Diary of a Theologian

    The reports from Canada are particularly disturbing. “Medical Assistance in Dying” is the term used there—MAiD they call it—and in the few years since the Canadian supreme court found a fundamental right to demand medical assistance with one’s death, the numbers have ballooned. MAiD has become another treatment option that can be offered—and it is offered, according to reports, even without being requested. As in: You could have surgery (though it might take months before we can schedule you); we could request some home assistance (but ditto regarding the timeline); there are drugs that might alleviate your pain; and of course there’s MAiD.

    But Canada is unique only in the speed with which physician-assisted deaths have taken hold. The number of doctor-assisted suicides and the instances of doctor-administered deaths have increased in much of Europe, from the Low Countries to Scandinavia and Switzerland. Such practices are on the rise in the United States, too, where they are legal in more than twenty percent of our states. And in the U.K., legalization is on the march through Parliament even as I write.

    Euthanasia is the looming frontier. (For simplicity, I write “euthanasia” rather than “euthanasia and physician-assisted suicide,” since they are closely related and involve quite similar considerations.) What accounts for its growing acceptance? In an article in the Fall issue of National Affairs, Aaron Rothstein unpacks the “Origins of the Modern Euthanasia Movement.” He identifies several factors: diminished religious commitment; the conception of the patient as a consumer of medical services; thinking of people as minds that just happen to inhabit bodies (that therefore can do as they wish with their bodies); and the loss of the old wisdom contained in what was called “the art of dying.” These factors are deep-seated and commonly accepted in our culture. In most modern cultures, they are prevalent truisms. Religion is relatively unimportant. Autonomy is most important, and therefore medical practice should defer to the patient’s wishes. We humans are like software that happens to run on the hardware of our bodies. And—the art of dying? Who ever heard of that? (Sounds kind of gross.)

    I’ve written often, one way and another, about the middle two factors that Rothstein speaks of, autonomy and body-soul dualism. But I have written little about the decline of religion, and almost nothing about the arts of dying. Nonetheless, each of these factors is of pastoral importance, and it is incumbent upon serious pastors to address them as best they can.

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    The first story I recall hearing was told to me by an elegant senior woman. It was pre-Covid trip I took to New York City. This woman had had a friend of long-standing in California whom she had recently visited. Her visit turned out, unexpectedly, to be her last. Shortly after her return to New York, she learned that her friend had terminated her life with legally available medical assistance. It was something she had been secretly planning even during their visit. The woman spoke to me of her deep sadness, and also of her anger—not really against her now-deceased friend, but at the system which had facilitated her death. She felt cheated; she was angry that such a thing was legally possible. I had known for decades that anger is a typical reaction to the suicide of those who take their lives in the old-fashioned way, that is, without medical assistance. People left behind often feel cheated, betrayed, and diminished in importance. While they acknowledge that the person had been suffering, they nonetheless feel they should have had the chance to stick with their friend, to be present, to share somehow in the suffering of their friend.

    There is a feeling, in other words, that suffering is not the worst thing, a sense that suffering can be shared and it is meaningful to do so—that it is far worse to be abandoned, alone.

    This New York woman’s experience is increasingly common. People want to orchestrate their own deaths, to stage-manage their final good-byes. Such is, in effect, the desire to be self-created, to be master of our lives to the very end. And it is important for us to see that such thinking excludes from our consciousness a body of old wisdom that is now largely incomprehensible. Death just is a process of losing control over ourselves. And we used to have ways of incorporating that reality into our lives.

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    One value of a religious framework is that it aids in resistance. We should not kill ourselves because, fundamentally, we do not belong to ourselves but to God. Here are a few points from Christian thought on this through the ages. 

    Augustine stated that the commandment against killing means suicide is wrong. “Thou shalt not murder” includes “Thou shalt not kill thyself.”

    Aquinas unpacked this particular wrongness. It is, among other things, a violation of two basic relationships. First, as social animals we humans belong to one another (which is to say, autonomy cannot be the trump card). To be a social animal includes (the uncomfortable fact for moderns) that we do not belong to ourselves but to families, neighborhoods, cities, and so forth. Second and even more fundamentally, as creatures we belong to God who made us. The choice to end our lives deliberately is not a choice proper to a creature.

    With this in mind, Dante placed suicides in his Inferno.

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    But a rehearsal of catechetical truths, important as it is, only goes so far. Today, lost in the mix of thinking not only on euthanasia but also on the death that every one of us faces, are the practices that constitute “the art of dying.” We are mortal, and that means death is in the future for every one of us. The modern and highly medicalized world we live in has strained with almost herculean effort to hide this basic fact from us. And so we do not often experience the death of another person. Many people die in hospitals or other medicalized settings. Some people die as a (likely needless) final surgery is attempted. Most of us die without having any way to think with others about how it is appropriate to die. 

    This is not a good situation. The problem is not just that suicide is wrong, a bad death; the issue is not just that I should take care of my life because it is a gift of God’s; the truth at stake here is that the life God has given me is a mortal life, a life that includes death. Because my life is a mortal life I should learn how to die.

    I do not think I have ever preached a sermon or taught a class on how to die. Historically speaking, this is very strange. As Rothstein reminds us, victorious Roman generals were admonished to remember they were mortal. Death was understood as a universal destiny, and it was not denied and hidden away (even in moments of great triumph). People used to die with others around them. With their household or friends at their bedside, the dying might confess their sins—and they might offer hope and encouragement to those who would outlive them. Such are but a few of the elements of the art of dying that we have lost.

    The move toward legalization of euthanasia is, I think, a wake-up call to Christian communities. We need to recover the art of dying as an important part of living a human life. Here is a (very small) step that I have taken. I have told my family and friends that when I am dying, I would like the Psalms to be read to me (and I have specified the Book of Common Prayer translation, new or old, as something familiar to me). Dear reader, you are hereby put on notice: when it comes to my end, if you are there with me, please read aloud from the Psalms. 

    Let us encourage one another, not to try to control our deaths, but to admit that death will come upon us, to embrace the loss of control that dying means. Let us become students of the art of dying and embrace the old wisdom of honesty in the face of human mortality.

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    Out & About. This Sunday, Dec. 15, I am to preach at Good Shepherd Cedar Hill, just south of Dallas (at 8:15 and 10:30 a.m.).

    Again for your 2025 calendars: The next three “Good Books & Good Talk” seminars will be (each a Sunday at 5 p.m. at St. Matthew’s):

    Shakespeare’s “Hamlet” on January 26, 

    Bessie Head’s Where Rain Clouds Gather on February 23, and

    Parts of a World by A. G. Motjabai on March 23.