End of Life

One of my parishioners asked me whether I’d be willing to carry out a funeral service for someone who’d signed a Non-Resuscitation Agreement, ‘because I’ve signed one’, he said, ‘and I’ve heard of priests who treat it as amounting to suicide and won’t’. ‘I’ve got no intention of popping my clogs yet,’ he went on, ‘But if my heart does stop I don’t want to be kept going wired and tubed up to a machine’. Patients who have signed the form, apparently, have to put a symbol on the gatepost so that when the paramedics turn up they know to go into the house and retrieve the paperwork. I assured him that I had no problem with the idea. The Prayer Book merely states that the Funeral Office is not to be used ‘for them that have laid violent hands upon themselves’- although it gives no guidance as to what ministers are supposed to do instead – and, of course, we all follow the Prayer Book implicitly. There’s a clear difference between laying violent hands upon yourself, and insisting on your life not being artificially prolonged.

At least so we instinctively feel; or is there? The intentional suicide takes life, and as it is their own life, dies, so an old-fashioned view might argue, in a state of mortal sin. But nobody I have known kill themselves, or who was tempted to do so, was in a sound mental state. Terrible though the act always is, the suicidal person has tragically reached the point where they can’t see beyond their own pain and despair, and you may question the degree of responsibility such a person has. Yet, if mere life is the criterion the Church is to judge by, then setting down the circumstances in which you would ask medical professionals not to keep that life going when they could is perhaps morally no different from catching the plane to the death clinics in Switzerland at a time of your choosing, and both acts witness to an intentionality greater than that of the mentally disturbed suicide.

We often talk about dying naturally and distinguish it from being ‘kept alive artificially’ by all the paraphernalia of modern medicine. Yet most of the time a natural death at the hands of disease or injury is the last thing we want: if we have useful years of life left to live, we want that artificial intervention. The dreadful paradox of modern medicine is that exactly the same miraculous technology and the same medical ethic that drive the saving of life when we do want it are the same as those which drive the extension of life beyond the point where it burdens us; you can’t have one without the other. Again, an old-fashioned Christian ethic might have condemned the removal from God’s hands of the control over when a human being dies; yet, if God’s will is seen as being expressed by natural forces as opposed to human acts, then any medical intervention at all is a rebellion against God, and we tend not to think that.

Our language is inadequate to express the problems posed by our technological advances; and, although the purpose of the Church’s moral categories and strictures is, rightly, to insist on the absolute worth of human life, when that insistence produces perverse results in terms of inflicting pain and damage on real people you have to question whether we really understand our own ethic. Clearly ‘mere life’ is not what we are talking about, and there has to be some sense of a life having value – but the decision as to where value lies is profoundly dangerous. It can’t be its value to the person alone, or you are left with nothing to say to the suicide in their hopelessness. It can’t be its value to society, or you are left with no weapon against the eugenicist. Could it be the value of a life to God? But what is the value of a human life to God?

If we are God’s children, and life is his gift to us, does a loving parent force an unwanted gift on their child? They might, if it would do them objective good. But what might that good be, if the life is burdensome and painful? ‘Who of you fathers’, says Jesus in Matthew’s Gospel, ‘when your son asks for bread, will give him a stone? Or if he asks for a fish, will give him a snake? If you then, who are evil, know how to give good gifts to your children, how much more will your father in heaven give good gifts to those who ask him.’ God is not cruel and is not arbitrary. What he gives us must be with reason. The question is whether a particular state or situation is his gift, or just part of the world’s arbitrarily-distributed pain, and whether working with that pain will do us or anyone else any good, any longer.