principle Paul is teaching here is that we cannot earn our way to Heaven. Nor can we earn our way to Hell. Our identity in Christ–His forgiving work–is what matters. (Suicide is not the “unforgiveable sin.” That phrase comes from Mark 3:29: “…whoever blasphemes against the Holy Spirit will never be forgiven; they are guilty of an eternal sin.”)
I would suggest that dying by MAiD does not decide one’s eternal destiny. That decision is not made by one act (either of personal atonement or of sin), but by one’s relationship to Christ — ”I have been crucified with Christ and I no longer live, but Christ lives in me. The life I now live in the body, I live by faith in the Son of God, who loved me and gave himself for me” (Galatians 2:20). “Therefore, there is now no condemnation for those who are in Christ Jesus. For in Christ Jesus the law of the Spirit of life set you free from the law of sin and death” (Romans 8:1-2). Jesus said, “Very truly I tell you, whoever hears my word and believes him who sent me has eternal life and will not be judged but has crossed over from death to life” (John 5:24).
- Does the Bible speak to the question of MAiD as it is currently practiced in Canada?
- “I want to learn more about God’s Word so that I could defend my belief that MAiD is not sinning (or find sufficient evidence that it is).”
- “I don’t think there is any advantage to this kind of (prolonged) suffering.”
- “As Evangelical Christians, we have always valued the dignity of life. But, how does the dignity of choice fit into that?”
- “If it’s ok for me to end my dog’s suffering and have her euthanized, then why should a human not have the same courtesy? I feel that although medical discoveries can prolong lives, sometimes it’s not the best thing.”
- “In the church we have ideas as to what it means to say “it is appointed unto man to die,” or “our lives are in God’s hands.” It is as though these statements preempt the action under discussion.”
- “But if we truly believe that God can perform miracles and is in control, then it wouldn’t make sense.”
As I’ve said above… no. The Bible doesn’t speak of suicide specifically. But there are a few passages that are quoted in discussions around MAiD.
I’ll look at some of those here:
Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honour God with your bodies. (1 Corinthians 6:19-20)
The context of this passage is sexual purity. The broader New Testament perspective on our physicality is that it matters. We are not just ‘spirits in bodies.’ Our physical, earthly existence was created by God to be a blessing to the rest of Creation as we worked to multiply His image and His holiness on the planet of which we are a part. When we defile our bodies, we defile His image–the image that dwells in His temple. This passage reminds us of our individual, unique physicalness and the responsibility we have for wearing it well.
So… it could be argued that there is a principle here, of “honouring God with our bodies” that would preclude harming them or ending life.
But… for the believer in Christ there is the hope that these bodies will, like Christ’s own, be made new and incorruptible in eternity. That might suggest that, when this body has failed irretrievably, choosing to lay it to rest is not the worst thing we can do.
At the same time, the decisions we make about our bodies impact other people. “You are not your own” is here reminding us of Christ’s work, but in other passages, we’re reminded of our responsibility to each other. Principles like, “…do not think of yourself more highly than you ought” (Romans 12:3), “…in humility value others above yourselves, not looking to your own interests, but each of you to the interests of the others” (Philippians 2:3-4), “…submit to one another out of reverence for Christ” (Ephesians 5:21). Even the Beatitudes (Blessed are the poor in spirit… Blessed are the meek (Matthew 5:3ff)) challenge us to consider the impact of our decisions on the people in our lives.
Don’t you know that you yourselves are God’s temple and that God’s Spirit dwells in your midst? If anyone destroys God’s temple, God will destroy that person; for God’s temple is sacred, and you together are that temple. (1 Corinthians 3:16-17)
This passage may seem very similar to the one above, but the context is quite different. Here, Paul is talking about unity and divisiveness in the Church. The “you” he is talking to is the collective of all of us. We are, all together, God’s temple and dwelling place. The temple we are to preserve is the Church. As a small part of a larger ‘body,’ our actions impact the other parts. Our examples speak to our sisters and brothers. The values we embody inform the faith journey of those who surround and come after us. How we live and die speak of what we believe, and who we believe in.
Just as people are destined (some translations: appointed) to die once, and after that to face judgment, so Christ was sacrificed once to take away the sins of many; and he will appear a second time, not to bear sin, but to bring salvation to those who are waiting for him. (Hebrews 9:27-28)
The context here is the completeness of Christ’s work on the cross. The language of being “appointed” to die does not carry the suggestion of a set time of meeting. It refers to the inevitability of death, and the fact that our earthly bodies can die only once.
Your eyes saw my unformed body; all the days ordained for me were written in your book before one of them came to be. (Psalm 139:16)
The context here is the completeness of God’s knowledge. He knows beforehand all of days we will live, and that are recorded or formed for us. The writer reflects on the fact that there will be an end to our days. The text doesn’t require that the duration of those days be dictated by God, but reminds us that He is intimately and lovingly aware of our experience.
Into Your hands I commit my spirit; You have redeemed me, O LORD, God of truth…
But I trust in You, O LORD; I say, “You are my God.” My times are in Your hands; deliver me from my enemies and from those who pursue me. Psalm 31:5, 14-15
The context here is one’s trust in God for deliverance from enemies. The writer is calling God’s people to have courage, and to trust Him. Illness and dying are, indeed, enemies.
- If someone in my family or my church chooses MAiD, how should I respond?
- “Christians are compassionate (or should be) about neglect, poverty, homelessness, war, etc. Why would they not be compassionate about this kind of suffering too?”
- “It must be hard knowing the hour! I think it is a courageous choice to leave life well.”
- “I have seen the indignities that people suffer because our culture believes that quantity > quality.”
- “I have traditionally been against MAiD of any kind, for any reason. However, as I’ve been journeying with and learning from people (Christ-followers and not) who have navigated this in their families, I am left with less certainty.”
- “People are living and wrestling with huge decisions in the tension. How we care well for people, respect people, and love people with compassion matters.”
- “[Name] died yesterday with the help of MAiD. They had been diagnosed a few months ago as having maximum six months to a year before dying ‘naturally’ after suffering through the decay of their quality of life.”
- “I don’t think any of us can know what is in the dying person’s heart and head during their journey to MAiD. I don’t believe there is anything Biblical either affirming or precluding MAiD.”
- “Of course if someone accesses MAiD, there will be issues following for the network of family and friends to come to terms with, even if they have been part of the journey.”
“In everything, then, do to others as you would have them do to you. For this is the essence of the Law and the Prophets.” (Matthew 7:12) Jesus’ command to us is to respond to others in a spirit of humility and empathy.
If someone chooses MAiD, our responsibility is to respond to them as we would to someone who is in pain and fear, and who is grieving for all they have lost. People who have reached the threshold of making the MAiD decision are dealing with some of the worst that life can hand us.
Respond with sensitivity and love. Go as far with them on the journey as they invite you, and as far as you are comfortable. Death impacts those of us left behind as well as those of us departing.
Be kind to yourself. Not everyone is comfortable being in the room at the moment of death. That’s ok. Seek the support you, as an ally or griever, need. Be aware that the passing of someone you love, or even just know, is a source of trauma, and different people are impacted differently in those experiences. Permission is granted to say ‘no’ if you need to. But say it graciously.
Conclusion:
We can all hope to die as David did–peacefully of old age, having given his blessing and final words to his family, and having kept his promises and served God faithfully by ruling Israel for forty years (1 Kings 2). When that is not our experience, we may have a decision to make.
In making that decision, we need to consider among other things:
- Our relationship with God in Christ.
- Our view on miraculous healing.
- The perspective of those who love us.
- Our motivation for either ending our suffering, or for enduring through it.
Our trust in God to catch us when we stumble across the line, whether or not of our own volition.