We present this catechism (or primer) on death and dying by Dr. Ewan Goligher and pastor Kyle Hackmann. With the advent of MAID or euthanasia becoming legal in Canada, Christians need to re-examine how they think about death and dying. To that end, we hope that this catechism will help you and your church more clearly understand what the Bible says about death and dying—especially as the eligibility criteria for MAID continues to expand. Soon mental illness alone will make one eligible for MAID (March 17, 2024). The pastoral challenge will be (and is) immense. This catechism is one resource to help you meet this challenge.
Our thanks to Pastor Paul Martin for suggesting the need for a primer on these issues, and for constructive suggestions on an early version of the document.
Questions
- What is your only comfort in life and death?
- How should Christians view death?
- What is the meaning of death?
- What are we tempted to believe concerning death?
- Should Christians fear death?
- Of what may I expect to die?
- When may I expect to die?
- When should we begin to prepare for death?
- How can I prepare to die well?
- What are the spiritual challenges of the dying process?
- How may we prepare to meet the spiritual challenges of the dying process?
- What temptations do the dying often face?
- What character qualities will enable us to overcome these temptations?
- How can we grow in these character qualities?
- What are the physical challenges of the dying process?
- How may we prepare to meet the physical challenges of the dying process?
- How should Christians view medical care?
- What are life-sustaining therapies?
- What is cardiopulmonary resuscitation?
- What is the purpose of life-sustaining therapies including CPR?
- Are we always obligated to seek life-sustaining therapies?
- What is palliative care?
- What is physician-assisted suicide?
- What is euthanasia?
- What is medical-aid-in-dying?
- Is physician-assisted death part of palliative care?
- Is physician-assisted death a form of suicide?
- How is euthanasia performed?
- Is withdrawing life-sustaining measures morally equivalent to physician-assisted death?
- What is the purpose of withdrawing life-sustaining measures?
- What is the cause of death when life-sustaining measures are withdrawn?
- What is the cause of death in physician-assisted death?
- What reasons are given to justify physician-assisted death?
- What is personal autonomy?
- Why should we be concerned to avoid violating autonomy?
- How do advocates of physician-assisted death conceive of autonomy?
- How does this concept of autonomy reflect fallen human nature?
- Why is this concept of autonomy mistaken?
- Is this concept of autonomy liberating?
- How does this concept of autonomy undermine respect for autonomy?
- In what way should doctors respect autonomy?
- How is physician-assisted death said to be beneficial?
- What kinds of suffering prompt patients to seek physician-assisted death?
- Is it appropriate to treat pain with opioids?
- What can doctors do if pain cannot be adequately controlled with opioids and other pain-killers?
- How is a patient expected to decide if physician-assisted death is good for them?
- What is the missing gap in the death calculus?
- How does this gap reveal the quasi-religious beliefs underpinning physician-assisted death?
- Is death a state of non-existence?
- What is it like to be dead?
- What does physician-assisted death assume about the value of life and of suffering?
- What kind of value do humans have?
- What happens if we deny that humans have inherent and unconditional value?
- Can we value someone without also valuing their existence?
- What does it say about someone’s value if we decide that is no longer good for them to exist?
- What does the inherent and incalculable value of our fellow humans require of us?
- What does love require of us in our attitude toward the life of our neighbour?
- Is it loving to perform physician-assisted death?
- What makes it wrong to deliberately cause the death of a person?
- What does deliberately ending someone’s life imply about their value?
- Why can’t humans be the foundation of their own value?
- What is the sure foundation of human value?
- How does Scripture explain the wrongness of deliberately ending someone’s life?
- Are there conditions under which it may be justifiable to intentionally end human life?
- How does physician-assisted death regard the human body?
- How should Christians view the body?
- What is our highest good and final purpose?
- How does suffering tempt us to give up on life?
- Can suffering make life pointless?
- Can suffering help us find true meaning?
- How can we steadfastly endure suffering even if we cannot be freed from it in this life?
- Will death and suffering be with us forever?
1. What is your only comfort in life and death?
That I am not my own,[1] but belong with body and soul, both in life and in death,[2] to my faithful Saviour Jesus Christ.[3]
He has fully paid for all my sins with his precious blood[4] and has set me free from all the power of the devil.[5] He also preserves me[6] in such a way that without the will of my heavenly Father not a hair can fall from my head;[7] indeed, all things must work together for my salvation.[8]
Therefore, by his Holy Spirit, he also assures me of eternal life[9] and makes me heartily willing and ready from now on to live for him.[10]
2. How should Christians view death?
Christians should view death as a great enemy and a tragic evil.[11] In God’s original created order, He did not intend for us to die.[12] Death reminds us that something is tragically wrong with our world.[13] Death is a great indignity,[14] the ultimate humiliation for those originally created to rule with God[15] but deposed because of sin and pride.[16] Though Christ has begun the work of undoing the power of death and has promised to fully and completely defeat this enemy, it will be the last enemy he will defeat.[17]
3. What is the meaning of death?
Death signifies the brokenness of the world because of sin.[18] Death shows us the devastating and just consequences of our refusal to love, worship, and obey the God who made us and who continually sustains us in existence.[19] Death reveals our limitations, our weakness, and our dependence on God. Death calls us to repent and cast ourselves on God’s mercy. Death reminds us of the emptiness of idolizing anything that cannot last forever. Death reveals what we truly need–eternal life.
4. What are we tempted to believe concerning death?
We are tempted to believe the lie of the deceiver, that we will not actually die.[20] In our youth we are tempted to believe that death is far off; we are tempted to live as if we will live forever. In suffering and infirmity, we are sometimes tempted to believe that death is better than life.[21] When life brings tragedy, we are sometimes tempted to forget that death itself is a tragedy.
5. Should Christians fear death?
Although the dying process is not pleasurable, those who find forgiveness and life in Christ need not fear death.[22] To depart and be with Christ is far better.[23] The prospect of our death should produce in us a holy solemnity and devoted obedience, knowing that we will one day appear bodily before the judgment seat of Christ to give an account for every idle word and deed in this our bodily life.[24] This should cause us to live with holy focus and unspeakable joy as we contemplate the weight of eternal glory that awaits us in God’s presence forevermore.[25]
6. Of what may I expect to die?
According to Statistics Canada,[26] the most common causes of death in Canada are cancer (about 30%), heart disease (about 20%), accidental injury (5%), and stroke (5%). The remaining 40% of deaths are attributed to chronic lung disease, diabetes, pneumonia, dementia, kidney disease, liver disease, and other causes. We will most likely die of one of these conditions.
7. When may I expect to die?
On average, women in Canada live to age 84 years, while men in Canada live to age 80 years on average.[27] Approximately 10% of Canadians die by age 64 years; 30% die by age 78 years. Approximately 25% live beyond age 90 years. Most of us will die some time between 65 and 90 years of age.
8. When should we begin to prepare for death?
Faithful Christians will regard all of life as a preparation for death because we anticipate a day of judgment and accountability to God.[28] It is therefore wise to live with our mortality and the transientness of this life in view,[29] even from our earliest days.[30] Like the ten wise virgins whose lamps were ready, we should strive to grow daily in readiness to meet the Lord.[31] Moses the man of God gives us a model prayer of preparation: “So teach us to number our days, that we may get a heart of wisdom.”[32]
9. How can I prepare to die well?
We may prepare to die well by abiding in Christ, so that we will not be ashamed when we see the Lord.[33] We must ensure that we are united to Christ by faith, and that we have a righteousness that comes not from law keeping, but from Christ. We must remember that Jesus is the ”resurrection and the life” and he has promised that ”all who believe in him will live even though they die.”[34] We should make our calling and election sure[35] for blessed are those who die in the Lord.[36] We should meet together with other Christians regularly.[37] We should “strive for peace with everyone, and for the holiness without which no one will see the Lord.”[38] We should seek to know Christ and experience the power of his resurrection and the fellowship of his sufferings, becoming conformed to him in his death, so that we might attain the resurrection of the dead.[39] We should devote our lives to loving God with all our heart, soul, mind, and strength, and to loving our neighbour as ourselves, by the wise stewardship of our time, talents, and money, so that the Lord will greet us saying, “Well done, good and faithful servant. You have been faithful over a little; I will set you over much. Enter into the joy of your master.”[40]
10. What are the spiritual challenges of the dying process?
For some, dying can occasion serious existential and spiritual distress.[41] This distress arises from the frustrations of loss and dependence leading to a sense of being a burden,[42] a loss of dignity and sense of personal value,[43] an inability to face the end of one’s life, a sense of regret in life,[44] and a struggle to make sense of the meaning and significance of one’s life.[45] Additionally, even faithful believers may sometimes find themselves feeling forsaken by God in times of great suffering leading to death.[46]
11. How may we prepare to meet the spiritual challenges of the dying process?
Humans are an organic whole constituted of both body and soul. Peace of soul can ease physical suffering,[47] while relief of physical suffering contributes to peace of soul.[48] Therefore we may prepare to meet the spiritual challenges of the dying process by seeking good medical care for our bodies, and by seeking wise pastoral care to shepherd our souls. Through the diligent use of the means of grace of Word, prayer, and the Lord’s supper we may grow strong in faith in God. Moreover, we are social beings, parts of a body, dependent on one another for our full flourishing: none of us lives to ourselves alone and none of us dies to ourselves alone.[49] So we may prepare for the challenges of the dying process by cultivating life-long community through family, friends, and the church.
12. What temptations do the dying often face?
Christians have traditionally identified several forms of temptation common to those who are dying.[50] We can be tempted to doubt or even despair, believing that God is not with us but has abandoned us.[51] We can be tempted to grow bitter and impatient at God’s providence.[52] We can be tempted to trust in our own strength and resources[53] or be unwilling to surrender earthly possessions and wealth.[54]
We can experience loneliness which can tempt us towards ingratitude and even hatred towards others.[55]
13. What character qualities will enable us to overcome these temptations?
Christians who are strong in faith,[56] full of hope,[57] patient,[58] more concerned for others than for themselves,[59] humble,[60] and devoted to God[61] will be more ready to overcome the temptations they may encounter during the dying process, always dependent on the grace of God.[62]
14. How can we grow in these character qualities?
By setting our hearts on the truths that God knows us[63] and loves us,[64] that God is for us,[65] that He is always with us,[66] that He will never leave us nor forsake us,[67] that our sins are forgiven[68] and we are accepted in his sight,[69] that we have already passed from death to life,[70] that we belong to him as his children,[71] that we are unspeakably valuable to him,[72] that nothing is outside his sovereign and wise supervision,[73] that He is working all things for our good[74] and his glory,[75] that He guides us with his counsel,[76] that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us,[77] that we will be resurrected physically with a new and glorious body,[78] that death will be destroyed,[79] that we shall be like him,[80] holy and blameless,[81] and that He will receive us into eternal glory[82] to reign with him forever.[83] And by applying ourselves to the diligent use of the means of grace of Scripture, prayer, baptism, and the Lord’s supper, through which the Holy Spirit sanctifies us and seals to our hearts that we belong to Christ.
15. What are the physical challenges of the dying process?
The dying process may not be easy for some. It may involve progressive loss of physical and mental abilities, sometimes over a prolonged period of time. It may involve physical pain, shortness of breath, and other symptoms.[84] It may involve increasing dependence on others to care for even basic bodily activities (eating, dressing, toileting, etc.). For others, dying may be sudden or relatively painless.
16. How may we prepare to meet the physical challenges of the dying process?
As humans we are constituted of both body and soul.[85] Peace of soul can ease physical suffering, while relief of physical suffering contributes to peace of soul.[86] Therefore we may prepare to meet the physical challenges of the dying process by making spiritual preparation for the same, and by seeking the attention and care of a wise and skilled physician, experienced in the care of the dying.[87]
17. How should Christians view medical care?
Christians should regard medical care as a gift of common grace from God, given as a means of reprieve from suffering and caring for the body in this present broken world.[88] Even if physical illness falls within God’s redemptive purposes in doing all things for good,[89] under God’s creation moral order it is an evil to be combated with all available means.[90] Yet medicine and medical science are not ultimate, for they are only temporarily necessary, and they cannot resolve the basic fallenness of the world because of sin. Indeed, fallen human nature may misuse the powers of medicine for evil rather than good, whether out of ignorance or intention.[91] In the new heavens and the new earth, there will be no threat of illness or disease.
18. What are life-sustaining therapies?
Life-sustaining therapies are interventions that artificially replace the function of failing bodily organs. They include dialysis for kidney failure, mechanical ventilation for respiratory failure, extracorporeal life support for respiratory failure or circulatory failure, and cardiopulmonary resuscitation (CPR) for loss of circulation. These therapies temporarily sustain the body in existence when it would otherwise die because of organ failure.
19. What is cardiopulmonary resuscitation?
Cardipulmonary resuscitation (CPR) is a particular type of temporary life-sustaining therapy used to attempt to revive the circulation when it has unexpectedly ceased. CPR involves chest compressions to generate pressure swings inside the chest to pump blood around the body when the heart is not beating and to pump air in and out of the lungs when the patient is not breathing. These chest compressions may result in rib fractures and serious internal injuries. CPR may include the administration of stimulant drugs to attempt to revive the circulation and external defibrillation to treat abnormal heart rhythms causing circulatory arrest.
20. What is the purpose of life-sustaining therapies including CPR?
Life-sustaining therapies are designed to overcome temporary and potentially reversible threats to bodily health and life. Life-sustaining therapies allow time for healing and recovery in the face of a life-threatening illness or injury. Their purpose is not merely to sustain biological life (which they can only do for a limited time) but to enable the restoration of bodily health.
21. Are we always obligated to seek life-sustaining therapies?
Life is a gift from God, and the body is a gift to be nourished and cared for. When life-sustaining measures cannot achieve their intended purpose of restoring health, or if they entail burdensome suffering without a meaningful possibility of restoring health,[92] then such measures are not appropriate and Christians are not obligated to seek them. In the course of declining health, we may reach a point where it is wise to decline or discontinue life-sustaining measures, entrusting ourselves to a faithful Creator. Such decisions require discernment with counsel from skilled physicians and from godly pastors.
22. What is palliative care?
Palliative care is a specialized discipline of medical practice focused on the relief of pain and symptoms and the care of the whole person.[93] Palliative care aims at comfort rather than cure,[94] but it is still aimed at restoring health in that it improves bodily function through the proper relief of pain, shortness of breath, and other symptoms. The goal of palliative care is to enable the patient to live and to function to the fullest extent possible as they journey toward death, wisely accepting that cure is no longer possible.
23. What is physician-assisted suicide?
Physician-assisted suicide is one type of “physician-assisted death.” Physician-assisted suicide involves having a doctor prescribe a lethal drug and dose to a patient based on the patient’s voluntary request.[95] The patient self-administers and ingests the lethal dose. The express aim of these actions by the doctor and the patient is to cause the patient’s death.
24. What is euthanasia?
Euthanasia is another type of “physician-assisted death.” Euthanasia is the practice of administering a lethal drug and dose to a patient by a physician. The lethal combination of drugs is injected intravenously. The express aim of this action by the doctor is to cause the patient’s death. Euthanasia is “voluntary” when it is requested by the patient; it is “non-voluntary” when it is administered to an incapacitated patient; it is “involuntary” when it is administered against the wishes of the person.[96] Advocates for “physician-assisted death” generally only support voluntary euthanasia, although some support non-voluntary euthanasia (e.g., for patients with dementia who have made a prior request for euthanasia when they were capable of making medical decisions).
25. What is medical-aid-in-dying?
Medical-aid-in-dying (MAID) is another word for “physician-assisted death”, referring to both physician-assisted suicide and euthanasia. These practices are also euphemistically referred to as “death with dignity”. The defining feature of all these practices is that the doctor (or other healthcare provider) is acting with the goal of causing the patient’s death.
26. Is physician-assisted death part of palliative care?
Palliative care and physician-assisted death are fundamentally different. Palliative care aims to maximize bodily function and quality of life by addressing physical symptoms along with emotional, spiritual, and existential concerns. Palliative care never aims at causing death. By contrast, the goal of physician-assisted death is to cause death, and it achieves that end by undermining, rather than promoting, the function of the body.[97]
27. Is physician-assisted death a form of suicide?
Some deny that physician-assisted death counts as an act of suicide, particularly because they wish to avoid undercutting efforts at suicide prevention.[98] Some presume that suicide implies mental illness and incapacity, whereas physician-assisted death relies on proper rational deliberation by the patient. Some also argue that physician-assisted death is different from suicide because suicide is carried out alone and in isolation, while physician-assisted death often involves attendance and support from family and friends. Despite these differences in the psychological experience of the dying process, from the standpoint of moral evaluation, both physician-assisted suicide and voluntary euthanasia are equivalent to acts of suicide in that the patient purposefully acts to end their own life, whether by their own hand or by having someone else (a doctor or nurse) end it for them.
28. How is euthanasia performed?
Exact combinations of medications used for euthanasia vary between jurisdictions, but in general some combination of the following medications are used.[99] First, a sedative tranquilizing agent is injected to relieve anxiety and to have the patient fall into a light sleep. Then, an intravenous anesthetic agent is administered (in a very high dose) to put the patient into a coma and to take away the brain’s drive to breathe. Third, a paralytic agent is administered to prevent the breathing muscles from contracting so that the patient ceases to breathe. Finally, an intravenous dose of local anesthetic or potassium chloride is administered to stop the patient’s heart from beating. This process usually requires just a few minutes, and the patient is declared dead shortly after completing the procedure. Sometimes additional doses of drug are required to cause death. Sometimes (though not often) complications can occur from an incomplete or failed procedure necessitating calls for ambulance assistance via 911.[100]
29. Is withdrawing life-sustaining measures morally equivalent to physician-assisted death?
Withdrawal of life-sustaining measures can be morally distinguished from physician-assisted death both in terms of the purpose of the action and in the cause of death. Given these distinctions, withdrawal of life-sustaining measures is not morally equivalent to physician-assisted death.
30. What is the purpose of withdrawing life-sustaining measures?
Life-sustaining measures are discontinued in order to relieve the patient of burdensome and invasive interventions when they cannot achieve their intended therapeutic goal (restoration of health). Life-sustaining measures are not withdrawn in order to cause death. After withdrawing life-sustaining measures, a small minority of patients do not immediately die, and this is not regarded as a “failure” of withdrawal. By contrast, the goal of physician-assisted death is (by definition) to cause the death of the patient. Physician-assisted death is “successful” if and only if the patient is rendered dead. This difference in intention makes physician-assisted death fundamentally different from withdrawal of life-sustaining measures.
31. What is the cause of death when life-sustaining measures are withdrawn?
When life-sustaining measures are withdrawn, the patient dies naturally of their underlying illness. Withdrawing life-sustaining measures indirectly contributes to the timing of the patient’s death, but it is the underlying illness (the disease process that was counter-acted by life-sustaining measures) that actually causes death. Withdrawing life-sustaining measures are not sufficient on their own to cause death.
32. What is the cause of death in physician-assisted death?
In physician-assisted death, the administration of a lethal dose of medication prescribed (or administered) by a healthcare professional is the direct and sufficient cause of death, not the patient’s underlying illness.
33. What reasons are given to justify physician-assisted death?
Those who support physician-assisted death believe that it is morally acceptable to cause death if the patient wants to have their life ended; that is, it is a matter of respecting their personal autonomy.[101] Furthermore, they believe that by causing death they are helping the patient to escape from unwanted suffering. If a patient finds their suffering unbearable and prefers to be dead, then physician-assisted death is good for them.[102]
34. What is personal autonomy?
Autonomy refers to the idea of self-government or capacity for choice. In traditional medical ethics, it signifies the right to informed consent for treatment and to make medical decisions for oneself.[103] Under the traditional version of the principle of autonomy, doctors cannot impose treatment upon you without making sure you are fully informed about the treatment options, outcomes, and risks and that you consent to proceed.
35. Why should we be concerned to avoid violating autonomy?
Respect for autonomy derives from the more general principle that all persons should be treated with dignity and respect. We are rational creatures, capable of making choices based on priorities, values, and judgments about potential outcomes of actions; respecting autonomy is about respecting that rationality as a central feature of human dignity. Our autonomy and agency are the basis for moral responsibility; if we did not have the freedom to make voluntary choices, we could not be held responsible for our actions. Conversely, because we are morally responsible for our actions, we are to be granted freedom to act freely in pursuit of good according to our best lights (provided these choices are at least minimally rationally defensible and they are directed toward the good of others as well as our own).[104] This conception of moral agency is one which Christians can and should endorse, recognizing our high status as Divine image bearers and governing stewards of the created world.[105] Christians make moral choices in a spirit of freedom and liberty.[106]
36. How do advocates of physician-assisted death conceive of autonomy?
Reflecting broader cultural movements, advocates of physician-assisted death conceive of autonomy not merely as the power to make decisions for oneself, but as the power to decide for oneself what is good.[107] Under this view, autonomy is respected not merely so that one can make good choices, but rather so that choices can be made good. To maximize our control over our circumstances and futures, and to exercise that control, is our highest good.[108] Losing control of life makes life pointless, and people should decide for themselves when life is no longer worth living. For someone who thinks of autonomy in this way, physician-assisted death makes sense as a means to maximize personal control over their life and their death.
37. How does this concept of autonomy reflect fallen human nature?
In making claims to the authority to decide for oneself what is good and evil, the concept of autonomy underpinning physician-assisted death recapitulates the basic problem of sin by putting oneself in the place of God.[109]
38. Why is this concept of autonomy mistaken?
This concept of personal autonomy would justify actions that are self-destructive and harmful. Hence this conception of autonomy is unlivable–no conscientious doctor would follow a patient’s wishes by prescribing just anything they want, however medically unnecessary or destructive to health it might be.
39. Is this concept of autonomy liberating?
No, it actually brings bondage, for we become slaves to our selfish desires[110] rather than subjects of a higher purpose and good given to us by our Creator.[111] Since we cannot control what we find desirable, we become slaves to our desires and mere creatures of instinct, irrational animals instead of rational animals.[112] Physician-assisted death is a paradigmatic example of this slavery: any freedom that leads us to self-destruct (and hence to end our autonomy) cannot be true freedom.
40. How does this concept of autonomy undermine respect for autonomy?
This concept of autonomy disconnects choice from rationality: choosing becomes a pure act of will, determined by (unchosen) desire, and unrelated to reasons or rational judgments about what is objectively good for us and others. But if the choices of others are dictated by their (unchosen) desires, then we lose any reason to think that their choices are worthy of respect (especially when their choices threaten to limit our own choices). This form of autonomy proves to be a false freedom.[113]
41. In what way should doctors respect autonomy?
Because God endowed us with a rational mind and moral agency, respect for personal autonomy is a fundamental part of respecting human dignity and value. God manifests respect for our autonomy and voluntary choice in creating humanity with the freedom to choose good or evil.[114] Respect for autonomy has both “negative” and “positive” aspects. “Negative” autonomy should always be respected; we should not compel patients to undergo treatment without consent. “Positive” autonomy—the obligation to honour patient requests for treatment—is important in healthcare, in that a patient’s sense of what is appropriate in the context of their life situation weighs heavily in determining the best treatment plan for a medical condition. However, doctors may sometimes decline to offer interventions to patients when they ask for medicine or surgery that is not in the interest of their health. For example, doctors should decline if a patient asks for prescription opioids when they don’t have pain. In other words, just because someone autonomously desires us to do something is not sufficient to establish that we ought to do it for them. Respect for autonomy is part of respecting the value of persons, but there are other additional considerations to establishing how to care for someone.
42. How is physician-assisted death said to be beneficial?
Advocates for physician-assisted death contend that it benefits patients by enhancing their autonomy (giving them control over the manner and timing of their death) and by offering them an escape from suffering.
43. What kinds of suffering prompt patients to seek physician-assisted death?
Patients primarily seek physician-assisted death because of psychological and existential suffering. The most common reasons for requesting physician-assisted death are loss of personal autonomy, inability to enjoy one’s life, and fear of being a burden.[115] Uncontrolled physical pain or discomfort are rarely the reasons for seeking physician-assisted death,[116] in part because pain and other symptoms can generally be effectively controlled through palliative medicine.[117]
44. Is it appropriate to treat pain with opioids?
Sometimes patients or their families raise concerns about the use of opioids (e.g., morphine, hydromorphone) to treat pain for fear of causing respiratory depression or of becoming “addicted” to opioids. However, the risks of harm from appropriately aggressive use of opioids and sedatives to control pain and distress are very low.[118] Indeed, effective and timely management of pain and symptoms can actually prolong survival.[119] Even given these risks, the use of opioids and sedatives to ensure adequate pain and symptom control is justified so long as one is not intending to cause death or injury and the treatments are proportionate to the symptoms being treated.[120]
45. What can doctors do if pain cannot be adequately controlled with opioids and other painkillers?
In rare cases, pain or other severe symptoms may not be adequately controlled by opioids and other painkillers. If these medicines have been titrated to the maximum dose, and the patient remains in severe distress from physical pain or agitated delirium, then it can be appropriate to sedate the patient to unconsciousness, adjusting the sedatives to have the patient sleeping while trying not to affect their breathing or circulation. This “palliative sedation” should be regarded as an option of last resort under extreme circumstances when all other palliative measures have failed, and so long as it is administered to relieve suffering and not to hasten death.[121] Patients should be reassured that severe physical suffering can always be effectively controlled by all means available.
46. How is a patient expected to decide if physician-assisted death is good for them?
According to advocates for physician-assisted death, patients can decide whether physician-assisted death is good for them by assessing whether the goods associated with being alive are outweighed by the harms of remaining alive (i.e. suffering). They argue that if a patient believes that, all things considered, the harms of being alive outweigh the goods of being alive, it is rational for her to conclude that she is better off dead and that physician-assisted death is good for her.
47. What is the missing gap in the death calculus?
To determine whether one is better off dead, one needs to know not only what it is like to be alive, but also what it is like to be dead. This logical calculus fails to consider what it is like to be dead, or implicitly takes for granted that death is a state of non-existence.
48. How does this gap reveal the quasi-religious beliefs underpinning physician-assisted death?
By taking for granted that death is a state of non-existence, arguments for physician-assisted death assume a specifically Secular concept of reality. This concept assumes without evidence that everything is physical and material, nothing exists outside of time and space, and can be observed through scientific study. Since conscious life after death is not observable to science, it is assumed that it does not exist. Absence of a certain kind of evidence is taken to be evidence of absence. This Secular vision of reality counts as a kind of religious belief. By taking this belief for granted without evidence, physician-assisted death manifests a kind of blind religious faith. A willingness to act on one’s beliefs about reality by offering to end one’s own life or to end someone else’s life in order to do them good requires a profound level of faith.[122]
49. Is death a state of non-existence?
No, death is not a state of non-existence. Reason reflecting on nature shows us that humans have an immaterial soul as well as a material body, making it unlikely that our existence would cease when the body dies.[123] Scripture clearly affirms that we have an eternal soul and that our conscious existence continues beyond the grave.[124] Our souls will be reunited with our material bodies when Christ returns.[125]
50. What is it like to be dead?
Christians believe that at death, the human soul is temporarily separated from the body and awaits the final judgment. Though the souls of believers are with Jesus in paradise immediately after bodily death, the bodies of believers still wait for the final judgment and the new creation. The souls of unbelievers are held in temporary judgment[126] awaiting the resurrection of their bodies and their final judgment.[127]
51. What does physician-assisted death assume about the value of life and of suffering?
The logic of physician-assisted death assumes that life has no inherent value apart from the value we find in it, and that suffering has no inherent purpose apart from the purpose we give it.
52. What kind of value do humans have?
Humans have inherent and unconditional value.[128] We matter because of who we are, not merely because of what we can do. We also have incalculable value. Each of us is worth more than we can imagine. No matter what, it is good that we exist.
53. What happens if we deny that humans have inherent and unconditional value?
If we deny that humans have inherent and unconditional value, then our value derives only from our usefulness to ourselves or to others. We would be valuable only as means to ends, and there would be no absolute basis for requiring respect for the value, welfare, or rights[129] of others, except insofar as is useful. This attitude towards human value accounts for many of the most egregious moral failures of human history, including exploitative labour, human trafficking, and human medical experimentation.
54. Can we value someone without also valuing their existence?
If something is of value, then by definition it is good that it exists. We cannot value something without also valuing its existence. Because humans have inherent and unconditional value, it is inherently and unconditionally good that they exist. The death of a person is a tragic loss of something priceless and irreplaceable. Hence we are obligated to value our existence and that of others and death should always be regarded as evil (even if unavoidable) rather than good.
55. What does it say about someone’s value if we decide that is no longer good for them to exist?
If it is no longer good that someone exists, then they have lost their value. In Canada, the law is willing to permit euthanasia for people with disabilities, but not for healthy people. This suggests that our society values people differently, depending on their abilities. It also suggests that we value people not simply for who they are (a human being) but rather for what they can do.
56. What does the inherent and incalculable value of our fellow humans require of us?
That we love our neighbour as ourselves.[130]
57. What does love require of us in our attitude toward the life of our neighbour?
To love our neighbour as ourselves requires that, mindful of their inherent and unconditional value, we always treasure the existence (life) of our neighbour and show them in word and deed how much they matter. To act in a manner that undermines, forgets, or denies the value of their life is to fail to love them.
58. Is it loving to perform physician-assisted death?
While assisted death might be motivated by good intentions (e.g., a desire to end suffering), to end someone’s existence is to deny the inherent and unconditional goodness of their existence and hence to deny the inherent and unconditional value of their person. Assisted death is more concerned for the person’s suffering than for the person themselves. You cannot show love by ending the beloved.
59. What makes it wrong to deliberately cause the death of a person?
Because humans have incalculable, inherent, and unconditional value, it is always good that we exist. Hence it is wrong to deliberately act to end our existence, because acting with this intent requires that we deny the goodness of our existence and by extension the value of our person.
60. What does deliberately ending someone’s life imply about their value?
By affirming that it can be good to end the existence of a human person, euthanasia denies that the person’s value is inherent, unconditional, and incalculable. Rather it affirms that their value–and the value of their existence–is calculable and conditional merely on their capacity for personal fulfillment, reducing their value to a matter of personal choice. This view requires that we regard ourselves as the foundation of our own value.
61. Why can’t humans be the foundation of their own value?
Humans by nature do not have the authority to establish their own value. Any claim we might make to assert our value could easily be challenged as arbitrary and as mere wishful thinking. We cannot make ourselves matter simply by asserting that we matter. Moreover, our frailty, our limitations, our dependency on others, and the transience of our mortal existence often incline us to doubt whether we matter, and thus we depend on others to remind us of our value.
62. What is the sure foundation of human value?
The sure foundation of human value is the truth that we are made in God’s image and likeness.[131] We were created to be priests and rulers over creation and under God,[132] divine regents crowned with glory and honour above all creation.[133] On this basis, human value is inherent, unconditional, and incalculable.[134]
63. How does Scripture explain the wrongness of deliberately ending someone’s life?
God’s covenant with Noah expressly links the wrongness of causing the death of an innocent human person to the inherent, unconditional, and incalculable value that humans possess by virtue of being made in God’s image.[135]
64. Are there conditions under which it may be justifiable to intentionally end human life?
Intentionally ending human life may be justified when motivated by respect for the true value human life and aimed at the protection of human life. Acts of self-defense, just war (a form of self-defense), and capital punishment (which expresses the demands of justice with respect to human value[136]) may, under appropriate conditions, be grounded in and necessitated by a deep reverence for human value and for the image of God in each person.[137] Importantly, these actions are generally the prerogatives of the civil magistrate, whom God has appointed to restrain evil and to protect human life.[138]
65. How does physician-assisted death regard the human body?
Physician-assisted death regards the human body as something to be used and disposed of according to our preferences and desires. The body has value only insofar as it enables our personal satisfaction. It is a mere means to an end. Physician-assisted death regards the body as separate from our person; it aims to show respect for persons by destroying (and hence disrespecting and devaluing) the body.
66. How should Christians view the body?
Christians should view the body as a marvellous and precious gift from God, and as an essential aspect of who we are. We are not merely souls trapped inside bodies; rather we are both body and soul, and our bodily reality is as basic and integral to our person as our mental and spiritual reality.[139] Christians should remember the dignity accorded to the human body by the incarnation of Christ in human flesh,[140] and by the care devoted to Christ’s body by his disciples before[141] and after his death.[142] For Christians, the body is not merely a means to an end or a tool to be used for personal gain, but a beautiful and inherently valuable creation of God,[143] essential to the ends for which we were created and to embodied worship and service of our Creator.[144] Our bodies now serve as a temple of the Holy Spirit.[145] Hence we should treat our body with great respect and act only for its good. This precludes actions that aim to destroy the body and its functions.
67. What is our highest good and final purpose?
To glorify God and enjoy him forever.[146]
68. How does suffering tempt us to give up on life?
When disease and disability rob us of our hopes and dreams, prevent us from flourishing, bring us pain, threaten to isolate us from others, blind us to our worth, and deprive us of hope for a better future, then we may be tempted to believe that our life is pointless[147] and that we are better off dead.[148]
69. Can suffering make life pointless?
Though serious suffering can tempt us to feel that life is pointless, it cannot make life actually pointless, for, by God’s grace, it cannot finally prevent us from pursuing our highest good and final purpose either in this life[149] or in the life to come.[150]
70. Can suffering help us find true meaning?
Suffering can expose the idols of our heart and lead us to repentance and renewed devotion to God.[151] Suffering can teach us to forsake self-dependence and to depend on God’s grace.[152] Suffering allows us to experience the love of God through the love of God’s people.[153] Suffering can free us to worship our Creator and Redeemer for his own sake, not merely because of the gifts he gives us.[154] When our suffering is on account of our loyalty and devotion to Christ, we experience a unique comfort; namely since we are sharing in Christ’s suffering we will also share in his resurrection and life.[155] Those who in the midst of suffering and loss find rest for their souls in the grace of the Lord Jesus Christ, the love of God, and the fellowship of the Holy Spirit,[156] glorify God most truly and enjoy him most fully.[157]
71. How can we steadfastly endure suffering even if we cannot be freed from it in this life?
We may steadfastly endure suffering by remembering that Christ our Saviour truly suffered in his body[158] and died but also was resurrected to life unending and eternal glory.[159] Even as we endure the sufferings of this present time[160] and await the redemption of our bodies,[161] the Spirit of God who raised Jesus from the dead now indwells us[162] and seals to our hearts that we are heirs of glory with Christ[163] and that God is for us.[164] The Spirit helps us in our weakness;[165] the power of the Holy Spirit that raised Jesus from the dead enables us to grow in faith, hope, and love[166]: faith in God’s unsearchable wisdom,[167] sovereign power,[168] and infinite goodness;[169] hope in God’s promises of sustaining grace[170] and eternal glory;[171] and love for and from God and his people.[172] Thus we may find grace to endure and even to “rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame, because God’s love has been poured into our hearts through the Holy Spirit who has been given to us.”[173]
72. Will death and suffering be with us forever?
No. Christ will return, death will be defeated, and God will wipe away all tears from the eyes of his people. “Behold, the dwelling place of God is with man. He will dwell with them, and they will be his people, and God himself will be with them as their God. There shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away.”[174] “He who testifies to these things says, ‘Surely I am coming soon.’ Amen. Come, Lord Jesus!”[175]
[1] Drawn from Heidelberg Catechism, Question 1. 1 Corinthians 6:19,20
[2] Romans 14:7-9
[3] 1 Corinthians 3:23, Titus 2:14
[4] 1 Peter 1:18-19
[5] John 8:34-36, Hebrews 2:14, 1 John 3:8, 2 Timothy 2:25-26
[6] 1 Peter 1:5
[7] Matthew 10:29-31, Luke 21:16-18
[8] Romans 8:28
[9] Romans 8:15-16, 2 Corinthians 1:21-22, Ephesians 1:13-14
[10] 2 Corinthians 5:15
[11] 1 Corinthians 15:26, Hebrews 2:15
[12] Genesis 2:9, 1 Corinthians 15:22
[13] Hebrews 2:14-15
[14] Though we strive to uphold human dignity for those who are suffering and dying, to uphold human value we must insist that death itself is an indignity. It is never good for humans to cease to exist. This was the insight of the eminent Christian moral theologian Paul Ramsay: “To deny the indignity of death requires that the dignity of man be refused also. The more acceptable in itself death is, the less the worth or uniqueness ascribed to the dying life” (The Indignity of Death with Dignity, 1974).
[15] Psalm 8
[16] Daniel 5:20
[17] 1 Corinthians 15:26
[18] Romans 5:12
[19] Ezekiel 18:20, Romans 6:21-23
[20] Genesis 3:4
[21] Job 10:1
[22] 1 Corinthians 15:50-57, 1 Thessalonians 4:13-14
[23] Philippians 1:23
[24] 2 Corinthians 5:10, Matthew 12:36, Romans 2:6-8
[25] 1 Peter 1:8, Colossians 1:27, Colossians 3:1-4, 2 Corinthians 4:16-18
[26] Statistics Canada. Table 13-10-0114-01 Life expectancy and other elements of the complete life table, three-year estimates, Canada, all provinces except Prince Edward Island. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310011401. Accessed March 27, 2023.
[27] Ibid.
[28] Hebrews 9:27, 2 Corinthians 5:10
[29] 2 Peter 3:11
[30] Ecclesiastes 12:1
[31] Matthew 25:13
[32] Psalm 90
[33] 1 John 2:28
[34] John 11:25
[35] 2 Peter 1:10-11
[36] Revelation 14:13
[37] Hebrews 10:24-25
[38] Hebrews 12:14
[39] Philippians 3:10-11
[40] Matthew 25:21
[41] Boston, P., Bruce, A. & Schreiber, R. Existential Suffering in the Palliative Care Setting: An Integrated Literature Review. J Pain Symptom Manag 41, 604–618 (2011).
[42] Chochinov, H. M. et al. Burden to Others and the Terminally Ill. J Pain Symptom Manag 34, 463–471 (2007).
Loggers, E. T. et al. Implementing a Death with Dignity program at a comprehensive cancer center. New Engl J Medicine 368, 1417 1424 (2013).
[43] Chochinov, H. M. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. Bmj 335, 184 187 (2007).
[44] Neimeyer, R. A., Currier, J. M., Coleman, R., Tomer, A. & Samuel, E. Confronting Suffering and Death at the End of Life: The Impact of Religiosity, Psychosocial Factors, and Life Regret Among Hospice Patients. Death Stud 35, 777–800 (2011).
[45] Chochinov, H. M. et al. Dignity in the terminally ill: revisited. J Palliat Med 9, 666 672 (2006).
[46] Psalm 22
[47] Cassel, E. J. The nature of suffering and the goals of medicine. New Engl J Medicine 306, 639 645 (1982).
[48] Chochinov, H. M., Tataryn, D., Clinch, J. J. & Dudgeon, D. Will to live in the terminally ill. Lancet 354, 816 819 (1999).
[49] Romans 14:7
[50] See the Ars Moriendi; also, Jeremy Taylor, The Rule and Exercises of Holy Dying. Available at http://www.anglicanlibrary.org/taylor/holydying/index.htm. Accessed May 9, 2023
[51] Matthew 8:25-26, Psalm 69:19-21, cf. Matthew 27:46
[52] John 11:21
[53] Psalm 73:3-11,18-20
[54] Matthew 6:19, 1 Timothy 6:7-10, 1 John 2:15-17
[55] Jonah 4:8-11, Psalm 88:18
[56] 1 Timothy 6:11, Mark 11:22, Hebrews 11:13-16, James 5:7-8
[57] Psalm 42:11, Romans 5:5
[58] Romans 8:25
[59] 1 Corinthians 13:13, Ephesians 5:1-2, Philippians 2:3-5
[60] Philippians 2:3-5
[61] Colossians 3:1-4, Matthew 6:33
[62] 2 Corinthians 12:9-10
[63] Psalm 139, Exodus 2:24-25
[64] 1 John 4:9-11
[65] Romans 8:31-32
[66] Matthew 28:20, Psalm 74:23
[67] Hebrews 13:5, Romans 8:38-39
[68] 1 John 1:9
[69] Romans 15:7
[70] John 5:24
[71] Romans 8:15-17, 1 John 3:2, Ephesians 1:5
[72] Luke 12:7, 1 John 3:1
[73] Lamentations 3:37-39, Isaiah 45:7-9, Colossians 1:16-17, Matthew 10-29-31
[74] Romans 8:28
[75] Ephesians 1:6,12
[76] Psalm 73:24
[77] Romans 8:18
[78] 1 Corinthians 15:42-44
[79] 1 Corinthians 15:26
[80] 1 John 3:2-3
[81] Ephesians 1:4
[82] 1 Peter 5:10, Psalm 73:24
[83] 2 Timothy 2:12
[84] Kelley and Morrison, N Engl J Med 2015; 373:747-755; Potter et al. Palliative Medicine 2003; 17:310-314.
[85] Matthew 10:28, cf. Loose, J., Menuge, A. J. L., & Moreland, J. P. (2018). The Blackwell companion to substance dualism. John Wiley & Sons, Inc.
[86] Psalm 131. See also Cassel 1982 and Chochinov 1999 cited above.
[87] Kelley and Morrison, N Engl J Med 2015; 373:747-755
[88] 1 Timothy 5:23, Matthew 9:12, Isaiah 38:21
[89] Romans 8:28
[90] John 11:35
[91] Wiesel, E. Without Conscience. New Engl J Medicine 352, 1511–1513 (2005)
Alexander, L. Medical science under dictatorship. New Engl J Medicine 241, 39 47 (1949)
Tobin, M. J. Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The Story and Timeless Lessons. Am. J. Respir. Crit. Care Med. 205, 1145–1158 (2022).
[92] The idea here is that the harms of the intervention are disproportionate to its limited benefit (or futility).
[93] Kelley and Morrison, N Engl J Med 2015; 373:747-755
[94] Stuart et al. Mayo Clin Proc. 2019 Apr;94(4):677-685
[95] Sumner, L. W. (2013). Assisted death : a study in ethics and law. Oxford University Press.
[96] ibid.
[97] See, for example, the recent (carefully worded) statement by the Canadian Hospice and Palliative Care Association (CHPCA): “Provision of MAiD is a practice separate and distinct from hospice palliative care. CHPCA does not promote or oppose any practices that seek to hasten or postpone death as they definitionally fall outside of the scope of hospice palliative care.” In support of this statement, they cite international consensus definitions of palliative care. See https://www.chpca.ca/resource/position-statement-on-hospice-palliative-care-and-medical-assistance-in-dying-maid/, accessed August 23, 2023.
[98] American Association of Suicidology statement on physician-assisted death (2017); this statement was recently removed and may be under revision; see also https://www.camh.ca/en/camh-news-and-stories/maid-and-mental-illness-faqs
[99] https://camapcanada.ca/publications/, Accessed May 13 2023
[100] https://camapcanada.ca/wp-content/uploads/2022/02/Failed-MAID-in-Community-FINAL-CAMAP-Revised.pdf, accessed May 13, 2023
[101] Downar J. Care, Compassion, and Respect. CMAJ. 2014 Nov 18;186(17):1336;
Schüklenk U, et al. End-of-life decision-making in Canada: the report by the Royal Society of Canada expert panel on end-of-life decision-making. Bioethics. 2011 Nov;25 Suppl 1(Suppl 1):1-73; Sumner, L. W. (2013). Assisted death: a study in ethics and law. Oxford University Press.
[102] ibid.
[103] Campbell, L. Kant, autonomy and bioethics. Ethics Medicine Public Heal 3, 381–392 (2017).
[104] Romans 13:8
[105] Revelation 5:10
[106] Galatians 5:1, 1 Peter 2:16; see also Westminster Confession of Faith, Chapter 20
[107] Genuis, Q. I. T. A Genealogy of Autonomy: Freedom, Paternalism, and the Future of the Doctor–Patient Relationship. J Medicine Philosophy 46, 330–349 (2021).
[108] For an informative account of the development of the concept of autonomy in healthcare and culture over time, see Genuis, Q. I. T. A Genealogy of Autonomy: Freedom, Paternalism, and the Future of the Doctor–Patient Relationship. J Medicine Philosophy 46, 330–349 (2021).
[109] Genesis 3:5
[110] 2 Peter 2:19, John 8:34
[111] John 8:31-32, 1 Peter 2:16
[112] 2 Peter 2:12
[113] 2 Peter 2:19
[114] Matthew 23:37; theological note: God in mercy does not always leave us to ourselves in slavery to self but can open our hearts to see the good and to love the good (e.g., Acts 16:14), so that we voluntarily choose him in response to the effectual call of the Holy Spirit. Voluntariness here does not imply “the possibility of the contrary” but rather “ownership of choice.”
[115] Li, M. et al. Medical Assistance in Dying – Implementing a Hospital-Based Program in Canada. New Engl J Med 376, 2082-2088 (2017).
Loggers, E. T. et al. Implementing a Death with Dignity program at a comprehensive cancer center. New Engl J Medicine 368, 1417 1424 (2013).
[116] ibid.
[117] Hagarty, A. M., Bush, S. H., Talarico, R., Lapenskie, J. & Tanuseputro, P. Severe pain at the end of life: a population-level observational study. BMC Palliat Care 19, 60 (2020).
[118] Sykes, N. & Thorns, A. The use of opioids and sedatives at the end of life. Lancet Oncol 4, 312–318 (2003).
[119] S., T. J. et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. New Engl J Med 363, 733–742 (2010).
[120] Here we appeal to the time-tested rule of double effect. For a classic and clear exposition of this rule, see Sulmasy, D. P. & Pellegrino, E. D. The Rule of Double Effect: Clearing Up the Double Talk. Arch Intern Med 159, 545–550 (1999).
[121] Sulmasy, D. P. Sedation and care at the end of life. Theor Med Bioeth 39, 171–180 (2018).
[122] Many religious believers are willing to put their lives on the line as a consequence of their beliefs. Those who support physician-assisted death, even if they claim to be non-religious, are no exception.
[123] For a succinct and accessible introduction for philosophical arguments demonstrating the existence of the soul, see Chapter 18 “The Uniqueness of Humanity: Consciousness and Cognition” in Groothuis, Christian Apologetics. Intervarsity Press, 2nd edition.
[124] Psalm 73:24; 1 Thessalonians 4:13-18
[125] 1 Corinthians 15:51-54
[126] Luke 16:23; 2 Peter 2:9
[127] Revelation 20:13-15
[128] We take this claim to be self-evidently true. Subsequent questions will support and defend this fundamental claim by showing the impossibility of the contrary and by giving explicit Scriptural support for this claim. Note: the mere fact that some deny the idea that humans are inherently valuable does not entail that it is not self-evident. Rather, denying that which is self-evident is the definition of “suppressing the truth in unrighteousness” (Romans 1:18).
[129] Note that claims about a “right to die” assume that people have inherent value, since the notion of “rights” assumes that value is located in our person, not in our performance or abilities.
[130] Mark 12:31, Leviticus 19:18, Romans 13:8-10
[131] Genesis 1:26-27
[132] Revelation 5:10
[133] Psalm 8:4-8
[134] Luke 12:7
[135] Genesis 9:5-6
[136] Genesis 9:5-6
[137] Christians debate and disagree over the ethics of taking life in the context of war and capital punishment. Our claim here is merely that it is reasonable for those with a very high view of human value to regard war or capital punishment as potentially justifiable insofar as these practices can be grounded in and motivated by respect for the value of persons and of their life
[138] Romans 13:1
[139] Genesis 3:19
[140] John 1:14
[141] Luke 7:36-38
[142] John 19:38-42
[143] Genesis 1:26-31, Ephesians 5:28-29
[144] Romans 6:12-13, Romans 12:1, 1 Corinthians 15:53-55
[145] 1 Corinthians 6:19-20
[146] Drawn from Westminster Shorter Catechism, Question 1. 1 Corinthians 10:31, Romans 11:36, Psalm 73:25-28
[147] Ecclesiastes 1:12-15
[148] Job 3:20-22
[149] Romans 8:31-39, Hebrews 13:6,20-21, Psalm 138:8, John 16:33
[150] 1 Corinthians 13:9-13, Psalm 16:9-11, Revelation 21:1-4
[151] Psalm 119:71, Hebrews 12:4-13
[152] 1 Corinthians 12:7-10
[153] Philippians 4:14-19, 2 Corinthians 1:3-6, Acts 20:35, Galatians 6:2
[154] Job 1:21
[155] Philippians 3:10-11; Colossians 1:24; 1 Corinthians 1:5-7
[156] 2 Corinthians 13:14
[157] Philippians 2:7-11, Job 42:5-6, Revelation 7:9-17
[158] Hebrews 4:14-16
[159] Philippians 2:9-11, Hebrews 12:2
[160] Romans 8:18
[161] Romans 8:23
[162] Romans 8:10-11
[163] Romans 8:17
[164] Romans 8:31-32
[165] Romans 8:26
[166] 1 Corinthians 13:13, 1 Thessalonians 1:3
[167] Job 39:26, Romans 11:33-36
[168] Job 38-40, Psalm 115:3, Daniel 4:34-35, Hebrews 1:3
[169] Psalm 31:19, Psalm 107:1, Psalm 119:68, James 1:17
[170] 2 Corinthians 12:9
[171] Psalm 119:50, Psalm 16:11, 1 Peter 5:10, 2 Corinthians 4:16-18
[172] 1 Corinthians 13, John 17:22-24, John 15:9,12-17
[173] Romans 5:3-5
[174] Revelation 21:3-4
[175] Revelation 22:20
