This recording has been released into the public domain by the Bonson Institute, where we aim to bring into captivity every thought to the obedience of Christ. Our first lecture today having to do with euthanasia, which really is a continuation of our discussion of medical issues pertaining to the end of life. We've discussed suicide and now euthanasia. You would assume that we as Christians should take a rather stringent position that says we never should allow life to end, people shouldn't willingly go to their death. There's no circumstance where mercy killing or mercy dying might be acceptable. I'd like now to go back and to look at a different kind of situation and perhaps qualify the conclusions to which we've come thus far, or at least to extend them further so we see what they don't apply to. We have said that people do not have the right to commit suicide and have the right to take their own lives. However, we do have the right to engage in sacrificial or altruistic self-sacrifice. If I decide to go into a certain line of work, for instance, I want to be a missionary in a dangerous country, I really believe the Lord has given me the task to go to this country and present the gospel, and I end up losing my life for it. There's certainly a difference between that and committing suicide. There's also a difference between my going to defend my wife's chastity against an attacker and realizing that since he has weapons and I don't, that very likely I'm going to end up dying in the process of giving her the time to run away. That again would be an altruistic, self-sacrificial situation. It would not be suicide. Now we've said that euthanasia is wrong as well. We take a person who is suffering, let's say in a terminal situation, is suffering excruciating pain, is going to die anyway, and we've argued we do not have the right, even when it's voluntary, to take that person's life. However, I do think we need to recognize that there's a difference between active and passive euthanasia. A difference between mercy dying and mercy killing. mercy dying and mercy killing. One thing for me to take unwarranted risk with my life and indirectly commit suicide. For instance, I may not purpose to die, but if I decide to go on the freeway system in Los Angeles and drive my car a hundred miles an hour, I mean, do so in a reckless fashion, I am inviting death in a reckless way and in a sense would be guilty of not honoring the requirements in scripture about the protection of human life. I would indirectly be committing suicide. I would actually be doing something which is irresponsible. Moreover, let's say that I'm on a regiment where I have to take blood pressure medication for my health and long-term service to my family, to my church, to my state, my employer, what have you. And I decide that I really don't care that much about taking my blood pressure medicine. Well, I'm not in the same way that a person who is driving a car recklessly taking my life in an immediate way. However, I am, some of you in the audience can see obvious applications of what we're saying already, you can see that. I am guilty of not sustaining human life in the way that I should. If I don't protect my long-term health, I'm just as guilty as violating the Sixth Commandment as if I take my life more directly and quickly through recklessness. Now, if I take the life of somebody else, when that person is unwilling to die, for instance, I go up to somebody on the street and say, I don't like what you said about me, pull out a gun and shoot them, then I quite clearly am violating the sixth commandment. And then if somebody comes to me and says, I just don't have the wherewithal to take my own life, but I am really depressed and I don't want to live, please shoot me, I would again be guilty of violating the Sixth Commandment. And if the person shows some good reason why they should die, they're in excruciating pain, they're never going to be serviceable again, and they're going to be just enduring this pain to the point of their death, the idea that I should hasten their death would still not justify my taking their life. And so it does seem that we have all these circumstances where, apart from altruistic self-sacrifice, we are not allowed to take our lives, directly anyway, or even through long-term negligence, or to take the lives of others, whether it's voluntary, involuntary, terminal, or not terminal. And yet, one can imagine a circumstance that might seem to be ruled out by the principles we have taught by analogy to the circumstances I've just rehearsed, but one which I do believe is appropriate. And I'd like to detail it for you. Imagine that you have somebody who is first of all a Christian. Okay, so the eschatological consideration has been dealt with. And this person is in a very miserable situation, and the appeal to emotion is a strong one. And we've already said we don't rule out appeals to emotion in Christian ethics. There is a place for that. Okay, so we have a very emotional situation. Let's say the person is blind, is on kidney dialysis, is diabetic, has uncontrollable vomiting all the time, cannot hold food down, has a heart problem, suffers pain because of arthritis. The person, now add to this, the person has lived a fairly full life. His family has grown. He does not have to support his wife and children to any great extent any longer. The person is older, is probably going to die, even apart from all these medical ailments, probably going to die in a matter of months or just a very few years because of old age, has served the kingdom of God well, but because of these various ailments does not show any promise of being able to return to any meaningful ministry after this. What if such a person says, no, I'm just not going to pay the price any longer. I'm not going to drain my children's inheritance funds. I'm not going to take away the money my wife will need after I die to pay for this constant kidney dialysis, all these expensive medications to control, and they're not working, the pain and the indignity and the suffering that I'm going through. I'm an older person. I'm not going to live forever. I'm going to let myself die. Seems to me that in such a circumstance, We can voluntarily choose to let nature take its course. Now that's not a natural law argument. I want to guard against that. When I say nature take its course, I mean the natural thing going to happen, then I'm going to die. We can allow the natural thing to happen. Now again, this would be a case of not pursuing blessed treatment. It'd be a case where I'm just refraining from doing something for my well-being. Now, haven't I already said, though, that in other circumstances, refraining from doing something for your well-being, not taking your blood pressure medicine, not driving safely on the freeway, that that would be sinful? Yes, I have. However, the difference is just in the circumstance. All the same principles apply, but the facts have changed. And consequently it seems to me that you can imagine situations where a person doesn't have to pursue every available line of defense of their life. Now although this is not altruistic self-sacrifice and it would be illegitimate to appeal to that analogy. The economic consideration here does seem to me to be an important one. The person realizes that his life is not meant to go on on this earth anyway forever and that his life has served a useful purpose. and is nothing but really a pain and a burden to his loved ones, and he is spoiling his inheritance, and consequently he says, I'll accept death. That's no problem. The enemy death has been defeated for me already, so I'll go ahead and accept that. What you have here is a situation very similar, well, you have a situation somewhat like that portrayed in the Bible when Jacob died. The Bible tells us that when Jacob died, he lifted his feet up upon his bed and expired. The idea of lifting the feet up on the bed, I take it, is the idea that he just accepted it. He acquiesced in it. He relaxed, laid back, and allowed death to take over. Clearly, there are cases of accepting death, even when it's not altruistic self-sacrifice. Obviously, Jesus accepted death, too. He said to the Lord and to thy hands I commit my spirit. He was willing to die. He laid down his life willingly. This is not the same kind of situation. We're not in a redemptive setting or a martyrdom situation. But nevertheless, the Bible does give us illustrations of people not gasping for life, you know, for one more breath or doing everything they can to clutch at life and to hold on to it and saying anything is worth another heartbeat. No, the Bible portrays an attitude of acceptance of death too. Okay, now there was a question. Well, it's a matter of eating up the inheritance. Is there an element of altruistic self-sacrifice involved there in some sense now? No, I think the way you put it is right. There is an element of altruism when a person says, I could conceivably live for six more months, but if I did, there'd be no inheritance. And if I died now, there'd be a minimal inheritance. And so I'm willing to sacrifice myself for the sake of these others. Yeah, that's true. I was thinking it's not so much an altruistic act like going to the mission field and being a martyr or like Christ laying down his life for others and that sort of thing. But you are thinking of others and clearly that's altruistic. Now obviously, if I'm right in teaching this, then you must be able to distinguish between active and passive euthanasia. Passive euthanasia here will be a matter of mercy dying, being willing to die and not pursuing all of the available technology to keep your life sustained for some period of time further, be it five minutes, five years. One difficulty with this is the old slippery slope difficulty. It's called various things, but it's the problem of drawing the line. At what point is it all right to accept death and not pursue available medical treatment? And at what point is it illegitimate? Now, when may we, when may we not do this? And I do not have prepared for you any general guidelines for that systematically worked out so that you can work closer and closer to the borderline circumstances and make rational and objective decisions. I'm simply going to say I believe that those guidelines can be formulated, but it's going to take some hard work, some hard thinking, some creative working with counter illustrations to keep yourself honest and that sort of thing. But even though I don't know where the exact dividing line is, it seems to me that's very similar to what we say about pornography. I have seen some movies where things take place in the movie which strike me as definitely pornographic. I've also seen movies where, again, sexual liaisons are portrayed in a way which I would not call pornographic and do serve a constructive and are tactfully done and that sort of thing. And yet the difference may not be all that discernible in terms of visual alterations between the two scenes. Now if somebody says, since you cannot draw the line exactly and cannot give me guidelines so that I can draw the line, therefore there is no line, the person would reason that way, they would certainly, it seems to me, be committing a logical fallacy. The fact is I can tell you between extreme cases the difference between pornography and something which serves a useful artistic purpose. I can tell you in the extremes and likewise in the case of active and passive euthanasia, I can at least tell you in certain extreme cases the difference between a person who sins through negligence, a young person, for instance, who doesn't ever eat vegetables or any good meals, eats only junk food is high on drugs and that sort of thing. The difference between that and a person who is old and simply isn't going to put out all the money he's got for a kidney dialysis machine. So, I mean, the poles are rather clear. You can tell the difference there. All I'm saying is I have not put all the work into defining closer and closer or moving closer and closer to the middle, to the borderline, those general guidelines that would be necessary for teaching you how to make the decision. I'm only assuring you the decisions, I think, can be made. And it may well be also, and I'll add this, that there always will be ambiguous cases. It may be that sometimes we get in circumstances where you're right on the border. And at that particular point, you can't make the decision. At that point in ethics, the guiding principle is always the one of Romans 14. Whatever cannot be done in faith is sin. And since there is a presumption in favor of our obligation to pursue life and its protection, if you're in a borderline situation, you must always go ahead and pursue the medical treatment. Now somebody says, well, now wait a minute. We can't always pursue it. I mean, there are good cases when we don't have to. My answer is, in the good cases, you don't have to. So I hope we've cleared up some confusion that sometimes comes into ethics when there is still some remaining ambiguity or lack of conviction on some point. The fact that that may be true in my particular case here doesn't mean that it's wrong for me to draw the distinction between taking one's life through negligence and allowing one's life to be lost at an appropriate time, such as old age and under the circumstances I've outlined. But there's an even stronger line against what I'm arguing in favor of here, which has been recently published in the Christian Journal of... What is that now? It used to be the Gordon Review. I guess it is the Christian Scholars Review. Yes, it's now being edited at Calvin. Anyway, a former philosophy professor of mine, Robert Wenberg, has published an article just recently, A Sympathetic Appraisal of Euthanasia. Now, Wenberg's technique is, well, it's clever. We can commend the technique, although I think that the argument is a poor one, and I don't agree with it, and I don't honor the motivation that lies behind it. But his technique is good. He begins with just such a case. where we would, it seems, find no good reason why a person shouldn't allow himself to die. However, Weinberg then goes on to say, however, the difference between a person allowing himself to die and our helping him to die is minimal. The difference in terms of motivation and consequences is not there at all. The motivation for having him die is not for our gain. I may be a doctor that doesn't, you know, I'm not going to gain anything from it apart from perhaps money from my medical services. But imagine that you have a doctor who doesn't need any more patients. So I mean, he's not motivated by greed. He's just trying to help this man die peaceably and without pain. And the consequences are going to be the same. If the man, in one circumstance, you can imagine a man saying, I'm going to go off my kidney dialysis machine. We know in nine days he's going to be dead. Another circumstance where we have a patient who will probably live about nine days, but is going to live with all this racked body and pain for nine days, and the doctors say, we're just going to put in a little too much morphine and let the person die today. What's the difference, Weinberg says? The difference is, if anything, just that you helped somebody do actively what this other person was going to do passively. So what's the big thing, active-passive? Who cares if the consequences and motivation are the same? Well, once we grant that there is an acceptable case of euthanasia, and then add that there is no difference between active and passive euthanasia, then what have you proven? That you can accept active euthanasia too. Now, he does say, and I want to guard his reputation here, Weinberg does say that it's always voluntary euthanasia. It can never be a case of the state deciding this person has lost his utility or in a case where a person, although in excruciating pain and drawing all the family's money, nevertheless says, I want to live, I want to live. You don't go in and take the person's life against his will. But in voluntary cases, he says, once you've granted that we're dealing with only voluntary cases, that even active euthanasia should be acceptable. Well, seems like on the surface, that's a pretty good argument. After all, There doesn't seem to be any difference between motivation and consequences when it comes to active and passive distinctions. And now those who have studied with me in these ethics courses, however, should, if nothing else, immediately think, well, yes, motive and consequence have been discussed, but there is one other perspective in ethics too, and that's the normative perspective. And whatever good and necessary consequences can be deduced from it. What does God's word teach from a normative standpoint? And upon reflection, I'm convinced that from a normative and analytical perspective, there is indeed a difference between active and passive euthanasia. That is a morally relevant difference. Nobody's going to deny that there's obvious differences between a doctor injecting morphine into a person and a person not going on a kidney dialysis machine. However, these are all incidental differences rather than morally important ones. Passive euthanasia is viewed as a wrong, as a sinful thing, when it is viewed as a sin of omission against our duty to pursue health and life. That is, if passive euthanasia were to be condemned, and there are plenty in the Christian Church today who would condemn even it, if passive euthanasia were to be condemned, it would be condemned as a sin of omission, failing to do your duty to pursue life at all costs. After all, active euthanasia is viewed as a sin, on the other hand, as a sin of commission, right? Active euthanasia is actually taking a life when we're supposed to be guarding lives at all costs. Now, if there is in fact a symmetry between sins of omission and sins of commission, then I believe Wenberg is right to say that the active-passive distinction is morally irrelevant. But I will maintain now that there is In fact, an asymmetry between sense of omission and sense of commission under the same category. Okay? There's some obvious illustrations. I'm under duty not to commit adultery. I am to be pure in my sexual relations. Which is to say that I'm under obligation to be faithful to my wife. Does that mean that I have a contrary duty to have a wife? To whom I can be faithful? No. That isn't the case. However, Weinberg would reply to that kind of counter-illustration. There is a commandment in the Bible, a prohibition in the Bible about adultery, but there isn't a positive commandment to be married. Well, I'd want to qualify even that response by saying it's true that there is no positive injunction that you must be married, but it is taught throughout the Bible this is God's norm and that is how God wants things dealt with. And yet we have to add finally that there are exceptions. Paul says some people have the gift of being consonant and don't need to be married. God's given marriage to man as a way of dealing with his sexual urge and there's some people who have that urge under such control they don't need to be married. They well and good. What we have to understand therefore, now this is my response further, but we have to understand is what is the positive duty that we are sinning against through omission. Let's understand fully what the positive duty is, and then I think the asymmetry between sin of omission and sin of commission will be clear with respect to our active-passive distinction in euthanasia. Do we have a duty to pursue life under all circumstances as best we can? On the other hand, Do we have a duty to guard innocent human life under all circumstances as best we can? Well now the asymmetry becomes very clear. Because in answer to the second question, I say yes. We do have a duty to protect innocent human life no matter what the cost. However, we do not have a duty, and remember I said innocent human life. not thinking here of just war or legal execution of somebody. But when an innocent person's life is threatened, we bear obligation to protect that life to the best of our ability. However, we do not, in biblical perspective, have a duty to pursue life and the extension of life at all costs. Now what I'm saying is the Bible shows us that you can acquiesce to death sometimes. You can accept death peaceably. And that, then we see, I would liken this response to the appeal to Paul's words about although men are to be married, there are some exceptions. The Bible does show us that not everybody has to be married. You know, the Bible shows us we do have a duty to pursue life and health and well-being. However, the Bible also shows us that there are exceptions, that we don't have to pursue life and well-being on and on and on and on and on, right down to the very last breath you can finally draw into your lungs. The Bible does say that we can give up the ghost, you know. We use the archaic language, we can lift our feet up on our bed and say, so be it. Lord, I'm willing to die. We don't have to say, keep me going, keep me going, you know, please administer some kind of mouth-to-mouth resuscitation, don't let me die. Now, if we had a duty to pursue it in almost this fanatical way, don't let me die, I want my heart to pump one more time. Then, of course, there would be a perfect symmetry between omission and commission. Where you see, I do have to defend innocent life, even to the point of saying my last heartbeat will be given to strengthen my defense of this person. I mean, to the very end, the innocent have to be defended. And I am not to kill, I'm to avoid killing in all ways. On the other hand, that is the killing of human life anyway, but I don't have to pursue my own life in its protection or its extension to the very last gasp of a breath. Consequently, if we don't have that duty, it does seem to me that there's a difference between omission and commission with respect to human life and its taking, and thus there would be a normative Analytical difference, as you just look at the logical consequences of these two types of injunctions in the Bible, the prohibition of taking life and the duty of pursuing life. If we look at the logical consequences of these two, there is a normative difference between active and passive euthanasia. There is no prohibition forbidding us to resign ourselves to die at some point. That's another way of putting it. I'm not adding another argument, but it's another way of stating it. Perhaps you might want to put it in your notes this way. Somebody could forbid passive euthanasia only if they could show a prohibition in the Bible to resigning ourselves to die at some point. And yet that prohibition can't be shown, even though we can show a generalized duty to pursue human life and an absolute prohibition of taking life. Since there is an absolute prohibition for taking life, but there is no absolute prohibition about resigning in death, there is a difference between active and passive euthanasia. So there's a legitimate distinction regarding the universality of the prohibition and the universality of the duty. The duty is not universal, the prohibition is. So logically, there is a distinction between active and passive euthanasia. Even though, as I've said, the conditions under which a person is wrong not to pursue life and the conditions under which it is legitimate not to pursue life may be fuzzy for the time being. Logically, we know there's a difference between active and passive, so we don't have to be held up here. Let me stop at this point before I move on because we're going to increase the difficulty of our discussion another notch here as we take on the question of a comatose patient. Yes. I'd like to make a point about where you draw the line between active and passive. Yeah. One of the things you called into yesterday was ordinary and extraordinary needs. And when I imagine the patient's salary for it, that is a very situational time in terms of what he needs. Yes, it's true that you wouldn't want to say there's a universal obligation for a person that has a kidney disease, for instance, to go on a dialysis machine. because obviously some people don't have a dialysis machine available to them or can't afford it. And in some cases, I understand there are not sufficient machines for all the people who need them. So you obviously can't have a duty to do something you can't do, especially if the machinery is not available, if you don't have the medical circumstance. And with the advance of medical science, what we're under obligation to do is going to change. I would think that open heart surgery would not have been an obligation in the 1930s. was not a safe technique. It was only an idea in the 1930s. However, in the 1980s, when it's a perfected technique and survival incidence is like in the 90% range, then I think there is a duty to pursue open-heart surgery if your life is to be sustained. And there may be older people who don't have a duty to have it and to go through the trauma, but I think younger people, especially Christians and that sort of thing, have a duty to protect their lives. Yes, it does change from circumstance to circumstance. Now what happens, let's say a person's in an automobile accident, is brought into the emergency room, and the doctors judge that the person's dead. I mean, it's just moments and the person's going to be dead. And even if we could sustain the life, life isn't going to be worth anything from the standpoint of value, interaction with others and all the rest. Then a doctor comes and says, oh, but there is a new technique that we have, not very well tested, but we have the machinery here, And it's going to cost an awful lot of money to the family of this person. And we might be able to keep him going for another week. Then the question is, are you under obligation to pursue this new technique and all that? That would be a highly extraordinary, heroic measure to try to keep his life going. And I would say that you have to pursue all ordinary means, but you're not under obligation to pursue extraordinary means. Now the same rebuttal will be given, as we've already talked about, but where do you draw the line between ordinary and extraordinary means? And there are, obviously there was a time when doctors looked upon open heart surgery. Some said, well, it's become ordinary. Some are saying, well, it's still a bit strange. We don't know. So there's progress. We're in history, obviously. Yes. What analogy that you could perhaps use, John Graves says that what are worse than necessity on the sample is very important. What is the norm of the patient's system? of expectations of science. Now that may happen. What is ordinary points of view of what's within your horizon. Yes, and that's what I'm saying when I say it's historically relative, depending on the progress of medical science in your day. However, I'm worried that, well, I think we have to recognize you couldn't have a tribunal of all the doctors and count on a very clear voice from the doctors at any particular time. How about a situation where A man says, I don't care if it costs a million dollars to keep me going, but the family says, we can't afford that, that'll put us in debt beyond six years. Are there limits like that that the family can call upon to say... Well, you have to decide though. Now, it's your scenario. Are we talking about a theonomic culture or a non-theonomic culture? Persons who... Because they shouldn't incur massive debt and rely on the virus to show that they shouldn't incur massive debt. Yeah, but you have to understand they're dealing with a debt situation. How can I put this without having to meander around here? You can't have it both ways. You can't have all of the protections. of biblical law and economics if you don't have all the responsibilities and vice versa. As long as we live in a mixed situation, there's always going to be shading here for and against the law. I'm not in favor of antinomianism, but nevertheless, in that situation, It is a personal conviction of theirs that they shouldn't be in debt over six years. However, that is not socially recognized and they don't have as, let's put it this way, the obligation is not as stringent for them to recognize that in this culture when they don't also have the protections of six-year debt limitation. so that in a theonomic culture what one should say is well of course we'll go into debt and take all the money necessary because that's what God would want us to do but of course we recognize too that God after six years is going to say you've done your best now you're free of that obligation so it's rather hard to answer your question I think that well the question is mixed and the other half of it is what if the person wants to live and the family says we don't think we can afford and we think you should just go ahead and Does the individual have the right to be what? A dog in a manger? Let's try to construct the situation to write the scenario so that all sorts of outs are precluded. Let's say that it's not the head of the house. Because obviously if the husband in the family says, we're going to spend the million dollars for my kidney dialysis machine, there's very little the family can do short of killing him. He is the one who controls the checkbook. He's going to obviously do it. And you may try to persuade him and all the rest. So let's get rid of all that complication. Let's say that it's a child in the family. Let's say you have a 14-year-old boy who needs the kidney dialysis work, and it's going to take all the family's money. Now, is the family under obligation? And here we have the emotional situation that it's a young life and all the rest. Now, what would we say there? I think that's a clear case where we say the family, if the son wants to live, the family must do what they can to have him live, even if it drains their money. Because when the money is gone, the family can always throw themselves on the mercy of the doctors. Well, that's what's going to be the next step. As you know my technique, you work from one case to another and see if you can find what's different between them. Go ahead. Yes. Realistically, even the church could be drained of its money in a case like this. Now, what if it is a 70 year old man who says, I want to live? Do we not have obligation to honor? You know, our father and our mother? Well, yes, we do. Are we to honor them in their immoral request? No, we're not. Is it immoral to ask to live? No, it's not. Is it immoral for an older person to be selfish? I think that's where the rubber hits the road, finally. We have to decide, is that selfish or not? You know the old technique that I talked about, how you categorize things, how you describe them? You know, I believe that I'm very firm and principled, but I believe that you're pig-headed, and yet you're just doing the same thing I'm doing. It's all a matter of your perspective. Now, is it the case that the family doesn't want the pleasures of life taken away from them, and so they say, well, he's just being selfish, and we're not going to honor that request. How do you make these decisions? Do you have a suggestion? Take it to the LR. Sure. Have an objective. In every case anyway. I mean, I'm just wondering if upon consultation there is a category for you. In other words, if you are excluding anything but an individual acting autonomously making the decision, or if we are allowing for a larger social group to be involved in advancing the information. And one could say that if everything was being done right in this family in the first place, that they're the one and the many would have been balanced out. that the family and this man would have been of one mind and they could have talked it out and decided, but that's an ideal situation. Obviously, you're going to have cases where the old person doesn't want to die and the family wants him to, or maybe doesn't want him to die, but doesn't feel they really can afford over against their other obligations, keeping him alive. I have to admit, I'm very nervous about turning it over to a tribunal, even though it's the tribunal of the elders in a very good church. Because one of the arguments we have against turning over to the state is the state will make the decision on what? On what basis? Well, on what is favorable to the state. And the elders will eventually do the same thing. Even without being malicious, the elders will have to take into consideration things like, well, the person, you know, is not tithing to the church and he's been, type, cantankerous, or hasn't been to church in 10 years. I mean, all sorts of things could enter the decision we don't think should enter their thinking at all. And besides, do the elders have the right to, in effect, sign the death warrant for a 70-year-old man who says he wants to live? No, no, no, no. Now that one is fairly easy to deal with, it seems to me. If I'm in the middle of a lake drowning... And somebody has a life preserver that they can throw to me. And every time they get ready to throw to me, you stop them. You always grab their arm or block it. So they never can get that thing through to me to save me. You've killed me. You've prevented something being done that I want to be done. I want to live. My example, which I think is supposed to be the extreme clear example here, is of a man who himself says, no, I don't wish to live and I don't wish to put out all this money. And I've lived a healthy, full life. And so now I'm going to die. In your case, you have a man who may be in a very similar situation. He's lived out his life and all the rest, but he doesn't want to die. Now, is it right for us to keep from him the aid that he should receive? Isn't it possible in that situation for the family to say, although in an absolute sense, we have so many dollars in the checking account that could go to this, they go to the doctors and they tell the hospital staff, for instance, given the other priorities in our lives and I mean good priorities, not just we want more popcorn. But given the priorities in our lives, we can't afford this treatment, and therefore he has become your ward. You'll have to decide what to do with the man. It's as though you have a family that doesn't have money in the first place. And then the doctors, as I understand it, should, because of their priestly function, should extend mercy indefinitely to the person. Yes? Yeah, now let me help you understand something in ethical reasoning. The suggestion has been that the way to deal with that is to have a form of insurance that will handle it. And the answer is exactly right. The difficulty is that the problem can be reintroduced simply by saying, now we have somebody who overlooked that. Now what are you going to do? As long as it's a real possibility that you'll face that, then Christians should have some kind of answer prepared. But if nothing else, the difficulty of working out this situation in ethics shows us preventative measures. And I think your suggestion is very good there. All of us should be thinking about that in terms of our parents, too. As my parents get older, should I not take out an insurance policy so that if I'm ever in that situation, I won't have the agony of having to say to them, well, you may want to live, but I can't afford it. So I mean, that's good advice. But coming back to the heart of the question is, once that hasn't been observed, What do you do? How do you adjudicate issues of life and death under those circumstances? Were you going to add something to that? Yeah, there are all sorts of things that having insurance would help here and alleviate all sorts of difficulties. Let me just add here just as an aside about insurance. Most insurance policies have a limit of expenditure on them. Insurance company won't allow one patient to drain the company dry. And now usually that limit is so high that most people don't have to worry about it. But that was drawn to my attention when I had some very costly bills for my open heart surgery. that at some point, the insurance company that was carrying me would finally say, we don't pay any more. There's some upper limit, $100,000. I think it's even more than that, but never about $250,000. But there is a limit. Yes, sir. You can buy a rider on your policy to take it up a million. OK. You can have one policy with $100,000 deductible that goes from $100,000 to a million. Yeah. You can keep adding more and more insurance all the time. Yeah, like for an order a month, I have a million dollars to top out. Yeah. Well, that's a good observation. However, you know, limits of our creative imagination haven't been reached yet. You can still say there's this really rare disease and on and on and on. And for all of your advanced preparation, you've used all the money. But I think we're now wandering. Yes. You may be intending to take this up. One question that comes up in connection with this is what happens when a doctor has only so much time It's a problem that I'm very familiar with, and it's one which could be brought up. I didn't have it in my outline for today's presentation. But let's look at that. The question is, what does a doctor do when he can't help everybody? Is he then to help nobody, or is he to make the decision to help one over the other? And if so, on what grounds is he to choose one over the other? In fact, if you want to really escalate the difficulty of this problem, let me add this little wrinkle to it. Let's say that the doctor can only help one of two people. Both of them want help. Both are willing to do whatever the doctor says. There's no difference in terms of willingness. But the one person says, and doctor, I can supply for you $10 million for a new medical clinic that you've been wanting to build. And the other person can't. But the other person, although he doesn't have the money, is, let's say, some great mathematician or physicist that can help make some great contribution to his society. The person who has the money is a no-good drunk person who just goes to parties and operas and all the rest all the time, and the other guy is a hard-working scientist trying to solve the problems of humanity. What does the doctor do? Well, I think in all honesty, if you have a genuine situation where the doctor cannot help both, he has first of all the duty to try to find a way to help both. Now, in the meantime, he's got to be doing something else. What I'm saying is though, he can't say, well, I can't help both, so that's the end of the story. He has to say, I can't help both and I've got to do something so that I will be able to help both, either before they die or when the next situation arises. And then secondly, in the meantime, that is the one circumstance where he has to make what seems to me utilitarian judgment. He has to say, who really deserves our... Where will the best consequences be? That means... It may be a very difficult decision to make. Maybe he can't calculate the consequences. The person who has all the money may have offered to build a medical clinic that may turn out to be more valuable in his eyes than having this other guy continue his mathematical research or something. It may be that one of the patients is his brother-in-law and the other patient is the President of the United States. Of course, in that situation, I think the strong arm of the law would probably help him make the decision, but nevertheless, unless you have some rebuttal to that. I just think in that situation, the doctor is under obligation to go to the existential and consequential perspective. Yes. The other question now is that it comes up in connection with abortion too, although it's not an analogy about abortion. If you have an automobile accident, the husband comes out all right, but a mother and one child are both post-divorce. The doctor can only say, It seems to me that if you have a scenario where the husband has to tell the doctor give your attention if you only have time and enough blood on hand or whatever the techniques can only be applied to one of these people in this small emergency room in this hospital from all we can see and let's assume we'll write the story so that it is true that they are equally bad off and to the point of death. Is the husband under obligation to favor the wife over the child on the basis that that relationship is a permanent relationship? And what I was thinking is, wouldn't it be possible to really turn that argument inside out and say that since that relationship is a permanent relationship and there's a stronger bond of love, sympathy, and understanding, even if the wife doesn't recover to understand these things, that the obligation should go to the one that In other words, you help those who are... Well, that isn't true though, because there's a sense in which you help your own household before you help other households, the households of God before a general unbelieving world. So somebody might say, she's permanently in my household and therefore I help her. There's also the altruistic thing that shouldn't... Honoring the desire of others. Wouldn't the mother want the child to receive the help first, given the maternal instinct, self-sacrificial motivation, I think in all honesty, it's difficult to resolve that question. Well, it is being honest. I can't resolve that right now. I'm just not sure. I feel I could run both ways with the argument and make a pretty good case for it, but sometimes people appeal to the Old Testament law that says you don't take the mother verb with her children, but I think that is highly inappropriate and analogical reasoning. There isn't an analogy there because after all we're not going to be eating the children or the mother in the human situation. It's again, you're jumping, it's like a quantum leap morally into the context of the dignity of human life. You've got a completely different set of parameters than when you're dealing with animal life that is really at the service of the human race. Well, I'll just take up more lecture time than I have to. All I can say is, I can go both ways with that, yes. Well, actually, when we get into the comatose patient situation, I'm going to be arguing very similar to what you're suggesting. However, in this situation, where you have to make a decision, all I'm saying is, well, it's not speculation. Let's assume that the husband and the wife have had long talks about it. you know, some night when there wasn't anything good on TV, they just got to talking about these problems, and the mother has said on that occasion and repeated other times, there's ever a choice between me and little Johnny, save little Johnny. I mean, there's no doubt in your mind that that is the way she feels. It is similar to a living will situation, that's true, she could change her mind if she were conscious and under the pressure of the circumstance, say, no, save me. But we're talking about dealing with the known factors. And the only known factors, since you're going to have to decide what amounts to against somebody, the only known factor is that she was at least willing to have you decide against her. Now I'm going to argue against living wills here when we come back after a break as well. And maybe after a break I'll have some more clear thoughts to present on this question. You know, we can praise God that isn't often the case, but having said that, our obligation is to have an answer when it is the case, and I just don't feel like I have a very good one. As you know, I'm fairly sensitive as a professor. When I say things, take a position, I feel like I can stand, hopefully, against any kind of criticism and answer things. And so I haven't written into my notes anything on that because I just don't feel competent to defend one position or the other. But give me five minutes. Maybe I will. I doubt it, though. Let's take a break. 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