Christian Ethics on Death and Dying

October 18, 2016
Darrell L. Bock and Scott Rae

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Topic Time Codes

01:10
Rae’s work in Christian ethics
03:46
Discussing ethics from a wholistic study of the Bible
07:16
Can we agree on the common good?
10:26
Defining a principal-driven society
12:54
Three levels of the end-of-life conversation
18:14
If a patient could speak, would they want additional treatment?
20:12
Eternal fellowship with God as the highest good
22:55
Distinguishing termination of care from termination of treatment
25:26
Thinking theologically about physician assistant suicide
31:04
Legal opinions on end-of-life issues
32:00
Distinguishing euthanasia form physician assistant suicide
37:48
How much of economics are playing into this?
42:21
How should people think about euthanasia?

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Transcript

Dr. Darrell Bock
Welcome to The Table. We discuss issues of God and culture. I'm Darrell Bock, Executive Director for Cultural Engagement at The Hendricks Center at Dallas Theological Seminary, and our topic today is Christian ethics, particularly issues associated with death and dying, and my expert is a good friend of mine, Scott Rae, Dr. Scott Rae, who teaches out at Talbot Theological Seminary and is dean of faculty there. Have I sufficiently introduced you, Scott?
Dr. Scott B. Rae
That's good enough.
Dr. Darrell Bock
Okay. And a little disclaimer here at the start. Scott and I have known each other for a very, very long time. We grew up down the street from one another, known each other since we were five years old. We're literally childhood friends who know far more about each other than we ought to, but Scott has developed his expertise, particularly in the area of Christian ethics, and has written a book that's just come out called Introducing Christian Ethics, one of several that he's written on moral choices. In fact, the subtitle of this is A Short Guide to Making Moral Choices. So Scott, why don't you tell everybody how you got into the field of Christian ethics.
Dr. Scott B. Rae
Well, I started more in the sort of the traditional seminary route and went, did Old Testament and then transitioned into Ethics, and I remember speaking to a provost at another university, and he asked me how did you get from Old Testament into Ethics, and I looked at him straight forwardly and said I read the text. I took the Old Testament text seriously. I don't think you can read the Scriptures very long without having an interest in Ethics, what Roman Catholics call Moral Theology.

What I wanted to do – what I was most interested in is doing some field where I could connect my background in Bible and theology to issues that people actually cared about and were reading in the front page of the newspaper. Because what I found was that people who were really good in biblical studies and theology were not so good on the issues of the day and vice versa. The people who were good on the issues, if they even cared about biblical studies and theology, tended to play it fast and loose with the Scripture. So I wanted to try and do both of those well and bring those together and speak to issues that I still think desperately needed coherent, biblically-based, theologically sound position.
Dr. Darrell Bock
Yeah. We talk about it here this way. We say that seminaries do a pretty good job generally speaking of trying to train people to go from the Bible to life, but when you switch it and go from life back to the Bible, that's a little harder move. It's a little more difficult move, complicated move, and as a result, people tend not to do that as well and seminaries don't do quite as good a job at training people to go in that direction as they ought to.
Dr. Scott B. Rae
Well, sort of – I mean I agree. It's too bad that that's a shortcoming because as you and I have talked about, that's actually the way the Bible tends to approach it.
Dr. Darrell Bock
Exactly right.
Dr. Scott B. Rae
Starting from life and then going back to what's necessary and to be well-grounded biblically and theologically.
Dr. Darrell Bock
And of course what makes that challenging is that when you move from life back to the Bible, and let's stay and talk about a little method here before we get into the specific topic. But when you move from life to the Bible, you have to deal with the whole of the Bible in many ways as opposed to this passage or that passage, and it's too easy in discussing ethics in the Bible to cherry pick from passages rather than being holistic in how you put that package together. Is it a fair summary?
Dr. Scott B. Rae
I think that is a fair summary. And where I think we really benefit from seeing the whole picture is if we can give people the full four chapter, what I call the four-chapter view of biblical history where we go – we're good at giving them fall and redemption but not so much at creation and consolation.
Dr. Darrell Bock
Go ahead. I'm sorry.
Dr. Scott B. Rae
The bookends are the part that I think are missing from a lot of theological education.
Dr. Darrell Bock
Yeah. We talk about this in relationship to the gospel all the time, that the gospel doesn't start in Genesis 3. It starts in Genesis 1. We're made for relationship with God. We're made in the image of God. We're made to be connected to God, and when we start with the fall and we forget that starting point, we forget God's commitment to be related to us or we risk forgetting God's commitment to be related to us from the very beginning. And the consummation of course takes you back to that starting point so that it wraps the story of the tensions the fall introduces around a prequel, if you will, that says God made us to be good creatures who are to be connected to Him.
Dr. Scott B. Rae
Right. And that's why we would suggest that our salvation is for the life of the world, not just for our own personal eternal life.
Dr. Darrell Bock
That's right.
Dr. Scott B. Rae
That's why I think the bookends give us that's so important.
Dr. Darrell Bock
So we push towards a set of values that push in the direction of seeking common good in the best sense of that phrase and seeking human flourishing in the best sense of that phrase, and we are also taught to think beyond ourselves and beyond our own individual lives to what's going on with people around us and the creation around us, et cetera.
Dr. Scott B. Rae
I put it in terms of how Jeremiah spoke to the exiles. Even though Israel is in exile in Babylon, they were still commanded to seek the welfare of the city that they were in, seek the welfare of the common good. And I think in our culture today with the church, I think more resembling being in exile today than it has at any other time in my lifetime. I think that's still good advice from Jeremiah.
Dr. Darrell Bock
The other image that I often put forward as we're thinking about this is we're called to be ambassadors for Christ. We are representatives of the kingdom of heaven in such a way that how we interact, even how we engage with conflict and tension is to reflect the way in which God has done it, and God takes the initiative of stepping into that tension through the incarnation with Christ and to show how he is taking the initiative and try and defuse situation as opposed to contribute to the tension.
Dr. Scott B. Rae
Well, I think that's why this material on the end of life matters so much. Not just because it's the doorstep to eternity, but because the body matters. If the incarnation tells us anything is that the body counts and it counts for eternity. And that's why I think it's so important that we get this right about how to care for people at the end of life.
Dr. Darrell Bock
One more question before we transition to that discussion specifically, and that's this. As we think about – sometimes the question gets asked this way: how can we talk about the common good when we hold so little in common we can't agree on what's good. How do you that in a world where there's so many different ideas out there about what the common good is? So how do you build those bridges?
Dr. Scott B. Rae
Can we take the rest of the time on that?
Dr. Darrell Bock
[Laughs].
Dr. Scott B. Rae
But I guess I'd quibble with the premise a bit on this because I think sometimes when we acknowledge the moral diversity, culturally we forget about all the areas in which there is moral common ground. I think if we had as much moral diversity as we sometimes think we do, our culture, we wouldn't be able to survive on a day-to-day basis. But the very fact that we get meaningful communication, that we have mostly trustworthy market-based transactions, that we drive our cars at 60 to 70 miles an hour without killing or maiming each other on a daily basis, and a number of other things, suggests that there's actually I think a little deeper reservoir of shared values than we want to admit.

And I want to be careful too to distinguish between disagreement in terms of values and a difference in application because I think there are values that are widely shared, but the application of those can look pretty different in different cultures. And I'm not sure I'd call that an example of moral diversity. I'd call that an example of — I think it's applicational diversity, but I think we probably have a little more in common than we give ourselves credit for. And in some parts of the world, that may be less true than others.
Dr. Darrell Bock
It's interesting because I do think that you're right, that if you ask what motivates people to act as they do – actually the way I describe this is that there are tensions that you've got competing biblical values sometimes because we live in a fallen world that come against one another, and what people are debating is not this tension or that tension, but how to balance those two in relationship to each other a lot of times.
Dr. Scott B. Rae
That's a good observation. We tell this to our business students all the time. We say in a fallen world, don't be surprised that you have genuine moral conflicts. A moral conflict is when biblical values come into conflict. And I don't think – in fact, I'm surprised when it doesn't happen more often. And so the debate is often over how you weight competing values and for what reasons and trusting more than just your gut or your intuition to do that.
Dr. Darrell Bock
And the hard thing here is that what tends to happen and our rhetoric that gets in the way is that people will pick – they'll what I'll call cherry pick – those values and land on one almost at the expense of the other and in the process cut off the conversation that needs to be had about how balance the things that are in tension.
Dr. Scott B. Rae
That's right. That's right. This is why we say, for the most part, even though the way we view morality in general is predominantly through a blend of virtues and principles. We would call ourselves a prima facie absolutist or prima facie principle-driven, and that's Latin for first face, first glance, which suggests that the things that we consider moral absolutes are generally absolute but calling them prima facie leaves room for there to be exceptions to those when they come into conflict with other competing values.

Now for example, we say truth telling is a prima facie moral value, but if somebody comes knocking on the door for The Table podcast and says where is the host, pointing a loaded gun, I hope that your staff person is going to tell them something that will mislead them.
Dr. Darrell Bock
Like he's occupied [laughs].
Dr. Scott B. Rae
I don't know. Maybe we shouldn't stretch that too far.
Dr. Darrell Bock
[Laughs].
Dr. Scott B. Rae
But I think we would all say that there are times in which the obligation to tell the truth conflicts with some other important value that may or may not be weighted more heavily.
Dr. Darrell Bock
So I mean you tell that story and I immediately think of the way in which the Gentile woman hid the Israelite spies.
Dr. Scott B. Rae
Exactly. Or take when the Gestapo knocked on Corrie Ten Booms door in World War II and said are you hiding Jews, which she was, and if she had told the truth there, they would've been shipped off out to Auschwitz, and I think she did not just a lesser evil, I actually think she did a morally justifiable thing.
Dr. Darrell Bock
Interesting. We're probably due for another podcast that's just about how to make these moral choices and pursue the common good and kind of thing, but I think it's kind of important to set the table for what we're going to discuss because there's no doubt that when you come into the area of assisted suicide and in death and the expectations tied to that, that you’re dealing in some senses with really competing values that people are appealing to as they go through these options, and Scott, what struck me about the chapter that you wrote, and we're looking at Chapter 8 in this book, Death, Dying and Assisted Suicide, is a distinction that you make early on that I'd like you to elaborate on a little bit between the three levels of conversation you need to think about as you talk about end of life, the difference between withdrawing treatment, between what's called PAS, or I guess what's called physician assisted suicide, and then termination of life support or what you call TLS. I know something is important when it gets an abbreviation and it's all in caps. So talk a little bit about the difference of those three levels and why it's important for this kind of a discussion.
Dr. Scott B. Rae
Yeah. In fact, I think the trickiest conversations are not around assisted suicide. They are around the termination of life support.
Dr. Darrell Bock
Yes.
Dr. Scott B. Rae
I think those are the things that cause families and loved ones the most angst at the end of life. So termination of life support is simply exercising what I think is a person's biblically allowed option under the right conditions to say stop the medicine and to say enough. And I actually think it's a way of entrusting the patient back to the Lord by removing all medical obstacles that prevent a disease from taking its natural course. So it's the cause of death when life support is removed or treatment is stopped or withheld is the underlying disease or condition that's allowed to run its natural course.
Dr. Darrell Bock
Because it's killing the person.
Dr. Scott B. Rae
Right. And generally because continuing to treat the person is – if the prognosis is very poor at the end of life, continuing to treat the person is either futile, which means it's not going to stop this irreversible downward spiral toward death; or more commonly, it's more burdensome than beneficial to the patient. Because most treatments are at least moderately beneficial, but the problem is that they impose such burdens on the patient.

For example, I spent about 15 years as an ethics consultant for various hospitals around Southern California area. And I'll never forget one case where this poor — this 98-year-old man. He couldn't have weighed more than about 98 pounds. He was at the end stage of stomach and colorectal cancer. His family was requesting that he be prepped for a colonoscopy, God forbid, to enable one last round of radiation treatment to try and get him to live a little bit longer. The nurses brought the case to the ethics committee and you know what they said? They said why are we torturing this poor man. In fact, I think you probably could've held him up to a nice strong bright light and been able to see about as much as you could from a colonoscopy. He was so thin. But I think what they recognized is that the potential of this treatment was just vastly outweighed by the burden that it was causing to this poor man, whose family were good hearted, but the family, they weren't in the room; they weren't watching what was going to go on. I mean they went now for lunch after they authorized this without a clue about what they were actually authorizing medicine to do to their loved one. I think under that condition especially, I think it would've been not only appropriate, I think it was their obligation to say enough to medicine, and the treatment would now – they transition to what's called palliative care, just pain control only.
Dr. Darrell Bock
Yeah. I think you and I have been both through these kinds of decisions personally. I remember – and this is actually interesting. I actually remember my wife's grandmother going through after a stroke and slowly going downhill, getting to the point where her family was put in the position of having to make this decision, and interestingly enough, a very well-known doctor, facing these decisions all the time, and they were getting down to this kind of level of care. And it's the only time they've consulted with me on something moral. And they came to me and said here are the choices. We've got a disagreement between the doctor who is caring for this woman and my father-in-law who is a doctor, and they were asking me for an opinion about the withdraw of care.

And basically the response I gave was very much like yours. It's asking the question what real good is this going to do to extend this care, and what kind of prognosis do we really have, that kind of thing. There comes a point where you say this disease in a sense has won and let it run its course.
Dr. Scott B. Rae
That's right. I'd say a prior question we encourage family members to ask themselves is if this patient could speak for himself or herself, would they want this additional treatment. So we use in bioethics, the term we use for that is substituted judgement where you substitute your own judgement, representing as best as you can what you think the wishes of that patient might be. Which is another good reason why all of us ought to be writing these things down.
Dr. Darrell Bock
Yes, I was going to — obviously you get this consent ahead of time.
Dr. Scott B. Rae
Yeah. And then it becomes a lot simpler because the family's role then, if they have something in writing, the family's role is simply interpretive. Sorry, not interpretive. It's enforcement. Because that's not – the family's function is not a hermeneutical one. They don't get to reinterpret and come up with a better idea.
Dr. Darrell Bock
Yeah.
Dr. Scott B. Rae
Their job – the patient, they've done their homework and written this down because they take it seriously, and they expect those things be followed, particularly by their family members. But that's not always the case.
Dr. Darrell Bock
Now this introduces an element to the conversation that is probably going to run us up into the break and we're going to have to cover on the other side. But obviously when we're dealing with the desire of the patient, we're running up against another standard that is driving this discussion and that is the preciousness of life and whom gets to make choices about the precious nature of life. And so when those come into conflict, you're sliding, if you will, you might be sliding away from dealing with terminal care — if I can characterize this first category that way — to the idea of physician assisted death, and we're moving across a track here. It becomes more complicated morally.
Dr. Scott B. Rae
I think that's right. And with the termination of treatment, the reason I don't think that you have a genuine moral conflict, although emotionally you have a huge one, is because the notion of death being a conquered enemy. See, I think strongly suggests that it need not always be resisted. And we are not obligated to keep everybody alive at all times and at all costs no matter what. I think that's forcing us to make a theological statement that I really don't think we want to make because if we are obligated to keep everyone alive at all times and at all costs, I think what we're saying theologically is earthly life is the highest good, which theologically that's not true. Earthly life is a penultimate good. It's pretty high up the list, but it's not at the top of the pot. I think Augustine was right when he said that our highest good is our eternal fellowship with God.
Dr. Darrell Bock
So part of what you do in this chapter is to talk about the biblical background to the idea that life is precious, and that we need to understand kind of what that ranking is, if I can use a picture. That's what you're getting here, right?
Dr. Scott B. Rae
I think so. Yeah. And I think you can hold to the sacredness of life without it becoming an idol. And I think the term we use for the notion that you have to keep everybody alive at all times and at all costs is vitalism. And the Bible doesn't teach vitalism. The sanctity of life and vitalism are not the same thing because although with the sanctity of life suggests is what violates the sixth commandment, which is deliberately – human beings cannot deliberately be the cause of death in another innocent human being, including themselves. But it doesn't follow that we can let go of medical treatment so that the cause of death is allowed to be the underlying disease or condition. Those are two very different things morally and philosophically.
Dr. Darrell Bock
And now we're coming to physician assisted suicide and the rest of spectrum in terms of taking life, and I think the way I want to introduce this segment is to talk about the way in which this has gotten portrayed in our culture is kind of setting the table for this conversation, and we've been through in recent times two movies that have portrayed this, and I'd like for Scott to kind of walk us through these two movies and what they put out on the table and how we should think about them.
Dr. Scott B. Rae
Can I go back for 10 seconds?
Dr. Darrell Bock
Absolutely.
Dr. Scott B. Rae
Just to be clear, I wouldn't want your readers to think that – your listeners to think that the termination of care is ever an option. That's why we always try to use the term termination of treatment. Because care is always morally obligated regardless of decisions about treatment. So what we do is we transition a person from aggressive care to palliative care or pain relief care. So in fact, I've had to talk to physicians about this. Nurses not so much. But to say we're not ending care. We're ending treatment. So I think that's an important distinction, especially for pastors and for family members who are at the bedside. It's really important that they reassured that their loved one, even though we may terminate treatment, that there's still going to be cared for and their dignity is still going to be protected.

A few years ago, Million Dollar Baby came out, which was advertised as a boxing movie, but in reality it was an assisted suicide movie that I think fairly aggressively advocated for assisted suicide and was illegal at the time and so it wasn't really an option. But Hillary Duff [transcriber's note: it's Hillary Swank] plays a boxer who is coached by Clint Eastwood, and after years of boxing and the injuries involved, came to a place where she wanted to end her life and it was viewed in the movie as sort of tragic that the law at the time was preventing her from doing that.

Contrast that I think to the movie, which is the more recent one that I think this podcast is going to be released even before it comes out, is Me Before You, which is a great story about the value of life of the disabled, the seriously disabled, and the obligation of care for the most vulnerable among us. And I think it illustrates I think really well that the biblical notion that we are obligated to care and to advocate for the most vulnerable among us as opposed to considering them the first candidates for assisted suicide.
Dr. Darrell Bock
Okay. With that kind of in place as kind of the background, let's talk a little bit about what's called PAS or physician assisted suicide. How should Christians think about this, and maybe the way into this, Scott, is to talk a little bit about the theology that comes before it, that how should we think about life and death, both, as we think about these situations that often times lead to the injection of the possibility of PAS.
Dr. Scott B. Rae
I think theologically I think – the explanation, the grounding theology bumps directly up against the most common argument used for assisted suicide and euthanasia, and that is it's an argument for personal autonomy: it's my body; it's my choice; it's my life; it's my decision; it's my death; and morality and the law should just stay out of it.

I think the Bible is really clear about the place that personal autonomy has and the place, the fulfillment of our desires has, in the hierarchy of things that are important to a person who is committed to following Jesus. I find as I read the New Testament the idea of the fulfillment of my desires ranks pretty low on the priority list of those things that are important to the people that are committed to following Jesus. I read texts like "deny yourself," "take up your cross and follow me" would suggest that the satisfaction of my desires is a fairly low priority. Not that my desires are useless, but that they are trumped by a whole lot of other things. I think the reality with the assisted suicide — and this is actually very timely in my home state of California here because as of July 1st, the law that was passed permitting assisted suicide actually when into effect just not even a couple months ago.

But I think theologically, the mandate to protect innocent life, the mandate for a human being is not to be the direct cause of death for another innocent human being is something that comes from passages like Hebrews 9:28, which suggests it's appointed to a man to die once and then comes judgement. It's appointed by whom, right? Obviously appointed by God, which suggests that God is the one who has the ultimate say in the cause of death for innocent human being. So take the first few bits of Ecclesiastes 3 where there is a time for everything: a time to be born and a time to die. The point of that is that life is this grand symphony in which God is the composer, and that the reason there is a time to live and a time to die is because God has set the times to live and the times to die. So I think what that suggests theologically is that the timing and manner of our death ultimately belongs to God. And for the believer, it seems to me that doing an end run around the dying process, I don't find anything particularly dignified about that. In fact, the dignity in dying comes from how you cope with all of the necessary losses that are a part of the dying process, and how you endure that with grace, how you endure that with faith and trust seems to me that's what it means for a believer to die with dignity.

And the reality is that the number of people who actually face the end of their lives in unremitting, unrelieved pain is minisculely small. That's why the argument for mercy, which makes for a great 30-second soundbite has largely been abandoned by the advocacy groups that are promoting euthanasia and assisted suicide, and it's focused more on an autonomy argument, and the reality is that medicine, particularly good palliative care medicine can control almost everyone's pain at the end of life, short of killing them. And what we found is that when people have their pain controlled – it's not a big surprise – but when their pain is under control, they actually give up the desire for assisted suicide.
Dr. Darrell Bock
So I take it here that the idea of assisted suicide – now this is legal in some states now. Is that correct? I think you mentioned California.
Dr. Scott B. Rae
Five states in the U.S. now. It's Washington, Oregon, California, Montana, and Vermont.
Dr. Darrell Bock
Oh, so I was going to say it's completely a Northwest thing until Vermont came into the mix.
Dr. Scott B. Rae
No, it's not.
Dr. Darrell Bock
But it's obviously an ongoing discussion. It's the opposite end of the life discussion in some ways from perhaps more famous discussion that takes place among Christians related to issues tied to birth, but it's still in many ways a similar kind of conversation about how to view life.
Dr. Scott B. Rae
Yeah. It's just the other end of the coin, at the other end of life. In fact, people who said in 1973 at the Court's view of abortion would eventually come back to impact how the courts view the end of life has turned out to be exactly true.
Dr. Darrell Bock
Interesting. So where are the courts on this. I mean like you said, you obviously have served on ethics commissions of hospitals. Where are the courts on these kinds of issues?
Dr. Scott B. Rae
Well, the Supreme Court ruled on this definitively in 1997 with a case from the Northwest and a case from New York in the East Coast. And essentially what they ruled is that there's nothing unconstitutional about either allowing or prohibiting assisted suicide. So it left it entirely to the states through the legislative process to come up with whatever they wanted their policy to be on this, and just by the way, that's the primary criticism of Roe v. Wade, which legalizes abortion. That's what most people who are opposed to abortion think that the Court should've done with Roe v. Wade.
Dr. Darrell Bock
Interesting. So distinguish for me between physician — I'm sorry. I keep calling it passive — physician assisted suicide and euthanasia. Is there a distinction there?
Dr. Scott B. Rae
Yes. And it's actually – it's an important one I think for the law. Morally I think though it's probably a distinction without much of a difference.
Dr. Darrell Bock
Okay. That's actually what I'm driving at.
Dr. Scott B. Rae
Assisted suicide occurs when a patient has six months or less to live with a diagnosable, terminal illness and the physician comes in and prescribes, advises and supervises the patient ingesting the life-ending dose of medication himself or herself. The patient actually does this under the – with the assistance of the physician.
Dr. Darrell Bock
So the person has made the choice basically to say I want to terminate my life and, doctor, will you help me do that.
Dr. Scott B. Rae
Right. Yeah. So it's basically employing doctors so people don't have to shoot themselves.
Dr. Darrell Bock
Right, right. Okay. All right.
Dr. Scott B. Rae
Now euthanasia generally occurs when the person is too sick or debilitated to commit suicide themselves. And so the physician himself or herself will provide the lethal dose of medication, usually through an IV line, and so there is the direct intentional action of the physician as opposed to the action of the patient that's the cause of death.
Dr. Darrell Bock
So physician assisted suicide is really the agent making the decision is still the patient himself or herself. And all the physician is the mediator of that decision. Whereas in euthanasia —
Dr. Scott B. Rae
The guy on the side.
Dr. Darrell Bock
Okay. And in euthanasia, the physician is making all the calls.
Dr. Scott B. Rae
The physician is the active agent. Now what we need to be clear about is that in some context, in some countries, the physician acts only when the patient gives consent. Now you would think that should be non-negotiable, but what we're learning from 20 to 30 years' experience of this in Europe is that roughly somewhere from 15 to 20 percent of all cases of euthanasia are done without the explicit consent of the patient.

In fact, the Dutch – actually this is one of the first places where this was loosely legalized and then formally legalized. The Dutch coined a term for this back in the 80s calling it cryptonasia, which is euthanasia done cryptically which is generally without the patient's consent but also most of the time without the patient's knowledge. These are patients in a vegetative state or in severe cases of dementia, things like that. It seems to me once we go down that road, then it's hard not suggest that these patients are being harmed because if they're being put to death either against their will or without their knowledge, that's a line I think that's we ought not be crossing.

And it seems to be that's an inevitable result of this because imagine talking to your elderly in-laws for example, and let's say – they're both living, right?
Dr. Darrell Bock
Mm-hmm.
Dr. Scott B. Rae
Okay. Let's say Sally's mom is really seriously ill, and she's demented and doesn't really know kind of which end is up, and your father-in-law and you and the kids all come around and start putting pressure on her to sign this assisted suicide declaration, and you eventually wear her down, and she does it not because she's tired of living but essentially because you all are tired of her living. And she signs the declaration, assisted suicide is performed, and under one set of ways to look at this, all is well. In California if that happened, you just committed a felony. My question is who will ever know that this has happened. Without intolerable invasions of privacy, nobody will ever become aware that the family has essentially twisted her arm —
Dr. Darrell Bock
— that the signature really wasn't hers.
Dr. Scott B. Rae
Right. Into signing this – essentially you've coerced her into doing this. This is why way back when this first started being debated, Daniel Callahan who was the head of The Hastings Center, the preeminent bioethics think tank in the world still, said there is no way even in principle that the demand, that the request for assisted suicide or euthanasia be completely voluntary can be enforced. And that is I think a really troubling part of the legalization of this.

Now if I can amplify this just slightly, and this is where we need to take our lesson, not from what's going on in Oregon and Washington but what's going on in Europe. Because Europe, I submit to you is about 20 years ahead of where we will be on this.
Dr. Darrell Bock
Not unusual.
Dr. Scott B. Rae
They understand that we're facing a demographic landslide where in the next 20 years we're going to have record numbers of people like you and me who are going to be over the age of 65. And arguably needing care when it's the most costly to provide it.
Dr. Darrell Bock
Yeah, actually that's going to be my next question: how much is economics playing into this?
Dr. Scott B. Rae
It's huge, especially in Europe. And what they're doing – and this is what's so troubling about this is in Europe now they're explicitly linking the legalization of assisted suicide and euthanasia with controlling this avalanche of costs at the end of life caused by the Baby Boomers becoming Geezer Boomers. And as a colleague of mine put it some years ago, she said there's nothing cheaper than dead. Now that's not a great public relations line for assisted suicide, but there is no mistaking the reality that in Europe they are explicitly connecting these two, which is forcing some folks who are sort of traditionally I'd say pro-abortion and liberal on a variety of causes to oppose assisted suicide because they see what's coming. And that's the really troubling part of making this legal and opening the doors to it across the board.

If it's legalized on the basis that everybody has a fundamental right to die, then the other sort of – I think the other point of tension with this is that if it's based on the fundamental right to die, then everybody over the age of 18 should be able to exercise it and the reason shouldn't matter. It's a fundamental right.
Dr. Darrell Bock
Yeah, and you do understand that there are some forms of medical care that exists today in which procedures that could enhance and prolong life are refused because of the costs that they have and the age of patient who is asking for the procedure.
Dr. Scott B. Rae
That's right. And I don't think that's entirely inappropriate. Because – take my dad for example. He died of this horrible cancer that it started at his feet and ankles and spread to his brain, and he was at MD Anderson, which is the priciest cancer care probably in the world. It's also some of the best. But I'm convinced that if he knew that his being treated was going to bankrupt my mom, he would have foregone it without a second thought. And I think rightly so. Now I want that to be someone's choice. The reason I wouldn't say that's an obligation because that creates a counter claim that family members can then exercise, which I think that families exercising that claim I think is fundamentally incompatible —
Dr. Darrell Bock
Much less a government doing so. Right? Much less a government doing so. In other words, having it be mandated as a matter of – what happens in Europe is that certain I think tables are put into place, if you will, or processes or policies that say if you're over this age with this kind of procedure, with this kind of a condition, then the government because it subsidizes the medical care will not pay for the process and for the procedure.
Dr. Scott B. Rae
Yeah. I mean just for example, some of this is coming home to roost already. A handful of cases in Oregon where the insurance company denied the potential life extending treatment, and grant it, the prognosis was poor. They probably should've denied it. But they instead offered to pay for assisted suicide. And don’t tell me that that's not a financial inducement that's designed to encourage assisted suicide precisely because the financial cost. It's easy to see this now and say, well, we're not in crisis mode. But our healthcare system is going to be in crisis mode probably sometime in the next decade or two because the system is just not equipped to deal with all of us Baby Boomers —
Dr. Darrell Bock
— growing old.
Dr. Scott B. Rae
— needing end of life care.
Dr. Darrell Bock
Yeah.
Dr. Scott B. Rae
Which does not bode well for folks like you and me.
Dr. Darrell Bock
Well, I appreciate you bringing us near the end of this podcast with great news. Let's talk a little bit about euthanasia, which is kind of where most people this discussion starts, but it really is in many ways as it has been for us kind of the last point.
Dr. Scott B. Rae
This is the caboose on the train.
Dr. Darrell Bock
Okay. And how do you think people should think about euthanasia?
Dr. Scott B. Rae
I think euthanasia is murder. And it's murder particularly of the class of people that the Bible calls us to advocate for, which is the marginalized. In the Scripture, the figures of speech for the most vulnerable among us are the widow and the orphan. Today, I think those figures of speech ought to be changed to the unborn and the elderly.
Dr. Darrell Bock
In other words, they include those groups because they're among the vulnerable.
Dr. Scott B. Rae
Right.
Dr. Darrell Bock
Yeah.
Dr. Scott B. Rae
But I think the predominant figures of speech today, widows not so much. Orphans probably still true. But we ought to expand that to include the unborn and the elderly.
Dr. Darrell Bock
And your point here is that the principle that the Scripture is talking about is that it's people who are sensitive to the life and what life means and the way God gives it and seeks for it to be managed in a way we're suppose to encourage one another with regard to life should pay special attention to the people who can't advocate for themselves.
Dr. Scott B. Rae
Exactly. The Bible is so clear on the obligation of the people of God to care for the most vulnerable among us. You can barely read one page of the Scripture without seeing that come out.
Dr. Darrell Bock
Yeah, I mean the sense of compassion and understanding we're suppose to have about life runs pretty deeply through the Scripture as a commitment of the way we love our neighbor and the way we're suppose to relate to one another in support of people.
Dr. Scott B. Rae
And I think that's the really good news about the movie, Me Before You. That's what I love about the movie is because people – the main character was somebody who's terribly disabled, clearly fits among the most vulnerable among us. Lots of people in Europe would say that's a clear candidate for euthanasia yet what the movie is about is this obligation that was fulfilled by meeting and caring for people that we tend to write off as unimportant and marginalized.
Dr. Darrell Bock
Interesting. Well, Scott, I really do appreciate you taking the time to walk us through this. It's interesting. I was in Australia and New Zealand this summer and was doing a lot of stuff on cultural engagement, and I was in Christchurch in New Zealand and they said that when you come back, we want you to look at some specific issues for us, and one of the ones that they did was the topic of death, dying and euthanasia, which is becoming a topic of tension up there. So I thank you for giving some material to work with when I do this. It's helpful to talk to someone who's spent time thinking about this ethically and theologically and is also has dealt with it on the ethical side as being on a hospital board that makes these decisions regularly. So I really do appreciate you coming in and talking to us about it. I think it's an important topic we don't think enough about.
Dr. Scott B. Rae
Well, it's my pleasure. I do think it's a crucial one. I've often asked families who are hanging on to earthly life for their loved one, do you really believe this stuff about eternity that you say you do, and I'd like for us to be able to approach the end of life like we actually believe this stuff about resurrection and eternity.
Dr. Darrell Bock
Well, thank you again, Scott. And we thank you for being a part of The Table and hope to see you again soon.

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