In Life and in Death We Belong to God: Euthanasia, Assisted Suicide, and End-Of-Life Issues

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Cover art: Ruf des Todes (Call of Death), by Kathe Kollwitz Courtesy of Philadelphia Museum of Art. In Life and in Death We Belong to God: Euthanasia, Assisted Suicide, and End-of-Life Issues

A Study Guide

Christian Faith and Life Area, Congregational Ministries Division, Presbyterian Church (U.S.A.)

Introduction…………………………………………………………iii

Session 1 Moral Discourse in the Christian Community…………………………..1

Session 2 It’s a New Day—or Night……………………………………………….4

Session 3 Whose Life is It, Anyhow?…………………………..….………………7

Session 4 Good Death, Bad Death………………………………………………..10

Session 5 Scriptural Perspectives on Suffering and Death……………………….12

Session 6 The Experience of Sufferers: A Personal Encounter………………….15

Session 7 The Experience of Sufferers: What We Learn………………………..17

Session 8 Christ’s Suffering……………………………………………………...19

Session 9 On the Possibility of Knowing That One’s Time Has Come………….22

Session 10 Responses of Caring……………………………………….………..…24 Session 11 Public Policy: Striving for a Better World……..……………………..27

Session 12 Conclusion……………………………….………………………….…30

Appendix 1 Glossary of Terms………………………………….………………….32

Appendix 2 A Sermon and a Response………………………….………………….33

Appendix 3 Prior Denominational Statements on Euthanasia…..….…….………...40

Appendix 4 A Commitment to Caring…………………….………………………..53

Appendix 5 Selected Bibliography………………………………………….……...55

Response Form…………………………………………………….57 INTRODUCTION

Why has the denomination • Critical issues (a prepared this study guide? summary statement of The 202nd General Assembly (1990) of basic theological issues) the Presbyterian Church (U.S.A.) • Questions of group directed the Theology and Worship discussion Ministry Unit (now called the Offices of • Suggested prayers Theology and Worship) to prepare a • Suggestions for group study document examining the process theological issues that emerge from a Study participants may wish to prepare consideration of the public debate of for each session by reading the goals, the euthanasia and assisted suicide. While suggested Scripture, and the critical previous General Assemblies have issues. The other resources that are touched on the topic of euthanasia (see listed can also be read in advance or can Appendix 3), it has not up to now been be used as material for further reflection the subject of a full-scale at the end of the study. denominational study. While it is possible to structure As part of its effort, the Office of discussion around the “Questions for Theology encouraged a number of Group Discussion,” the task force and congregations and other grassroots the Office of Theology believe that the groups throughout the denomination to study will have greater value if it takes engage in study of these issues, and to place in communities characterized by appraise preliminary study materials. prayer and mutual accountability. The “Suggestions for Group Process” On the basis of what it learned from indicate ways to give significant participants in these groups, as well as attention to the community’s common from a group of professors in one of our life. Note that each session includes denomination’s theological schools, the more suggestions than a study group will Office of Theology supervised the probably use. Participants are preparation of this second and final encouraged to modify sessions to meet study guide, working with a task force of the needs of their particular groups. thirteen persons, many of whom had participated in the grassroots studies. It is possible to condense the study into fewer sessions. The Office of Theology, What does the study guide however, encourages groups to use as many sessions as possible. (A possible include? eight-session study would utilize Each of the twelve sessions includes: Sessions 1 through 4 and Sessions 9 • Goals through 12.) Personal, self-directed • A list of resources study of each session is also possible. • Suggested Scripture readings The appendices include a glossary of terms, a brief bibliography, and portions of prior denominational statements that touch on euthanasia. In addition, a suicide, it concluded that they point to sermon and a response are included as a broader issues of suffering and dying. model for the kind of discussion that can The study’s overall goal, therefore, is to take place in congregations. help Christians consider what is at stake for the faith when people face end-of-life At the end of the study, participants are issues, including euthanasia and assisted asked to return a response form (pp. 57- suicide. Basic to the study are questions 59) to the Office of Theology. Your of Christians’ response to those who comments will help the Office of suffer and die. Theology determine whether to take additional steps to address issues relating While the study suggests no neat to euthanasia, assisted suicide, and end- resolution of the issues, it will encourage of-life decisions. A summary of participants to wrestle with ambiguities, responses will be shared with the to respect one another’s perspectives, General Assembly and General and to model ways of effectively Assembly Council. considering controversial topics. The authors hope that, when the study Who can lead a group? concludes, participants not only will Any minister or member who has a have learned new information but will lively interest in helping others explore have also grown in faith. and understand euthanasia, assisted suicide, and end-of-life issues can help This growth in faith may embody a lead the study. In some cases, it may be certain tension. On the one hand, the possible to form a leadership team of study encourages open conversation. As pastors, physicians, nurses, and attorneys a community of moral discourse and from within a congregation. action, we can learn as a church that controversy need not tear us apart. If a What assumptions shape the study group meets in a spirit of respect and guide? understanding, it can find its common life stronger in the end, despite people’s The study does not promote a particular differences. church policy or legislative agenda relating to euthanasia or assisted suicide. On the other hand, the study identifies It does encourage participants to Scripture, confessions, and personal consider a wide spectrum of views and resources that can help participants make experiences. decisions, identify boundaries, clarify their own positions, become aware of Persons will come away from this study different cultural perspectives, and know having wrestled with the gravity of these what God requires both of them and of issues for themselves. They will the church as a whole. encounter the Christian moral tradition, address questions of faith, and listen to Session 6, “The Experience of the wisdom of others who have engaged Sufferers: A Personal Encounter,” will in similar reflection. require special preparation. This session asks class participants to engage in As the task force explored issues conversation with persons who have relating to euthanasia and assisted faced end-of-life decisions, with persons should bring a Bible to each session. It who have actually considered the option will also be helpful for each member of of euthanasia or assisted suicide, and the group to have a copy of the study with health care professionals. Study guide. leaders will need to be in extended conversation with physicians, nurses, Members of the Task Force chaplains, hospice workers, and others in Task force members included: Richard order to arrange this session. Allman, Villanova, PA; Eugene Bay, Bryn Mawr, PA; Margaret Cheesbrough, An important supplemental resource is Prescott, AZ; Brian Childs, Decatur, the book Choosing Death: Active GA; John Dalles, Pittsburgh, PA; Bruce Euthanasia, Religion, and the Public Humphrey, Prescott, AZ; Peggy Debate, edited by Ron P. Hamel and Lindamood, Paradise Valley, AZ; published in 1991 by Trinity Press Michael Krech, Memphis, TN; Linda International. This book provides a Peeno, Louisville, KY; Dell Richards, summary of past and contemporary Iowa City, IA; Blake Richter, Iowa City, Christian thought relating to euthanasia, IA; and Polly Schrimper, Memphis, TN. assisted suicide, and end-of-life issues. Copies of Choosing Death may be Joan McIver Gibson, Albuquerque, ordered from the publisher (Trinity Press NM, and Herbert Hendin, New York International, 3725 Chestnut Street, City, NY, offered the task force special Philadelphia, PA 19104). The study, assistance. however, is not of the book itself but of the theological issues that emerge from a John Burgess and Dick Junkin provided consideration of euthanasia, assisted staff support from the Offices of suicide, and end-of-life decisions. Theology and Worship in the Christian Faith and Life Area. Since reflection on Scripture will be an important part of the study, participants SESSION 1 Moral Discourse in the Christian Community

Goals In this session, participants will (1) get As Reformed Christians, we believe acquainted with one another; (2) get that God generally speaks better through oriented to the study as a whole, all of us, as we engage each other, than including what they will do, why they through the view of any one of us will do it, and how they will do it; and individually. The church is and should (3) be invited to commit themselves to be a community of moral discourse and making the study a success. action. A community of moral discourse and action is one in which people Suggested Resources acknowledge their need for each other’s “The Church: A Community of Moral wisdom and experience as they try to Discourse,” James M. Gustafson, in The resolve basic questions of right and Church as Moral Decision Maker wrong. When the church is such a (Pilgrim Press, 1970) community, it allows people to speak freely, to raise big questions, and to A Brief Statement of Faith grapple with the fundamental issues of human existence. Glossary of Terms (Appendix 1) As we begin this study, it is appropriate Suggested Scripture: for us to think together about the Ecclesiastes 3:1-22 character of the church. In baptism, we Romans 8:28-39 die and rise with Christ (Romans 6:1-4). Romans 12:3-5 We become a covenant people committed to realizing God’s purposes. Critical Issues Though we often fall short of these purposes, we cannot forsake them When Christians gather to reflect on without forsaking ourselves. As the euthanasia, assisted suicide, and end-of- Brief Statement of Faith proclaims, “In life issues, our principal goal in neither life and in death we belong to God.” It to engage one another in debate not to is this identity as God’s people that satisfy intellectual curiosity. Debate and make us a community of moral discourse satisfaction of curiosity are good and and action, and that makes discussion in have their place, but Christians gather the Christian community distinctive. for another purpose. When Christians approach euthanasia, assisted suicide, Life in community with God and with and end-of-life issues, we seek to learn one another contrasts with much of more about ourselves, about our world, contemporary society and its and about God. We seek to grow in our commitment to autonomy. (For a capacity to live with faith and joy, to definition of “autonomy,” see the come nearer both to God and to one Glossary of Terms, Appendix 1.) another, and to draw on our theological and moral tradition in order to relate it to Throughout the study, we will be new challenges and situations. asking ourselves how our being Christians and members of a community of moral discourse and action shapes our Suggestions for Group Process understanding of these issues and our 1. Read Ecclesiastes 3:1-22. Invite response to them. participants to join in praying together: Opening Prayer: O This study is both deeply personal and God of every moment, we read deeply corporate. It is personal because your Word, and so we believe it is we ourselves who are to be that there is a time, a season, for transformed and renewed in the depths every purpose under heaven. of our beings. The life of each of us is And yet, when we face the tough on the line. But we are also on the line issues of intractable pain or together. We are not a gathering of overwhelming suffering, and isolated individuals, but of brothers and when we know that we have sisters who learn from one another and technology to prolong our dying, who are accountable to one another. what does it mean to say, “a time Rightly undertaken, therefore, our study to be born and a time to die”? involves mutual commitments and a These words sound so fitting, but common discipline. then out circumstances blur their meaning. When this happens, O Questions for Group Discussion God, how can we know whether 1. Why are we interested in it is a time to weep, or a time to studying euthanasia, assisted mourn? Speak to us, we pray, so suicide, and end-of-life issues? that all we say and do together What is there about our own lives may be synchronized to your that makes the issues important timing. In Jesus Christ our Lord. to us? How would we like to be Amen. different as a result of this study? 2. Invite participants to mention 2. What will it mean for us to their names and to take a few approach these difficult moral moments to say why it is that, at issues as persons who in life and this particular moment of their death belong to God? What is lives, they choose to invest their (or should be) different about our time and energy in this particular doing this study together than if study. it were being done by a group of persons without a common faith 3. Draw out stories from in Jesus Christ? participants based upon their own experiences with family 3. What do we owe one another as members or friends in the last we undertake this study? How stages of life. Then, in pairs or might we become a community threesomes, ask participants to of moral discourse? What reflect on what obstacles may commitments might we make to exist for them personally or for one another that would help all of the entire group in discussing this us benefit from the study to the topic. Invite them to share some greatest possible extent? of their concerns with the whole issues, these issues will class. be framed in such a way as to draw attention to 4. Discuss with participants the issues of a more general goals for the study and the way nature, including our you are going to try to achieve identity in Christ, the them. As you do so, you might relationship of faith and wish to make such points as the culture, and the way following: Christians make a. You will be intentional in decisions. looking at euthanasia, e. We are approaching this assisted suicide, and end- study opportunity open to of-life issues not as just one another’s diverse anyone might but as views, opinions, beliefs, people who find their and cultural traditions. identity in Jesus Christ. b. You will therefore be 5. Invite participants to read approaching these issues together Romans 12:3-5 and to as people who live in a discuss the commitments they are certain way: who pray prepared to make both to together, who share their themselves and to one another as lives with others, who members of one body of Christ in take the concerns of the order to help make the study a world seriously and try to success. (Such commitments understand what is might include that of being happening in it, who present at each session, carrying listen carefully to out any assignments, praying for Scripture, and who seek the class as a whole and for one to know God’s will for another in particular, responding the community and to act honestly and openly as issues upon it. come up in the class sessions, c. When this study is over, and keeping a journal of thought, the most important thing feelings, and reflections.) will be not what has been learned about euthanasia, 6. Before concluding, tell assisted suicide, and end- participants that in the next of-life issues, but whether session they will be discussing the participants have the new challenges and grown in faith and in their responsibilities presented by capacity to live their lives advances in medical technology. faithfully. d. While the content of each 7. Conclude by reading Romans of the sessions of the 8:28-39 and inviting participants study will be related to to pray together: euthanasia, assisted Closing Prayer: O God, our suicide, and end-of-life source and sovereign, you chart all of our journeys and every remember that we were not born moment of life is in your for death but for life. Be with us keeping. We praise you for you and with all who cry out, “O never-failing love in Jesus Christ, Lord, save my life.” When the and we rejoice that you care for winnowing wind sweeps over us, us without limit. You hold us may we learn to bend and yet not close through all circumstances, break. And though we are turned whether mountaintops of joy or about, help out faith remain an valleys of sorrow. O God, when ever-fixed mark. In Jesus Christ we walk those valleys, may we our Lord. Amen. SESSION 2 It’s a New Day—Or Night

Goals generally live longer. We can affirm a In this session, participants will (1) list health care system that values and the concerns that make our era a new protects our autonomy: We should have day (or night) in relation to euthanasia, a right to receive and refuse treatment. assisted suicide, and end-of-life issues; Yet out technology had advanced so (2) explore the social context of these rapidly that we are experiencing a new issues; and (3) reflect on what it means day (or night) in our medical to deal with these issues as Christians. capabilities. Difficult, troubling issues confront us. We have reason to fear that Suggested Resources the good we intend with our medicine Heidelberg Catechism, question 1 can become distorted. At what cost do we prolong our dying after many good A Brief Statement of Faith years of living? At what cost do we prevent those with multiple birth defects Glossary of Terms (Appendix 1) from dying, even if their future “quality of life” appears minimal? Suggested Scripture: Genesis 11:1-9 These questions imply a number of Psalm 14 larger issues. One set of issues concerns 1 Corinthians 13:8-13 our faith in technology. While the best intent of the medical community is to Supplemental Scripture: heal, we know that we live in a world of Genesis 1-3 sinful human nature. Are we tempted to Romans 3:10-18 make technology our god, seeking to 1 John 1 prolong human life at any cost?

Critical Issues A second set of issues concerns the complexities of medical economics. The Gospels tell us again and again of What forces provide for, or prevent Jesus’ concern to heal people with access to, health care? How do we physical, emotional, and mental provide for just allocation of resources afflictions. Jesus was deeply concerned for healing? How do we deal with for the wholeness and well-being of realities of resource rationing both in our people. As Christians, we too seek the own country and in a world context wholeness and well-being of others. We (where, for example, the cost of one are committed to healing the brokenness heart transplant may be equivalent to the of the world and to helping people with cost of vaccinating thousands of children illness and disease. in the third world)? Yet issues of wholeness and healing are Third, we face issues relating to the complex. We can celebrate the good nature of suffering, especially suffering that medical science offers: More at the end of life. What constitutes people are able to get well, and people “quality of life”? How do we care for the least of our brothers and sisters? Scripture as the basis for what we What does it mean to be a child of God, believe and do; drawing on the best dependent both upon God and upon wisdom of our tradition; engaging in others? ministries of compassion; acting as faithful stewards of God’s creation; Fourth, there is the danger that the cost seeking justice and living in obedience of medical treatment will undermine our to God’s Word. commitment to compassion. What will happen if a right to euthanasia converges The question narrowly defined appears with a situation of economic constraint? to be whether it is ever morally How do we guard against the possibility acceptable and consistent with Christian that people will choose death or be practice for people to kill themselves or pressured to choose death in order to to seek assistance in ending their lives save money? when death is imminent or suffering is intractable. Questions of euthanasia and assisted suicide cannot be separated from larger Yet it is not entirely clear that this issues surrounding suffering and dying. question is the most important one for us Twentieth-century medical and to ask. As this and the remaining technological advances have created a sessions of this study unfold, many other new kind of crevice between life and end-of-life issues will emerge, including death. In this crevice, we find those questions of withdrawal of treatment, whose dying is a lingering twilight, alleviation of pain (even at the risk of those in a permanently unconscious death), and quality of care. As state, as well as newly-born children participants work together, they will with such severe problems that their very consider the possibility that issues of existence seems more a biological euthanasia and assisted suicide raise a mischance than a genuine life. Our laws more fundamental question: How do we and our ethics have not yet managed to shape a kind of medicine that bridge this crevice. concentrates not only upon curing but also upon caring, and where medical These questions challenge our theology personnel and patients are more fully too. How might our Reformed faith partners in healing and decision-making? address the needs of these living-dead, or dead-living? How might it respond to Questions for Group Discussion those who wish to choose death, even if 1. What in your experience helps they are still relatively healthy? What explain why euthanasia, assisted does it mean to be a member of Christ’s suicide, and end-of-life issues body? Are there limits to our freedom to have become topics of such great choose for ourselves? concern over the past century?

Christians are called to address these 2. What current medical technology issues from a faith perspective, utilizing have you experienced that the traditional resources of faith: reassures you? What do you find engaging in personal and corporate frightening about it? prayer; reading and appealing to 3. Which concerns in particular do account for why euthanasia, Christians bring to a discussion assisted suicide, and end-of-life of euthanasia, assisted suicide, issues are more of a concern and end-of-life issues? today than a century ago. You may wish to ask them to consider Suggestions for Group Process ways they have experienced (a) 1. Read aloud 1 Corinthians 13:8- the ability of modern medicine to 13 and the first question and keep people alive beyond what answer of the Heidelberg was possible in past generations, Catechism. Invite participants to (b) the impact of suffering on join in praying together: quality of life, and (c) the Opening prayer: O God of all, our unevenness in medical about how fortress and fountain, we celebrate they experience the technology the wonders of life and the goodness of modern medicine: What of health and the authority of your seems reassuring about it? What healing power. We thank you, as seems frightening about it? well, that you have given us a measure of your own wisdom and a 5. Invite the participants in small knowledge of how to work for the groups to consider one or both of healing of others. Yet, we admit that the following case studies: our thankfulness sometimes Case A oversteps appreciation and moves to Alec is a Christian, a 35-year-old an infatuation with medical man who has a history of heart technology. Our trust twists away problems. He wears a pacemaker. from you to lesser purposes. For He has also been diagnosed with this, we are sorry. Be with us as we metastatic lung cancer. He has no seek to understand how medicine can blood relatives. A close friend has be an instrument of your everlasting agreed to be the decision maker for care as will as a source of bodily him, but Alec has not yet signed a cure. Through Jesus Christ our Lord. durable power of attorney statement. Amen. His illness has brought him to the hospital, where he learns that 2. As what, if anything, the chemotherapy will provide him, at participants have seen or heard best, about six more months to live. since the last session As he talks with his physician, Dr. (newspapers, television, radio, Pratt, in the hospital, Alec says that art, etc.) that has reminded them he is tired of fighting his disease, that of the concerns of this study. he does not want to go on with the chemotherapy, and that he no longer 3. Refer participants to the wishes to receive morphine for his “Glossary of Terms” (Appendix pain. He is not afraid of addiction; 1), and ask them to become he wants the course of his disease to familiar with it. proceed naturally. Alec also says that he wishes Dr. Pratt to “zap” his 4. Invite participants to discuss any pacemaker, to scramble its signal, so personal experiences that help he will die. Alec reasons with his doctor that since he gave permission would be the most loving thing either to insert the pacemaker, he also has one of could do.” the right to request that it be deprogrammed. Dr. Pratt, troubled Following the discussion in small by the role Alec is asking him to groups, invite a member of each play, consults the hospital’s ethics group to describe in plenary the department. Among the concerns issues raised by the case they Dr. Pratt wishes to discuss are discussed, asking the group as a whether deactivating Alec’s whole: “Is it morally acceptable and pacemaker will be considered a consistent with Christian practice for lethal action. persons to seek assistance in ending Case B their lives?” Della is a lifelong Presbyterian and 63-year-old widow. Until her recent 6. Move into a general discussion. hospitalization three weeks ago, she Invite people to discuss the way had lived alone in a first floor Christians should think about apartment and enjoyed her these issues. Remind independent living. She was participants of the affirmation in admitted to the hospital for difficulty A Brief Statement of Faith that in breathing caused by her pain “In life and in death we belong to medication, which gave her relief God.” Ask them how this from the pain of poor circulation in affirmation might affect the way her legs and arms. Della is also a they think about these issues. diabetic and has heart problems. (You may wish to use the Because of her circulatory problems, supplemental Scripture readings the doctors are recommending to help move the discussion multiple amputations of her fingers forward.) and feet. They do not expect her to be able to live alone and predict that 7. Before ending this session, tell she will need constant attention. Her participants that in the next daughter and son-in-law want her to session they will be discussing have the operation, though they live issues of control, autonomy, and in another part of the country and stewardship of our bodies and cannot take her into their small invite them to prepare by reading home. Della refuses to have the chapter 3 of the book Choosing operation. She says, “I have lived a Death. good life. Why should we spend what I have on a nursing home? My 8. Conclude by reading Psalm 14 daughter, son-in-law, and grandchild and inviting the participants to would be better off with my pray together: insurance money now, rather than go Closing prayer: O Righteous into debt to pay some nursing home One of Israel, we acknowledge to watch me die. If my heart doesn’t that we are your children. In life stop soon, why can’t my doctor help and in death we belong to you me with the pain medication? That and are linked to one another by your love. Help us be more aware of how dependent we are a reciprocal joy in our service to upon you and how one another. As we join in a interdependent we are with the shared quest for each other’s rest of your children, who well-being, may we ever hold in comprise our global family. common a reliance upon your Give us a greater measure of grace. Through Jesus Christ our mutual concern, and restore to us Lord. Amen. SESSION 3 Whose Life Is It, Anyhow?

Goals Yet none of us can escape nagging In this session, participants will be anxieties about the end of life. Our invited (1) to discuss why our lives are desire to be in control of our destiny not ours alone; (2) to explore issues of merely underscores our fear that we personal autonomy and life in really are not in control, that powers and community; and (3) to determine, from a forces greater than ourselves will finally Christian perspective, whether or not dictate both the way we live now and the there is such a thing as a right to die. way we will eventually die.

Suggested Resources We may attempt to ignore these Choosing Death, chapter 3 anxieties or even to repress them. We may try to keep ourselves busy with the Westminster Shorter Catechism, lives that we wish to make for ourselves. question 1 But again and again we experience limits to our efforts. For all our talk about Suggested Scripture: individual rights, we know that we also Genesis 1:26-31 need others. We long for friendship and Philippians 2:1-18 community. We long for comfort in the midst of our own brokenness and in the Supplemental Scripture: midst of a broken world. We long for Genesis 23:4 ultimate assurance that we make a Exodus 20:13 difference and that we are not entirely Deuteronomy 26:5 alone. Judges 21:25 Isaiah 40:8 As Christians, we understand life as a Matthew 25:31-46 gift that we hold in trust from God, our Romans 14:7-9 Creator. Even when we succumb to 1 Corinthians 6:20 anxious strategies either of trying to Ephesians 5:29 control what we cannot or of refusing to Philippians 1:21 do what we can (trusting God and each other), we hear another voice among us, Critical Issues the words of Scripture and of Christians of other times and places, reminding us We often live as though life were our that we belong to God and that our chief own to do with as we please. We are purpose is “to glorify God and enjoy him tempted to act as if our lives go on forever” (Westminster Shorter forever and are completely under our Catechism, question 1). control. When we experience constraints on what we wish to do, we When we understand that we hold our protest. We claim a right to choose what lives in trust from God, we become all is best for ourselves. the more aware that life is fragile, precious, and passes so very quickly, that we are therefore called upon to be good stewards of life, both our own and community go in asking us to test our others’. We also become thankful. We decisions against its larger wisdom? come to mark our lives with daily Can we ever become such a burden to gestures of gratitude, trusting that God the community that it has the obligation will care for us through life and death, to let go of us for the common good? even when we are unable to make sense of them for ourselves anymore. Christian moral tradition has generally been reluctant to allow for the possibility Yet living by this trust is not easy. As of euthanasia or assisted suicide. It has, Christians make decisions in the face of however, often justified the decision to suffering and death, we find that the withhold or withdraw treatment, even if good that we seek for ourselves does not death results more quickly. The key necessarily correspond to the good that question has been whether or not God seeks for us. medical interventions are able to reverse the dying process. In broad terms, “personal autonomy” is the major concern here. If our life is One finds a similar tension in relation God’s gift in trust to us, and if death is to pain. The Christian tradition has often the end of our earthly life, how do we, as allowed for the possibility that members of the Christian community of alleviating pain through drugs may moral discourse and action, face death? induce death. The key question has been If God cares for us, must we accept even one’s intent in administering them. intractable suffering and a process of prolonged dying? Does God ever ask us As we noted in Session 2, we live in a to end our life? How do we know, and new day. Medical technology puts what do we do when God appears to be Christians in a new situation. Because absent, giving us no clear answer? What we wish to respond faithfully to the are the limits to our decision-making? If choices that come at life’s end, we must we decide to leave some things in the examine the wisdom of the past and hands of God, how do we know whether determine how it speaks to our we are trusting God or simply evading circumstances today. the responsibility that God gives us to make decisions? Questions for Group Discussion 1. Is life really a gift? Why or why Personal autonomy also raises the not? question of accountability to the Christian community. As Christians, we 2. How do we as Christians respond believe that we belong to each other. to those who assert that we are We are members of the one body of free to do whatever we please Jesus Christ. What does this community with our lives? owe each of us individually as we face our deaths, and what do we owe it? Is 3. Can faithful stewardship of the there any meaningful way in which life that we hold in trust from Christians can guide each other through God ever mean the decision to the valley of the shadow of death (Psalm give it back to God? Why or 23)? How far can the Christian why not? charge to us to care for portions 4. Is there a right to die or a right to of your creation, and to seek to be dead? sustain the very lives of our brothers and our sisters. In Jesus 5. Is there a difference between Christ our Lord. Amen. putting down a pet and human euthanasia? 2. Ask what, if anything, participants have seen or heard 6. How might a Christian reconcile since the last session the tension between personal (newspapers, television, radio, autonomy and life in art, etc.) that has reminded them community? To whom am I of the concerns of this class. accountable? Are there limits to our freedom to choose for 3. In plenary, invite participants to ourselves? discuss the following quotation from Choosing Death: “It’s my 7. What do we believe about the life do to with as I please, to live biblical mandate of dominion out in accordance with my over creation? Does it mean to beliefs, values, personality and exercise this responsibility over style” (p. 30). Do we agree? Is all of life, including those created this life ours alone? Why or why in the image of God? What not? responsibility do we have to the senile and comatose? or

Suggestions for Group Process In plenary, invite participants to 1. Read Genesis 1:26-31 aloud. discuss whether there is a Invite participants to join in difference between the merciful praying together: act of putting down a cherished Opening prayer: O God, our pet and human euthanasia. Is mercy and our might, you give human life an absolute good? Is life, and your purpose gives life death an absolute evil? Do we its meaning. Yet, we avoid your have “mastery” or “dominion” purpose, and instead we carve over life? Is there a right to die, our names for ourselves. In the a right to be dead? carving, we forget you, we forget others. How long, O Lord, until 4. In pairs or threesomes, read we learn the long-term effects of Genesis 1. Ask participants to instant gratification? Our reflect upon what it means to be concern is self-worth; yet, what given dominion over God’s will become of us when, no creation. Ask each group to longer able to work, we ask, “Am write a summary statement and I only valuable as long as I am to share it with the whole group. productive?” May we at last return to you and discover life’s 5. Ask participants to discuss the meaning in you and in your following: To what extent is the desire to die with dignity a denial the meaning of “good death” and of what it means to be created by “bad death.” Ask then to read God? To what extent is the the preface and chapter 2 of desire to have doctors employ Choosing Death. “heroic measures” to save us a denial of what it means to be 8. Conclude by reading aloud created by God? Philippians 2:1-18 and inviting the participants to pray together: 6. Ask members of the group to Closing prayer: O God, our read aloud 1 Corinthians 6:20. Shepherd and Savior, who in (You may wish to include some your son Jesus chose to serve or all of the other supplemental rather than to be served and who Scripture passages: Genesis came to redeem the lost, grant 23:4, Exodus 20:13, that we may follow you. Guide Deuteronomy 26:5, Judges us in Christ’s way, so that we too 21:25, Isaiah 40:8, Matthew will put ourselves in the place of 25:31-46, Romans 14:7-9, the least of our sisters and Ephesians 5:29, Philippians brothers. There, may we look 1:21.) Then, consider how a beyond our own self-interest to Christian might resolve the the larger scope of human need. tension between personal In so doing, may we ever know autonomy and accountability to that our ties to one another and God and to the Christian our ties to you are not limited by community when considering time or circumstance, for in life euthanasia, assisted suicide, and and in death we belong to you. end-of-life issues. Through Jesus Christ our Lord. Amen. 7. Tell participants that in the next session they will be discussing SESSION 4 Good Death, Bad Death

Goals When we do manage to contemplate In this session, participants will (1) our own mortality, it is natural to share with one another what they regard imagine the circumstances of our dying as a “good death” or “bad death”; and and to hope for certain things and to fear (2) reflect on their fears and hopes when others. Having witnessed or heard about they think about dying. others’ deaths, we begin to project ourselves forward to our own bend in the Suggested Resources road and say, “May it happen like this,” Choosing Death, preface and chapter 2 or “May it not happen to me like that.”

Suggested Scripture: In contemplating our anxieties about Deuteronomy 34:1-8 our own death, we come face to face 1 Samuel 31:1-6 with the issue of our limits and finitude Job 14:1-4 as creatures of this earth. Our hopes and Luke 2:25-35 fears with respect to our dying reveal a John 10:14-18 great deal about the values we hold with John 14:25-27 respect to our living. They are, Acts 7:54-60 therefore, immensely valuable material for theological reflection. They are a Supplemental resources: profound test case, helping us Phaedo, Plato (The death of understand with greater clarity what we Socrates) actually believe about the meaning of The Death of Ivan Ilych, Leo life, about God’s providence, about Nikolaevich Tolstoy human freedom, and about out salvation How We Die, Sherwin Nuland in Jesus Christ. Needless to say, the (chapter on accidents, suicide, and reverse can also be true: To clarify our euthanasia) beliefs about life’s meaning and God’s “Because I Could Not Stop For providence and human freedom and Death,” poem by Emily Dickinson salvation can also be an opportunity to We Live Too Short and Die Too reshape our hopes and fears about our Long, Walter M. Bortz (chapter on “The dying. Last Passage”) Questions for Group Discussion Critical Issues 1. How do we define for ourselves Our dying is the final, most “good death” and “bad death”? impenetrable mystery of our lives. What is it that we hope for and Many of us have a tendency to deny its what is it that we fear with reality, to think about it as little as respect to our dying? possible, to live as if death did not, in fact, await us at the bend of the road we 2. In what sense is what we hope are traveling. for (e.g., absence of pain) and what we fear (e.g., loss of control) also that which we hope for and fear with respect to our living? 4. Explain to participants that they will spend ten minutes in silence. 3. Does the fact that Jesus Christ During the silence, each person claims our lives make it harder or should think about “good death” easier for us to die? Is it easier, and “bad death,” preparing to since we trust that we will inherit describe, in about five minutes eternal life? Is it harder, since each (or however much time will God may yet have a reason for us be available to be alive? 5. After the few minutes of silence, Suggestions for Group Process invite all the group members to 1. Read Job 141-4 together. Invite share their thoughts. the group to join in praying together: 6. After all have spoken, spend Opening prayer: O God of each some time talking about what of life’s passages, we confess participants have said. What do that our first reflex is to avoid they hope for with respect to thoughts of death—especially their deaths? What do they fear our own death or that of people the most? Do any of these hopes we love. Yet, we know that or fears also relate to what they death is part of our human life, hope for or fear about their and even when we are in the living? presence of death, you are our very present help. Help us, then, 7. Invite participants to consider to understand what it means to any differences in perspective trust in you. Grant us a calm that may result from cultural with a depth of assurance, differences among them. knowing that neither death nor life, nor things present nor things 8. In plenary, ask the participants to to come, nor heights nor depths discuss the following: Does the nor anything else can separate us fact that Jesus Christ claims our from your love, a love more lives make it harder or easier for continuous than the starts. In us to think about our own death? Jesus Christ our Lord. Amen. Why is it easier? Why is it harder? 2.Ask what, if anything, participants have seen or heard 9. In plenary, ask participants how since the last session that has being a person of faith might reminded them of the concerns of affect what one hopes for or fears this class. with respect to death.

3. If it seems helpful, participants or may recall and renew the commitments they made at the Have participants look up first session. Deuteronomy 34:1-8, 1 Samuel 31:1- 6, Luke 2:25-35, John 10:14-18, Acts As you close in prayer, suggest 7:54-60. In each of these passages, that people bear in mind the fears is death “good” or “bad”? Why? and hopes that have been expressed during this session. or Invite the group to join in If your group is reading Choosing praying together: Death, you may wish to invite Closing prayer: O God, you are participants to share any particular the very soul of concern, and questions or observations related to while the world is uncertain, you the assigned reading in chapter 2. alone are ever sure. All of life Note any questions for which they moves to the fullness of your hope to receive answers during the timing, and in life and death we remainder of this study. How does belong to you. We pray for the reading connect with the issue of ourselves and all persons that we the participants’ hopes and fears in may not die alone, without our respect to their deaths? friends or family, nor in a senseless way. Yet, grant that 10. Before concluding, tell whenever the time comes to die, participants that in the next you will tenderly gather us as session they will be discussing pebbles in your holy stream, the suffering of Jesus. refresh us with your living water, and keep us in perfect peace, all 11. Read John 14:25-27 together. sorrows ended, all loss restored. Remind participants to be in In Jesus Christ. Amen. prayer for all who are taking part. SESSION 5 Scriptural Perspectives on Suffering and Death

Goals In this session, participants will (1) One approach to Scripture would be to listen to different biblical understandings line up all the passages that seem to of the meaning of pain, suffering, and speak for or against euthanasia. On the death; (2) relate these different one hand, the Bible affirms life and understandings to their own life prohibits murder. On the other hand, the experience; and (3) talk about what it Bible records several stories of suicide means to be a part of a community that without appearing to condemn it. has resolved to listen carefully to Scripture in the fullness of its witness. Yet this approach may be too narrow. For euthanasia, assisted suicide, and Suggested Resources end-of-life issues raise basic concerns Choosing Death, chapter 4 about our understanding of pain, suffering, and death. Here Scripture has Suggested Scripture: a great deal to say. Deuteronomy 30:15-20 Job 42:2-3 When we inquire of Scripture with Psalm 20:6 respect to the meaning of pain, suffering, Psalm 22:1-21 and death, we discover several strands of Psalm 44 thought, a variety of insights and Ecclesiastes 3:2-8 emphases. In some of these strands, Isaiah 53:1-6, 10-12 pain, suffering, and death are the result Amos 8:1-8 of human sin. They represent divine Mark 8:31 punishment. In other strands, there is no Mark 15:33-34 clear reason for pain, suffering, and John 9:2-3 death. They defy explanation; we are Romans 5:3-8 left with the mystery of God’s ways, Romans 8:18-22 perhaps even a fear of divine neglect. 2 Corinthians 4:7-12 Elsewhere, Scripture sees suffering as Philippians 2:4-11 having redemptive possibilities; it may Colossians 1:24 deepen our faith. God may even ask us Hebrews 2:10, 14-18 to suffer on behalf of others. Yet 2 Timothy 1:8, 12 Scripture also recognizes that some forms of pain, suffering, and death are Critical Thinking the consequence of human oppression and human evil. God asks us to resist Christians listen to Scripture. Scripture the sources and causes of such pain, helps us unlock the mysteries of human suffering, and death. Finally, Scripture existence. While it is important to know recognizes that pain, suffering, and death the historical context of particular are part of the human condition; they scriptural passages, our primary concern reflect our finitude. is to listen to Scripture as God’s Word for us today. Listening to the whole of Scripture is Suggestions for Group Process no easy matter when we have to sort out 1. Read Romans 5:3-4 together. these different strands and apply them to Invite the group to join in prayer the complex circumstances that surround together: euthanasia, assisted suicide, and end-of- Opening prayer: O God, speak life issues. As Christians, we believe, to our hearts and minds. Tell us nonetheless, that it is in the whole of of your authenticity that is Scripture that God meets and speaks to beyond our human us. Our challenge is to take all of understanding. Help us hear you Scripture seriously and to find a way to and by your insight know that the live within its tensions. voices of human suffering defy any particular time or nation. Some may ask, “What do I do with a They are our sisters and brothers book filled with tensions, even seeming who cry out; their experience of contradictions?” Perhaps our task is not suffering is universal to our to deny the various strands, but to view mortal life. O Present Help, be them as pieces of a whole fabric of with us, and with them, with all understanding about suffering. Because whose cross seems too great to human suffering has many facets, it is bear. Help us to place all not surprising that Scripture speaks to it burdens upon you and to know, in different ways. even in the midst of turmoil, the peace that you alone can give. In Questions for Group Discussion Jesus Christ our Lord. Amen. 1. What points of view do we find in the Bible, with respect to the 2. Invite participants to share meaning of pain, suffering, and anything relating to the issues in death? How should the Christian this study that has come to their community respond to suffering attention since the last session. or death that is perceived in one way or another? 3. Divide participants into small groups. Distribute the follow 2. How do we understand the fact Old Testament texts: (a) that Scripture appears to offer Deuteronomy 30:15-20; (b) different points of view, different Psalm 22:1-21; (c) Isaiah 53:1-6; strands of thought? Is this fact (d) Amos 8:1-8; (e) Ecclesiastes troubling to us or comforting? 3:2-8. (Or use some of the other suggested Scripture passages.) 3. What does it mean to take the Note that each of these passages whole of Scripture seriously? has a different understanding of How do we live within the suffering. Ask each group to tensions created by the existence read it assigned text or text, to of different strands of thought? talk about what might be inferred How do we take seriously the from each about the meaning of variety of witness about pain, suffering, and to call to mind a suffering, and death? personal experience of suffering that the text suggests. and viewpoints that are in tension 4. In plenary, have someone from with one another? each small group report, sharing what text was read, what 7. Before concluding, tell perspective on the meaning of participants that in the next suffering they heard in it, and session they will be visiting with what personal experience of persons who have either suffering (if any) the text considered euthanasia or assisted suggested. After each small death for themselves, or have group has reported, invite people been close to persons who have from other small groups to considered such an option. suggest other ways each text Explain that the purpose of the might be heard. Finally, invite session will be to clarify the participants to discuss how the issues from the perspective both community of faith should relate of health care providers and of to anyone who might be sufferers. experiencing the kind of suffering described in each text. 8. Read Isaiah 53:2-12 together. (The way the community Invite the group to join in prayer responds to those who suffer together: oppression will be different from Closing prayer: O merciful the way it responds to those who God, you have given us your suffer because of disease.) Word and shown us in Jesus our Savior that when we suffer, you 5. Ask participants to listen to the suffer alongside us, that our pain following texts from the New is your pain, our despair is your Testament: (a) Mark 15:33-34; despair. Hear our cry for (b) 2 Corinthians 4:7-12; (c) comfort in time of distress! Hebrews 2:10, 14-18; and (d) Come quickly, O God, and meet Philippians 2:4-11. (Or use our every need, extending your some of the other suggested brokenness as our source of Scripture passages.) Again ask wholeness, your torment as our them to identify the meaning or source of relief. In all times and significance of suffering in each places, may we remember that in passage. you we live and move and have our being, and may we hold fast 6. Part of our Christian identity is to the truth that in life and in that we take all of Scripture death we belong to you. seriously. Is it possible to do so Through Jesus our Lord. Amen. even if there appear to be voices SESSION 6 The Experience of Sufferers: A Personal Encounter

Goals would often rather avoid. To come face- In this session, participants will (1) to-face with the pain, suffering, and listen to the stories of persons, including death of others may also be the “means persons of faith, who have contemplated of grace” that allows us to face our own euthanasia or assisted suicide pain, suffering, and death. themselves, or who have known or worked professionally with persons who Special Instructions for Preparing have contemplated one or the other, or This Session who have grappled with other end-of-life In preparing for this session, decisions; (2) become aware of some of participants are asked to discuss among the factors that lead people to consider themselves whom they might invite to the option of euthanasia or assisted speak our of their own life experience as suicide; and (3) hear how health care it relates to these issues. While groups workers and patients think about pain, may feel some hesitancy about inviting suffering, and death and about the such people, especially from within the possibility of effectively relieving pain congregation, forming such a panel can and suffering. also be an opportunity to bring members to a deeper appreciation of each other’s Suggested Resources struggles and perspectives. Suggested Scripture: Psalm 42:11 Guest speakers could include legal and 1 Peter 3:12-14 medical professionals, family members of persons who are sick, parents of Critical Issues children with terminal illnesses, It is possible to discuss pain, suffering, chronically ill persons, and/or persons on and death as theoretical issues. They dialysis. In virtually every congregation, are, however, anything but theoretical. there will be persons who have faced Together they constitute a major portion end-of-life decisions for themselves or of human experience. with others.

One way to convince ourselves of the Also, most congregations will access to issues under discussion is to deliberately agencies that care for persons with put ourselves in contact with persons terminal illness (cancer, AIDS) as well who are struggling with them. Such as agencies that advocate a particular contact provides us an opportunity to position on euthanasia and assisted increase our awareness of the suicide, such as the Hemlock Society or complexity of the issues and to test the the American Suicide Foundation. reality of whatever ideas we have about them. Participants may need to consider other options if no one in the local community Listening to the experience of sufferers is available to serve as a guest speaker. may help us face complex issues that we Persons in the group might be invited to focus on their own personal experiences where end-of-life decisions had to be Explain to the guests that made and the question of euthanasia or participants are involved in a assisted suicide came up or could have study of euthanasia, assisted come up. Whether the guest speakers suicide, and end-of-life issues are from within or beyond the local and that they are trying to learn congregation, be sure that there are how to think about these issues people present to facilitate the discussion as people of Christian faith. and to support the persons who share Explain that as a part of the study information. If it is helpful, consider it will help participants to hear adding another session or two to the the personal stories of some who study in order to have several meetings have contemplated euthanasia or with guest speakers. assisted suicide, or who have actually been involved with Another option is to utilize videos. The ending life in one way or National Bioethics Resource Center has another, whether by euthanasia, a good library of such videos. assisted suicide, or other end-of- life decisions, such as withdrawal Suggestions for Group Process or withholding of treatment. 1. Read Psalm 42:11. Invite the participants to join in praying 3. Then invite the guests to share together: their stories. Afterward, Opening prayer: O God of participants in the study are storm and stillness, we offer you likely to have questions, and the our thanks and praise, for you are guests may well have questions with us in all times and through that they would like to put to the all circumstances. We ask your participants. Encourage blessing upon all who are in pain participants in the study to write this day, and for whom the future down any new insights. holds little hope for recovery from illness. We pray that you 4. Before concluding, remind might surround them with your participants to read chapter 5 of tender mercies and bless them in Choosing Death for next time. ways beyond our earthly art or science. We pray as well for all 5. Conclude by thanking the guests who work with those who are for their help. Then read 1 Peter facing death, or who help to meet 3:12-14 and invite guests and the needs of those whose daily participants to join in praying realities include terrible anguish together: of body, mind, or spirit. Help us Closing prayer: O God, our to minister unto them and to see word and our source of wisdom, how they minister to us, as we thank you for the witness of together we seek wisdom. In those who share their stories with Jesus Christ our Lord. Amen. us. Because they have opened their life journeys to us, we can 2. Introduce the guests and begin to sense the wide range of participants to each other. feelings present when we consider suffering and pain. remembering that in life and in Help us, by hearing them, to death we belong to you. discern ways in which we and Through the action of the Holy your church can more faithfully Spirit and in the love of Jesus serve you by serving them, Christ. Amen. SESSION 7 The Experience of Sufferers: What We Learn

Goals ways of the complexities of the debate In this session, participants will (1) relating to euthanasia, assisted suicide, think together about insights that they and end-of-life issues. Particular guests have gained from the guests’ personal may have given us insight into legal, struggles with euthanasia, assisted moral, or medical dimensions of these suicide, and end-of-life decisions; (2) issues. Others may have shared either examine which of their insights and explicitly or implicitly their own experiences helped us better understand struggle to resolve their questions about these issues and which raised new euthanasia and assisted suicide. questions; (3) discuss ways in which our Christian faith might help any who are As we listened to any guests who dealing personally with euthanasia, described their suffering, we may have assisted suicide, and end-of-life learned that it is difficult to determine decisions; and (4) discuss the difference just what constitutes pain. While between pain and suffering. patients’ descriptions of pain may be so vivid and intense that we feel Suggested Resources overwhelmed, medical science has no Insights offered by guests in Session 6 adequate way to measure or gauge pain. Within the medical community, people Choosing Death, chapter 5 debate whether or not there exists pain too severe for medicine to alleviate Suggested Scripture: without inducing death. Judges 16:23-31 2 Samuel 18:9-33 Another consideration may be the Job 1 & 2:1-10 difference between pain and suffering. Psalm 139 Some mistakenly think that if we Matthew 27:5 diminish the pain, the suffering too will Luke 19:41-42 decrease. But pain and suffering are not John 1:1-5 identical. Even when one’s pain is under John 9:11-12 control, one’s suffering, one’s sense of 2 Corinthians 12:7-10 being burdened, can continue. (also see the passages listed for Session 5) Yet another consideration may be the array of emotions expressed by people Supplemental resources: who contemplate assisted suicide and Medical Nemesis, Ivan Illich euthanasia regret, remorse, sorrow, guilt, The Nature of Suffering, Eric embarrassment, pain, loneliness, Cassell estrangement, abandonment. Persons of faith may be called upon to help Critical Issues sufferers recognize and address these emotions. The guest speakers from the previous session may have made us aware in new Finally, those who suffer have an effect the shadows; those who wait on those around them. When one upon others in a ministry of contemplates or indeed chooses presence and prayer; those who euthanasia or assisted suicide, family carry in their hearts bitter members, close friends, concerned memories, painful regrets, harsh neighbors, and the community in general remorse, or the anguish of broken experience many feelings—including relationships. Comfort the anger and anguish. Again, the lonely, be with all who are left community of faith may be able to help behind, and by your presence, people deal with these feelings. ease their melancholy. In Jesus Christ our Lord. Amen. Questions for Group Discussion 1. What aspects of the guests’ 2. Ask what, if anything, information and experience participants have seen or heard added to our understanding of since the last session that has euthanasia, assisted suicide, and reminded them of the concerns of end-of-life issues? this class.

2. What aspects of the guests’ 3. Ask participants in pairs or information and experience threesomes to discuss which of challenged us to think in new the comments made by the guests ways about euthanasia, assisted in Session 6 were helpful to their suicide, and end-of-life issues? understanding of euthanasia, What, if anything, disturbed us? assisted suicide, and end-of-life issues. Similarly, invite 3. What might our Christian faith participants to discuss which of say to these particular guests, the comments made by the guests who shared what it means for raised questions or concerns. them to have contemplated the questions surrounding or euthanasia, assisted suicide, and end-of-life decisions? In pairs or threesomes, ask participants to list on newsprint 4. What are the differences between or a chalkboard the feelings pain and suffering? expressed by the guests in Session 6 (e.g., anger, anguish, Suggestions for Group Process pain, remorse, embarrassment, 1. Read Psalm 139 together. Invite guilt, regret, fear of the participants to join in praying abandonment). How might we together: respond to each of these Opening prayer: O God, our feelings? root and vine, we pray for all whose lives are intertwined with 4. Ask persons in the class to keep those who are facing death. Be in mind the comments of the with them all: those who stand guest speakers while reading beside loved ones in the valley of aloud several of the passages of Scripture that appeared in 7. Tell participants that in the next Session 5: (a) Deuteronomy session they will be discussing 30:15-20; (b) Psalm 22:1-21; (c) the meaning of suffering. Ask Isaiah 53:1-6; (d) Amos 8:1-8; them to read chapter 4 in (e) Ecclesiastes 3:2-8; (f) Mark Choosing Death. 15:33-34; (g) 2 Corinthians 4:7- 12; (h) Hebrews 2:10, 14-18; and 8. Conclude by reading John 1:1-5 (i) Philippians 2:4-11. (Or use and inviting the participants to some of the other suggested pray together: Scripture passages.) Ask Closing prayer: O God, whose participants to consider, in a life all life conferred, if we but period of silence, which of the knew how, our aim would be to texts help them better understand soothe the bodily pain of those what is happening in the lives of whose lives are broken, and to the guests and which do not. grant a solace to those whose minds are assailed by anguish. 5. Following the period of silence, We would, as well, seek to lift invite participants to share the the spirits of all who are results of their personal downhearted. In your great reflections. Which of the texts mercy, help us to help others in help make sense of suffering and their distress. We pray your which do not? Why or why not? blessing for all whose misery is beyond our ability to grant relief, 6. Ask participants to reflect upon or whose sorrow is beyond our the experiences of the guest gift of consolation. In their woe, speakers with regard to pain and O God, be their ever-present suffering. Encourage them to comfort. Surround them with the identify the difference between assurance that in all pain and suffering. circumstances, in life and in death, they belong to you. In Jesus Christ. Amen. SESSION 8 Christ’s Suffering

Goals In this session, participants will (1) At the very heart of the biblical witness consider a portion of the witness of to Jesus is a story that includes pain, Scripture that speaks of the suffering and suffering, and death. Jesus is the one death of Jesus Christ; (2) think about who relieved the suffering of many with what it means to be a people who find whom he came into contact, and he is their identity in Christ and are enjoyed to the one who called back to life a friend “have the same mind” as he had; and (3) who had died. But he is also the one as persons who find their identity in who, when his own time had come, Christ, relate their thinking about entrusted himself into God’s hands and euthanasia, assisted suicide, and end-of- endured suffering and death for the sake life issues. of the life of the world.

Suggested Resources For people of faith, Christ’s witness Suggested Scripture: stands as a profound challenge to our Job 42:2-3 culture’s assumptions that the “good Psalm 20:6 death” is easy and painless, while the Psalm 22:1-21 “bad death” is hard and painful. If ever Psalm 44 a death was “good”, it was that of Jesus, Deuteronomy 30:15-20 for it is to that death that we owe our life Ecclesiastes 3:2-8 in God. But, if ever a death was “bad,” Isaiah 53:1-6, 10-12 in terms of suffering and pain, it was Amos 8:1-8 also that of Jesus. Mark 8:31-9:1, 9:30-32, 10:32- 34 What a challenge Scripture gives us, Mark 15:21-41 therefore, when it enjoins us to “have the John 9:2-3 same mind” Christ had, or when it tells Romans 5:3-8 us that we are to take up our cross and Romans 8:18-22 follow him. On the one hand, Jesus’ 2 Corinthians 4:7-12 suffering and death do not necessarily Philippians 2:1-11 give us any clear guidance for our Colossians 1:24 decisions in the face of suffering and 2 Timothy 1:8, 12 death. Jesus died at the hands of sinners; Hebrews 2:10, 14-18 most of us will die of disease or perhaps in a tragic accident. Jesus understood Critical Issues God to require him to suffer on behalf of a sinful world; our suffering may appear Christians acknowledge that their to have no intrinsic value. For us to identity and the very meaning and have the same mind as Christ is for us to purpose of their lives is found in Jesus focus first of all on his ministry, not to Christ. To know ourselves in Christ, equate our suffering and dying with his. however, we must first listen carefully to Scripture’s witness to him. On the other hand, we may find us that he himself felt forsaken in his meaning in our own experience of pain, suffering and dying. suffering, and death as we contemplate Jesus’ crucifixion. The one who has Both the cross and the resurrection gone before us has plumbed the depths teach us not only of God’s presence, but of human experience. We are not alone also of the experience of God’s absence. as we face the mystery of our own end. A life of faith does not save us from moments of doubt and protest. We can This tension challenges us to exercise believe even now, however, that Christ great care in relating Christ’s suffering has claimed us as his own, regardless of to our own. Rather than being a source the struggles and questions that we face of comfort, Christ’s suffering may in moments of intense suffering and in actually remind us that we too often seek our final hours. to escape the kind of suffering that Jesus endured. Yet Christ’s suffering also Questions for Group Discussion testifies to God’s compelling power in 1. In what sense can it be said that human life. In contemplating the the most important thing about mystery of Christ’s suffering, we may the life of Jesus Christ was his become aware in a new way of God’s death? power to sustain us and to call us to new life even in the midst of our suffering 2. What do we learn about pain, and dying. suffering, and death from Jesus’ life and ministry? From his Perhaps of equally great consequences death? for our understanding of suffering and death is Jesus’ resurrection. By virtue of 3. How does the scriptural witness our baptism, we share in that about the life and death of Jesus resurrection. We trust that our lives challenge or affirm our own belong to God. Sin and death do not notions about “good death” and have the last word; they cannot “bad death”? ultimately rob our lives of meaning. How, then, do we live as a resurrection 4. With respect to our own deaths, people as we face suffering and death? what might it mean to follow How does our confidence in sharing in Jesus, to have the same mind he “life everlasting” free us to take had? What would it not mean? responsibility for whatever decisions present themselves to us in our final 5. In what respect was Christ’s days and hours? suffering unique and not applicable to our own? Here too are dangers. We easily trivialize the resurrection, seeking to Suggestions for Group Process avoid the reality of suffering and death. 1. Read Mark 15:33-39 together. We may try to forget that suffering and Invite the group to join in prayer dying also bring moments of despair. together: Jesus’ own words from the cross remind Opening prayer: O God of mystery and meaning, we cannot sufficiently understand your suffering and death in the days limitless love. You care for us to following his crucifixion. Ask such an extent that you accepted them to decide which texts help undeserved ridicule, and an them understand what happened unthinkable death on our behalf. to Jesus and which do not. Yet, we know all we need to know, that you did it, and that 4. Following the period of silence, you did it for us. We can do no invite participants to share the more and no less than thank you, results of their personal love you in return, and pledge reflections. Which texts help ourselves to you. We know that them make sense of Jesus’ a part of human life is suffering. suffering and death, and which And while we would recoil from do not? Why does each help or needless, irrational suffering, not help? help us not to shrink when you call us to bear crosses for the 5. Ask participants to listen to these sake and in the name of Jesus New Testament texts: (a) Mark Christ our Lord. Amen. 8:31-9:1 (in which Jesus explains that he must suffer and die—also 2. Ask what, if anything, see 9:30-32 and 10:32-34); (b) participants have seen or heard John 9:2-3 (in which Jesus sees since the last session that has suffering not as a consequence of reminded them of concerns of sin, but as an opportunity for this class. God to work); (c) Romans 5:3-8 (in which Paul says that suffering 3. Write on the chalkboard or can teach Christians endurance); newsprint the following Old (d) Romans 8:18-22 (in which Testament texts: (a) Job 42:2-3 Paul sees suffering as relatively (in which Job resigns himself to unimportant in the full context of the undeniable, yet baffling God’s plans and purposes); (e) 2 wisdom of God); (b) Psalm 44 Corinthians 4:7-12 and/or (which assails God violently for Colossians 1:24 and/or 2 neglecting the people); (c) Psalm Timothy 1:8, 12 (which speak of 20:6 (which suggests suffering is the suffering that the church must divine education by which the be prepared to endure). people will return to God); and (Alternatively, participants could (d) Isaiah 53:10-12 (which revisit the New Testament texts affirms that God suffers in listed in Session 5). After each solidarity with humanity). text has been read, invite (Alternatively, participants could conversation. Which passages revisit the Old Testament texts help participants understand the listed in Session 5). Suggest that suffering and dying that they participants read each text in may someday face? silence, imagining themselves to be Jewish followers of Jesus who or are trying to make sense of his Read the story of Jesus’ death in Mark 15:21-41. Talk together 8. Tell participants that in the next about what you have heard. Was session they will be discussing it a “good death” or a “bad the possibility of knowing when death”? On what grounds would one’s time has come. one call it either? 9. Read Philippians 2:1-11 6. Invite participants to talk with together. Invite participants to one another about what they have join in prayer together and to heard during this session and remember all those Christians about what they think and feel throughout the world who are about what they have heard. Is it also praying to be conformed to important to listen to Scripture in the mind of Christ. If they wish, this way? Do we really want to participants may voice brief be persons who have in ourselves prayers, then close by praying “the same mind that was in together: Christ Jesus?” If we do wish to Closing prayer: O God, our be such persons, what can we do counselor and comfort, our lives to help make it happen? are lived in the light of your presence. In life and in death we 7. Ask the participants to discuss belong to you. Yet, to each there the following: comes a time when life and death collide, with a dimming of the a. Did Jesus choose to end light and a drawing-down of the his life? If you believe blinds. While our every instinct that he did, do you see tells us to rage against the dying parallels to people of the light, we know that in considering euthanasia or Jesus our Lord is light and life assisted suicide? Why or eternal. Help us cherish this why not? tender grace you give us, hear the sound of your still voice, and b. How was Christ’s trust your love which never fails. suffering unique and not In Jesus Christ our Lord. Amen. comparable to our own? SESSION 9 On the Possibility of Knowing That One’s Time Has Come

Goals mistaken. The mystery is that many In this session, participants will (1) times we do not know and cannot predict discuss the possibility of knowing that when death may be near. (Indeed, a “one’s time has come”; (2) discuss how third of all deaths are sudden and one might determine whether his or her without forewarning.) time, or the time of another, had come; and (3) discuss how the suffering and The theological issues are complex. death of Jesus Christ help us reflect on For instance, what is it that one “knows” the question of knowing one’s time. if that one’s time has come? Does one know that God is ready for a given life Suggested Resources to end, or does one know only that God Suggested Scripture: is permitting one to exercise her or his Exodus 13:21-22 freedom to allow death to come? 1 Kings 19:9-13 Mark 8:31-33, 9:30-32, 10:32-34 Second, how does one come to know Luke 9:51 such a thing? Is it a private determination that requires no Supplemental Scripture: confirmation from the community of 1 Kings 21 faith? What is there to ensure that the Job 38:4, 42:2-3 decision is not simply a reaction out of Ecclesiastes 3 fatigue or depression in the aftermath of Isaiah 55:8 much pain and suffering? Luke 2:25-35 John 2:4 And third, is it really possible that John 12:27-33 death, the “last enemy” (see 1 John 13:1 Corinthians 15:26) can finally be John 14:16 regarded by a person of faith as a friend? Acts 13:1-3 How should a Christian view death? Acts 15 And what about those whose families Romans 8:26 include those of other faiths, or of no Galatians 4:4 faith?

Critical Issues Jesus himself seemed to know that his time had come. Yet his death for the life Some persons at some point in their of the world, after persecution and at the lives decide that their “time has come.” hands of sinners, is a calling few of us They conclude that they have lived experience. What may we learn from enough, have accomplished enough, Jesus’ experience and what should we have loved enough. They are ready, not learn, we who one day may wish to perhaps even eager, to die. Death for know whether our time or the time of such persons becomes a friend. By the another has come? same token, it is not uncommon for such persons to discover later that they were Questions for Group Discussion 1. Is it possible for us to know that 3. Tell the group that in this session our time has come? That the we will be thinking about time for another has come? How whether or not it is possible to would we know? “know that one’s time has come,” and if so, how one can 2. How might we faithfully test our know such a thing. Invite sense that our time or the time of participants to spend a few another has come? moments in silence reflecting on a time when they knew that their 3. What do we learn about our lives were reaching some suffering and dying from Jesus’ important turning point. How way of approaching his suffering did they know? In retrospect, and dying? how confident are they that their knowing was accurate? Ask Suggestions for Group Process them to reflect upon a time when 1. Read Exodus 13:21-22 together. they did not now that they were Invite the group to join in prayer reaching some important turning together: point. After a few moments of Opening prayer: O God of cloud silence, invite a few persons to and fire, God of all wisdom and share their stories if they wish. knowledge, all certainty rests upon your truth and all flawless insight 4. Invite participants to share stories comes from you. It is you about persons they have known discernment that we seek so that we who thought their time had come. may comprehend the circumstances What led those persons to believe of our lives. We are so grateful that that their time had come? Was it by grasping your truth we may begin in some way tied to a medical to perceive what is right, and that by disclosure? Have any of the following your counsel, we may start participants thought that their to understand what we are to do. We own time had come? Is it ask your perfect guidance in all of possible to will one’s self to die? life, and especially when we seek to How might we faithfully test our identify the end of life. Help us sense that our time or the time of watch the signs so that we may another has come? You may recognize your voice calling us wish to include some or all of the home. And when our time comes, supplemental Scripture passages may we ever remember that in life to augment this discussion. and in death we belong to you. Through Jesus Christ. Amen. 5. Read the following texts: Mark 8:31-33; 9:30-32; 10:32-34; 2. Invite participants to share Luke 9:51. Did Jesus know that anything relating to the themes of his time had come? How did he the class that they have heard, know? How did he act on his seen or thought since the last knowledge, or not act? Would session. his example help us to know whether our own time or the time your still, small voice! When our of another had come? Why, or life circumstances become extreme why not? and it seems that we alone are left to cope with illness, degeneration, and 6. Tell participants that in the next pain, bring to us, we pray, your session they will be discussing timely message of direction and issues of caring for the suffering pertinence. Even as you hear every and dying. earnestly whispered prayer, help us, as we call to you, to know your 7. Read 1 Kings 19:9-13 together. timing for our lives and to trust you, Invite the group to join in a even when it is time for us to die. prayer together: For in you we live and move and Closing prayer: O God, who have our being, and ever and always speaks through fire, wind, and we are yours, O God. Through Jesus earthquake, help us ever to listen for Christ our Lord. Amen. SESSION 10 Responses of Caring

Goals Anthropology, ed. Brian H. Childs In this session, participants will (1) and David W. Waanders discuss ways in which the church can be a community of caring and Hope Springs from Mended Places: compassionate action as people confront Images of Grace in the Shadows of euthanasia, assisted suicide, and end-of- Life, Diane M. Komp life issues; (2) identify obstacles that keep the church from being this kind of Critical Issues community; (3) discuss ways in which In the face of pain, suffering, and death, we can share the love and grace of Jesus doctors seek cures that will restore us to Christ with persons in crisis; and (4) health. This concern for healing has seek ways to pray for each other. deep roots in the Christian tradition. The Christian community has often been at Suggested Resources the forefront of establishing and Descent Into Hell, Charles Williams supporting hospitals and clinics and of (chapter on “The Doctrine of Substituted training people to enter medical Love”) professions.

Suggested Scripture: At the same time, the church has Psalm 23 understood itself to be concerned with 1 Corinthians 13:4-7 more than curing. As a company of the Galatians 6:2 faithful, we also seek to become a 1 John 4:7-8 community of caring, a community of compassion. Caring includes measures Supplemental Scripture: to cure disease and illness but goes Genesis 1 beyond them. Ruth 1:16-17 Matthew 7:12 When we care for each other, we seek Luke 6:31, Isaiah 53:4 to be present to each other. Even when Romans 12:17 we cannot cure another, we can stand by Romans 14:7-9 him or her. Our very physical presence James 2:8-26 may bring comfort. A loving touch may be as powerful as words. Or we may Supplemental Resources: find ourselves simply listening, The Death of Ivan Ilych, Leo encouraging those in distress to tell us Nikolaevich Tolstoy the best and the worst of all they are experiencing. Even when others can no “Whose Participation and Whose longer recognize our care, our standing Humanity? Medicine’s Challenge to by them in the presence of death may Theological Anthropology,” Brian offer us privileged moments of Childs, in The Treasure of Earthen remembering and experiencing God’s Vessels: Exploration in Theological mysterious grace. Yet such caring is not easy. Those who efforts to “cure” them in their last days are suffering and dying may resist it. and hours. Despair, on the one hand, and a desire for control and autonomy, on the other, Public interest in a “right to die” may especially in those moments when one also reflect a fear of death, a sense of feels least in control, can wrap a band of powerlessness and depression in the face isolation around a person. In such a of death. As Christians, we situation, Christians are challenged not acknowledge that any of us may one day to impose their presence on others, but utter, like Jesus, “My God, my God, why also not to abandon them. have you forsaken me?” Yet we believe that even in the darkest moments of Caring is also difficult because the despair, such a cry also conveys an Christian community itself is imperfect. enduring hope that God will hear. We We find ourselves with busy schedules. wish, therefore, to be present to others Individual caregivers may reach points and to comfort them. of exhaustion. They may find themselves torn between the needs of the Such caring continues even when one who is suffering or dying and the medical treatment reaches its limits and needs of his or her family or friends who is only futile. Such caring may include feel unable to deal with the situation. In honest words that the time has come to other cases, communities may find their withhold or even withdraw treatment resources of money and energy depleted. that can no longer restore life. Such Moreover, there is concern about caring may require the Christian intruding into other people’s lives. And community to take initiative in those who are suffering and dying may developing and supporting new models make us feel uncomfortable, even of car, such as hospice. Such caring also anxious, if we find ourselves thinking challenges the Christian community to about our own dying. find ways to support and assist medical professionals to deepen their own It is also important that we examine our capacity to integrate caring and curing. own motivations if offering care. We may be tempted to believe that we can Within the Christian community itself, do more than we really can. In priding prayer will have a special place as ourselves on our commitment to care for Christians minister to those who are others, we may fail to recognize that suffering and dying. Through prayer, there is a time to let go. the Christian community seeks wholeness and healing for those in need. Yet the Christians discipline of caring Christians cannot promise that prayer is all the more important in a world in will cure people. They pray not because which many fear that their suffering and it guarantees a better “success rate,” but dying will put them at the mercy of because it opens the possibility of our machines and experts. The very cry for recognizing God’s Spirit moving among euthanasia and assistance in dying may us, caring for us in life and in death, as reflect people’s fear of abandonment and people who belong to God. of becoming a mere object of futile Questions for Group Discussion 2. Ask participants to share 1. How might the church be a anything relating to the issues in community of caring and this study that has come to their compassion for all those who attention since the last session. face end-of-life issues, including decisions relating to euthanasia 3. Read Psalm 23 aloud together. and assisted suicide? then 2. What obstacles prevent the church of Jesus Christ from In small groups, invite participants being this kind of community? to discuss ways in which the church can be a community of caring and 3. How might Christians better compassion for those who are share the love and grace of Jesus confronting end-of-life issues and Christ with persons in crisis? may even be considering euthanasia or assisted suicide. Have 4. How might Christians better pray participants list these ways on chart with persons facing life-and- paper and share them with the entire death decisions and group. Help participants become predicaments? For what might aware of any resources that may be one pray? Why? unfamiliar to them, such as hospice care. Suggestions for Group Process 1. Read 1 Corinthians 13:4-7 and or invite the group to join in prayer together: In plenary, have participants Opening prayer: O compassionate identify particular individuals in their and caring God, you alone grant congregation who are presently healing, and all you touch receives facing these kinds of decisions. Ask comfort. Thank you for listening to participants what the congregation our concerns with infinite patience might be doing to minister to these and love. We would satisfy the people. Try to be specific and needs of others as Jesus did, waiting concrete about your strategies for with those who wait, weeping with caring for them. those who weep, in a personal encounter, with a calm and peace to 4. In plenary, consider which go beyond words or understanding. obstacles keep the church from Help us press forward into all places being a community of care. in an attitude of prayer, so that in diminishing isolation and increasing 5. Ask members of the group to community, we may represent you read aloud from the supplemental and your church. Fashion us as Scripture passages. agents of your peace. We ask in Jesus’ name. Amen. or Read together excerpts from the policy relating to euthanasia, chapter entitled “The Doctrine of assisted suicide, and end-of-life Substituted Love” in British novelist issues. Ask them to read Charles Williams’ book, Descent Choosing Death, chapter 6. Into Hell and Galatians 6:2. 8. Read 1 John 4:7-8 together. then Invite participants to conclude in prayer together: Ask the group to think of ways we Closing prayer: O God of might try to express the love and encounters, who meets us in all grace of Jesus Christ toward persons phases of life and who challenges us in crisis (such as being present, using to live the adventure of the unfolding touch, listening, becoming aware of of time, may we seek for others the others’ emotions, speaking a word of wholeness we would like for love, praying). ourselves. Gather us from wherever we have wandered; confront us with 6. Share a time when prayer has our responsibilities to our neighbors, made a difference in your life or our sisters and brothers, all who are in the life of someone you know. your children. Greet us with an As a group, discuss ways in assuring word that overcomes our which prayer opens us to God’s every fear. Answer us in our presence. thundering doubts; satisfy us in our unquenchable fearsome place. May 7. Tell participants that in the next we be thankful, now and always, that session they will be discussing in life and in death we belong to you, ways in which Christians and the O God. In Jesus Christ our Lord. church might respond to public Amen. SESSION 11 Public Policy: Striving for a Better World

Goals salvation but also for service. From the In this session, participants will (1) ago of John Calvin onward, we discuss the role of Christians in effecting Presbyterians have stressed our calling change in society; (2) consider ways in to order society in ways that reflect which this study might influence their God’s will. As we confront issues of outlook on public policy relating to euthanasia and assisted suicide, we again euthanasia, assisted suicide, and end-of- find ourselves called to help shape life issues; and (3) seek to identify public policy. projected action for the future. Yet those questions of euthanasia and Suggested Resources assisted suicide are complex. In calling Choosing Death, chapter 6 for the study of euthanasia and assisted suicide, the General Assembly explicitly The Confession of 1967 directed the Office of Theology and Worship to prepare study materials, not Suggested Scripture: a denominational position paper. Isaiah 65:17-25 Moreover, the task force that met to Amos 5:24 prepare these materials found its own Matthew 25:31-46 thinking evolving to include broader Acts 3:1-10, 4:13-14 issues of care for the terminally ill. 1 John 5:19 Revelation 21:1-4 The church will have to decide whether to support, reject, reframe, or ignore Critical Issues particular proposals for public policy and legislation relating to euthanasia and The General Assembly overture that assisted suicide. But these are not the called for this study of euthanasia and only public policy questions and are not assisted suicide noted that the necessarily the most important public Presbyterian Church (U.S.A.) could “no policy questions. While the public longer remain aloof from this important debate of euthanasia and assisted suicide debate” if it were to “be responsible to is sometimes posed in terms of “right” the mission and ministry of Jesus language, something more may be going Christ.” Since the Assembly’s action, on. The public interest in euthanasia and several states have considered ballot assisted suicide may, in fact, reflect initiatives to legalize euthanasia and/or people’s fear that they will be abandoned assisted suicide under certain in their times of suffering and dying and circumstances. It seems clear that these become objects of an impersonal issues will remain on the legislative medical establishment. agenda in the days ahead. Both as a community of caring (see As Christians, we profess Jesus not Session 10) and in its commitment to only as our Savior but also as our Lord. just public policies and legislation, the This Lord claims us not only for Christian community can speak to this fear. First, the Christian community can that we do not yet have or have not yet support public policies that inform adequately implemented. Questions of patients of their right to refuse treatment. euthanasia and assisted suicide belong to The Christian moral tradition allows for this larger context. the possibility of withholding or withdrawing treatment when it can no Fifth, the Christian community can help longer restore life. People should not engage society in consideration of the have to fear that others will larger implications of legalizing unnecessarily prolong their dying. euthanasia and assisted suicide. It is important to note that hard cases do not Second, the Christian community can necessarily make for good law. Some work to guarantee health care to all who support the possibility of euthanasia people. In a society without universal and assisted suicide under certain health care, the legalization of circumstances, nonetheless argue against euthanasia and assisted suicide could legalization. The Christian community implicitly pressure the most vulnerable will be concerned about ways in which to choose death rather than to burden laws shape public morality and about society with the expenses for their legalization of euthanasia and assisted treatment. People should not have to suicide if it further devalues life in a fear that their lives are worth less than society in which violence is rampant and others’. Nor should they choose death not all members of society feel valued. out of a temporary depression that may be treatable and reversible—a major Christ calls us to risk involving issue of concern, since some studies ourselves in the world. The question is suggest that the overwhelming majority how we can be most faithful God and to of people seeking euthanasia or assisted each other as these debates continue. suicide are in fact suffering from Perhaps we still need time for consensus treatable forms of depression. to emerge both in the church and in society on issues of such complexity. Third, the Christian community can Perhaps it is right to continue our study support public establishment of hospice of these issues, seeking to be thoughtful and similar programs that help relieve and prayerful, until such consensus people of the fear of dying alone and out emerges. of control. Similarly, the Christian community can support public policies Questions for Group Discussion that encourage research into pain 1. Do Christians have an obligation management and that educate health care to help shape public policy? professionals in pain management, so Why or why not? that no patient has to choose death out of fear of intractable pain. 2. Which public policy questions does the euthanasia/assisted Fourth, the Christian community can suicide debate raise? support the establishment of public commissions and panels that provide for 3. Should Presbyterians now our nation’s best minds to discuss end- develop a position paper on of-life issues and to consider strategies euthanasia and assisted suicide, seeking to influence legislation applies itself to present tasks and one way or another? Why or strives for a better world. It does why not? not identify limited progress with the kingdom of God on earth, nor Suggestions for Group Process does it despair in the face of 1. Read Isaiah 65:17-25 together. disappointment and defeat. Invite the group to join in prayer together: Then, invite discussion with Opening prayer: O Perfect respect to the role of the church One of Israel, we live in an as a community of moral imperfect world. We are an discourse and action by posing imperfect people, an indistinct this question: Do Christians reflection of your flawless have a responsibility to shape the design. So too, our hospitals and life of the greater society? Why medical abilities, wonderful as or why not? they may be, nonetheless comprise an imperfect system of 4. Divide the participants into five healing efforts, all too small groups. Assign each group underdeveloped and all too one of the five positions on inaccessible. You are unlimited public policy in chapter 6 of power and purpose; may we be Choosing Death (Margaret your representatives as we work Murphey, Robert Moss, Don C. to transform public policy, until Shaw, Albert R. Johnson, Albert the long awaited day when all of W. Alschuler). Invite each group your children may receive to develop a plan for action in the without restriction the full area of public policy based on its measure of healing you intend assigned viewpoint. In plenary, for them. In Jesus Christ our request each small group to Lord. Amen. report their action plans. Note similarities and discrepancies and 2. Invite participants to share highlight areas of agreement. anything that has come to their attention since the last session. or

3. Distribute Part III (“The Read Isaiah 65:17-25 again (or Fulfillment of Reconciliation”) one of the other suggested from The Confession of 1967, Scripture passages). Before emphasizing the following: reading, ask participants to listen to the text with ears sensitive to God’s redeeming work in Jesus the issues that they have been Christ embraces the whole of discussing over the last weeks. man’s life; social and cultural, Then, invite conversation about economic and political, scientific what the participants heard in the and technological, individual and reading that suggests how the corporate…With an urgency church could strive for a better born of this hope the church world where pain, suffering, and the threat of death will lose their 7. Conclude by reading Revelation dehumanizing power. 21:1-4 and inviting the participants to pray together: 5. Inquire if any participants believe Closing prayer: O Word of Life, that the group as a whole should you have called us to speak to one undertake initiatives in the area another your good news. Yet, in so of public policy. If so, ask if any many corners of our communities, participants would like to work the news is not good. Make us bold on the development of these to speak your truth, so we may say to initiatives. the medical community your word of justice for all. May we speak to our 6. Remind participants that the next dehumanizing social structures your session will be the final session will for equities in service and and that they will be discussing dignity. May we speak to the how any of their perspectives favoritism still present in our judicial have changed over the course of system your spirit of impartiality that the study. transcends the letter of narrow laws. Until that day, O God, may we not rest our voices in the cry for truth! This we ask in Jesus’ name. Amen. SESSION 12 Conclusion

Goals Has this study prompted (or In this session, participants will (1) could it prompt) new or further review the study as a whole; (2) share outreach toward meeting the with one another ways in which they needs of persons facing end-of- have grown in faith; and (3) identify life decisions? Has our study what they have learned about dealing been (or could it become) the openly with a complex and controversial occasion for other initiatives on issue. our part (educational, public policy, etc.)? Suggested Resources “A Commitment to Caring” (see 4. What did participants learn about Appendix 4) how a group of Christians can deal openly with a complex and Suggested Scripture: controversial issue? How has Ecclesiastes 3:1-22 this study impacted us? In what Romans 14:7-9 ways has this study been helpful in providing material for our Critical Issues denomination in developing public policy? See the statement under “Critical Issues” for Session 1. 5. How did you feel about the topic of euthanasia/assisted suicide Questions for Group Discussion when this study began? How do 1. Was the study a success? Why you feel about it now? Do you or why not? What were the high think that euthanasia or assisted points of the study and why? suicide can be a faithful What sessions were the most decision? Why or why not? difficult or disturbing and why? How does your understanding of what we owe God and each other 2. What key questions have affect your response? emerged? (Responses might include such issues as autonomy 6. If you do see euthanasia/assisted and accountability; the suicide as an option, under what relationship between the Creator conditions and with which and the created; suffering, both safeguards? If you do not see it redemptive and meaningless; as an option, what are the access to health care. alternatives?

3. How have we been changed? 7. Should the church take a stand on How are we different at the end the legalization of euthanasia and of this study? Do we know assisted suicide? Why or why more? Is our faith stronger? Are not? If we close the discussion, we living our faith in new ways? are we better off or not as a society and a church? Who are Explain to participants the the winners and the losers if possibility of participating in a euthanasia and assisted suicide Commitment to Caring as one are legalized? response to this study. Read aloud the Commitment to Caring Suggestions for Group Process statement (Appendix 4). 1. Read Romans 14:7-9 together. Invite the group to join in prayer then together: Opening prayer: O God, assist Invite discussion on the study as us in sharing what we have a whole in light of the “Critical learned, so we may pass it on the Issues” or the Commitment to others who face these issues. Caring. How, if at all, have the Make us alert to the many ways faith and life of the participants in which we can work to change been affected by this study? inequities in out health What, if anything, might they community. Give us minds of wish to do in response? faith and hearts of compassion to provide comfort for all who 4. Invite participants to respond to suffer and experience pain. Even any and all of the “Questions for as you are working out your Group Discussion” listed for purposes, O God, make us Session 12. persons of open minds and willing hearts, so we do not shy 5. Invite participants to fill out the from difficult issues, not resist response form on pp. 57-59. the transforming wind of your Please return forms to the Office Holy Spirit. Even as you prompt of Theology. Your comments us, may we respond by joining in will help the Office Theology the pursuit of righteousness for determine whether to take all people, and by entering into additional steps to address issues the enterprise of fulfilling your relating to euthanasia, assisted plan for all creation. Through suicide, and end-of-life Jesus Christ our Lord. Amen. decisions. A summary of responses will be shared with the 2. Invite participants to tell about General Assembly and General anything new they have heard, Assembly Council. seen, or thought since the last session in relation to the themes 6. Read Ecclesiastes 3:1-22 under discussion in this study. together. Invite the group to join in prayer together: 3. Share with participants the Closing prayer: O matchless statement under “Critical Issues” God, we have gathered trusting in Session 1 of this study guide. one another and trusting you as we seek to understand end-of-life or issues, including concerns surrounding euthanasia and assisted suicide. The questions together the pieces in a design are so many! Like pieces of an favorable to others and pleasing unformed quilt, they have at to you. We know that, in this times confounded us. Yet, we study, our work has only begun. have looked at the many hues of Still and awed, we pray it would the affected lives and the many form a motif for the future, for shapes of the arguments pro and ourselves, and for our church, con and in between. In the until we realize the full potential looking, we have tried to see the of our calling, remembering that pattern of your hand amid the in life and in death, we belong to crazy-work. We have searched, you, O God. In Jesus Christ our as well, for a way in which to put Lord. Amen. APPENDIX 1 Glossary of Terms

With acknowledgement to Tom L. that its exact probability is incalculable; Beauchamp, J. Fletcher, Robert George, interventions that are physiologically Richard M. Gula, Steven Miles, Edmund implausible or are statistically D. Pellegrino, and Lawrence improbable, unproven, or of no value to Schneiderman. the patient as a person.

Assisted Suicide: See suicide. Involuntary Euthanasia: See Assisting in suicide entails one’s being a euthanasia. Carried out without the necessary and relevant condition of patient’s consent when it could have death, but not a sufficient condition. been obtained. Also includes euthanasia Assisting in suicide requires affirmative, performed against the patient’s wishes. assertive, proximate, direct conduct such as furnishing a gun, poison knife, or Nonvoluntary Euthanasia: See other instrumentality or usable means by euthanasia. Performed when consent which another could physically and cannot be obtained, as in the case of immediately inflict some death- comatose, profoundly demented, or producing injury upon himself or herself. retarded persons. Such situations are far different than the mere presence of a doctor during the Passive Euthanasia: Thought by most exercise of a patient’s constitutional scholars not to be a useful concept. rights to refuse treatment. Withdrawing or withholding treatment that the patient does not want because Autonomy: Rule of the self. To be the relief afforded by it would not author of one’s life plan. outweigh the burden resulting from it. Confuses euthanasia with the well- Euthanasia—Mercy Killing: Death is established and acceptable practice of intended by at least one other person withholding or withdrawing useless who is either the cause of death or a treatment. casually relevant condition of the death. The person who is to die is either acutely Suicide: Acts or omissions that suffering or irreversibly comatose (or intentionally bring about one’s death. soon will be), and this alone is the primary reason for intending the Voluntary Euthanasia: See person’s death. euthanasia. Done with the patient’s consent. An active or direct means to Futility: Inability to achieve goals of an end the life of a dying person who action, no matter how often repeated; an requests another to terminate his or her expectation of success that is either life in the name of mercy. predictable or empirically so unlikely APPENDIX 2 A Sermon and a Response

I. combination of two Greek words THE CHRISTIAN FAITH AND meaning “a good death.” These days, EUTHANASIA the word refers to the taking of the life of a terminally ill or dying person for A sermon from the pulpit of reasons of compassion—either by doing THE BRYN MAWR PRESBYTERIAN something to cause death, called “active CHURCH euthanasia,” or by not doing something Bryn Mawr, Pennsylvania that might prolong life, called “passive November 7, 1993 euthanasia.” By Dr. Eugene C. Bay The topic, as I conceive it, has many dimensions: physician assisted Readings: Genesis 1:26-31 dying—of which Dr. Kevorkian is the Romans 14:1-12 most prominent, if also one of the least ethical, examples; the freedom to refuse Text: So then, each of us will be medical treatment, or to stop treatment accountable to God (Romans 14:12). once it has begun; the responsibilities of physicians, nurses, hospitals, and Earlier this fall, I said that any nursing homes; the involvement of congregation that is serious about family members; the role of the courts; Christian nurture has to be ready and and the question of how, as a society, we willing to explore the complex and often should allocate health care resources. In ambiguous issues with which people are other words, I have in mind the broad confronted today. I am devoting this range of issues concerning what is morning’s sermon time to one such sometimes called “the right to die.” matter. It involves decisions that some within this congregation have already So far, I have been talking about these had to make. Many more will likely be matters in an abstract and impersonal involved with such questions in the way. But these issues come to our future. attention because they involve real people. It’s time to meet a few of them. Let me say, at the outset, that this sermon is not intended as any kind of Dr. and Mrs. Henry Pitt VanDusen, for final word. My purpose is not to stop example. Some of you may recall conversation, but to get it started. hearing, some twenty years ago, about Whether or not you agree with me their double suicide. Dr. VanDusen was doesn’t matter. That you think about a Presbyterian minister and a former these issues from a Christian perspective president of Union Theological does. Seminary in New York. At the time of their suicide, he and his wife were both I should also say that my topic is more elderly, both physically enfeebled, and inclusive than the sermon title might both intellectually alert. They left a suggest. The word “euthanasia” is a letter saying that their infirmities had become intolerable, and that their that the changed personality may bring decision to end their lives was an out some horrible beast within himself? expression of Christian stewardship, Answering his own questions, Lukey thoughtfully and prayerfully made… said: “…it comes to me that, ultimately What do you think? Is it possible for and finally, the Christian has always to such a decision to be called “Christian”? view life as a gift from God, and see that every precious drop of life was not Another, “for instance.” Diane was earned but was a grace, lovingly diagnosed as having acute leukemia. bestowed on him by his Creator, and it is After exploring her options with her not his to pick up and smash. physician and her family, she not only decided to refuse treatment, but asked “And so,” Lukey went on, “I find the her doctor if he would help her end her position of suicide untenable, not life when she determined the time had because I lack the courage to blow out come to give it up. After many my brains, but rather because of my deep discussions with Diane and much soul- abiding faith in the Creator who put the searching, the physician gave Diane a brains there in the first place. And now prescription for barbiturates, exacting the result is that I lie here blind in my from her a promise to consult him before bed and trust in the loving, sustaining taking enough of them to commit power of the great Creator who knew suicide. Months later, the two of them and loved me before I was fashioned in met for what was to be the final time. my mother’s womb. But I do not think it Of that encounter, the physician writes: is wrong to pray for an early release “…It was clear that (Diane) knew what from this diseased and ravaged she was doing, that she was sad and carcass.”2 frightened to be leaving, but that she would be even more terrified to stay and This is a courageous and profound state suffer…” Two days later her husband of faith! …What do you think? Could called to say that Diane had died.1 someone else have made a different …What do you think? Should Diane’s choice and been equally faithful in doing doctor be condemned or commended? so? Or did Lukey make the only possible Christian decision? Charles Lukey was a pastor. He died a few years ago of a rare disease that, as A final example. Elizabeth is twenty- one man describes it, involves “a eight and suffering from severe cerebral galloping degeneration of the nerve palsy. She is a quadriplegic and wholly cells.” When the crisis came, Lukey unable to care for herself. She also wrote a letter to his friends. “What,” he suffers from degenerative arthritis and is asked, “does the Christian do when he in continuous pain. She wants to die. stands over the abyss of his own death The guess is that by force-feeding her, and the doctors have told him that the Elizabeth could live another fifteen or disease is ravaging his brain and that his twenty years. Right-to-life advocates whole personality may be warped, believe she has a duty to live. Elizabeth twisted, changed?” Then, does the has gone to court to secure permission to Christian have any right to self- forego medical treatment or life support destruction, especially when he knows through mechanical means.3 What do you think? Does Elizabeth have the about it, here are some things I have right to say when her life no longer has come to see as important. quality or meaning? Or, is she obligated to wait until her body revolts against the First, we need to remember the biblical medical technologies that are keeping warning about human frailty and human her alive? sinfulness. We are limited in wisdom. We are imperfect people, with mixed Time was when questions such as these motives and hidden agendas. So, as had neither to be asked nor answered. regards these life and death decisions, Life and death decisions were made for caution is called for, not recklessness. us, not by us. The tragedy was that Ethicists are right to worry about “the many people died before their time, slippery slope”—a way of saying that prematurely. once we start down a certain path, something like gravity will pull us Today, the situation is different. Some further along. Applied to euthanasia, the children and young people will die worry is that once we allow physicians, before their time, as some in this or others, to end the lives of people like congregation know only too well. But Diane or Elizabeth, it won’t stop there, now there are many older people who and before long we will be intervening feel that they have lived beyond their to end the lives of the senile, say, or of time. Medical technology is able to handicapped newborns, or the lives of prolong life and cure disease, but it can those whose care is judged to be too also keep “alive” those who are severely expensive. brain damaged, or the comatose, or those, like Elizabeth, who no longer This cautionary note is important, but want to live. for me, at least, it doesn’t end the discussion, or relieve us from the The result is that, today, what people responsibility and burden of deciding in fear, sometimes, is not the approach of individual instances. So what other death, but its postponement—they fear guidance is there? that their dying will be prolonged beyond what is reasonable, or that their There is, of course, the biblical lives will be extended when their dignity admonition to “choose life,” along with and purpose have long since the commandment not to kill. But, at the disappeared. It’s because of this new time when Moses urged his people to situation that we are facing the issued of “choose life,” the definition of life was euthanasia and the related questions I simple: if you were breathing only mentioned earlier. because he or she is hooked up to a machine? Again, is the command not to The question is how, given this new kill absolute? What about killing in self- situation, we can make wise, defense? What about war? What about compassionate, faithful moral choices. capital punishment? In these cases, As Christians, what should we keep in many Christians make exceptions to the mind as we encounter these new and rule. Is euthanasia another possible difficult dilemmas? As I have thought exception? These biblical injunctions are important, but they don’t end the discussion either, they don’t relieve us more than one acceptable decision from from the burden of decision-making. a Christian perspective. As a Christian community we should, of course, So where are we? With regard to these support a Charles Lukey when he life and death dilemmas, where we are, chooses to live out his life, come what and where we will always be, I think is may. But should we not also respond somewhere between two poles of a compassionately to a Diane or an theological kind: one we might call Elizabeth, not condemning, but valuing a “finitude” and the other, “freedom.” different kind of courage and faithfulness? At the one end, near the pole labeled “finitude,” the emphasis is on Which is where the lesson read earlier, acceptance, on playing the hand that life from Romans, comes into the picture. deals you, not complaining about the The issue Paul was dealing with seems quality of the cards, but playing them to trivial when compared with the the best of your ability—in other words, questions we are thinking about. But his accepting whatever comes, be it good or warning against making one’s own bad, joyful or sad, and seeking in and decisions normative for everybody else, through your acceptance to honor God. applies nonetheless. Each of us, says Of the people we met earlier, Charles Paul, is accountable to God. But even Lukey heroically represents this though we all are equally serious about response. our accountability, we may not all arrive at the same decision. And Paul pleads At the other end of the spectrum, near with us to refrain from easy judgments the pole labeled “freedom,” the emphasis about the difficult decisions others make. is on taking responsibility. The passage read earlier, from Genesis, seems to One final thought: I am persuaded that encourage this response. For there it is this new situation in which we find said that human beings are created in ourselves should cause us to re-examine God’s image and are given “dominion.” our understandings of both life and When, in other words, we take death. responsibility for our lives, we are not usurping a divine prerogative, but only Those who oppose “the right to die,” assuming our God-given power and for example, are often heard to speak of responsibility. The VanDusens are the “sacredness” of life. Life is a representatives of this response. precious gift, to be received with gratitude and treated with utmost Somewhere along this spectrum, respect. But, while life is precious, for between finitude and freedom, between people of faith it is not the only thing of acceptance and responsibility, Christians value in this world. Something more will take their place as they are important can cause us to put our lives confronted by these life and death on the line. It is clear teaching of the decisions. Rarely will we confront a New Testament that something more clear moral choice. Most of the time the important caused Jesus to put his choice will be ambiguous. And my obedience to his heavenly Father. “No contention is that there may well be one takes my life from me,” Jesus said. “but I lay it down of my own accord.” We are faced today with choices our The question is, may people like the grandparents did not have to make. It’s VanDusens, or Diane, or Elizabeth also obvious that I cannot offer you a few lay down their lives if and when they easy solutions on how to deal with these decide that their lives have become questions, something to laminate in unbearably painful and without plastic and carry in your wallet. As meaning? My own answer is yes, that regards those two poles I talked about can be a faithful decision. And as a earlier, I myself gravitate—not without pastor, I have supported people in fear and trembling—to the responsibility making such a decision. side. But you will have to determine your own position. What I want to do, We also need to think anew about above all, this morning, is remind you death—about how to define or recognize that you are not alone as you make these it. A hospital chaplain by the name of life-and-death decisions. Whether you Gerald Oosterveen, writes: “It is time are deciding for yourself or another, for the Christian community to see death whether you are patient or physician, in a broader context than mere biological family member or friend, attorney or or brain death…A human being is more pastor, God is with you in your struggle. than the total of his or her functions, Be confident of that. Do the best you more than heartbeat and breathing and can. And know that God’s grace and brain flow combined. Life is mercy surround you. relationships with God and human beings.” He goes on: “As the evidence II. mounts that a loved one will never again MEMORANDUM have a meaningful relationship with DATE: June 20, 1994 another human being on earth, is that TO: Gene Bay person not dead? …Have we, as FROM: Rich Allman committed Christians, the right to bring SUBJECT: THE CHRISTIAN FAITH to the bedside every possible machine, AND EUTHANASIA drug or procedure that cannot change the ultimate outcome but only prolongs the Thank you for your willingness dying process? If,” Oosterveen thoughtfully and courageously to address concludes, “we truly believe that ‘this a vexing issue which engages our world is not our home, that we are only concern as professionals and as passing through,’ how can we justify Christians. I am pleased to accept your delaying the going-home of a dying invitation to use what you have said as a person? Do we,” he asks, “love our beginning of dialogue. Areas of loved ones enough to let go? And do we common ground exist; areas of trust God enough to let our loved ones 4 confusion should be clarified; areas of enter into God’s presence?” I would irreconcilable difference summon our add: As Christians, should not our need for mutual respect. You are perspective on these matters be different familiar with my position, often from those who hold onto life because stated—you might say overstated! they have nothing else to hold onto? I believe euthanasia to be bad medicine, misapplied compassion, and socially destructive. My views, if not of-life care. The prohibition of medical very original are deeply felt, hopefully killing has been a genuine impetus to coherent, and open to what I know will developments in palliative care. We be your spirited rebuttal. should take further steps in improving our patients’ dying rather than taking the Regarding euthanasia, no matter how wrong step and simply kill them. merciful the intent, the result is still the deliberate killing our patients distorts What ought we to think of a society and perverts the purpose of medicine, that conspires to work out way to kill which is to facilitate healing. Notice I patients before it has provided a decent didn’t say curing, which is often, and minimum of health care for 37 million of ultimately always impossible, but rather its citizens? A related question is: Will I said healing. The good of healing can euthanasia become a tool for resource and must be achieved by means other allocation? In any inevitable multitiered than killing patients. We cannot heal health care system, will those with more and improve our patients’ lives by robust levels of coverage get ending those lives. We can improve comprehensive medical care? Will those their lives as Stanley Hauerwas writes by with more limited coverage more embodying fidelity in our commitment frequently be economically compelled to to be partners in a caring community and opt for euthanasia? A further societal by being present to those we cannot concern is: When in human history has cure.5 In a single act of mercy, or moral progress occurred when the desperation, or exasperation, or circumstances for sanctioned killing annoyance, or faulty judgment, to have been expanded? I know from deliberately end the life of a patient is a conversations that you share some of wrong turn on the road to human dignity. these concerns. It deprives dying persons of the opportunity for the proper relational and After hearing, reading, and rereading spiritual closure that will occur for those your sermon, I was disturbed by how whose symptoms are controlled and much I agreed with much of what you whose care givers are the presence said. I even feared that my mind might Hauerwas demands. At a time when be changed! Paraphrasing, but hopefully medicine stands accused of a staying true to your thoughts, I share technocratic, impersonal approach to your rejection of the idolatry of patients, sanctioned killing is a wrong biological life. Physical conditions that way back to improved doctor-patient are gravely burdensome do exist, communications. Even if one certainly in the opinion of those who generation—my generation—of suffer such torments. Life without the physicians would carry out euthanasia possibility of any human interaction is with awe, respect, fear and trembling, no life at all. The preservations of such the routine would soon become rote and life violate the standards of good mechanistic and simply another medicine, evoked as early as treatment choice. It would undermine Hippocrates, who admonished doctors to and abort the genuine progress we have recognize when patients were made in patient self-determination and overmastered by disease. I am high touch, as opposed to high tech end- persuaded that such pointless and meddlesome therapy violates sound pastoral care and the interactive and theological practice as well. nurturing techniques we can learn from you and your colleagues are vital Those faithful people in your sermon adjuncts to the care of the dying. You who chose to end their lives all had can do something that as a physician I moving narratives. Most suicides are in cannot do, that is, to help the sick and the context of depression and thus are dying understand the meaning of their not truly autonomous or rational, but suffering and of the presence of God and some are. Statistically, fewer than 2 God’s servants in the face of inevitable percent of suicides are for the kinds of demise. You can also serve as valued situations you have so movingly intermediaries in helping the dying, their described. Rather than to condemn or loved ones, and their care givers to commend, I prefer to wonder if the establish treatment goals that meet their choice taken was the only way to face needs and life plan at penultimate what was happening in their lives. I am moments. Ventilators, intravenous lines, uncomfortable with endorsing suicide dialysis machines, and feeding tubes are when the statistical odds are so poor substitutes for the humanity God overwhelming that the act is neither wants us to provide. Intensively kind, autonomous nor rational, although supportive end-of-life care ought not to admitting it may occasionally be. be confused with intensive care and Similarly, I am fearful of a retreat from mechanical life support. The morally, as medicine’s, society’s, and hopefully the opposed to technically, heroic care I church’s commitment to the prevention refer to must be medically and of suicide. Yale Psychiatrist Patricia technologically restrained, Wesley has properly wondered how unencumbered by the idea that if Diane would have responded had Dr. something can be done, it must be done. Quill as an act of human nurturing said “no…but” to her request for barbiturates In your sermon, you set out to think and, instead of referring her to the about euthanasia, but what you Hemlock Society, had referred her to a accomplished was to present in a cancer support group and suicide Christian context a catalogue of prevention society.6 alternatives to euthanasia, some of which, like assisted suicide trouble me, Where I come down in the face of others of which such as honoring patient progressive disability and decline is to wishes for withholding of treatment or support, comfort, be a presence, and try withdrawal of burdensome and futile to render healing that is neither treatment, as a physician, I demand. In biological cure nor medicalized assault our own faith tradition, Bonhoeffer with unwanted burdensome writes that where death is only one of interventions that provide no benefits to several plausible choices, it is the choice the patient as a person. Good care that always must be rejected.7 requires attentiveness to medical needs and symptom control, even if that This from a man who paid with his life symptom control runs the risk, for the conviction—correct, I acceptable I believe, of shortening life believe—that the only way out of the by suppression of respiration. Vigorous moral sewer that was Nazi Germany was by the assassination of Hitler. The kind called freedom. Such freedom excludes of intervention and nonintervention you the impulse to euthanasia, which would describe and directly or inferentially be the Janis Joplin freedom—just endorse provides a rich menu of another word for nothing left to lose. alternatives to that which would take us Finding the moral locus of freedom is as health professionals and Christians better than asking an old and honorable onto a pernicious path of medicalized (though admittedly flawed) profession to killing of persons. take on a role it has historically rejected. This would grant to physicians a You framed end-of-life decision- responsibility society heretofore has only making on a continuum between the given to soldiers, police, and extremes of finitude and freedom. I executioners, that of killing persons. prefer to think of two separate continua. What would we call mistakes? One has as its polar extremes finitude Malpractice? Homicide? and infinitude. The other continuum has as its polar extremes enslavement and at Gene, your ministry is a constant the opposite end hubris and license. The blessing and gift in the lives of my midpoint of this continuum is freedom. fellow congregants, my family, and Where medicine gets into trouble is myself. One of the reasons why this is when we deny the finitude of biologic so is because of the seriousness with life and of our resources to preserve that which take your ordination vows. As a life, however burdensome or poor its physician, on the day I graduated from quality. If we as physicians deny the medical school, I too swore an oath to all finitude of human existence, we will that I hold holy to live my life in a acknowledge no limits to what we can certain way. Whether one swears the do and no limits to how much of oath of Hippocrates, or of Maimonides, society’s resources are to be used in such or of the World Health Organization, a an elusive quest. At the end of this constant element of those oaths is that misbegotten journey, human death and we will not, even if asked, kill our decline still await. Human finitude, if I patients. This moral precept has stood might quote a prior sermon of yours that our profession in good stead for two and still resonates, demonstrates to us who is a half millennia. I hope the church will God, and who is not. I perceive that the always hold my colleagues and me to opposite of finitude is God, who though fidelity to the oath. Within the confines incomprehensible except in the person of of that prohibition has developed a rich Jesus, is the only infiniteness I can matrix of palliative, comfort care; pain imagine. The other continuum is one control; and end-of-life care. If an more grounded in values. Enslavement urgency exists in our society, it is to to pointless technology and hubristic make that care available to all—“to the notions of control by acts such as least of these”—rather than to add a new euthanasia and other acts that assume and grotesque dimension such as killing medicine can control everything are the by physicians or physician-assisted polar extremes. Patient choices about suicide. If a place for such activity treatment options, within proper moral exists, it is neither historically, uniquely, boundaries, coincide with the virtuous nor properly medical. Anyone with midpoint of that continuum at a place access to a knife, a gun, a poison, a rope, a club, or a live electrical wire could do The Spirit of the Sovereign Lord is on the deed. me, because the Lord has anointed me to preach good news to the poor. He has sent me to bind up the broken As a moral profession, medicine at its hearted, to proclaim freedom for the best responds to prophetic voices, both captives and release from darkness within and beyond the institutional for the prisoners, to proclaim the year religious community. Sometimes those of the Lord’s favor and the day of vengeance of our God, to comfort all voices arise within our professional who mourn, and provide for those community. Leon Kass raises such a who grieve in Zion—to bestow on voice. He writes: them a crown of beauty instead of ashes, the oil of gladness instead of People who are for autonomy and mourning, and a garment of praise dignity should try to reverse this instead of a spirit of despair. They dehumanization of the last stages of will be called oaks of righteousness, a life, instead of giving dehumanization planting of the Lord for the display of its final triumph by welcoming the his splendor. (Isaiah 61:1-3, NIV) desperate goodbye-to-all that is contained in one final plea for This is how I believe good doctors, poison… good patients, and a good society …Should doctors cave in, should achieve their freedom in the face of doctors become technical dispensers finitude. To take up your summons, it’s of death, they will not only be the best I can do. And thanks for the abandoning their posts, their patients, assurance that God’s grace and mercy and their duty to care; they will set surround me as a person and as a the worse sort of example for the community at large—teaching physician. technicism and so-called humaneness 1 where encouragement and humanity Timothy E. Quill. M.D., “Death and are both required and sorely lacking. Dignity”—A Case of Individualized Decision On the other hand, should physicians Making,” The New England Journal of hold fast…should doctors learn that Medicine, (March 7, 1991): 691-694. 2 finitude is no disgrace and that human James W. Crawford, Worthy to Raise Issues wholeness can be cared for to the (Cleveland: Pilgrim Press, 1991), p. 41. 3 very end, medicine may serve not Howard Moody, “Life Sentence,” Christianity only the good of its patients but also, and Crisis (October 12, 1987). 4 by example, the failing moral health Gerald Oosterveen, “Decisions at Life’s End,” of modern times.”8 Presbyterian Survey (November, 1993): 19. 5 S. Hauerwas and R. Bondi, “Memory, Community, and Reasons for Living: Reflection As a Christian physician, I can only try on Suicide and Euthanasia,” in S. Hauerwas, to hold to such high standards. End-of- Truthfulness and Tragedy (Notre Dame, IN: life care still has its University of Notre Dame Press, 1977). purpose—enrichment of whatever 6 P. Wesley, “Dying Safely,” Issues in Law and limited and compromised life remains. Medicine 8 (1993): 467-85. 7 D. Bonhoeffer, Ethics, trans. N. H. Smith (New The British AIDS hospice physician, York: MacMillan, 1995), pp. 160-6. Robert George, in his “quest…for 8 L. R. Kass, “Neither for Love Nor Money: dignity, hope, freedom, and healing for Why Doctors Must Not Kill,” Public Interest 94 our patients as they pass through death,” (Winter 1989): 25-46. 9 9 quotes a more familiar prophetic voice, R. George, “Euthanasia: The AIDS Dimension,” in Death Without Dignity, ed. N. Isaiah: Cameron (Rutherford House, 1990), pp. 176- 195. APPENDIX 3 Prior Denominational Statements on Euthanasia

I. which obligation is more expressive of EXCERPTS FROM “THE respect for life if conflict is seen to exist. NATURE AND VALUE OF Perhaps cases of intense and HUMAN LIFE” st unrelievable pain furnish the most A Paper Adopted by the 121 General difficult examples. Because human Assembly (1981) of the Presbyterian beings are finite creatures, we know that Church in the United States and there are definite limits to the amount of Commended to the Church for Study pain that anyone can bear without having the relational quality of their life pp. 16-19 completely consumed by the relentless battle with pain. It is not terribly Euthanasia. The topic of euthanasia is difficult to imagine some such complicated by the fact that one term is circumstance where we would be often applied to quite different kinds of inclined to perceive the obligations to do circumstances. Therefore it is important no harm and to protect from harm as at the outset to make a fundamental being in direct conflict. The harms also distinction between taking life would appear to be proportionate to one (sometimes referred to as “active another since uninterrupted, intense pain euthanasia”) and allowing to die can probably destroy the ability to enjoy (sometimes referred to as “passive relationships as fully as can physical euthanasia”). Our consideration of each death. Thus the judgment called for at of these matters will be carried out in this point in the process would be the terms of the framework utilized in the designation of which obligation is more discussion of abortions. consistent with respect for life in this situation. It might be argued that (i.) Taking Life. “Active euthanasia” is contradiction of its meaning and purpose a question that arises in situations of and causes such palpable harm to the medical extremity where it is thought person in question, that greater respect is that an individual is beyond the reach of shown for life by giving priority to the medical care. Some have at least posed obligation to protect from harm. the question of whether the most humane treatment might be to terminate life. Happily extreme situations of such However, the dominant value of respect intense and unrelievable pain are less for human life and its accompanying and less likely in the context of modern obligations to do no harm and to protect medical services, especially with the from harm establish a clear prejudice availability of pain relieving drugs. against such direct taking of life. The Therefore, the conflict of obligations just only relevant question for us is whether described can often be reduced through there is a conceivable conflict between drug therapy. While human life might these obligations. Once again it is also be less than ideal under such treatment, necessary to formulate a judgment about it does not present us with a direct conflict between the obligations of doing no harm and protecting from harm. euthanasia” and abortions, questions that Nonetheless, there may be circumstances are based on the circumstances of the which have no access to such medical fetus. There is an accompanying treatment and which would continue to prejudice against the taking of life in pose a situation of conflict. Moreover, both cases, since the conflict between there may be other circumstances than doing no harm and protecting from harm sheer pain which could present us with a has reference to one and the same conflict of obligations. Thus it is useful individual. The ambiguity of this to illustrate the procedure of determining situation serves to reinforce what has whether a conflict exists and which already been said about cautious and obligation best satisfies the concern for consultative decision-making. respect for life. It reminds us as well that certain tragic choices do confront us (ii.) Allowing to Die. “Passive at the boundaries, for which we do well euthanasia” presents a somewhat to have a clear procedure to guide our different picture from “active consideration. euthanasia.” Whereas the latter assumes that death cannot be expected to follow If and when we are confronted by such from the person’s medical condition, the boundary choices, caution and former assumes that death is predictable. consultation are important ingredients of The question is basically whether our deliberations. From our earlier medical interventions should be made or considerations on the moral character of continued, or whether the person should human life, we recall our proclivity to let be allowed to die as a result of the our self-interest cloud our judgments on medical condition. important matters. From our analysis of the finite character of human life we also The moral question posed here is not recall limitations on our knowledge and whether two obligations are in conflict. the importance of being aware of all It is rather the question of what relevant knowledge. Thus we should not constitutes the fulfillment of the encourage hasty decision-making, nor obligation to protect from harm. In should we abandon patients, families, allowing to die, one is not active but and doctors to make such monumental passive. It follows that the activity of decisions with the collaboration of other doing harm cannot be attributed to the experts. Here too there is a need for passive procedure of not intervening. relatively disinterested helpers in the Thus we are not confronted with a decision-making process, so that conflict between obligations to do no judgments satisfying the moral claims harm and to protect from harm. Rather, described in this study might be reached. we are confronted with the question of what our obligation to protect from harm “Active euthanasia” is extremely means in such circumstances. difficult to defend morally. There are, however, extreme circumstances in In one sense, every medical which we may have to at least raise the intervention represents a decision not to question of a fundamental conflict of allow a person to die. Therefore, it obligations. There is an analogy would appear that normally we assume between such cases of “active that the obligation to protect from harm means that we do not allow people to die if we can do something about it. Yet a In such a situation the obligation to further distinction is relevant just at this protect human life from harm does not point. When we speak of not allowing a require us to treat the condition that is person to die, we usually mean that we leading to death. On the other hand, it are prolonging their life. However, there does require us to accompany and care is a difference between prolonging life for persons in every relevant way. and prolonging dying. If the effect of a Certainly it obliges us not to abandon given intervention is not to prolong life, persons, leaving them to die alone. but to prolong dying, then we cannot Instead, protection from harm means that claim that we have protected human life we will remain with them, offering from harm by the intervention. Our company and support as they confront earlier discussion of the finite character the inevitable implication of their own of human life makes plain that death is finitude. Additionally, medical not always to be understood as a harm. treatment designed to relieve pain and Where ding is judged imminent and make persons more comfortable would inevitable, death is not a harm from continue to be very much in order. which we can conceivably be protected. Entailed in this commitment to Hence, there can be no obligation to accompany dying patients is a readiness protect from this event. to undertake medical treatment that will prolong dying if requested by patients, Thus the fundamental judgment that assuming their competence. Perhaps has to be made in the matter of “passive most often in the situation of dying, the euthanasia” is whether the person in person will be unable to make judgments question is dying or not. This is not the or requests of this sort. Here, where same thing as asking whether a patient is doctors and guardians are necessarily terminal. A person with a certain form entrusted with the decision, no moral of cancer may clearly be terminal, but obligation to treat the dying patient this does not necessarily mean that the exists. However, if a patient is able to individual is confronted by impending and does make a request for so-called death. The dying condition obtains “heroic” medical measures, even against when it becomes apparent that no the best medical judgment, it would be a available medical treatment will reduce failure of readiness to support and the disability or improve the capabilities accompany to refuse such a request. of a terminal patient facing impending death. The effect of medical treatment Obviously this response assumes that in this case cannot be to prolong life, but the requested treatment does not portend at most to prolong dying by marginally a more harmful result for the patient than forestalling impending death. The already experienced; nor does determination of the condition of dying responsiveness to such a request is fundamentally a medical judgment preclude careful review with the patient that will need to be rendered by qualified of the medical judgment and even the medical personnel. Once the judgment theological implications to enable the is made, the situation can be analyzed in patient to better grasp the rationale for terms of our obligation to protect from not prolonging dying. Nevertheless, the harm. medical judgments involved are human and therefore fallible. With due act could constitute taking life, allowing explanation and discussion, it would not to die, or acknowledging be appropriate to refuse request for death—depending upon the condition of treatment from the patient. the patient. If it were either of the first two possibilities, it would be subject to It should go without saying that should analysis in terms already provided. Here the medical indications suggest that the we need to indicate what is involved if person is not in a condition of dying, the third possibility, acknowledging then the obligation to protect includes death obtains. the obligation to treat medically to the maximum extent possible. Such a To determine when death occurs is a severe, even terminal, but non-dying subtle admixture of medical and medical condition does not change the philosophical or theological judgment. normal implication of out obligation to On the basis of our earlier discussion of protect from harm. Here not to intervene the relational character of human life, medically constitutes a clear violation of our theological judgment is that death the obligation to protect. occurs where the capacity for such relationships is irretrievably lost. The Just as “active euthanasia” requires a related medical judgment is that such process of moral reasoning that is capacity is lost when cerebral function is deliberately cautious and collaborative, lost. Traditionally, the most readily so “passive euthanasia” requires the evident signs of lost cerebral function same ingredient. While we are not have been lost heart and lung function. concerned in “passive euthanasia” with a Modern medical technology complicates conflict between the obligations to do no the picture, however, since heart and harm and to protect, very difficult lung function can sometimes be judgments, especially of a medical supported by the use of a respirator. In nature, need to be made. It is especially such a situation, the question is whether important that people deeply involved in any determination can be made about the situation are helped to ask and cerebral function. Through the use of answer the question of whether the electroencephalogram and possibly other condition is one of dying, then those tests of responsiveness and reflexes, involved medically and familially must judgments about whether cerebral be assisted in determining how they can function is present or not can be made. continue to care for and accompany the If judged to have been irretrievably lost, person as death is confronted. the individual is properly determined to be dead. (iii.) Acknowledging Death. While not technically part of our consideration of There are important considerations for euthanasia, the matter of determining certain difficult cases. It is important to when death occurs is an important insist that removal of life support related issue. There are circumstances in systems is such a circumstance is neither which taking life or allowing to die can taking life, not allowing to die. It is be confused with acknowledging death, acknowledging death. Thus it as when the use of a respirator for a constitutes no failure of the obligations comatose patient is discontinued. The to do no harm or to protect from harm, to acknowledge the fact of death whenever take such action. cerebral function, which makes possible human relationships, is irretrievably lost, (iv.) Summary and Conclusions. What distinguishing it from both taking life goes under the label “euthanasia” can be and allowing to die. usefully distinguished as “active euthanasia” and “passive euthanasia.” II. The former, which is the act of taking EXCERPTS FROM “THE COVENANT life directly, can only be raised as a OF LIFE AND THE CARING moral possibility in situations where we COMMUNITY” experience a conflict between out two- The 195th General Assembly (1983) fold obligation not to harm another and Received the Report and Adopted the to protect that person as well. To justify Policy Statements and such action morally requires the Recommendations demonstration that the conflict is real, pp. 20-24, 29-30. cannot be reduced, and that the action of Chapter 5: Decision-Making at the End- protecting for harm is more consistent of-Life with respect for life. Each of these Do not seek death. Death will find you. conditions is extremely difficult to But seek the road which makes death fulfill. In any event, the inherent fulfillment. (Dag Hammarskjold) ambiguity of such a decision requires Never harm (primum non nocere), cure that it be [made] thoughtfully and sometimes, comfort always! (Medical prayerfully, in collaboration with Maxim) knowledgeable persons not emotionally captured by the situation. The primary focus in decisions about life or death should be the individual’s “Passive euthanasia” or “allowing to wishes and needs, but decisions of this die” is indistinguishable from “active magnitude ought also to occur within the euthanasia” if the person is not in a context of community. Since individuals condition of dying. If, however, the differ in their understanding and patient is determined by appropriate acceptance of death, their decisions medical indications to be dying, the regarding care at the end of life will also matter becomes one of a right differ. Those views must be considered. understanding of the obligation to In Christian perceptions the believing protect from harm. Protecting persons community is the body of Chris, so we from harm involves caring for them and must be concerned with the whole body accompanying them, but not medical and also with the individual members. interventions which can only prolong As a body sensitive to corporate as well dying. Decision-making requires expert as personal needs and desires, the medical consultation as well as other Christian community should provide a consultation that enables affected parties model to guide others in society. But to distinguish meaningfully between this is no easy task since individuals prolonging dying and prolonging life. differ, as is illustrated by the following Of special importance is continuing to case studies. care for and support the person who is Fourteen-year-old Tim Clark said good- allowed to die. It is also important to by Wednesday night to his friends during a prayer meeting at Abbots biomedical and theological reflection be Creek Baptist Church. Weary of three joined: that of dying and death. Our and a half years of dialysis treatments and three unsuccessful transplant attention now turns to biomedical attempts, Tim finally chose to die developments that affect the end of life having received a sign from God to and then to theological and ethical “come home” to live. Mrs. Clark said analysis of those developments. Tim had discussed going off dialysis for more than a month. “On Tuesday night after reading his Bible and saying his A. The Biomedical Assault on Death prayer, I heard him say, ‘God, if you want me to come home and live with Life expectancy has changed you, give me a sign.’ A little later, I dramatically in the last forty years due to heard him get up and he came down the the discovery and use of vaccinations stairs. He was aglow. He showed me his arm. It was bleeding where the and antibiotics, in addition to dialysis needles had been nine hours improvements in sanitation. In the before. He interpreted this as a sign that typical deathbed scene of the nineteenth God wanted him to come home.”1 century, the physician looked on helplessly as infection carried the person When Jane Gahagan, a young woman from Evanston, Illinois, read the story, away. At the present time infections she was not moved. Having struggled remain a frequent cause of death, with dialysis treatments for 8 years, especially in the developing countries; “…I thought of all those who are but in Western culture, other factors struggling to hang on, who five such as renal failure, toxemia, or everything they’ve got to be alive.” Gahagan wrote an open Christmas letter cardiopulmonary collapse are more to her fellow dialysis patients. “Life likely to be its cause. really begins when we know we might lose it. Suddenly, all the little things A major changeover. The past fifty become important again, as they were years have brought a major change in the when we were children. The sun on the lake, the flow of the seasons, the sting place where death occurs. Today this of wintry air on our faces, the sound of event takes place more often in leaves falling…Most of us know that institutions, namely, in hospitals and time in the middle of the night when we medical centers. In 1937, 37 percent of are very much alone. That hour of Americans died in hospitals; in 1958, the truth, the one in which we have no voice but our own echo…Still, that percentage had increased to 73 percent. moment becomes a triumph. There is Today over 80 percent of deaths occur always rising an instinct toward another away from home in hospitals or other day and the desire to make it count. institutions. This statistic underlies two And that is life, burgeoning in the midst primary characteristics of death in the of death, defiantly saying, ‘I will not give in.’”2 modern world: (1) Death most often occurs in the presence of powerful The vignettes above briefly describe technology. (2) Death most often occurs two inspiring and courageous at a time, place, and manner outside of perspectives on chronic illness and ways one’s control. of accepting death: two theologies of death and eternal life. These two stories Most people die in centers where frame the single human experience that advanced technologies capable of most invites, indeed mandates, that prolonging life, and thus the dying process, are available and often used. In definition of irreversible coma (or some a clinical consultation at a university modification thereof) has been widely teaching hospital, the question was accepted as the best objective standard raised whether emergency dialysis by which to determine death and has should be used for a patient who was been adopted into legislative statutes and refusing therapy. “Of course,” the hospital policies.3 dialysis team claimed, “that’s what we’re here for.” When the services are The great Puritan physician, Sir available and highly trained teams are on Thomas Browne, summarized the plight hand to initiate these efforts, it is of modern society seeking both to virtually assumed they will be used. assault death via biomedical skill and yet This is also true for resuscitation efforts to retain the grace of acceptance, even and a wide range of emergency victory, in the face of the inevitable. measures. The modern hospital is well equipped with a number of specialty With what shifts and pains we come teams who are always on call to do all into the world, we remember not; but ‘tis commonly found no easy matter to they can to stave off inevitable death. get out of it. Many have studied to exasperate the ways of Death, but fewer As a result, many persons now die in hours have been spent to soften that institutions under intensive care, at a necessity.4 much older age, surrounded by an impressive battery of devices and Many people today fear that they will machines. Under these circumstances, lose control over their lives when they dying takes much longer and costs far approach death; that things will be done more. Our technology may be capable to them that they would not want; and of rescuing an individual from death but that they will not be given a choice to may not be able to save the person from accept or refuse contemplated therapies. existence in a vegetative state with high This fear has given rise to two social costs. Severely ill or injured movements in public policy that have persons are often stabilized in conditions import for our consideration of death and of permanent impairment, which raises dying, particularly as the church questions about the long-range efficacy contemplates its own policy and its of these technological efforts. counsel to the secular society on these issues. Some persons have signed a Modern technology has forced us to “living will.” This is a document that reexamine the question, “When does attempts to clarify a person’s wishes death occur?” This questioning has been about time, manner, and condition of his made more urgent by economic and or her own death and what he or she 5 organ transplant considerations. The insists not be done. It is limited in its older definitions of death: “when a usefulness because of its lack of physician declares death,” or “when specificity. Various religious bodies heart and lung function cease,” have in have formulated versions of a living recent years yielded to the criterion of will. The Roman Catholic affirmation of cessation of brain function as the life and Sissela Bok’s “Personal 6 decisive factor in determining death. Directions for Care at the End of Life” The Harvard ad hoc committee’s are more specific and thus are helpful examples. Both are included in the appendix along with text examples from safeguard persons from unnatural deaths the Euthanasia Educational Council and assure that their rights to “natural (name now changed to Concern For deaths” are sustained. Dying). The experience of death has not The “living will” movement is both changed dramatically since the dawn of tragic and encouraging. It is tragic in human history. It is terrifying because it that it is necessary. Individuals and is either the end of everything, or it leads families should, under optimal to the unknown. In theological language conditions, have discussed these issues it portends salvation or damnation. To a fully and made their wishes clear to large measure death remains out of physician, family, and designated agents human control. As Sissela Bok, the before the final days of life. In an earlier Harvard philosopher, has argued, it is time, when one’s pastor, physician, not the fear of being dead that brings lawyer, and mortician were personal dread to modern people; it is the fear of friends, these convictions could be dying, fear of long and hard suffering voiced and arrangements made, so that and pain, fear of losing contact with formal documents were unnecessary. loved one, and fear of “physical Now, one may die in unfamiliar debilitation, senility…the loss of surroundings in the presence of strangers freedom and the loss of knowing what’s where one’s wishes are not known. going on.”7 People are therefore beginning to take initiatives so that guidance is given to How does theology reflect on these loved ones in the event that he or she developments in the experience of death lapses into coma or in some other way is and what ethical wisdom does that unable to control medical decisions theology present? through personal consent. Thus, proxy judgments can be made according to the B. The Christian Theology of Life, patient’s desires. This, of course, Death, Eternal Life confronts the proxy with new responsibility and burden as a maker of We seek good deaths, natural deaths, moral decisions. explainable deaths in the same way that the ancients did. In his study of An increasing number of states have primitive cultures, Frazer shows that all enacted in law “natural death acts.” This people stand in awe of death, seek to type of legislation seeks to give legal avoid it, and propose all manner of authority to a person’s wishes and at the rationalizations and escapes from it.8 same time protects health professionals Death was sometimes likened to a dream and institutions from litigation arising in which a person enters another world. out of an accusation that they failed to Reverence for the dead is evident at the do all that could be done to prolong life. prehistoric burial sites in Africa, the An interesting philosophical and Near East, and Europe. This reverence theological concept underlies these laws. in part arose from the belief that the dead They suggest that there are “natural” and still had contact with and could influence “unnatural” ways to die and that ethical for good or ill the lives of the living. and legal sanctions should apply to Whether death is seen as natural (a part found a primal transgression as the root of life) or unnatural (provoked by evil cause of human death. Thus even at this spirits) by primitive persons is disputed early intuitional stage, death was by the anthropologists. It is likely that separation from the source of life. people from earliest times saw death as it is seen today—with a mixture of In the first tradition, death is merely the emotions. On the one hand, it is natural, cessation of life. Vital power (nephesh) a part of life and inevitable. On the is exhausted from the body when breath other hand, it is unnatural and an leaves, and the body lapses into intrusion, an evil to be explained, a corruption and impurity (Numbers 9:6). problem to be solved. The early In the complementary tradition, death is Christians were divided over the a force controlled by God. Premature question whether death was part of the death was seen as a punishment allowed original creation. Would our progenitors by God but delivered by a hostile power. have died even if they had not disobeyed This strain in Hebrew thought became God? Or is immortality the primal the basis of Paul’s doctrine that death is natural state? In some cultures the “sting” which is the just wage of sin infanticide and senilicide are practiced in (Romans 6:23). order to hasten facilitate natural destruction. In other cultures childhood Superseding both of these notions, in and old age are revered and protected which death is seen either as natural or from assault. The seeds of the modern as evil, is the confidence that God impulses of both accepting and fighting contends against death with humanity. death seem to have existed since the God snatches believers from the hand of beginning.9 death (Psalm 18:6, 116:3). God accompanies persons in the valley of The Hebrews in biblical times began to death and allays their fears, sustaining reflect on death in a new way. Taking them forever (Psalm 23). God holds these primitive precedents, they found power over death. For those who have several explanations of the meaning of turned against God, death is the death. On the one hand, death was instrument of isolation and natural. Death was the normal end of condemnation. For God’s own, death is life. When a human life, like a fruit, is an instrument of deliverance and full grown, it is harvested (Job 5:25). salvation. Thus the meaning of death, “Full of years,” one is gathered to one’s like the meaning of life, is determined by people (Genesis 15:15). We are like the the covenant relationship. grass that flourishes, then dies, our days are a fragile breath that will soon be over The essential Christian teaching that (Psalm 39). In another understanding, bears on death is centered in the death life continues through the offspring into and resurrection of Christ. In Christ’s the next generation. Thus, to die without crucifixion, God has decisively children was to be completely dead. conquered the powers and dominions of Also there is the question of the fullness this world, especially the power of death of one’s life. Jepthah’s daughter wept (Acts 2:24, I Cor. 15:45-46, Rev. 6:8). about her unfulfilled maidenhood (Cf. The “last enemy,” whose fate is sealed in Judges 11). The prophetic tradition Christ’s atoning death, is death itself. In its fellowship with the living Christ, the the body. These two ideas framed the Christian community has already been theology of human death in early transported in anticipation to the other Christian history and were crucial as side of death. New life in Christ, which individual persons and the community is resurrection, can look back at death came to terms with physical death. from beyond (Colossians 3:2, cf. Col. 2). Oscar Cullmann writes: The Gospel of John uses eternal life as both experience and promise for Only he or she who apprehends with the Christians (Cf. John 5-6). first Christian the horror of death, who takes death seriously as death, can comprehend the Easter exultation of the To set the stage for an ethical response primitive Christian community. to the biomedical issues of dying and …Belief in the immortality of the soul death, it is necessary to review briefly is not belief in a revolutionary event. the evolution of Christian thought about Immortality, in fact, is only a negative assertion; the soul does not die, but death and resurrection. Early Christians simply lives on. Resurrection is a believed, as did the Jews of the first positive assertion: The whole person, century A.D., that a universal bodily who has really died, is recalled to life resurrection of the dead was forthcoming by a new act of creation by God. in the messianic age. This belief Something has happened—a miracle of creation! For something has also informed their understanding of the happened previously, something fearful: destiny of Jesus, then dead, now vital to Life formed by God has been their faith. This resurrection belief was destroyed.10 further intensified by the experience with Jesus. The earliest Christian burial The biomedical implications of the customs and tests, and the abandon with theology of death and eternal life which first and second century disciples reflected in contemporary theologians went to their deaths, exemplify in are several: (1) We fight with God behavior their faith in bodily against the power of death; (2) we hope resurrection. It is clear that the apostolic for a time in history when disease and community knew that Jesus, alive and untimely death will be overcome; (3) we powerful, was with them. They accept death as a part of life experience; expected his imminent return, which (4) we do not live under the dominion of would mark the final victory over the death but live toward the promise of life; grave. Thus, there was watchful waiting (5) we trust the details to God; and (6) in and a call to be faithful unto death. life and death we are with God.

In the first and second centuries a great C. The Ethics of Life and Death struggle ensued over the manner and meaning of Christ’s death and Reformed theological ethics lift up resurrection. Generally, Hellenistic several points about death that are moral Christians, especially Gnostics, issues of life and living. emphasized a spiritual resurrection and the derivative doctrine of the (1) The direction of biblical ethics is immortality of the soul, while Jewish against taking the life of another, even Christians ordinarily held a more for benevolent reasons. Persons should apocalyptic belief in the resurrection of not be deemed worthless, too old, too weak, unproductive, sociopathic, or a be aware of “the duty only to care for the burden, thereby justifying some act of dying, simply to comfort and company positive “mercy killing,” or the more with them, to be present to them.”12 fashionable slow killing by neglect. When persons fall into deep sickness, (2) Most discussions of ethics in health pain, suffering, unconsciousness; when care address the issue of autonomy (i.e., they life helpless under deep sedation or a person’s right to make—or at least at the brink of danger in intensive care, participate in—decisions related to his or they must know that they will not be her own body), primarily when abandoned. discussing death and dying. The popular clichés related to this issues are: “the While the direction of biblical ethics is right to die,” “death with dignity,” and against taking the life of another, it in no the “right to refuse treatment.” way claims that it is necessary to Although cases (Quinlan, Fox, prolong the life—or the dying Saikewicz) that have been prominent in process—of a person who is gravely ill the mass media and that have focused on with little or no hope for cure or these extraordinary issues are more remission. Persons who are terminally dramatic than commonplace, they still ill must be able to trust that their dying necessitate a moral response. In a will no be prolonged by unrequested pluralistic society where people have technological interventions. As different beliefs about life and death, theologian Paul Ramsey has stated, “We basic Christian respect for persons need…to discover the moral limits demands that a person’s decisions about properly surrounding offers to save life. death be honored in most instances. We need to recover the meaning of only caring for the dying, and the The choice of whether or not to justification—indeed the obligation—of undergo further treatment, whether or intervening against many a medical not to consent to experimental therapy, intervention that is possible today.”11 or to donate tissue should be a personal The existence of specific medical decision. Since the atmosphere of technology does not require that it be critical care medicine is highly charged used. with values such as medical authority, vested interest, and patient submission, Admittedly, it is often difficult to know care should be taken by the physician to or to acknowledge when a person is converse freely and candidly with the dying. It is equally difficult to stop patient. The patient ought to know the aggressive, curative types of treatments options, the pros and cons of each and therapies or to say that ordinary option, the thoughts of the attending types of therapy have become clinicians, and then be encouraged to extraordinary. Sometimes the person make his or her own decision. This view will know that he or she is dying, will try holds that it is unkind or unreasonable to to communicate that knowledge to invite the patient into the debate over family and caregivers who prefer not to options (and that the physician knows hear and keep busy trying to cure, rather best), and so the physician proceeds to than sitting quietly by, showing care and make proxy decisions for the patient. concern. Ramsey admonishes readers to The second unfortunate course sets the options and scenarios before the patient For the time being, given the like a computer. It gives the complexity of the modern medical probabilities and statistics and then says, center, the anonymity of doctor-patient “There you are, now decided!” Both of relationships, the tendency to do things these approaches shrink from the pain to and for other people, and conflicting and reward of cooperative judgment. interests, it is best to safeguard The best course is one that involves autonomy in medical decision-making coming to a thoughtful medical by whatever means. Patient review judgment, sharing this with the patient, boards, hospital ethics committees, reviewing the alternative courses, and institutional review boards for research inviting the patient’s response. The protocol, patient advocates, and a patient tragedy of patient refusal—or bill of rights all serve the function of thoughtless acceptance—of procedures safeguarding personal freedom. None of and the increased possibility of legal these can take the place, however, of action often arise from failures to respect honest, fair, and compassionate human the patient’s humanity and enter into relations and communication. responsible dialogue with him or her. (3) The real, almost inevitable danger Another variation on paternalistic of reducing human lives to statistics or decision-making involves the externally mechanical processes must be imposed judgment about a patient’s acknowledged. The influences of quality of life. If a patient’s quality of economic factors, often unspoken, loom life is deemed unsuitable or intolerable large. The efforts to place economic by members of the health care team, values on patients’ lives or determine treatment may be terminated—or not how many treatments an individual initiated—and the patient allowed to die. deserves, while reprehensible, This judgment about a person’s quality nonetheless occur. If medical care must of life made by someone other than the be rationed (e.g., no dialysis after 60 patient is far different from an years of age), policies should be made individual’s making such a decision following public deliberation so that about his or her own life quality. While those affected will have had a chance to members of the health care professions participate. are called upon to make quality-of-life decisions at many levels—and it is Impulses to quantify or stage the unrealistic to deny that such decisions experiences of moving toward death or are not necessary—a word of caution is beyond death should be stifled. The in order to those who make such thought of nurses or others with decisions and to all who may be patients handbooks trying to assess whether the at some point in time. We must take patient is in the “denial” or “acceptance” great care not to denigrate the worth or stage of dying is frightening. To reduce life of others and impose a judgment of a person to a stage, a disease (“the ulcer poor quality that might provide in Room 210”), or a statistic is to wish justification for stopping treatment or that person dead. The awesome mystery avoiding the patient. and unpredictability of life and living, to say nothing of an enduring respect for persons, should be sustained in I-Thou the next chapter in the surprising story of rather than I-It relations. life.

(4) There is the danger and temptation (6) Decision-making is never sure; to idolize bodily life by making retention deciders are seldom secure. Persons are of physical life the only good and ambivalent about whether to approach primary goal. Jesus touches this subject death with dread or hope, whether to when he says that “Whoever would save resist or to accept. Possibly this his life shall lose it.” Too much effort to ambivalence comes from the built-in defend one’s own life, to bury it in a safe will to live and the corresponding will to place like the one-talent man, to refuse die. Whatever its origin, ambivalence is to give life away, or to fail to use it up woven into the fabric of being itself, and goes against the grain of Christian decisions of life and death are met with a calling. It is indeed idolatrous to try to kind of frustrating ambiguity. Since life- keep a person’s body alive no matter death decisions can rarely be made with how to empty that life may be. Human certainty, even when all the evidence is beings are transcendent creatures. Real in, decisions must be made with humility life comes from beyond bodily function. and with a posture of seeking God’s Jesus asks: “Is not life more than food, forgiveness and acceptance. and body more than clothing?” (Matthew 6:25b). Often hospitals and (7) Finally, the church is in the world to medical personnel are simply engaged in be an example, not to impose values or a contest to preserve “life,” with little beliefs. By its life and its attitude concern for quality or expectation. toward life, it can and should bear Sometimes they win the battle, but the witness to the faith. The church in this patient loses. Clinging to life rather than area, as in many others, must be the reaching out to life compounds the community of care, protection, and tragedy. nurture. In this way, the church can be a model in a pluralistic society for how (5) The affirmation about eternal life these decisions ought to be made while that is woven into the Gospel according preserving and enhancing human dignity to John should be emphasized. Eternal and worth. life is here and now. According to the apostle Paul, the light of promise shines in the present moment. Eternal life, not death, is the ultimate reality. That assurance keeps Christians from living Decision-Making at the End-of- all of life being afraid of death. For Life Christians the adventure is never toward an end but toward new beginnings. Elizabeth Kubler-Ross has written that 1. Many members of the Presbyterian death is the final stage of growth; it Church (U.S.A.) will face health care would be more appropriate to affirm that decisions toward the end-of-life that death is another stage of becoming. For they could not have anticipated, and Christians, death can be understood as many of those decisions will require judgments that relate to values held by the patient. Therefore, the 195th qualified resource persons whenever General Assembly (1983) calls upon possible. its members to: c. Advocate that human need and a. Select their physicians with regard benevolence replace the opportunism not only to the skillfulness of the and exploitation that so often medical care that they can provide surround the death experience but also for their values regarding presently. human life and community, whenever such a choice is available. 3. Harmony and integration should be sought between intensive care, b. Take time to reflect on their own curative hospitals, and hospices so values and discuss these with family that end-of-life care can be free from members, close friends, and their jurisdictional conflict and that clergy. therapeutic and palliative care are available to all. c. Speak with their physicians about their concerns regarding care and become educated about their Appendix A conditions in order to permit informed decision-making. Directions for My Care d. Provide instructions (and designate I, ______, want to two agents to carry out instructions) participate in my own medical care as with regard to extraordinary long as I am able. But I recognize that therapies and treatments to prolong an accident or illness may someday life. make me unable to do so. Should this come to be the case, this document is 2. The church should be a place where intended to direct those who make individual and families can make choices on my behalf. I have prepared it plans about death, manner of death, while still legally competent and of th living wills, etc. Therefore, the 195 sound mind. If these instructions create General Assembly (1983) calls upon a conflict with the desires of my the church to: relatives, or with hospital policies or with the principles of those providing a. Request the Program Agency to my care, I ask that my instructions make available information and prevail, unless they are contrary to study tools for use by congregations existing law or would expose medical regarding options available at the personnel or the hospital to a substantial end-of-life and means of informing risk of legal liability. health care professionals of these wishes. I wish to live a full and long life, but not at all costs. If my death is near and b. Hold seminars utilizing the cannot be avoided, and if I have lost the aforementioned materials and ability to interact with others and have no reasonable chance of regaining this ability, or if my suffering is intense and New England Journal of Medicine 295 irreversible, I do not want to have my (August 12, 1976), 367-369.) life prolonged. I would then ask not to be subjected to surgery or resuscitation. Nor would I then wish to have life Appendix B support from mechanical ventilators, intensive care services, or other life Christian Affirmation of Life[1] prolonging procedures, including the administration of antibiotics and blood To my family, friends, physician, products. I would wish, rather, to have lawyer, and clergyman: care that gives comfort and support, which facilitates my interaction with I believe that each individual person is others to the extent that this is possible, created by God our Father in love and and which brings peace. that God retains a loving relationship to each person throughout human life and In order to carry out these instructions eternity. and to interpret them, I authorize ______, to accept, plan and I believe that Jesus Christ, lived, refuse treatment on my behalf in suffered, and died for me and that his cooperation with attending physicians suffering, death, and resurrection and health personnel. This person prefigure and make possible the death- knows how I value the experience of resurrection process which I now living, and how I would weigh anticipate. incompetence, suffering, and dying. Should it be impossible to reach this I believe that each person’s worth and person, I authorize ______dignity derives from the relationship of to make such choices for me. I have love in Christ that God has for each discussed my desires concerning individual person and not from one’s terminal care with them, and I trust their usefulness or effectiveness in society. judgment on my behalf. I believe that God our Father has In addition, I have discussed with them entrusted to me a shared dominion with the following specific instructions him over my earthly existence so that I regarding my care: am bound to use ordinary means to preserve my life but I am free to refuse (Please continue on back.) extraordinary means to prolong my life. Date ______I believe that through death life is not Signed ______taken away but merely changed, and though I may experience fear, suffering, Witnessed by ______and sorrow, by the grace of the Holy and ______Spirit, I hope to accept death as a free human act which enables me to (Source: Sissela Bok, “Personal surrender this life and to be united with Directions for Care at the End-of-Life,” God for eternity. Because of my belief: Date ______

I request that I be informed as death approaches so that I may continue to Appendix C prepare for the full encounter of Christ through the help of the Sacraments and A Living Will the consolation and prayers of my family and friends. To My Family, My Physician, My Lawyer, My Clergyman: To Any I request that, if possible, I be consulted Medical Faculty In Whose Care I concerning the medical procedures that Happen To Be; To Any Individual Who might be used to prolong my life as May Become Responsible For My death approaches. If I can no longer Health, Welfare, Or Affairs: take part in decisions concerning my own future, and there is no reasonable Death is as much a reality as birth, expectation of my recovery from growth, maturity, and old age—it is the physical and mental disability, I request one certainty of life. If the time comes that no extraordinary means be used to when I ______can no prolong my life. longer take part in decisions for my own future, let this statement stand as an I request, though I wish to join my expression of my wishes, while I am still suffering to the suffering of Jesus so I of sound mind. may be united fully with him in the act of death-resurrection, that my pain, if If the situation should arise in which unbearable, be alleviated. However, no there is no reasonable expectation of my means should be used with the intention recovery from physical or mental of shortening my life. disability, I request that I be allowed to die and not be kept alive by artificial I request, because I am a sinner and in means or “heroic measures.” I do not need of reconciliation and because my fear death itself as much as the faith, hope, and love may not overcome indignities of deterioration, dependency, all fear and doubt, that my family, and hopeless pain. I, therefore, ask that friends and the whole Christian medication be mercifully administered to community join me in prayer and me to alleviate suffering even though mortification as I prepare for the great this may hasten the moment of death. personal act of dying. This request is made after careful Finally, I request that after my death, consideration. I hope you who care for my family, my friends, and the whole me will feel morally bound to follow its Christian community pray for me and mandate. I recognize that this appears to rejoice with me because of the mercy place a heavy responsibility upon you, and love of the Trinity, with whom I but it is with the intention of relieving hope to be united for all eternity. you of such responsibility and of placing it upon myself in accordance with my Signed ______strong convictions, that this statement is made. incapable of giving directions, at Signed ______the discretion of the physician in charge of my case. Date ______B. In the event of my suffering from Witness ______any of the conditions specified above, I request that no active steps Witness ______should be taken, and in particular that no resuscitatory techniques be Copies of this request have been given to used, to prolong my life or restore me to consciousness. ______C. This declaration is to remain in ______force unless I revoke it, which I may do at any time, and any request ______I may make concerning action to be taken or withheld in connection ______with this declaration will be made without further formalities.

Appendix D I WISH it to be understood that I have confidence in the good faith of my Form or Declaration under the relatives and physicians, and fear Voluntary Euthanasia Act 1969 degeneration and indignity far more that I fear premature death. I ask and Declaration made ______authorize the physician in charge of my case to bear these statements in mind [and re-executed ______] when considering what my wishes would be in any uncertain situation. by ______SIGNED ______[SIGNED ON RE-EXECUTION] of ______WE TESTIFY that the above-named I DECLARE that I subscribe to the declarant [2][signed][2][was unable to code set out under the following articles: write but assented to] this declaration in our presence, and appeared to appreciate A. If I should at any time suffer from a its significance. We do not know of any serious physical illness or pressure being brought on him to make a impairment reasonably thought in declaration, and we believe it is made by my case to be incurable and his own wish. Insofar as we are aware, expected to cause me severe we are entitled to attest this declaration distress or render me incapable of and do not stand to benefit by the death rational existence, I request the of the declarant. administration of euthanasia at a time or in circumstances to be Signed by ______of indicated or specified by me or, if it ______is apparent that I have become

Signed by ______of 10 Oscar Cullman, “Immortality of the Soul ______or Resurrection of the Dead?,” in Immortality and Resurrection, ed. Krister [Signed by ______of Stendalh, New York: MacMillan, 1965, pp. ______on re- 26-27. 11 Paul Ramsey, The Patient as Person, New execution] Haven and London: Yale University Press, 1970, p. 118. [Signed by ______of 12 Ibid., p. 125. ______on re- execution]

ENDNOTES:

Chapter 5: Decision-making at the End-of- Life

1 “Boy Needs ‘Signs,’ Makes Choice to Die,” Chicago Tribune, Thursday, June 22, 1982, p. 1. 2 “Her Choice: Don’t Give in to Death,” Chicago Tribune, Friday, July 30, p. 4., Sec. 1. 3 “A Definition of Irreversible Coma,” Journal of the American Medical Association, 205, No. 6, August 5, 1968, pp. 85-88. 4 Sir Thomas Browne, Christian Morals, Part II, Sec. XII, Works IV, ed. S. Wilkon, London: William Pickering, 1835, p. 170. 5 See versions of “Living Wills” in Kenneth Vaux, Will to Live/will to Die, Minneapolis: Augsburg Press, 1978; Marvin Kohl, ed. Beneficent Euthanasia, Buffalo, NY: Prometheus Books, 1975; “Death,” Encyclopedia of Bioethics, New York: Macmillan Free Press, Vol. 1, 1978, p. 221. 6 Sissela Bok, “Personal Directions for Care at the End-of-Life,” New England Journal of Medicine, 295:7, August 12, 1976, pp. 367- 369. 7 Sissela Bok in “Death and Dying,” Hard Choices, produced by KCTS/9, Seattle, Washington, p. 4. 8 James George Frazer, The Belief in Immortality and the Worship of the Dead, 3 Vols., London: MacMillan, 1913-1922. 9 “Death: An Anthropological Perspective,” The Encyclopedia of Bioethics, op. cit. pp. 225ff. APPENDIX 4 A Commitment to Caring

God’s compassion toward humanity is compassion in the public arena: to shown in Scripture, in the history of the confront apathy, insolation, and the church, and most specifically in the marginalization of children, the poor, the person and message of Christ Jesus. hungry, the stranger, the homeless, the Although people seek to live for chronically and terminally ill, the themselves alone, God continually acts prisoner, and others in need of care, to set people free from selfishness, knowing that even as we serve them, we calling them into a community of serve the Lord Jesus. (Matthew 25:31ff.) faithful discipleship, and directing them toward particular ministries of caring. RECONCILIATION—demonstrating in our individual and corporate lives a Responding to God’s compassion and love that is genuine, an abhorrence of guided by the Holy Spirit, the church evil, a zeal for service, a joyful seeks to become an intentional hopefulness, patience in adversity, a community of caring to represent more constancy in prayer, a generosity toward fully the living Christ in faith and others, and hospitality for all, so that the practice. For this reason, the session of many may become one. (Romans ______Church now 12:9ff.) commits itself to a covenant of caring. In fulfilling this commitment, we will ADVOCACY—standing with and for engage in ministries of caring through: those who cannot speak for themselves, as advocates of compassion in their WORSHIP—providing worship that lives, to be a prophetic witness for conveys the reality of God’s compassion removing economic, social, and to our congregation. structural obstacles to care in society, including care at the end-of-life. PRAYER AND BIBLE STUDY—encouraging members of our RESPONSIBILITY—involving the congregation to accept God’s congregation in one or more acts of compassion in their own lives and, by caring, such as: member-to-member daily prayer and openness to Scripture, care-giving (e.g., Stephen Ministry); to seek God’s compassion for today’s support for in-home health care (e.g., world. hospice); establishing parish nurse program; organizing a bereavement EDUCATION FOR CHILDREN, committee; housing and/or supporting a YOUTH, AND ADULTS—giving health clinic; caring for, supporting, members of the congregation means to nurturing, and empowering professional help them grow as caring persons in and volunteer care-givers. their homes, their church, and their community. The session will lead and support the congregation in this caring response to SERVICE—holding before the God’s compassion for us. congregation an urgency to work for Moderator of Session, ______e. It offers a series of guidelines for assessing the church’s caring Date ______efforts.

Clerk of Session, ______f. It can become a vehicle for networking the ministries of care of Date ______different churches.

g. It can offer a congregation new 1. What is the Commitment to energy and initiative. Caring? 3. Does a congregation have to do The Commitment to Caring is a way something in all seven areas of the for the session to state the intention that Commitment to Caring at one time? the church shall engage in a ministry focused upon caring. No. Most congregations will seek to target several areas initially. They may 2. What value does making a also find that they are already engaged in Commitment to Caring hold for our caring efforts in a number of these areas. congregation? It is hoped that eventually a congregation will choose to be involved in all seven a. It may help a church grow in its areas. By adopting the Commitment to vision and understanding of Caring, a congregation states its intent to compassion, until caring is an become involved in all seven areas at a inherent part of the church’s life. pace consistent with its own resources and abilities. b. It offers members a pattern for planning providing care in the 4. What prompted the Commitment to congregation. The Commitment to Caring? Caring implies that caring can be a component of much of the church’s Since 1990, at the direction of General ministry, including worship, prayer, Assembly, the Offices of Theology and Bible study, education, and service, Worship have been engaged in and acts of reconciliation, producing a study guide for pastors and advocacy, and responsibility. churches about end-of-life issues, including euthanasia and assisted c. It gives direction to the church suicide. As the task force met over the leaders as they plan for the future. course of a year to plan this study document, it came to believe that these d. It serves as a witness to others, both issues are part of a much larger concern, members of the church and the that is, that our churches become larger community, that an essential intentional communities of caring. In component of being Christian is to order to highlight this need, the care for others. Commitment to Caring was created. 5. Caring has always been an Because according to our Presbyterian important aspect of the life of our form of government the session is the church. Why should our congregation primary body of leadership in a make such a commitment now? congregation. Elders who have been chosen, elected, ordained, and installed Even though the church may assume it to direct the church have the proper is caring community, a Commitment to authority to implement a new initiative Caring moves the congregation beyond such as is described in the Commitment assumptions to actions. By taking the to Caring. steps to adopt and then highlight the Commitment to Caring, a congregation 8. How might a session decide to adopt makes specific and intentional what may the Commitment to Caring? have been unspecified and haphazard in its approach to compassionate ministry It could be presented by the clerk, in the name of Christ. moderator, or any session committee for a first reading and further study. Then, it 6. May we rewrite the Commitment would probably be discussed at the to Caring to make it more appropriate to following meeting of session. Members our church’s vision of caring? of session might be asked to note areas of the Commitment to Caring in which Certainly. It is expected and likely that the congregation is already engaged. many congregation will use the Commitment to Caring as is, but it is 9. Is there help available to our also offered as a guideline for churches congregation as we inaugurate our to consider and to tailor to suit their own Commitment to Caring? circumstances and needs. Yes. The study guide on euthanasia, 7. Why should the session be the body assisted suicide, and end-of-life issues to agree to the “Commitment to addresses many of the themes of the Caring”? Commitment to Caring. For other, helpful resources, see the bibliography (Appendix 5). APPENDIX 5 Selected Bibliography

These are resources in addition to ones previously listed. Choosing Death also An important set of essays, providing an has an excellent bibliography. overview of historical and contemporary perspectives on the topic. “Are Your Affairs in Order? A Planning Guide and Resource Book” Howard Brody, “Care of the (available from Bryn Mawr Presbyterian Hopelessly Ill: Proposed Clinical Church, Bryn Mawr, PA, 19010). Criteria for Physician-Assisted Suicide,” A helpful, practical guide to putting New England Journal of Medicine one’s affairs into order (including (November 5, 1992): 1380-1388. financial, medical, and funeral planning), so that one’s wishes for oneself and for others can best be A significant article in the discussion of respected when death comes. assisted suicide.

Joseph E. Beltran, The Living Will (and Daniel Callahan, The Troubled Dream Other Life and Death Medical Choices) of Life: Living with Mortality (Simon (Thomas Nelson Publishers, 1994)/ and Schuster, 1993).

A helpful, practical guide for individuals An important investigation of what wishing to make responsible medical constitutes a life fully-lived. While the choices for themselves. Medical, legal, author opposes euthanasia, he raises and theological issues are considered. provocative questions about how far we should go in sustaining life in the face of death. Dan W. Brock, “Voluntary Active Euthanasia,” The Hastings Center Daniel Callahan, Gilbert Meilander, Report (March-April 1992): 10-22. Christine Whitbeck, William Smith, M. Therese Lysaught, William May, and A thoughtful assessment of arguments Eric Cassell, “The Sanctity of Life for and against euthanasia. While the Seduced: A Symposium on Medical author argues for the possibility of Ethics,” First Things (April 1994): 13- euthanasia and assisted suicide, he 27. demonstrates the complexity of the issue. A fine discussion centering on death and dying, euthanasia, religion, and public Baruch Brody, ed., Suicide and policy. Virtually all points of view are Euthanasia: Historical and expressed. Contemporary Themes (Kluwer Academic Publishers, 1989). Courtney S. Campbell, “Religious Ethics and Active Euthanasia in a Herbert Hendin and Gerald Klerman, Pluralistic Society,” Kennedy Institute of “Physician Assisted Suicide: The Ethics Journal (September 1992): 253- Dangers of Legalization,” American 277. Journal of Psychiatry (January 1993): 143-145. A survey of various religious and denominational perspectives on A psychiatric perspective. The authors euthanasia, with particular attention to argue that the majority of persons themes of sovereignty, stewardship, and requesting euthanasia or assistance in the self. dying are suffering from treatable forms of depression. Eric J. Cassell, “Recognizing Suffering,” The Hastings Center Report Leon R. Kass, “Is There a Right to (May-June 1991): 24-31. Die?,” The Hastings Center Report (January-February 1993): 34-43. An important essay on the nature of suffering, and on how we become aware An argument that there is no firm of another’s suffering and more philosophical or legal argument for a sensitive to it. Also, see his book The “right to die.” To speak of rights in the Nature of Suffering (Oxford, 1991). very troubling matter of medically managed death is ill suited both to sound personal decision-making and to Ezekiel J. Emanuel, “Euthanasia: sensible public policy. Historical, Ethical and Empiric Perspectives,” Archives of Internal Medicine (September 12, 1994): 1890- Gilbert Meilander, “I Want to Burden 1901. My Loved Ones,” First Things (October 1991): 12-14. A clear historical and ethical approach to the issue, written for the A provocative essay on Christian nonspecialist. It is a valuable general responsibility in the face of suffering introduction. and dying. The author argues for the importance of our bearing each other’s burdens. Also, see relevant chapters in Stanley Hauerwas, Naming the the author’s book The Limits of Love: Silences: God, Medicine, and the Some Theological Explorations Problem of Suffering (Eerdmans, 1990). (Pennsylvania State University Press, 1987).

A provocative set of reflections on the distinctive character of the Christian J.P. Moreland and David M. Ciocchi, community, including its ability in faith Christian Perspectives on Being Human to protest suffering. (Baker Book House, 1993). Making,” New England Journal of Readily accessible to a lay audience. Medicine (March 7, 1991): 691-694. The author expresses a fairly traditional evangelical point of view. See especially Chapter 8, “Views of Human An important and controversial essay. Nature at the Edge of Life.” Quill relates a personal experience and argues for the right of physicians to assist patients in dying. Timothy E. Quill, “Death and Dignity: A Case of Individualized Decision Response Form for Study on Euthanasia, Assisted Suicide, and End-of-Life Decisions

Your comments will help the Office of Theology determine whether to take additional steps to address issues relating to euthanasia, assisted suicide, and end-of-life decisions. A summary of responses will be shared with the General Assembly and General Assembly Council.

Please type or print, and return to the address at the end of the form. Many thanks for your participation and response.

PART I.

1. Name of Congregation (or if not congregationally based, a description of your study group): ______

2. Location: ______

3. Number of Study Sessions: ______

4. Approximate Time Per Study Session: ______

5. Average Number of Participants Per Session: ______

6. Name, Address, and Phone Number of a Contact Person: ______

PART II.

7. What were the high points of the study, and why? ______

8. What key questions or concerns emerged? ______

9. Did you use the background book, Choosing Death: Active Euthanasia, Religion, and the Public Debate (ed. Ron Hamel)? (Circle one) Yes No

10. How did you feel about the subject of euthanasia/assisted suicide at the beginning of the study? (Choose one.)

a. I could contemplate it for myself and could support the legalization of euthanasia/assisted suicide, with certain safeguards.

b. I could not contemplate it for myself but could support the legalization of euthanasia/assisted suicide, with certain safeguards.

c. I believed that euthanasia/assisted suicide is wrong under all or almost all circumstances but should be legalized, with certain safeguards.

d. I believed that euthanasia/assisted suicide is wrong under all almost all circumstances and should not be legalized.

e. I had not given the subject much thought, or I had no opinion.

11. How do you feel about the subject of euthanasia/assisted suicide now, at the end of the study? (Choose one.)

a. I can contemplate it for myself and can support the legalization of euthanasia/assisted suicide, with certain safeguards.

b. I cannot contemplate it for myself but can support the legalization of euthanasia/assisted suicide, with certain safeguards. c. I believe that euthanasia/assisted suicide is wrong under all or almost all circumstances but should be legalized, with certain safeguards.

d. I believe that euthanasia/assisted suicide is wrong under all or almost all circumstances and should not be legalized.

e. I have no opinion.

12. Should the General Assembly of the Presbyterian Church (U.S.A.) take a stand on the legalization of euthanasia/assisted suicide?

a. Yes, for this reason: ______

b. No, for this reason: ______

c. I don’t know, here’s why: ______

13. If you answered “Yes” to Question 12, please answer the following:

What stand should the General Assembly take? ______

14. In your opinion, how important is it that the church does each of the following, in response to the public discussion of euthanasia/assisted suicide? (Answer each of the following.) don’t very important somewhat not very know/ no important important important opinion a. promote hospice care, both by offering financial support to hospice programs and by making people more aware of hospice services b. work to ensure that all people have access to sufficient health care c. work to ensure that doctors receive better training in pain management d. work to ensure that the church reaches out to people who experience isolation or fear as they face suffering and/or dying e. help to resolve—one way or the other—the issue of whether or not euthanasia/assisted suicide should be legalized

PART IV.

Any other comments that you would like to direct to the Office of Theology and Worship: ______PART V.

Results will be tabulated and shared with the General Assembly and the General Assembly Council. If you wish to receive a copy of the results, please check here ( ___ ) and provide your name and address if different from the contact person listed in Part I:

(Please print.)

Name: ______

Address: ______

Please send response form to: Charles Wiley, Office of Theology and Worship, Presbyterian Church (U.S.A.), 100 Witherspoon St., Louisville, KY 40202, phone: 502- 569-5734.