Dr. Payne is Associate Professor of Family Medicine, Medical College of Georgia, Augusta, Ga.
This book is at first glance a welcome addition to the sparse literature by evangelicals concerning end-of-life issues. The authors' reviews of history, current ethical debate and legal issues are substantial and the "meat" of the book. The advantages and disadvantages of living wills and durable powers of attorney are quite helpful. On these topics the book is a valuable resource.
Their attempt to define and answer ethical issues from a "Christian" perspective is inadequate. In fact, most Christians who speak to ethical issues make the same mistake. They confuse "Christian" with Biblical. Christian ethics would be some survey or other consensus of what Christians as a group believe or how they behave. What we should define is what God says about the issues, as He has spoken in the Bible. What Christians should pursue, then, are Biblical ethics, not Christian ethics. For example, Spring and Larson spent much more time on what past and present Christian writers say, than they do developing Biblical positions.
They also ignore the economic issues. Although they briefly present early in the book what some of these problems are, they never return to discuss the principles that ought to be applied and their practical application. Since one could make a case that some major decisions in end-of-life issues are being made on economic bases, a failure to give direction here is seriously deficient.
The most central Biblical text, the Sixth Commandment, is briefly mentioned in one short paragraph when it should be the cornerstone to these issues. In a similar way they fail to deal with the Biblical reasons that death occurs at all. These are profound theological issues that cannot be dealt with in a superficial or popular manner.
The principle of authority within the family is not mentioned. The Bible is clear in that the husband has authority over his wife. This authority would fall to her, should he become mentally incompetent. Both parents have authority over their children. Authority within the family, however, is not absolute. For example, a husband cannot rightfully steal from his wife or children.
They also overlook some central matters of ethical debate, such as the false distinction between ordinary and extraordinary measures and the false categories of active and passive euthanasia.
On the one hand they do not take the extreme position of some evangelicals who believe that almost unlimited measures should be provided for virtually everyone. On the other hand their definition of euthanasia ("putting a person to death by a deliberate act or omission") does not allow for a limited application of medical technology. To withhold or withdraw any medical or other life support means is a "deliberate act or omission." Here, they fail to take motives into account.
The authors fail to discern that the greater problems do not concern people who are "terminally" ill, but the chronically ill who have severely damaged organs and minimal levels of consciousness. These are the ones who have the greatest need of medical resources and are the greatest burdens to themselves and their families. Like most ethicists, they have focused on the more dramatic cases and overlooked the more common, but greater problems.
The authors' praise of modern medicine is overstated. They attribute increased longevity in the United States to advanced medical care when it has little, if anything, to do with longer lives.
It is clear that these evangelicals have made a serious
effort to address an important subject. What Christians need, however, is an
understanding of the content and method of Biblical ethics, as well as a more
thorough approach to all the relevent issues. As evangelicals, we need
to sort through, define the issues and then look to the Bible for our ethical
principles. Unfortunately, this book offers only slightly more than a conservative,
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