In 2023, I completed a master’s thesis titled, “Is This How Human Life Should End?: A Methodist Examination of Physician-Assisted Suicide.” Through this year-long research project, completed through the Th.M. program at Boston College School of Theology and Ministry, I considered the history and growing popularity of physician-assisted suicide (PAS) in the United States and Europe, examined this practice through a Methodist theo-ethical lens, and looked ahead to the proposed changes to Methodist positions on PAS in the revised Social Principles due to be considered at the General Conference of the UMC in April and May 2024.
As delegates meet in legislative sections this week and then come together as a full body to make these monumental decisions, I believe some of the changes contained in the revised Social Principles’ sub-section “Death With Dignity” are positive and others are confusing or problematic. While I would love to share my full 60+ page thesis here, I recognize that few will spend the time reading a position paper of that length, especially given the volume of decisions at hand over the next ten days. Thus, here I share a summary of my research. I begin with an overview of physician-assisted suicide and euthanasia positions in the existing UM Social Principles. Then, I examine five revisions being proposed in the new document, with suggestions on what must be considered by the voting body of General Conference prior to their approval.
What is the UMC’s current position in PAS and euthanasia?
Most Christian traditions in the United States formally oppose PAS, including the United Methodist Church.[1] The UMC’s opposition to PAS is found in the denomination’s Social Principles (SP), which begins by stating: “We believe that suicide is not the way a human life should end,” and “the Church has an obligation to see that all persons have access to needed pastoral and medical care and therapy in those circumstances that lead to loss of self-worth, suicidal despair, and/or the desire to seek physician-assisted suicide. . . . The Church opposes physician-assisted suicide and euthanasia.”[2]
Early position
This position has developed over time alongside growth in the wider cultural and legal conversations about PAS and euthanasia. In the first Social Principles adopted in 1972, a section titled “Birth and Death” applauds “the advances in medical science and treatment that extend meaningful life, while also asserting the right of every person to die in dignity, with loving personal care and without efforts to prolong terminal illnesses merely because the technology is available to do so.”[3] In 1976, the UMC separated and expanded this principle to a new section called “Death with Dignity” and added: “We recognize the agonizing personal and moral decisions faced by the dying, their physicians, their families, and their friends.”[4]
GC 2000: Removing the language of “death with dignity”
No further meaningful changes were made until 2000, at the first General Conference held after the Oregon Death with Dignity Act (DWDA) was enacted in 1997, becoming the first U.S. state to allow “terminally ill individuals to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.”
In response, the UMC distanced itself from the principles behind the DWDA by overhauling the “Death with Dignity” section of the Social Principles. The section title was changed to “Faithful Care of the Dying” and doubled in size to state that “care for the dying is part of our stewardship of the divine gift of life,” and dying persons and their families “have the liberty to discontinue [life-sustaining] treatments when they cease to be of benefit to the patient.” But “even when one ceases to resist death, the church and society must continue to provide faithful care, including pain relief, companionship, support, and spiritual nurture for the dying person in the hard work of preparing for death.”[5] This change formalized support for a patient’s right to decline or discontinue life-prolonging treatment and insisted upon the responsibility to continue relational and spiritual care at the end of life, including compassionately providing dying persons relief from pain.
GC 2000: Adding a section on suicide
In 2000 the UMC also added an entirely new section titled “Suicide” (¶161.M) to address all forms of ending one’s own life. In this addition, the Church recognizes that suicide is often the result of untreated depression, pain, or suffering, and states “an obligation to see that all persons have access to needed pastoral and medical care and therapy in those circumstances that lead to loss of self-worth, suicidal despair, and/or the desire to seek physician-assisted suicide.”
The section encourages education to address biblical, theological, social, and ethical issues related to death and dying, and to reject judgment or stigma of persons who complete suicide or their family and friends. Referencing Romans 8:38-39, this section states: “A Christian perspective on suicide begins with an affirmation of faith that nothing, including suicide, separates us from the love of God.”[6] This is also the first time PAS is explicitly addressed in the SP. The section “Faithful Care for Dying Persons” states: “The Church does not endorse the enlistment of medical providers, who are charged to cure and to care, to assist people in taking their own lives.”[7]
Minor changes in 2004 and 2008
The 2004 General Conference made small changes, changing “physician-assisted suicide” to “assisted suicide” and adding a concluding sentence: “The Church opposes assisted suicide and euthanasia.”[8] Since 2004, no changes have been made to this section. In 2008, one change was made to “Faithful Care for the Dying” by adding: “We reject euthanasia and any pressure upon the dying to end their lives. God has continued love and purpose for all persons, regardless of health. We affirm laws and policies that protect the rights and dignity of the dying.”[9]
Current position on PAS
As it currently stands, the United Methodist argument against PAS seems to rest fully on the word “suicide.” The Church defines PAS as suicide, and since suicide is “not the way a human life should end,” the Church opposes the practice of PAS. No further reasons or justification are given, demonstrating that the United Methodist argument against PAS is underdeveloped. As support and legal protection for PAS grows in the United States and in Europe, this requires more attention and moral reasoning. The proposed revisions in the United Methodist Revised Social Principles (UMRSP) have societal and political implications that must be considered in preparation for General Conference in 2024.
“Do we have an obligation to live, and if so, what kind of obligation is it? Or, perhaps more fundamentally still, what are the moral reasons that should form our interest in continuing our existence?” – Stanely Hauerwas[10]
PAS and Euthanasia in the proposed new Social Principles
Although there is much to consider in these proposed UM Revised Social Principles, this piece looks primarily at the sub-section titled “Death with Dignity”, further sub-divided into “Faithful Care of Dying People” and “Euthanasia and Suicide.” This section proposes five subtle yet significant shifts in the denomination’s position on PAS:
- Reintroduction of the phrase “death with dignity”
- Combining physician-assisted suicide and euthanasia into a single definition (a mistake that ignores the distinctions and moral considerations between the two practices)
- Stronger language in support of empowering patients and their loved ones “to make informed decisions about continued treatment or end-of-life decisions that are consistent with applicable legal statutes and established medical protocols and standards.”[11]
- More explicitly stating a responsibility of the church to practice a ministry of presence even with those who choose PAS.
- A call for epistemological humility regarding PAS and euthanasia
1. Reintroduction of the phrase “death with dignity”
On the surface, “death with dignity” may sound compassionate and unbiased. But in PAS debates, it is a common phrase used by advocates of the practice to empower “people with terminal illness to have the control they want during the last days of their lives” and to “ensure people with terminal illness can decide for themselves what a good death means in accordance with their values and beliefs, and that should include having an option for death with dignity.”[13]
Furthermore, death with dignity is both the name of a leading PAS advocacy group in the United States and the name of the Oregon legislation enacted in 1997 to legally protect PAS. If the proposed SP document is going to use the phrase “death with dignity” while at the same time arguing against PAS, it must give a clear definition of “dignity” and be aware of the unintended consequences of using the phrase. As currently written, the proposed SP does neither.
To be human, or a “creature of the earth,” is to live on a scale of disability and always be subject to the “vulnerabilities of finite life.”[14] But the phrase “death with dignity” is commonly used as an appeal to a person’s autonomous right to choose death in a manner and time of their choosing, not as an assertion of a person’s human dignity, or as the Social Principles have always termed it, “sacred worth.” Calling PAS “death with dignity,” especially when death is not imminent, communicates a view of dignity based upon physical and cognitive capacity rather than human dignity as inherent, inestimable, and sacred worth.
In other words, “death with dignity” language implies dignity is something we “do” or “act” out as part of our living. But as United Methodists, we have always seen dignity as an inherent aspect of our being as God’s beloved creations. Dignity isn’t determined by how we are able to live our lives; it’s based on the God who has created that life in the first place and called it (us) good.
My recommendation: remove all “death with dignity” language so as to avoid confusion about the UMC’s position on PAS and euthanasia, and to avoid inadvertently shifting the UMC’s definition of human dignity.
2. Combining physician-assisted suicide and euthanasia into a single definition
This language in the proposed SP mistakenly defines euthanasia and PAS to be the same, but they are different acts with distinct and specific moral implications for each.
Ezekiel Emanuel et al., define PAS as follows: “PAS occurs when lethal drugs are prescribed or supplied by the physician at the patient’s request and self-administered by the patient with the aim of ending his or her life.” This differs from the practice of euthanasia, also referred to as “active euthanasia,” in which “a person, usually a physician, actively and intentionally ends a patient’s life by some medical means such as injection of a neuromuscular relaxant.”[15]
The difference between euthanasia and PAS raises different moral and ethical questions, most prominently in the role of the physician or medical provider. Whereas in PAS the patient still commits the act of killing, or taking one’s own life, euthanasia requires another person—usually a physician—to administer the lethal dose and thus become more clearly implicated in the act of killing. Taking one’s own life (PAS) is neither legally nor morally equivalent to actively taking the life of another (euthanasia).
Daniel Callahan points out that “Euthanasia is thus no longer a matter only of self-determination, but of a mutual, social decision between two people, the one to be killed and the other to do the killing.”[16] This “mutual, social decision” may also be applied to PAS, but there is clearer moral culpability of the physician who actively takes a life by euthanasia than the culpability of a physician who assists in suicide, i.e. prescribes a lethal dose of medication that may or may not be actually used, and if it is used is administered by the patient.
Because of this moral difference, it is possible to advocate for both euthanasia and PAS, to oppose both euthanasia and PAS, or to oppose one yet advocate for the other. Furthermore, persons or groups may support PAS in some circumstances but not others, and the same can be said of euthanasia. The UMRSP should not be adopted by the General Conference until/unless this confusing language is amended to better clarify the distinction between euthanasia and physician-assisted suicide.
My recommendation: amend the current definition by substitution. . .
Euthanasia occurs when physicians or other health professionals directly administer lethal doses of drugs to patients who request it. Physician-assisted suicide, also known as physician-assisted death, occurs when lethal doses of drugs are prescribed or supplied by physicians or other health professionals to patients who request it, and the patient self-administers the prescribed drugs with the aim of ending their life.
3. Stronger language in support of empowering patients and their loved ones “to make informed decisions about continued treatment or end-of-life decisions that are consistent with applicable legal statutes and established medical protocols and standards.”[17]
The UMC’s position on PAS has never previously appealed to “applicable legal statutes and established medical protocols and standards.” Adding this line suggests an intention to leave open the door for changing the UMC’s position on PAS if or when it becomes more commonly accepted and legally protected in the US and elsewhere.
Determining the moral rightness of PAS in terminal cases requires development of individual moral conscience for these affected agents. But in the Christian tradition, development of conscience is not an invitation to moral relativism. The answer to hard questions—like whether PAS is ever morally justified—can never be reduced to allowing each person to come up with their own answer and to act however they desire.
Rather, when moral rightness and wrongness is less clear, individuals must develop a robust moral conscience within a larger community of moral formation. John Wesley believed conscience to be “placed in the middle, under God, and above man,”[18] and defines conscience as the natural faculty a person has to (1) know one’s own tempers, thoughts, words, and actions; (2) know the rule of God which directs the Christian disciple; and (3) discern, with the assistance of the Holy Spirit, whether and how one’s thoughts, words, and actions are in agreement with or opposed to God’s rule.[19]
When diagnosed with a terminal disease and reasonably expected to die within six months, a patient considering a request for PAS in a state in which it is legal must first discern whether the desire is truly in agreement with God’s will for them in that moment, or merely a human-centered desire to avoid the difficulties of death and dying. This discernment can be centered around three questions to guide their moral conscience before deciding whether to make a request for PAS:
- Is the patient motivated by their own desires or by God’s?
- Does the patient have something left to live for?
- What might be missed by hastening death?
My recommendation: no changes to the proposed Social Principles, but a better commitment to educating pastors and other Christian caregivers in helping patients through moral reasoning of end-of-life options.
4. More explicitly stating a responsibility of the church to practice a ministry of presence even with those who choose PAS.
The current UM Social Principles reminds the reader that nothing—not even euthanasia or PAS—can separate a person from the love of God.[20] The proposed SP takes this further, more explicitly stating the church’s responsibility to practice a ministry of presence even with those who choose PAS.
Where PAS is legal, United Methodist clergy and congregations will be asked to provide spiritual care for persons choosing PAS. This care must be given as an expression of love for the dying and as fulfillment of the responsibilities of ordained ministry and congregational life. This care should include counseling the patient on the ethics of PAS and helping them to develop a moral conscience, including the questions above.
However, clergy and congregations should also respect the patient’s autonomous choice. Clergy and others in the circle of care may express to the patient their own position on PAS but must also make clear that the patient’s autonomous choice remains. Spiritual care is meant to be supportive and discerning, not a manipulative attempt to shame or guilt a person into making a decision.
Second, the UMRSP affirms the benefits of palliative care to minimize pain and suffering. Any conversation on PAS must consider the potential negative implications of PAS on access to and providing of palliative care.
In palliative care, the primary purpose is to minimize pain and suffering and provide comfort to persons throughout the dying process. United Methodists should support easy and equitable access to palliative care for all persons. One concern raised in debates about PAS is that allowing PAS may result in the unintended consequence of a reduction of palliative care. However, in the Netherlands, where euthanasia and PAS have been widely available for decades, this concern has not yet come to fruition.[21]
This is encouraging, but it also requires continued intentionality. The current United Methodist Social Principles affirms the need to care faithfully for “those growing old in years” with respect and dignity.[22] Palliative care expert David Jeffrey believes growing support for PAS is partially a symptom of a lack of adequate access to palliative care, especially in the United States given the nation’s complicated and inequitable healthcare system. Patients who feel as if there is no other option are turning to PAS, he says.
In Oregon, the first state to offer legal protection for PAS, Jeffrey reports that there is a lack of specialist inpatient palliative care beds in that state, and hospice home care is limited by the financial constraints and lack of coverage of the US healthcare system. He argues that PAS and palliative care cannot flourish alongside each other.[23] Any legislative consideration of PAS must fully consider the impact on palliative and hospice care. Furthermore, these forms of care ought to be more fully supported and invested. More equitable and easily accessible palliative care will allow more patients to experience a good death without needing to turn to PAS as a solution.
My recommendation: no changes to proposed SP.
5. A call for epistemological humility regarding PAS and euthanasia
The proposed SP add the following sentence: “While euthanasia or suicide cannot be condoned, we humbly confess the inadequacy of the church understanding and response.”[24] This expression of respect for differing positions on non-creedal matters is a key tenet of Wesleyan theology and practice, grounded in John Wesley’s sermon, “Catholic Spirit,” in which he says:
But although a difference in opinions or modes of worship may prevent an entire external union, yet need it prevent our union in affection? Though we can’t think alike, may we not love alike? May we not be of one heart, though we are not of one opinion? Without all doubt we may. Herein all the children of God may unite, notwithstanding these smaller differences. These remaining as they are, they may forward one another in love and in good works.[25]
With an appeal to 2 Kings 10:15, Wesley then invites those who disagree with him on smaller differences to “give me thine hand,”[26] not as a sign of agreement but as a sign of love across differing opinions.
When a patient chooses PAS, clergy and congregants should be willing to literally give their hand to another in love, up to and including the point of death, and to those who grieve after the death. Even—perhaps especially—if a person thinks the patient’s choice of PAS is morally wrong, a ministry of presence reminds the patient that nothing, not even decisions which may be unethical, can separate them from God’s love, grace, and forgiveness.
Rev. Dr. Cole Hartin, an Episcopal priest, says that in situations of PAS, practicing a ministry of presence is more important than making moral or ethical arguments. In an article for Commonweal Magazine last year he wrote:
“This is not the time for a priest to make a moral stand and leave a reeling and confused family out in the cold. Rather, after having graciously given an account of Christian death, it is the time for pastors to walk alongside those who are ending their own lives, even if this means walking with some distance. A pastor can point out that a path is dangerous and is not meant to be trod, and still—not without risk—follow behind in the hope that repentance will come in due course. The vocation of the pastor in this instance is to be a physical reminder of the judgment and mercy of God.”
The UMC’s commitment to epistemological humility—recognizing one’s own limitations of knowledge—is commendable. However, it should not be understood as moral relativism, nor as an invitation to forego rigorous research and reasoning. The solution to difficult problems or controversial debates should never be to throw up one’s hands in willful ignorance and allow each person or group to have unrestricted autonomous choice in every situation. Rather, congregations should “educate themselves regarding the complex set of motivations and factors underlying these practices.”[27] This education is a never-ending pursuit of truth as new information about end-of-life ethics is revealed.
My recommendation: no changes to proposed SP.
Interested in reading my full thesis? Email me at erik.hoeke@gmail.com.
[1] “Religious Groups’ Views on End-of-Life Issues,” Pew Research Center’s Religion & Public Life Project, July 27, 2020, https://www.pewresearch.org/religion/2013/11/21/religious-groups-views-on-end-of-life-issues.
[2] United Methodist Church, The Book of Discipline of the United Methodist Church (Nashville: United Methodist Publishing House, 2016), ¶161.O.
[3] United Methodist Church, The Book of Discipline (1972), ¶71.D.
[4] United Methodist Church, The Book of Discipline (1976), ¶71.D.
[5] United Methodist Church, The Book of Discipline (2000), ¶161.L.
[6] United Methodist Church, The Book of Discipline (2016), ¶161.O.
[7] Ibid., ¶161.M.
[8] United Methodist Church, The Book of Discipline (2004), ¶161.N.
[9] Ibid., ¶161.M.
[10] Stanley Hauerwas, “Memory, Community, and the Reasons for Living: Reflections on Suicide and Euthanasia” in The Hauerwas Reader, ed. John Berkman and Michael Cartwright (Durham: Duke University Press, 2001), 582.
[11] The General Board of Church and Society, “Social Principles 2020,” GBCS, n.d., https://www.umcjustice.org/news-and-stories/social-principles-2020-607, 25. This was due to be considered at the 2020 General Conference, but that General Conference was postponed multiple times and will now take place in 2024. [emphasis mine]
[12] Ibid., 25.
[13] Death With Dignity, “About Death with Dignity,” Death With Dignity, https://deathwithdignity.org/about. Accessed April 6, 2023.
[14] Shane Clifton, Crippled Grace: Disability, Virtue Ethics, and the Good Life (Waco: Baylor University Press, 2018), 39.
[15] Ezekiel J. Emanuel et al., “Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe,” JAMA : the Journal of the American Medical Association 316, no. 1 (2016): 80.
[16] Daniel Callahan, “When Self-Determination Runs Amok,” Hastings Center Report 22, no. 2 (1992): 52.
[17] GBCS, “Social Principles 2020,” 25. [emphasis mine]
[18] John Wesley, “On Conscience” in The Complete Sermons: John Wesley (CreateSpace Independent Publishing, 2013), 516-20.
[19] Ibid.
[20] United Methodist Church, The Book of Discipline (2016), ¶161.O.
[21] Gerrit Kimsma, “Physician-Assisted Death in the Netherlands,” in The Oxford Handbook of Ethics…, 354. Kimsma says, “Since 1996, the Dutch government and the European Community have provided substantial funding for institutions, palliative care teams, research, journals, and the inauguration of university departments. In 2011, the European Association for Palliative Care concluded that ‘palliative care is well developed in countries with legalized euthanasia/assisted suicide, or at least no less developed as in other European countries.’”
[22] United Methodist Church, The Book of Discipline (2016), ¶162.E.
[23] David Jeffrey, Against Physician Assisted Suicide: A Palliative Care Perspective (New York: Radcliffe Publishing, 2009), 67.
[24] GBCS, “Social Principles 2020,” 25.
[25] John Wesley, “Catholic Spirit” in John Wesley’s Sermons, 301.
[26] Ibid., 305.
[27] GBCS, “Social Principles 2020,” 25-26.
Faith working by love 
Leave a comment