Physician-Assisted Suicide

You shall not murder.

Definition

Physician-assisted suicide occurs when a doctor writes a prescription for a fatal overdose so that a patient, usually one with a terminal diagnosis, can end his or her own life; unlike euthanasia, where a physician carries out the lethal act directly, the patient here takes the final, fatal step alone.¹ It is also distinct from withdrawing treatment, where an underlying disease is simply allowed to run its course.² Because Scripture treats self-killing as a violation of the sixth commandment, this practice stands against the sanctity of human life.¹

Confessional Witness

The 1689 London Baptist Confession has no chapter devoted to suicide or medical ethics as such. It does state, in agreement with the wider Reformed confessional family, that the moral law “doth for ever bind all, as well justified persons as others, to the obedience thereof.”³ The confessional ground for treating physician-assisted suicide as a violation of the sixth commandment is this abiding force of the Decalogue, rather than any confession chapter naming the practice itself.

Biblical Basis

Several suicides are recorded in Scripture without approval: Saul and his armor-bearer at the end of a losing battle (1 Sam. 31:3-6), Ahithophel (2 Sam. 17:23), Zimri (1 Kings 16:18), Judas (Matt. 27:5), and possibly Abimelech (Judg. 9:54). Each of these figures was in rebellion at the time of his death, and Scripture nowhere commends the act.¹ Samson’s death, which came from destroying a temple while inside it and taking many Philistines with him (Judg. 16:29-31), is treated separately as an act of war rather than an instance of suicide.¹

Suicide violates the sixth commandment, since the prohibition of murder extends to taking one’s own life.¹ Scripture is nonetheless candid about the reality and weight of the temptation to it: Job, under his own suffering, considered hanging himself (Job 7:15), and the text records this without treating suicide as therefore a morally acceptable response to unbearable pain.¹ A believer who dies by suicide remains within the scope of salvation by grace (Eph. 2:8-9); Scripture’s rejection of the act is not the same claim as a rejection of the person.¹

Historical Development

Oregon’s 1997 Death with Dignity Act was the first US law permitting physician-assisted suicide specifically; Washington, Montana, Vermont, New Mexico, and California followed over the next two decades, with Colorado, the District of Columbia, and Hawaii added by 2019.² In 1997 the United States Supreme Court, in the companion cases Vacco v. Quill and Washington v. Glucksberg, held that there is no constitutional right to die, leaving the question of legalizing physician-assisted suicide to individual states.²

The case that did the most to popularize the practice was Brittany Maynard’s. Diagnosed with terminal brain cancer in January 2014, Maynard relocated from California, where the practice was not yet legal, to Oregon specifically to use its law, and died there that November after taking a prescribed lethal dose.²

Opposing Views

Proponents of physician-assisted suicide generally extend to it the same case made for euthanasia: mercy toward unbearable suffering and personal autonomy over the timing and manner of one’s own death.² Some go further and argue physician-assisted suicide is morally cleaner than euthanasia precisely because the patient, not the physician, performs the final act. Maynard herself argued this way, rejecting the label “suicide” for her own choice: “I’m not killing myself. Cancer is killing me. I am choosing to go in a way that is less suffering and less pain.”²

Objections and Responses

Physician-assisted suicide is not really suicide, since the disease, not the patient, is what kills. Magnuson finds Maynard’s own distinction unpersuasive on her own terms: the impulse behind most suicide is less a desire to be dead than a desire to be free of pain, which is exactly the motive Maynard herself named for taking a lethal prescription.² Self-administering that dose still involves a deliberate choice to end one’s own life before the disease would have; that the disease was going to be fatal eventually does not remove the intervening deliberate act, so Scripture’s prohibition of self-murder still applies.¹

Since the patient, not the physician, performs the final act, physician-assisted suicide carries less moral weight than euthanasia. Nothing in the sixth commandment’s prohibition of self-murder turns on who administers the fatal dose; a physician who knowingly supplies the means for a patient’s death remains morally implicated in it even without directly causing it, a point the underlying medical tradition once captured in the maxim “always to care, never to kill.”² The same objections raised against euthanasia generally, including from mercy, autonomy, and the slippery-slope record of jurisdictions that have legalized either practice, bear on physician-assisted suicide as well; see Euthanasia for that fuller case.

Ending unbearable suffering by a merciful death is compassionate, not wrong. Branch does not dispute that suffering is real and terrible, but disputes that mercy requires ending the sufferer’s life rather than the suffering itself: aggressive pain management, treatment of the depression that commonly accompanies terminal illness, and the presence of others at the point of death answer the same need for compassion without requiring an act Scripture identifies as a form of killing.¹ Branch grounds this alternative in Romans 5:3-4, that suffering, endurance, and character serve God’s purposes even at the end of life, and in Christ’s own promise in John 11:25, “I am the resurrection and the life.”¹

Related Doctrines

• Euthanasia
• Suicide
• Ethics

References

1. J. Alan Branch, 50 Ethical Questions: Biblical Wisdom for Confusing Times (Bellingham, WA: Lexham Press, 2021), chap. 18, “Should Christians Affirm Physician-Assisted Suicide?” ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

2. Ken Magnuson, Invitation to Christian Ethics: Moral Reasoning and Contemporary Issues (Grand Rapids, MI: Kregel Academic, 2020), chap. 13, “Euthanasia and Physician-Assisted Suicide.” ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

3. The Second London Baptist Confession of Faith (1677/1689), chap. 19, “Of the Law of God,” para. 5. ↩