Suffering Redeemed: A Reformed Argument Against Physician Assisted Suicide and Euthanasia

Introduction to the Debate and Basic Argument

The nature of the debate between those who support and those who reject euthanasia and physician-assisted suicide is complex at almost every level, and thus care must be given to define terms adequately and make proper distinctions among end-of-life circumstances. For the purposes of this essay, physician-assisted suicide1 (PAS) will be defined as that moment when “a doctor, acting on a patient’s request, provides that person with the means to end his or her life, often to relieve the person’s pain and suffering. The physician provides the means, but the final act is the patient’s.2 Euthanasia, 3 a more difficult term to define because it takes many forms, may be divided into the following: voluntary euthanasia occurs when a non-coerced, competent, and informed patient asks another individual to end his or her life; involuntary euthanasia involves the killing of a competent and informed individual against his or her will and request; nonvoluntary euthanasia happens when a person without proper mental faculties is killed; passive euthanasia is the process of withdrawing or withholding the treatment of a patient with the result being death— this is contrasted with the direct ending of life in active euthanasia.4 In this essay, the term at the heart of the debate, euthanasia, will refer to voluntary, active euthanasia only—involuntary and nonvoluntary forms will simply be considered murder and not be treated in the text, and passive euthanasia will not be considered killing, but “allowing to die.”5 Because both PAS and euthanasia as defined above involve a voluntary, informed, competent decision for actively ending the life of a patient with that patient’s consent and full cooperation, the only distinction concerns who it is that directly participates in the ending of life: the physician at the patient’s request, or the patient himself.

Since this essay will argue on the basis of a Reformed theological approach against engaging in the act of PAS and euthanasia, a certain theological distinction must be made. I want to make a distinction between the term suffering 6 as a general category of description in terms of quality of life, and what I would call suffering unto death, which I define as suffering the knowledge and completion of an approaching death without exercising the freedom to prematurely and actively end it by means of self-inflicted acts or acts deliberately authorized for completion by another. Suffering, though natural, must be alleviated, whereas suffering unto death, by its very definition, is a different kind of suffering altogether.7 Consistent with this logic, I would advocate, when possible, the utilization of an advance health care directive so when situations arise whereby a person becomes incapable of making such end-of-life decisions, he or she would vow suffering unto death prior to the terminal medical reality.

Certainly, part of the oath taken by contemporary medical doctors involves the prescription of drugs for the alleviation of suffering,8 and from a theological perspective it would be difficult to argue against the use of modern medicine (specifically narcotic drugs) to alleviate physical pain, considering a very large portion of the Gospel narratives involve Jesus’ ministry of healing to those going through such physical suffering.9 Though this is the case, a distinction remains: whereas Jesus worked to alleviate suffering, there was a kind of suffering which he modeled as a way of approaching death for those who were to follow him; this involves a lifestyle consistent with the surrendering of one’s death to the will of God for the sake of a higher purpose. Put in the simplest terms, whereas vitalism views “…human physical life [as] an ‘incommensurate good,’ that is, without any exception of benefit outweighing any burden…,”10 I propose that proponents of PAS and euthanasia view the alleviation of suffering in much the same way, precisely because no distinction is made between suffering and suffering unto death. Alleviation of suffering, though tragic, becomes the highest and greatest calling, towering above the Hippocratic responsibility to do no harm, and the more modern secular and theological arguments based on palliative care and adequate options concerning hospice for those in terminal situations.

I argue in this essay, following the past declarations of the Roman Catholic Church, that the current Presbyterian Church (USA) stance against the practice of PAS and euthanasia (as described above) could use the concepts of suffering unto death and the historical act of Jesus Christ’s redemptive act in his passion, death, and resurrection as resources to give a greater theological underpinning for the foundational argument previously made against pursuit of these end-of-life practices. For the purpose of this essay, I do not seek to argue against the legalization of these practices in the civil sense, though the argument would lean in such directions. The primary trajectory of the essay involves answering why a devout member of the Presbyterian Church (USA)—or other Reformed Christians—would be compelled not to engage in euthanasia or PAS for him or herself, if such options were legal, but instead seek alternatives such as palliative care and/or hospice.


Modern Arguments Against Euthanasia and PAS: Secular and Roman Catholic

Contemporary arguments against PAS and euthanasia typically revolve around a handful of logical debates. Some arguments against euthanasia and PAS do not require a specifically theological worldview in order to apply, and advocates of such typically make appeal to reason in support of their case. For example, the “slippery slope” argument states that “…euthanasia could be seen as the first step toward adopting Nazi-style policies of killing the old, weak, and socially disfavored.”11 Advocates of such a contention see PAS as the first step toward a broader and even more dangerous line of action and consider it “…naïve to think that one can support the legalization of PAS and not also support the legalization of voluntary and some kinds of nonvoluntary euthanasia.”12 Though at first glance such theories may seem irrational and associated with conspiracy movements, recent research has suggested that nonvoluntary euthanasia occurs more frequently than once thought.13 Other reasons that compel experts in the field of medical ethics to reject euthanasia and PAS are the possibility of an incorrect diagnosis, the likelihood that the vulnerable and elderly may feel pressured to commit euthanasia against their will or feel coerced because they view themselves as burdens, the effect it will have on patient/physician relationships, and the fact that PAS goes against the traditional understanding of the Hippocratic oath to “…benefit [the] patients and to do no harm….”14

Roman Catholic theologians share the above concerns as they refer to the application of PAS and euthanasia, but have additional theological justifications for rejecting the practice. Centuries of religious experience, biblical interpretation, and theological heritage have formulated the foundation for the Catholic Church’s view, utilizing resources as diverse as the straightforward rejection of the practice by Augustine15 to the Thomistic, and virtuebased ethics applied by modern scholars such as Lisa Sowle Cahill to the promotion of community-based alternatives to euthanasia. According to Aaron Mackler, “appeals to human reason and experience are frequent in classical and contemporary Roman Catholic ethics. Such appeals commonly are presented in terms of natural law. Such approaches attend to patterns of meaning found in creation and center on a normative model of human nature or the human person.”16 This normative element helps to explain why the majority of the Catholic Church’s recent statements on active euthanasia and PAS have been blatantly clear in their language concerning the practice’s denial of the natural instinct to pursue life over death:

It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being…one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. Nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of divine law, an offense against the dignity of the human person, a crime against life, an attack on humanity.17

The first reason given for the prohibition against euthanasia is that it constitutes a violation of divine law. The text in the Decalogue, “Thou shall not kill,” appears to be the central command in decision-making for the Catholic Church in reference to abortion and euthanasia, whereas the application of the principle of double effect would render other forms of ending a person’s life not coequal with “killing.” An example of this would be the indirect ending of life for a purpose other than the ending of life itself—a purpose which would be proportionately greater than the damage caused. The assumption here is that the proper authority for delegating time of death is God, and thus withdrawing life-sustaining treatment or withholding it is a passive way of allowing this to come to fruition and, in a sense, not interfering with God’s plan. Direct euthanasia and PAS, on the other hand, interferes with the process of dying by making a conscious effort to kill the patient, thus circumventing God’s role in the process.18 According to James F. Keenan, “behind the Catholic belief in the Lordship of God and the natural law prohibition against direct killing of the innocent is the acknowledgement that there are some limits to the control of our destinies. Non-Catholics have for centuries shared that insight.”19 Though there were and are Catholic theologians who have “…argued that suicide cannot be absolutely ruled out based on claims regarding God’s wishes…,”20 among them St. Thomas More, the large part of Christian history has shown resistance and prohibition of the practice. This is evident when one examines the early Catholic Church’s uneasiness concerning an overly eager thirst for martyrdom, and the early theologians’ distinction between passively accepting martyrdom and “…suicide undertaken for nonreligious motives [i.e., relieving the burden of pain from oneself as one is approaching death].”21

Beyond the reasons mentioned above, namely the violation of divine law and the view that PAS and euthanasia are an attack against life and humanity because they violate the “will to live” which is naturally imbedded in human persons by virtue of the fact of the imago Dei, the prohibition against euthanasia and PAS in Catholic moral teaching is intimately tied to the death of Jesus Christ and the sharing by the suffering individual and his or her community of caretakers in this sacred model of dying.22 Pope John Paul II has addressed some of the societal factors which have given rise to the acceptance of euthanasia and PAS in his March 25, 1995 encyclical Evangelium Vitae. He states that “when the prevailing tendency is to value life only to the extent that it brings pleasure and well-being, suffering seems like an unbearable setback, something from which one must be freed at all costs.”23 This statement reveals one of the primary assumptions of the many who support euthanasia, that is, that the alleviation of suffering justifies the killing of oneself or killing on behalf of another. Ironically, those who propose such steps would be unwilling to go so far as to make licit the voluntary killing of depressed individuals or young persons living within the scope of unbearable suffering due to urban decay.24 We must ask what it is that makes the circumstances of terminally ill patients different from an individual who bears the immense burden of suffering on a daily basis, due to severe sociological, political, economic, or psychological stress.25 Certainly one significant distinction is that the individual knows they are going to die—although one could argue the same concerning persons living in certain urban situations— but do such practices expose a desire in the United States and in the Netherlands to rid society of burdensome dying individuals26 or simply embrace an attitude toward death which makes the experience of it quick and almost non-existent? Herbert Hendin, MD is convinced that openness to PAS and euthanasia in America and the Netherlands is anything but coincidental and discloses latent tendencies within each society to see euthanasia primarily “…as a response to being freed of religious restrictions….”27

Before returning to the concept of redemptive suffering, we should mention another foundational justification associated with those who support euthanasia and PAS– the notion of private autonomy. This too is mentioned in detail by Pope John Paul II: “…when he denies or neglects his fundamental relationship with God, man thinks he is his own rule and measure, with the right to demand that society should guarantee him the ways and means of deciding what to do with his life in full and complete autonomy.” Again, it is interesting to note that the countries which emphasize promotion of the legalization of PAS are also the countries that stress autonomy to the absolute neglect of communality. One need only look at the view of terminally ill patients to see that a perception of being “a burden” is directly tied to a stigmatization of reliance on others. In support of this autonomy, Cauthen holds that “…this ultimate decision [of euthanasia] should be given to the only person who is doing the actual experiencing of a life that has become intolerable and without hope of effective remedy…,” and not the decision of the government or even society in general.28 It remains a mystery as to why this would not apply to individuals who are going through various kinds of suffering and have little hope of adequate remedy but are not terminally ill, yet Cauthen’s opinion brings up a valuable point. The Church must give valid reasons why PAS and euthanasia are illicit, and these reasons must have theological profundity—they must be compelling and convincing and correlate to faith. The burden of proof has shifted to the Church and the typical answers associated with the idea that God has handed down the verdict of “no” for all forms of killing is both indefensible based on history (due to just war theories, various exceptions to causing the death of individuals, the rare instances of permissible suicide in the context of martyrdom, application of the principle of double effect, etc…) and too simplistic in the context of contemporary medical advancement. Those who promote the legalization of PAS use the fear of the continuation of “the Kevorkian spectacle,” and paint pictures whereby “what could and should otherwise be a dignified choice and ending to a life takes place in a van or room, secretly, and the only things revealed about that choice and death are what the physician and/ or family chooses to reveal.”29 On the contrary, the concepts which should truly be feared in today’s culture are not secret, behind the scenes events that pit doctors against their own consciences for the sake of performing illegal PAS, but doctors who would rather risk their freedom and careers over the legalization of euthanasia than to do so for the reform and perfection of palliative care. As modern Catholic wisdom suggests, “…the killing of a human is never a means of caring; nor can it be compared to putting an animal out of its misery. The true form of compassion and care of the dying is found within the auspices of palliative care.”30

The final topic breached by John Paul II in his encyclical is the one I advocate as the most plausible reason for arguing against euthanasia—one that is uniquely Christian and informative for the believer who is about to choose between embarking on the painful and difficult decision to suffer unto death31 or to choose, based on other admittedly tempting rationalizations, euthanasia or PAS. Since one third of the world’s population is Christian of some variety, giving sufficient rationale for rejecting euthanasia and embracing suffering unto death is imperative and deeply related to the traditional view of the redeeming nature of the suffering of Jesus. Dowbiggin mentions that the history of thought on the topic of suffering unto death reveals the worldview of the Middle Ages, both Protestant and Catholic, that “in the midst of the elaborate and deeply emotional drama surrounding death, the physician was forbidden to do anything that might detract from the spiritual journey the patient was undertaking. Any medical hastening of the dying process was strictly prohibited.”32 Such practices formed the foundation for care of the sick until the late 19th century when secularization and the convenience of therapeutic medication sparked an interest in mercykilling.33 The modern Catholic Church, not without its dissenters34 often utilizes the language of meaningful suffering in approaching the topic of euthanasia. Pope John Paul II stated that …the so-called “culture of well-being” often involves an inability to see life’s meaning in the situations of suffering and debilitation that accompany human beings as they approach death. This inability is all the worse when it occurs in humanism closed to the transcendent, and is often expressed as a loss of trust in the value of the human person and life.35

Such language grinds against the typical cultural stature which views suffering as a sovereign entity which must be vanquished by the power of technology, even if this means the death of a patient. If read closely, it becomes obvious that the Pope’s statement above is not an endorsement of suffering in itself, but instead a trust and reliance on God that the suffering at hand is permeated with life, even at the moment of dying. It is difficult for some contemporary ethicists in the field of theology to see merit in this view, precisely because of the pervasive attitudes discussed above, namely the alleviation of suffering at all costs, the stress on autonomy in Western culture, and the demand for rights associated with one’s own body combined with the stigmatization of being a burden to others.

Paul Badham of the University of Wales sees almost no redeeming quality in the process of suffering and states that the argument of those who view suffering as redemptive is open to two serious objections. First “…that the theory does not correspond with human experience, since there is a great deal of evidence to show that suffering however bravely borne is rarely ennobling.”36 Though it becomes obvious that suffering while dying is an aspect of the horrible consequences of the break-down of the human body and alleviation of physical, emotional, and psychological pain is crucial to the well-being of the patient, Badham’s argument falls apart upon his use of the term “ennobling.” The assumption, of course, is that death is meant to be an ennobling process indicative of a “high and exalted character.” The very notion of nobility in the Christian Gospel is associated with Jesus’ reinterpretation of the idea of blessedness in the Sermon on the Mount (“Blessed are the poor in spirit, for theirs is the kingdom of heaven”—Matthew 5:3). The noble believer is one who submits all he has and is to the will of God, humbling himself before the sovereign Creator. Badham’s second contention with those who argue against euthanasia is that they are willing to allow a person to suffer by dying naturally, but not to suffer by going without pain medication. He states that “almost everyone concerned with the dying accepts the duty and responsibility to do everything in one’s power to minimize the discomfort of the terminally ill.”37 It would be sadistic to advocate the pain and suffering of a dying individual and the withholding of pain medicine if such resources are available, but if the phrase “…everything in one’s power to minimize discomfort…” means killing the patient, then a serious problem exists. As mentioned earlier, this attitude is no different from advocating doing “everything in one’s power” to keep a patient alive if they have no reasonable chance to live. Vitalism and active euthanasia are opposite sides of the same coin. Furthermore, Badham does not see the distinction between suffering pain associated with illness and suffering unto death, which may not include physical pain but must include surrendering one’s life and death to the will of God without direct and intentional interference.3

In accordance with Catholic tradition through the ages, John Paul II stated that “…the certainty of future immortality and hope in the promised resurrection cast new light on the mystery of suffering and death, and fill the believer with an extraordinary capacity to trust fully in the plan of God.”39 It is precisely in the fact that suffering and death are mysteries that the circumventing of the body and mind’s natural response to illness and old age becomes questionable.

In addition to the pursuit of autonomy, the modern Western mind is obsessed with knowing all things in advance in order to control the object of knowledge— a holdover from the Enlightenment and German Idealistic philosophy. Under this worldview, death and suffering becomes the pervasive enemy that is as elusive as sand running through a person’s fingers. As the Jewish philosopher and theologian Franz Rosenzweig put it, “All cognition of the All originates in death, in the fear of death. [Western] philosophy takes it upon itself to throw off the fear of things earthly to rob death of its poisonous sting, and Hades of its pestilential breath.”40 Is euthanasia simply an extension of a philosophical system that is determined to rob death and suffering of its mystery? Must human beings control every aspect of life, along with its disappointments, unexpected shocks, and pains? One need only examine the quantity of prescription pain medications and psychotropic drugs consumed in the United States41 to see that alleviation of not only pain, but all feeling, is connected deeply with our humanistic desire to avoid death altogether.

As mentioned above, one of the primary reasons the Catholic Church has officially prohibited “mercy killing” is because of the biblical desire for individuals to suffer
unto death and in such a way follow in the footsteps of Jesus in terms of his passion and death. The 1980 Declaration on Euthanasia states that “according to Christian teaching…suffering, especially suffering during the last moments of life, has a special place in God’s saving plan; it is in fact a sharing in Christ’s passion and a union with the redeeming sacrifice which He offered in obedience to the Father’s will.”42 Though there are distinctions between the notion of redemptive suffering among Catholics and Protestants, the statement above illustrates that the suffering which takes place near death has been regarded as a mediating experience between the individual who is dying and the God in whom they place their trust, Jesus Christ.

The Current Presbyterian Church (USA) Stance On Euthanasia and PAS

Since the primary purpose of this essay is to shed light on contemporary arguments against euthanasia and PAS as they are utilized by the Presbyterian Church (USA), and illustrate why an argument based upon suffering unto death is consistent with the Reformed tradition, it is important to examine the current official stance of the Church. The most current definitive statement on PAS and euthanasia associated with the PC(USA) was drafted in 1981 by the Advisory Committee on Social Witness Policy (ACSWP) and was entitled “The Nature and Value of Human Life.”43 Though the document reflects a definitive stance against euthanasia, its reasoning for doing so is consistent with a deontological ethical framework and the text is ambiguous in sections, opening the door for euthanasia and PAS in certain extreme circumstances, thus revealing a proportionalist understanding of the debate. For example, the text reads: “Active euthanasia” is a question that arises in situations of medical extremity where it is thought that an individual is beyond the reach of medical care. Some have at least posed the question of whether the most humane treatment might be to terminate life. However, the dominant value of respect for human life and its accompanying obligations to do no harm and to protect from harm established a clean prejudice against such direct taking of life.44

This text clearly states that the PCUSA argues for a prejudice against direct euthanasia on the basis of “the dominant value of respect for human life” and its connection to traditional Hippocratic duties. Again, the Church bases its decision primarily on the sixth commandment as rendered in Exodus 20:13, “Thou shall not kill,”45 and thus we see the influence of Kant’s deontological, duty-based ethical system on the Reformed understanding of killing. Jesus’ suffering as a model for Christians is utilized far less than the universal law explicitly expressed in Scripture. Additionally, the document states that “not all killing is prohibited, but rather killing that is incapable of justification. The Reformed tradition has tended to acknowledge the possibility of justifiable killing whenever there is a conflict among obligations which, taken alone and abstractly, are equally consistent with the guiding value of respect for life.”46 The text frames the question in terms of two conflicting obligations, i.e., the obligation not to cause harm by killing, and the obligation to maintain relational quality in the midst of extreme pain and suffering. The first several sections of the document describe relational activity as the primary standard for defining life. This culminates not in a normative statement against euthanasia—as implied by the term “gravely evil” used in the Catholic Church’s description cited above—but in a statement emphasizing even further the ambiguities of the PCUSA’s stance. It is stated that because human beings are finite creatures, we know that there are definite limits to the amount of pain which anyone can bear without having the relational quality of their life completely consumed by the relentless battle with pain…[in this case]…the harms…[i.e., to do no harm and protect from harm]…also would appear to be proportionate to one another since uninterrupted, intense pain can probably destroy the ability to enjoy relationships as fully as can physical death.

The problems that I perceive as obvious with this statement are twofold. First, the proportionalist stance of pitting the impairment of the enjoyment of relationships concerning an individual who is dying in pain against the direct killing of such a patient opens up an opportunity for the suicide or physician guided death of anyone who has hindrances to proper relational activity. As mentioned before, this could include the mentally ill and the physically disabled, in addition to the terminally ill. Second, as mentioned in Kaldjian’s resistance to Cahill’s defense of precisely the same argument, “the biblical witness does not describe any point at which a human life becomes deprived of sanctity because of disease or disability, nor does it suggest that the value of human life depends on an ability to perform behaviors deemed necessary for human relationships.”48 I believe it is dangerous to assume that relational integrity is the primary standard upon which the sanctity of life is decided. This proportionalist underpinning is contrary to the biblical witness specifically, and the Reformed tradition in general. It is also dangerous, on the one hand to advocate “consultative decision-making”49 with doctors and others who may recommend euthanasia, and on the other hand state that “active euthanasia is extremely difficult to defend morally.”50 Such ambiguity may explain why the most recent survey available suggests that “most members (51%) and specialized clergy (55%) [of the PCUSA]…believe that law should allow doctors to comply with the wishes of a dying patient in severe distress who asks to have his or her life ended.”51

The Redeemed Nature Of Suffering and the Reintegration Of Discipleship and Witness In the Reformed Tradition

Curiously absent from “The Nature and Value of Human Life” is any suggestion of the central Christian notion that suffering unto death is a participation in the suffering which Jesus experienced and redeemed on the cross atop Mt. Calvary. A brief statement on euthanasia from Presbyterians Pro-Life illustrates the organization’s acknowledgment that “Scripture teaches that affliction often produces spiritual growth and holiness [and] such spiritual fruit is far more valuable in God’s eternal economy than those commodities so frequently mentioned by proponents of ‘quality of life’ ethics such as self-determination and autonomy.”52 Aside from this statement, such language is avoided in official and non-official Presbyterian discussions on the topic. I argue that suffering unto death was viewed as a participation in the redemption of humanity won by Christ, and this may be proven by examining the Reformed tradition’s three greatest representatives since the Reformation: Scripture itself, John Calvin, the founder of the Reformed tradition, and Karl Barth, the most prolific Reformed theologian of the past century. These three sources teach rather explicitly that (1) suffering unto death, for the Christian, is a participation in the death of Jesus, which redeemed the world, therefore intentionally hastening death is an interruption of one’s conformity to Christ, (2) suffering, though itself evil, is used by God to produce spiritual fruit in the believer who suffers, and (3) conformity to Christ in all aspects, is a matter of Christian obedience, up through death.

The Pauline epistles are perhaps the most influential part of the Scriptures for the Reformed tradition because of their stress on sola fide, sola gratia, and sola Christus. Paul states …whatever things were gain to me, those things I have counted loss for the sake of Christ. Moreover, I count all things to be loss in view of the allsurpassing value of knowing Christ Jesus my Lord, for whom I have suffered the loss of all things, and count them but dung so that I may gain Christ, and may be found in Him, not having a righteousness of my own derived from the Law, but that which is through faith in Christ, the righteousness which comes from God on the basis of faith, that I may know Him and the power of His resurrection and the fellowship of His sufferings, being conformed to His death; in order that I may attain to the resurrection from the dead (Philippians 3:7-11).

Here, according to Paul, the all-surpassing value of life is not human relationship but relatedness to Jesus, of which suffering unto death is a prerequisite. Christ’s suffering, death, and resurrection are viewed as the primary mediative means by which humanity is redeemed, yet the disciple does not achieve resurrection without first being “conformed” to the death of Jesus Christ. The question then becomes, what kind of death did Jesus model for his disciples?

One need look no further than the Gospels to see that Jesus’ ministry involved total and free surrender and obedience to the will of God, through the moment of death. Jesus allowed the Father to choose the way in which Jesus would die.53 Jesus went so far as to refuse first century pain-killers, exemplifying his desire to approach and experience suffering unto death in order to glorify God.54 As mentioned previously, suffering unto death need not be equal to an experience of physical pain, since part of Jesus’ ministry was to alleviate the suffering of people, but the alleviation of pain was not pursued at any cost. Unlike the Catholic view of redemptive suffering whereby the suffering of an individual is a participation in Jesus’ passion in order to redeem the self or another,55 a more consistently Reformed way of looking at it is as a participation in the suffering of Jesus which has already redeemed all of humanity.56 The world is redeemed but the disciple must attach to the death which Jesus modeled as a witness to the “seal” of redemption—as a witness to the fact that one day, the world will be made whole, even beyond death.57 Thus, even the suffering experienced by a dying person has been redeemed by Christ, but Christ calls the believer to experience it by faith, knowing that it too will be renewed in the eschaton. This participation in the suffering of Jesus is not a kind of sadistic gesture, but exemplifies the very essence of Christian existence—to know Christ in his death, is somehow to attain to the resurrection. For a terminally ill patient who is experiencing suffering, palliative care and/or hospice would give that individual a communal relief, care, and love, without taking away the opportunity to follow Jesus in the most profound act of Christian obedience.

Earlier I mentioned that in our contemporary situation, Presbyterians, and indeed all Christians, would need reasons beyond the typical deontological arguments for not engaging in euthanasia or PAS. The Scriptural argument above makes a good case for why an individual believer would want to die a “natural death in Christ,” yet such an argument is not limited to the Biblical witness. Strict Calvinism’s “…self-righteous intensity in its dedication to work, its discouragement of pleasure, and its belief that the endurance of suffering was redemptive”58 is one reason the Netherlands have been so open to the legalization of euthanasia, as a secular reaction to its religious roots. This “discouragement of pleasure” is certainly not indicative of the Reformed tradition in its entirety, but nevertheless it is worth noting that John Calvin in his sermon “On Suffering Persecution,” asked Are we so delicate as to be unwilling to endure anything? Then we must renounce the grace of God by which He has called us to the hope of salvation. For there are two things which cannot be separated— to be members of Christ, and to be tried by many afflictions. We certainly ought to prize such a conformity to the Son of God much more than we do. It is true that in the world’s judgment there is disgrace in suffering for the Gospel. But since we know that unbelievers are blind, ought we not have better eyes than they?59

Calvin’s connection between affliction and membership in the Body of Christ alludes to the same conformity articulated by St. Paul in his Letter to the Philippians. For Calvin, faith in Christ was most tested upon life’s greatest calamities, not excluding disease and terminal illness. Three kinds of spiritual fruit accompanied connecting oneself to the redeemed suffering of Christ according to Calvin: trust in God’s power, hope for the future, and physical and spiritual healing both before and after death. According to Calvin, it is not the hastening of death that brings healing, but God, who “…confronts us and subjects and restrains our unrestrained flesh with the remedy of the cross.”60 Though one could argue that an application of Calvin’s theology to contemporary health care ethics is both anachronistic and insensitive to the needs of those in pain, supporters of euthanasia appear quick to utilize sources older than the sixteenth century to support their own agenda of killing. The writings of John Calvin are so central to the Reformed mind that to ignore his views on redeemed suffering would be to divorce oneself from the greater portion of the tradition in favor of a proportionalism unheard of in Presbyterianism until the Enlightenment; a system ignorant of the Church’s majority teaching on the subject of euthanasia for the breadth of its continual history.61

If the biblical witness and the writings of John Calvin teach the Christian disciple of the value in conforming to Christ’s cross and death, Karl Barth’s writings teach that following Christ in conformity is in reality a way of life and a witness to the Gospel, as opposed to a macabre insistence on suffering, as it is often portrayed. Through the despair and agony of life’s final moments, God’s command, “Thou may live,”62 resounds in the mind and heart of those flirting with ending their own lives. “The suicidal person hears this command as a light piercing the darkness, not as a command that she must live but as the good news that she is permitted, enabled, to live by God’s grace.”63

Barth’s conception of life in the world was inextricably interwoven with his concept of the disciple’s duty as a witness to Christ in full conformity with His suffering, death, and will. This conformity to Christ, even unto death, is a cause for hope and not despair: What the man who hopes as a Christian expects is not twilight. It is not light and also shadow, good and also evil, salvation and also destruction. It is unequivocally and uninterruptedly light and good and salvation. For the One whom he sees before him is unequivocally and uninterruptedly God, the living God in his grace and righteousness and mercy and glory, the God towards whom he can go, not with a mixture of confidence and suspicion, but only with confidence.64

Suffering unto death is the calling of all Christ’s disciples, because such suffering is a sign of faith in the God who is good and chose to forsake the eternal Son, thus embracing the world.65 Suffering alongside those who are experiencing tremendous pain and discomfort is likewise a sharing in the mystical event that is Christ’s work of redemption piercing into the life of the dying, guiding them into hope and eternal life. For those who are terminally ill, the Church becomes both the sign and sacrament of Christ and His cross and fulfills its earthly destiny as hope for the hopeless. Euthanasia and Physician Assisted Suicide (PAS) are wrong not only because they disrespect the normativity of the sixth commandment, but also because they directly and intentionally deny a dying patient an experience with the redeeming cross of Jesus, which has redeemed every aspect of life and death.

In sum, in this essay I have sought to outline the distinctions and complications in the contemporary language of moral theology that is associated with the debate concerning Physician Assisted Suicide and euthanasia. Among these distinctions was the differentiation between suffering in general and suffering unto death in a theological sense, and the difference between viewing suffering as redemptive (in the Catholic sense) and viewing suffering as redeemed but open to participation (in a Reformed sense). I have argued that a more complete knowledge of redeemed suffering in addition to advances in and commitments to palliative care and hospice would go a long way in reducing the temptation for euthanasia. In the second section, in framing the question of redeemed suffering as it relates to the terminally ill, I sought to include opposing voices, engaging in debate over general reasons behind support or opposition to euthanasia, giving ample space to review both secular and Roman Catholic challenges to the practice; challenges which historically formed the foundation for Reformed reactions to euthanasia. In the third section I summarized the contemporary stance of the Presbyterian Church (USA) on the subject of euthanasia and attempted to expose its flaws in terms of its ambiguities and quick embrace of proportionalism, which in my understanding is contrary to the bulk of its own tradition. Last, I examined theological resources typically held in high regard in the Reformed tradition: The New Testament, the writings of the sixteenth century reformer, John Calvin, and writings of the contemporary Reformed theologian, Karl Barth, and attempted to show a proclivity in these sources to support life, reject casuistic approaches to suicide, and form a foundation for the concept of suffering unto death and participation in Christ’s redeemed suffering.

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Steven D. Aguzzi
Rev. Steven Aguzzi, Ph. D. candidate, is associate pastor at Mt. Lebanon United Presbyterian Church and instructor of theology at Duquesne University in Pittsburgh, PA.

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