End of Life: On Refusing Treatment (Meilaender)

 Tragically, it happens: we are diagnosed with an illness or condition that means death is inevitable sooner rather than later.  To knowingly face death is one of the hardest things in life, and it leads to some very difficult choices.  Should we undergo treatment(s) trying to prolong life?  Or should we forego them and perhaps better enjoy the short time we have left?  This isn’t a black-and-white ethical area.  There are various factors that lead Christians to different decisions in this area.

I like Gilbert Meilaeander’s wisdom here.  In chapter seven of Bioethics: A Primer for Christians he talks about refusing treatment.  The entire chapter is very much worth reading, but since I can’t put it all here, I’ll summarize:

“On the one hand, we ought not choose death or aim at death.  But on the other hand, neither should we act as if continued life were the only, or even highest good.  It is not a god, but a gift from God.  Thus, we should neither aim at death nor continue the struggle against it when its time has come.  ‘Allowing to die’ is permitted; killing is not.”

“If I commit suicide (an am of sound mind), I intend to die.  I aim at my death or choose death.  But, of course, there might be occasions when, if I refuse a certain treatment, I will also die.  Are they therefore morally equivalent?  Is treatment refusal the same as the forbidden suicide?  Although they could sometimes be morally equivalent – I could refuse treatment so that I will die – they need not be.  To see why we must think about the aim and the result of the action.”

“[For example] a soldier may charge the enemy, knowing that he faces almost certain death in so doing.  He does not thereby commit suicide.  He does not choose to die, even though he foresees that death is the likely, perhaps almost certain, result of his action.  …Dying is not part of his plan of action, just its very likely result.”

“This distinction between an act’s aim and its result is crucial to bear in mind when we consider decisions to refuse or withdraw treatment.  The result of such decisions may be that death comes more quickly than it might have.  Nevertheless, the fact that we ought not aim at death for ourself or another does not mean that we must always do everything possible to oppose it.  Life is not our god, but a gift of God; death is a great evil, but not the ultimate evil.”

“There may come a time, then, when it is proper to acknowledge death and cease to oppose it.  Our aim in such circumstances is to care for the dying person as best we can.  …Because life is not our god, we need not accept all burdens – no matter how great – in order to stay alive.  …Treatment may be refused or withdrawn when it is either useless or excessively burdensome.  In either of those instances, refusal of treatment is not the forbidden suicide or euthanasia.”

These are just a few highlights of an excellent chapter that gives some ethical Christian wisdom on when to accept treatment and when to refuse it.  If you have – or are – wrestling with this difficult decision, I very much recommend Meilaender’s contribution in Bioethics.

Shane Lems
Hammond, WI