Faith and works

Nitpickerus: You argued last time that although as Christians we have received eternal life as a gift,[1] we are still required to obey God's commands.

Dionysius: Yes. Obedience is one of the tests as to whether our faith is genuine or not.[2]

Nitpickerus: But we can't obey without God's help.

Dionysius: Exactly. God never gives us a command that he doesn't also empower us to obey.[3] This is one of the purposes of the Holy Spirit. He gives us the ability to obey.

Nitpickerus: But it's not obedience that saves us?

Dionysius: No, obedience is rather the evidence of our being saved. As Luther put it: 'Good works do not make a man good, but a good man does good works'. We are made 'good' by God's gift of salvation received by faith. It's not our own doing at all[4] Our obedience and good works then flow out of thankfulness for what God has done- not out of guilt, but out of gratitude.

What sort of killing is wrong?

Nitpickerus: Anyway, back to the commandments. You said we 'd start with 'you shall not kill'(RSv).[5] Now there is an obvious problem here. How can God say that and yet in the Old Testament command capital punishment and the slaughter of the Canaanites?[6] Isn't that a little inconsistent?

Dionysius: I agree it appears that way, but not if we understand what it was God actually said.

Nitpickerus: What did he say then?

Dionysius: Well for a start he was speaking Hebrew, not English. What he said was 'Don't commit the act of ratsach'.

Nitpickerus: That's a great deal of help. What's ratsach?

Dionysius: Murder (NIV).

Nitpickerus: You're splitting hairs.

Dionysius: Not at all. There are ten different Hebrew words - all with varying shades of meaning that our authorised version translates as 'kill'. The English language creates confusion where there was none. Only ratsach or murder is referred to in the sixth commandment.

Capital punishment

Nitpickerus: So what is murder?

Dionysius: Murder is the intentional killing of an innocent human being.[7]

Nitpickerus: So killing animals isn'tt murder?

Dionysius: Not by a biblicaI definition.

Nitpickerus: You'll upset a few animal rights activists with that statement Dionysius. And killing guilty human beings isn 't murder either?

Dionysius: No, which is why capital punishment authorised by God is not murder. In the Old Testament there were over twenty offences punishable by death, ranging from drunkenness[8] to premarital sex[9] to murder.

Nitpickerus: Hang on, we need to preserve the future generation of doctors. That's a bit rough of God isn't it?

Dionysius: It was a disincentive to sin. God's intention was to stop others trying the same thing and the social pandemonium which would inevitably result.[10] Think what would happen to the incidence of AIDS and the road toll if these laws were still in force.

Nitpickerus: But this doesn't really square with the idea of a merciful God.

Dionysius: God shows his mercy by delaying judgment in order to give people a chance to change their ways,[11] not by acquitting the guiIty.[12] Of course in the way that Jesus understood the commandments we're all guilty of capital offences Who hasn't lusted or hated?[13]

Nitpickerus: But didn't Jesus die in our place to take our punishment?[14]

Dionysius: Yes, but it's only any good if we respond in repentance (turning from sin) and faith (trusting obedience).[15] Nitpickerus: So those that don't respond still face judgment?[12]

Dionysius: Yes.' Of course, Jesus hasn't come back yet (at least at the time nucleus went to press) so they still have a chance to respond.

Holy war

Nitpickerus: The Amorites didn't get much of a chance, did they?[16]

Dionysius: Really? Why do you suppose God kept his own people as slaves in Egypt for 400 years?[17]

Nitpickerus: To give the Amorites a chance to repent?

Dionysius: Yes, but they didn't. Why do you suppose God waited 40 years after the crucifixion of Christ before allowing the Romans to destroy Jerusalem in 70 AD? It was to give the Jewish nation a chance to repent. Of course some of them did - but not the majority. So God. with great reluctance after longsuffering patience brought justice to bear.

Manslaughter

Nitpickerus: Let's get back to the biblical definition of murder intentional killing?

Dionysius: Yes it must be intentional. Unintentional killing, what we might call manslaughter, is not the same as murder. As the Bible says 'For instance, a man may go into the forest with his neighbour to cut wood, and as he swings his axe to fell a tree, the head may fly off and hit his neighbour and kill him.[18]

Nitpickerus: That's a very narrow definition of manslaughter. What about if someone hits another person in a fit of rage and kills them, but the act wasn't really premeditated?

Dionysius: According to the Bible it's still murder.[19] Hate is equivalent to murder by Jesus' estimation[13] and so is killing resulting from negligence apparentIy.[20]

Nitpickerus: So any intentional killing of an innocent human being is wrong?

Dionysius: Yes. Innocent blood is not to be shed.[21] In fact God singles out groups of people who could potentially be exploited for special protection: the poor[22] widows and orphans,[23] immigrants,[24] the handicapped,[25] slaves and servants[26] and the elderly.[27]

Forgiveness and the crusades

Nitpickerus: So as Christians we should protect the innocent, but it's all right to carry out capitai punishment on the guilty?

Dionysius: Nitpickerus, you are a nit-picker. The New Testament teaches that that within the church we are to forgive sin, not punish it.[28] No, God has delegated the role of punishment to the State.[29]

Nitpickerus: What about killing the infidel? Should we be waging Holy War? The crusaders obtviously thought they should.

Dionysius: The crusaders misunderstood who our enemy is. Our enemy is not 'flesh and blood' but rather spiritual powers. Our enemy is the devil who has men in his grip through his wily deceptions.[30] What's the point of killing those who don't believe in Jesus? Our aim is to get people into the kingdom of God!

Is euthanasia murder?

Nitpickerus: Okay. Let's get back to medicine. Is euthanasia murder or not?

Dionysius: Is euthanasia intentional killing?

Nitpickerus: Yes.

.Dionysius: Of an innocent human being?

Nitpickerus: Well in the sense that the patient hasn't committed a capital offence, yes. Although we could question whether severely demented, retarded or brain damaged individuals are really human beings.

Dionysius: You could, but you are on a dangerous slippery slope. Don't forget that what ended in the gas chambers at Auschwitz in the 1940s began in the nursing homes, geriatric and psychiatric institutions all over Germany in the I 930s. We have seen the same slippery slope operating in Holland over the last decade. It started with voluntary euthanasia for terminally ill patients. There were 3,500 cases last year, but according to official figures 1,000 of them were involuntary. Besides, there is little support for categorising human beings as having varying degrees of humanness biblically. God shows no partiality. In fact, as I've already pointed out, those groups who can potentially be exploited are given special protection. The biblical principle is that the strong lay down their lives for the weak, not the other way round.[31]

What if the patient wants it?

Nitpickerus: But surely if a patient asks to be killed, haven't we an obligation to respect their choice?

Dionysius: This is a very dangerous precedent. How can we be sure that we have the diagnosis and prognosis right? What if the patient's judgment is impaired by confusion, depression, dementia or a false sense of worthlessness? His request may be because of symptoms which may well be reversible. How do we know that the one in our care is not feeling subtly pressurised because he feels he is a burden to relatives, carers or a community short of resources?[32] No Nitpickerus. The sick person is too easily exploited. In fact many firm advocates of euthanasia decline it themselves later on if it is offered. They find that they adapt to suffering. 'It's not bad enough yet Doc'.

Nitpickerus: But what if a patient is close to death, in great pain which cannot be controlled and actually requests to be killed. Surely compassion demands we comply?

Dionysius: The Bible actually gives an account of euthanasia in this exact situation - the Amalekite's dispatch of Saul.[33] There he was, after a failed attempt at suicide by falling on his sword. Close to death, which was inevitable, in severe pain presumably from peritonitis, and begging to be killed. And so he was killed. However David's response is not to reward the Amalekite for compassion but to have him executed. In the mind of David the compassionate killing of Saul was murder. He saw the Amalekite's willingness to kill as a threat to the security of Israel. Anyway the question is all a bit academic for us. With modern palliative care virtually all symptoms can be controlled. Perhaps one of the reasons euthanasia has taken off in Holland is because there are very few hospices there. The answer is better terminal care, not euthanasia.

Have we a right to commit suicide?

Nitpickerus: Then what about suicide? Surely we have the right to end our own lives if we so choose?

Dionysius: In most suicide attempts, the patient is really issuing a call for help. But even in the calculating deliberate kind, the person does not have the right to kill themselves. Maybe the power, but not the right. Human life belongs to God.[34] It is not the possession of human beings. Only God has the right to kill. He may delegate it to the state[29] or to one nation destroying another[35], but it is still only he who may take life. We must not, even if the life is 'our own'.

Nitpickerus: Are there any accounts of suicide in the Bible?

Dionysius: Yes, there are four: Saul,[36] Ahithophel,[37] Zimri[38] and Judas[39]. Look them up! The overall picture is that suicide in Scripture comes at the end of lives of sin and wrongdoing. We may feel great sadness and compassion for the victim but this does not make suicide right.

Nitpickerus: That seems very hard Dionysius.

Dionysius: I'm not denying that people may face tremendous temptation to commit suicide. In some situations it may seem the only way out of suffering, be it mental or physical or spiritual. Of course that is only deception. Death doesn't bring release but rather leads to judgment.[40] Of course the situation that precipitates the desire for release may not be one's own fault at all. Look at Job for example. If anyone had reason for killing himself Job did, but he resisted the temptation.[41] I'm sure Jesus was tempted as well as he contemplated what was ahead. The Christian response to suffering is perseverance[42] not giving in. There is always a purpose in it even if we can't see it at the time.[43]

Nitpickerus: That's very British! Stiff upper lip and all that.

Dionysius: Courage is a Christian virtue[44] but cowardice isn't.[45] Of course as doctors we have a responsibility to do everything within our means to make our patients comfortable. The fact that they need to be courageous doesn't mean that we can shirk our role to ease their suffering. If your patient is requesting euthanasia then you need to ask why and treat the distressing symptom. But killing is a cop-out.

Don't we already perform euthanasia?

Nitpickerus: But is there really any difference between killing by act or omission? Don't we already kill people by withholding antibiotics, ventilators and CPR for hopeless cases?

Dionysius: Murder is always wrong. Letting die sometimes is. It is wrong if we can do something worthwhile to save a person's life and we deliberately withhold treatment. But it is bad medicine to prolong someone's inevitable death. The decision depends upon the reversibility of the condition and the effectiveness of the treatment.

Nitpickerus: You're creating an artificial distinction to justify the practice of doctors.

Dionysius: Not at all. As Christians we recognise that physical death is inevitable.[46] It will come to us all, unless Jesus comes backfirstorwe get miraculously transported to heaven like Elijah[47] or Enoch.[48] But the chance of the latter is fairly remote. Our obligation is to cure those illnesses we can, relieve those we can't cure and to console when we can neither cure nor relieve. It's bad medicine to launch into all sorts of inappropriate, valueless and potentially harmful interventions when a patient is on the way out. If death is inevitable, let them die. This is not killing. It's recognising that death is taking place and that we are powerless to stop it. We are not gods, Nitpickerus.

Nitpickerus: What about abortion, is that murder too?

Dionysius: We'll discuss that in the next issue.