LCMS Convention Workbook St. Louis, Missouri — 2026, Page 195

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THEOLOGICAL DOCUMENTS­­—COMMISSION ON THEOLOGY AND CHURCH RELATIONS
INTRODUCTION

195

INTRODUCTION

The 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 first parents in
the Garden, death has been the inescapable reality of human existence. People often approach the end of their earthly pilgrimage with a variety of regrets, expressed and unexpressed. A hospice social worker chronicled some of the most common:
1. They wish they had been more loving to the people who matter the most.
2. They wish they had been a better spouse, parent or child.

I. Introduction
In 1993, the Commission on Theology and Church Relations (CTCR) published Christian Care at Life’s End. The report
was an update of the CTCR’s earlier (1979) Report on Euthanasia with Guiding Principles.1 This 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 biomedical revolution whose consequences defy description.”2 The 1993 report repeated that assessment, and it is still true.
Thirty 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 The 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
This 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
Thielicke 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 The “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.
The 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 questions about care for those at the end of life in a way that is robustly biblical, theologically sound and pastorally sensitive.
This report therefore is not a substitute or revision of that previous work. Rather, it is intended as a supplement and informational 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 participate in assisted suicide. Together with these legal changes, the United States population has become increasingly supportive
of physician-assisted suicide.
1
Commission on Theology and Church Relations, Christian Care at Life’s End (St. Louis: The Lutheran Church—Missouri Synod, 1993). The 1993 report includes as a supplement (pages 33–44)
the CTCR’s Report on Euthanasia with Guiding Principles (St. Louis: The Lutheran Church—Missouri Synod, 1979). The 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.

3. They wish they had not spent so much time working.
4. They wish they had taken more risks.
5. They wish they had been happier and enjoyed life more.
6. They wish they had lived their dream.
7. They wish they had taken better care of themselves.
8. They wish they had done more for others.
9. They 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 existential threat death posed. Indeed, while others fled 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 first 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 final 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: “This 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

The Commission has also developed a supplementary resource with definitions, timelines and other information, see appendix.

7

Paul D. Steinke, “Comfort in the Face of Death,” The Lutheran Witness (May 1998).

Grace Bluerock, “The 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-oflife.html.
8

2

CTCR, Report on Euthanasia, 33.

3

CTCR, Report on Euthanasia, 33.

4

The Ramsey Colloquium of the Institute on Religion and Public Life, “Always to Care, Never to Kill: A Declaration on Euthanasia,” First Things (February 1992): 45–47.

5

Helmut Thielicke, The Doctor as Judge of Who Shall Live and Who Shall Die (Minneapolis: Fortress, 1976), 1.

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–).

1

2

INTRODUCTION

INTRODUCTION

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 The way of Christ is the way of the cross. Indeed, “God can be
found only in suffering and the cross.”12 This view of suffering, however, is neither fatalistic nor masochistic. The Christian
recognizes both a responsibility to care for those who suffer and a recognition that God is at work even while His children
suffer.

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? The goal of this report is to provide theologically 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.

Christians serve in myriad vocations where we are called to “fear, love, and trust” God and to love our neighbor.
Loving our neighbor will often 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. The 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
The firsthand 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 The 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 after death? Does delaying death suggest a false hope
for a ‘quality’ of life in advanced age that is not biologically feasible?” Grobien concludes, “The 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.

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, scientific researchers,
attorneys, philosophers and theologians. Thielicke captured the challenge when he reminded us that “no one who is committed 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

The 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 The 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 “Yes” 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 The majority support for physician-assisted dying included
every demographic group surveyed. This 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

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.
13

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.

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: The Case Against Assisted Suicide (Grand Rapids: Eerdmans, 2002), 12–28.
16

17

See the summary of Quill’s rationale in Dyck, 13.

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.

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.
23

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 The 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.
18

19

20
Thielicke, The Doctor as Judge, 2. Thielicke 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.

24

“Polling on Medical Aid in Dying,” Compassion & Choices, https://compassionandchoices.org/resources/polling-medical-aid-dying.

Gifford A. Grobien, “The Future of Bioethics,” For the Life of the World 25, no. 3 (Fall 2021), 6.

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