With medical advances, people are living longer than ever before, and in many cases, with a higher quality of life for much of that time. Despite the potential of a long, healthy life, however, many individuals find themselves facing end-of-life issues they never anticipated. And to Christians, those decisions may be especially difficult. In My Hope Is Built . . . Christian Perspectives on Decisions at the End of Life, author F. Walton Avery examines critical writings about available options for those facing end-of-life decisions for themselves or for someone they love. He looks at Christian responses to vital questions that come at the end of life. Avery looks closely at whether the prohibition against suicide or assisted death can be suspended and, in the name of Christian faith, the suffering individual be permitted to commit suicide or be party to assisted death. Regardless of circumstances, making end-of-life decisions are likely to be difficult. My Hope Is Built . . . Christian Perspectives on Decisions at the End of Life can help one make those decisions in light of their Christian beliefs.

My Hope Is Built ...: Christian Perspectives on Decisions at the End of Life

By F. Walton Avery

iUniverse, Inc.

Copyright © 2011 F. Walton Avery, MD, MTS
All right reserved.
ISBN: 978-1-4620-6413-7

Contents

Prologue............................................................................................xiAcknowledgments.....................................................................................xixIntroduction: How Christians May Respond to Suffering and Breakdown of Contents.....................11. Christian Social Ethics..........................................................................71.1. The Politics of Jesus: Nonviolence as Normative................................................71.2. The Gospel, Strictly Applied...................................................................142. Ethics for Care at the End of Life...............................................................172.1. (Only) Care for the Dying......................................................................172.2. Theological Basis for (Only) Care for the Dying................................................233. Historical Perspectives on Assisted Death........................................................253.1. Janet Adkins: Dying Before Her Time............................................................253.2. From Ancient Greece to Joseph Fletcher.........................................................284. Justification for Unassisted Suicide or Assisted Death...........................................334.1. Suspension of the Ethical Norm.................................................................334.2. Ultima Ratio: The Exceptional Case for Unassisted Suicide......................................384.3. Christians at the Frontier of Life and in Harm's Way...........................................475. Other Voices: The Essential Features of Terminal Care............................................526. Other Voices: Medical Advances in "Last Resort" Options..........................................567. When Death is Near, Does Hope Abide?.............................................................658. Conclusion: Answers to the Question Raised.......................................................699. Epilogue.........................................................................................73Bibliography........................................................................................75Glossary............................................................................................83

Chapter One

CHRISTIAN SOCIAL ETHICS

1.1. THE POLITICS OF JESUS: NONVIOLENCE AS NORMATIVE

This subsection, a synopsis of John Howard Yoder's The Politics of Jesus, requires attention to the biblical underpinnings of Yoder's claim that the witness of Jesus Christ represents the standard for Christian social ethics. Up until 1972, few theologians or biblical scholars dared to suggest that: (1) "Jesus was ... a social critic and an agitator ..." and (2) "Jesus ... (was) not only relevant but also normative for a contemporary Christian social ethic." But in that year, Yoder published his seminal work and made these two observations. He further explains: "I shall, in other words, be testing the hypothesis that runs counter to the prevalent assumptions: the hypothesis that the ministry and the claims of Jesus are best understood as presenting to men (sic) not the avoidance of political options, but one particular social-political-ethical option."

In an analysis of the life and work of Jesus Christ in the gospel of Luke, Yoder asks one simple question, "Is there a social ethic in this gospel that would be relevant and normative for us today?" In other words, does the Gospel compel the church to be different socially, politically, and ethically? Yoder concedes that "If ... Jesus, whoever he was, is no model for ethics, it then becomes immaterial in the detail who he was and what he did."

To support his belief that Jesus is a model for moral inquiry, Yoder presents the following analysis of Luke's gospel: (1) After Mary's cousin, Elizabeth, delights in her expected birth of Jesus, Mary sings a canticle, the "Magnificate." It includes the incredible claim that, "he (the Almighty) has put down the mighty from their thrones and exalted those of low degree (1.52)." Based on these aorist verb tenses, this "eschatological reversal" is presented as an accomplished fact, having occurred in the past, but continuing into the future. Yoder comments on the latter sense of the canticle: "In the present testimony of the gospel we are being told that the one whose birth is now being announced is to be an agent of radical social change," and concludes, "... he comes to break the bondage of his people." Fred Craddock, a Lukan scholar, expands on Yoder's notion of radical social change:

"More is involved than the social message and ministry of Jesus in behalf of the oppressed and poor. That will follow, to be sure, but here we have a characteristic of the final judgment of God in which there is a complete reversal of fortunes: the powerful and the rich will exchange places with the powerless and poor."

Yoder's analysis of Luke continues: (2) After Jesus has been baptized and tested in the desert, he goes to the synagogue in Nazareth and stands and reads Isaiah 61:1-2:

"The spirit of the Lord is on me, for he has anointed me to bring the good news to the afflicted. He has sent me to proclaim liberty to captives, sight to the blind, to let the oppressed go free, to proclaim a year of favor from the Lord (Luke 4: 18-19)."

Yoder's interpretation of this passage is one of social revolution, "... the passage from Isaiah 61 which Jesus turns on himself is not only a most explicitly messianic one: it is one which states the messianic expectation in the most expressly social terms." This passage refers specifically to Jesus' reversing the oppression of God's people with the restructuring of their community. He anticipates the coming kingdom, interpreting his role as the Messiah to be one of intervention and renewal for the people of God. Furthermore, this proclaimed, "New Age," is to include the Gentiles as well as the Jews. Thus, it became an all-inclusive movement that filled the scribes and elders "with rage (4:28)."

Furthermore, (3) Jesus began to teach on the Sabbath (4:31), heal the sick and lame (4:39, 5:24), forgive sins (5:20), and consort with "undesirables" (5:27). He further compounds his problems by selecting from among his associates twelve men to be his disciples (6:12-16). At that point Jesus had become a formal movement and thus a political threat not only to the Jewish establishment, but the Roman as well. "New teachings," Yoder writes, "are no threat, as long as the teacher stands alone; a movement, extending his personality in both time and space, presenting an alternative to the structures that were there before, challenges the system as no mere words ever could."

A critical turn of events occurs in Chapter Nine, when, (4) after the feeding of the five thousand and the confession of Peter that you are "The Christ of God (9:20)," Jesus announces that "The Son of Man must suffer ... be rejected ... be killed, and on the third day be raised (v.22)." From then on Jesus, "... set his face to go to Jerusalem (v.51)." The crowds began to reject him, because he had become so "hardened" and determined to meet his fate there (v.53).

Thus it is clear to Yoder that Jesus exhibited such human traits as "pride" and was tempted at nearly every turn. But here is the crux of the matter for Yoder and that which separates him from many of his contemporaries:

"The one temptation the man Jesus faced - and faced again and again - as a constitutive element of his public ministry, was the temptation to exercise social responsibility, in the interest of justified revolution, through the use of available violent methods. Social withdrawal was no temptation to him: that option (which most Christians take part of the time) was excluded at the outset. Any alliance with the Sadducean establishment in the exercise of conservative social responsibility (which most Christians choose the rest of the time) was likewise excluded at the outset."

In the critical chapter, "Trail Balance," (5) Yoder asks the question whether in the story so far has this man Jesus, who did not yield to the temptation of violence, been proven to be authoritative for the church today. If, then, it has been demonstrated that the historical Jesus remains relevant today and the church follows him as the Christ of Faith, what does that have to say to the church about how it relates to the world? To capsule the answer, "The church accepted as a gift the fact that she was a `new humanity' created by the cross and not by the sword." Thus, this represents an ethic of social responsibility that is epitomized by the authority of the state (Rom.12-13), and the Sermon on the Mount (Mt.5-7). Yoder's analysis of these passages, particularly Romans, challenges Christians "... to be nonresistant in all their relationships, including the social." He continues:

"They both (scriptures) call on the disciples of Jesus to renounce participation in the interplay of egoisms which the world calls 'vengeance' or 'justice.' They both call Christians to respect and be subject to the historical process in which the sword continues to be wielded and to bring about a kind of order under fire, but not to perceive in the wielding of the sword their own reconciling ministry."

Richard B. Hays, a Christian theologian, a New Testament scholar and current Dean of the Duke Divinity School, puts this idea of Yoder's more succinctly, "To bear the cross as Jesus' follower is to join the community of those who share his refusal of violence as an instrument of the will of God." Demonstrating further support for Yoder's position, Hays concludes from an analysis of Matthew (5:38-48) that " ... the church's embodiment of nonviolence is—according to the Sermon on the Mount—its indispensable witness to the Gospel." Furthermore, from a review of the Pauline literature the same author writes, "There is not a syllable in the Pauline letters that can be cited in support of Christians employing violence." Hays summarizes his research on this subject of nonviolence in the New Testament, "Thus, from Matthew to Revelation we find a consistent witness against violence and a calling to the community to follow the example of Jesus in accepting suffering rather than inflicting it."

Another witness to the essential nature of nonviolence to the Gospel is Stanley Hauerwas, a Christian theologian and ethicist, who notes: "... the centrality of nonviolence as the hallmark of the Christian moral life" and that " ... indeed, nonviolence is not just one implication among others that can be drawn from our Christian beliefs; it is at the very heart of our understanding of God."

John Howard Yoder concludes his book with a capsule of what constitutes Christian social ethics:

"A social style characterized by the creation of a new community and the rejection of violence of any kind is the theme of New Testament proclamation from beginning to end, from right to left. The cross of Christ is the model of Christian social efficacy, the power of God for those who believe."

* * *

In summary, the Christian operates under specific rules of ethical or moral conduct exemplified by the life, death and resurrection of Jesus Christ. The cross of Christ, as understood by Yoder's work, requires a resounding "no" to social issues such as US and AD that violate the sixth commandment. Thus Christian ethics reflects a way of communal life that is authoritative for the one who confesses that Jesus Christ is Lord. Thus, for such a person, there is no more serious issue to face than the act of US or AD performed because of suffering at the end of life. In most circumstances the usual moral proscription against such violence holds sway and suicide or euthanasia does not come up in discussions concerning the fate of the dying patient. For the Christian this proscription, as Yoder shows, results from the authority of scripture, the biblical law, and the life and teachings of Jesus Christ.

Yoder's work cannot be brushed aside as the narrow opinion of a Mennonite sectarian theologian. His body of work bears witness to a consistent pattern of thought that stresses the apostolic witness of this man Jesus—inaugurating a new humanity, a new community and a new world. Yoder himself, respecting the tradition of the church and the importance of reason and experience, nevertheless resolves that the scriptures, rightly interpreted, are authoritative. He describes his approach thusly, "The convictions argued here do not admit to being categorized as a sectarian oddity or prophetic exception. Their appeal is to classical catholic Christian convictions properly understood."

These beliefs, then, call the confessing Christian to confirm and practice nonviolence; therefore, those who recognize and follow the primary apostolic witness of Jesus Christ would not consider, let alone practice, suicide or any form of assisted death.

1.2. THE GOSPEL, STRICTLY APPLIED

One can think of many Christians, some of them martyrs, who followed in the steps of Jesus, exhibiting his social ethic and his practice of nonviolence. One such martyr is the apostle Paul, who wrote to the Roman church, "If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord's (Rom. 14:8)." Thus, Paul makes no spiritual distinction between life and death; for, if we are Christ's, our life is holy and at our dying we joyfully await the resurrection of our spiritual bodies (2Cor. 4:14). Furthermore, Paul, reminds the Corinthians:

"Though our outer nature is wasting away, our inner nature is being renewed every day. For this slight momentary affliction is preparing for us an eternal weight of glory beyond all comparison, because we look not to the things that are seen but to the things that are unseen; for the things that are seen are transient, but the things that are unseen are eternal (4:16b-18)."

In other words, we are destined to die a physical death, our mortal flesh will rot away, but the believer's inner being, constantly being made anew, belongs to the heavenly Father through Christ Jesus.

Another such witness for the strict application of the Gospel to life and death was Thomas A' Kempis, an "inmate" in the convent of Mount St. Agnus near Cologne, West Germany, who wrote the The Imitation of Christ. Following the words of Jesus recorded in the gospel of John , "I am the light of the world; anyone who follows me will not be walking in the dark but will have the light of Life (8:12)," Thomas said: "let therefore our chiefest endeavor be to meditate upon the life of Jesus Christ." From this perspective Thomas moved to a reflection on life and death, "Labor now to live so, that at the hour of death thou mayest rather rejoice than fear." Following Jesus and walking in the light, we, by his example, live and die in joy.

A. K. Grieb, discussing the identity of Jesus in the book of Hebrews, concludes that "The use of imitatio Christi as a warrant for social ethics is pervasive within the New Testament." So, if confessing and imitating Christians have the "light of life," death casts no shadow over their lives.

A third example of a Christian martyr—who witnessed to the strict application of the Gospel message—is reflected in the life, imprisonment, and death of Dietrich Bonhoeffer. This German pastor and theologian chafed under the reign of Adolph Hitler. Bonhoeffer left Germany at one point, but, because of an intense sense of loyalty and compassion towards the Confessing Church and the people of Germany, returned to his homeland and joined the conspiracy to kill Hitler. He was executed as a spy and traitor about the time the war was drawing to a close. It has to be said that Bonhoeffer remains a controversial figure, because his part in the conspiracy to kill Hitler contradicted his stance of nonviolence.

Based strictly on the example of Dietrich Bonhoeffer, the reflections of Thomas A' Kempis and the writings of the apostle Paul, the Christian cannot abandon the hope for eternal life and intervene in the natural dying process. Furthermore, we will see that there are rules of care, aligned with these observations, that may reverse an unwarranted fear of death and/or quell any consideration of suicide or AD. To put it another way: many have observed that there is a direct correlation between Gospel-based care at the end of life and overcoming the fear of dying.

Chapter Two

ETHICS FOR CARE AT THE END OF LIFE

2.1. ONLY CARE FOR THE DYING

Briefly, we turn aside to make a distinction between terminal care for the patient at the end of life and care for the patient whose condition is irreversibly extremely poor, but not by the generally accepted term, "terminal." In the world of medicine, then, patients lose one or more of the usual signs of vitality, such as consciousness. (The issue of purposely induced terminal sedation to unconsciousness is dealt with in Chapter Six.) Doctors, philosophers, and even theologians may state that these patients' lives are "diminished." What does this mean? Based on the dictionary definition of "diminished," these writers have concluded that these patients' illnesses have somehow "reduced their lives," have made them seem "less than they were," or have made them seem "less important." If life is considered an absolute value, how can it ever be "less" than it was. Thus, the use of the word, diminishment, is unfortunate, misleading and controversial. As it relates to terminal or comfort care, it is also incomplete, because it does not indicate whether or not the changes in vitality are temporary or permanent. Temporary loss of consciousness is reversible and potentially responsive to therapy. Permanent loss of consciousness, as in persistent vegetative state, is irreversible and unresponsive to therapy that would improve the current state. That argument, making a distinction between permanent and temporary consciousness, carries great weight with doctors and other caregivers. It, however, may not carry any weight with these patients' families who may reject the concept of diminishment altogether. These "vitalists" see only the distinction between life and death and nothing in between. They see breathing and heart function as evidence of life, a life which can not be taken away—only God can do that.

(Continues...)

Excerpted from My Hope Is Built ...: Christian Perspectives on Decisions at the End of Lifeby F. Walton Avery Copyright © 2011 by F. Walton Avery, MD, MTS. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.