Perhaps there is no more difficult time in life than when we are coming to its end. This time brings not only deep emotional issues to the fore, but also challenges us with some difficult ethical dilemmas as well. The moral dimensions at the end of life can be, and usually are, especially troublesome. Dr. Ira Byock has observed, "unlike many areas of medicine in which it is the occasional case that presents an apparent ethical dilemma, care at the end of life is full of ethically poignant and emotionally charged situations." This may be because this is an area of ethical reflection that every person, regardless of race, creed, color, gender, etc. will come to face, whether it be someone close to them, or themselves. “Today, questions about death and dying have become more than ever before complex and troubling almost all of us in western culture are faced with multiple options regarding our own and our loved ones’ dying.”
One thing that clearly complicates the question of dying is advancing technology. Farley highlights the nature of the quandaries that technology forces upon us.
In large part our fears are in being given too much medical treatment, being kept alive too long, dying not in peace but in a wild frenzy of efforts to give us a little more time to live. The radical possibilities introduced by modern medicine lead ir onically to scenarios of dying that have become unacceptable to many individuals. To more and more persons, it appears that the only way to retain some control over our death—to die a death marked by conscious self-awareness, with knowledge of our ending, surrounded by those we love—is to take our death into our own hands.
Consequently, she, although opposed herself, understands why people might consider physician-assisted-suicide (hence PAS) and voluntary active euthanasia (hence euthanasia) The fear of the over all loss of autonomy and control, and, more commonly, of being a burden to one’s loved ones, are driving forces behind the increasing willingness to vie for euthanasia, especially PAS, as a legitimate option when one approaches the end of life. The prevalence of this sentiment can be seen in a March 1996 Washington Post report in which 51 percent of Americans polled favored PAS.—among men 54 percent polled favored it; among women, 47 percent.
In view of this increasing allure of euthanasia and PAS, Christians must ask themselves what it means not to “be conformed to this world,” with regard to how we think about and approach end of life issues. How should the church think about death, or more to the point, dying, and what measures should be taken when facing life’s end? How shall we choose when it comes to questions of autonomy, palliative care, terminal sedation, the refusal of treatment, the right to die, and a whole company of other such issues that are nearly unavoidable concerns when it comes to the end of life?
The following will attempt to address some of the common and more difficult issues that arise at the end of life, and how the church can develop cogent moral and ministerial responses in a culture which increasingly seems to be favoring death. What the church must do is defend a position of affirming life, the sanctity of human life as that which is exclusively created in the image of God, and applying this view to practical situations. The final chapter and conclusion of this essay will explore more concrete ways in which the church can draw upon rich biblical resources while offering practical alternatives to the culture of death.
ASSISTED SUICIDE AND AUTONOMY: AN APPRAISAL
Being a Christian means having confidence of our future hope in heaven once we die, but this awareness does not necessarily make the dying process any easier, nor does it immunize believers from struggling with similar fears and questions enumerated in the introduction. Christians can be tempted to give in to the cultural pressures around them when it comes to the potential misery and suffering of the dying process. After all, we are also human and, although carefree about what becomes of us after we die, we do not necessarily feel any different from others about dying. Arthur J. Dyck has noted that Christians are not “immune from the kind of thinking that has come to link compassion with ending the life of one whose suffering is thought to have no more meaning, or whose life is thought to be such that the efforts to alleviate suffering are no longer worth the time and trouble.” No one, whether Christian or not, really wants to be indefinitely kept alive through artificial means, or burdensomely hooked up to tubes. No one wants to continue in a suspended state of life sustained only by machines that vicariously perform the roles of our autonomic nervous system, with recovery highly unlikely. Consequently, we are forced to consider the morality of end-of-life issues.
As stated in the introduction, with the possibility of great indignity the temptation is significant, even for professing Christians, to consider the offerings of assisted suicide and active euthanasia. One such proponent, writing from an allegedly Christian position, is Mark A. Duntley Jr. He suggests that PAS is a viable alternative for the Christian and society as a whole.
“There are cases where assisted suicide is wrong, and there are also cases where assisted suicide is right. The only way we can be sure we are not missing the mark concerning assisted suicide is to get beyond merely saying no, we need to understand that in prolonging life, modern medicine has changed forever the way we die. We need to rediscover that mercy should lie at the heart of how we care for the dying. Then we can move beyond the simple rejection of assisted suicide and begin to watch with open spirits for those times when merciful care for dying persons involves helping them die assisted suicide can indeed be a Christian moral response to the question ‘How shall we die?”
Duntley defends the position that, due to the same dilemmas considered earlier, assisted suicide can be a “right” choice at times.
As the boundaries of life are extended by modern medicine, and we are faced more frequently with the suffering involved in dying slowly from a terminal disease, we should begin to question whether preserving life and making someone as comfortable as possible are the primary principles that should guide us in care for the dying.
Seeking to make the case for assisted suicide from a biblical perspective, Duntley draws upon the concept of mercy as displayed in the commitment of a covenantal relationship. Mercy is demonstrated in compassion, he claims, and sees Jesus as the ultimate model for such mercy. “We find his covenantal relationships and acts of mercy linked through his deep compassion for others.” He then refers to Jesus as the model of such mercy acting in compassion when He is seen, “healing the blind, feeding the multitudes and even raising the dead.” Yet strangely missing from this account of Jesus’ merciful acts, is an instance when He, out of compassion, killed someone, or insisted that this was the right course of action. Having no biblical instance to refer to prove his point, Duntley steps outside the Bible and uses the case of Dr. Timothy Quill as a praiseworthy example of how mercy and compassion, resulting in assisted suicide, might be played out in a doctor-patient relationship. He relates how, in 1971 Dr. Timothy Quill, wrote about overcoming his intuitive qualms about assisting a patient in dying, and, for the first time, prescribed the pills needed to help his patient end her own life. 
Diane was a middle-aged leukemia patient who did not want to take a 25 percent chance of recovery through chemo-therapy, and instead chose to end her own life. Dr Quill, who admits that it was, at first difficult to consider, became convinced that this was “the right decision for her, ” He reported feeling “uneasy about the boundaries I was exploring—spiritual, legal, professional, and personal,” yet was torn because he also “felt strongly that I was setting her free to get the most out of the time she had left, and to maintain dignity and control on her own terms until her death.”
Another professed Christian who sees no problem with entertaining the possibility of assisted suicide is Dr. Timothy Johnson, an ordained minister in the Evangelical Covenant Church, best known for being the medical editor for ABC News. Johnson, in a debate with former Surgeon General C. Everett Koop, stated, “I personally believe that helping someone die in peace and without pain, even if that might hasten the biological timetable of death by a few hours or even days is not only acceptable it is mandatory for modern medical care.” That he includes in this assisted suicide is evident when he states,
While I personally gag at the idea of helping a person to commit suicide, I am at least willing to theoretically consider the possibility under very limited circumstances. I say this because I have always believed that a physician has a dual role: to preserve life and prevent suffering. And I believe that both are equally valid and sometimes in conflict. Let me emphasize that I am willing to consider physician assisted suicide only in situations of clearly terminal illness in which there is no hope of ultimate recovery.
To buttress this proposition, Johnson, like Duntley, refers to the case of Dr. Quill. He cites, with sympathy, the actions of Quill, and says that such a decision was a “careful and thoughtful action.” While he himself would not advocate the legalization of physician-assisted-suicide because there are “too many moral dangers that outweigh its possible benefits,” Dr. Johnson would not condemn fellow physicians, like Quill, who may come to other conclusions. He comes to this position “reluctantly” because he feels sympathy for “people who feel they have no control over their dying” and states that Diane, the woman Quill assisted in suicide, was able to “maintain dignity and control on her own terms until her death.”
By way of critique, for both Duntley and Johnson to try to argue as Christians for assisted suicide, citing the experience and actions of Dr. Quill as a paradigm, is quite misguided. First, Quill is in no way informed by a Christian view of dying and death. In fact, at the end of his reflection about his experience with Diane, he approvingly quotes her about, after dying as being “at her favorite spot on the shore of Lake Geneva at sunset, with dragons swimming on the horizon.” So first of all, in his final reflections on the death of this patient, he comes to a rather pagan, conclusion, and thus one that is inconsistent with Christian eschatology
A second reason that Quill is not a good example for the Christian to follow is due to his focus on Diane’s autonomy as a patient. From the standpoint of the patient this raises the issue of the degree of autonomy we have when it comes to our dying, and whether this is compatible with a Christian view of life. While we live in a highly litigious society, and must insist on our autonomy and freedom, because we are Christians, we must admit that our autonomy is actually quite limited, especially in terms of our dying. Theologically we must accept that God, alone, is sovereign over our life and death, which means that God alone has the prerogative to end our lives, and we do not share that authority.
This is an era in medicine when one of the most important principles is patient autonomy. Agneta Sutton writes, “The legal recognition of the right to euthanasia is based on an assumption that it is the prerogative of autonomous agents (in this case, patients) to claim that what they desire is right for them and should therefore be granted without question.” This is the assumption which drove Dr. Quill to the violation of his own conscience; he believed that Diane was the only one whose thinking was to be considered in this decision about her own death. Sutton suggests that patients now see themselves as consumers and their doctors as providers who must, when they make the demand, give them what they request.
As far as how Christians should be thinking about autonomy, it is true that, especially as Americans, we do have certain legal freedoms, but we must ever acknowledge that God is the ultimate authority when it comes to all of our decisions, including those about our dying. John F. Kilner puts the issue bluntly when he states, “to assume ultimate responsibility for one’s life [by deciding when it should end] is to reject God, no matter when, in the course of life, one elects to do so.” The necessary perspective for the believer is that we are, as Paul said, “not our own” Our focus must not be upon human autonomy, as a principle inferred through unaided human reason, but rather divine authority evinced clearly in divine revelation. We are not self-determined sovereigns who depend solely on our reason to make decisions, but rather submissive stewards who look to God’s revelation where we discover that our Maker reserves the right to end a human life and forbids homicide. Lest the reader think that this notion of God’s ultimate sovereignty is understood only by Christians, and thus suspect, even Hemlock society founder Derek Humphry affirmed this position when in the introduction of his book Final Exit, addresses his readers saying,
If you wish to deliberately leave this world [but are not on any kind of life-support] then active euthanasia is your only avenue. Read on carefully. (If you consider God the master of your fate, then read no further, seek the best pain management available and arrange hospice care.”(21).
It is striking that such a proponent of active euthanasia knows that it is inconsistent with a Christian worldview to seek it Yet two professing Christians, Duntley and Johnson, see it as legitimate in some situations. By Humphry’s own recognition, it is completely inconsistent to consider euthanasia (assisted-suicide) if one is a Christian who believes in the sovereign authority of God.
 Ira Byock, cited by Robert J. Kingsbury. “The Debate over Total/Terminal/Palliative Sedation,” (Accessed 12/20/04); available from http://www.chhd.org/resources/endoflife/Kingsbury-ducharme_2002-01-24.htm; Internet
 Margaret A. Farley, “The Choice of Death in a Medical Context,” in Issues in Contemporary Christian Ethics, 194
 James F. Keena, “The Case for Physician-Assisted Suicide?” in Moral Issues and Christian Responses, 7th ed., Eds. Patricia Beattie Jung and Shannon Jung (Belmont, CA: Wadsworth, 2003), 188.
 Arthur J. Dyck, Life’s Worth, The Case Against Assisted Suicide, Eardmans, Grand Rapids: Eerdmans, 2002, 106.
 Mark A. Duntley Jr., “Physician Provided Medication for Termination of Life,” in How Shall We Die? Helping Chrisitans Debate Assisted Suicide, Eds. Sally B. Geis & Donald E. Messer, Nashville, Abingdon, 1997), 85-86.
 Duntley, 80-81
 Duntlrey, 82
 For the text of this memoir see Timothy E. Quill, “Death and Dignity: A Case of Individualized Decision Making,” in Contemporary Moral Issues, Diversity and Consensus, 2 ed. Ed. Lawrence M. Himan, (Upper Saddle River, NJ: Prentice Hall, 2000), 135-139. The problematic nature of a Christian drawing upon this account will be addressed below.
 Quill, 134.
 Quill, 138.
 C. Everett Koop and timothy Johnson, Let’s Talk; An Honest Conversation on Critical Issues (Grand Rpids: Zondervan, 1992), 39.
 Koop and Johnson, 42 (Johnson’s emphasis).
 Ibid, 43.
 Ibid, 42-43.
 Quill, 139.
 See Deuteronomy 32:39 and 1 Samuel 2:6
 Agneta Sutton, “Legalizing Euthanasia: A Significant Move,” (accessed 12/20/04); available from http://www.cbhd.org/resources/endoflife/sutton_2001-11-19.htm; Internet.
 It should be noted here that although Quill thought he was acting only on the basis of his patient’s interests, he was not neutral. For a discussion, see Arhur J. Dyck, Life’s Worth, the Case Against Assisted Suicide, (Grand Rapids: Eerdmans’s), 11-28, for an insightful critique of Quill’s actions.
 John F. Kilner, Life on the Line; Ethics, Aging, Ending Patients Lives, and Allocating Resources (Grand Rapids: Eerdmans, 1992), 119.
See Genesis 9:5-6 and Exodus 20:13
 Derek Humphry, Final Exit; the Practicalities of Self-Deliverance and Assisted Suicide for the Dying (Eugene, OR: The Hemlock Society), 21.