Can Christians “pull the plug” on a dying loved one? Is euthanasia biblical? A conversation with Jackson McNeece

Jackson McNeece and Dr. Mark Turman discuss the bioethics of euthanasia and physician-assisted suicide, why our culture has begun to accept physician-assisted suicide, and what the Bible says about “pulling the plug” on people on life support.

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Show notes:

Jackson McNeece begins by explaining biomedical ethics, giving the state of the modern debate and culture’s view on euthanasia, and how Christians should react (2:52).

They move to define terms like physician-assisted suicide, active and passive euthanasia, and “letting die” (10:10). They talk about why people are choosing physician-assisted suicide in such large numbers (20:44).

Then, they discuss “brain death” and persistent vegetative states, comas, heroic measures, life support, and how to treat people with these conditions (26:45).

They talk about biblical dualistic versus holistic views on the soul and body, and why it’s important to talk to loved ones about death and dying (36:43). If the holistic view is correct, how should we treat comatose patients? Can Christians ever “pull the plug” on a dying loved one (41:42)?

They end by considering why the disabled community is so against physician-assisted suicide and why Christians should never take their own lives (56:39).

Resources and further reading on the bioethics of euthanasia and physician-assisted suicide:

• “What does the Bible say about euthanasia?” Dr. Jim Denison
• “What does the Bible say about suicide?” Dr. Jim Denison
• “6 topics in biomedical ethics every Christian should be concerned about” Jackson McNeece
• “No Other Options: Newly revealed documents depict a Canadian euthanasia regime that efficiently ushers the vulnerable to a “beautiful” death.” Alexander Raikin
• “Will Euthanasia Be Secular or Sacred?” Ross Douthat
• “What Euthanasia Has Done to Canada” Ross Douthat
• “Having suicidal thoughts? Call or text 988” Mark Legg

About the host

Mark Turman, DMin, is the executive director of Denison Forum. He received his DMin from Truett at Baylor and previously served as lead pastor of Crosspoint Church.

About the guest

Jackson McNeece is a Master of Divinity student from Oklahoma City, OK. In May of 2021, Jackson graduated from Baylor University with a degree in Medical Humanities. Throughout his studies at Baylor, he developed an intense curiosity for medical ethics, particularly within a healthcare setting. While studying at Duke Divinity, Jackson hopes to continue to cultivate his fascination with medical ethics, learn to ground medical ethics within a theological context, and develop an understanding of what it means to serve in a pastoral capacity in medicine.

Transcript

Transcribed by Otter.ai

Mark Turman  00:10

Welcome to the Denison Forum Podcast. I’m Dr. Mark Terman, Executive Director at Denison forum sitting down for another culturally relevant conversation today we’re in the area of medical ethics and particularly going to focus in on the growing topic of euthanasia. Our guest today is Jackson McNeece Jackson, say hello to everybody.

Jackson McNeece  00:32

How are y’all doing?

Mark Turman  00:34

Let me give you a little background of Jackson Jackson is originally from Oklahoma City. He is a graduate of Baylor University with a degree in Medical Humanities. While he was studying at Baylor, he developed an intense curiosity in the area of medical ethics, particularly in a healthcare setting, we’re going to get him to talk about that in a moment. He is currently doing master’s work at Duke Divinity School. And he hopes to continue to consult, to cultivate his fascination with medical ethics, to learn to ground medical ethics in a theological context, which we would be very excited to hear him talk about, and to develop an understanding of what it means to serve in a pastoral capacity within medicine. So Jackson, we’re glad to have you with us and look forward to the conversation. But before we get into our topic of euthanasia, just tell us a little bit about how you got interested in passionate about medical ethics in a broad way.

Jackson McNeece  01:32

Hey, thanks for having me on today. I’m excited, excited for our conversation where it goes, I became interested in medical ethics as a sophomore at Baylor University. And when I was a nursing major realized that that wasn’t for me, even though it’s it’s a necessary profession. And over the pandemic, we’ve seen nurses play an invaluable role in the health care field. But that wasn’t for me, and I was struggling, where do I go? What do I do? I was having questions along the way of why can we do certain things in medicine? And how do we know it’s appropriate? My nursing professors were directing me to different professors throughout the university. I also I didn’t know what I was looking for, was searching for new majors came across this major called Medical Humanities, looking through the course catalog, and a lot of the professors that have been recognized, recommended to me, were teaching in this major. So I was like, seems like a great option changed. My major took the first class that was available, and realize this is what I love to do. We’re doing a unit on theological bioethics. And so through the professor, who I still keep up with today, and the the reading materials and the conversations we’re having in class, I realized that Biomedical Ethics is what I really wanted to do, especially bent towards the church to helping pastors and Christians think about how do we honor our bodies? Well, in light of what God has given us,

Mark Turman  02:52

wow, what a what a great clarifying experience. So much of what college ought to be about for all of us is to bring that kind of clarity around what God is wanting us to be about what he wants us to prepare for? How do you ultimately hope to serve Christ and serve others? When you finish your training? What is it? What do you mean by serving in a healthcare setting? And by being pastoral in that environment? How is God clarifying that for you at this point?

Jackson McNeece  03:23

So dealing in ethics, which is like in a healthcare setting would be in a hospital, it’d be negotiating between patients, and physicians, patients in the hospital, who really sometimes they’re often in the most tumultuous moments of their lives, big conversations, questions about what does it mean to be human? What is life and what is death are something that they’re grappling with, and I would hope that I, in those moments can serve as a translator of here’s the really complex topics that we’re talking about. Here’s how we can make it digestible to anyone. And then ultimately, through this conversation, be able to say there’s a hope it does not have to be this way. We don’t have to look at life as just culmination of death, but there’s there’s a hope beyond death. And that’s what I hope to do is yes, it’s in the it’s in the clinic. It’s in the hospital setting, but it’s also in the church, teaching congregants, how do you have these conversations before you’re in the hospital before you’re in life’s biggest moments, where you can think about it Well, think about it rightly and have these conversations with your Christian community.

Mark Turman  04:28

Wow. So, so important, and really a great, great and needed area. So we’re cheering for you and look forward to seeing how that’s going to work out. Jackson has been writing for us at Denison forum already. He has contributed some articles that you can find on our website Denison forum.org. In this area, and we look forward to him offering us additional articles going forward. But we want to talk today about something that’s been in the news and in the culture for a long time but has kind of come back to the surface in some ways, this topic of euthanasia. So we’re going to get into that a little bit the word euthanasia. You may know or may not know if you’re listening to this is a word that literally means a good death, or is sometimes translated as mercy killing. Some of you may listening to this may have read recent articles in the news about things going on in Canada related to some of their policies and laws regarding euthanasia. The New York Times conservative columnist, Ross Douthat has written on this in recent weeks, and you can find those articles online as well. Some very insightful and helpful things but part of what you’ll read in ROSS doubt that’s writing is that in the last year that’s on record, 3% of those who died in Canada died through some form of physician assisted death or physician assisted suicide. And Jackson, I just like to get you to react to that but also to a couple of other stats and stories. Let me just share a little bit where we’re both kind of reading from and relying on an article that will include in the show notes that Dr. Jim Denison, the founder and director or primary contributor to Dennison forum wrote around euthanasia, he quoted in his article about a Catholic nursing home in Belgium recently, that was fine because they refused to let a terminally ill woman receive a lethal injection in their facility. A Christian nursing home in Switzerland, has been told that it must either allow assisted suicide or it will lose its status as a charitable organization. Today, according to a couple of articles that we referenced a minute ago, one in five Americans can legally access physician assisted suicide, LifeWay Research, one of the research firms here in the United States recently reported that when a person is facing a terminal illness, this was the question they asked when a person is facing a painful terminal illness. Is it morally acceptable for a physician to aid that person in taking his or her own hurt his or her own life? 67% of Americans agreed with that assertion that they should be able to ask a physician for help. Going a little bit deeper lifeways research indicated that 59% of American Christians also agreed and 38% of evangelical Christians agreed. Jackson when you hear stories and stats like that, what’s your initial reaction?

Jackson McNeece  07:47

There are multiple reactions I think are first, the first reaction. This is This is sad. The report you mentioned the there’s Ross Douthat talked about this is the report and they’re out there. This is public knowledge, there’s three 3%, of deaths in Canada last year came came with mid physician assisted suicide, which we can talk about the terminology later, and the word games that’s going on there. But 3% of an entire population is one of the leading causes of death in Canada right now and that, that this topic can be an abstraction. But I think this is a moment for us as Christians to mourn and say there’s something going on in the culture that’s causing the this despair, that are the brothers and sisters, that our fellow image bearers think there’s no way that they can go on and they have to seek and seek a way to end their life. And it’s also unfortunate that cultures provide medicine, no less, not even culture is providing a way in which people can kill themselves. That’s, that is the moment that we that we really should mourn as a society that we’re that where we are looking across Europe, it really is this the same story again, and again, it’s been going on there for much longer, we as Christians have the responsibility to defend life to protect life. And then when we’re required to act in a way that’s unjust, as Christians need to stand for their conviction stand firm, and say that there’s a different way that this, this should happen. And this can happen. And then also, it’s time for Christians to model what authentic Christian community looks like and what is a truly good death, and not death with dignity as the culture wishes define?

Mark Turman  09:24

Well, well said. So let’s, let’s get into some of the terminology. You mentioned that there’s word games that are being played. And some of the resources that we’ve mentioned, some of the articles referenced this as well. But when you get into conversations about euthanasia, and I’ll just say, you know, I’m going to be 60 this year, and every day that goes by it seems like the reality of death is getting closer. If I am blessed enough to live two more years, then I will have outlived my dad’s length of life. And so that’s very much on my mind. We still are we’re Mark The 30th year of his passing this spring, but when we start talking about euthanasia, there’s a lot of terms floating around death with dignity, physician assisted suicide, and then you get into terms of passive and active euthanasia. Can you kind of sort some of that out for us a little bit?

Jackson McNeece  10:19

Yes, so I’ll try my best. And we’ll go from there. And we can talk, we can talk as we go. But physician assisted suicide, that is kind of the historical term that’s going on right now, especially in America. And that is when a patient with tip now there are certain conditions and it depends on what the conditions are, whether state by state, and then also an America versus Canada, that generally what happens is a patient goes to a physician, they’re diagnosed with a terminal illness, the, the they asked to die, the physician then prescribes a cocktail of drugs, that on their own fruition whenever they wish, the patient then takes those drugs on their own accord. And then it’s a slow process, generally painless, until they die. Euthanasia is an edit a new is a different process in which the physician administers the drugs to the patient in the hospital, and then the patient passes away under the supervision of the physician. Those are really the two frameworks. Now, a lot of what you’ll hear today with Death with Dignity, or medical aid and dying, or made, as we’ve said, or add, there were physician assisted death, those three options, those are all physician assisted suicide, but they’re newer iterations. And generally what they’re to do is to sanitize the process is to they’re trying to strip away the stigma of suicide. They’re trying to strip away the the shock and the horror surrounding this process and give it a more quote unquote, honorable name. Now, I think also as Christians and believing in the inherent dignity of life, there ought to still be a shock to this process. And so yes, PHS PA, D, Ma, IID, which are all acronyms for physician assisted suicide, and, and their other names, they ought to bring us word, and they also ought to cause us to think and to love people who are struggling with these thoughts of like, what if the world doesn’t love me? I think that’s the church’s responsibility to step in. Now, you also I believe, asked about the difference between active and passive euthanasia. And though that is so active euthanasia, that’s what we most commonly think about when you hear of Dr. Jack Kevorkian, that’s active euthanasia. And that’s when the physician in this case acts in a way to produce death. So they administer the drugs, the drug kills the person, that’s what’s going on, generally the Netherlands, then there’s also passive euthanasia, which is when the patient is either treated or not treated in such a way that brings about death, but the actions by the physician don’t directly bring about death. So that would be if the physician chooses to withhold nutrition and hydration from the patient, and then the patient dies as a result of that. That’s passive euthanasia. Does that make sense?

Mark Turman  13:14

Yeah, so it doesn’t take very long before you feel like you’re pretty deep in the weeds when you start talking about this. And, you know, as a pastor, so I had a chance to pastor for churches for 35 years in length. And I would have, on some occasion, the opportunity to be with families when they were talking about, you know, a person that was in their family that had some kind of an injury or an illness. And it was rare. I wouldn’t want to say that it was common, fortunately. But they would often get into these conversations about, you know, particularly if it was a situation involving cancer, beginning conversations. Well, the treatment is, in some ways worse than the, than the outcome of death in. And so we’re getting into conversations about, and we hear this fairly regularly of, well, this person has been battling cancer, they battled for a long time, perhaps years, they’ve been through several regimes of medication of radiation of chemotherapy, and they’ve had this conversation that started to emerge between quantity of life and quality of life. And fortunately, we we kind of as a culture for a long time, saw that as hopefully a very rare and narrow thing. But but now we’ve really expanded that out to be something that the wider culture is really considering on a much broader scale. Is that Is that where we’re going?

Jackson McNeece  14:47

It seems to be that that’s the trajectory

Mark Turman  14:50

and and then kind of talk about the difference between any form of euthanasia and Gen and then just the decision to say, you know, this is This person has a clearly established terminal illness or condition in which the continuation of some form of treatment, particularly aggressive things like radiation or chemotherapy, would might possibly extend their death in some ways, but there, there’s no real realistic expectation that they’re going to be cured, or that they’re going to get back to some type of living that approximated what they had before they were ever diagnosed with this disease. What’s the difference? Where Where have we pivoted further in your mind?

Jackson McNeece  15:42

So I will for to answer this question. I’ll only really deal with physician assisted suicide, specifically in America. That’s that’s what we have. There. Euthanasia is not legal, anywhere in America right now, as you said in the intro is 10 states, I believe, plus DC, one in five Americans have access to physicians whose physician assisted suicide. So that’s really what I’ll talk about the difference between PHS and then letting someone die is that PHS in America, you do have to be diagnosed with a terminal condition. But the drugs that you receive when you request PHS, from your physician, accelerate death. Now what you’re talking about and letting die letting letting a patient die, who has a terminal condition is no drugs are being administered that accelerate death, you’re just letting the disease or the condition, progress naturally. And eventually, that will take the patient’s life. So that’s the that’s in my mind, the difference between PHS and then letting someone die is one one’s natural, and then one’s unnatural and one accelerates? It’s alright. That your second question, I understand is, is letting someone die ethical, that I understand that correctly. Anything you want to change about that?

Mark Turman  16:58

Yeah. And that would be one of the things to talk about is, is it ethical to let a person die? We can get into that in a minute. And then we also get into the other question of, you know, to what extent does any of us as an individual, it biblically, is that within our prerogative right as choosing our death, but where I want to stop for a moment right here is just this idea that Christians need to be thoughtful, careful and biblical in the idea that the medical profession should not embrace death as a therapy. Can you kind of talk about that a little bit, just fundamentally, some of the things that we’ve seen, particularly outside the United States, as you said, Canada, Europe and other places, we seem to be moving from a healthcare standpoint to saying that this that death itself is a legitimate treatment of illness. And that’s never been the case, for the most part up to this time, correct?

Jackson McNeece  18:03

That’s correct. I think there there are two, two great resources. I think today that can help us think about this. The first is the end modern bioethics. There are two authors and they’ve written essentially, the Bible for the field, is Tom Beecham and James Childers. So their names and they write principles and Biomedical Ethics. I unfortunately have this book right next to me right now, I was reading I was reading it this morning for class. But in the in this book, they give they give four principles for medical ethicist to how to help them navigate and decide what what is ethical treatment and what is not ethical treatment is written from the perspective of the provider, which is which is helpful. And then there are two salient principles. The first is non maleficence, which is do no harm. And the second one is beneficence, which is to help and so in, in this instance, specifically non maleficence. It’s flies directly in the face of non maleficence. to harm to kill someone thinking it’s not harming them when it quite literally is the life. Another thing I just thought about was the Hippocratic Oath, the very first the tooth and 235 BC, I believe it was we can we can double check that Hippocrates wrote that one of the first commitments that are possessed physician has is to not harm their patient. I think a third thing that Gerald McKinney talks about, he’s a professor of philosophy at Notre Dame is that modern medicine seeks to override the rules and limitations of nature in the pursuit of eliminating suffering. Now, McKinney talks about when that’s impossible to eliminate the the focus of suffering, the goal of modern medicine is to eliminate the sufferer altogether. I think that’s exactly what we’re seeing right now. out is that there are certain conditions that we have medicalized in, in our culture, and that we’ve realized that these are really hard to deal with. And rather than doing the difficult work of properly diagnosing the problem properly, getting a prognosis and and then doing the necessary work to solve the issue that we see, instead of doing that, we’re just giving up and saying, you know, it’d be better if we just eliminated the the problem and the person altogether. So I think those are, those are three resources that help us to see truly how askew the medical industry is right now from helping the patient recover, and, and pursue full health and flourishing. They’re just eliminating the patient altogether.

Mark Turman  20:44

And that that makes me think of some of the writing of Ross Douthat in this area most recently, and this idea that that starting to be kind of exposed in Canada, that it’s as often is the case when it comes to health care, that things seem to be at least in the Canadian statistic skewed toward those who who are less wealthy, those who are more toward the poor side of the economic spectrum, and or don’t have as good of access into the healthcare system. That’s part of question that that just simply out of economic reasons or frustration with getting to the best of care that some of the some of these people seem to be just throwing their hands up and saying, Well, if death is an option, I’ll take death because of the things that they’ve dealt with. There’s also an interesting provision expansion of Canadian euthanasia that’s coming in March that is going to include provisions around mental health and Douthat and some of his work expose the story of one lady who said it was about her terminal illness, but in private conversation said it was more about just feeling isolated feeling alone not having a good support network of community and people which reference is part of what you said a moment ago. But this idea that that it becomes an option not not because of a very narrow set of really tragic terminal illnesses, but is now kind of becoming an accepted well I just this is this is a way oversimplification but Well, I just don’t like my life. Or as one adopts articles where it reference somebody who gets advanced in age and just says what many almost all parents and grandparents say I don’t want to burden my family so it would be a noble thing for me to in my life so that my family is not encumbered. Give me your thoughts on that your reaction reflection to hearing that kind of conversation emerging

Jackson McNeece  23:10

yeah so I so you reference Ross doubt that there’s also there’s a really great article in the New Atlantis journal by Alexander awaken is the journalist name and Alexandra goes through goes through similar to Ross Douthat several accounts request for ma ID and Canada and lists so many of them simply as their reason for requesting requesting ma D as homelessness. So it’s not it’s not even a medical condition anymore. It’s just like I’m cold on the streets. There’s no will to live. That’s ma ID is not not the solution to this moment. I think also in terms of you’re talking about isolation, the pandemic the pandemic was hard it for so in lockdowns, force a lot of people and into deeper into their isolation. They found isolation for the first time in ways they hadn’t. We’re losing community around us. This is this is not. Death is not the solution to what we’re talking about right now. Go going back again, I think the church the church provides a viable and healthy alternative to say, Welcome to Community it’s, you know, when we take communion each week, we realize that we’re part of the work we’re part of the body of Christ, we’re communion together. It’s not necessarily me. But yes, I have a communing relationship with Christ and I have the community relationship with the person taking it to my right into my lip. I think that’s a wonderful testament to what the Christian response ought to be is not death. It’s our church. It’s, it’s our brothers and sisters in Christ. And there was one other thing mental health is a new is the sunset clause, I believe is what it’s caused. And that’s happening in March in Canada concerning mid and mental illness. I think that again, mental illness is not a reason that we that we pass away We die. Mental illness is something that we, as physicians and healthcare providers ought to be willing to help because those people too, are made in the image of God. And they ought to be recipients of our care and love and assistance. We have the medical abilities to to take care of persons with mental illness, to return them to their flourishing states, with community with God, to simply say that we’re going to give up on these people is really a dereliction of our duties and health care of what we’ve committed to do is beneficence and justice.

Mark Turman  25:33

Well said, and even, even if they have gotten to a place where they’ve kind of given up on themselves, we should still believe in them and believe that their life is important. It’s sacred, it’s valuable. We often at Denison forum, just remind people that what we believe is that life is sacred. It is a gift of God, every human being made in the image of God and is of inherent eternal worth because of that, and that we believe that life is sacred from the moment of conception until natural death, is starting to get a seemingly more and more gray about what the definition of natural death is. And maybe that brings us around to something that might be a little bit more familiar to our audience. We we get sometimes into these conversations, either because we’re actually involved with people or we set up a straw man, if you will, about, well, what about people who are quote, unquote, brain dead? Can you explain a little bit I didn’t realize until I started reading into some of this research, that there are nuances about what the term brain death actually means. Can you explain that a little bit? Sure. So

Jackson McNeece  26:45

Brain death is very, very complicated. And it’s relatively new terms when 1968 Harvard Medical School created an ad hoc committee on the definition of death, and then from this committee in the committee’s developed deliberations, is where they came out with a concept of brain death. So that’s, I’m not great at math 5060, or 55, something like that years ago. So the condition has existed prior, but our terminology or in our terminology, and our language surrounding brain death, is relatively new. And even since then, people disagree. Can someone really even be brain dead? What is it? Why is it just the lower brainstem of the body, and so we can unpack that in a minute. But generally, what Brain death is, is there’s if you can picture your brain, you’ve got your two lobes. And then and then coming from the two lobes is a brain stem. And then the brainstem really is the passageway from what happens in your brain and the two lobes down through your spinal cord and through your neurons into the rest of your body. Can you have to has a function for you to really truly like live as we as we understand it, to run, walk, breathe, that kind of stuff. So when so brain death, is when this this lower brainstem ceases to function. That’s brain death. So, so humans, we no longer have that there’s also another alternative to that called permanent vegetative state, or PVS. And that’s when the upper brain so that’s those are components in the brains that see that’s in the two lobes is different than the brainstem. That’s when that ceases to function. So if you were to test it, it would just totally be flatlined in terms of neural activity. And so that’s PVS, both of which are permanent, irreversible conditions, you cannot recover from brain death, you can’t recover from PBS. And But the tricky thing about both PBS and Brain death is a person appears alive by all normal circumstances, they can breathe, they need calories, they still use the restroom. But they’re not they’re not quite alive as we know it. Talking is not a thing, but they might Twitch because there’s still neural activity. There famous cases like this, if you want to go back and look, that’s PVS. That’s brain death. It’s really complicated. How do you assess that? How do we even diagnosis if a person is brain dead? And then if if a person is brain dead? What do we do with the body that otherwise still functions kinda as we know it? Yeah,

Mark Turman  29:21

we and I would suspect most everyone that listens to our podcast has run into some kind of a story around this, right? And but we, in our culture, we kind of flippantly tossed these terms around in some ways. I remember when I was pastoring. One family didn’t really understand this distinctive and I may get this wrong. So I know if I don’t want the doctors to start calling or emailing me in case I get this wrong because it could be I’m not a doctor, but just this idea that there was there was upper brain damage and death where we would, you know, commonly say that there’s just no activity there. No brainwaves, that type of thing. But that this person continued to breathe on their own. And as one person, one doctor explained to me, you know, God made it so that the respiration function is kind of buried deep into the brainstem and is, you know, highly protected. So the ability of somebody who’s lost most, if not almost all of their functioning, their cognitive ability to be aware of themselves to interact with other people to interact with their environment, that may be all gone. But down in the brainstem, the ability to continue to breathe on their own may still very much be there. And to keep their heart functioning as well. So that’s where, you know, I think most people don’t know the difference between upper brain death and brainstem death, if we can say it that way. But in those particular cases, we often hear stories about people talking about, okay, well, what measures are ethically correct, biblically correct, and you get into these terms that we hear on, we hear them on medical television shows, right, that’s where so many of us I serve on a local hospital board. And we had a conversation about this just recently, in one of our board meetings about how many people come to the hospital, with their understanding of illness and health care, having been informed and built because they watch, you know, two or three or 10, medical shows on television, right? But we hear these terms, heroic measures, ordinary measures, and then basic life support. Can you kind of unpack those a little bit for us? What’s the distinction? As we understand it today, not in TV terms, but maybe more in real life terms? What does it mean when you’re giving somebody heroic care, ordinary care or basic care?

Jackson McNeece  31:58

These the turret Yeah, I totally agree. Even as great as Chicago Med is on NBC, it can be it can really blur the lines is what what is medicine? And how does the medical complex truly work. So for heroic and ordinary care, those nothing is concrete about what that might be. When we talk about heroic or extraordinary measures, that means whatever care that’s being prescribed, is extremely burdensome or overly burdensome to the patient, it’s got a low, low Outlook to do it, it’s risky, there’s going to be a lot of complications that come with it. But that’s, that’s heroic or extraordinary care. Ordinary care is things that are going to be generally acceptable, they have a strong likelihood of success rate, the patient will probably recover. It’s, it’s a smart decision, potentially, for the patient to pursue this care. Now, again, those are really also context dependent. So it can be a heart attack is different than an aneurysm. And so extraordinary care in one case, might be ordinary care. In another case, it really depends on a lot of circumstances, some outside the patient’s control. And then the third one basic care, that is just no other care outside of nutrition and water. So it’s the most minimal, it’s that is very concrete as to what it is. And it’s it’s really letting the patient and their body respond as best the patient’s body can respond, and then anything else is outside their control.

Mark Turman  33:36

Yeah, that’s helpful. So I’ll refer people back to Dr. Denison’s work on this and some other things that we’ll reference in our show notes. But when when we start to get into these two conversations about levels of care, heroic, extraordinary, ordinary basic care, you know, particularly water when you get down to basic care, and then you start connecting that with terminal illnesses or, you know, things like stroke, heart attack, and you start getting into questions of, you know, vegetative states or brain death, then, people often start having contemplations. They even will write a medical power of attorney with some of these terminologies and situations, spelled out in some way. But, but we’re all kind of coming around to this deal of what would I do if I was the family member or the person charged with determining some medical decisions for another person, or maybe even spelling them out ahead of time for myself? Right. I’ve heard of medical powers of attorney that I don’t want they might spell out I don’t want him heroic measures utilized in this condition, right. Any guidance that you have there and then and then let’s pull this in to what Dr. Dennison writes about in his paper from a theological perspective, what he calls the dualistic view versus the holistic view. Tell me if I get this right the dualistic view being the theological, somewhat possibly medical, but mostly theological idea that a person’s soul in certain conditions that we’ve been describing a person so could actually leave their physical body before their physical body completely shuts down. I’ve heard this as a pastor, I’ve heard this many, many times, I feel like my loved one, I feel like they left, they left a long time ago, when they can no longer be awake and alert relating to people themselves, their environment, they left, but their body remained for a certain number of hours or even a certain number of days. You hear those stories, and then other people who say, You know what, that that doesn’t happen, the holistic view would be no, this is a person and it is a person with the image of God, even if they are comatose, and unaware and unable to interact or relate. They are still a person and alive person. And they are that image of God until their body fully ceases to function. Give us your take on that. Give us further insight. What do you think? Which one of those perhaps represents the most biblical view and there are biblical references either side of this argument, but thus far in your thinking, Where do you kind of come out on that?

Jackson McNeece  36:43

Yeah, Mark, I want to go back URL, you said something that was great. And I want to return to that really quickly. But the point when when the person listening to this, or they’re reading the articles comes across the question of like, if I were ever in this case, what do I want to do? Or what would I want my mom or dad to do? Or what would I want my child to know about me have those conversations with your family and loved ones, I’m not asking you to do that over Thanksgiving dinner, because quite frankly, that would just really put a damper on your turkey, as you’re talking about your desire, your desired way to die. But but one of the greatest gifts you can give your loved ones is for them to know how you want to pass away those conversations when their child’s age appropriate. Begin to have that conversation. If you don’t know how your parent who’s aging, wants to pass away, given certain certain circumstances, have that conversation there are there are guides out there online that you can Google to guide this conversation, you can write it down, then also a medical power of attorney is is one of the best things that you can do to provide your loved ones. If you’re ever in the circumstance with the guidance and assistance. When should they ever need that they’re generally depending on the state, legally bound your loved ones are legally bound to follow your wishes, if not ethically bound to follow your wishes. So it’s a great way to ensure that there’s a no more unnecessary drama, that has to be no more emotional consternation, it really makes the process of dying, much easier, smoother, and more peaceful. Then so that that was that I thought that was a great comment that you made earlier. Just wanted to reiterate it. But the second question, does No, no, that was great. Does does a person in PVS, or brain dead bear the image of God, I think you’re totally right. In laying out the two, the two perspective found really in Scripture in the Christian tradition. Personally, I’m beholden to the to the holistic view, I think that’s for a few reasons. One, one of which is that if it’s if it is the dualistic view, that it requires a person to have a certain amount of brain function to be made in the image of God. Now, that means we’re gonna have to start defining what amount of brain function does mean were made in the image of God. And then whatever person is, is conscious, but lacks that amount of brain function. What do we do there, I think, presents some issues with who we are as humans, and understanding made in the image of God based on neural activity. I think reading and Genesis one and two, both creation stories. The scriptures never tell us why we’re made the image of God. So I’m very hesitant to say that this is a defining characteristic of being made in the image of God. And as because starting XYZ I also think, looking at the arc of scripture that God cares Yes, about our souls, but equally about our bodies when you read about the hemorrhaging woman and Mark, I don’t remember the chapter but you read about her and Mark, Jesus heals her body. And then he says, go on on your way, and that’s supposed to mean something to us. There are other stories about Jesus raising Lazarus from the dead. I will I don’t know what we would do with that story. If we have this dualistic view that Jesus only cared about ourselves. Now, as you said, there are there are other scripture stories that you can interpret a more dualistic interpretation of who we are as humans. But I’m convinced that that the whole arc of Scripture lends towards have a unified image of humans being made in the image of God. Now, what does that mean, when a person’s brain dead, or in a permanent, vegetative state, it means they’re still made in the image of God. They’re beholden to the same respect that we give someone like you and I, that they’re, they’re beholden to the same autonomy and love and care and nutrition and water, it just because they’re simply lying there, that doesn’t mean they’re there a pile of carbon atoms composed in the bed, is there a person and they had the full capacity and respect and dignity that anyone else does? So that’s my take on my take on the debate. No, there, there are serious scholars out there who have other opinions. And I think that’s great, I think, to wrestle with scripture seriously, gives us a unified vision of who we are, as humans is made in the image of God.

Mark Turman  41:12

Well, so let’s let’s kind of go with that a little bit further, in that range, as people start talking about, okay, well, if that’s true, then what does that mean biblically and ethically for what we should do for this person. And the the first principle, we’ve already talked about that human beings are unique and special, because God chose to make us in His image, as the pinnacle part of His creation, no other part of creation, shares in that the way that human beings do with the ability to not only talk and communicate, but to relate both to each other, and to God and to ourselves. And to be able to think, to feel, and to decide, that makes that’s at least in part, what it means to be made in the image of God. And therefore, the whole conversation that we’re having about euthanasia, as it pertains to human beings is completely different from what it would be if we were talking about animals, because that’s mostly where we hear this term, we talk about the fact that animals get euthanized, usually, because they’ve been injured, or they’re ill. And that’s one whole conversation. But talking about it, when it comes to human beings is completely different, because human beings have a soul animals don’t. And human beings are made in the image of God in that sense. But then you get down to this conversation we were just having about, okay, what is the, what is the biblical, ethical right approach, when it comes to a person who has grown ill grown old or grown, incapable of doing some of those things? If they are in this condition, medically and biblically, I think we would want to say and tell me if you agree with this, we have to remember that we are in major ways, holistic, and we don’t believe in a Greek dualistic idea that says that, that our true selves are our soul. And we’re kind of imprisoned in this body for a period of years. But our true selves are this interior spirit that eventually is going to get released. That’s a very Greek idea that is not biblical. We don’t just as people like to say it this way. We, we don’t just have a body we are a body. We are body, soul, spirit, mind, we are a oneness of unit. So what I the reason I want to emphasize that is, is that we don’t want people thinking that their physical body is in some way secondary, or unimportant. It’s not its critic, the material world is a world that God created and is a world that is sacred, and that includes our physical bodies. So now let’s move forward to when somebody is clearly not able to be fully functioning in every way and may have an illness or an injury. What level of care minimally must be there, Dr. Dennison articulates his own opinion in this he he agrees with you, as I think I do on the holistic view. But basically what he says is no human being should ever be abandoned in any case, and no human being should ever be denied water or the most basic form of sustenance to the degree that they’re able to participate in that they should never be denied that. Is that where you would land is that is that the outcome and the application that you would land on?

Jackson McNeece  44:58

i Yes, I Do I think yeah, water, water and sustenance are basic necessities to human life, regardless of how we conceive of that person. And if if the physician, if the physician team at a hospital or hospice unit doesn’t doesn’t believe that’s necessary or that they’re unwilling to provide that I think that it’s the responsibility of the patient’s church or community to step up and be like, No, you may think otherwise. But I’m going to afford this person dignity, regardless of it’s a burden to me, if it’s a burden to you, this person’s a person. In the classic Dr. Seuss, a Horton Hears a Who a person’s a person, no matter how small, a person’s a person, no matter their needs. And I think that that’s a principle here that we can apply regardless of permanent vegetative state, brain death, euthanasia, mental illness, homeless, that is, that is the opportunity that Christ compels us as a church as a community, to say, Hey, I care about you, regardless of your condition, I’m going to afford at least water and food to you, so that you can live out the rest of your days.

Mark Turman  46:09

Right. And, obviously, shelter, and appropriate care in those other physical ways would also also be appropriate. So if we, if we bring this down to where, what we might say the the average or typical person lives, if we try to start narrowing in this conversation, how would you advise a person or a family member about if they’re faced with a situation like this in terms of, okay, is it ever right? And again, this is one of those terms that just gets tossed around that needs to be better defined a better use, which is, is it ever right or wrong to quote unquote, pull the plug on a human being? How do you? How do you kind of nuanced that conversation?

Jackson McNeece  46:56

Yes, so I so is it difficult, it’s a difficult conversation to have? I think so for purpose. And you can clarify this, when you say pulling the plug, we’re going to assume some things that they have a terminal condition that they’re currently maybe on life sustaining measures right now, and that their death is inevitable. It’s not like, I don’t know, they cut their they scrape their knee, and they’re not have a little band aid. That’s not what we’re talking about and pulling the plug right now. Yep. So it’s so it’s a challenging conversation. And the way that specifically American culture and I think largely Western culture, has understood death to be is the the line between letting someone die, and then killing someone has been blurred so much. They seem like they’re the same thing. And so if a family is faced with this face with this issue, and they’re in just emotional turmoil, struggles of do I pulled the plug, I don’t want to kill grandma. I understand why they’re feeling this way. That’s like, the medical industry and the medical education industry has done a horrible job about educating the public as to what’s happening. Now we’ll go back to kind of our hypothetical scenario about grandma, in this instance, or whoever it may be. It’s grandma, grandma is going to pass away. Like we need to remember that grandma is a human, and that grandma is finite. And that’s, that’s part of the how we we are created to be and to try to outrun our finitude is, in some ways, a rebellion against God is God. God created us to live and God and we were to die. And that’s in part a consequence of our sin. And so to try to just prolong that unnecessarily, is not faithful to our vocation as who we are as Christians. I think the second thing that I hear Gilbert Highlander, who’s a kind of an elder statesman, elder statesman of Christian bioethics right now, I hear Gilbert say, I’ve heard heard him said a few times, that our goal in life is not to make our days the most, but it’s to make the most of the days we have left. Now, Grandma is going to pass away soon. And the health care that she’s receiving right now isn’t making her better. It’s just delaying the inevitable. And so there’s there’s several concrete several ways this conversation should go but to be responsible and resourceful with the things that we’ve been given. In part, that’s medicine, and that’s medical supplies, and that’s medical personnel. If grandma’s close to passing, we need not delay that. Yes, because we’re rebelling against God, but also because we’re using resources that can be given to someone else. I think that’s it. We’re supposed to be steward early on Genesis in Genesis one, we’re given stewardship to the earth. I believe that includes medicine and medical supplies and other people and delaying passing simply because we’re unwilling to make the decision is not being a good steward of the resources we’ve been given. So I think there’s a there’s a theological imperative on dying. Well, there’s the theological imperative not To delay death, when that’s inevitable, and there’s also a theological imperative to be resourceful with the things we’ve been given. Now, I know I may have sounded really harsh in that moment. And that’s not not my intent by any means. Because we realize death is death is a very death is a profound thing, Jesus, when Jesus cried in the gospels was when Lazarus died, and death is emotional, taxing, and there’s often family drama wrapped up in it. And I understand that it can be hard, and it can bring up memories and emotions that we aren’t ready to deal with. And for that, there needs to be a space carved for the family in this decision making time that that health that in a healthy manner, addresses those concerns and addresses those needs. I understand that. But I also understand from a purely abstract principle, and that’s kind of where I’m coming from at the moment, is that that letting die is something that and that’s important as a Christian is how we die in what way we die. And it’s making the most of the days that we have left in this in this hypothetical that we keep going back to a grandmother doesn’t have many days, it’s time to let her pass away. And that’s different than killing her. And I’m hope I’ve articulated kind of the difference between intentional killing and letting die.

Mark Turman  51:18

Yeah. And I think that that that may be one of the most important contributions of this conversation is that Christians need to think clearly about that. And they need to advocate clearly around that, that there is a difference between the the normal expected process of natural death. That is clearly the Bible says going to happen until Jesus comes again, and restores all things, that that is a natural reality that we are confronted with not something we should celebrate not something we should desire. But it is a reality. Jesus called death, the Bible calls death, our last and greatest enemy. And as people of faith people have of Christ centered fate, that’s what we celebrate most right is that he overcame that enemy, and that we have a hope that is beyond the grave. We know that everybody doesn’t share in that. But that’s our testimony, that’s our witness is that no matter how God might enable us as believers to make the most of all of our days be they few or many, that they those are still not the end of our days, we have an eternity that’s unfolding before us. That’s why the Bible says that we can grieve in the reality of death just like Jesus did. But we don’t grieve as people without hope. We grieve as people with hope. But we have to remember that this is not our permanent home. And this is not our permanent life. And whether the people we are with share that belief or not. That’s what we need to witness to and contend for in the in the best ways possible. So I think you’ve made a really helpful distinction there between, especially in a medical context, letting our theology inform that, from the standpoint of there’s a very big difference between letting die and actively doing things that either kill a person or enable them to kill themselves. And maybe that’s a Jackson, the last question I just maybe get you to touch on before we wrap up here today, which is kind of a two fold thing is, there’s an interesting little caveat here that we’ve kind of come across, which is that disabled people are one of the group’s most against this whole idea of dying with dignity. And then this this other kind of collaborative idea of whether or not theologically to what extent should any individual should you or I or any individual, what say do I have in my own death in terms of, of scheduling it or causing it to come about? So that’s a those are two big questions, but just kind of a thumbnail answer from you. Why do you think the disabled community is against the expansion of, you know, physician assisted suicide, these things that we’ve been talking about? And what about my own theological right, if you will, to decide about my own death? Got a response to either side of that?

Jackson McNeece  54:30

Yeah. Well, we’ll try to tackle both of those quickly, I think for in terms of disability, thinking back to earlier in the conversation talking about Gerald McKinney, and the the aim of modern medicine is to eliminate suffering and if not, if that’s not possible, eliminate the sufferer. Those with disabilities are they’re typically assumed data says otherwise. But they’re typically assumed to have a lower quality of life. And so in this instance, when were when we’re a school By being a certain value to persons with disabilities, that they probably don’t have a great quality of life, they’re probably quote unquote, not happy. It only makes sense that the natural, the natural solution, since we can’t we can’t eliminate disability from these people is to just simply eliminate them altogether. Since, as I said earlier, statistically, that’s not true. Persons with Disabilities typically report higher quality of life than persons without disabilities. We also live in a product driven society, persons with disabilities, specialists, especially profound intellectual disabilities can’t produce in the way that we think about. So again, because there’s no production, there’s really no reason to live. Again, as Christians, we know a that every person, regardless of their ability, or disabilities made the image of God. And then also our value is not in what we produce. So again, already as Christians, there are two other reasons why we can partner with persons with disabilities and say, we wholly oppose physician assisted suicide and euthanasia on these grounds. Until your second question, which reminded me what it was.

Mark Turman  56:12

Yeah, so what about my right as a as a Christian or not a Christian, but my right, to determine my own death? You know, even from a societal standpoint, ethically, and spiritually, even if I want to die, does that mean that I have a right to make that happen?

Jackson McNeece  56:39

Yeah, that’s a that’s a great question. I think I think the quick answer is absolutely not. When we surrender our life to Christ, we surrender dominion, the Lordship, of our life to Christ, and that that dominion and lordship doesn’t end at law at death in like it, it extends through death. My mind went to the him till he returns or calls me home. It was I think that’s, that’s a hymn that’s been sung throughout the centuries for Christians than, and it still rings true today is that when we call ourselves Christ, and we are covered with the blood of the Lamb, we lose all opportunity to choose what we think is best. That’s Christ’s decision. So in God’s providence, that’s when we’re called, we’re called home, we don’t get the opportunity to say when we think that’s best, or when we like to go, or how we’d like to go. We rest in the faithfulness of God and what God chooses for our life.

Mark Turman  57:33

Yeah, what a good word. And as that him says, until that day, in Christ, I stand right. And it may be that in Christ, I lay down, but either way, I live my life in Christ and seek in every way for myself and for others, to make the most of their days, even if those days may not be necessarily as many as what we might like, for ourselves or for others. Jackson, thank you for a fascinating conversation. Really, really great stuff. Thank you for being a part of our podcast today. And we are so glad to have you as a part of our team.

Jackson McNeece  58:07

I appreciate it. It’s been a joy talking about this today. It’s been great conversation.

Mark Turman  58:12

All right. Well, I look forward to future conversations and you can find this podcast at our site. You can also find Jackson’s writing at Denison forum.org. As we often say, if this conversation has been helpful to you, please share it with others so that they can be a part of the conversation rate and review us on your podcast provider that will help other people to find our show and to benefit from it as well. Again, thank you for being a part of today’s conversation. We look forward to hearing you and seeing you on the Denison Forum Podcast soon. God bless you