Herman C. Hanko is professor of Church History and New Testament in the Protestant Reformed Seminary.

Dying was once, from a certain point of view, a rather simple matter. A person grew up, took up his life’s work, worked hard (usually without vacation) until he was in his sixties or seventies, and after his “threescore and ten years” or “fourscore years if strength was great,” he died. He never thought of retirement, social security, pension plans, spending his “golden years” profitably. He lived and worked—and went to his eternal reward.

As is true of so many things in life, modern technology and social “advances” have changed all that. Not only is it now true that most people work only till they retire at 62 or 65 years old, but they can usually look forward to many years of retirement in which they enjoy the fruits of their years of labor, or are in a position to change their vocations to something less strenuous and demanding. This part of life is not, however, what is of particular interest to us in this (and a few succeeding) articles.

Modern advances in the field of medicine have extended one’s life expectancy to beyond “threescore years and ten.” In countries where medical technology is readily available, people can, generally speaking, expect to live into their eighties and even nineties. Life has been extended greatly because of modern medicine—which includes both the treatment of disease and the use of mechanical devices which take over the work of or assist in the work which was done by the organs of the body. When these organs can no longer perform their work, mechanical devices can be used.

While this has indeed made life more enjoyable for countless people, it has also created innumerable problems. Life is indeed extended beyond what it once was, but rest homes and nursing homes are almost beyond counting and are filled with people who seemingly merely exist without clearly-functioning minds, without purpose in life, without the normal varieties with which life is filled and which so often make life bearable. Their life is a mindless and totally boring routine of endless days and idle hours in which the only event to look forward to is the next meal served in the dining room. Modern medicine and surgery and modern medical technology keeps them alive. Even thirty or forty years ago they would have long since died. But it is not exactly with this problem either that we are concerned.

Many of these people are kept alive through mechanical devices which have been developed in the field of medical research. In many cases this is a great boon. One need only think of the person whose life has been prolonged by a. pacemaker; by a person suffering from kidney failure whose life continues because of regular dialysis; by gravely ill people who have been given an opportunity to recover because ‘of a respirator which breathed for them when they could not breathe on their own. In many other cases, this has been a great problem and has created dilemmas in medical ethics and problems in the field of medicine, which are only now being resolved (for better or for worse) in bitter legal battles and in far-reaching court cases and decisions.

We are all acquainted with these problems, and many of those who read this article have come face to face with them in concrete situations in life. They are problems which are mostly (though not entirely) faced at the beginning of life and at the end. At the beginning of life, God sometimes ordains that a child is born with many serious defects which make it necessary for that child to be on life-support systems to continue life. Perhaps these are temporary, and a period of time (in an incubator, e.g.,) is enough to carry a baby through critical days until it can live on its own. Perhaps they are permanent; i.e., perhaps such a child can never live without life support equipment, so that if such machines are used, the child will have to spend all its years in this world attached to them. It is then that the question arises: Ought a child to be “hooked up” to such equipment? And if he is, ought he to be left to remain on that equipment, or does a time come when he is taken off and allowed to die?

It is possible, of course, that one can also find himself in such a situation at any time in his life. A person may, in the providence of God, be involved in a serious automobile accident in which he suffers severe brain damage, and enters the emergency room of the hospital in a deep coma. The only way his life can be preserved is to put him on mechanical devices which have been invented to breathe for him and to keep his heart beating. Ought he to be put on such devices? And if he is, ought he to remain on them even though the coma persists, not days or weeks, but months and years? Or ought he to be put on them in the first place when the doctors know beyond doubt that, though the time will come when he can be taken off these machines, his mind has been so destroyed that he will be a vegetable the rest of his earthly life?

But near the end of life the problem becomes yet more acute. As people age, their bodies begin to break down, and they are subject to massive heart attacks or strokes, and can be kept alive only through various life support systems. If these life support systems are used only to bring a person through a critical period, and a person can expect to recover and resume a relatively normal life, the problem is not so serious. But if he must remain on such support systems to stay alive, ought he to be put on them to begin with? And once. having been put on them, ought he to continue on them, even if his life continues for months and years? Or does a time come when one “pulls the plug?” Or perhaps one need not remain on such a machine, but having recovered sufficiently to be taken off the machine, his life is so limited and so circumscribed that he is very literally an invalid who can expect to spend the remaining years of his life completely dependent on others.

There are those who suffer debilitating diseases such as cancer which, they are assured by their doctors, can only end in death. The disease is terminal. The life expectancy of such people is, say, six months to a year. However, if they are willing to undergo extensive treatment such as chemotherapy (involving a great deal of discomfort and distress) their lives will be extended to three to five years—although their last months may be filled with far more suffering because their bodies literally waste away as they are consumed by the cancer. Ought they to forego the treatment and die within months? Do they have a solemn obligation before God to make use of what means are available to prolong their life? Or do they do no wrong before Gods eyes if they tell the doctors: No treatment, please. Let me go home and die in the midst of my family.

These are the problems and questions which modern medicine has brought before us. There are many who, in the light of all this, speak of the fact that a person has indeed the right to live; but he also has the right to die. At such a time as he thinks life is no longer worth its while, he ought to be given this right, and no law of the land ought to be allowed to interfere. Not only that, but someone, somewhere, somehow has to be able to decide when a person ought to be taken off life-support machinery and allowed to die in peace.

This is called euthanasia.

John Jefferson Davis, in his book, Evangelical Ethics, has a good statement of the problem. He writes:

The moral issues surrounding death and dying pertain to the very old, as well as the very young. Advances in medical technology that allow the sustaining of biological life in terminal cases also bring in their wake ethical dilemmas that were not so acute in an earlier age. The very definition of death has been a matter of moral and medical dispute. Fears of prolonged over treatment have raised the public’s interest in the so-called “living will.” Some have proposed voluntary euthanasia as a legal and moral option for the terminally ill, thereby raising a host of complex issues for society, the medical profession, and for the dying individual and his family. 

At the beginning of the twentieth century, two-thirds of the people in; the United States died before the age of 50, and most died at home in their ‘beds, in the presence of family and friends. Today most deaths occur in an older population, and two-thirds die in medical institutions and nursing homes. In a changing demographic situation, with the American population having an increasing percentage of elderly people, the ethical dilemmas surrounding death in institutional settings will become more rather than less acute. 

In 1929 the United States spent 3.5 percent of its gross national product on medical care; by 1982, the figure had increased to 10.3 percent. The public’s seemingly insatiable demand for health care, including highly expensive forms of therapy such as cardiac transplantations and kidney dialysis, make the issues of the “rationing of life and death” more than purely academic and speculative concerns. Pressing issues of death and dying will inescapably face Americans for the rest of the foreseeable future (p. 174).

It is this problem which we face in today’s society. It is not an abstract problem which can be discussed from the vantage point of one’s ivory tower as he surveys life from above, but remains untouched by it. It is a problem which every person has faced, faces at the moment, or is going to face at some time soon. If he does not have this problem put before him by the debilitating illness of a member of his family, he realizes that he himself will soon be old, subject to disease, placed in a position where life-support equipment may be needed to keep him alive, and thus confronted with the difficult decision of what to do. Ought he to make provision for this? Ought he to leave directions concerning his wishes while he is still mentally competent—lest the time come when he cannot make the decision himself and someone makes it for him?

It is this area that we wish to explore in’ a few future articles.