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LCMS Convention Workbook St. Louis, Missouri — 2026, Page 197

Scan: The Lutheran Church—Missouri Synod

Transcription machine transcription, uncorrected

THEOLOGICAL DOCUMENTS—COMMISSION ON THEOLOGY AND CHURCH RELATIONS

197

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

are never valued on the basis of our merits or even for our functional capabilities, but always an existence that is “merely
owed.”46 Bayer puts it so well:

bestowed value of persons as created in the image of God and those for whom Christ died. As Bartlett and Rehder put it:
Christians do well to build our responses on the Truth of God’s Word, which says that:

This means that humankind — any human without exception — is, without any merit or any worth that he could
grant himself or expect from other humans as recognition, unconditionally and absolutely recognized and valued by his creator, redeemer and perfecter. This means that he has an inviolable and indestructible dignity. Since
this dignity is not conferred on him by any human person, no human being can deny it to him.47
This does not imply that a right view of human dignity flows only from a theology of creation. Lutherans, following
Luther, base their view of the dignity of man in a theology centered in the cross and in a theology of justification. While it
is “broadly anthropological” and equally applicable to all, we cannot escape the fact that it must also be seen through the
lens of salvation and concerned with matters of eternity.48
We are and ever shall be creatures, made by our Creator. However, the basis for our dignity rests on an interconnectedness of what Bayer calls “three irreducible respects.” In addition to being made by God, we are those who have become
corrupted and lost our dignity (ROM. 3:23) and yet persons who have been redeemed by Jesus Christ and set free from the
systemic corruption of our original creation. Viewed from the perspective of the cross, one might say that what makes us
human is a universal need to be justified by faith.49
Rather than basing human dignity on something intrinsic to us, as if we owned it and were owed deferential treatment
because of it, our dignity must always be viewed as a bestowed endowment. And because of the irrevocable and unconditional grant of dignity by the Triune God, it will always be extrinsic to our abilities, functional capacities and merits.
This last point bridges the gap between creation and redemption. Lutheran theology views both creation in Eden and
consummation in eternity through the lens of justification and the cross of Christ. Justification addresses the loss of our
original dignity and secures it for all humankind, as those for whom Christ died, regardless of one’s faith or lack thereof.
In short, “According to Luther, human dignity … is warranted only by the triune God: the creator, redeemer and perfecter
of humans and the world around them.”50
But if we are radically and irrevocably dependent on God as our “creator, redeemer, and perfecter,” then dependence
on others cannot be seen as a necessary loss of dignity. Creaturely dependence marks and circumscribes the very meaning
of our identity. To be creaturely is to know our true dignity as those created in the image of God. An embodied existence as
creatures involves a dependence in faith upon the One who is Lord of life. It also means that we are placed in community
where we willingly give aid to others and receive it from them. “When we act for the benefit of another, we do not simply
act heroically or philanthropically. We are doing what we have been given to do. As co-workers with God in the ongoing
work of creation, we are given the task of supporting and securing the life of others.”51
Unlike arguments based on the instrumental value of a person (how much they can do, earn, contribute, their level
of cognitive capacity or physical ability, and the like), Christians base their understanding of life’s preciousness on the
46
Oswald Bayer, “Martin Luther’s Conception of Human Dignity,” in The Cambridge Handbook of Human Dignity: Interdisciplinary Perspectives, ed. Marcus Düwell, Jens Braarvig, Roger
Brownsword and Dietmar Mieth (Cambridge: Cambridge University Press, 2014), 103.
47
Bayer, “Martin Luther’s Conception of Human Dignity,” 102. Bayer cites Luther’s three seminal works on this topic of human dignity as The Disputation Concerning Man (1536), On the
Freedom of the Christian (1520), and his dispute with Erasmus, On the Bondage of the Will (1525). See also Andrew Ronnevik, “Lutheran Conceptions of Human Dignity in a Global Context: A
Conversation with Indian Dalits and European/Americans,” Dialog: A Journal of Theology 59, no. 4 (December 2020): 325–333.
48

Ronnevik, “Lutheran Conceptions of Human Dignity in a Global Context,” 326.

Bayer, “Martin Luther’s Conception of Human Dignity,” 102–103, referencing Luther’s central thesis 32 of the Disputation Concerning Man.

Bayer, “Martin Luther’s Conception of Human Dignity,” 106.

Arand, “Personal Autonomy versus Creaturely Contingency,” 397.

(2) God is Lord over all matters of life and death and we can trust Him to do what is right according to His will,
(3) God has demonstrated His goodness and love for us in the cross of Jesus and nothing can separate us from
His love,
(4) God has a purpose for every life.52

B. Death with Dignity?

Driving the engine of the “death with dignity” crusade have been two central ideas: (1) an absolutist approach to human
autonomy and its corollary of self-determination, and (2) an emotion-laden desire to limit or relieve suffering.53 “Advocates
of euthanasia and physician-assisted suicide believe that ‘dignity’ demands the freedom to call our own shots — when we can
end our lives before we become ‘helpless’ and dependent on others to care for us.”54 Indeed, much of the literature in favor of
physician assistance in the dying of patients takes for granted that patient “wishes” bear the weight of moral obligation.55
This emotional tilt toward autonomy does not always come packaged with coherent rational explanations. The same
physician who would defend abortion on the grounds of the woman’s right to determine what should happen to her body
might ignore a suicide note pinned to the shirt of an ER admission with slashed wrists and proceed to attempt to save the
person’s life despite the patient’s expressed intents.56 Beyond that, one might legitimately question whether “doing what the
patient wants” can truly escape the physician imposing his or her values on the patient at the end of life’s journey.57
Behind the central arguments, however, stand a couple of additional factors. First, the 1960s and 1970s were an era of
rebellion against authority that affected medical care. Physicians were no longer automatically trusted to act in a patient’s
best interests, almost as a parent. Their judgments were questioned, second opinions were sought, and patients became
more consumerist in their desire to make their own choices and decisions for modalities of care. Second, despite the publicity attendant to laws respecting advance directives, patient wishes continued to be set aside for various reasons.58 Some of
the reasons for the success of efforts to legalize physician-assisted suicide, then, originate in a reaction to how patients have
been treated in hospitals and by physicians. Pathologist turned physician-assisted-suicide crusader Jack Kevorkian summed
it up on his way to jail: “If I have lost my freedom, I have lost something more valuable than life. Therefore, continuing life

Bartlett and Rehder, “Ventilators, Feeding Tubes, and Other End-of-Life Questions,” 1.

53
Trueman, The Rise and Triumph of the Modern Self, especially 64–70, discusses the implications of “psychological man and expressive individualism” shaping the societal idea of what it means
to be a “self ” in the contemporary world. The absolutist approach to human autonomy accompanies the sociological and philosophical shifts chronicled by Philip Rieff and Charles Taylor that
Trueman explains. Indeed, without these changes, a slogan such as “death with dignity” would be difficult to understand. A valuable analysis of the autonomy-based and utilitarian arguments for
assisted suicide can be found in Neil M. Gorsuch’s The Future of Assisted Suicide and Euthanasia (Princeton: Princeton University Press, 2006). The Supreme Court associate justice concludes:
“After considering arguments from history, fairness, autonomy doctrine and theory, and utilitarianism, I suggested that courts and legislators may wish to consider a less frequently voiced perspective on the assisted suicide and euthanasia question, one grounded in the recognition of human life as a fundamental good. Under this view, private intentional acts of homicide are always
wrong” (217–218).
54

Bartlett and Rehder, “Ventilators, Feeding Tubes, and Other End-of-Life Questions,” 1.

See, for example, Tom Beauchamp and James F. Childress, Principles of Bioethical Ethics, 8th ed. (New York: Oxford University Press, 2019).

Stanley Hauerwas, Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church (Notre Dame: University of Notre Dame, 1986), develops this exact scenario in his discussion of suicide and the ethics of autonomy, 100–101.
56

57
Dr. Patricia Wesley, a psychiatrist, observes (in Dyck, Life’s Worth, 15): “It is frighteningly naïve to assume that when our guide to medical practice is ‘doing what the patient wants,’ we will
escape the imposition of the physician’s values on the clinical encounter. Personal values can be sequestered in the question not asked, or the gentle challenge not posed, when both should
have been.”
58
Sometimes hospitals do not have a copy of the patient’s advance directive on hand. Clinical circumstances may have changed to render obsolete the original intention of the author. There may
be disagreements with a family about treatment decisions.

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

C. The Quest for Absolute Autonomy 64

is pointless. It’s as simple as that.”59
Public arguments for euthanasia and physician-assisted suicide almost always conjoin these two factors: an absolutist
approach to human autonomy and self-determination together with an emotional desire to limit or relieve suffering. We
often hear pleas for allowing people who are suffering greatly to request assistance in “ending it all.”60 One may wonder
how often this is “a purely strategic maneuver aimed at keeping the argument for the time being a relatively narrow one.
Whatever our judgment of motives, however, the fact is that, simply as a matter of logic, the two prongs of the argument
will gradually become independent of each other.”61
Once we grant the overarching significance of self-determination, why does it matter whether one is suffering
“greatly” or not? How does one’s degree of suffering enter in as a factor in the moral equation? If self-determination is but
one aspect to be considered and if it must be evaluated along with “great suffering,” what kind of suffering is reason enough
for ending one’s life? Would a young athlete who sustained a career-ending injury have the right to claim that the loss of
fame and financial security was sufficient justification for assisted suicide?
The other prong of the argument proves problematic as well. If the great suffering of a person makes such powerful
moral claims on us that we should kill to end his agony, why would we insist that the person be self-determining or competent to request it? We readily ask veterinarians to intervene to “put down” our pets whose bodies are consumed with
cancers and painful maladies. We consider it merciful to do so.
The conventional defense of a “right to die” advances by promoting two ideas, both of which can easily expand the
class of candidates for such merciful ministrations. “Those who suffer greatly but cannot request relief and those who
request help even though their physical pain is not great will begin to seem more suitable candidates.”62
Evangelical writer Joni Eareckson Tada has lived for 55 years since suffering a fracture between the fourth and fifth
cervical vertebrae at age 17 and becoming a quadriplegic, paralyzed from the shoulders down. Her years of living with the
limitations of her condition have afforded her ample time to reflect on the questions of the quality-of-life ethic and end-oflife decisions. She wisely observes: “When we clamor about the sanctity of our individual rights, we may be reinforcing an
all-too-human failing, and that is the tendency to place ourselves at the center of our moral universe. We label our desires
‘rights’ as if to give those willful determinations a showy kind of dignity.”63
The doctrine of creation establishes the principle of partnering with God as co-regents called to exercise dominion
over His creation. But this takes place in the context of our creaturely receptivity and response to God who is the Creator.
In this context, the idea of self-determination can never be the defining value by which human lives are lived. Our dignity
does not lie in our autonomy, but in our dependence.

(1) human life is sacred regardless of condition or health,

As Arand has observed, exalted notions of autonomy elevate isolation and separation, ultimately excluding relevant others
from moral conversation and decisions; relationships become merely voluntary associations based on my absolute decision-making authority. Callahan shows that this leads to an atrophy of our sense of obligation toward others and their
obligations to us.65 Older cultures either grounded their claim to moral authority on myths (e.g., the oracle of Delphi
demands it) or on a transcendent appeal to faith rather than fate (e.g., Christianity).66 In both cases, they operated with a
clear sense of the transcendent and the authority such an attitude toward a “higher power” had on the moral commands
of the culture. In stark contrast with such approaches, our society increasingly exists without rooting its moral imperatives
in anything sacred. That does not relieve us of the necessity to justify our norms, “but they cannot do so on the basis of
something sacred or transcendent. Instead, they have to do so on the basis of themselves. Ethics, shorn of its reference to
the transcendent, becomes little more than a statement of personal preferences and, increasingly in our therapeutic culture,
of ‘feeling.’”67 The inherent moral instability and volatility of this approach should be obvious.68
Against this, biblical doctrine teaches us that our autonomy is circumscribed and bounded by our creaturely nature as
those born into community, not into isolation. It holds that relationships are the currency of our creaturely existence, and
that we are called to render and receive assistance to our fellow human beings. Where in this do we have an autonomous
right to refuse life or refuse to help our sisters and brothers in their need?
First, Christians affirm the qualitative distinction between Creator and creation. As Creator, God does not cede His
rights to the creation, but retains them. This is the thrust of St. Paul’s affirmation in 1 Corinthians 6 when he declares: “Or
do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your
own, for you were bought with a price. So glorify God in your body” (1 COR. 6:19–20). Christian doctrine insists that all other
ideologies fail to grasp this central truth of existence that there is an infinite qualitative distinction between the Creator and
the creation.
Second, the reality of our creatureliness includes an inescapably communal element. Meilaender recounts the lesson
he learned from one of his students when discussing suicide. She “described her cousin’s suicide and its continuing effects
on his family by saying: ‘He didn’t just take his own life; he took part of theirs too.’”69 We are never able to escape the import
of the existential question: “Am I my brother’s keeper?”
Third, Scripture repeatedly affirms that not only does God retain the rights to our life, but He determines the number
of our days. “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” (PSALM 139:16). Not only is God infinitely higher than we are, and not
only are we thrown into community with all of its joys and messy obligations, even the length of our sojourn on this planet
remains properly with the One who is not only our Creator but also our Sustainer.
64
In 1985, bioethicists Tom L. Beauchamp and James F. Childress produced their influential Principles of Biomedical Ethics (Oxford: Oxford University Press, 2019), now in its eighth edition.
They put forth a four-principle approach to common medical morality: respect for autonomy, beneficence, non-maleficence and justice. They address the issue of autonomy by speaking of autonomy as creating both “negative” and “positive” duties. Negatively, “autonomous actions should not be subject to controlling constraints by others,” while positively, autonomy requires “respectful
treatment in disclosing information” so people can make their own decisions. The idea is that the decision-maker should be as free as possible under the constraints of the existing circumstances.
In developing their other three points, they speak of the duty of non-maleficence: “first do no harm” (“avoiding anything which is unnecessarily or unjustifiably harmful”), beneficence: “do as
much good as you can,” and justice: distribute health resources fairly. As they apply the principles, “physician assistance in hastening death is best viewed as part of a continuum of medical care.”
They find no significant moral difference between “comfort-only care that hastens death and PAS and euthanasia,” Dyck, 45.

Quoted in Arand, “Personal Autonomy versus Creaturely Contingency,” 387.

60
Many arguments for PAS appear shaped more by the life experience of the writer rather than upon enduring principles. Famed Roman Catholic theologian Hans Küng, for instance, readily
admits his argument in favor of PAS has been formed in the context of watching his brother die a very painful death from a brain tumor. Hans Küng, “A Dignified Dying,” Section 145 in Therese
M. Lysaught, On Moral Medicine: Theological Perspectives in Medical Ethics, 3rd ed. (Grand Rapids: Eerdmans, 2012).
61

Meilaender, Bioethics: A Primer for Christians, 75.

Meilaender, Bioethics: A Primer for Christians, 76.

Joni Eareckson Tada, When Is It Right to Die? (Grand Rapids: Zondervan Publishing House, 1992), 73.

Arand, “Personal Autonomy versus Creaturely Contingency,” 399.

Trueman helpfully demonstrates the relevance of Rieff to this topic, The Rise and Triumph of the Modern Self, 74–82.

Trueman, The Rise and Triumph of the Modern Self, 79.

Trueman, The Rise and Triumph of the Modern Self, 76. Rieff refers to this by the nomenclature “third world,” roughly equivalent to what Charles Taylor means by the “immanent frame.” It
denotes a culture where transcendence has collapsed into immanence and partakes of the kind of ethics Alasdair MacIntyre dubs emotivism.
68

Meilaender, Bioethics: A Primer for Christians, 74.

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