How Should We Then Die? A Christian Response to Physician-Assisted Death by Ewan C. Goligher. Lexham Press, 2024. Paperback. 160 pp. $18.99.
The creep of physician assisted suicide in the West has been steady and patient. Moving from Europe to Canada and the United States, public approval and legalization of so-called “Medical Assistance in Dying” (MAiD) have trended directly upward through the late-twentieth and early-twenty-first centuries. Gut-wrenching reports of people unable to pay medical bills, struggling with PTSD, or diagnosed with autism being killed by physicians have become commonplace.
Among the recent responses to the euthanasia plague is Dr. Ewan Goligher’s book How Should We Then Die? A Christian Response to Physician-Assisted Death. As Goligher states in the first chapter, the book is a response to the question “why not?” regarding MAiD, offering answers grounded in natural law and Christian doctrine.
Goligher’s writing draws on his extensive experience as a critical-care physician who makes daily decisions about the care of the chronically ill and dying. His writing labor has clearly been born of necessity—for him the questions of MAiD are immediate and consequential. Each chapter begins with an anecdote taken from his own experience which illustrates the question he is addressing at each juncture.
Goligher’s strongest argument by far is his attack on the pretense that the medical establishment can justifiably offer death as a remedy for suffering to its patients when the nature of death is unknown. Why would an untested drug be given to anyone who asked for it? To believe that whatever comes after death is better than the circumstances of life, however dire, is an act of faith, not scientific rigor (64-68).
Goligher also poignantly observes that assisted death turns people from a means into an end. Traditionally, human health—and by extension humans themselves—has been the end goal of medicine. For supporters of MAiD, that end goal has changed, be it to preserving dignity or avoiding suffering. Assisted death moves people from being the end goal to being the means of achieving that goal—eliminating the sufferer in order to eliminate the suffering (40).
Another insightful point comes in the chapter “Why Assisted Death?” Goligher notes that most recipients of MAiD in Canada are white, wealthy, and non-religious. Because they are not poor or part of an ethnic minority, many MAiD advocates argue that they don’t belong to a “vulnerable group.” Yet for Christians, these non-religious Canadians are actually among the most vulnerable to lies about MAiD. Lacking any framework for dealing with pain and loss of agency, these wealthy Canadians are adrift and desperately in need of the Gospel. We should not scorn them. We must minister to them (17-19).
As commendable as the bulk of his book is, Goligher’s argument against MAiD based on human value doesn’t hold up. His argument, found in chapter three, runs like this: everyone agrees that people matter—they have intrinsic value. Because people matter, their existence matters. “To say that something is of value is to say that it is good that it exists” (35). To claim the opposite is absurd. One would never seek to destroy something that has value. “Since assisting suicide expresses the belief that it is good for someone not to exist…it necessarily denies that the person has intrinsic value” (45). Therefore, MAiD devalues people.
The fundamental argument can be organized syllogistically:
- Things with intrinsic value are things which should always exist.[1]
- Humans are things with intrinsic value.
- Therefore, humans are things which should always exist.[2]
To illustrate the problem with this reasoning, consider a tragic example from recent history: On March 27, 2023, a shooter entered The Covenant School in Nashville, TN and killed six people, three of them children. The shooter was subsequently shot dead by police.
According to the grain of Goligher’s argument, it is difficult to see how the killing of the shooter could be justified. In arguing that things with intrinsic value should always exist, and that therefore humans should always exist, Goligher overlooks situations—common in Scripture—where intrinsically valuable people need to be destroyed.[3] Because the minor premise—that people are intrinsically valuable—is true, and the conclusion proves false, the error must lie in the major premise.[4]
It could be objected that I am strawmanning Goligher’s argument. After all, his concern is with assisted suicide, not war or policing. But the universal language he employs cannot be ignored—it is fundamental to his argument.
Just War advocates, including Augustine, tend to argue that killing someone bent on unjustly harming others when there is no other way to prevent that harm—as in the case of the school shooter—is in fact the loving action to undertake, both for the assailant and the victims.[5] If that is true, then there are instances when it is right to destroy someone despite their intrinsic value.
It may be that Goligher is a pacifist, which would make these objections irrelevant for him. Even so, for those of us who are not, it is important to see clearly the implications of his premises. Either it is not permissible for officers of the law to use lethal force, or Goligher needs better grounds on which to base his argument; after all, if it is ok to kill a shooter in the name of love, why not kill a chronically ill patient for the same reason?
The answer may lie in the distinction Goligher makes between euthanasia and withdrawing life support from the dying. He writes “The intention, or the goal, of the action is the key distinguishing feature” (15). The argument against MAiD ought to derive from suicide, assisted or otherwise, being always a wrong purpose for killing rather than killing always being wrong.
Goligher’s observation that human intrinsic value is fundamentally connected to human existence is true to a certain extent. The goodness of that existence, however, is not absolute. The fall of humanity into sin created conditions in which destruction can be necessary to address the corruption of what is good. This is why God commanded the Israelites to destroy the Canaanites, appoints rulers to exercise the sword in pursuit of justice, and punishes the unrepentant with hellfire.
In attacking MAiD, we cannot begin with a universal premise based on the necessary existence of intrinsically valuable beings. Humans are intrinsically valuable, and that matters for arguments concerning MAiD, but the framework Goligher employs does not allow for the hierarchy of goods which is necessary to combat wickedness. The rest of Goligher’s book provides a better, though less definitive, starting point for engagement with the secular world.
In his fifth chapter, Galigher makes the key pivot from answering “why not MAiD?” to answering “why live?” As Goligher writes:
We have failed to truly care for our patients if we hear their cries of despair, their requests for death, and simply throw our hands up to say, ‘Sorry, it’s wrong for me to end you, so I can’t help you.’ Rather, we must probe the reasons for the request; we must understand the fears and the pain that lead to such a cry. And we must find a way to come to their aid (93).
It is not enough for Christians to offer arguments against MAiD. Christians must provide an alternative, both spiritually and practically. Spiritually, this means being true witnesses to the Gospel. It means evangelizing ferociously, being bold to show how, in Christ, suffering is neither wasteful or shameful. This should be done not just with our words but with our deeds. We must prepare ourselves to die well, even in the face of extended suffering.
Practically, this means attending to the battle against medical killing on multiple fronts. While nationwide legal and political battles can easily dominate our attention and efforts, they may not be the most important. As Goligher writes, we need to do more than just say “no” to assisted death.
For Americans, the pro-life movement offers a cautionary example: Despite the overturn of Roe, abortions rates rose slightly in the year following the Dobbs decision.[6] While the long-term effects of that supreme court victory remain to be seen, it is reasonable to worry that it may have been a pyrrhic victory. Perhaps Christian money and support would have been better invested in building more crisis pregnancy centers.
Modern palliative care may serve as a parallel alternative. A practice of medicine created by a Christian to serve the chronically ill, palliative care can do much to relieve suffering. Yet, as Goligher points out, such care is far from universally available (12). As the Western church continues to respond to assisted death, its leaders should look for opportunities to support long-term care for those who need it, as well as to minister to those undergoing it.
Excepting the argument of chapter three, Goligher’s book advances many strong points and should be read and considered by Christians. His willingness to take the issue head on is valiant, and sets a valuable precedent for future engagement with the topic. In public engagement and private conversation alike, we should emulate his example.
Alex Hibbs is an Assistant Editor at National Affairs. He lives in Arlington, VA with his wife, Naomi.
The term “things” is not meant to denigrate human dignity. It serves as a logical placeholder. ↑
Goligher provides a syllogism on pg. 126, but it is not valid, as it posits too many premises. ↑
Lev. 20:2, Lev. 24:16, Deut. 7:1-2, 1 Sam. 15:3, and 1 Kings 18:40, to list a few. ↑
The intrinsic value of people is clear in Scripture: Gen. 1:27, Ps. 8, Lev. 19:9-18, Matt. 6:25-31. ↑
Cahill, Lisa Sowle, Blessed are the Peacemakers: Pacifism, Just War, and Peacebuilding. (Minneapolis: Fortress Press, 2019), 111-112. ↑
Claire Cain Miller and Margot Sanger-Katz, “Despite State Bans, Legal Abortions Didn’t Fall in Year After Dobbs,” New York Times, Published October 24, 2023, https://www.nytimes.com/2023/10/24/ upshot/abortion-numbers-dobbs.html. ↑