Should Communion be Served at Weddings?
minimum 1000 word response
Utrum Paper[footnoteRef:1] [1: Adapted from Nancy Duff’s course “Issue in Bio-Medical Ethics,” Fall 2004.]
Instructions: Students will compose two 1000-word utrum papers on topics related to course content. Further instructions will be posted on Discovery. DUE 24 February and 24 March, respectively.
· First Paper
· Closed vs. Open Communion
· What Happens During Communion
· Should Communion Be Served At Weddings
· Wine vs. Juice in Communion
· Digital Communion vs. In-Person Communion
· Traditional vs. Non-Traditional Elements
· Should Communion Only Be Served By Clergy
· Other Related Topic as Approved by the Professor
· Second Paper
· Egalitarian vs. Complementarian/Traditional Marriage
· Divorce and Remarriage
· What Constitutes Christian Marriage
· Cohabitation
· Performing Weddings for Divorced Christians
· Performing Weddings for Non-Christians
· Same-Sex Marriage
· Other Related Topic as Approved by the Professor
The paper must interact with the selective topic as well as authoritative outside sources and give 1) a fair hearing to a position that you oppose and 2) a persuasive argument for the position you hold.
1. The utrum. “Whether or not it is the case that…” (utrum=“whether”)
In one (!) sentence state your issue in such a way that you will be able to provide two fair and persuasive, yet opposing, arguments, one of which you will refute.
Example, using abortion:
Whether or not it is the case that abortion should legally be defined as murder.
Do not add comments to this statement. Also, do not word the utrum to reveal your own position, e.g. “Whether or not it is the case that baby-killing should be legal.”
2. The videtur. “It seems that…”
State in one sentence and then present arguments for a position that you finally reject.
Example:
It seems that abortion is murder and should be legal only in cases where it can be deemed self-defense, i.e., when the pregnancy threatens the life of the women.
Following this statement write a few pages giving as convincing an argument as possible supporting this position. Remember our rule for academic debate: “You should be able to state your opponent’s position so clearly and so fairly that your opponent could say ‘Yes, that it what I mean.’” Present arguments that are actually worth refuting, not “straw” arguments that are easily dismissed. In other words, present arguments that you find challenging and worthy of addressing, when you present your own position.
3. The respondeo. “I answer that…”
In one or two (!) sentences state your position. Do not just repeat the utrum, but state your position clearly and concisely so that someone reading it would know where you stand even before reading your defense of this position.
Example:
I answer that even though early stage abortion entails the destruction of nascent human life, it should not legally be defined as murder.
4. The ergo. “Therefore…”
Write in a few pages a convincing argument for the position that you hold, drawing on material (of a suitable academic quality) you find helpful. Respond to legitimate questions and issues you have raised in the videtur (step #2), explaining why you finally reject them.
“[It] would seem like wisdom but for the warning in my heart” 1
An Utrum Investigation of Physician-Assisted Suicide
1 Frodo Baggins, The Lord of the Rings
Joshua R. Ziefle
ET436: Issues in Biomedical Ethics
November 8, 2004
LG
SBN 424
1. Utrum: Whether or not it is the case that physician-assisted suicide is ever morally acceptable.
2. Videtur: Though not morally acceptable in every circumstance, there are times when a person’s
quality of life and/or potential for recovery make physician-assisted suicide a viable moral option.
It can be said without a doubt that physician-assisted suicide is one of the more contentious issues
in today’s society. By this we here refer to the process known as “voluntary active euthanasia,” wherein a
patient desires that active methods be taken to end their own life. Whatever term is used for the
procedure— “mercy-killing,” euthanasia, or otherwise—the seriousness of its action never fails to impress
itself upon those considering its use. Thus it is no great surprise that related issues are often emotionally
charged and various individuals have solidified and combative opinions thereto. But to acknowledge that
the issue is controversial and demands serious thought does not mean for that reason that it should be
rejected outright. Complicated issues require complicated and nuanced answers, and physician-assisted
suicide is no exception. Through this discussion, it will be shown that while it remains a difficult and
complicated issue that has clear moral boundaries of right and wrong, there are circumstances and
considerations that make physician-assisted suicide morally acceptable.
Perhaps the main issue around which all else revolves is the question of whose right it is to end a
life. For this, at least, we have the law to guide us. Murder, which involves the taking of a person’s life
without their consent, is criminalized by nearly every legal system known to humanity. Life is seen as
important to protect and human beings guard their own existence against the wishes of others. In this
fashion there seems to be an axiom in nature—all things being equal, it is inappropriate for someone else
to decide when another person’s life is to end. This said, the debate over whether a person has the right to
decide when they themselves will die remains open. For if a major problem with murder flows from the
notion that it deprives one of their life from without, the question of whether or not the choice to die can
come from within is still cogent. While it is not clear that one flows directly from the other, the seeming
inviolability of outside interference in ending a life at least leaves open the possibility that one’s life is one’s
Ziefle 2
own to decide. That an individual has the right to say when someone cannot end their life means that they
themselves have a modicum of control over their existence. Though no one else may do so for them, it
would seem that an individual can decide to end their own life—simply because it is theirs. We would cite
Dr. Timothy Quill at this point, who states: “I have been a longtime advocate of active, informed patient
choice of treatment or nontreatment, and of a patient’s right to die with as much control and dignity as
possible.”1 Though some might argue that murder is prohibited not because of a lack of permission but
because of the general sanctity of life, we would disagree with this position and cite the less stringent laws
on suicide in places like Washington state and the Netherlands as examples of this difference.2 Suicide
can be allowed because it places responsibility for one’s life exactly where it belongs—in one’s own hands.
A few clarifications deserve to be offered at this point. First, as we have attempted to delineate
above, there must be a clear distinction between physician-assisted suicide and physician-initiated murder.
Under no circumstances should the latter, as involuntary active euthanasia, ever be used. Since the right
to death lies solely with the person doing the dying, only he or she can make that decision. Only if they do
so can the action be considered morally justifiable. Even this position needs to be clarified, for though a
patient has the right to decide upon death, assisting physicians must be clear that the person’s true
thoughts on the matter have been revealed. Both evidence of a sound mind and clear deliberation need to
be observed and discussed before any action or assistance can be provided by a physician. In this we
would be much more in agreement with the rules of the group “Compassion in Dying,” which has “written
guidelines that cover every detail, from how patients are chosen to how many Compassion members will
attend an assisted death,”3 than the questionable and sensationalist actions of Jack Kevorkian. Especially
important in this is the notion that “only lucid patients who could take their medicines themselves would
1 Timothy E. Quill, “Sounding Board: Death and Dignity—A Case of Individualized Decision Making,” The New England Journal
of Medicine 324 (March 7, 1991): 692.
2 Lisa Belkin, “There’s No Such Thing as a Simple Suicide,” New York Times Magazine (November 14, 1993): 50, 53.
3 Ibid., 51.
Ziefle 3
qualify for help.”4 The last consideration that would need to be made before a physician might assist in a
suicide would revolve around quality of life matters. Simply stated, physicians should only be allowed to
assist in suicides if there is a specifically medical dimension—unacceptable physical pain, terminal illness,
or debilitating physical impairments. The existential crises and decisions of physically healthy individuals,
while no less serious, will have to be prosecuted outside the medical purview.
Having established the general basis for physician-assisted suicide and establishing a framework
for its use, it is equally essential that we turn to the specifics of how it can be a morally acceptable choice.
First in this are the issues of health and quality of life concerns. Though we agree that life in general
deserves to be protected and recognize that physicians are charged with that duty, there are times in
patients’ lives when the pain and anguish of existence have become too painful or meaningless for them
too continue onward. As Mark Duntley Jr. writes, “it is understandable that many have come to believe that
there are indeed times when the hopelessly suffering should be allowed to choose a quick and merciful
death at the hands of a medical professional.”5 Heretofore simple decisions are much more complex.
What is, after all, more moral—keeping someone alive who is suffering from debilitating and persistent pain
or letting them end their life and its accompanying anguish? We feel that it is ethically untenable to force
someone to continue in pain that will not get any better and has no purpose. Even Timothy Quill—though
opposed to physician-assisted suicide—can cite theologian Karl Barth to call this action “well-meaning
humanitarianism.”6
So too ought physicians to assist in suicides where there is deep psychical pain that has no hope
of being remedied. Those with debilitating illnesses who are handicapped beyond their ability to live a
meaningful life should be given the choice of ending an existence whose very being is for them one of pain.
4 Ibid., 54.
5 Mark A. Duntley, Jr. “Covenantal Ethics and Care for the Dying,” in On Moral Medicine: Theological Perspectives in Medical
Ethics, 2nd Edition, eds. Stephen E. Lammers and Allen Verhey (Grand Rapids: Eerdmans, 1998), 663.
6 Gilbert Meilaender, “Euthanasia and Christian Vision,” in On Moral Medicine, 658.
Ziefle 4
Though every option should be presented to them and time allowed for them to make an informed decision,
forcing them to continue in a painfully diminished existence is an unacceptable moral position. Gloria
Maxson’s article, though holding a position opposite to this, does not remove the possibility that one would
want to end their life. To be sure, it shows that she personally does not want to end her life via suicide—“I
will never willingly relinquish a life that contains my husband, family, [etc.]”7—but this remains a far cry from
denying the possibility that no one is morally justified in so wishing.
For the terminally ill, the question of physician-assisted suicide is much clearer. Faced with the
prospects of life in a dying body wracked with pain, discomfort, and diminishing ability to maintain an
equilibrium in life, some choose to die on their own terms and in their own time. Here we part company
with Pope John Paul II, who refers negatively to a “culture of death” that involves the taking of life “before
one reach[es] the natural point of death.”8 As the kind of “living death” we have been describing seems
much more akin to perpetuating what we consider a “culture of death” than what the Pope has considered,
there seems little reason not to finish what nature is taking its painful time to do. Ending the lives of
terminal patients who desire such action can help to give them a peace of mind and sense of control, allow
them to die with a modicum of dignity and respect, and give those they leave behind a last image of their
loved one in control and lucid rather than shrunken, weakened, and emaciated. Again we ask which is the
more merciful—making someone and their families go through the slow and debilitating decline into death
over a potential period of weeks or months, or letting someone die quickly and painlessly? For our part, the
answer is clear: “mercy or compassion toward the dying and suffering seems to be central to any
philosophy of healing, and most certainly is the primary argument for the morality of euthanasia.”9 It is this
manner of psychological comfort that plays a key role in our argument for physician-assisted suicide.
7 Gloria Maxson, “’Whose Life Is It, Anyway?’ Ours, That’s Whose!,” in On Moral Medicine, 649.
8 Pope John Paul II, “Homily of Pope John Paul II at Cherry Creek State Park, Denver, Colorado, on the
Feast of the Assumption,” (August 15, 1993), available at http://www.columbia.edu/cu/augustine/arch/jp2/denver17.html
9 Duntley, 664.
Ziefle 5
Needless pain need not be suffered, and those who support this method of addressing the issue are the
most merciful.
From the Christian perspective, physician-assisted suicide remains complicated. As Nancy Duff
has pointed out, the tradition both sees death as both a natural part of life and a great enemy to be
defeated.10 As both of these positions are accurate from the Christian mindset, there is a sense in which
death presents the ultimate puzzle. What this means for physician-assisted suicide is equally complex. In
this Duff’s provisional answers offers a helpful guide through the surrounding debate. Understanding ethics
through the lens of vocation and an emphasis on a person’s God-given life in the here and now leads her to
hold that “Christians need to enter the discussion about assisted death not with absolute rules nor with an
eye solely to what is practical” but need to be attentive to the fact that “the Reformed doctrine of vocation
leads us to reject the utilitarian response to assisted death…[and] also prohibits an absolute position
against ever taking an action which would hasten death.”11 Situations present themselves in which the
procedure may be acceptable; conversely, there may be times when it is wholly inappropriate. A casuistic
approach is ultimately necessary to address the situations as they arise. Thus a doctor who refused to help
a patient die because he wanted to maintain biological life at all costs could be in the wrong. So too would
a patient who desired to die rather than undergo a minimal corrective surgery. The former puts too much
emphasis on death as an enemy rather than a natural part of life; the latter emphasizes that death was a
part of life to the expense of seeing it as an opposable enemy. Clearly, a case-by-case approach to the
issue of physician assisted suicide is important if we are to determine its moral viability. That it can be
morally acceptable in certain circumstances must not be denied.
In the end, the morality and ethics of physician-assisted suicide—while complex—are nevertheless
worth investigating. For just as such a system is (as some have posited) open to abuse, the benefits that it
10 Nancy Duff, “Reformed Theology and Medical Ethics: Death, Vocation, and the Suspension of Life Support,” in The Future of
Reformed Theology: Tasks, Topics, Traditions, eds. David Willis and Michael Welker (Eerdmans, 1999), 306.
11 Duff, 319, 318.
Ziefle 6
provides under the proper circumstances are worth the risk. The basis of this argument derives from an
ethical framework that understands a sane and psychologically balanced person to be the best judge of
whether or not they should continue living. As they make responsible decisions and choose to involve
physicians in their suicides, all are able to participate in a morally justified manner. By assisting in
alleviating the physical pain, mental anguish, and the suffering of patients and their loved ones, doctors
through physician-assisted suicide can be performing a moral action. Letting a painful life needlessly drag
on is not justifiable if the patient does not wish it; physicians, ethicists, and people of all persuasions must
become aware of this. For the Christian thinker or one more hesitant to engage in said action, this means
that attention must be given to the specific cases in which euthanasia is requested. Only then is a moral
choice able to be made. Even if general rules may exist, callous and unchangeable laws may not.
3. Respondeo: I respond that in spite of the pain and suffering that can occur the natural
progression of life must be honored and physician-assisted suicide rejected as morally and
ethically unacceptable.
4. Ergo:
From the outset, my position in this matter rests with the conviction (shared with Meilaender and
Barth) that “’our lives are not our own.’”12 They are created by God and sustained by God’s grace and love.
The prohibitions against murder in worldwide societies thus have little to do with the fact that one’s life is
being taken away from them without permission, but with the fact that a God-given life is being killed that
should not have been. Suicide is in a moral sense akin to murder because both are illegitimate aims. We
should make no mistake at this point—physician-assisted suicide, as active voluntary euthanasia, is not the
same as withholding the technological means of unnaturally prolonging life. It is the ending of a natural life
that could exist and remains viable. It is an active force opposed to that “loving gift from God” to which “all
12 Meilaender, 656.
Ziefle 7
human beings must live their lives in accordance.”13 As the Divine is that which creates human existence
in nature, human beings ought to follow that nature wherever it leads. There thus remains a normative and
appropriate course and progress to life.
All of this is not, of course, to discount the immense pain and suffering that can and does take
place in the world at large. Whether self-inflicted, expected, or surd, these evils reach to our collective core
and cause us pain as great as it is profoundly real. Thus I am not here suggesting that this pain be
accepted because it will make us better people or draw us closer to the sufferings of Christ. The assertions
of Pope John Paul II and Gilbert Meilaender to this effect are troubling in any case and need to be heard
only with great care.14 These are often second-level reflections coming from those with no pain in their
lives and should not be projected upon the masses. While for the Christian these statements may carry a
great deal of truth with them, they just as easily may not. Further, what of the secularist, agnostic, or
atheist? Will these appreciate the great gift that pain is? Most likely, they will experience it just as it is—
suffering and evil.
So why then should I rule out physician-assisted suicide as a viable moral alternative? Because
suffering, like death, is a part of fallen human existence common to all. Because it is not in our right to take
a life, whether ours or that of another. And finally, because love and concern for the person in question is
what is required in an ethic that would never aim for death: “love could never euthanize.”15
That suffering is a part of fallen human life is an axiom.16 Few if any have gone through life without
the kind of pain or anguish that could be classified as real suffering. Humanity tries to address it in many
ways and has a host of counselors, therapists, druggists, and doctors to deal with its pain. We manage as
best we can in this life to deal with pain of all shades, yet never finally put it to rest. Indeed, the only way
13 Pope John Paul II, “Declaration of the Sacred Congregation for the Doctrine of the Faith (May 5, 1980) in On Moral Medicine,
651.
14 Ibid., 652-3 and Meilaender, 659.
15 Meilaender, 661.
16 Pope John Paul II, “Declaration…,” 652.
Ziefle 8
we would be able to take care of the matter of pain with any true finality would be for all of us to end our
own lives—for as long as we live we are open to the potential and reality of suffering. Of course at this
point some will aver and say that not all suffering is the same and sometimes it may be of such a long-term
and excruciating level that suicide is the only option. While this could be the case, I would ask simply:
Which cases? Who gets to decide? How much is too much suffering and how much is “not quite enough?”
To these questions there can be many answers, but ultimately none that are correct.
Ultimately, the issue is not able to be resolved as long as it is human beings who assume the
authority to decide. The taking of one’s own life or helping one to do the same is akin to “playing God” and
assuming a responsibility that is and has not been given. In so doing one acts with callous autonomy in
what Richard McCormick calls “an act of isolation and abandonment.”17 However, if we recognize
ourselves as “creatures—not Creator” instead of those who “have ceased to believe in a God whose
providential care will ultimately bring about whatever ought to be the case,” we “will recognize limits even
upon [our] obligation to do good.”18 Attempting to help someone in alleviating their suffering is one thing—
indeed, this statement in itself would provoke little controversy—but inappropriately taking the power of life
and death into one’s own hands is ultimately wrong. Simply stated, we as human beings cannot state
when it is right for someone—including ourselves—to die. That right rests with God and the natural world
in which God has placed us. Thus when it is time for a person to die, all must accept it and not try to
illegitimately prolong life. At the same time, we must take care never to hurry it along when it is not yet a
person’s time.
However lambasted or critiqued as an argument, the idea of the so-called “slippery slope” here
applies. To be sure, I am not suggesting that by allowing physician-assisted suicide we will eventually turn
our world into a utilitarian hell of Hitleresque eugenics. This is not my point. The crux of the argument is
17 Richard A. McCormick, “Physician-Assisted Suicide: Flight from Compassion,” in On Moral Medicine, 669.
18 Meilaender, 657.
Ziefle 9
rather that by deciding to draw a proverbial line in the sand one takes an issue that needs to remain in the
world of black and white and throw it into a peculiarly unfortunate world of shades of gray. The line we
draw may be acceptable for us, but by saying that we can make a decision about when it is proper to end a
life we are allowing everyone else to make decisions that may be worlds apart from our own. If we can
decide that it is possible to ethically terminate life, who is to say that everyone will agree with us what
circumstance are or are not necessary for that termination? While this type of “gray area” moral is possible
and even useful in some areas of ethical discussion, the fact that we are dealing here with life and death
makes it dangerous. By taking the authority away from the God and abrogating it for ourselves, we are
setting up a scenario that not only might lead to future abuses, but has the potential for such in the here
and now. As Gilbert Meilaender notes, “the list of questions needing clarification is endless once we start
down this path.”19
Contra the argument of Nancy Duff that the issue of physician-assisted suicide should be
discussed more under the rubric of casuistic ethics, attention needs to be paid to the fact that a clear rule is
needed in this case. As the right to life and death rests only with God and allowing human beings to decide
on a case-by-case basis is fundamentally dangerous and an enterprise prone to error and missteps, it
seems most appropriate that physician-assisted suicide should be rejected as a morally viable option in all
cases. While it is to be admitted at this juncture that this statement is as tinged with pain as it is truth, I
cannot but affirm that physician-assisted suicide is wrong. It is perhaps in this light that we must invoke
Meilaender, saying that “no action which deliberately hastens death can be called ‘love.’”20 What we are
called to do is love people in their suffering and do all we can to help thereto. We are to ask doctors to
apply “the full skills of their art to the advantage of the sick and dying” and use our common human abilities
19 Meilaender, 656.
20 Ibid., 659.
Ziefle 10
for “unlimited kindness and devoted charity”21 to help those in need. Each of us is able to do this through
the gifts of comfort and presence and discoveries of science that have helped the art of pain management
grow over the centuries. Further, it is clear that despite the great evil that pain brings, is does allow us the
opportunity to realize our shared human dependence. Despite its callousness, I suspect that this is what
lies behind the statement of Pope John Paul II: “the pleas of the very seriously ill…are almost always
anguished pleas for help and love.”22 Those opposed to this position are in an unfortunate circumstance:
“rejection of our own dependence means ultimately rejection of our interdependence and eventually of our
very mortality.”23 Clearly, the prescription for suffering is not the flagrant use of our abilities to end
someone’s life but rather our loving efforts to help them insofar as we are given authority.
The final goal to which all of this aims is of course, the cultivation of a “culture of life.”24 Though
more wide-ranging and pervasive than the simple rejection of physician-assisted suicide, this mindset
would be fundamentally focused upon promoting life and respecting its bounds. For the sake of our
discussion this would mean acknowledging that suffering is a part of human life, but one that we must work
against with every skill at our disposal. That one power which is not given us but which we try to assume—
the power of life and death—cannot be utilized in the alleviation of suffering. Where it is used we must
come to terms with this fact and admit that it is a great wrong. One cannot and must not attempt to
alleviate one’s conscience by asserting that what they have done is right. To allow anything else would be
to deny the respect for God-given life and its natural progression in the created order. Only by not giving in
to the temptation to take matters that are not ours into our own hands can human beings begin to realize
what it is to be truly human. It is to be morally responsible agents, but it is to be those agents in a complex
21 Pope John Paul II, “Declaration…,” 654.
22 Ibid., 652.
23 McCormick, 669.
24 George W. Bush, “Second Presidential Debate: Washington University, St. Louis, MO,” (October 8, 2004), available at
http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html. Though he was here referring specifically to
abortion, the phrase could be applied to euthanasia issues and dovetails nicely with the Pope’s reference to a prevailing “cu lture
of death.”
http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html
Ziefle 11
web of relationships that includes a respect and deference to the Creator of all things. To do otherwise and
transgress those boundaries would place us in the unenviable position of our original ancestors, reaching
for a power that is not ours to have. Some knowledge—and some actions—are simply beyond our ken.
Though we are called to feel sympathy for those who suffer beyond our God-given ability to aid, we must
never accord the practice of physician-assisted suicide moral sanction.
Ziefle 12
Bibliography:
Belkin, Lisa. “There’s No Such Thing as a Simple Suicide.” The New York Times Magazine, 14 November
1993, 49-56, 74-5.
Bush, George W. “Second Presidential Debate: Washington University, St. Louis, MO.” 8 October 2004.
Available at http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html.
Duff, Nancy. “Reformed Theology and Medical Ethics: Death, Vocation, and the Suspension of Life
Support.” In The Future of Reformed Theology: Tasks, Topics, Traditions, ed. David Willis and
Michael Welker, 302-320. Eerdmans, 1999.
Duntley, Mark A. Jr. “Covenantal Ethics and Care for the Dying.” In On Moral Medicine: Theological
Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey, 663-6.
Grand Rapids: Eerdmans, 1998.
John Paul II, “Declaration of the Sacred Congregation for the Doctrine of the Faith (May 5, 1980).” In On
Moral Medicine: Theological Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers
and Allen Verhey, 650-4. Grand Rapids: Eerdmans, 1998.
__________, “Homily of Pope John Paul II at Cherry Creek State Park, Denver, Colorado on the Feast of
the Assumption.” 15 August 1993. Available at
http://www.columbia.edu/cu/augustine/arch/jp2/denver17.html.
Maxson, Gloria. “’Whose Life Is It, Anyway?’ Ours, That’s Whose!” In On Moral Medicine: Theological
Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey, 648-50.
Grand Rapids: Eerdmans, 1998.
McCormick, Richard A. “Physician-Assisted Suicide: Flight from Compassion.” In On Moral Medicine:
Theological Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey,
668-71. Grand Rapids: Eerdmans, 1998.
Meilaender, Gilbert. “Euthanasia and Christian Vision.” In On Moral Medicine: Theological Perspectives in
Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey, 655-62. Grand Rapids:
Eerdmans, 1998.
Quill, Timothy E. “Sounding Board: Death and Dignity—A Case of Individualized Decision Making.” The
New England Journal of Medicine 324 (March 7, 1991): 691-94.
http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html
http://www.columbia.edu/cu/augustine/arch/jp2/denver17.html
Utrum Paper[footnoteRef:1] [1: Adapted from Nancy Duff’s course “Issue in Bio-Medical Ethics,” Fall 2004.]
Instructions: Students will compose two 1000-word utrum papers on topics related to course content. Further instructions will be posted on Discovery. DUE 24 February and 24 March, respectively.
· First Paper
· Closed vs. Open Communion
· What Happens During Communion
· Should Communion Be Served At Weddings
· Wine vs. Juice in Communion
· Digital Communion vs. In-Person Communion
· Traditional vs. Non-Traditional Elements
· Should Communion Only Be Served By Clergy
· Other Related Topic as Approved by the Professor
· Second Paper
· Egalitarian vs. Complementarian/Traditional Marriage
· Divorce and Remarriage
· What Constitutes Christian Marriage
· Cohabitation
· Performing Weddings for Divorced Christians
· Performing Weddings for Non-Christians
· Same-Sex Marriage
· Other Related Topic as Approved by the Professor
The paper must interact with the selective topic as well as authoritative outside sources and give 1) a fair hearing to a position that you oppose and 2) a persuasive argument for the position you hold.
1. The utrum. “Whether or not it is the case that…” (utrum=“whether”)
In one (!) sentence state your issue in such a way that you will be able to provide two fair and persuasive, yet opposing, arguments, one of which you will refute.
Example, using abortion:
Whether or not it is the case that abortion should legally be defined as murder.
Do not add comments to this statement. Also, do not word the utrum to reveal your own position, e.g. “Whether or not it is the case that baby-killing should be legal.”
2. The videtur. “It seems that…”
State in one sentence and then present arguments for a position that you finally reject.
Example:
It seems that abortion is murder and should be legal only in cases where it can be deemed self-defense, i.e., when the pregnancy threatens the life of the women.
Following this statement write a few pages giving as convincing an argument as possible supporting this position. Remember our rule for academic debate: “You should be able to state your opponent’s position so clearly and so fairly that your opponent could say ‘Yes, that it what I mean.’” Present arguments that are actually worth refuting, not “straw” arguments that are easily dismissed. In other words, present arguments that you find challenging and worthy of addressing, when you present your own position.
3. The respondeo. “I answer that…”
In one or two (!) sentences state your position. Do not just repeat the utrum, but state your position clearly and concisely so that someone reading it would know where you stand even before reading your defense of this position.
Example:
I answer that even though early stage abortion entails the destruction of nascent human life, it should not legally be defined as murder.
4. The ergo. “Therefore…”
Write in a few pages a convincing argument for the position that you hold, drawing on material (of a suitable academic quality) you find helpful. Respond to legitimate questions and issues you have raised in the videtur (step #2), explaining why you finally reject them.
“[It] would seem like wisdom but for the warning in my heart” 1
An Utrum Investigation of Physician-Assisted Suicide
1 Frodo Baggins, The Lord of the Rings
Joshua R. Ziefle
ET436: Issues in Biomedical Ethics
November 8, 2004
LG
SBN 424
1. Utrum: Whether or not it is the case that physician-assisted suicide is ever morally acceptable.
2. Videtur: Though not morally acceptable in every circumstance, there are times when a person’s
quality of life and/or potential for recovery make physician-assisted suicide a viable moral option.
It can be said without a doubt that physician-assisted suicide is one of the more contentious issues
in today’s society. By this we here refer to the process known as “voluntary active euthanasia,” wherein a
patient desires that active methods be taken to end their own life. Whatever term is used for the
procedure— “mercy-killing,” euthanasia, or otherwise—the seriousness of its action never fails to impress
itself upon those considering its use. Thus it is no great surprise that related issues are often emotionally
charged and various individuals have solidified and combative opinions thereto. But to acknowledge that
the issue is controversial and demands serious thought does not mean for that reason that it should be
rejected outright. Complicated issues require complicated and nuanced answers, and physician-assisted
suicide is no exception. Through this discussion, it will be shown that while it remains a difficult and
complicated issue that has clear moral boundaries of right and wrong, there are circumstances and
considerations that make physician-assisted suicide morally acceptable.
Perhaps the main issue around which all else revolves is the question of whose right it is to end a
life. For this, at least, we have the law to guide us. Murder, which involves the taking of a person’s life
without their consent, is criminalized by nearly every legal system known to humanity. Life is seen as
important to protect and human beings guard their own existence against the wishes of others. In this
fashion there seems to be an axiom in nature—all things being equal, it is inappropriate for someone else
to decide when another person’s life is to end. This said, the debate over whether a person has the right to
decide when they themselves will die remains open. For if a major problem with murder flows from the
notion that it deprives one of their life from without, the question of whether or not the choice to die can
come from within is still cogent. While it is not clear that one flows directly from the other, the seeming
inviolability of outside interference in ending a life at least leaves open the possibility that one’s life is one’s
Ziefle 2
own to decide. That an individual has the right to say when someone cannot end their life means that they
themselves have a modicum of control over their existence. Though no one else may do so for them, it
would seem that an individual can decide to end their own life—simply because it is theirs. We would cite
Dr. Timothy Quill at this point, who states: “I have been a longtime advocate of active, informed patient
choice of treatment or nontreatment, and of a patient’s right to die with as much control and dignity as
possible.”1 Though some might argue that murder is prohibited not because of a lack of permission but
because of the general sanctity of life, we would disagree with this position and cite the less stringent laws
on suicide in places like Washington state and the Netherlands as examples of this difference.2 Suicide
can be allowed because it places responsibility for one’s life exactly where it belongs—in one’s own hands.
A few clarifications deserve to be offered at this point. First, as we have attempted to delineate
above, there must be a clear distinction between physician-assisted suicide and physician-initiated murder.
Under no circumstances should the latter, as involuntary active euthanasia, ever be used. Since the right
to death lies solely with the person doing the dying, only he or she can make that decision. Only if they do
so can the action be considered morally justifiable. Even this position needs to be clarified, for though a
patient has the right to decide upon death, assisting physicians must be clear that the person’s true
thoughts on the matter have been revealed. Both evidence of a sound mind and clear deliberation need to
be observed and discussed before any action or assistance can be provided by a physician. In this we
would be much more in agreement with the rules of the group “Compassion in Dying,” which has “written
guidelines that cover every detail, from how patients are chosen to how many Compassion members will
attend an assisted death,”3 than the questionable and sensationalist actions of Jack Kevorkian. Especially
important in this is the notion that “only lucid patients who could take their medicines themselves would
1 Timothy E. Quill, “Sounding Board: Death and Dignity—A Case of Individualized Decision Making,” The New England Journal
of Medicine 324 (March 7, 1991): 692.
2 Lisa Belkin, “There’s No Such Thing as a Simple Suicide,” New York Times Magazine (November 14, 1993): 50, 53.
3 Ibid., 51.
Ziefle 3
qualify for help.”4 The last consideration that would need to be made before a physician might assist in a
suicide would revolve around quality of life matters. Simply stated, physicians should only be allowed to
assist in suicides if there is a specifically medical dimension—unacceptable physical pain, terminal illness,
or debilitating physical impairments. The existential crises and decisions of physically healthy individuals,
while no less serious, will have to be prosecuted outside the medical purview.
Having established the general basis for physician-assisted suicide and establishing a framework
for its use, it is equally essential that we turn to the specifics of how it can be a morally acceptable choice.
First in this are the issues of health and quality of life concerns. Though we agree that life in general
deserves to be protected and recognize that physicians are charged with that duty, there are times in
patients’ lives when the pain and anguish of existence have become too painful or meaningless for them
too continue onward. As Mark Duntley Jr. writes, “it is understandable that many have come to believe that
there are indeed times when the hopelessly suffering should be allowed to choose a quick and merciful
death at the hands of a medical professional.”5 Heretofore simple decisions are much more complex.
What is, after all, more moral—keeping someone alive who is suffering from debilitating and persistent pain
or letting them end their life and its accompanying anguish? We feel that it is ethically untenable to force
someone to continue in pain that will not get any better and has no purpose. Even Timothy Quill—though
opposed to physician-assisted suicide—can cite theologian Karl Barth to call this action “well-meaning
humanitarianism.”6
So too ought physicians to assist in suicides where there is deep psychical pain that has no hope
of being remedied. Those with debilitating illnesses who are handicapped beyond their ability to live a
meaningful life should be given the choice of ending an existence whose very being is for them one of pain.
4 Ibid., 54.
5 Mark A. Duntley, Jr. “Covenantal Ethics and Care for the Dying,” in On Moral Medicine: Theological Perspectives in Medical
Ethics, 2nd Edition, eds. Stephen E. Lammers and Allen Verhey (Grand Rapids: Eerdmans, 1998), 663.
6 Gilbert Meilaender, “Euthanasia and Christian Vision,” in On Moral Medicine, 658.
Ziefle 4
Though every option should be presented to them and time allowed for them to make an informed decision,
forcing them to continue in a painfully diminished existence is an unacceptable moral position. Gloria
Maxson’s article, though holding a position opposite to this, does not remove the possibility that one would
want to end their life. To be sure, it shows that she personally does not want to end her life via suicide—“I
will never willingly relinquish a life that contains my husband, family, [etc.]”7—but this remains a far cry from
denying the possibility that no one is morally justified in so wishing.
For the terminally ill, the question of physician-assisted suicide is much clearer. Faced with the
prospects of life in a dying body wracked with pain, discomfort, and diminishing ability to maintain an
equilibrium in life, some choose to die on their own terms and in their own time. Here we part company
with Pope John Paul II, who refers negatively to a “culture of death” that involves the taking of life “before
one reach[es] the natural point of death.”8 As the kind of “living death” we have been describing seems
much more akin to perpetuating what we consider a “culture of death” than what the Pope has considered,
there seems little reason not to finish what nature is taking its painful time to do. Ending the lives of
terminal patients who desire such action can help to give them a peace of mind and sense of control, allow
them to die with a modicum of dignity and respect, and give those they leave behind a last image of their
loved one in control and lucid rather than shrunken, weakened, and emaciated. Again we ask which is the
more merciful—making someone and their families go through the slow and debilitating decline into death
over a potential period of weeks or months, or letting someone die quickly and painlessly? For our part, the
answer is clear: “mercy or compassion toward the dying and suffering seems to be central to any
philosophy of healing, and most certainly is the primary argument for the morality of euthanasia.”9 It is this
manner of psychological comfort that plays a key role in our argument for physician-assisted suicide.
7 Gloria Maxson, “’Whose Life Is It, Anyway?’ Ours, That’s Whose!,” in On Moral Medicine, 649.
8 Pope John Paul II, “Homily of Pope John Paul II at Cherry Creek State Park, Denver, Colorado, on the
Feast of the Assumption,” (August 15, 1993), available at http://www.columbia.edu/cu/augustine/arch/jp2/denver17.html
9 Duntley, 664.
Ziefle 5
Needless pain need not be suffered, and those who support this method of addressing the issue are the
most merciful.
From the Christian perspective, physician-assisted suicide remains complicated. As Nancy Duff
has pointed out, the tradition both sees death as both a natural part of life and a great enemy to be
defeated.10 As both of these positions are accurate from the Christian mindset, there is a sense in which
death presents the ultimate puzzle. What this means for physician-assisted suicide is equally complex. In
this Duff’s provisional answers offers a helpful guide through the surrounding debate. Understanding ethics
through the lens of vocation and an emphasis on a person’s God-given life in the here and now leads her to
hold that “Christians need to enter the discussion about assisted death not with absolute rules nor with an
eye solely to what is practical” but need to be attentive to the fact that “the Reformed doctrine of vocation
leads us to reject the utilitarian response to assisted death…[and] also prohibits an absolute position
against ever taking an action which would hasten death.”11 Situations present themselves in which the
procedure may be acceptable; conversely, there may be times when it is wholly inappropriate. A casuistic
approach is ultimately necessary to address the situations as they arise. Thus a doctor who refused to help
a patient die because he wanted to maintain biological life at all costs could be in the wrong. So too would
a patient who desired to die rather than undergo a minimal corrective surgery. The former puts too much
emphasis on death as an enemy rather than a natural part of life; the latter emphasizes that death was a
part of life to the expense of seeing it as an opposable enemy. Clearly, a case-by-case approach to the
issue of physician assisted suicide is important if we are to determine its moral viability. That it can be
morally acceptable in certain circumstances must not be denied.
In the end, the morality and ethics of physician-assisted suicide—while complex—are nevertheless
worth investigating. For just as such a system is (as some have posited) open to abuse, the benefits that it
10 Nancy Duff, “Reformed Theology and Medical Ethics: Death, Vocation, and the Suspension of Life Support,” in The Future of
Reformed Theology: Tasks, Topics, Traditions, eds. David Willis and Michael Welker (Eerdmans, 1999), 306.
11 Duff, 319, 318.
Ziefle 6
provides under the proper circumstances are worth the risk. The basis of this argument derives from an
ethical framework that understands a sane and psychologically balanced person to be the best judge of
whether or not they should continue living. As they make responsible decisions and choose to involve
physicians in their suicides, all are able to participate in a morally justified manner. By assisting in
alleviating the physical pain, mental anguish, and the suffering of patients and their loved ones, doctors
through physician-assisted suicide can be performing a moral action. Letting a painful life needlessly drag
on is not justifiable if the patient does not wish it; physicians, ethicists, and people of all persuasions must
become aware of this. For the Christian thinker or one more hesitant to engage in said action, this means
that attention must be given to the specific cases in which euthanasia is requested. Only then is a moral
choice able to be made. Even if general rules may exist, callous and unchangeable laws may not.
3. Respondeo: I respond that in spite of the pain and suffering that can occur the natural
progression of life must be honored and physician-assisted suicide rejected as morally and
ethically unacceptable.
4. Ergo:
From the outset, my position in this matter rests with the conviction (shared with Meilaender and
Barth) that “’our lives are not our own.’”12 They are created by God and sustained by God’s grace and love.
The prohibitions against murder in worldwide societies thus have little to do with the fact that one’s life is
being taken away from them without permission, but with the fact that a God-given life is being killed that
should not have been. Suicide is in a moral sense akin to murder because both are illegitimate aims. We
should make no mistake at this point—physician-assisted suicide, as active voluntary euthanasia, is not the
same as withholding the technological means of unnaturally prolonging life. It is the ending of a natural life
that could exist and remains viable. It is an active force opposed to that “loving gift from God” to which “all
12 Meilaender, 656.
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human beings must live their lives in accordance.”13 As the Divine is that which creates human existence
in nature, human beings ought to follow that nature wherever it leads. There thus remains a normative and
appropriate course and progress to life.
All of this is not, of course, to discount the immense pain and suffering that can and does take
place in the world at large. Whether self-inflicted, expected, or surd, these evils reach to our collective core
and cause us pain as great as it is profoundly real. Thus I am not here suggesting that this pain be
accepted because it will make us better people or draw us closer to the sufferings of Christ. The assertions
of Pope John Paul II and Gilbert Meilaender to this effect are troubling in any case and need to be heard
only with great care.14 These are often second-level reflections coming from those with no pain in their
lives and should not be projected upon the masses. While for the Christian these statements may carry a
great deal of truth with them, they just as easily may not. Further, what of the secularist, agnostic, or
atheist? Will these appreciate the great gift that pain is? Most likely, they will experience it just as it is—
suffering and evil.
So why then should I rule out physician-assisted suicide as a viable moral alternative? Because
suffering, like death, is a part of fallen human existence common to all. Because it is not in our right to take
a life, whether ours or that of another. And finally, because love and concern for the person in question is
what is required in an ethic that would never aim for death: “love could never euthanize.”15
That suffering is a part of fallen human life is an axiom.16 Few if any have gone through life without
the kind of pain or anguish that could be classified as real suffering. Humanity tries to address it in many
ways and has a host of counselors, therapists, druggists, and doctors to deal with its pain. We manage as
best we can in this life to deal with pain of all shades, yet never finally put it to rest. Indeed, the only way
13 Pope John Paul II, “Declaration of the Sacred Congregation for the Doctrine of the Faith (May 5, 1980) in On Moral Medicine,
651.
14 Ibid., 652-3 and Meilaender, 659.
15 Meilaender, 661.
16 Pope John Paul II, “Declaration…,” 652.
Ziefle 8
we would be able to take care of the matter of pain with any true finality would be for all of us to end our
own lives—for as long as we live we are open to the potential and reality of suffering. Of course at this
point some will aver and say that not all suffering is the same and sometimes it may be of such a long-term
and excruciating level that suicide is the only option. While this could be the case, I would ask simply:
Which cases? Who gets to decide? How much is too much suffering and how much is “not quite enough?”
To these questions there can be many answers, but ultimately none that are correct.
Ultimately, the issue is not able to be resolved as long as it is human beings who assume the
authority to decide. The taking of one’s own life or helping one to do the same is akin to “playing God” and
assuming a responsibility that is and has not been given. In so doing one acts with callous autonomy in
what Richard McCormick calls “an act of isolation and abandonment.”17 However, if we recognize
ourselves as “creatures—not Creator” instead of those who “have ceased to believe in a God whose
providential care will ultimately bring about whatever ought to be the case,” we “will recognize limits even
upon [our] obligation to do good.”18 Attempting to help someone in alleviating their suffering is one thing—
indeed, this statement in itself would provoke little controversy—but inappropriately taking the power of life
and death into one’s own hands is ultimately wrong. Simply stated, we as human beings cannot state
when it is right for someone—including ourselves—to die. That right rests with God and the natural world
in which God has placed us. Thus when it is time for a person to die, all must accept it and not try to
illegitimately prolong life. At the same time, we must take care never to hurry it along when it is not yet a
person’s time.
However lambasted or critiqued as an argument, the idea of the so-called “slippery slope” here
applies. To be sure, I am not suggesting that by allowing physician-assisted suicide we will eventually turn
our world into a utilitarian hell of Hitleresque eugenics. This is not my point. The crux of the argument is
17 Richard A. McCormick, “Physician-Assisted Suicide: Flight from Compassion,” in On Moral Medicine, 669.
18 Meilaender, 657.
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rather that by deciding to draw a proverbial line in the sand one takes an issue that needs to remain in the
world of black and white and throw it into a peculiarly unfortunate world of shades of gray. The line we
draw may be acceptable for us, but by saying that we can make a decision about when it is proper to end a
life we are allowing everyone else to make decisions that may be worlds apart from our own. If we can
decide that it is possible to ethically terminate life, who is to say that everyone will agree with us what
circumstance are or are not necessary for that termination? While this type of “gray area” moral is possible
and even useful in some areas of ethical discussion, the fact that we are dealing here with life and death
makes it dangerous. By taking the authority away from the God and abrogating it for ourselves, we are
setting up a scenario that not only might lead to future abuses, but has the potential for such in the here
and now. As Gilbert Meilaender notes, “the list of questions needing clarification is endless once we start
down this path.”19
Contra the argument of Nancy Duff that the issue of physician-assisted suicide should be
discussed more under the rubric of casuistic ethics, attention needs to be paid to the fact that a clear rule is
needed in this case. As the right to life and death rests only with God and allowing human beings to decide
on a case-by-case basis is fundamentally dangerous and an enterprise prone to error and missteps, it
seems most appropriate that physician-assisted suicide should be rejected as a morally viable option in all
cases. While it is to be admitted at this juncture that this statement is as tinged with pain as it is truth, I
cannot but affirm that physician-assisted suicide is wrong. It is perhaps in this light that we must invoke
Meilaender, saying that “no action which deliberately hastens death can be called ‘love.’”20 What we are
called to do is love people in their suffering and do all we can to help thereto. We are to ask doctors to
apply “the full skills of their art to the advantage of the sick and dying” and use our common human abilities
19 Meilaender, 656.
20 Ibid., 659.
Ziefle 10
for “unlimited kindness and devoted charity”21 to help those in need. Each of us is able to do this through
the gifts of comfort and presence and discoveries of science that have helped the art of pain management
grow over the centuries. Further, it is clear that despite the great evil that pain brings, is does allow us the
opportunity to realize our shared human dependence. Despite its callousness, I suspect that this is what
lies behind the statement of Pope John Paul II: “the pleas of the very seriously ill…are almost always
anguished pleas for help and love.”22 Those opposed to this position are in an unfortunate circumstance:
“rejection of our own dependence means ultimately rejection of our interdependence and eventually of our
very mortality.”23 Clearly, the prescription for suffering is not the flagrant use of our abilities to end
someone’s life but rather our loving efforts to help them insofar as we are given authority.
The final goal to which all of this aims is of course, the cultivation of a “culture of life.”24 Though
more wide-ranging and pervasive than the simple rejection of physician-assisted suicide, this mindset
would be fundamentally focused upon promoting life and respecting its bounds. For the sake of our
discussion this would mean acknowledging that suffering is a part of human life, but one that we must work
against with every skill at our disposal. That one power which is not given us but which we try to assume—
the power of life and death—cannot be utilized in the alleviation of suffering. Where it is used we must
come to terms with this fact and admit that it is a great wrong. One cannot and must not attempt to
alleviate one’s conscience by asserting that what they have done is right. To allow anything else would be
to deny the respect for God-given life and its natural progression in the created order. Only by not giving in
to the temptation to take matters that are not ours into our own hands can human beings begin to realize
what it is to be truly human. It is to be morally responsible agents, but it is to be those agents in a complex
21 Pope John Paul II, “Declaration…,” 654.
22 Ibid., 652.
23 McCormick, 669.
24 George W. Bush, “Second Presidential Debate: Washington University, St. Louis, MO,” (October 8, 2004), available at
http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html. Though he was here referring specifically to
abortion, the phrase could be applied to euthanasia issues and dovetails nicely with the Pope’s reference to a prevailing “cu lture
of death.”
http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html
Ziefle 11
web of relationships that includes a respect and deference to the Creator of all things. To do otherwise and
transgress those boundaries would place us in the unenviable position of our original ancestors, reaching
for a power that is not ours to have. Some knowledge—and some actions—are simply beyond our ken.
Though we are called to feel sympathy for those who suffer beyond our God-given ability to aid, we must
never accord the practice of physician-assisted suicide moral sanction.
Ziefle 12
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Belkin, Lisa. “There’s No Such Thing as a Simple Suicide.” The New York Times Magazine, 14 November
1993, 49-56, 74-5.
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Available at http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html.
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Support.” In The Future of Reformed Theology: Tasks, Topics, Traditions, ed. David Willis and
Michael Welker, 302-320. Eerdmans, 1999.
Duntley, Mark A. Jr. “Covenantal Ethics and Care for the Dying.” In On Moral Medicine: Theological
Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey, 663-6.
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Moral Medicine: Theological Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers
and Allen Verhey, 650-4. Grand Rapids: Eerdmans, 1998.
__________, “Homily of Pope John Paul II at Cherry Creek State Park, Denver, Colorado on the Feast of
the Assumption.” 15 August 1993. Available at
http://www.columbia.edu/cu/augustine/arch/jp2/denver17.html.
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Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey, 648-50.
Grand Rapids: Eerdmans, 1998.
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Theological Perspectives in Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey,
668-71. Grand Rapids: Eerdmans, 1998.
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Medical Ethics, 2nd Edition, ed. Stephen E. Lammers and Allen Verhey, 655-62. Grand Rapids:
Eerdmans, 1998.
Quill, Timothy E. “Sounding Board: Death and Dignity—A Case of Individualized Decision Making.” The
New England Journal of Medicine 324 (March 7, 1991): 691-94.
http://www.washingtonpost.com/wp-srv/politics/debatereferee/debate_1008.html
http://www.columbia.edu/cu/augustine/arch/jp2/denver17.html
