Against Assisted Dying

Introduction

The elders asked me if I would speak from time to time on what some people call ‘hot topics’. And so, since we finished Lamentations last Sunday evening, I thought I would take the time this evening to speak about assisted dying, which has become a hot topic in the last few years and especially now that a Private Member’s Bill is to come before the House of Commons at the end of this month (November 2024).

Perhaps I should begin by making clear what is meant by assisted dying. Ewan Goligher, who is assistant professor of medicine at the University of Toronto and who has written a book on the topic from a Christian perspective (How Should We Then Die? A Christian Response to Physician-Assisted Dying), defines physician-assisted death as ‘intentional and deliberate actions on the part of the physician aimed at causing the death of the patient.’ So, we’re talking about actions taken by a doctor to bring about the death of a patient. Why would a patient want a doctor to take such action to end their life? In the UK, campaigners want assisted dying for patients who have six months or less to live. They see assisted dying as a way to let people have a safe and peaceful death and not a painful and undignified death.

Goligher goes on in his book to distinguish two different kinds of action by physicians. They can either provide a prescription for a lethal dose of a drug which the patient administers him- or herself. So, the doctor only makes the drug available to the patient. Alternatively, the doctor may administer the lethal dose directly to the patient. So, in the first case, the patient self-administers the drug. In the second case, the doctor administers the drug to the patient. Goligher says that, from an ethical standpoint, there is no real distinction between these two kinds of action, because in both cases the doctor is deliberately and knowingly acting to cause the patient’s death. The details of the Private Member’s Bill coming to the House of Commons have not yet been published. So I don’t think we know for sure which of these two actions are being proposed. Some countries have already legalised assisted dying, beginning with the Netherlands in 2001.

It’s important that we also distinguish assisted dying from withholding or withdrawing life-sustaining treatments. When patients are critically ill so that there is no hope of recovery, and when life-sustaining treatments are no longer effective, the decision may be made to withdraw the treatment which is no longer working and to let nature take its course. In those case, the decision is made to terminate treatment. But terminating treatment is not the same thing as assisted dying, where the goal is to terminate, not the treatment, but life itself.

So, what we’re talking about this evening is assisted dying, which is ‘intentional and deliberate actions on the part of the physician aimed at causing the death of the patient.’

And I want to approach this topic by thinking about creation, the fall, redemption and consummation. In the beginning God created the heavens and the earth. Adam then disobeyed God and he and everyone who is descended from him in the ordinary way fell into a state of sin and misery and death. But God so loved the world that he sent his Only Begotten Son to redeem his people from our sin and misery and to renew us in his image. And when Christ comes again, unbelievers will be raised from the dead to suffer everlasting punishment away from the presence of God, whereas believers will be raised from the dead to enjoy everlasting life in the presence of God in the new and better world to come. And as we think about these four stages in the history of the world, we’ll see that assisted dying is contrary to God’s will for the world and that the Lord our God is the giver of life.

Creation

Before we think about creation, we should think about God and say that he has all life in himself. No one created him and no one gave him his life, but he exists eternally and for ever. And the God who has all life in himself created the heavens and the earth and all that they contain. And he’s the one who gives life to his creatures. He made the vegetation and gave life to all plants and trees and the ability to produce seed and to reproduce themselves. He made the birds in the sky and the fish in the sea and the animals on the earth and gave life to them and the ability to increase in number. And last of all, he made humans. We read in Genesis that he made the first man from the dust of the earth and breathed into his nostrils the breath of life, so that man became a living being. And then he formed the first woman from out of the man. And he brought them together so that that they were united as one flesh in marriage and were able to produce new life by having children together.

In Acts 17:25, when Paul was speaking in Athens, he said that God gives all men life and breath and everything else. And this is true, not only for all men, but for all living creatures, because all of life comes from the one, true and living God. And he not only gives us life, but he sustains our life in the world. According to Psalm 104, the earth is satisfied by the fruit of his work and the trees of the Lord are well watered. So, he waters the ground by sending rain which makes the trees and plants grow and flourish. And by sending rain, he also provides water for the beasts of the field so that no one has to water wild donkeys. And by causing grass to grow, he also feeds the cattle. He causes plants to grow which we can cultivate and use for food. And since he placed us over the rest of creation, he gives us all things for food including the animals, which we can eat with thanksgiving. In Matthew 6, the Lord Jesus spoke about God’s care for his creation and how he feeds the birds of the air and he dresses the flowers of the field and makes them beautiful. And since God cares for birds and flowers, we can be sure that he cares for humans too.

And, of course, we depend on God for all things. As Paul also said to the Athenians, in God we live and move and have our being. So, God is the one who gives us our life and he’s the one who sustains our life in the world. And when he created Adam in the beginning, he placed him in a garden which he had planted for Adam and which was full of trees which were pleasing to the eye and which were good for the food. And in the centre of the garden was the Tree of Life which held out to Adam the hope of everlasting life and blessedness in the presence of God. And so, life in the garden of Eden was only a foretaste of the even better life which God had in mind for Adam and his descendants and which Adam would achieve for us by his obedience to God.

And so, the one, true and living God, who has all life in himself, gave us life. And he promised us everlasting life. That’s how things were in the beginning.

Fall

But we know that Adam disobeyed the Lord’s command concerning the Tree of Knowledge, which was also in the garden. And by his disobedience to God’s command, Adam forfeited the right to eat from the Tree of Life and to live for ever. And since Adam was our head and represented us, then we sinned in him and fell with him into what our Shorter Catechism calls the state of sin and misery. It’s a state of sin, because everyone who is descended from Adam in the ordinary manner is born a sinner and therefore sinning comes naturally to us. We are naturally inclined to disobey God in our thoughts and words and deeds. And it’s a state of misery, because sin causes misery. It spoils every relationship we have, beginning with our relationship with God. And it spoils married life and family life and work life and life in the community. And because the wages of sin is death, death came into the world so that instead of enjoying everlasting life in the presence of God, everyone dies.

All of this was summed up by the words of the Lord to Adam and Eve after they fell. To the woman, God said that he will greatly increase her pains in childbearing so that she will give birth to children with pain. In other words, family life will be hard. Moreover, her desire will be to rule over her husband, but he will rule over her. And so, instead of loving one another, they will oppose one another. And to the man, God said that he will only produce food through painful toil and by the sweat of his brow. In other words, work will be hard and frustrating. And in the end, you will die, because dust you are and to dust you will return.

The Tree of Life held out to Adam the hope of everlasting life and blessedness in the presence of God. But Adam, by his sin, forfeited for us the right to eat from the Tree and live for ever. And so, death came into the world. And in Genesis 5 we have the first genealogy in the Bible and there’s one phrase which is repeated over and over and over again (with one exception) which is the phrase ‘and he died’. And he died. And he died. And he died. We all die because death is the wages of sin.

And throughout the rest of the Old Testament, we read about the sins of men and women and the misery they cause one another. And, of course, one of the first sins which was recorded for us in the Bible is murder. Adam and Eve had two sons, Cain and Abel. And Cain killed Abel. And shortly after that, we read about Lamech who boasted to his wives that he had killed a young man who had wounded him. And throughout the Old Testament period, all kinds of people are murdered; and all kinds of people commit murder, including King David, who took Uriah’s wife and then he took Uriah’s life when he arranged for Uriah to be killed on the battlefield.

But God gave us laws and warnings to make his will clear to us and to restrain our wickedness. For instance, in Genesis 9, after the flood in the days of Noah, the Lord said that he would demand from each man an accounting for the life of his fellow man. In other words, whoever kills another person must answer to God. And then, there’s the sixth commandment which not only forbids murder but the taking of our own life. And by forbidding murder and the taking of our own life, it also forbids everything that leads up to murder and self-murder, including hatred and bitterness and harming ourselves and others. And the sixth commandments not only forbids us from harming ourselves and one another, but it also requires us to take care of ourselves and others and to preserve life in the world. So, God’s will for us is to preserve life and not to take it.

God also gave his people in Old Testament times other laws and commandments to teach them to love one another and to care for widows and orphans and others who are weak and defenceless. And the New Testament contains similar laws and commandments about how we’re to love one another and care for one another and we’re to preserve life and not take it. Indeed, God expects us to love even our enemies and to do good to all, just as God himself does good to all.

Our church’s Larger Catechism explains that the sixth commandment forbids the taking of our own life or that of any others. And then it offers three exceptions to that general rule. So, God forbids us from taking the life of any others except for these three cases: public justice; lawful war; and necessary defence. By referring to public justice, the catechism means that God has given the governing authorities the power of the sword or the right to use capital punishment. By referring to lawful war, the catechism is saying that it is lawful to kill an enemy when nations are at war with one another. By referring to necessary defence, it is saying that we have the right to defend our lives when someone attacks us. Apart from those three cases, we have no right to take our own life or the life of another person. And that therefore rules out assisted dying.

And we have no right to take our own life or the life of another person because every life belongs to God. As it says in Psalm 24:

The earth is the Lord’s, and everything in it,
the world, and all who live in it;
for he founded it upon the seas
and established it upon the waters.

The psalmist is saying that the earth belongs to the Lord; and everything in it belongs to the Lord; the world and all who live in it belong to the Lord. In other words, you and I and everyone else belong to the Lord, because he made us. And since we belong to him, then he is the only one with the right to take our life. Just as you have no right to destroy my property, so none of us has the right to destroy God’s property.

Those who advocate assisted dying forget God. They don’t include him in their thinking. They think their life belongs to themselves and therefore they should have the right to decide whether or not to keep their life or end it. But our life does not belong to us; it belongs to God who made us.

And one reason God forbids us from taking our own life or any other person’s life is because the life of everyone is precious to God. Remember how the Lord Jesus put it in Matthew 6? Referring to the birds of the air, he said, ‘Are you not much more valuable than they?’ God cares for the birds of the air. But you are more valuable to him than birds. You are valuable to him. Your life is valuable to him. He regards us as precious in his sight.

Think of what the psalmist said in Psalm 8:

[What] is man that you are mindful of him,
the son of man that you care for him?
You made him a little lower than the heavenly beings
and crowned him with glory and honour.

He’s saying that God is mindful of us. That is to say, he pays attention to us. And he has bestowed on us the honour of being just a little lower than the heavenly beings. Since we came from dust, we’re part of the world around us which includes trees and plants and fish and birds and animals. However, God has also placed us above trees and plants and above fish and birds and above animals. He has placed us above all the other creatures on the earth and he’s placed us just a little lower than angels. In fact, he’s given us greater honour than the angels, because he has made us in his image. None of the animals are in God’s image. None of the angels are in God’s image. We alone are in God’s image. He made us in his likeness and he made us to represent him on the earth. And what a privilege that is! What an honour! And this privilege and honour belongs to every person. In the eyes of the world, one person is more important than another. But in the eyes of God, we are of equal worth because we are all made in his image.

And that’s important, because some people who advocate assisted dying for people who are terminally ill do so because they believe that their illness means that their life now has no meaning or purpose and therefore it is worthless. They believe that their life had meaning before their illness, because of the things they were able to do for themselves and for other people. Their work gave them meaning and purpose. Their place in their family gave them meaning and purpose. People looked up to them or people relied on them. Their lives mattered because of what they did. But now, because of their illness, they’re unable to do those things. And so, they believe they have lost their purpose in life and they have lost their reason for living. They say: If I can’t do those things which I used to do, and if I can’t enjoy those things which I used to enjoy, then what’s the point in living? My life has no value or purpose now.

And people who are retired and whose family has moved away and whose spouse has died often feel the same way. They think to themselves: What reason do I have to keep going when my life is so empty now? What difference would it make to anyone whether I lived or died?

But God has created us in his image. And that gives our life value and meaning and purpose. Our value comes, not from what we do, but from what we are. And what we are is someone who was made in God’s image. And since this is true, then God’s glory can be seen in every person we encounter. It may only be seen in us weakly, because of our sinfulness. But it’s there in every single person. And that makes the life of every single person valuable.

And so, assisted dying is wrong because God forbids us from taking our own life or the life of another person. And assisted dying is wrong because every person is precious to God. We are valuable to him. People think their value comes from what they do. But our value, our worth, comes from God who made us in his image.

And people understand this instinctively. They understand instinctively that we matter. They understand it intuitively. That’s why we’re still horrified when we think of the millions of Jews who were killed in the Nazi concentration camps. That’s why it distresses us when we hear of the suffering of so many people because of the wars in Ukraine and the Middle East. That’s why we’re saddened when we hear of the deaths of so many people this week in Valencia. That’s why we’re appalled when we hear of children who have been neglected by their parents. That’s why we have hospitals where the sick and the dying can be cared for. That’s why we have laboratories where research is undertaken to find cures for diseases. And do you remember the Chilean mining accident in 2010 when thirty-three miners were trapped underground? And do you remember the effort that was made at that time to rescue them? People worked at great expense for over two months to rescue them. Why was so much effort made to rescue them? It’s because we recognise that people matter. They are valuable. We want them to go on living and not to die.

We know this intuitively. We feel it. And Christianity gives us a reason for what we know intuitively, because Christianity tells us that every person is valuable, because every person bears the image of God.

Redemption

And because we matter to God, he sent his Only Begotten Son into the world to save us from our sin and misery by his life and death and resurrection. God the Son loved us so much that he was prepared to become one of us and to die for us and for our salvation. And by dying on the cross in our place, he paid for our sins with his life, taking the blame for all that we have done wrong so that everyone who believes in him receives forgiveness and peace with God and the hope of everlasting life.

And he also fills us with his Spirit to renew us in his image and to make us more and more willing and able to do his will here on earth and to keep his laws and commandments. And so, he enables us to love and care for ourselves and other people. And even though it is often a burden to care for the sick and the weak — and it is a burden — nevertheless he makes us willing to bear that burden and to do what we can to help those who are suffering.

And so, throughout the history of the church, God’s people have been at the forefront of efforts to care for the poor and the sick and the dying. For instance, we read in Acts 6 about a program which the early church set up. to feed needy widows in Jerusalem. The Apostle Paul wrote to the believers in Corinth about a collection to raise funds for poor believers in Jerusalem. And this desire to help the weak continued. And so, one writer (John Dickson, Promoting the Gospel) says that by AD 250, the Christian community in Rome was supporting 1,500 destitute people every day. He says that all around the Mediterranean churches were setting up food programs and hospitals and orphanages, which were available to believers and unbelievers alike. Christians cared for human life and wanted to preserve it. And what they did had an influence on the world around them so that caring for the weak and the sick is commonplace. In the ancient world, few people cared for the weak and sick. But now, because of the influence of Christianity people who are not Christians take it for granted that it is right and good to preserve life and not to take it. And while they may not understand why it is right and good to preserve life, the Christian faith gives them a reason, which is once again that every person is valuable because every person is made in God’s image and his glory is seen in them.

Consummation

And we believe that the time will arrive when the Lord Jesus Christ will come in glory and with power to raise the dead. Every person who has ever lived will be raised from the dead to face the judgment of God. All those who did not believe in the Saviour in this life will be condemned for all that they have done wrong; and they will be sent out of the presence of God to be punished for ever and for ever for what they have done wrong. On the other hand, all those who trusted in the Saviour in this life will be acquitted, because of Christ who paid for their sins with his life and who shares his perfect righteousness with them. And they will be brought into the presence of God in the new and better world to come to enjoy perfect peace and rest and joy and happiness for ever and for ever as they gaze on the glory of God in the face of Christ their Saviour.

And here’s the thing: those who advocate assisted dying have left the resurrection out of their thinking. They assume that death means the end of life. And they assume that death means the end of suffering. As far as they are concerned, when someone is suffering in this life they should be allowed to end their life, because that will mean the end of their suffering. But Christ’s resurrection from the dead demonstrates that death is not the end; and that there’s this life and there’s the life to come. And for those who do not believe, death is only the beginning of everlasting suffering and pain. And so, they are dead wrong when they say that death means the end of suffering.

Those who advocate assisted dying want to avoid suffering. But the Bible makes clear that our suffering in this life is not meaningless. It does not happen by chance, because God sends it into our lives. And he sends it into our lives for a reason. God speaks to us through our pain. As C.S. Lewis says (The Problem of Pain), suffering is God’s megaphone. Lewis says that we rest contentedly in our sins. So, we’re not bothered by them. And though God is his word forbids us to sin, we can easily disregard God’s word. However, pain insists on being attended to. We can’t ignore it. It demands our attention. And through what we suffer, God speaks to us. Lewis says: God shouts in our pains. Suffering is his megaphone to get our attention. God is calling us through our pain to turn to him for eternal life.

Or then there’s John Calvin, the French reformer. He wrote the following about our present sufferings (A Little Book on the Christian Life):

In whatever trouble comes to us, we should always set our eyes on God’s purpose to train us to think little of this present life and inspire us to think more about the future life. For God knows well that we are greatly inclined to love this world by natural instinct. Thus, he uses the best means to draw us back and shake us from our slumber, so that we don’t become entirely stuck in the mire of our love for this world.

Calvin is saying that God uses the troubles of this life — including sickness and pain — to awaken us from our slumber and to cause us to yearn more and more for the new and better life to come, which God promises to all who trust in his Son. He sends trouble into our life in this world so that we will yearn for the world to come. But Calvin also says that we must not hate our present life or seek to end it. Our present suffering makes us yearn for the life to come, but we have to wait for it. And we mustn’t be ungrateful to God, because even in this troubled life, God surrounds us with his blessings and he fills our life with good things. He shows us that he’s our loving Heavenly Father by filling our lives with good things to enjoy even in the midst of our suffering. And after this life is over, he gives us, as our inheritance, eternal life in his presence where he promises to wipe the tears from our eyes and where there is no more sorrow or suffering or disease or death, but only eternal peace and rest and life.

Conclusion

Those who advocate assisted dying think that this life is all that there is. And if this life is all that there is, then we’d better enjoy it as much as we can. And they therefore think that once we no longer enjoy this life, because of illness or pain, we may as well bring it to an end.

But God in his word makes clear that there’s this life and there’s the life to come. There’s this troubled life — and it’s a troubled life because of Adam’s fall in the beginning when sin and misery came into the world. But then, for those who believe in the Saviour, there’s the hope of the life to come and everlasting happiness in the presence of God. By his disobedience, Adam forfeited for us the right to eternal life. But by his obedience to death on the cross, Christ has won for us the right to eternal life. And we receive it by grace alone through faith alone in Christ alone.

And while we go on living in this troubled life, God helps us to endure whatever troubles and trials he sends into our life for our good.

The modern western world, and its way of thinking about life in the world, seems so appealing, because it says to people that it’s your life and what you do with it is up to you. And that seems so liberating. But it’s ultimately cruel, because it means that your value and meaning comes from what you do. But what happens when an illness prevents you from doing those things that once gave your life value and meaning? When you can’t do those things, you’re left with despair. And the modern western world has no solution for despair apart from death.

But Christianity is kind. Christianity is kind, because it says that the God who made you gives value and meaning to your life, because his glory is seen in you. And he offers you everlasting life and happiness in his presence through faith in his Son who loved you so much that he was willing to die for you. The modern western world is cruel, because its only solution for despair is death. But Christianity is kind, because it gives hope to the world of everlasting life.