Was it Suicide?

I have seen a couple of social media posts where some have questioned whether or not Steve’s death was a form of suicide.  After all, the announcement we made included the fact: “He had cancer and heart disease. Both conditions were initially treatable, but he declined treatment.”  So that brings up the moral question: If you decline treatment for something, is that the same thing as committing suicide?

Before answering this broadly, we can first look at the specifics as it relates to Steve Hays.  If you read his memoir, A Backward Providence, you will see that when Steve was in his thirties, he was diagnosed with Fibromyalgia (p. 65).  At the bottom of that same page, he notes: “…I was thirty-five, which is a very different time of life. I had far more to live for. I underwent the full course of treatment.”

So Steve had already gone through the treatment he subsequently refused back when, as he pointed out, he had far more to live for.  There are a couple of ways you could parse that phrase, but included in it would definitely be the fact that at thirty-five you are much closer to your prime than when you are sixty years old.  You have more strength and vigor.  You don’t have as many aches and pains.  In addition, Steve was 35 years old in 1994. He still had both parents at that time (his father passed away in 1999, and Steve became the caretaker for his mother until she passed away in 2013).  When he was diagnosed with the recurrence, he had none of that remaining: no youthful strength, no family to take care of, and the long pain of Fibromyalgia, in addition to other health issues.

Knowing this will address a couple of other things raised by other individuals.  Since Steve was a Calvinist, some have questioned whether he had decided to “accept his fate.”  But Calvinism is not fatalism, so that’s already framing the issue incorrectly.  Steve clearly held to the belief that predestination included the means, not just the end, and “means” included the ability to use doctors for treatment of normal diseases.  So it was not due to a belief that God had predestined him to die that he refused treatment, for he would have held that God had predestined him to use doctors to fight against his disease had he wanted to fight the disease.

Somewhat ironically, another person speculated that perhaps Steve was trying to get God to heal him miraculously.  This is due to the fact that Steve was not a full cessationist and had argued against some cessationists in the past.  However, when you read A Backward Providence, it is very clear that Steve was ready to die.  He didn’t want God to heal him, although if God had done so Steve would have accepted it as God’s desire.  But as mentioned above, he had less to live for as he aged.  So, he prepared himself for his death, and he was ready to meet his Savior.

To add a bit of my own speculation (since Steve and I never talked about this point directly), I also think that since Steve went through the full treatment already, he knew what kind of toll it would have on his body.  And he also knew that “treatment” wasn’t the same thing as “cure” and there’s a good chance he would not have wanted to add another couple of years to his life just to have to go through the same painful treatment again and again until it finally killed him.  Add on the reality that treatment can be expensive, so those painfully extended years might have come at the cost of Steve being forced to live on the streets, unable to blog or to do anything he considered useful.

So those are some specifics in dealing with Steve’s death itself.  But while that may perhaps give us understanding for why Steve chose not to get treatment, it does not yet answer the question of whether it was morally licit for Steve to decline treatment.  So let us examine the moral question.

First is the question: what is suicide?  At a simple level, suicide is deliberately taking an action, the result of which will knowingly cause the end of one’s life.  But even this simple definition needs to be examined.  I can immediately think of a counter: if a soldier sees an enemy about to shoot his friend, and he leaps in front of the bullet and subsequently dies, he has deliberately taken an action that ended his own life.  Yet hardly anyone would view such a death to be suicide.  It was instead noble.  Indeed, Jesus Himself would declare such an action to be that of which there is no greater love (John 15:13).

There is also the fact that refusing to do something is not the same thing as deliberately taking an action.  That is, it was not Steve taking an action that resulted in his disease not being treated—it was the absence of an action that resulted in the disease not being treated.  So defining suicide as "deliberately taking an action that will end one's life" clearly would not apply.

So let us amend it slightly.  "Suicide is deliberately taking an action, or refusing to take an action, the result of which will knowingly end one's life." And that brings us to the crux.  If refusing to take an action to save one’s life results in one’s death, is that suicide or not? 

It's perhaps beneficial to look at the conundrum slightly differently.  When Terri Schiavo was being kept alive with a feeding tube, pro-life activists argued that removing the feeding tube would be murder.  Under the same logic, if one chose to remove one’s own feeding tube, would that be suicide?

The Terri Schiavo case helps us examine this philosophically.  Why was it that removing a feeding tube was considered tantamount to murder by the pro-life side?  After all, the opposition to the pro-life crowd pointed out:  “We’re not killing her.  We are just removing the feeding tube and letting nature take its course.”

But of course, if you keep anyone from food, then “nature’s course” is death.

This brought up the key distinction in the ethical debate.  Terri Schiavo was not on a ventilator or heart bypass machine.  She could breathe on her own, and her heart beat on its own.  What kept her from dying was the nutrition her feeding tube gave her.  Nutrition—the same thing that keeps all of us from dying.  The pro-life argument had been that there was no medical issue with refusing extra-ordinary treatment, but ordinary care that everyone needs for basic survivability could not be turned off without resulting in murder.  In other words, turning off a heart bypass machine resulting in the death of the patient would not constitute murder because hearts beat on their own naturally, but because everyone needs food to survive then depriving her of food was tantamount to murder because everyone needs food to survive.

This moral argument clearly made sense to a lot of pro-life adherents, myself included, and so using that same principal we can ask: is chemotherapy ordinary or extra-ordinary treatment?  Chemotherapy is poisonous.  The hope is that the cancer cells die before all the healthy cells die.  Given that, if you are healthy and you take chemotherapy, only bad things could possibly happen to you.  Clearly chemotherapy is not ordinary care, like food and water are.  This means that under the same principal that it is moral to turn off a heart bypass machine because of it being extra-ordinary care, so too one can refuse chemotherapy without it constituting suicide.

Of course one could still object that this is just a philosophy argument, not Biblical.  The Bible may still forbid one to refrain from doing anything possible to stay alive.  To that, I would respond: “Do you think that I cannot appeal to my Father, and he will at once send me more than twelve legions of angels?”  These words from Jesus recorded in Matthew 26:53 show that Jesus could have done much to keep Himself from the crucifixion.  Does the fact that He did not act to save Himself, knowing full well that He would die if He did not act, mean that He committed suicide?  Clearly not!

So there is at least one example where not choosing to save one’s own life does not constitute suicide.  Indeed, I would suspect that no one could come up with an example where someone does nothing at all to save their life—while also not doing anything active to endanger it—where that would be classified as a suicide.  Regardless, the onus is on the person who says that refusing treatment for a disease is equivalent to suicide to prove that it is.

At the end of the day, I think it’s clear both from philosophy and theology that there is no rational basis to claim that there is a moral imperative to prolong one’s life using extra-ordinary means.  There’s no admonition against it either.  So when faced with two options, neither of which is sinful, then whichever option is chosen is, by definition, not sinful to take.