One of the most common reasons given for assisted suicide is the desire not to be a burden to one’s family and loved ones.
The overriding reason for pursuing PAS seems to be the fear of being a burden to others, as 93 percent of Oregon physicians thought. In the Washington survey, 75 percent of terminally ill patients cited concern about being a burden as grounds for PAS. Distress and dependency are the primary concerns of P.A.S. candidates.(Keenan - 189).
This is precisely what has motivated Professor John Hardwig to promote the idea of a “duty to die.” He argues from a utilitarian perspective that we may have a duty to die by committing suicide in order not to overly burden our family. He states,
A duty to die is more likely when continuing to live will impose significant burdens-emotional burdens, extensive care giving, destruction of [others’] life plans, and, yes, financial hardship—on your family and loved ones. This is the fundamental principle underlying a duty to die.
Hardwig considers obligations to his own family paramount throughout life, and no less in dying, thus, “The impact of my decisions upon my family and loved ones is the source of many of my strongest obligations and also the most plausible and likeliest basis of a duty to die.”
Wesley J. Smith observes, “this may sound like fringe thinking, but it is disturbingly close to the mainstream,” and explains that Hardwig has written his articles explaining this duty in The Hastings Report, “one of the foremost bioethics journals in the world.” Through this forum, Smith explains, “the duty to die is actively discussed within bioethics as a respectable topic of discourse, and few eyebrows are raised.” Hardwig even speaks of the duty to die in a clinical setting. This is where his utilitarian language becomes particularly unnerving.
Physicians would no longer be agents of their patients, and would not strive to be advocates of their patients’ interests. Instead the physician would aspire to be an impartial adviser who would stand knowledgeably but sympathetically by . . . and discdern the treatment that would best harmonize or balance the interests of all concerned.
What a sad and utterly deplorable state this envisions. Instead of being people to be cared for, the dying would be considered, and be made to consider themselves, burdens to their families, and not worthy of medical or other resources. Understand, also that Hardwig does not want the elderly and ill to wait until they are incompetent and decidedly terminal before submitting to this “duty to die.”
Let me be clear . . . there can be a duty to die before one’s illness would cause death, even if treated only with palliative measures. I nfact, there may be a fairly common responsibility to end one’s life in the absence of any terminal illness at all., finally, there can be a duty to die when one would prefer to lif=ve. Granted, many of the conditions that ca generate a duty to die also seriously undermine the quality of life. Some prefer no to live under such conditions. But even those who want to live can face a duty to die.
Consequently, he asks the “sick and debilitated to step up and take responsibility.” and with regard to the elderly asserts, “To have reached the age of, say, seventy-five or eighty years without being ready to die is itself a moral failing, the sign of a life out of touch with life’s basic realities.” Hardwig, in effect, is saying that to desire to live when your care is burdensome to those around you is immoral.
In view of this concept, it is quite significant that nearly two thirds (63%) of the patients in Oregon in 2000, since the passing of the Death with Dignity Act legalizing PAS in that state, reported that their primary motivation was to avoid, “being a ‘burden on family, friends or caregivers,’” compare this to the 26% of the previous year, and one can see a frightening trend.  It seems the legalization of physician assisted suicide, the “right to die,” easily develops into a “duty to die,” or a sense that you must “get out of the way,” so as not to be a burden to those who care for you.
It is also quite significant that Scriptures deal with the concept of burden bearing. Galatians 6:2 exhorts believers to “bear one another’s burdens and so fulfill the law of Christ.” Christ’s law (John 13:35-35) was ‘that you love one another.” So love, in a biblical sense, entails bearing the burdens of others. An important insight here is that we are not to consider other people as burdens, but rather people with burdens. These burdens are not to be carried alone, but Christ’s people should, in true compassion (suffering with), bear them along with those who are afflicted by them. There is an explicit and implicit moral duty here. The clear duty is for those without a particular burden, is not to leave those with them alone in their suffering. The implied duty is that those who are suffering must allow themselves to be served, i.e. to be in a state of dependence upon others. This is exactly opposite of the ideas proposed by Hardwig, who feels it is a moral responsibility to remove oneself from being a burden by killing oneself. John Dunlop captures well the essence of this bilateral moral responsibility found in Galatians 6:2.
Believers are commanded to "Carry each other's burdens, and in this way . . . fulfill the law of Christ.” This command is a charge to help others. At the same time it obligates people to allow others to help them. The older years often teach us how to depend more on others. There is, indeed, a ministry of dependence. The Church is a community that is to be characterized by true fellowship. We are to participate in each other's lives, which mean sharing in each other's sufferings. How often we see that pain and suffering can be decreased as it is shared within a caring community. It must be one of our goals in the Church to develop a community that can feel deeply one another's pain. One of the ways God is glorified in His Church is when the members develop a depth of fellowship adequate to allow them to bear one another's burdens 
One always hears how Job’s friends were really not too friendly in that they hastily concluded that Job suffered as he did because of some sin he had committed. The book of Job was no doubt partially written to debunk this thinking. Job suffered for God’s glory, and it is a grave error to decide immediately that suffering in anyone’s life is an indication that they have sinned. Yet despite his friends’ poor display in the dialogues, their friendship is exemplary when they first hear of their friend’s grave misfortune. In Job 2:11-13 Scripture records,
When Job's three friends heard of all this adversity that had come upon him, each one came from his own place Eliphaz the Temanite, Bildad the Shuhite, and Zophar the Naamathite. For they had made an appointment together to come and mourn with him, and to comfort him. And when they raised their eyes from afar, and did not recognize him, they lifted their voices and wept; and each one tore his robe and sprinkled dust on his head toward heaven. So they sat down with him on the ground seven days and seven nights, and no one spoke a word to him, for they saw that his grief was very great.(Emphases this writer’s)
There is definitely a place for a ministry of silent presence, especially with those who are in the dying process. A ministry to the dying and their families should minimally entail such.
The significance of such a ministry for those who are going to die is seen in vivid beauty in the life of our Lord. In the throes of his agonizing anticipation of his own death, Jesus gives a simple, but oft neglected, mandate, to his disciples to “watch and pray” with Him. He also refuses to succumb to his own desire to eliminate the suffering altogether. Bringing these two ideas together, Arthur J. Dyck makes the following insightful observations. From Christ’s example one can draw the following lessons:
One can serve God’s purposes simply by refusing to ask for PAS or euthanasia . . . this is a witness to the incalculable worth of life . . . [further] the enormous suffering Jesus experienced . . . does contain an important moral imperative. Jesus expected his followers to be in prayer with Him, and be a companion to Him while He was suffering.
He then makes application for all those who call themselves followers of Jesus and what this example means for us in both medicine and ministry.
In short, followers of Jesus owe compassion to those who suffer. What happened in the Garden of Gethsemane contains a very urgent message for all those who are attending the sick and the dying: Do not abandon the suffering; pray with them and for them; do not shun the suffering any of us feel when we are present to those who are physically diminished and suffering in any way.
Elsewhere, Dyck remarks, “Suffering people need the support of others; suffering people should not be encouraged to commit suicide by their community, or that community ceases to be a community.” The reader should remember that Job’s friends looked upon him and “did not recognize him” but stuck it out while he grieved. This is our responsibility to those who are afflicted in such a way that we may not recognize them, or their presence is pleasant in neither sight nor smell, which is common when people are in the dying process. Jesus scolded his disciples for not suffering with him, but abandoning him to do it alone. These examples affirm the significance of a ministry of silent and prayerful presence when attending those who suffer deeply and are about to die.
From this we must conclude that pressure toward, or espousal of, a duty to die is alien to a biblical ethical framework. We affirm life at every point and in every stage, no matter how week, dependent or compromised. Dependency cannot be thought of as an evil or an undesirable condition. The “rugged individualism,” of the American mindset not only fosters selfishness, but also contributes to the inability to accept assistance, giving one a sense that they are a burden. If someone voices a notion of being a burden, or suggests a duty to die, or if those who care for them echo these sentiments, the church must counter this mindset with an affirmation of their existence and their worth, and insist that they are not a burden, but that they have a burden that we are going to lovingly bear with them.
A biblical approach to end-of-life issues does not include assisted suicide or active euthanasia of any kind. It precludes any suggestion that people are familial or social burdens who are just getting in the way. It does allow for the termination of life support when it is judged to be nothing more than prolonging death, and keeping a person alive by completely artificial measures. It also allows for helping a person out of their pain using narcotics to induce sleep. But beyond the ethical and clinical aspects of these concerns, there is a higher responsibility for the church in light of the end-of-life issues being faced by our culture. This societal crisis provides yet another rich opportunity for the church to minister, and to shine as lights in the world” “in the midst of a crooked and perverse generation.” Mark Blocher has insightfully observed that,
More than anyone else, Christians have a major stake in what happens to people at the end of life. Such a large stake provides a powerful incentive to improve care at the end of life . . . If anyone should have an interest in how people die it is the church. If there exists a group of people a dying person should be able to count on to walk with him through the valley of the shadow of death, it is those who claim to belong to the Good Shepherd.
According to Blocher, the body of Christ should actively offer three promises to the terminally ill and dying.
To the best of our ability, we will not allow you to die in pain.
We will not allow you to die alone.
You will not be a burden to anyone.
These promises are an excellent starting place for the church to begin thinking about its responsibilities in addressing the social crisis which inches ever closer to fully embracing a culture of death. The church must not be silent.
Beauchamp, Thomas L. “A Reply to Rachels on Active and Passive Euthanasia.” Contemporary Moral Problems, 4th ed., Ed. James E. White, Minneapolis/St. Paul: West Publishing Company, 1994.
Blocher, Mark. The Right to Die?; Caring Alternatives to Euthanasia. Chicago: Moody Press, 1999.
Frame, John M. Medical Ethics; Principles, Persons and Problems, Phillipsburg, NJ: Presbyterian and Reformed Publishing Company, 1988.
Duntley, Mark A. Jr. “Physician Provided Medication for Termination of Life.” How Shall We Die? Helping Christians Debate Assisted Suicide. Eds. Sally B. Geis & Donald E. Messer, Nashville: Abingdon, 1997.
Dunlop, John T. “Successful Aging: Living the End of Life to the Glory of God.” Accessed 12/18/04. Available from http://www.cbhd.org/resources/endoflife/dunlop_2001-01- 05.htm; Internet.
Dyck, Arthur J. “An Alternative to the Ethic of Euthanasia.” Morality and Moral Controversies, 6th ed., Ed. John Arthur, Upper Saddle River, NJ: 2002.
Dyck, Arthur J. When Killing is Wrong, Physician Assisted Suicide and the Court. Cleveland: Pilgrim Press, 2001.
Dyck, Arthur J. Life’s Worth; The Case Against Assisted Suicide. Grand Rapids: Eerdmans, 2002.
Hardwig, John, “Is There a Duty to Die?” Contemporary Moral Issues: Diversity and Consensus. 2nd ed., Ed. Lawrence M. Hinman, Upper Saddle River, NJ: : Prentice Hall, 2000
Humphry, Derek,. Final Exit; The Practicalities of Self-Deliverance and assisted Suicide for the Dying. Eugene, OR: The Hemlock Society, 1991.
Keenan, James F. “The Case for Physician Assisted Suicide?” Moral Issues and Christian Responses,7th ed., Eds. Patricia Beattie Jung and Shannon Jung, Belmont, CA: Wadsworth, 2003.
Kingsbury, Robert J. and Howard M. Ducharme “The Debate Over Total/Terminal/Palliative Sedation.” Accessed 12/18/04. Available from http://www.cbhd.org/resources/endoflife/kingsbury-ducharme_2002-01-04.htm; Internet.
Kilner, John F. Life on the Line; Ethics, Aging, Ending Patients Lives, and Alllocating Resources, Grand Rapids: Eerdmans, 1992.
Koop, C. Everett and Timothy Johnson. Let’s Talk; An Honest Conversation on Critical Issues, Grand Rapids: Zondervan, 1992.
Mitchell, C. Ben. “Oregon’s Lethal Experiment: An Annual Report.” Accessed 12/20/04. Available from http://www.cbhd.org/resources/endoflife/mitchell_2001-02-22.htm; Internet.
Quill, Timohty E. “Death and Dignity: A Case of Individualized Decision Making.” Contemporary Moral Issues: Diversity and Consensus. Ed. Lawrence M. Hinman, Upper Saddle River, NJ: : Prentice Hall, 2000.
Rachels, James. “The Morality of Euthanasia.” The Right Thing to Do; Basic Readings in Moral Philosophy, Ed. James Rachels, New York, NY: Mcgraw Hill, 1989.
Rachels, James . “Active and Passive Euthanasia: An Impertinent Distinction?” Social and Personal Ethics,3rd ed. Ed. William H. Shaw. Belmont, CA: Wadsworth,1999.
Smith, Wesley, J. Culture of Death; The Assault on Medical Ethics in America. San Francisco: Encounter Books, 2000.
Sullivan, Thomas D. “Active and Passive Euthanasia: An Impertinent Distinction?” Social and Personal Ethics,3rd ed. Ed. William H. Shaw. Belmont, CA: Wadsworth,1999.
Sutton, Agneta M. “Legalizing Euthanasia: A Significant Move.” Accessed 12/20/04. Available from http://www.cbhd.org/resources/endoflife/sutton_2001-11-19.htm; Internet
 James F. Keenan, “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), 189.
 John Hardwig “Is There a Duty to Die?” in Contemporary Moral Issue; Diversity and Consensuss 2nd ed., Ed. Lawrence M. Hinman (Upper Saddle River, NJ: Prentice Hall, 2000), 157.
 Ibid, 152.
 Wesley J. Smith, Culture of Death: The Assault on Medical Ethics in America (San Francisco, CA: Encounter Books, 2000), 153.
 Smith, 152.
 Smith, 153.
 Hardwig, 151.
 Ibid, 159
 Ibid, 157.
 C. Ben Mitchell, “Oregon’s Lethal Experiment: An Annual Report,” (accessed 12/20/04); available from http://www.cbhd.org/resources/endoflife/mitchell_2001-02-22.htm; Internet.
 Wesley J. Smith reports that Hardwig told him this in a personal interview. See Smith, Culture of Death, 154, n. 69.
 John T. Dunlop, “Successful Aging: Living the End of Life to the Glory of God,” (accessed 12/18/04); available from http://www.cbhd.org/resources/endoflife/dunlop_2001-01-05.htm; .Internet.
 The following is based on the gospel narratives which speak of Christ’s suffering in Gethsemane. See Matthew 26:37-44, Mark 14:32-41, and Luke 22:39-46.
 Dyck, Life’s Worth, 104.
 Arthur J. Dyck, “An Alternative to the Ethic of Euthanasia,” in Morality and Moral Controversies, 6th ed. Ed. John Arthur (Upper Saddle River, NJ: Prentice Hall, 2002), 247.
 See Philippians 2:25
 Mark Blocher The Right to Die? ; Caring Alternatives to Euthanasia (Chicago: Moody Press, 1999), 190, 192.
 Blocher, 193. this is actually the essence of Blocher’s entire work. He focses on how these promises given and fulfilled will build a community of caring that makes PAS irrelevant. Blocher also articulates LIFT (Loving Individuals in Final Transition), a ministry he has developed to assist churches in dealing with difficult end of life cases.