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LCMS 2026 Convention Workbook: Reports and Overtures, PDF page 230
2026 Convention Workbook 195 THEOLOGICAL DOCUMENTS —COMMISSION ON THEOLOGY AND CHURCH RELATIONS INTRODUCTION 1 I. Introduction In 1993, the Commission on /T_heology and Church Relations (CTCR) published Christian Care at Life’s End. /T_he report was an update of the CTCR’s earlier (1979) Report on Euthanasia with Guiding Principles.1 /T_his report is, in turn, a further update on the CTCR’s past work. In its introduction, the 1979 report said, “Our culture lives in the stormcenter of a bio- medical revolution whose consequences defy description. ” 2 /T_he 1993 report repeated that assessment, and it is still true. /T_hirty years later, the biomedical storm has not abated. As was true in 1979, those who promote euthanasia or assisted suicide continue “to justify the taking of human life on moral grounds by describing it as a truly compassionate act aimed at the relief of human suffering. ” 3 /T_he LCMS continues to reject such false compassion. Instead, we affirm that at the end of life the Christian’s responsibility toward those who are suffering is, in the words of the Ramsey Colloquium, “always to care, never to kill.” 4 /T_his does not mean, however, that Christians themselves are not faced with difficult end-of-life decisions occasioned by the use of modern technology and medical advances to prolong life beyond previously known limits. As Helmut /T_hielicke observed already in the 1970s, “Medicine has made such tremendous advances in the modern period that there seems to be almost no limit to what it can do. ” 5 /T_he “biomedical revolution” has touched the lives of us all, and as the end of our life or that of a loved one approaches, more of us will be called upon to apply the principles of God’s Word in this difficult time. /T_he CTCR fully affirms its 1993 and 1979 reports. Christian Care at Life’s End (1993) together with the principles of the 1979 report, which formed the basis of Christian Care at Life’s End, remain valuable in addressing the sensitive ques- tions about care for those at the end of life in a way that is robustly biblical, theologically sound and pastorally sensitive. /T_his report therefore is not a substitute or revision of that previous work. Rather, it is intended as a supplement and in- formational resource to help concerned Christians better understand various new challenges that complicate an already delicate, difficult topic. We note especially that since Christian Care at Life’s End was published, the legal environment has continued to move in the direction of greater personal autonomy and statutory permission to allow physicians to partici- pate in assisted suicide. Together with these legal changes, the United States population has become increasingly supportive of physician-assisted suicide. 1 Commission on /T_heology and Church Relations, Christian Care at Life’s End (St. Louis: /T_he Lutheran Church—Missouri Synod, 1993). /T_he 1993 report includes as a supplement (pages 33–44) the CTCR’s Report on Euthanasia with Guiding Principles (St. Louis: /T_he Lutheran Church—Missouri Synod, 1979). /T_he genesis of the 1993 update was the 1992 LCMS Convention Resolution 3-11A, “To Reaffirm Synod’s Position on Euthanasia and Assisted Suicide. ” See 1992 Proceedings, 116–117. 2 CTCR, Report on Euthanasia, 33. 3 CTCR, Report on Euthanasia, 33. 4 /T_he Ramsey Colloquium of the Institute on Religion and Public Life, “ Always to Care, Never to Kill: A Declaration on Euthanasia, ” First /T_hings (February 1992): 45–47. 5 Helmut /T_hielicke, /T_he Doctor as Judge of Who Shall Live and Who Shall Die (Minneapolis: Fortress, 1976), 1. INTRODUCTION 2 /T_he framework of the report consists of four parts: Part I — a historical and contextual section, Part II — a theological section, Part III — a medical and ethical section, and Part IV — a pastoral and spiritual section. Individual parts may be of greater or lesser interest to different readers with different questions.6 A. Death, the Existential Reality A rabbinic adage claims that it is impossible to look long into the sun or into death.7 Since the rebellion of our /f_irst parents in the Garden, death has been the inescapable reality of human existence. People o/f_ten approach the end of their earthly pilgrim- age with a variety of regrets, expressed and unexpressed. A hospice social worker chronicled some of the most common: 1. /T_hey wish they had been more loving to the people who matter the most. 2. /T_hey wish they had been a better spouse, parent or child. 3. /T_hey wish they had not spent so much time working. 4. /T_hey wish they had taken more risks. 5. /T_hey wish they had been happier and enjoyed life more. 6. /T_hey wish they had lived their dream. 7. /T_hey wish they had taken better care of themselves. 8. /T_hey wish they had done more for others. 9. /T_hey wish they had chosen more meaningful work. 8 Martin Luther dealt with death as a daily reality, not as a theoretical one. Living in times of high infant mortality, untreatable diseases, a lack of effective surgical interventions and recurrent outbreaks of plagues, he understood the exis- tential threat death posed. Indeed, while others /f_led the most recent scourge of plague in Wittenberg in 1527, Martin and his pregnant wife, Katie, remained behind, opening their home to care for the dying. Some speculate that the death of his infant daughter Elizabeth a few months before her /f_irst birthday in 1528 was partly due to their ministrations to the dying the previous year. Another one of his children, his beloved daughter Magdalene, died in his arms in 1542. In 1524, Luther based his hymn “In the Very Midst of Life” on a Latin antiphon. Part of it reads: “In the very midst of life Snares of death surround us; Who shall help us in the strife Lest the foe confound us? … In the midst of death’s dark vale Pow’rs of hell o’ er take us. Who will help when they assail, Who secure will make us?” 9 Christian theology does not support cultural notions of death as “natural, ” part of the “circle of life” or the way for a loved one to become an angel. Christian thinking about death is nuanced. Death, with sin and Satan, has been vanquished by the risen Lord, but the unholy triad continue to wield dangerous power while we still await the /f_inal advent of Christ. Biblical theology has a similarly subtle understanding of suffering. Suffering marks a fallen world, but it cannot simply be equated with evil. In Luther’s 1518 Heidelberg Disputation, he articulated a “theology of the cross. ” “ A theologian of glory calls evil good and good evil. A theologian of the cross calls the thing what it actually is. ” Furthermore: “/T_his is clear: He who does not know Christ does not know God hidden in suffering. ” 10 But in our culture where ease is valued and any 6 /T_he Commission has also developed a supplementary resource with de/f_initions, timelines and other information, see appendix. 7 Paul D. Steinke, “Comfort in the Face of Death, ” /T_he Lutheran Witness (May 1998). 8 Grace Bluerock, “/T_he 9 Most Common Regrets People Have at the End of Life, ” Mindfulness (Feb. 24, 2020), mindbodygreen.com/0-23024/the-9-most-common-regrets-people-have-at-the-end-of- life.html. 9 “In the Very Midst of Life, ” Lutheran Service Book (St. Louis: Concordia Publishing House, 2006), 755. 10 LW 31:53. Quotations marked LW are from Luther’s Works, American Edition, ed. Jaroslav Pelikan, Helmut T. Lehmann and Christopher Boyd Brown, 75 vols. (Philadelphia and St. Louis: Augsburg and Concordia Publishing House, 1955–). INTRODUCTION 3 discomfort viewed with alarm, we tend to default to our old Adamic nature in preferring our own “works to suffering, glory to the cross, strength to weakness, wisdom to folly. ” 11 /T_he way of Christ is the way of the cross. Indeed, “God can be found only in suffering and the cross. ”12 /T_his view of suffering, however, is neither fatalistic nor masochistic. /T_he Christian recognizes both a responsibility to care for those who suffer and a recognition that God is at work even while His children suffer. Christians serve in myriad vocations where we are called to “fear, love, and trust” God and to love our neighbor. Loving our neighbor will o/f_ten involve standing in solidarity with the neighbor and bearing his suffering as well. But Christian vocation never calls for a false “compassion” that would conclude that we may kill our neighbor, even in the name of mercy. /T_he Christian is “always to care, never to kill. ” In our increasingly secularized world, spiritual counsel in the face of death is given little attention. A growing number of our fellow citizens are availing themselves of a more direct course of action in order to deal with their most pressing existential reality: impending death. Aided by changing laws permitting their physician to prescribe medications to hasten death, they are resorting to assisted suicide. 13 /T_he /f_irsthand account by physician Timothy Quill, originally published in the New England Journal of Medicine in 1991, famously articulated the rationale for physician-assisted suicide with respect to his patient Diane, who had been diagnosed with acute myelomonocyte leukemia. 14 “Knowing of her desire for independence and her decision to stay in control, I thought this request made perfect sense. ”15 His case study has been much discussed as a model.16 In a manner now common for arguments in favor of physician assistance in the death of patients, Dr. Quill lays out his steps: (1) assuring that the suicide would be effective and that a slow, lingering death would not occur; (2) avoiding a violent death of the patient; (3) providing the patient with the requisite information about organizations that might assist in the effort; (4) prescribing the dosages of the medications that would permit death to come as quickly and painlessly as possible; and (5) providing comfort to the family of the patient. 17 /T_he actions by Quill eventually became the subject of landmark court rulings.18 Such hastening of death, as Quill advocates, is one problem. Another is desperately seeking to prolong life when a person is irretrievably dying. Gifford A. Grobien recently posed a pair of questions facing us as we navigate the waters of the brave new world of medical possibility and legal permission: “In considering caring for our mortal life, especially as it approaches its end, a couple questions may help us to sharpen our thinking: has our desire to delay or even eliminate death clouded or undermined faith in resurrection to immortal life a/f_ter death? Does delaying death suggest a false hope for a ‘quality’ of life in advanced age that is not biologically feasible?” Grobien concludes, “/T_he single greatest challenge in bioethics is living the natural life God has given us, with faith, thanksgiving, and love, while also recognizing the limits of this life when they come and hoping for the life of the world to come. ” 19 11 LW 31:53. 12 LW 31:53. 13 Assisted suicide of one form or another is also known as Physician-Assisted Suicide, Physician-Assisted Dying, Physician-Assisted Death, Physician Aid in Dying, Medically Assisted Dying (MAD), Medical Aid in Dying (MAID) or Patient-Administered Hastened Death. 14 Timothy Quill, “Death and Dignity: A Case of Individualized Decision Making, ” New England Journal of Medicine 324, no. 10 (1991): 691–694. 15 Quill, 693. 16 Cf. Timothy E. Quill, “Death and Dignity, ” in Michael M. Uhlmann, Last Rights?: Assisted Suicide and Euthanasia Debated (Grand Rapids: Eerdmans, 1998), 319–42; Andrew J. Dyck, Life’s Worth: /T_he Case Against Assisted Suicide (Grand Rapids: Eerdmans, 2002), 12–28. 17 See the summary of Quill’s rationale in Dyck, 13. 18 See the thorough discussion of the Quill arguments as they wound their way up through the courts, eventually resulting in a landmark 1997 ruling in Neil M. Gorsuch’s /T_he Future of Assisted Suicide and Euthanasia (Princeton: Princeton University Press, 2006). Quill contended that laws prohibiting physician-assisted suicide violate provisions of the Fourteenth Amendment. 19 Gifford A. Grobien, “/T_he Future of Bioethics, ” For the Life of the World 25, no. 3 (Fall 2021), 6. INTRODUCTION 4 Put simply, we are addressing this question: How should faithful Christians respond to the advance of medical possibilities and legal permissions, particularly in dealing with terminal illness? /T_he goal of this report is to provide theo- logically sound practical and pastoral guidance for Christian care at life’s end. Since our goal is practical and pastoral, the discussions of medical terms and legal documents in this report related to end-of-life matters are for information only and should not be considered legal advice. We encourage all who need or desire legal counsel for a particular situation to consult an attorney familiar with the laws in their jurisdiction. All of our efforts in this arena, however, must be prefaced with a frank admission of humility in the face of the daunting challenges of understanding the array of specialized knowledge possessed by physicians, scienti/f_ic researchers, attorneys, philosophers and theologians. /T_hielicke captured the challenge when he reminded us that “no one who is com- mitted to the gospel—the message of the incarnation of the eternal Word—can claim to have some kind of supratemporal knowledge (a philosophia perennis). He knows that he is simply one of the many who have not yet arrived but are still on the way (theologia viatorum) .” 20 B. A Culture on the Move in Attitude and Legal Permissions /T_he relentless march toward “physician-assisted dying” has made major inroads into law and public acceptance in a growing number of places within the United States. Despite sometimes vigorous opposition by groups opposing physicians enabling the deaths of patients, the trend has been for jurisdictions to liberalize laws governing physician assistance with the death of terminally ill patients. One may reasonably assume that this trend will continue in the coming years in our increasingly secularized culture as “death with dignity” forces continue to mount sustained campaigns to change laws and litigate the matter in the courts. For decades, polling in the United States has surveyed both the general public and the medical community on the topic of physician involvement in providing lethal medications to terminal patients. For instance, a 2020 Medscape Oncology Ethics Report found that when asked “Should physician assisted dying be made legal for terminally ill patients?” 55% of the more than 5,000 oncologists surveyed nationwide agreed, “compared with 49% in 2018. ” Of the doctors surveyed, 34% said “no, ” and 12% indicated that “it depends. ” 21 /T_he report concluded: “ Acceptance of this concept has grown over the decade. More specialists (57%) than primary care physicians (51%) are in favor of physician-assisted dying being legal. ” 22 A May 2020 Gallup survey found that nearly 3 out of 4 Americans (74%) answered “Y es” to the question: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” 23 /T_he majority support for physician-assisted dying included every demographic group surveyed. /T_his was true among males (75%), females (73%), white people (77%), people of color (65%), college graduates (79%), high school graduates or less education (71%), Republicans (69%), Independents (72%), Democrats (85%), conservatives (57%), moderates (80%) and liberals (87%). 24 20 /T_hielicke, /T_he Doctor as Judge, 2. /T_hielicke writes eloquently about the “ambiguity” created by living with the unintended, but predictable, consequences of so-called medical “advances. ” Each instance of progress carries with it a “price to be paid, ” 8. 21 See Shelly Reese, “Medscape Oncology Ethics Report 2020, ” Medscape (Jan. 29, 2021), medscape.com/slideshow/2020-ethics-rpt-oncology-6013582. 22 Leslie Kane, “Life, Death, and Painful Dilemmas: Ethics 2020, ” Medscape (Nov. 13, 2020), medscape.com/slideshow/2020-ethics-report-life-death-6013311#2. 23 Published as “Gallup Poll Social Survey 2020” and cited by a prominent medical aid in dying group, “Polling on Medical Aid in Dying, ” Compassion & Choices, https://compassionandchoices. org/resources/polling-medical-aid-dying. 24 “Polling on Medical Aid in Dying, ” Compassion & Choices, https://compassionandchoices.org/resources/polling-medical-aid-dying.