Euthanasia

In his hand is the life of every living thing and the breath of all mankind.

— Job 12:10 (ESV)

Euthanasia is the act of intentionally killing a patient, typically by lethal injection, out of a professed motive of mercy toward someone suffering from a terminal illness or an incurable condition. The word comes from the Greek eu (“good”) and thanatos (“death”).¹ It is distinguished from physician-assisted suicide, in which a doctor supplies the means for patients to end their own lives rather than administering the lethal act directly,¹ and from withholding or withdrawing treatment that has become futile, which allows an already-dying patient to die rather than causing death.²

Confessional Witness

The 1689 London Baptist Confession, written three centuries before euthanasia entered public debate as a medical and legal question, does not name it. Two of its chapters bear on the question it raises.

The Confession states that God created man and woman “being made after the image of God, in knowledge, righteousness, and true holiness,” with reasonable and immortal souls.³ That image does not depend on a person’s health, usefulness, or stage of life; a patient disabled by terminal illness bears it the same as anyone else.

The Confession also states that the moral law, “after his fall, continued to be a perfect rule of righteousness,” delivered by God at Sinai “in ten commandments… the four first containing our duty towards God, and the other six, our duty to man.”⁴ The prohibition on murder falls within that second table, though the Confession itself, unlike some catechisms, does not enumerate the Ten Commandments individually.

Biblical Basis

The sixth commandment, “You shall not murder” (Ex. 20:13), grounds the historic Christian objection to euthanasia as a form of intentional killing.⁵ That prohibition rests on humanity’s creation “in the image of God” (Gen. 1:26-28), a status the Bible does not make contingent on a person’s circumstances, abilities, or usefulness to others.⁵ Scripture also commends care for the suffering as care rendered to Christ himself: “I was sick and you visited me… as you did it to one of the least of these my brothers, you did it to me” (Matt. 25:35-40).⁶ For those tempted to see death as the only answer to fear and pain, “the LORD is near to the brokenhearted and saves the crushed in spirit” (Ps. 34:18).⁵

Historical Development

The Hippocratic tradition

The Hippocratic oath, originating with Hippocrates of Cos (c. 460-c. 370 BC), bound physicians who swore it neither to “give a deadly drug to anybody if asked for it,” nor to “make a suggestion to this effect.”⁷ For centuries the oath, or some version of it, stood as a professional guardrail summarized in the phrase “Always to Care, Never to Kill.”⁷ By the mid-1990s, a survey of 157 American medical schools found that only one still used the original oath, while just 14 percent of schools’ versions prohibited euthanasia and assisted suicide at all.⁷

Right-to-die cases and legalization, 1976-2015

A series of American legal cases brought end-of-life questions before courts and the public over four decades. Karen Ann Quinlan’s parents won a 1976 New Jersey Supreme Court ruling permitting removal of her respirator, though she continued breathing unaided for nearly a decade afterward.⁸ Nancy Cruzan’s parents won permission in 1990 to remove her feeding tube after the U.S. Supreme Court had first denied the request for lack of clear evidence of her wishes.⁹ Terri Schiavo’s case, disputed for years between her husband and her parents, ended in 2005 when a Florida court ordered her feeding tube removed.¹⁰ Unlike these three, Brittany Maynard was conscious and asked to die: in 2014 she moved from California to Oregon to use its Death with Dignity Act, dying by prescribed lethal dose that November.¹¹ Her case contributed to California’s 2015 legalization of physician-assisted suicide; by 2019, Colorado, the District of Columbia, and Hawaii had joined Oregon, Washington, Montana, Vermont, and New Mexico in permitting some form of it.¹²

The Netherlands

The Netherlands has tolerated and eventually decriminalized euthanasia for decades, permitting it for patients at least twelve years old (with parental consent required between ages twelve and sixteen) who are experiencing unbearable suffering and have persistently requested it.¹³ Reported Dutch cases have extended beyond this original standard: one twenty-something woman was legally euthanized in 2016 after childhood sexual abuse left her with depression, PTSD, and an eating disorder, though she had no terminal illness.¹⁴

Opposing Views

Philosopher James Rachels, a prominent defender of euthanasia, built his case around a paradigm of a patient who is deliberately killed, near death, suffering terrible pain, has asked to be killed, and is killed as an act of mercy.¹⁵ On this basis he argued that mercy alone justifies ending unbearable suffering, that a qualified utilitarian calculation shows active euthanasia benefits everyone involved and violates no one’s rights, and that the Golden Rule commits us to grant others what we would want for ourselves.¹⁵ Karen Lebacqz went further, calling it “absurd, if not obscene” to question whether euthanasia is permissible for a consenting, terminally ill patient in “enduring and intractable pain.”¹⁶

Rachels also distinguished active euthanasia (the patient “is killed”) from passive euthanasia (the patient “is not killed but merely allowed to die”), arguing that if passive euthanasia is sometimes permissible, active euthanasia should be too, since it is often more humane.¹⁷

Objections and Responses

The argument from mercy assumes killing is the only way to end suffering. Advances in pain management have made unbearable physical pain avoidable in the great majority of cases; the National Cancer Institute states that “having cancer doesn’t mean that you’ll have pain. But if you do, you can manage most of your pain with medicine and other treatments.”¹⁸ The euthanasia debate has increasingly moved beyond physical pain toward loss of autonomy and “quality of life” as the justification, a shift the mercy argument alone does not anticipate.¹⁹

Personal autonomy includes the right to determine when and how one dies. In 1997 the U.S. Supreme Court, considering Vacco v. Quill and Washington v. Glucksberg, found no constitutional right to die.²⁰ A right to die grounded in radical autonomy denies that human beings are dependent, “first and last, on God, who is our creator and sustainer,” and ironically requires enlisting another person’s help to exercise it, which is less an act of assistance than one of abandonment.²¹ As Gilbert Meilaender observes, “death is the starkest reminder of our limits. It is therefore a peculiar moment at which to attempt to seize ultimate control of our life and pretend that we are independent self-creators.”²²

Rachels’ distinction between active and passive euthanasia collapses the more important distinction between killing and allowing to die. Most patients who die after treatment is withheld or withdrawn are not victims of passive euthanasia at all: when further treatment is truly futile, “the decision not to begin or continue treatment is made without the intent to hasten death.”¹⁷ John Stott makes the same point: “there is a fundamental difference between causing somebody to die (which is euthanasia) and allowing him or her to die (which is not).”²

If we euthanize suffering animals out of mercy, why not suffering people? The comparison assumes human beings and animals should be treated alike, but Christians draw a principled distinction: animals do not bear the image of God as human beings do, and in the case of animal euthanasia, no one asks the animal’s consent, since someone else simply judges it more merciful for the animal to die.²³

Restricting euthanasia to a narrow set of hard cases, with adequate safeguards, would prevent abuse. Once the underlying principle is granted, that a person’s own judgment that death is preferable to continued suffering can justify killing, it is difficult to explain why the boundary should stop at physical pain, at adults, or at patients who can consent. Rachels’ own paradigm case has, in jurisdictions that have legalized euthanasia, been followed by extensions to those merely anticipating future suffering, to non-physical suffering, to children with parental consent, and to patients unable to consent at all.²⁴ The Netherlands’ own experience, moving from a narrow standard to the 2016 case of a non-terminally-ill woman euthanized for psychological suffering, illustrates the same trajectory.¹⁴

Related Doctrines

References

Ken Magnuson, Invitation to Christian Ethics: Moral Reasoning and Contemporary Issues (Grand Rapids, MI: Kregel Academic, 2020), chap. 13, “Euthanasia and Physician-Assisted Suicide”: “Euthanasia literally means ‘good death’… In simple terms, the person who triggers the lethal act is what distinguishes physician-assisted suicide, where the patient initiates the act, and euthanasia, where typically it is a physician who initiates the lethal act.” ↩ ↩²
Magnuson, chap. 13, quoting John Stott: “to withhold or withdraw useless treatment from a terminally ill patient is not euthanasia. Nor is the administration of painkillers to a dying patient which may incidentally accelerate death, but the primary intention of which is to relieve pain… there is a fundamental difference between causing somebody to die (which is euthanasia) and allowing him or her to die (which is not).” ↩ ↩²
The Second London Baptist Confession of Faith (1689), chap. 4, “Of Creation,” para. 2. ↩
The Second London Baptist Confession of Faith (1677/1689), chap. 19, “Of the Law of God,” para. 2. ↩
J. Alan Branch, 50 Ethical Questions: Biblical Wisdom for Confusing Times (Bellingham, WA: Lexham Press, 2021), chap. 19, “Should Christians Affirm Euthanasia?,” 97-99: “The principle of the sanctity of human life forbids taking an innocent human life… Because all humans are created in the image of God (Genesis 1:26-28), Christians reject the idea that people with no purported value to society are expendable.” ↩ ↩² ↩³
Magnuson, chap. 13: “We ought to affirm the life of human beings, made in the image of God, in all of its stages… We ought to affirm God’s sovereignty over life and death, as the gracious Creator and Lord of life.” ↩
Magnuson, chap. 13. ↩ ↩² ↩³
Magnuson, chap. 13. ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13. ↩
Branch, chap. 19. ↩ ↩²
Magnuson, chap. 13, discussing James Rachels, “Euthanasia,” in Matters of Life and Death, ed. Tom Regan, 2nd ed. (New York: Random House, 1986), 35-76. ↩ ↩²
Magnuson, chap. 13, quoting Karen Lebacqz, “Reflection,” in On Moral Medicine: Theological Perspectives in Medical Ethics, eds. Stephen E. Lammers and Allen Verhey, 2nd ed. (Grand Rapids: Eerdmans, 1998), 666-67. ↩
Magnuson, chap. 13. ↩ ↩²
Branch, chap. 19, quoting the National Cancer Institute. ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13, discussing Vacco v. Quill and Washington v. Glucksberg (1997). ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13, quoting Gilbert Meilaender, Bioethics: A Primer for Christians (Grand Rapids: Eerdmans, 1996), 64. ↩
Magnuson, chap. 13. ↩
Magnuson, chap. 13. ↩