Pulse
4 May 2026
This article is based on a presentation delivered by Dr Roland Chia at the Christian Bioethics Symposium held on 18 April 2026, organised by the Bandung Theological Seminary and the Christian Medical and Dental Fellowship of Indonesia.
In June 2025, the Members of Parliament in the United Kingdom voted narrowly to back the bill on assisted dying. The Bill has now moved to the House of Lords where peers are debating the details, especially those pertaining to possible safeguards, including patient protections. Once the Bill is passed, the UK will join a growing number of countries and jurisdictions that have legalized euthanasia or assisted dying.
Currently, about twelve countries in the world have explicit national laws that allow euthanasia or assisted dying. These include the Netherlands, Belgium, Canada, and New Zealand. In addition, there are about twenty-five to thirty sub-national jurisdictions that have made it legally permissible for the sick to terminate their lives. For example, in the United States, there are about twelve states where euthanasia and assisted dying are legal – including Oregon, California, and Washington. And in Australia, voluntary assisted dying is legal in states and territories such as Victoria, Queensland and New South Wales.
An increasing number of people support assisted dying as a compassionate approach to alleviating the terminally ill from their suffering. This includes Christian advocacy groups such as Catholics for Compassion (USA), Christians Supporting Choice for Voluntary Assisted Dying (Australia), and Religious Alliance for Dignity in Dying (UK).
In this brief talk, we will reflect on the Christian understanding of issues surrounding the end of life. We will begin by examining what the Bible and Christian tradition teach about human life. We will then discuss why palliative care is the approach that best conforms to the Christian vision of care for the dying, rather than euthanasia and assisted dying. And finally, we will address some issues that Christians may have on the treatment of terminally ill patients, such as do-not-resuscitate orders.
THEOLOGICAL FOUNDATIONS
We begin by discussing the theological foundations for reflecting on issues pertaining to the end of life, drawn from Scripture and the teachings of the Church. This is extremely important for Christians because we live in an era of profound medical advancements and cultural shifts. Both of these have challenged traditional views on medicine, especially the way in which the terminally ill and vulnerable are to be treated. In the face of these seismic changes, it is easy for even Christians to lose sight of the fundamental theological principles found in Scripture about human life. What are these principles?
The first theological principle is the doctrine of the sanctity of human life. This is the heart of Christian ethics in general and biomedical ethics in particular. Unlike secular ethics which regard human life as having value because of its utility, autonomy, or quality, Christian ethics maintain that human life is sacred because it is created by God. More significantly, human beings and the life they possess are valuable because they bear the image of God (imago Dei). This fundamental truth about the dignity and value of human beings is stated in the first chapter of the first book of the Bible. In Genesis 1:27, we read: ‘So God created humankind in his image, in the image of God he created them.’
This doctrine – that human beings are bearers of God’s image – underscores the fact that human life possesses intrinsic worth from its beginning to its natural end. It emphasises that human life is a gift entrusted to us by God. It is not a possession that we can dispose of at will. Only God has this prerogative because he is the author and the Lord of life, as Job puts it: ‘The Lord gives and the Lord takes away’ (Job 1:21). Because every human being is made in God’s image, every human being is valuable in the eyes of God. This includes the unborn, the terminally ill, the disabled, and the person who is comatose. Christian theological ethics resist any framework that measures the value of human life by productivity, independence or freedom from suffering.
Secondly, a Christian approach to issues pertaining to the end of life must be informed by what Scripture teaches concerning death, sin and Christian hope. Christian ethics concerning end-of-life issues must be set within the framework of the Christian theology of death and Christian eschatology. Viewed through the lens of Scripture, Christians can never understand death as a mere biological event or as a morally neutral phenomenon. According to Scripture, death is not the original intention of the Creator when he brought human beings into existence. Death, Scripture tells us, is an intruder into God’s creation, a consequence of human sin. ‘The wages of sin is death,’ Paul writes in Romans (6:23).
The Gospel and the Christian narrative view death not through the lens of defeat but hope. Death does not have the last word. Through his resurrection, Christ has conquered death, which Scripture describes as the last enemy. Thus, the Apostle Paul could write, ‘O death, where is your victory? O death, where is your sting?’ (1 Corinthians 15:55). Christians who have put their faith in Christ should no longer fear death. At the same time, because death is a conquered enemy, Christians should not oppose death at every turn. This is an important consideration in the Christian’s approach to issues surrounding the end of life – especially with regard to futile treatments or resuscitation procedures, which we will discuss later.
The third issue that Christians must consider is the question of suffering. This is an important issue for any end-of-life discussion because suffering is felt most intensely at that stage of the patient’s life. Here, the Christian understanding of suffering and the Christian approach to suffering is profoundly important. According to the Christian faith, suffering must be understood in light of the rebellion of Adam and Eve and the profound disruption that resulted from the primordial fall. Suffering is therefore never the original intention of the Creator when he brought the world into being. Suffering and death signal that the world in which we live is not in its original state. It is a world fractured by sin and evil.
The Christian response to suffering must be guided and shaped by the ministry of Jesus Christ, the incarnate Son of God. In the incarnation, Jesus himself experienced human suffering, the most excruciating of which is of course his agonising death on the cross. In his earthly ministry, Jesus always responded to suffering with compassion, healing and presence. Since its inception, the Church has followed in the footsteps of Jesus as she obeys the command to ‘heal the sick’ (Matthew 10:8). Hence, the earliest Christian communities reached out to the suffering and vulnerable in their societies. They were also responsible for the setting up of hospitals and hospices to provide compassionate care for the sick and the dying.
Christian theological realism offers a measured view of human suffering and grounds that Christian tradition’s notion of redemptive suffering. Redemptive suffering is when human suffering, freely accepted and united with the suffering of Christ, can have profound spiritual meaning and value both for the sufferer and for others. Suffering can bring about spiritual maturity in the sufferer. By suffering and dying faithfully, the Christian can be a powerful testimony of God’s grace and presence. Nevertheless, it is important to stress that in the Christian tradition, suffering in itself is never sentimentalised or valorised. Suffering is never sought. As we have seen, suffering is the result of the fall and not the original intention of God when he created the world.
As I mentioned earlier, the Christian response to suffering is compassionate care. And, in the case of the terminally ill patient, when there is nothing more that medicine can do to change the prognosis for the better, the most appropriate Christian response is palliative care – to which we now turn.
PALLIATIVE CARE
Our discussion on the theological framework for thinking about life’s end from a Christian perspective has made it quite clear that euthanasia or assisted dying can never be an option for Christians. As we have seen, the human being is created in the image of God, and human life is sacred. God is the giver of life, and he alone has the authority and the prerogative to bring it to an end. In the Christian tradition, euthanasia and assisted suicide or dying are therefore acts of murder that the sixth commandment clearly prohibits (Exodus 20:13).
For the Christian, the only appropriate approach to persons with terminal illnesses and who are at the end of their lives is to provide palliative care. There are many definitions of palliative care, but I think the WHO has provided a succinct yet comprehensive description. Palliative care is
… the total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families.
Palliative care has gained much secular acceptance. In what follows, I will develop a Christian understanding of palliative care based on the theological framework that we have discussed.
The basic principle for Christian palliative care is compassion for the sick and the dying. The English word ‘compassion’ is derived from the Latin compati, which means ‘to suffer with’. Christian compassion can never be reduced to sentiment. In the context of palliative care, compassion has to do with the spiritual and moral commitment to accompany (‘suffer with’) the suffering other when no cure is possible – to the very end of their lives.
Christian compassion is Christologically shaped. For in the incarnation, the second person of the Godhead enters into the full spectrum of human vulnerability, including pain, suffering, grief and mortality. The incarnation of the Son can therefore be said to be God’s ultimate act of ‘suffering with’ humanity ravaged by sin and death. Jesus Christ is therefore the very embodiment of Christian compassion as he touches the leper, delivers those tormented by demons, and weeps at the tomb of Lazarus. In his ministry, Jesus shows that true compassion requires a kenosis (self-emptying) which has to do with the humble, self-giving presence in accompanying the vulnerable and the dying.
This is precisely the attitude and approach needed in the provision of palliative care, from the Christian perspective. Palliative care is about the selfless giving on the part of the carer (be they professional healthcare providers or members of the family). It has to do with the faithful presence of the carer as they accompany the patient in the final stages of their life. It has to do with the recognition that the patient is a bearer of God’s image, endowed with dignity and worth, and therefore fully deserving of care, attention and love until death. And in this act of compassion – this ‘suffering with’ – the carer participates in the compassionate heart of God.
If the first principle of Christian palliative care is compassion, the second principle is holism. Christian anthropology rejects any reductionist attempt to define the human being merely as a biological organism. According to Scripture and the Christian tradition, the human being is a complex integration of body, mind, spirit and relationships. This holistic anthropology further recognises that every human being has a narrative, emotions, memories, hopes and dreams, and a need for meaning.
Consequently, Christian palliative care must attend to the full range of the needs of the person who is at the end of their life. It must attend to physical pain and distressing symptoms through competent medical practice. It must also attend to psychological and emotional distress such as fear, anxiety, and guilt. There are also relational issues that must be addressed. Often serious illness disrupts the patient’s relationships with their spouse, children and other family members. Finally, Christian palliative care also emphasises the spiritual needs of the sufferer as they grapple with questions of meaning, reconciliation, death and hope.
Here, Cicely Saunders’ concept of ‘total pain’ is helpful. Palliative care can never be reduced to merely the treating of symptoms. It should never adopt a rigid dualistic paradigm by separating the physical from the spiritual and attending only to the former. It should provide care to the whole person in all their complexity and wonder, even as they are approaching life’s end.
The third and final aspect of Christian palliative care that I would like to briefly discuss is its sacramental nature. The sacraments, especially the Eucharist, have always been central to the Christian life. The Christian who is receiving palliative care should, of course, be allowed to participate in the Eucharist if they are able. But when I speak of the sacramental nature of palliative care, I am referring to a broader understanding of the sacrament in the Christian tradition. The great fifth-century theologian Augustine describes the sacrament as the ‘visible sign of an invisible grace’. In the sacrament, ordinary material things such as water, bread and wine become visible signs of God’s grace. They become the means by which divine grace is present and active.
Understood broadly, other material things can also be used by God to become conduits of his grace, love and mercy. This includes the provision of palliative care. Thus, the simple acts of bathing a dying person, holding a hand, administering medication, or just sitting next to them in silence can be sacramental in the sense that they can mediate God’s grace and presence. In performing these acts, the caregiver is performing what I’ve called a liturgy of love, which recognises and values the dignity of the patient, however compromised their life may be. It accords the dying patient with the respect, love and care that must be shown to every human being.
The Christian faith offers a profound and compelling vision of palliative care based on a compassionate, holistic and sacramental practice. It affirms the dignity of the person and recognises that care itself is a means of grace.
END-OF-LIFE DECISIONS
In the final part of my presentation, I would like to discuss the difficult end-of-life decisions that commonly confront us and offer Christian responses to them. In particular, I would like to briefly deal with four issues:
- Withholding or Withdrawing Treatment
- Do-Not Resuscitate Orders
- Artificial Nutrition and Hydration
- Palliative Sedation
But before we discuss these issues, there are two important concepts in Christian medical ethics that we must consider briefly. In Christian medical ethics, a distinction is made between ordinary and extraordinary treatments.
Ordinary (or proportionate) treatment refers to therapeutic strategies that offer a reasonable hope of benefit and that do not impose excessive burdens on the patient. Some examples of ordinary treatment are insulin for diabetes and surgery with a good prospect of success.
Extraordinary (or disproportionate) treatment refers to medical interventions that do not offer a reasonable hope of benefit and that impose excessive burdens relative to expected benefit. Some examples of extraordinary treatment are aggressive chemotherapy in the final stages of terminal cancer and mechanical ventilation for a dying patient who has no prospect of recovery.
With these two concepts in mind, let us turn to the first issue: withholding or withdrawing treatment. Christian bioethics support the moral legitimacy of withholding or withdrawing treatment when such treatment is futile, burdensome and disproportionate. This applies to both the withholding of treatment and its withdrawal.
The central principle here is the proportionate benefit of the treatment. When a treatment is futile, offering no reasonable hope of recovery or improvement, and when its burdens far outweigh its benefits, that treatment is extraordinary or disproportionate. According to Christian ethics, it is permissible – sometimes even required – for such treatments to be either withheld or withdrawn. The objective is not to kill the patient, but to refuse disproportionate and excessively burdensome treatment.
Because Scripture teaches that death is a defeated enemy, Christian ethics reject the philosophy of vitalism, which insists that life should be preserved at all costs. In fact, allowing the patient to die naturally when treatment is futile is, for the Christian, an act of humility and acceptance before God. Withholding or withdrawing futile treatment and allowing the patient to die naturally while providing palliative and spiritual care is an act of faith, hope and love. It must never be regarded as an act of abandonment.
These same principles apply to the next issue, namely, Do-Not-Resuscitate Orders. A Do-Not-Resuscitate (DNR) Order instructs the medical personnel not to perform cardiopulmonary resuscitation (CPR) or other resuscitative measures if the patient’s heart stops or breathing ceases. From the standpoint of Christian ethics, DNR orders are generally allowed when there is little or no prospect for the patient to make a recovery. In such circumstances, the application of CPR would be regarded as an extraordinary or disproportionate treatment, which, as we have seen, can be withheld from the Christian perspective.
It is understandable why the loved ones of the patient are sometimes reluctant to issue such an order. It must be clarified here that DNR orders do not suggest that one desires the patient’s death. Neither does it constitute euthanasia. The purpose of the order is to withhold excessive and futile treatment, not to cause death. DNR orders likewise should also not be regarded as ‘giving up’ on the patient. Rather, they express a refusal for a specific medical intervention while continuing to affirm the patient’s dignity and providing appropriate palliative care.
The next issue is somewhat more complicated. The provision of nutrition and hydration is always regarded as basic care, which is obligatory in healthcare. When the patient is no longer able to consume food and water unaided, it is delivered through feeding tubes or intravenous means. This is known as Artificial Nutrition and Hydration (ANH).
ANH has been subjected to sustained debate among ethicists, and no consensus has been reached on how to classify the humble feeding tube – as the provision of basic nutrition or as a form of medical intervention. Time does not allow us to examine the contours of the debate. For our purposes, I suggest the following approach to ANH on the basis of the principles of Christian ethics.
At the most fundamental level, we must regard ANH as an aspect of basic and ordinary care. As mentioned above, it is obligatory on the part of the medical team to provide nutrition and hydration through artificial means when the patient is unable to consume them unaided. This applies to patients with diverse medical conditions and with degrees of independence and incapacities, including patients in a persistent vegetative state (PVS). The withholding or withdrawal of ANH for such patients, thereby causing their deaths, would be morally unacceptable from the Christian perspective.
However, in circumstances when ANH becomes medically ineffective or excessively burdensome, or when nutrition is no longer assimilated by the body, it may be regarded as extraordinary or disproportionate. This takes place during the final stage of a terminal illness such as advanced metastatic cancer or end-stage organ failure when the patient experiences a systemic physiological shutdown. In such cases, it may legitimately be withdrawn. Again, this is not euthanasia. Neither is it the case of ‘giving up’ on the patient.
The final and equally contentious issue that we want to briefly discuss is Palliative Sedation. What is palliative sedation and why is it controversial in some circles? Simply described, palliative sedation involves the administering of sedatives to relieve refractory symptoms such as unbearable pain and terminal agitation. The sedative lowers the consciousness of the patient – sometimes to the point of unconsciousness – until the patient dies from the underlying disease.
Christian ethics across the different ecclesial traditions maintain that palliative sedation is permissible within strict boundaries and only as the last resort. It is used only when all other means of managing the pain and suffering of the patient have proved ineffective.
Christian ethics deem palliative sedation permissible within strict boundaries by appealing to the classical moral principle of double effect. According to this principle, an action with the possibility of both good and bad effects is permissible if:
- The act itself is good or neutral. In this case, the administration of palliative sedation is considered a good act because it is meant to alleviate the patient’s suffering.
- The intent is only the good effect of the treatment. In this case, palliative sedation is administered with the intention of relieving the suffering of the patient.
- The good effect is not achieved by means of the bad effect. The intention is not to relieve the patient’s suffering by causing death.
- There is a proportionately grave reason for permitting the bad effect. The administration of palliative sedation can relieve the suffering of the patient, even though it may result in his death. The relief of the suffering of the patient is a proportionately grave reason for permitting the bad effect.
Practised ethically and cautiously, palliative sedation can be seen as an extension of compassionate care. The intent must always be to relieve the suffering of the patient, even if the sedation foreseeably shortens the life of the patient. However – and this is important – it can also be used as euthanasia in disguise. It must, therefore, be practised under the strictest moral condition and always as the last resort.
CONCLUSION
We have covered a lot of ground in a very short time. I would like to conclude my presentation with a story.
In 2018, I received an email from my friend – a very well-known Christian bioethicist in the US. He told me that he had been diagnosed with a very rare form of cancer and that so far, he has not been responding well to the treatment. Then, he wrote this:
I am resting in the fact that none of this has taken God by surprise. When he brought me into being, for various purposes, he made sure that there would be sufficient time for me to accomplish those purposes. So I’ll carry on, as God enables, eager that he be glorified by all that I say and do, in my living and my dying. Of course, death is only gain for me – to be with Christ – so I am not threatened by the prospect of death. Yet there are things for me to do and to be for others, so I am hoping in God to sustain me sufficiently for their completion.
I am happy to report that his doctors have found a treatment strategy that has proved effective. He is still serving the Lord today!
However, his attitude and approach to the end of life are, for me, very inspiring, indeed. It should be the attitude of every Christian whose faith and hope are in our risen Lord and Saviour, Jesus Christ.
Dr Roland Chia is Chew Hock Hin Professor at Trinity Theological College (Singapore) and Theological and Research Advisor of the Ethos Institute for Public Christianity.