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

In our last article we talked about the great evils of euthanasia as it is increasingly being practiced in this country and abroad. In this article we want to attempt to see some light in the many problems which nevertheless arise, and with which the child of God is confronted in various ways by this perplexing problem.

The problems really arise out of the advances of medical technology, which has made it possible to sustain or prolong life artificially. That is, various machines are now commonly used which can keep a person alive when, without them, he would die. Is the believer required, under all circumstances and in every situation, to make use of these machines? If not, when may he or she say no?

Before I get to some specific guidelines which I believe are important to consider, a few general remarks are not out of place.

In the first place, the problem is one which will soon solve itself, I think, for the people of God. I mean that we live increasingly near the end of the ages. Christ gives many and clear signs that history, according to the purpose of God, is coming to its conclusion. Scripture tells us that before the Lord returns, Antichrist will reign, and during his reign the one who does not have the mark of the beast will be able neither to buy nor sell. Quite obviously, one who is faithful to his Lord and will not worship the beast will also be cut off from all medical care. He will not have to face the problem of whether or not to be put on a life-support system. Those days may not be so very far distant. Already it is true that not all medical treatment is available to everyone, simply because of the staggering costs which are involved, and the inability of some to pay these costs—especially if they have no medical insurance.

It is well to remember also in this connection that the costs of some medical treatment lie even beyond the resources of the church through her diaconate. If such is indeed the case, it is clear that God has, in His own wisdom, made treatment impossible; and in that too we must be content.

In the second place, in order to consider this whole question in the light of Scripture, it is important to keep Scripture’s teaching concerning living and dying before our minds. I fear sometimes that believers take the position that life in this world is so overwhelmingly precious that it must be preserved at all costs. This is surely true of wicked men. When I had opportunity to read what the newspapers said a while ago about a man who had a mechanical heart installed, I was struck by the great fear of death which clamps on the hearts of the wicked with a vise-like grip. They will, in many instances, do anything at all to avoid dying. But this is not true of the believer. Paul’s words to the Philippians are decisive here: “For to me to live is Christ, and to die is gain. But if I live in the flesh, this is the fruit of my labour: yet what I shall choose I wot not. For I am in a strait betwixt two, having a desire to depart, and to be with Christ; which is far better: nevertheless to abide in the flesh is more needful for you” (Philippians 1:21-24). The apostle preferred to die so that he could be with Christ. The one thing which kept him fastened somewhat to this earth was the need for him which the Philippians had: i.e., his work and calling which he had received of the Lord. And so, for him to live was Christ; but to die was gain. The one reason why we might want to stay in the world is our calling which God has given to us. But death has its attractions nonetheless, for that means to be with Christ. Thus, the motto of the Christian can never be: Life here at all costs.

In the third place, I am personally convinced that no rigid rules can be drawn up which every believer is in conscience bound to follow. God rarely treats us that way in any case. And that is surely not the way God works in this problem. I suppose, from a certain point of view, it might seem nice to have hard and fast rules which cover every situation in life and which we need only consult to know always what to do. But this is not really all that nice. And, anyway, being the ornery creatures that we are, we would break the rules at every opportunity. All this means that we are, in some respects, in the area of Christian liberty. It is an area in which the child of God must make decisions himself before God’s face and with good conscience. And those decisions have to be made on the basis of the broad principles of Scripture and the varied circumstances of life.

Having said these things, let us turn then to a few guidelines which we may safely follow.

In the first place, a child of God need not under all circumstances make use of every available treatment and every available life-support machine which medical science places at his disposal. It is true, of course, that all the advances in the field of medicine come about under the providence of God, and thus also for the sake of Gods people. They are means which God provides. It is also true that under normal circumstances we have the right not only to make use of these means which God provides, but also the obligation. A parent who will not bring his child to the doctor when the child is very ill does wrong. But it does not follow from this that the child of God isalways and under all circumstances obligated to make use of every treatment and every machine which science invents. An old man of ninety may decide in good conscience before God to forego chemo-therapy to treat a recently discovered cancer, even though treatment may, in the doctor’s opinion, stop the spread of and perhaps even eradicate the cancerous growth. Even a young man may decide to forego treatment of his disease if the doctors tell him that the treatment will be very painful, will perhaps not do any good, and if it should do any good, will only prolong his life for nine months. We are not obligated before God to make use always of every means available.

In the second place, some distinctions have to be made. Sometimes a distinction is made betweenactive and passive euthanasia. I think I mentioned this distinction in an earlier article, but to refresh our minds: active euthanasia means active killing—giving something to some one which will put that person to death. Passive euthanasia means. withholding from someone what he needs so that the ill person will die. The former is usually (though not always) condemned; the latter is approved. I personally do not care much for the distinction, and think it dangerous. After all, passive euthanasia can include withholding food and drink from a seriously and terminally ill patient. It can include putting such a helpless patient in a cold room without bedclothes (as has happened sometimes in hospitals). The distinction is one we ought not to use. Not to withhold from a person anything that person needs in the way of normal care and to make that person comfortable is always and under all circumstances our obligation. Anything else is also murder.

In the third place, the use of extensive treatment or unusual methods of prolonging life is to be decided on the basis of the circumstances under which a person finds himself. It ought to be obvious to all that a mother who has to have by-pass surgery which will correct a serious illness, but who can look forward to being helped by the surgery will be much more inclined to use a heart-lung machine and a respirator than an old man who has suffered a severe stroke and who can live in the future only on such equipment. In the former case such use of machinery is temporary; in the latter case, permanent—i.e., in the best judgment of the medical profession, recognizing all the while that doctors are also often wrong.

All the circumstances have to be taken into account. The station and calling in life in which God has placed someone; his obligations and responsibilities; his age and general health; the prognosis after treatment, etc., etc. God reveals His will in these matters only through life’s circumstances.

In the fourth place, generally speaking, unusual treatments and methods must be considered as good to use in the recovery from or control of disease, not necessarily in merely prolonging life. Of course, even here there are other factors that enter in which make this only a general rule. One who has a disease which is incurable, but who can live indefinitely through constant treatment (as, e.g., a diabetic) will surely make use of the means God provides. Even a person who has an incurable disease who will live two weeks without treatment, but two years with treatment, will give serious thought to making use of the means—especially if he or she is busy and active in a home. But mere prolongation of life under any circumstances and at any cost is surely not our calling before God.

In the fifth place, I am personally convinced that the final decision whether to have treatment, whether to make use of unusual methods of keeping one alive, is a decision which rests with the individual himself. He must make that decision for himself. He must answer before God for what he decides. And he is the only one who can weigh carefully all the considerations that finally make known to him what the will of God is.

This must not, however, be construed as if I favor so-called living wills. These are dangerous and ought not to be made. We cannot tell what God has in store for us in the future, nor how we will look at things in years to come. God reveals His will for us step by step in the pathway of life, and we must be content to be led by the hand of our heavenly Father, trusting that He will make clear to us His way for us in any given circumstances in which He is pleased to place us.

One might object that there are times when an individual cannot make such a decision himself. Perhaps he is in a car accident and is brought unconscious to the hospital. Perhaps he suffers a serious stroke and is unconscious. In these cases, it is usually possible and good that one very close to the person make the necessary decisions. A wife can make them for her husband, and a husband for his wife; parents can make them for their children, and children for their parents. But beyond this it is not good to go. If no one close is present to make the decision, then all must be done to care for the patient to the very best of the ability of those who are responsible. No one may lightly take another’s life in his hands and make decisions concerning that life.

Finally, there is always the problem of what to do when a person is on life-support machinery, but continues for days and weeks without any signs of life. May anyone, so to speak, order the plug to be pulled? There are problems here which are difficult to answer. One such problem is clearly: When is a person dead? Years ago doctors said a person was dead when his heart stopped beating. That is no longer true. Now doctors speak of “brain death;” i.e., the brain shows no more signs of activity of any kind. If a machine did not keep the heart beating and if a machine did not do the breathing for a person, he would no longer have a heart-beat and lung activity. Is the person dead? Has that person, if a child of God, gone to glory even while the machines keep up the work? I do not know. We stand before the mystery of death. Again, none but the very closest of relatives can make a decision in a case like this. No one else may presume to do so. And surely the rule applies: When in doubt, don’t.

It seems as if these perplexing problems are only going to increase as life goes on, as we near the end, and as medicine continues its rather spectacular and breath-taking advances. It is well for the believer to keep firmly in his heart the words of Paul: “For to me to live is Christ, and to die is gain.” If he does this, he will always make the right decision too, for he will make it before the face of God.