As we attempt to develop an authentic Christian response to assisted suicide and other forms of medical killing, we need to start with an understanding of creation, and in particular of the created moral order, the moral principles that God has embedded into the structure of the universe. God did not just create the physical stuff of the universe, atoms and molecules and photons. He also created a hidden moral order, like the grain imprinted in a piece of wood. What it means to be human -- and what it means to destroy human life -- is not ours to create and invent; it is given to us. It is part of the created order, of the way things are. And true freedom is to live your life along the grain of the deep hidden order of the creation.

To many modern people this is outrageous and unacceptable. They demand the right to make themselves whatever they choose. The idea of the created order is seen as a straight-jacket, a constricting, limiting, and demeaning force. So the modern understanding of freedom is that we should have the right to be freed from the limitations of the created order. We want to break out from those old rules and make up new rules for ourselves. But the truth is that I can only be truly free if I become the person that God created me to be. Christian freedom is freedom to be truly myself.
Made in God's image

"And God said, let us make human beings in our image... " Genesis 1:26

This foundational statement in the first chapter of the Old Testament tells us that human beings are not self-explanatory. Our ultimate identity cannot be derived by careful analysis of our genetic make-up, our anatomical structures, our brain mechanisms, or our social history. We are reflections of another reality, and we derive our meaning from outside ourselves, from God, in whose reflection we are made.

Because human beings are made in God's image we do not need to earn the right to be treated as God-like beings. Our dignity is intrinsic, in the way we have been made, in how God remembers us and calls us. So biblical ethics, the way we are called to treat one another, is derived from biblical anthropology, the way we are made.

The desperate modern attempt to be a totally autonomous individual, constantly creating myself by the decisions and choices I make, is out of touch with reality. It is a modern fantasy. In truth we are derivative, we are reflections of another reality. And this way of thinking confronts us with the radical nature of our dependence.

I did not choose to be a human being, to be a particular kind of carbon-based life form. I did not choose this form of embodiment, this frailty and these limitations. I did not choose my genetic inheritance, the structures of my body and brain, the nature of my conscious awareness, my sensory experiences and so on. These, whether I like them or not, are part of the given-ness of what it means to be a human being.

And I was not born as an isolated individual. I came into the world locked into a network of relations I did not choose, with a mother and father, grandparents, siblings, aunts and uncles, friends and carers. You and I came into the world utterly dependent on the love and care of people we did not choose. And in Christian thinking this was not some bizarre fluke or accident, it was an essential part of what it means to be human. An integral part of our created humanity is the reality that we are dependent on others, we are designed to depend on one another.

The narrative of a human life

We come into the world as helpless beings, totally dependent on another's love and care. We go through a phase of our lives when other people depend on us. We protect them, care for them, feed them, pay for them. And then most of us will end our physical lives totally dependent on the love and care of others. We will need other people to feed us, protect us and care for us. And this is not a terrible, degrading inhuman reality. It's part of the design. It is a part of the narrative of a human life.

This was brought home to me in a striking way in an incident I have referred to in a previous book. My mother had become totally dependent on 24 hour nursing care as a result of a tragic and rapidly progressive dementing illness. I was visiting her towards the end and someone put a yoghurt pot and teaspoon into my hand. I tried to feed her. "Open wide, here it comes..." And the thought struck me that this was exactly what she used to do with me, all those years ago. I could remember her words as she fed me. But now the tables were turned. And I remember thinking at the time, "Perhaps this is the way it was meant to be". I was learning more of what it meant to be a son, and she was learning more of what it meant to be a mother. Because dependence is part of the story, part of the narrative of the human lives that have been given us.

Designed to be dependent

In the words of Gilbert Meilaender, "We are dependent beings, and to think otherwise -- to make independence our project, however sincerely -- is to live a lie, it is to fly in the face of reality".

Even in our years of adult "independence" in reality we remain dependent beings. As I write these words I am dependent from moment to moment on the activities and contributions of countless other human beings -- on people who generate electricity to power my laptop, on those who grow, prepare, transport and sell food for me to eat, on people who purify water and remove waste, on police and security personnel who protect me ceaselessly from harm, and so on.

In biblical thinking our radical dependence extends to the creator God who knows and sustains every atom of our being. In the depth of his suffering and loss the biblical character Job reflects on this theme:

"Your hands shaped me and made me, and now you have destroyed me altogether. Remember that you have made me like clay and will you return me to the dust. Did you not pour me out like milk and curdle me like cheese, you clothed me with skin and flesh and knit me together with bones and sinews? You have granted me life and steadfast love and your care has preserved my spirit"Job 10:8-12

Being a burden to others

As we have seen, one of the greatest fears expressed by elderly or disabled people is that they will be a burden to others. In Oregon and elsewhere it is a frequent reason that elderly people give for requesting assisted suicide. But in God's creation order we are meant to be a burden to one another! This is part of what it means to belong to a family or to a community. Paul commanded the Galatians, as members of the Christian family, to "carry each other's burdens, and in this way you will fulfil the law of Christ" (Galatians 6:2). To be called into a family is to be called to share the burdens of the life which God has given us, the burdens which come from our creation out of dust. The life of a family, including the Christian church family, should be one of `mutual burdensomeness'.

Of course this is profoundly counter-cultural in a society that, at least in theory, prizes heroic individualism and self-governance. Here is an opportunity for the Christian community to model a different way of being fully human.

Biblical thought always draws a line between removing suffering and removing the sufferer Yes, we have an absolute duty to care for our suffering neighbour. Yes, we should be motivated by Christian compassion, following the example of Jesus Christ. But no, we are not at liberty to destroy innocent human life, however noble may be the motive. The sixth commandment, "You shall not murder" (Exodus 20:13) provides an absolute moral imperative, which we cannot evade.

"Whoever sheds the blood of man, by man shall his blood be shed, for in the image of God, has God made man." Genesis 9:6

As many commentators have pointed out, this ancient text combines two biblical themes. First there is the ancient blood taboo, a recognition of the special status of blood because it represents a spilled life, and secondly there is the recognition of the special status of murder, the intentional destruction of innocent human life which is linked to the indwelling image of God. To destroy human life is uniquely scandalous because it is a desecration of God's image, God's masterpiece.

The Christian view of a human life as a gift received from God is often caricatured by opponents. God is the slave-owner and humans are his slaves and therefore God 'owns' each life. We are not free to dispose of our own life as we wish because God 'owns' it. But this is a distortion of the biblical view. We are not merely slaves. Human beings are special because of how they are made -- because they are a mysterious expression of God's being.

How should Christians regard suicide?

Orthodox Christian thought has always been opposed not only to homicide, the taking of another human life, but also to suicide. The deliberate destruction of one's own life is also a desecration of God's image. In many ancient cultures, suicide has been glorified as a noble way to die, the death of a nobleman, the death of a hero. In ancient Greece, the Stoics supported suicide as justifiable and virtuous under circumstances when happiness was not possible.

Cicero, the prominent Stoic philosopher, wrote, "When a man's circumstances contain a preponderance of things in accordance with nature, it is appropriate for him to remain alive; when he possesses or sees in prospect a majority of the contrary things, it is appropriate for him to depart from life".

But in all cultures influenced by the Judaeo-Christian revelation, suicide has been opposed. It is never glorified in the Bible but instead is seen as act of hopelessness and despair, for example in the tragic ends of King Saul, the first king of Israel, and Judas Iscariot. Despite this, it is clear that suicidal thoughts are not uncommon in God's people. Elijah wanted to die but was sent on a sabbatical instead. Jeremiah wishes he had died in his mother's womb but discovers that God has plans for welfare and not for evil, to give "a future and a hope". Job too, wishes he had never been born, but learns that God is infinitely greater than his own perceptions.

So suicidal thoughts are not unusual in God's people but suicide itself is not honoured and glorified because human life is worth more than that. Both intentional killing and suicide are ultimately contrary to the Christian understanding of reality. Even when tempted to kill out of compassion, we come up against the limits of our creatureliness.

Human intuitions about the destruction of human life

It is not only those with an explicit Christian faith who sense a profound resistance to the taking of human life. The unease and distress expressed by many doctors and health care workers who have participated in euthanasia or assisted suicide are evidence of deep intuitions about the special nature of human life -- intuitions which stem from our creation in God's image.

Studies of doctors who have performed euthanasia and assisted suicide in the Netherlands and USA have shown high levels of temporary emotional discomfort, distress and a sense of burdensomeness. In the words of one Dutch doctor, "To kill someone is something far reaching and that is something that nags at your conscience... I wonder what it would be like not to have these cases in my practice. Perhaps I would be a much more cheerful person."

Another Dutch family doctor described how he always tried to resist a request for euthanasia from one of his patients. When the pressure became unbearable he arranged for euthanasia to be performed on a Friday afternoon. Afterwards he went for long walks in the countryside, he read poetry, he listened to Bach and he tried to prepare himself emotionally for starting work again on Monday morning.

"It is not a normal medical treatment. You are never used to it."

Another doctor, asked how he felt after his first case of euthanasia said simply "Awful"

Of course these emotional responses could be described as simple squeamishness which all health professionals need to overcome in order to practice effectively. But I believe these expressions of discomfort point to a deep moral unease, to a sense of having violated a moral boundary. They point to the hidden order of the creation. When we assist in the killing of another human being, however compassionate and rational our motives might seem to be, we come up against the moral order of the universe, and we damage our own humanity.

The human family

In Christian thought, not only is each individual human life special, but we are all members of the human family. We are created to be in community.

We see this in the enormous lengths that our society goes to in order to prevent suicides. Why are brave police officers expected to try to save the life of a man attempting to jump from a bridge, for example? Why on earth do they bother? If he wants to die surely we should let him. Why risk the lives of valuable citizens attempting to save someone who doesn't value his own life?

I would suggest it is because our society, though penetrated by liberal individualism, is still deeply influenced by Christian intuitions. From a Christian perspective we are not autonomous individuals doing our own thing. We are locked together in community, bound together by duties of care, responsibility and compassion. Respect for life, and the prohibition of suicide, is part of the glue which binds society. It is part of the hidden moral order, the grain in the wood, which God has placed in the creation.

Imagine a society which quietly encouraged the depressed, the inadequate, the isolated or the disabled to take their own lives. Where doctors made available lethal mixtures for their patients, where the desperate and lonely were encouraged to get on with it. What kind of society would that be?

"No man is an island, entire of itself; every man is a piece of the Continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were... any man's death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee."

It is because we are locked together in human community that suicide can have devastating effects on others. Although driven by desperation and hopelessness the one who commits suicide hurts those who survive. Whether intentionally or not, the suicide strikes at all those in community with him, wounding and damaging them, often for life.

The Dutch father of a Christian friend of mine rang up one day to announce that he was going to receive euthanasia from his doctor. Although not terminally ill, he was lonely and in some pain. My friend travelled to the Netherlands with his own son to plead with his father not to do it. But his father was adamant and euthanasia was duly carried out on the following week. Now the family have to live the rest of their lives with a sense of loss created by the actions of a loved family member.

When my loved one chooses to kill themselves rather than carry on living with me, they point at my own inadequacies. Perhaps I didn't love them enough. Perhaps I could have done more. It is common to see this in cases of assisted suicide reported in the media. In fact at times there seems to be a degree of emotional blackmail exerted by the suicidal individual. "If you really loved me you would help me to kill myself." The relatives often find themselves torn between horror at the implications of suicide, loyalty to their loved ones, and a deep sense of their own failure.

In summary, to commit suicide is to strike at the heart of what it means to live in community, for we are designed to be dependent on one another. We are all called to share the burdens of the physical life which God has given us.

Death: an outrage and a mercy

I am struck by a curious ambivalence in orthodox Christian attitudes towards death. On the one hand death is seen as an enemy and an outrage, and yet it can also be a mercy, a release, even a strange kind of healing. So because death is a terrible enemy we are called to fight against it with all our courage, skill and commitment. Christian love is a way of saying to another person, even in the face of pain, suffering and disability, "It is good that you are alive." And in the resurrection of Jesus Christ we see the first-fruits of the ultimate defeat of death.

But in God's providential care for fallen human beings, death may become, in C.S. Lewis's phrase "a severe mercy". In the biblical narrative human lifespan is limited, not just as a curse, but out of God's grace. To live for ever in a fallen and decaying body is not a blessing but a curse. In God's providence, death may be a merciful release from an existence trapped in a disintegrating body. So Christian attitudes to death must always reflect this strange ambiguity. Even though human death is fundamentally an evil to be fought against, a reality which can never be sought intentionally, it may also at times be accepted and recognised as a sign of God's mercy.

The person of Jesus

The Christian faith makes the astonishing claim that God has revealed himself in the physical stuff of our world, in a human person, Jesus of Nazareth. And the Gospel writers claimed that he rose physically from the grave on that first Easter Sunday. This shows us the importance of our current physical bodies and also points to something that is even more important: the future resurrection life which is invading the present. The risen Jesus shows us that our present limited physical existence is not the only or even the most important part of reality. So Christians affirm the importance of physical healing, while recognizing that behind our current physical experience there lies a deeper, richer, even more wonderful reality.

This means that we cannot make the extension of physical life by technology the ultimate goal of medicine. Sometimes we have to say no to medical progress. Sometimes we shall need the trust and the courage that enable us to decline what medical technology makes possible. To say no to burdensome or futile medical treatment is not a form of suicide or faithlessness, it is part of wise Christian living. This physical existence is not all there is; we need a deeper healing.

Human suffering: a mystery of human dependence

One of the novel features of our modern technological society is that we have lost the belief that suffering can have any positive value at all. Pain, whether physical, mental, relational or spiritual, is seen as useless, futile, destructive, incomprehensible, and terrifying. It is the ultimate threat to individual human autonomy and self-direction. Once we have adopted this perspective it is an easy step to accept that, in the name of eliminating the suffering, we are forced to eliminate the sufferer.

Yet, within a Christian understanding suffering can never be meaningless, even if it seems to be. Suffering is a painful reality which we are called to accept from the hand of a loving God. Even the word 'to suffer' implies an element of passivity. It comes from the Latin suffere meaning literally 'to bear under', and hence 'to permit or to allow'. The original meaning of the English word was 'to put up with', and hence the root meaning of suffering is the idea of submitting or being forced to submit or endure some circumstance which is beyond our control.

It seems this is the fundamental reason why suffering is regarded by secular philosophers as an affront to liberal ideas of individual autonomy. It is not so much that suffering impairs our ability to choose, but rather that suffering threatens the comforting illusion that we are in ultimate control. Suffering challenges our modern tendency to be control freaks. It challenges the widespread fantasy that we can be autonomous, choosing individuals. Instead suffering emphasises our deep and inescapable creaturely dependence. The suffering person cannot escape the reality of his or her profound dependence on others.

As theologian Stanley Hauerwas has pointed out, the initial reaction to witnessing suffering in another human being is often to be repelled. Suffering tends to turn the other person into a stranger. Yet suffering in another human being is a call to the rest of us to stand in community. It is a call to be there. "Suffering is not a question which demands an answer, it is not a problem which demands a solution, it is a mystery which demands a presence."

So those of us who are called to care for suffering people need to encourage them and demonstrate by our actions that they are not excluded from the human community. In fact by providing committed and sensitive caring for suffering people we are binding them into the human family. The sad reality is that, so often, modern medical and health care systems have precisely the opposite effect. They isolate and marginalise those who are suffering and dying from the rest of the human community.

The duty of care that doctors and other professional carers are bound by, is a moral commitment to be there for those who are suffering and dying. It is a practical demonstration of the covenant bonds of community. It is to say to the sufferer, "We are the community's representatives and we promise to care for you whatever will happen, whatever it may cost. We will walk this road with you to the end."

Of course this does not mean that we ought to welcome or enjoy suffering. Orthodox Christian thinking has often been accused of masochism and callousness. But this is a perversion of what Christians have thought and practised over the centuries. Suffering is not to be sought, but there are times when it should, at least to some degree, be accepted.

Suffering and glory are inextricably linked

However the Christian faith teaches us something more wonderful and mysterious than just acceptance of suffering. In the biblical narrative suffering and glory are inextricably linked and intertwined. The suffering Christ is also the glorified one. And there are mysterious hints in the New Testament that in the painful experience of suffering we may discover a profound intimacy with others who suffer, and with God himself.

"I want to know Christ and the power of his resurrection and the fellowship of sharing (koinonia) in his sufferings, becoming like him in his death"Philippians 3:10

Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God. For as we share abundantly in Christ's sufferings, so through Christ we share abundantly in comfort too. (2 Corinthians 1:3-5)

These are deep and complex topics and this is not the place to address them further. But in place of a simplistic utilitarian philosophy that sees suffering and pain as entirely negative and evil, the Christian faith provides a richer and more nuanced understanding. Suffering need not be all loss. It is a painful mystery that calls us to be a presence, to stand in community with those in pain, to enter into the koinonia of suffering.

This article is adapted from material in my book Right to die? Euthanasia, assisted suicide and end of life care. You can find the rest of my material on euthanasia and the end of life here, including my other introductory essays. How to die well can be seen here: https://johnwyatt.com/2021/09/10/interview-dying-well/