Talking about: Euthanasia

Foreword

We are all faced with questions of life and death, and how we respond to issues like euthanasia in a Christian way. The media and political discourse may leave us feeling unsure about how to appropriately respond. The Social Responsibilities Committee of the Anglican Diocese of Melbourne therefore commends Talking about: Euthanasia, written by Dr Justin Denholm, a member of the SRC, for your critical analysis and discussion. This study guide is designed to help you think about and engage with the issues surrounding euthanasia in a Christian way. This study guide is perfect for small group studies within parishes. It moves between the Bible and the issues of contemporary discussion. We imagine the studies will stimulate good discussion and allow people to share their poignant stories in a compassionate setting. We expected that doing the studies together will provide a basis for deep and ongoing prayer amongst members of a study group. Feedback may be provided to Dr Justin Denholm: [email protected] With every blessing, Bishop Philip Huggins Chair, Social Responsibilities Committee Anglican Diocese of Melbourne

This study guide is provided for information purposes and to stimulate discussion. The guide reflects the views of the author and does not necessarily reflect the official policy of the Anglican Diocese of Melbourne or the Social Responsibilities Committee.

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Leader’s notes

Studying ethics in a small group setting can be a very challenging and valuable experience. There is a real opportunity to deeply examine important issues, and particularly to explore the ways in which faith may practically impact the way we think and live. The three studies included in this booklet all deal with euthanasia, but cover different aspects of Christian approaches. The first study focuses on important virtues and relationships relevant to considerations of euthanasia, while the second study highlights some Biblical principles and rules. The final study, starting from this framework, then moves into more pastoral concerns as we focus on how to have good conversations around the difficult ethical and social issues involved. The studies do not need to be worked through in order, but group members should have some familiarity with the Biblical concepts before tackling the third study – if not using all three studies, this could be done by ensuring that the group members read the introductory material. Depending on your group, you may wish to cover this material over three sessions, or to combine elements into a single meeting time. Make sure to set aside plenty of time to talk, though, as these questions will often generate robust conversation! While leading ethical discussion has much in common with other small group studies, there are a few useful points to remember in planning and leading sessions. Ethical discussions can become abstract and philosophical, and it is important for leaders to encourage the group to return to dealing with these issues in a personal way as well. Our aim is not just to have an interesting conversation, but also to help each other clarify how we should live. Depending on the topic, this process can be confronting for some people. This is particularly true for those in your group who may have some previous experience around the questions you are considering. Be alert to this possibility, and sensitive to the individual responses from group members. Particularly in the early stages of discussion, there are few if any wrong answers. Group discussions are most valuable if participants are allowed to speak freely and give their honest opinions. Some opinions may appear unreasonable to you, but it is generally most helpful to avoid immediate correction or conflict. People may hold ethical opinions strongly without ever having articulated why or how they have developed. Guiding them to understand how their beliefs have formed and what assumptions underlie them will help to set the stage for reflection and reconsideration in light of the Bible passages you will be reading together. If there are medical people in your group, work hard to ensure that they don‟t dominate the conversation! While those with a medical background may have valuable insights into bioethical problems, it is critical to look for perspectives and reflections from other members of the group. Reinforce that non-medical perspectives are valuable, and often

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shed more light on aspects that can otherwise be forgotten. Professionals, too, need to remember that their own experience and training needs to be open to reassessment in light of the Bible text. Finally, do challenge group members to think about how their faith makes a difference in their position or approach to the situations. Where possible, encourage them to articulate how their ideas have formed and what the biblical basis for them is. Ideally, members should leave the session with a better idea about how they themselves would faithfully respond if found in these situations or others like them. This is a big task but well worth the effort!

Justin Denholm Centre for Applied Christian Ethics Ridley Melbourne Mission & Ministry College

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Definitions A variety of common terms are used in this and other discussions that may present confusion for those unfamiliar with aspects of this area. While all definitions may present some elements of controversy, the following are offered as a brief and relatively straightforward glossary. “Euthanasia” refers to the intentional and active killing of another person, usually with a severe or terminal illness. Euthanasia is “voluntary” when the person killed actively requests or accedes to euthanasia, or “involuntary” when it is not consented to (for instance, in the case of a person with advanced dementia or in a coma). Some commentators have used the terms „active‟ or „passive‟ euthanasia, intending to refer to the distinction between the active killing of a person and the „passive‟ removal of life support leading to death (ie killing vs letting die). This is unhelpful terminology as it falsely conflates the cessation of inappropriate or futile medical treatment with the provision of euthanasia. Accordingly, these terms are not used in this discussion, nor are they generally considered appropriate in modern writings. “Palliative care” refers to treatments, medical or otherwise, whose intention is to relieve symptoms rather than cure disease. Popularly, this is most commonly used to discuss pain relief; however, while this is important, a variety of problems may be addressed beyond simply pain.

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Euthanasia: a Christian worldview perspective

Euthanasia is one of the pre-eminent social and moral issues of our times. In Australia, debates over the introduction of euthanasia have been conducted in State and Federal parliaments over the better part of two decades, and show no sign of abating. At the time of writing, proposals to introduce euthanasia in Western Australia and South Australia have been recently rejected, while debates are slated in Tasmania, NSW and the Federal parliament for 2011. While euthanasia, then, is of political and ideological significance, its real importance lies in the heart-felt and challenging situations in which these questions arise. The value of human life, the desire for unrestricted choices regarding one‟s own life and the social impact of lives and deaths; these issues are talked about over hospital beds and dinner tables, and reflect genuine pain, needs and desires. It is an issue of importance to a great many people, and therefore it is imperative for the Church to engage with considerations of euthanasia with thoughtfulness and seriousness. There are a variety of grounds on which the morality of euthanasia may be considered. For instance, medical organisations worldwide have opposed the practice on grounds such as the erosion of trust in medical care, while people with physical disabilities have argued that allowing euthanasia will further marginalise and serve to devalue them within society. While these positions are robust and defensible, a Christian position should begin not from these secondary considerations, but arise from the foundation of our faith. We will start with a consideration of the worldview within which Christians approach the issue of euthanasia, because discussions of character and rights are meaningless without an appropriate context. For the Christian, the Bible provides the central window into understanding God and the world he has created and that we inhabit; any ethical conclusions we draw about euthanasia must be first grounded in this understanding. Therefore, this paper will begin with an overview of relevant scriptural passages and a sketch of a biblical worldview of death, human moral value and other aspects of theology that shed light on how Christians should approach ethical questions surrounding the end of life.

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Biblical themes

Human moral value Since the establishment of the Christian church, humanity‟s status as being made in the image of God has been considered key to our moral worth. In Genesis 1:26-27, we are shown God forming the first people „in his own image‟, while in 2:7 we also see him breathing life into them. While the precise characteristics of humanity that God‟s image relates to or bestows are not made explicit, it is clear that being made in the image of God sets humanity apart. These events demonstrate humanity‟s distinctness from the rest of creation, reinforced by God giving humans dominion over all the earth. Psalm 8:3-8 provides further reflection on humanity made in the image of God, marvelling at the dignity and value that human beings have been given. Furthermore, creation in the image of God is morally significant, as made explicit in Genesis 9. In this passage, the image of God is given as the reason why killing another person is wrong. While a variety of reasons to treat other people with dignity and respect are portrayed in the Bible, the first and most basic is that all of humanity bears the image of God. Illness and disability The biblical portrayal of disability is an important issue because of the frequency with which it is raised in discussions of euthanasia. The picture of illness and disability portrayed in the Bible can be seen as somewhat of a mixed picture. On one hand, sickness and disease were never intended in God‟s perfect world, and God‟s people look forward to a time when there will be no more suffering, when every tear will be wiped away (Is 65:17-25, Rev 21:3-4). On the other hand, the way in which David welcomes Mephibosheth, Saul‟s grandson with „crippled feet‟, is full of respect (2 Sam 9). We are shown Jesus‟ dealings with sick and disabled people in many instances through the Gospels, where we see him interacting with and caring for them (eg Mt 8:1-4, Lk 5:1726, Jn 5:1-9). This demonstration of care for the disabled is a consistent pattern, one we are shown being continued by Jesus‟ disciples (eg Acts 3:1-11). The weak and vulnerable The call to protect the widows, orphans and foreigners is perhaps one of the strongest societal obligations placed on God‟s people throughout the Bible. Deuteronomy 24:14 exhorts God‟s people to treat the poor fairly and equitably because of the vulnerability of their situation. In Zechariah 7:8-14, we see God‟s judgement on people who do not take care of the socially vulnerable, naming particularly the widows, orphans, strangers and the poor. Isaiah 1:17 equates righteousness with seeking justice for the oppressed and urges God‟s people to do so. In the New Testament, this theme is continued in many passages, both in the Gospels and the epistles (eg Lk 14:13, Gal 2:10, 1 Tim 5:3, Jas 2:2-

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6), further reinforcing the centrality of God‟s call to defend and protect the marginalised in our world. Families and old age The Biblical narrative has a great deal to say about the importance of family, far beyond what a brief synopsis can encapsulate. In this context, however, it is worth highlighting a few relevant aspects. The care for extended family, particularly provisions for elderly relatives, is modelled frequently. In his first letter to Timothy, Paul connects this imperative closely with true faith, saying “if anyone does not provide for his relatives… he has denied the faith…” (1 Tim 5:8). Chronically ill people are frequently brought to Jesus for healing, apparently by the faithful friends and family who cared for them (eg Lk 5:17-26). While the social and healthcare structures in place today are far removed from the Biblical world, the strong imperative to see family cared for faithfully remains. Killing Many passages in the Bible recognise a general prohibition against killing. The most recognised comes from Exodus 20, where it is included as one of the Ten Commandments; a number of other passages, however, are equally supportive of such a conclusion. Genesis 4 shows us killing for the first time entering the world in the aftermath of the Fall. Passages such as Deuteronomy 22: 8 indicate that God‟s people were required to take reasonable steps to prevent even accidental killing. In the New Testament, Jesus‟ commentary and explanation of the Law tended to, if anything, further strengthen the moral imperative against killing (Mt 5:21-22). Throughout, it is particularly the deliberate killing of other humans that is wrong, as evidenced by the provision of sanctuary cities in the Old Testament, where those who had accidentally killed would be protected (Deut 4:41-42). There are instances in the Bible where killing is commanded or approved of by God. We should acknowledge that there are situations where killing is either mitigated or considered acceptable. Apart from accidental killings, these situations appear to fall into two categories; either they are in the context of holy war or they are prescribed by God in the context of maintaining purity in the theocratic state of Israel (eg Deut 24:7, 1 Sam 15:1-3)1. Perhaps the most readily identifiable consideration of assisted killing in the Bible comes from the death of King Saul (1 Sam 31). In a hopeless military position and facing capture from the enemy, Saul commits suicide after another soldier refuses his request to kill him. As with much Old Testament narrative, the story is told in these verses without comment, but later referred to again (2 Sam 1:1-17) as a soldier tries to claim credit for having killed the king. Despite his claim that Saul, a wounded man close to death, had asked to be killed, the soldier is himself executed in punishment. Together, the

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Although there is not scope in this paper to consider this question in detail, I would argue that neither of these latter exceptions is applicable to Christians today.

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impression that the stories offer is that assisted killing in such circumstances is morally wrong. Compassion, pain and suffering The Bible has a great deal to say on the subject of pain and suffering. First, it is frequently mentioned, and understood to be a reality in this world. God promises, though, that he cares about people‟s suffering and is present with them in it (Ps 119:50). Because of Jesus‟ suffering, he understands suffering and can empathise with our pain (Heb 2:18). Jesus made it clear that illness and pain are not an individual‟s punishment from God (Jn 9:1-4). Frequently, Jesus healed those around him (eg Mk 1:34) as he dealt with both the spiritual and physical damage in people‟s lives, pointing to the complete healing that will ultimately come in God‟s kingdom (Rev 21:4). Many stories of Jesus‟ healing include specific mention of the care and compassion he felt for suffering people and those around them; sentiments that his followers are likewise called to (eg Mt 20:34). Even though pain and suffering are unwanted, they can also bring benefits, particularly in character and spiritual development (Romans 5:3-4, 1 Pt 4:16). While difficult circumstances may allow opportunities to grow in character and relationship to God, Christians are not called to be masochists or to seek pain. Even Jesus asked if his painful death on the cross could be avoided (Mark 14:36). Finally, pain and suffering are things that should be dealt with openly, in community. It is good to support and grieve with others in pain (Rom 12:14), and we are given many examples of reacting honestly to suffering and distress (eg Ps 55:22, Job 3).

Death Finally, a Christian perspective on euthanasia must be approached in the context of a Biblical understanding of death itself. Death entered the world at the Fall, as God‟s consequence for sin (Gen 3:21-3). Death, however, cannot separate Christians from God‟s love and control (Rom 8:38). Through his death on the cross, Jesus died to defeat death (Heb 2:9). Finally, Revelation 21:4 describes a new Earth after Christ‟s return, where sickness and death no longer exist. Christians, then, look forward to a time when there will be no more death. Christians do not need to fear death, but it is still frequently a sad occurrence. It may be particularly difficult for relatives and friends of dying people who do not know God, as after death everyone will face judgement from God (Heb 9:27).

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Systematic considerations

Taken together, these passages provide a powerful image of the world that God intends and that his people are charged to long and work for. We are shown a world where the elderly and extended families are loved and honoured. Human beings of all ages and abilities are respected and ascribed moral value because of their relationship with God and having been created in his image. God‟s people have been charged with responsibility to protect the weak and vulnerable people in our world, and more generally, to live in a way that reflects the standards and character of God. Finally, we see a general prohibition against killing which may not extend to every situation but appears to be a consistent principle that underpins our approach to other human beings. To envisage euthanasia in such a world would be a difficult, almost incomprehensible thing. It seems clear that the deliberate killing of a person stands in jarring contrast with the priorities and values of the biblical worldview outlined above. The Bible‟s message is consistent and provides little purchase for those who would seek to defend the practice of euthanasia. When seen in the setting of a biblical worldview, the practice of euthanasia is not simply one that hangs on the moral value of the individual, but one that devalues God, in whose image people are created. It is also one that devalues the sacrifice of families dealing with sickness and providing care for loved ones, by intimating that their dedication is unnecessary or even inappropriate. For some, the biblical ideal and the world we see around us are just too different. Christians might long for a day when every tear is wiped away and there no longer remains any need for euthanasia, but feel that the imperfect world around us will create situations where euthanasia is the right thing to do, or at least is the lesser of two evils. Others feel that opposing euthanasia is a „lost battle‟ – that the weight of modern society will eventually legalise the practice and that the church should just fall into line with society. It is true that we live in a fallen world where the tragic is commonplace and human brokenness stains every part of life. To think, however, that this somehow means that we should retreat from the teaching of the Bible on this subject is to miss the mark entirely. For the Christian, ethics is not a matter of pragmatism or influence but of being the faithful people of God. The difficult task for Christians who want to faithfully deal with ethical issues is that they must live in two worlds; the world that God planned and made and will one day make perfect, and the fallen world in which we now live. Christians who live only in the first world can have no answer to the problems of painful reality; Christians that live only in the second have no hope of showing a broken world what God longs for it to be.

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Application

With a Christian worldview in focus, we now turn more directly to the ethical questions of euthanasia. What conclusions can be drawn about how we, as individuals and the Church, should consider and respond to euthanasia? Generally, as I hope will be clear from the preceding discussion, I believe it means Christians should be opposed to euthanasia. The Christian worldview as seen in the Bible portrays a world where euthanasia is at the very least an issue of great moral significance, and our ethical starting point should be a strong presumption against it. There are a number of reasons for adopting these conclusions, of which I would like to touch on four as being of special significance. The first reason, which follows from the biblical outline above, is because human beings have intrinsic moral significance and value. As we have seen, humanity is accorded great worth and significance because of being made in the image of God. There is little basis for concluding that this value is dependent on physical or mental characteristics, or that it is lost due to physical impairment or illness. The consent of an individual or their desire to die does not change the way that the killing of another also violates and devalues God‟s image. A second reason for the opposition of euthanasia is to stand in defence of the weakest members of our community. There is a strong biblical call for God‟s people to protect those whom society abandons and marginalises. While in previous ages this was most strongly expressed in the care for widows and orphans, the call for the church is to stand on behalf of those in need of protection; something often missing in the debate about euthanasia in Australia. Like so many other marginalised groups, the terminally ill and disabled can sometimes be voiceless in this conversation, and the church is called to speak on their behalf. This consideration may surprise some people, as in Australia euthanasia advocates are often thought to be vocal and public. However, allowing euthanasia would increase pressure and marginalisation for many sick and elderly people, afraid of „burdening‟ their families and communities. Maintaining an opposition of euthanasia as a society, then, continues to support and value people in a way consistent with the Biblical ideal. Third, the church is to be distinct and visible. Our aim should not be to blend in with the prevailing morality of our time, but to be clear in upholding a gospel message and God‟s standard. Our moral call is to be “blameless and innocent, children of God without blemish in the midst of a crooked and perverse generation” (Phil 2:14-15). It is to be expected that we will be in conflict with a world that does not know Christ; our task is to faithfully represent the truth that has been revealed to us through the Bible. Finally, as Christians we must be prepared to submit to the teaching of the Bible. Although there are many moral issues today that require careful thought and deliberation,

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the way in which we think and respond to them must be grounded in God‟s Word. We need to be faithful followers of Jesus, and must take seriously the message given to us through the Bible. One important alternative Christians should reflect on is the provision of good palliative care for dying people in our society. Palliative care does not mean that appropriate medical care and attention ceases, but instead that the focus of that care is to ensure comfort rather than to seek cure. It is more than simply the provision of pain relief, although this may be an important element in some situations. The palliative care we should be striving to provide includes space for physical and mental peace, the reaffirmation of relationships or sometimes healing of those that have been damaged. It also may provide a space in which spiritual matters can be discussed, and the power and grace of Jesus may be brought. This is not simply a role for professionals, as any of us with dying friends or family have seen. While sometimes challenging, we can help to support and care for sick and dying people through sharing time, offering practical help and conversation; often things that are as valuable as any professional carer can offer. Despite the rhetoric that is sometimes heard, euthanasia and good palliative care are opposed to one another, and an introduction of euthanasia would inevitably damage our ability to care for dying people and their families. Good palliative care can be costly, both of time and resources, not to mention the emotional and spiritual support required from carers and families. Health professionals need support from Christian communities to continue to provide good and better palliative care, and the Church owes it to the dying people in our society to do so. We would seriously undermine the efforts to develop and provide palliative care if we were not to wholeheartedly affirm and defend the value of human life, both in our words and actions. For individual Christians, this means that we must approach questions of euthanasia with great seriousness and humility before God and his Word. We above all people should be examples to those around us in how we respect God‟s world and seek to behave as he would have us do. Christian health professionals or carers should not participate in or support euthanasia, because this is part of living faithful lives and because it represents a powerful way to show the difference that Christ makes in our lives. For the church and for Christians as members of society, this means that we should be unapologetic and visible defenders of life. In a democratic society, this should include seeking to defend laws that protect the lives of all. It should also mean a radical and transformational response to those around us who care for relatives and families, or those who are considering euthanasia. As much Church should defend life, we must not be simply a people who stand up and say „no‟. We must do more for suffering people, struggling carers and families than simply deny them an option many in society would offer them. We must be a people who stand and say „yes‟ – yes, we will care for you, we will stand with you, we will take you to Jesus for healing and forgiveness. We must be a people who will fight for protection of vulnerable people and their families, and who long for the inauguration of all of God‟s plan under the Lordship of Jesus Christ.

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Study guides

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Session 1 – Aging and caring

What does our society think about getting old? What are more valued, youth and energy or age and experience? Can you think of some examples, for instance from advertising or popular culture?

Read the following passages : 

Exodus 20:12



Leviticus 19:32



Proverbs 16:31



1 Timothy 5:1-2

How do these verses fit with our society‟s perspective on aging? Does our church think of elderly people differently from our society? How?

Read the following passages: 

Joel 1:2-3



Titus 2:2-5

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From these passages, what are some of the positive aspects of aging? What benefits might elderly people bring to a Christian community?



Read 1 Timothy 5:3-8.

What does Paul say about caring for family in this passage? Why is it so important?

How does our society approach caring for sick or elderly relatives? In what ways do you think this has changed in the last generation or two? Do you think our society does a good job in caring for people?

In what practical ways could our care for the elderly be improved? How might Christians practically demonstrate the way God cares for them?

Closing prayers might remember particular people or situations the group has identified during discussion, and practical ways members might respond to family or others in need around them.

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Session 2 – The image of God Start by reading the following passages: 

Genesis 1:27



Matthew 19:4

These verses talk about people being “made in the image of God”. What does this phrase mean? Read the following passages. What further insights into this idea might they offer?



Genesis 1:26-28



Psalm 8:5-8



Ephesians 4:24



James 3:9-10



1 John 3:2

It is often argued that the respect due to people made in the image of God itself makes killing wrong. Read the following passages. If human beings are made in the image of God, can killing people ever be justified? In what circumstances?

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Exodus 20:13



Exodus 22:2-3



Genesis 9:5-6



Deuteronomy 25:17-19

While these passages suggest that killing people might not be absolutely prohibited, they do appear to relate to special situations such as war or self-defence. While some elements of this may be controversial today, how do you think the passages so far might relate to killing that happens voluntarily, such as assisted suicide or euthanasia?

Discuss, then read the following passage: 

1 Samuel 31:1-13-2 Samuel 1:1-15

This is perhaps the Bible passage which most closely reflects voluntary euthanasia. How does it portray it? Does it fit with your earlier discussion? Finish by summarising the conclusions your group has come to about the image of God and what it means for how we might think about euthanasia.

Closing prayers could include thankfulness for humanity‟s creation in the image of God.

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Session 3 – Talking about euthanasia Start by reading this opening vignette: Mrs G is an 84 year old woman who has lived in a nursing home for the last 5 years. She had a long history of Alzheimer‟s dementia, and has become steadily less engaged in the last few years. Her family feel that it has now been some time since any of them were reliably recognised on their usual visits. Her family have talked together about this situation often. They feel strongly that she would „not have wanted to live like this‟, but agree that she does not seem to be in any pain or discomfort. Although they still visit regularly, they feel uncomfortable and are not sure what they‟re meant to think. They are Christians, and are not sure exactly what their faith has to say about their situation. Mrs G‟s son David has been talking with some friends at work about euthanasia, but hasn‟t made up his mind about what he thinks. He comes to have coffee with you one afternoon, and asks “what do you think about euthanasia?” How would you feel about being asked this question? Are you comfortable talking about it? Do you feel confident about what you would say?

David wants to find out what the Bible says about his situation. Below are three Bible passages that Christians sometimes have thought were relevant to these questions. Read each of them out loud, and talk about what light they might shed on his questions. 

Genesis 4:8-12



Exodus 20:13



Matthew 5:21-22

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Are these passages helpful? Are there other passages that you might talk about? What principles or values do they display? What would you say about them to David?

Some of David‟s non-Christian friends support making euthanasia legal, and he has sometimes found it difficult to respond to their arguments. Below are several common statements made supporting euthanasia. What do you think about the argument? How might you answer from a Christian perspective? “If a dog was in pain, you‟d put it down”

“It‟s everyone‟s right to die with dignity”

“Euthanasia is the only kind response to incurable illness”

Finish by talking about how your group might support each other in having good conversations about euthanasia or other ethical issues. What other resources might help you?

Closing prayers might include asking for confidence and help to support each other with tackling difficult questions faithfully.

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Further reading and resources

These studies are by necessity a brief consideration of euthanasia, and members of your group may wish to explore further. In particular, these studies have focused on Biblical approaches to euthanasia, rather than the range of pragmatic or non-Christian perspectives that might also be considered. The following short list of books may be helpful for considering alternative approaches to euthanasia, or to illuminating different aspects of the moral debates that surround it.

General Christian ethics “Moral choices: an introduction to ethics”, Scott B Rae. Zondervan, 2009 “The how and why of love”, Michael Hill. Matthias Media, 2002 “Issues facing Christians today”, John Stott. Zondervan, 2006

Christian bioethics “Bioethics: a primer for Christians”, Gilbert Meilander. WB Eerdmans, 2004 “On moral medicine: theological perspectives in medical ethics”, Steven E Lammers and Allen Verhey (eds). W B Eerdmans, 1998 “Valuing people: human value in a world of medical technology”, Gareth D Jones. Paternoster, 1999

Alternative perspectives on euthanasia “Causing death and saving lives”, Jonathan Glover. Fordham University Press, 1994 “The end of life: euthanasia and morality”, James Rachels. Oxford University Press, 1986 “Bioethics: an anthology”, Helga Kuhse and Peter Singer (eds). Wiley-Blackwell, 2006

Finally, the Centre for Applied Christian Ethics is continuously updating small group materials, which can be downloaded from www.ridley.edu.au. To discuss other issues or talk about personalised ethical discussion materials or sessions, please email us at [email protected].

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