The Church and Bioethics: Refusing Treatment

Below is a summary of a sermon I preached on May 29, 2016 concerning the bioethical issue of refusing treatment.

Four questions to answer on refusing treatment:
1. Is death a natural or unnatural occurrence?
2. Is there a moral difference between killing and letting die?
3. Should we ever refuse treatment?
4. How should the church respond?

Is death a natural or unnatural occurrence?
When considering the gospel ramifications of dying, we need to be instructed on exactly what death is to us as Christians. Is death a fried or a foe? It is natural or unnatural?

This is an example of where the Bible provides some balance for us. First, Christians must reject the idea that death exists only as a natural part of living. But second, the Bible teaches us that every person will die because of sin. So there is a regularity to death in our lives. Let’s consider the unnatural reality first…

God did not create the inhabitants of the world to die. He created life in the garden of Eden and called it “Good”, and all was perfect. There was no death, only life. This was natural. A world without death.

But then we know what happened. In Geneses 3, Adam and Eve disobeyed God and brought sin into the world. God had clearly promised what would happen if they disobeyed – their disobedience would bring about the curse of death. And it did. When Adam and Eve sinned, a couple of things happened.

First, there was immediate spiritual death. Adam and Eve were spiritually separated from God and now in need of his grace for reconciliation. This is why they were hiding from God, in fear of him for the first time because of being separated from him. That spiritual death passes to every person who has ever lived, and we are all born with a need to be reconciled to God. That is only possible through faith in Jesus Christ.

Second, there was physical death. God banished Adam and Even from the garden and from the tree of life, and over the course of time, they physically died. This physical death also spread to all people because of sin. Romans 5:12 says that “just as sin came into the world through one man, and death through sin, and so death spread to all men because all sinned.” Romans 8:12 describes all of creation “groaning” because of the curse of sin and death, waiting for the day it will be restored to its natural state that God originally designed. And finally, and most importantly, Christ had to become a curse in order to destroy the curse of death and sin. Galatians 3:13 mentions this – that “Christ redeemed us from the curse of the law by becoming a curse for us. Cursed is everyone who hangs on a tree (cross).

Death is also an enemy. Paul says in 1 Corinthians 15 that Jesus Christ will put all enemies under his feet. Let’s just pause there for a minute, friends. Do you hear that promise? That’s a promise of God, and God doesn’t break promises. You hear me? God doesn’t break promises. And he has promised that all enemies will be put under the feet of Jesus. Christ has conquered and will conquer. And then Paul describes the very last enemy that Christ will defeat – death itself. So Paul says in 1 Corinthians 15:26 that “the last enemy to be destroyed is death.”

So from this biblical perspective, death is anything but natural. But in light of sin and the curse, death has become unavoidable. And this is where we might begin to understand it to be natural in a certain kind of way. The Bible says we will all die. The death rate is 100%. The Bible is remarkably clear and precise about the death rate. God mentions 120 years old as about the oldest anyone will live, and David writes that 70-80 years is a normal length of time for a person to live. Remarkable how accurate that still is to this day.

Is there a moral difference between killing and letting die?
As we discussed last week, it is not morally permissible to take one’s own life. But does that mean we must take advantage of every possible medical treatment in order to preserve our lives? Is there a moral distinction between actively killing and passively allowing our bodies to physically pass away? I would say yes, there is a moral distinction. Here’s a few reasons why.

First, although God does not permit the active killing of another person or our own bodies, he has mercifully and graciously provided an escape from our present suffering that will usher us directly into his presence. That escape is called death. Thus, as we just mentioned, God has limited the number of days a person will live so that those who are in Christ will reap the fruit of their faith. God turns death, which is no doubt an enemy, into a great blessing for those who trust him. And God does that all the time. Takes suffering and turns it into blessings. So, it is better for us to ultimately be with Christ, which Paul says on a few occasions.

Second, although murder and actively killing are prohibited, there are times in Scripture when allowing oneself to die is commended, such as when it describes an allegiance to Jesus Christ above and beyond anything else. Paul says in Acts 21:33 that, “I am ready not only to be imprisoned but even to die in Jerusalem for the name of the Lord Jesus.”

Third, there is that beautiful Psalm 116 that has been used at so many funerals. It says, “precious in the sight of the Lord is the death of his saints.” Death can be a precious thing if you are in Christ.

So, in light of these biblical considerations, we see instances where there are moral distinctions between killing and allowing oneself to die.

Should we ever refuse treatment?
Since we have seen that death is a part of God’s providence over his sinful creation and since we have seen that there is a moral difference between killing and letting die, I would say there are scenarios where refusing treatment is morally permissible.

Whereby actively killing is the decision to choose death, refusing treatment is many times a choice of one kind of life over another kind of life. Let’s take for example a person who has a terminal illness or disease. This person has an option to undergo a long and painful series of treatments that might delay the inevitable for a bit longer, but in the process would keep them from seeing and being with the people they love, and would keep them from enjoying the hours of the days. Should this person refuse the treatment, the point is not that they are actively choosing death, but that they are choosing a shorter life that is free from the debilitating heartache of the harsh treatment.

Modern medical technology has certainly not eliminated death, but has delayed it in ways that keeps people alive in conditions that previous generations would have never thought imaginable. I believe a Christian moral ethic must avoid two things – first, we must avoid the idea that we can terminate life at will whenever it seems burdensome to us, and second, that we must avoid the idea that life should always be extended as long as possible.

Every family who must make these kinds of decisions will not have the luxury of plugging in some data into an ethical formula to receive a printed conclusion of what to do. These decisions take godly wisdom, prayer, and much conversation. But dear friends, be careful not to slip into the mistake of placing worldly values and ideas as the basis of your decision. These are wholly Christ-centered decisions that might look very different from a gospel approach than from a worldly approach.

How can the church help?
First, the church can help with these decisions by preparing one another to die in the confidence of Christ. This means preaching and teaching the gospel as the central purpose of our lives – to transform lives in Jesus. One of the great realities of the apostles and the great martyrs of our faith is that they had an unshakable belief in the gospel of Christ whereby their death, even in agony, was not something to fear but rather something to usher them into the sweet promise and embrace of God.

Second, the church can help by promoting service to Christ and to others, rather than ourselves. The time will come for so many of us when we will have to make critical decisions about the treatment of a family member or loved on. As I mentioned earlier, there are no easy formulas we can rely on. It takes prayerful conversation and wisdom, and sometimes there might not be a right or wrong answer. But when the time comes to begin making those decisions, the teaching of the church should play a vital role. We must be careful to not make decisions for our family members and loved ones based on what we most want to see happen, or for selfish reasons. In other words, if the time is right for a person to go be with the Lord, but we are not ready to have them depart us, we must think of others first.

Third, the church can help by carrying one another’s burdens. This means thinking of our church family in terms of people over programs. You don’t program burden carrying. We don’t set up a 6 week class or a summer event in order to suffer with one another. Bearing one another’s burdens takes an attitude of sacrifice and intentionality, to model the life of our Lord Jesus, and to let one another into our lives. Bearing one another’s burdens means to live as the church in such a way that we know we are never alone, not only do we have Christ has our great high priest, but we have one another. We have one another.

Fourth, the church can remember the power of prayer. Prayer changes hearts and lives. Prayer matters.