assisted dying

Is there a religious case for assisted dying?

This article is adapted from a sermon preached on Sunday 22nd September 2013. Bible readings were Deuteronomy 34:1-6, Luke 2:22-32 and Philippians 1:18b-26.

Over the last year or so there has been an ongoing debate about assisted dying. This article is my contribution to that debate. I want to widen my focus from the debate as it has been formulated so far in one way and close it down in another. In broadening the focus  I want to consider what we think about death and dying generally and not just in the context of very specific medical circumstances. I don’t see how we can attempt the latter until we have a clear perspective on the former. The area I’d like to close down is that about the practicalities of implementing any proposal. This is an extremely important part of the wider debate but I think it would help us to consider a theological perspective first and only then move onto the question of how we work to fulfill it.

It’s an area of debate where the church really should have something to offer. For most of the last millennium the church has had a monopoly on providing support to the dying and the bereaved. It’s an area of life we should understand and  where we have wisdom to offer to the world. I find it really disappointing, therefore, that the voices we tend to hear in the public debate are from non-Christians like Terry Pratchett and Steven Hawking. Hawking actually made the news last week with an announcement that he has changed his mind and is now in favour of the legalising of assisted suicide. A bill is currently passing through parliament sponsored by Lord Falconer who I don’t think has any particular religious affiliation either. A YouGov poll conducted earlier this year suggested that 75% of people are in favour of a change in the law to permit  assisted dying and only 14% oppose this (the other 12% don’t know).

It’s an argument we are going to have to face more and more as modern medicine progresses. Put bluntly we are getting better and better at keeping people alive and at some stage we are going to need a theological, moral or ethical framework to decide on when to stop. The number of centenarians in the developed world is increasing at over 5% a year at the moment. There is little doubt that this is going to continue. Think where medicine was 100 years ago, think what it can achieve today, imagine what it will be like in 100 years time when a baby born today reaches his or her hundredth birthday. I’ve little doubt that by then we’ll be able to keep that person living indefinitely if hooked up to the correct machines – but is this what we want?

So where does the church stand? If you go to the Methodist church web-site you’ll find that the church is “very strongly opposed to euthanasia”. There was a session at this year’s Conference, however, entitled “Is there a religious case for assisted dying?” which I’ve chosen for the title of this article and suggests things are not quite as clear cut. Finally that YouGov poll I referred to earlier included 121 individuals who identified themselves as Methodists. Nearly three time as many of them were in favour of assisted dying as opposed it. The certainty proclaimed on the web-site is clearly not reflecting the opinions of those sitting in our pews.

I think one of the problems that the church has is that it isn’t equipped theologically to adapt to the pace of development in the modern world. Many of us think that our theology is something fixed and is the same now as it was at the time of the early church. It isn’t. Think of how our understanding of women in the ministry has changed over our lifetime. As Methodists we pride ourselves on our strong female leadership both lay and ordained but it’s not that long since we ordained our first female minister (1974). Before then there was a widespread belief that this was theologically inappropriate.  Theology is a living discussion that we should expect to develop over time. Most importantly it needs to be worked out in the context in which we live. It needs to involve a conversation between the academics who help formulate theology and those of us in the pews who have to live it out. Pope Francis, of all people, this week,  warned of the dangers when theological thinking loses contact with the lives of those it concerns.

The reason why our theology needs to change is that the context in which we live and die has changed. For almost all of the two millennia since Jesus lived the major challenge has been that people haven’t lived long enough. Disease, hunger, war and persecution have historically led to people dying too early. Over this period a theology based very heavily on an understanding that life is sacred and that everything should be done to revere and protect life has served us very well. But in the developed world (note the emphasis on the “developed world” here) at the beginning of the twenty-first century the challenge is changing. We have largely eliminated hunger, war and persecution as a cause of death throughout much of Europe, and modern medicine is making great advances both in protecting us from disease. This is leading to a situation in which a larger and larger proportion of the population feel they are living too long. Some of the headline cases are people with rare diseases and disabilities that have interrupted them relatively early in life but an increasing number of people are starting to feel this as a consequence of what we now see as the natural ageing process. As the context in which we live changes our theology must change to reflect this.

It’s interesting that the statement on the Methodist web-site refers to debates at conference in 1974 and 1994. In this world we need to update our theology more often than that. It also uses the language of a past time. It only ever uses the word euthanasia whereas almost everywhere else in the current debate the term is assisted dying. These two phrases have very different connotations. Euthanasia implies that someone else is taking the decision to end a person’s life. Advocates of assisted dying are very clear that they are asserting an individual’s right to make a decision for themselves.

Before looking at three Bible passages which I feel can usefully inform this debate, I want to reflect on one traditional argument against assisted dying; the argument that God wills when we die and that it is wrong to interfere with this. Many of us nowadays would question whether this is an appropriate way to describe how God acts, but even if it is, it is something we don’t accept when we use modern medicine to extend a person’s life. If someone develops pneumonia in the modern world we don’t accept that their time has come (as would almost certainly have been the case a century ago). We prescribe antibiotics and unless the person is particularly frail we expect the person to recover. We do not accept God’s judgement that that this is the time for that person to die. It is completely illogical to use modern medicines to extend a person’s life and then argue that we are doing something against God’s will if we use modern medicines to move the time of death in the other direction.

Let’s turn to three passages in the Bible. Simeon, was an old man, we don’t know how old, given life expectancies at the time he may only have been in his sixties or seventies to be perceived as old. He was looking forward to a great event, the salvation of Israel, and the Holy Spirit had assured him that he would live to see this. When he saw the infant Jesus presented in the temple he realised that that time had come. The song he sang, the Nunc Dimitis, is a prayer for release, “Lord, now lettest thou thy servant depart in peace” as it was translated in the book of common prayer. This has struck a chord with Christians throughout the centuries and inspired some great music (I’m still haunted by the version that was sung during the credits of the BBC adaptation of Tinker, Tailor Soldier, Spy in 1979). It is how many of us would like to see death coming. We live for a purpose, we achieve that purpose, and then we pray to be released. Can this story be used to reflect upon how we would like to die? How does it square with the approach of modern medicine which simply appears to be to want to keep us alive as long as possible?

But of course life is messy. Not many of us have a single purpose in life that can be completed as easily as Simeon’s. Many of us want to live for a multitude of different reasons, to complete a task, to care for a relative, to see the birth of grandchild or great- grandchild. There is no single time when life feels complete. This is why I’ve chosen the story of the death of Moses. Moses strove all his life to guide his people out of Egypt and to lead them to the promised land. He nearly made it. At the furthest point to which he was to travel God led him to the peak of a high mountain and showed him what the future held for the Jewish people but having given him that vision, he took Moses life from him. We aren’t told how Moses died but I think the assumption is that he accepted God’s decision and departed as peacefully as Simeon. We will not always be granted the opportunity to live to see the things that we really want to see, on occasions we will not even  live to see the things that we have worked hard for all our lives. Many of us have a succession of things we would like to live for and it is virtually certain that we won’t live for all of them. We need to accept this, as Moses did, and develop a feel for the time when our lives are complete.

And then we come to the words of Paul writing to the Philippians, “For to me, to live is Christ and to die is gain.” He reminds us that whatever Christians believe (and we should be open in admitting that we don’t all believe the same things on a range of issues) we believe that the value of life lies not in its quantity but in its quality. Paul actually looks forward to death. He developed an incredibly deep relationship with God. The way he expressed this was by saying that he lived in Christ. His relationship with God was so intense that whilst he was prepared to stay alive if it suited God’s purpose, he would prefer to be with God in death. We need to be careful here that we don’t buy into the first century mind-set uncritically here (in the light of a modern scientific understanding of the human brain many of us will have a different view of death to that which Paul held) but we do need to take on board a belief that, at a certain time in life, death is not something to be feared but something to be welcomed. Jesus was not afraid to give up his life at an early age, Paul gave up his life later in life. Many generations of Christians have given up their lives when the appropriate time came. They were able to do this because they had developed an understanding of life, founded on the depth of their relationship with God, that removed the fear of death. It’s something we’ve lost in the modern age and I’m convinced that if the church could recapture it and offer it to the wider world then that world would be a better place.

I talk here in terms of the depth of our relationship with God. Others, with different faiths or none, may use different words to describe the same phenomenon. The most important thing that we can all acknowledge is that the quality of our lives is far more important than the quantity.

I’m fifty next year. In terms of the current composition of the Methodist church that still makes me a relatively young person. I don’t want to die yet. I don’t know how my thinking about death will change as I age, as my death becomes more likely. What I pray at the moment is that my relationship with my God will grow even deeper. It may deepen as I live through natural healthy ageing or it might deepen as I learn to cope with some, as yet unknown, disease or disability. I pray that as the quality of that relationship deepens I will be less and less concerned with how long I live. I pray that one day it will have deepened to such an extent that I am ready for release. If modern medical technology and ethics has developed to such an extent to grant me that release, then I suspect that I will count that as a blessing.

O love that will not let me go,
I rest my weary soul in thee:
I give the back the life I owe,
that in thine ocean depths it’s flow
my richer fuller be.                                                            George Matheson