How should a Christian view euthanasia or the Advance Medical Directive (AMD)? How should I respond if my father (who is an unbeliever) ask my opinion?


Let me begin my answer by stating that, in my mind, the AMD is quite different from euthanasia. Euthanasia, or mercy killing, involves actively terminating the life of a person who may be suffering pain for some reasons. I believe that euthanasia is always wrong as it involves the breaking of the Sixth Commandment.

The AMD (at least in Singapore), on the other hand, involves a person, who is still thinking rationally, giving advance directives to any doctor treating him to desist from using extraordinary life-sustaining treatment or equipment in case he becomes terminally ill and unconscious with no reasonable prospect of temporary or permanent recovery in the opinion of a panel of doctors (seehttp://www.gov.sg/moh/amd/).

How should Christians view the AMD? Before I state what I think, I must say that I am not about to give an official view of the church (we do not have any), and also that I may be holding a minority opinion in so far as the pastors in Singapore are concerned. So I would urge you to test what I have to say against the Scripture and against your conscience, and to reject it if you think it is unsound.

I share the view with Dr. R.C. Sproul, expressed in his book Now, That is a Good Question! (Baker, 1996), from which the title of this column was taken (though our answers are original), that it is not unethical to use an AMD. This is what he says:

Moses asked to die; Job asked to die; Jeremiah asked to die. And today many people ask to die. The pattern in Scripture seems to teach that we are not allowed to actively engage in the destruction of human life, even to put some one out of his or her misery. We do make distinctions between active and passive euthanasia. Is it possible to allow people to die naturally, to die with dignity? This question really requires a much more lengthy and detailed statement, but I would say that there are times when it is permissible to allow people to die—to forgo further treatment, for instance, or elect not to be kept alive artificially (op. cit., 457).

My own conviction on this matter, however, came through a study of Philippians 1:22–24, where the Apostle Paul says:

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.

Here we see the Apostle, expressing a tension within his heart as to what he prefers: whether to depart to be with Christ or to remain in the flesh. On the surface, it may appear that Paul is merely making known a tussle in his mind, which even if it is resolved in his mind, has no real consequence as to the outcome of his trial: whether he would live on or depart to be with the Lord.

However, we must notice two things: firstly, we should note that Paul’s choice or preference is based not on whim or fancy, but on sound reasoning, which involves an assessment of his usefulness if he remains alive. Secondly, we should note that this preference may easily translate to actual volitional choices during his trial, which may determine whether he lives or dies. This is perhaps why Paul uses the future (or more precisely, future middle, indicating a reflexive act) tense when talking about his dilemma. Indeed, the word translated “choose” (Greek: haireô) can hardly be translated as “prefer” (as in a mental notion) in the context. Not only does “I shall prefer” not make sense, but the other two occurrences of the same verb in the New Testament (2 Thes 2:13; Heb 11:25) are clearly indicative of active choice rather than passive preferment.

Putting these two thoughts together, and affirming that Paul acts infallibly here, we must conclude, firstly, that it is not wrong for a Christian, under certain circumstances, to choose death; and secondly, that our choice must be made not merely on the basis of pain and suffering, but on our usefulness for Christ’s sake.

Or, to put it more precisely, I see that it is not wrong for a believersuffering terminal illness, and knowing that his life’s work for the Lord is done, to refuse further medical treatment. The Apostle’s example, it appears to me, teaches us a principle of choice concerning life and death in which we may choose death if we are fairly sure that our work for the Lord in this world is complete; as, for example, if our mental faculties have failed, and when we are being supported on a artificial life support system with no reasonable prospect of recovery.

I know that there are always contrary examples, where persons who have been regarded as having no hope for recovery by the doctors, suddenly revive. I believe that God can work miracles if He chooses to. But I believe that the principle of biblical decision-making requires us to take into consideration the future only if we have reasonable confidence that something will happen. Death is appointed of God, and so if all the signs of providence indicate that God is calling us home, we must cheerfully summit to His will. We must neither choose death indiscriminately, nor resist death faithlessly.

Based on these considerations, it is my personal conclusion, that it is not wrong for a believer to sign the AMD, especially when he is already fairly advanced in years.

But note carefully my qualification that the choice is meaningful only to believers. Why? Because when a believer chooses death, he goes to be with the Lord, but if an unbeliever chooses death, he chooses to cut off all opportunities of faith and so he chooses sure damnation.

I trust I have answered the first part of your question sufficiently, for you to make an informed answer for the second part.