LCMS Convention Workbook St. Louis, Missouri — 2026, Page 196

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196

THEOLOGICAL DOCUMENTS­­—COMMISSION ON THEOLOGY AND CHURCH RELATIONS
INTRODUCTION

T H E O L O G I C A L F O U N DAT I O N S

In 2016, LifeWay Research conducted a major study of American attitudes.25 Their 1,000-person survey sample stratification mirrored the most recent U.S. Census data for gender, age, race/ethnicity, region, metro/non-metro, education
and income. The following are among the most relevant findings: 67% agree that it is morally acceptable for a person to
ask for a physician’s aid in taking his or her own life, and 69% affirm permitting physicians to assist terminally ill patients
in ending their life. Significantly, nonreligious persons are more likely to agree (84%) than Christians (59%) and other
religions (70%). Those defined as having “evangelical beliefs” were less likely to agree than those without evangelical beliefs
(38% vs. 73%).26

C. Dying in America

Death for most Americans will not take place in a hospital. A 2018 Harvard report stated that “although more than 700,000
people die in hospitals each year in the US, the trend is toward fewer in-hospital deaths” even during a time of increasing
hospital admissions. In fact, between 2000 and 2015, a sharp turnabout occurred in the places where people died. In
comparison with a 2000 survey, those who died in 2015 were more likely to die at home or in a community-based setting
(31% vs. 40%) and less likely to die in an acute care hospital (20% vs. 33%).27 Linda D. Bartlett and Karen Rehder claim
that death for most Americans is “peaceful, painless, and with family.”28 They note that “most Americans spend their last
days in their own homes with family and friends; most are alert and in control of their bodily functions; one-third die
at home while one-half transfer to a hospital shortly before death; most maintain active interest in the world; most are
not depressed; and many report a feeling of hope, believing they have something to live for.”29 M. Powell Lawton of the
Philadelphia Geriatric Center reported that, “On the day of death 51 percent had no difficulty with orientation or recognition of family; 61 percent had no pain; and 52 percent could breathe freely.”30

II. Theological Foundations
A. Christian Basis for Human Dignity and the Sanctity of Life

Christian discussions of end-of-life issues must begin with the doctrine of creation.31 Created by God, accountable to God,
we live as perpetual recipients in relation to His perpetual giving. Secondly, Luther reminds us that the commandment
against taking life also obligates us to be protectors and sustainers of life, for ourselves and for others. Lutheran theologians call this a theology of “receptivity and vocation.”32 All end-of-life conclusions are predicated on the premise of God’s
superior claim to us and are bounded by the limits of creation as He designed them. As Luther put it, “The First Article is
given for the purpose that we should know and learn where we come from, what we are, and to whom we belong.”33 Indeed,
Luther’s comments on the First Article of the Apostles’ Creed use a form of “all” nine times to emphasize God’s role.
What does this mean? I believe that God has made me and ALL creatures; that He has given me my body and
soul, eyes, ears, and ALL my members, my reason and ALL my senses, and still takes care of them. He also gives
me clothing and shoes, food and drink, house and home, wife and children, land, animals, and ALL I have. He
richly and daily provides me with ALL that I need to support this body and life. He defends me against ALL
danger and guards and protects me from ALL evil. ALL this He does only out of fatherly, divine goodness and
mercy, without any merit or worthiness in me. For ALL this it is my duty to thank and praise, serve and obey
Him. This is most certainly true.34

Nevertheless, despite the reality for the aggregate of persons, significant numbers of individuals do die in hospitals
amid various technological interventions. The resulting emotional strains and financial costs of hospital care for dying
patients are significant burdens. As a result, such factors continue to drive changes to law and custom that permit physicians to intervene in ways that ostensibly “relieve misery,” but do so by hastening or even causing death.
Recent years have witnessed an explosion of debates in the literature on end-of-life issues. A wide variety of voices are
heard: medical researchers and physicians, philosophers and ethicists, theologians, attorneys, journalists, disability activist
groups, and even presidential commissions.

The doctrine of creation, specifically the teaching of creation out of nothing (ex nihilo), confesses that everything in
the cosmos owes its existence to the divine will. This sets orthodox Christianity apart from pantheism, panentheism and
open theism.35 It also establishes the qualitative distinction between Creator and creature.
This idea of the primary differentiation between the Creator and the creature does not exist merely in the realm of
dogma. It is central to the Genesis narrative, the Old Testament teachings about idolatry, and Paul’s theology and soteriology. The language of Genesis reinforces the consistent teaching of radical differentiation. The verb “create” (bara — ‫ )אָרָּב‬in
the Hebrew Scriptures has God alone as its subject—only God creates.36

25

“American Views on Assisted Suicide — Lifeway Research,” LifeWay Research, http://lifewayresearch.com/wp-content/uploads/2016/12/Sept-2016-American-Views-Assisted-Suicide.pdf.

26
Those with “evangelical beliefs” “strongly agree” with these statements: The Bible is the highest authority for what I believe; it is very important for me personally to encourage non-Christians
to trust Jesus Christ as their Savior; Jesus Christ’s death on the cross is the only sacrifice that could remove the penalty of my sin; and only those who trust in Jesus Christ alone as their Savior
receive God’s free gift of eternal salvation. These doctrinal markers are shared by faithful members of the LCMS. Polling organizations frequently identify the LCMS as “evangelical” because of
such shared beliefs.
27

Robert H. Shmerling, “Where People Die,” Harvard Health (Oct. 31, 2018), health.harvard.edu/blog/where-people-die-2018103115278.

Linda D. Bartlett and Karen Rehder, “Ventilators, Feeding Tubes, and Other End-of-Life Questions,” Lutherans for Life (Feb. 28, 2020), lutheransforlife.org/article/ventilators-feeding-tubes-andother-end-of-life-questions/. The study surveyed 4,000 people age 65 and older.
28

29

Bartlett and Rehder, “Ventilators, Feeding Tubes, and Other End-of-Life Questions,” 7.

30

Quoted by Bartlett and Rehder, “Ventilators, Feeding Tubes, and Other End-of-Life Questions,” 7.

31
While Christian discussions of this topic begin with a doctrine of creation, this is not to say that one can only mount a defense against suicide and euthanasia on Christian grounds. Arthur J.
Dyck of the Harvard School of Public Health put forth a case based on “logic and facts” to demonstrate that one might argue for a natural and inalienable right to life, a natural love for life, and
as a belief in life’s sacredness or “incalculable worth” without committing oneself to the Christian faith tradition on the basis of “the moral structure of life’s worth and protection.” In his Life’s
Worth: The Case against Assisted Suicide (Grand Rapids: Eerdmans, 2002), before showing the importance of the “incalculable worth” of life in Christianity, he argues that such views are compatible with, but not dependent on, one’s adherence to the Christian tradition or its doctrine, 73.
32

Charles Arand, “Personal Autonomy versus Creaturely Contingency: The First Article and the Right to Die,” Concordia Journal (October 1994), 388.

33

Cited by Arand, “Personal Autonomy versus Creaturely Contingency,” 388.

34

Luther’s Small Catechism with Explanation (St. Louis: Concordia Publishing House, 2017), 16, emphasis added.

35
Simply defined: Pantheism identifies God with the universe; panentheism holds that God and the universe are distinguished, but the universe influences and changes God; open theism distinguishes God and the universe, but because of human freedom God’s knowledge of the future is limited and His current governance is limited by human cooperation with Him.
36

Thomas E. McComiskey, “278 ‫אָרָּב‬,” ed. R. Laird Harris, Gleason L. Archer Jr. and Bruce K. Waltke, Theological Wordbook of the Old Testament (Chicago: Moody Press, 1999), 127.

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T H E O L O G I C A L F O U N DAT I O N S

T H E O L O G I C A L F O U N DAT I O N S

Yet our history from the time of the Garden of Eden until the present has been marked by our rejection of God’s
rightful place as Creator and ourselves as His creation. As early as 1517, Luther declared: “Man is by nature unable to want
God to be God. Indeed, he himself wants to be God, and does not want God to be God.”37 In the New Testament, Paul
concludes his discussion in Romans 1:19–25 with the divine consequence of ignoring that created order: “Therefore God
gave them up in the lusts of their hearts to impurity, to the dishonoring of their bodies among themselves, because they
exchanged the truth about God for a lie and worshiped and served the creature rather than the Creator, who is blessed
forever! Amen.”

Thinking of ourselves as radically dependent on a Creator for our lives and identity bears critical implications for our
understanding of the topic of human dignity, so much discussed by the advocates of “death with dignity.” Charles Arand
couples the First Article of the Creed with the assertion of ex nihilo creation as the radical counter-cultural confession
of second-century orthodoxy. It confuted the idea that the material was intrinsically tainted with evil and notions of an
imposed chaotic order of creation popular in such Greek philosophies as Stoicism, Epicureanism and Platonism.41 Arand
proffers this truth as a potent affirmation of our belief in the worth of human life. Created by God, we do not have life on
our own nor are we free to dispose of it as we will.

Finally, the truth of Scripture affirms more than this. Unlike a sculptor who would have an instrumental relationship between himself and what he fashioned or a painter who would leave something of his genius in the paintings he
produced, God is related to His creation as “Absolute Giver to absolute receiver.”38 Put another way, God gives life; we
receive life. We are stewards, not owners, of the lives God entrusts to us. If our lives are given from God, we certainly have
no authority over the lives and deaths of others. Since God is the absolute Giver and our nature hardwires us to be receivers, “the most uncreaturely thing that a person could do is to refuse God’s gift of life.”39 Oswald Bayer helpfully explains
that human dignity lies in the “indissoluble intertwining of element and instituting word” by the One who has “bestowed,
given on loan—by the One who promises and gives himself unconditionally to humankind: namely, God.”40 Because my
human dignity does not develop out of my own works or merit, neither can any other human being rip it from me. It
belongs neither to me nor to those in power in society. Rather, it remains that which is on loan from God. The relationship
of Creator to creature as “Absolute Giver to absolute receiver,” is developed biblically by Paul in 1 Corinthians 6 where he
teaches that “you are not your own, for you were bought with a price. So glorify God in your body” (1 COR. 6:19–20).

Carl Trueman echoes these concerns in his discussion of dignity in The Rise and Triumph of the Modern Self.42 The
argument that we are created by God and radically dependent on Him has been eroded by the rise of what has been
dubbed “expressive individualism.” Philosophical trends from Rousseau through the Romantics, to Freud, and then to the
New Left have altered the popular understanding of the relationship between Creator and creation. As the self-emerged
triumphant, notions of volitional choice in countless arenas of life became the means for individuals to define themselves,
thinking that their identity is the sum total of their choices. Even being a Christian is viewed as a personal choice, together
with whatever “flavor” of Christian we elect to become. So also, morality is merely another choice. As Christians (and
as confessional Lutherans), we are not exempt from this lamentable psychologizing of identity and dignity. As Trueman
noted, “The general culture of expressive individualism and of choice of identity is ours too.”43

Since we are both dependent and finite, necessarily creature rather than Creator, any effort to arrogate to ourselves
rights that properly belong only to God (e.g., giving or taking life) can only be counted as foolish in the extreme or, more
properly, an act of cosmic treason. Continuing Sayer’s analogy of God’s creation to human artistry, we have no reason to
believe that our efforts to seize power from the Artist would be any more successful than if a painting refused to be painted.
In Psalm 139, verses 7–12 reflect upon the impossibility of evading the searching presence of the Creator, regardless of the
strategies or designs followed by the creature. David then explains:
For you formed my inward parts;
you knitted me together in my mother’s womb.
I praise you, for I am fearfully and wonderfully made.
Wonderful are your works;
my soul knows it very well.
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My frame was not hidden from you,
when I was being made in secret,
intricately woven in the depths of the earth.
16
Your eyes saw my unformed substance;
in your book were written, every one of them,
the days that were formed for me,
when as yet there was none of them.
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We are not suggesting that the shift from rigidly hierarchical notions to the current emphasis on individual dignity
was entirely wrong. The democratizing of government and society has certainly been beneficial in many ways. But such
benefits are most firmly grounded in the fact that God has created and provided redemption for every person rather than
in tenuous claims of human dignity. While human dignity is frequently ill-defined, it is certain that any authentic claim
of human dignity must be centered in the worth and identity God gives by His creating, redeeming and sanctifying work.
“The problem with expressive individualism is not its emphasis on the dignity or the individual value of every human
being. That is what undergirded the fight against slavery in the nineteenth century and the civil rights movement of the
1950s and 1960s. Rather, it is the fact that expressive individualism has detached these concepts of individual dignity and
value from any kind of grounding in a sacred order.”44 In place of dignity based on a universal human nature bestowed by
God, today’s psychologized expressive individualism grounds dignity in the sovereign right of every individual to determine his or her own identity and to act in ways that demand not mere tolerance but recognition by the society at large.
Lutherans do not stop with locating the nature of human dignity in the Creator-creature relationship. As Christcentered and cross-focused disciples of Christ, we cannot fail to describe our human dignity in terms of redemption as
well as creation. As such, dignity is a gift conferred by the Creator who is also the Redeemer. Luther’s explanation of the
First Article of the Creed in his Small Catechism defines human beings in terms of their original creation, but with a view
to justification when he writes: “God protects me against all danger and shields and preserves me from all evil. And all this
is done out of pure, fatherly, and divine goodness and mercy, without any merit or worthiness of mine at all!”45 Our lives
41

Arand, “Personal Autonomy versus Creaturely Contingency,” 393.

42

Carl R. Trueman, The Rise and Triumph of the Modern Self: Cultural Amnesia, Expressive Individualism, and the Road to Sexual Revolution (Wheaton: Crossway, 2020).

Trueman, The Rise and Triumph of the Modern Self, 386. Trueman cites numerous authors, such as Michael Horton, Christian Smith and David Wells, who have demonstrated some of the ways
expressive individualism and the choice of identity have had pernicious effects on the Christian church of our day. The descriptor “therapeutic” in the term made famous by Smith, “Therapeutic
Moralistic Deism,” describes this emphasis upon the shift from helping persons adjust to the demands of their duties toward God or their accountability to a larger society to an agenda that
makes the self-determining individual primary.
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37

LW 31:10.

38
Arand, “Personal Autonomy versus Creaturely Contingency,” 380. See also Oswald Bayer, “Self-Creation? On the Dignity of Human Beings,” Modern Theology 20, no. 2 (April 2004), 275–290.
Bayer opens with the provocative sentence: “The absurd desire of humans to become self-creators — be it in an individual or a collective way — is as old as humanity itself,” 275.
39

Arand, “Personal Autonomy versus Creaturely Contingency,” 392.

40

Bayer, “Self-Creation?” 279. Bayer calls this an unconditional “categorical gratuity.”

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2026 Convention Workbook

44

Trueman, The Rise and Triumph of the Modern Self, 387.

45

Martin Luther, “Small Catechism,” in The Book of Concord, Robert Kolb and Timothy J. Wengert, eds. (Minneapolis: Fortress Press, 2000), 354–355.

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