Providence in the End of Life Ethics vs. The Pharisaic Fallacy
by Rev. David W. Hall
Many late twentieth century Christian ethicists are confounded by end-of-life ethical issues raised by medical technology. One of the contributing factors is that the increased technology of the last generation has generated moral dilemmas heretofore unknown. As one recent report observed:
"A distressing irony of the on-going progress in science and related technology is that in many cases welcomed advances in these areas also create profound moral dilemmas ... However, this increasing ability on the part of the medical community to preserve life also raises the perplexing moral question of whether or not available technology ought always to be used."
The Pharisaic Fallacy
Another of the contributions to this confusion, often unnoticed, is the operation of the Pharisaic Fallacy. This theological error is not a pejorative term, certainly not the same as scornfully calling someone a "Pharisee." It is merely the description of a logical mistake. The Pharisaic Fallacy is not referred to in any logic textbook, but it is a fallacy which is sometimes present in theological ethics. It should be understood that to speak of such is to speak of a logical problem, not to make an accusation against someone's character or behavior. The Pharisaic Fallacy does not imply that the one who commits it even vaguely resembles a Pharisee. Let me attempt first to illustrate and then to define it.
One instance of the Pharisaic Fallacy is what has been called the "seamless garment" approach to the sanctity of life. The seamless garment approach links disparate ethical issues under a single "pro-life" ethical heading. According to the seamless garment proponents, if we hold to a pro-life ethic we must also be anti-nuclear warfare and anti-capital punishment. For all of those, according to this instance of the Pharisaic Fallacy, are ethical correlates of a pro-life view. The Pharisaic Fallacy here is the yoking of a number of different ethical issues under the same absolute while disregarding the dissimilarities of those issues.
Another instance of the Pharisaic Fallacy is seen in the issue of divorce and remarriage. Many evangelicals, out of respect for Scripture and desire for absolutes, have lamented the exponential growth of divorce in our century. In order to speak against such a rising tide we, in agreement with Scripture, have sought to condemn divorce apart from adultery or desertion (by the unbeliever). There are some who extend that one variable (i.e., the impossibility of easy divorce) to the conclusion that remarriage is impossible in all cases. A charting of such ethic might look like the following, with divorce on one end and remarriage on the other end of a straight line, covered by the absolute, "No."
Another illustration of the Pharisaic Fallacy regards the role of women. Often in our zeal to properly protect women from the Eldership, evangelicals have been known to prohibit women from any responsible ministry in a church. That is another instance of taking one biblical teaching and absolutizing it to apply to other phenomena. If the Scriptures do not speak of that second or third phenomenon then as we presume to link non-revealed categories under the same absolute, we lapse into the Pharisaic Fallacy._ _ No matter how well-intentioned we are, nonetheless, we are not permitted to over-absolutize. Good intentions do not excuse extending absolutes beyond their biblical applications.
A last example of the Pharisaic Fallacy is the recent environmental ethic, represented by some "Christian Greens." These Christians believe that God is the Creator of all of life on the cosmic scale. They further believe that all of life which is presently in the eco-sphere is to be regarded as equally "sacred," including whales, trees, and snail darters. To extinguish any of these, or any species, is tantamount to murder - even if the species is not created in the image of God. These enviro-ethicists link all species under one absolute without observing biblical distinctions. One consequence is that they believe in equal protection and equal treatment of all species. Such instance of the Pharisaic Fallacy results in the denigration of man, the only species created in God's own image. The culprit in this faddish ethical formulation is an ethic which blurs all distinctions, unites all species and prescribes the same ethical criteria for all.
A working definition of the Pharisaic Fallacy could be the following: The unwarranted (inappropriate) extension or application of one absolute truth to cover another ethical question which may be significantly different. Recall that it was the Pharisees who took God's law and extended it too far. Their error was not in being lawful, but in making what appeared to be logical extensions of the law to other cases without express authorization. For example, keeping the Sabbath was not wrong, but by the time of Jesus, the Pharisees had so truncated it as to render even the Co-Lawgiver in violation of it (cf. Mk. 2:27). In many other cases, the Pharisees were guilty_ _not_ _of keeping the Law but of extending it too far, to cover other cases without warrant. It was not the first instance of application which was improper, but the extension to a number of other insufficiently related cases which was improper. Such is what I have named the Pharisaic Fallacy.
In human life issues the Pharisaic Fallacy may have had more sway than we realize. The Christian who is sensitive to the whole counsel of God must be careful to heed the biblical teaching on both beginning-of-life issues as well as end-of-life issues. The Pharisaic Fallacy, however, may be detected if we too closely link both of those loci despite their substantial differences. There is a Pharisaic Fallacy abroad in the church which sees the sanctity of life as equally constructed at both ends of the spectrum of life, a fallacy which this essay seeks to expose. Once this deficiency is recognized by relocating the absolute we can better decide the end of life ethics. The result is a preserved absolutism, but also one more sensitive to the range of biblical teaching, especially as it concerns the providence of God. To do away with the Pharisaic Fallacy is not to lapse into relativism.
One may, and should still hold ever so firmly to the same absolute, i.e., the providence (or sovereignty) of God in the beginning of life as well as at the end of life.
For a beginning definition of providence we could borrow Louis Berkhof's working definition as: "that continued exercise of the divine energy whereby the Creator preserves all His creatures, is operative in all that comes to pass in the world, and directs all things to their appointed end."
Of course, one could hardly improve on Calvin's definition of providence as "not that by which God idly views from heaven what is going on in the world, but that by which as if grasping the tiller He controls all events."
Sanctity of Life Linkage
Let me attempt further illustration by way reviewing the teachings of some evangelicals who dealt with this issue after Roe vs. Wade in 1973. Francis Schaeffer was a leading voice, instrumental in awakening the consciences of many an evangelical to pro-life issues. Toward the late 1970's Schaeffer's books became increasingly attentive to pro-life ethical issues. As a pivotal thinker, he is an example of this unconscious linkage. The following quotes note that growing emphasis, anecdotally bearing witness to the fact that both Schaeffer and other evangelicals began to see the link between abortion and euthanasia more and more inseparably related. Unintentionally, we may have shackled both of those issues with the same absolute, inappropriate to the end of life ethical issues.
In How Should We Then Live Schaeffer stated the principle which would guide him. "And (taking abortion as an example) if this arbitrary absolute by law is accepted by most modern people, bred with the concept of no absolutes but rather relativity, why wouldn't arbitrary absolutes in regard to such matters as authoritarian limitations on freedom be equally accepted as long as they were thought to be sociologically helpful? We are left with sociological law without any certainty of limitation."
Thus, Schaeffer cast the ethical principle. Later he would apply this principle in practice, as he predicted:
"The door is open. In regard to the fetus, the courts have separated 'aliveness' from 'personhood,' and if this is so, why not do the same with the aged? So the steps move along, and euthanasia may become increasingly acceptable."
He further remarks, "As the Christian consensus dies, there are not many sociological alternatives," and resultingly, "...on this basis, if the majority vote supported it, it would become 'right' to kill the old, the incurably ill, the insane and other groups could be declared non-persons."
Thus is evidenced Schaeffer's early equivalency of abortion and euthanasia. His stern warning against Situationalism in 1976 was voiced as:
"... If there are no absolutes by which to judge society, then society is absolute. Society is left with one man or an elite filling the vacuum left by the loss of the Christian consensus which originally gave us form and freedom in Northern Europe and in the West ... Absolutes can be this today and that tomorrow...Arbitrary absolutes can be handed down and there is not absolute by which to judge them."
By the end of this book Schaeffer was observing, "Our own generation can thus disregard human life. On the one end we kill the embryo through abortion and on the other end we will introduce euthanasia for the old. The one is already here and the door is opened for the other."
Moreover, in the middle, Schaeffer also decried the use of genetic engineering as another possible relativistic measure to disregard the sanctity of human life.
Thus, one can see Francis Schaeffer defending moral absolutes and warning against incipient Situationalism. So determined was his defense of absolutes that he also yoked end-of-life ethics with beginning-of-life ethics, in the attempt to protect both from a relativism.
A few years later, Schaeffer went on to develop these thoughts with C. Everett Koop in The Christian Manifesto. His final published work, The Great Evangelical Disaster continued to demonstrate his conviction that abortion and euthanasia were ethical siblings. Hear Schaeffer toward the end of his life, as he says (after arguing that evangelicals must contend in this battle over ideas):
"This lowering of the view of human life may begin with talking about extreme cases in regard to abortion, but it flows on to infanticide and on to all of human life being open to arbitrary, pragmatic judgements of what human life is worthy to be lived - including your human life when you become a burden to society ... But the same principle applies equally in the crucial issues of human life. A lowered view of life and a lowered view of scripture go hand-in-hand. The watershed issue is obedience to the Bible just as much as it is belief in the doctrine of inerrancy. Since the Bible teaches that life in the womb is human life, one cannot accept abortion without denying the authority and truth of scripture in practice. In drawing a line or not drawing a line ..."
From this it seems clear that Schaeffer drew the line, both for abortion and euthanasia, along the same ethical coordinates. Still further in 1984, Schaeffer warned evangelicals:
"And if one thinks of human life as basically no different from animal life, why not treat people the same way? It would only be religious nostalgia to do otherwise. And so it first becomes easy to kill children in the womb, and then if one does not like the way they turn out, to kill the children after they are born. And then it goes on to the euthanasia of anyone who becomes a burden or inconvenience. After all, according to the secular world view, human life is not intrinsically different from animal life - so why should it be treated differently."
Finally, let Schaeffer's testimony be heard, as he said:
"If human life can be taken before birth, there is no logical reason why it cannot be taken after birth. Thus the quality of life, arbitrarily judged by fallible and sinful people, becomes the standard for killing or not killing human life - whether unborn, newly born, the rich, or the aged. But what then does this say about the handicapped now alive? Isn't their life wrongly and tragically de-valued? There are people who will read this book who would be allowed to die under these criteria if they were born today. The question of human life truly is a water-shed issue."
While being greatly appreciative for the entire ministry of Francis Schaeffer, and particularly grateful for his prescience in these and other matters concerning human life, one must also observe his ethical linkage of the beginning-of and end-of-life ethics under the same rubric. One might want to biblically question the precision of this, while simultaneously appreciating the other aspects of pleading for the sanctity of life on end-of-life issues, in similar terms, and with the similar intensity as beginning-of-life ethical issues. Intentional or no, this caught on in the evangelical community, somewhat uncritically.
To see Schaeffer's influence, one could note, for example, these assertions in a 1983 work:
"Protecting from one end of the age spectrum to the other, we see euthanasia for the elderly as the counterpart to abortion for the very young. There is no moral distinction between the two. Quality-of-life proponent Joseph Fletcher agrees: 'To speak of living and dying, therefore ... encompasses the abortion issue along with the euthanasia issue. They are ethically inseparable.' Those who take comfort in the fact that euthanasia is not practiced at present in America are leaning on a slim reed. Infanticide is euthanasia for newborn children..."
Thus did many other evangelicals join the chorus heralding that beginning-of-life and end-of-life ethical maxims were the same. Are the two really so identical and inseparable as these and other claims maintain? Is this a case of the Pharisaic Fallacy?
By the early 1980's Francis Schaeffer had been used of God to awaken a number of other evangelicals such as Jerry Falwell, James Kennedy and others to mount public platforms opposing abortion. Not only did they oppose abortion, they also yoked abortion with euthanasia as equally ultimate. They were certainly correct to see these as equally ultimate, but to lump them both under the same ethical formula might have been mistaken. As generic issues of life, both of which came under the umbrella of the same ethic, most evangelicals adopted this view of the equal ultimacy of the two, perceiving a mirror image between euthanasia and abortion. As Schaeffer and others warned, if we tread on the slippery slope of one we slide down the slope of the other. Francis Schaeffer and other biblical ethicists of the late twentieth century were effective in sensitizing a generation to avoid a situationalist ethic, particularly in regard to beginning-of-life as well as end-of-life ethical issues. The demon to be avoided was Situationalism.
The Linkage Questioned
By the mid 1980's a few Bible-believing ethicists began to move against the evangelical tide by raising questions about the supposed inseparability of these two ethical foci at the extremes of the life spectrum. One of the first pieces I saw of this sort was by Franklin E. Payne, M.D., of Augusta, Georgia, who in 1985 questioned whether or not we had an absolute commitment to extend human life as long as we could. His article, cautious and tempered by biblical moderation, raised the question in a strong, evangelical and pro-life publication. Though he raised the bare suggestion that we were not fully obligated to extend life to the farthest extent possible near the end of life in the very same manner as at the beginning, his essay was much criticized. He later noted, "To withhold or to withdraw medical treatment, as is being discussed here, does not constitute euthanasia and should not be placed in the same category with it."
Earlier, he wrote, "As Christians, however, we are also called to a wholistic approach. As God and His Word are a unity, so must we strive for unity in our ethics." Similarly, he queried:
"Families [as opposed to governments or companies] make choices every day according to the limits of their income. We choose the price and quality of clothes that we buy. With every purchase the family decides what it is willing to spend. Why should medical care be any different? Does not the family know what is best for its own? Is not only the family able to make this decision? Most importantly, does not the Bible clearly give this responsibility to the family, as we have seen?
The Providence Linkage
Thus, what the Lord gives us by His Sovereign decree, our lot in life, His Providence, has an important role in these ethical decisions, which is substantively different from beginning-of-life issues. Soon a few other doctors began to raise similar questions. Then in 1988 one evangelical church even raised the question to what extent were heroic measures necessary. During this time many pastors and medical professionals dealing with death in hospital or hospice environments came to realize that this question might have substantially different ethical considerations from beginning-of-life issues. Yet none wanted to be seen as disloyal to pro-life premises. All this while, the Pharisaic Fallacy may have been the culprit.
One problem was the perception that there were two and only two options in beginning-of-life and ending-of-life ethics. These two mutually exclusive options were: (1) Liberal/situational or, (2) Conservative/absolute. The liberal Christian community was noted for its Situationalism. Following Joseph Fletcher's situational ethics, evangelicals wanted to distance themselves from that relativism. As a result, they held to the very same absolute in both cases, in hopes of insuring against relativism. The effect was that evangelicals held to an extreme limit both at the end-of-life and at the beginning-of-life. This view maintained that the human life begins at the very point of conception. Correspondingly, they yoked that position with an end-of-life issue, holding that the human life should be seen as having the same sanctity in extremis as well. What happened was that the sanctity of human life became the anthropocentric absolute which yoked the whole spectrum of issues, instead of a theocentric absolute, the Providence of God. The extremes were covered, to be sure, but Providence, which had more bearing on one end of the spectrum, was nearly overlooked in the process.
Most evangelicals, in contrast to liberals, were absolutists. They wanted to be consistent absolutists on both ends of the spectrum. One can very easily erect an absolutist ethic in which life should be absolutely protected at its beginning without regard for situational factors. That life at the other end of its span should be protected or prolonged absolutely and apart from any situational factors whatsoever, is a Pharisaic Fallacy. - an illegitimate linkage of issues which have pertinent differences.
It was liberating, although somewhat terrifying, to question the tradition I had been taught. My initial reflection on Dr. Payne's articles was that they were mildly heretical. Yet, I found that, viewed in the light of God's Sovereignty and Providence, it was indeed valid that there were some situational factors in end-of-life matters. After all, it was decreed by God that at a certain time we die. Also, it should be recognized that there is a classic theological category which helps to elucidate these and to safeguard against unbridled Situationalism. That concept is the Providence of God.
Briefly, the end-of-life ethical absolute must be relocated from a man-centered sanctity of human life to the God-centered Providence of God Himself. The absolute we must maintain is the absolute of God's Providence. Providence, simply defined, is what God provides for our life, stemming from His eternal Decree both in the beginning-of-life and in the end-of-life. If our view is rooted in the Providence of God we are protected from a mindless relativism, since God's Providence is absolutely bound by His Word. His Word is no adversary of His actual Providence for us. The Providence of God is ontologically and ethically sufficient in and of itself to provide for the origin and preservation of human life from its conception to its end. The Providence of God is more ultimate than the sanctity of human life. The Providence of God itself gives life; it is not so much that life is "sanctious" in and of itself.
In end-of-life euthanasia cases, we ought to see the determining biblical variable as the Providence of God. Specifically, that means we shall ask, "What has God provided?" It is not the case that we are bound to extend life as far as humanly possible - due to its inherent sanctity. On the contrary, we are to attempt to extend life as far as possible under the Providence of God. This does not lead to euthanasia, even in difficult cases. It is hard to sustain the absolute compulsion to prolong life as long as it is now technologically possible to do. There is, after all, "a time to die" (Eccl. 3:2), that is part of God's Providence which we do not want to resist. This ethic is admittedly a more complex and difficult approach. For example, it is not uni-dimensional. No one ever promised that biblical absolutes would be easy, just absolute. In each case we must ask, "What has God provided?"
As we operate under the Providence of God we may find ourselves inquiring about end-of-life decisions with questions similar to the kind we ask about any other ethical dilemma. We'll explore not just one criteria or factor in a uni-dimensional frame, but we'll pursue many factors. Of necessity, we'll ask about economic viability to the family. For example, could non-insured costs lead to violation of the 9th commandment by demanding either excessive borrowing or outright theft? We'll ask about healing, leaving room in our ethical formulation for God to work miraculously. We'll ask about the state of the faith of the ill person. (The believer may be ready to be with the Lord.) We'll ask closely about the likely outcome of the medical possibilities, not just about what medicine offers. We'll ask about God's provision of "three-score and ten years" (Ps. 90:10).
Adoption of this view yields many practical benefits. Besides being more theologically defensible than other views, it is of great utility to clarify for God's people from God's perspective, just what is going on, in a time of crisis. It holds promise to spare our people as much false guilt as possible should they choose not to opt for maximum technology. The saint of God can be comforted and encouraged to rest in the end-of-life providence of God, while avoiding the unconscious humanistic propulsion to extend the mortality beyond that which God decrees. These and other benefits can flow from such view, and should be taught as Scriptural counsel from God's Word.
We'll seek God's will in His Providence. It will be a complex question, yes, but not a situational one in the sense of Joseph Fletcher's relative Situationalism. We will be bound by an absolute - the Providence of God. We find ourselves frail mortals in search for that Providence. If the search is difficult we must face up to that and follow God's Word through difficult terrain - even through biblical casuistry - rather than to create a superstructure in which we arbitrarily choose one variable to become our absolute in order to apply it in a comprehensive manner to situations not wearing the same biblical yoke. It is dangerous to select one focal point and attribute to it the recognition of absolute divinity. Making human life and its physical preservation the absolute errs in divinizing man.
Is this approach the harbinger of casuistry? It may be. Christians for centuries have known that casuistry in and of itself is not bad, although it is frequently spoken of pejoratively. Biblical casuistry, however, is another thing altogether. Biblical casuistry is the process when the ethicist finds himself bound by biblical absolutes, norms, and principles. Such casuistry, far from being a situational relativism, is the application of biblical teaching on a case by case basis. Development of it along with the prescription of biblical counsel by pastors and Christian physicians will help. It is theologically more defensible, avoiding, for example, the ungodly urge to achieve immortality in this physical body. It is time to recognize the Pharisaic Fallacy and realize the benefits of discarding it in favor of finding absolute value in the glory of God as He provides for us.
1. Report of the Heroic Measures Committee (PCA), Journal of Biblical Ethics in Medicine, Vol. 2, No. 3, July, 1988, pp. 41 - 46.
2. For example, to see one medical ethicist's formulation of the differentiation between these two cases, listen to what Dr. Franklin E. Payne has recently said to strongly emphasize that one need not necessarily fall into relativism, if he unleashes a few of these ethical questions. "Many ethicists who are not pro-life see no difference between letting die and giving the patient an injection to end the process. We must separate these actions by an unbridgeable chasm. On the one hand, I will give up my tenure, my medical license, and my own life before I will do an abortion or inject a patient to kill him. On the other hand, I have and will voluntarily 'let patients die' under certain conditions where no more can realistically be done." (cited from Biblical Reflections, Nov. 1990, p. 7) That's hardly slippery-sloping!
3. Systematic Theology, Eerdman's, 1949, p. 166.
4. cited in Reformed Dogmatics, Heinrich Heppe, ed., Baker, 1978, p. 252. One can further see the bearing of this on our subject, if a few of Calvin's phrases from _The Institutes_ are reproduced. Calvin sees providence as "God's governance extended to all his works" which is "not the empty idle sort ... but a watchful, effective active sort, engaged in ceaseless activity" (I, xvi,3). He denies that "God idly observes from heaven" only, and sees providence as "that by which, as keeper of the keys, He governs all events. Therefore we must prove God so attends to the regulation of individual events, and they all so proceed from his set plan, that nothing takes place by chance" (I xvi,4). Later, Calvin asserts that "nothing happens except from His command or permission" (I, xvi,8), and even applies providence to an example of the death of a merchant, as he explains, "His death was not only foreseen by God's eye, but also determined by His decree. For it is not said that he foresaw how long the life of each man would extend, but that he determined and fixed the bounds that men cannot pass [Job 14:5]" (I,xvi,9). Thus the Christian is to view "a death of this sort" ... as it is .. [as] God's providence exercised authority over fortune in directing its end" (I,xvi,9). For Calvin, providence "is the determinative principle of all things" (I,xvii,1) and "Indeed, the principal purpose of Biblical history is to teach that the Lord watches over the ways of the saints with such great diligence that they do not even stumble over a stone" (I,xvii,6). In sum, for Calvin, providence is essential, as well as practical, such that "ignorance of providence is the ultimate of all miseries; the highest blessedness lies in the knowledge of it" (I,xvii,11).
Of course, in addition to these definitions, one could quickly refer to the _Westminster Confession of Faith_, which in its fifth chapter reads, "God the great Creator of all things doth uphold, direct, dispose, and govern all creatures, actions, and things, from the greatest to the least, by His most wise and holy providence."
5. Schaeffer, Francis, How Should We Then Live, Crossway, 1976, p. 222.
6. Schaeffer, Ibid, p. 223, emphasis added.
7. Schaeffer, Ibid, p. 223-224.
8. Schaeffer, Ibid, p. 224.
9. Schaeffer, Ibid, p. 230.
10. Schaeffer, Francis, The Great Evangelical Disaster, Crossway, 1984, pp. 102 - 103.
11. Schaeffer, Ibid, pp. 104 - 105, emphasis added.
12. Schaeffer, Ibid, p. 108.
13. Young, Curt, The Least of These, Moody Press, 1983, p. 123, emphasis added.
14. Payne, op. cit., p. 44.
15. Payne, Franklin E., Jr., The Economics of Medicine: A Wholistic Approach, Journal of Biblical Ethics in Medicine, Vol. 2, No. 2, April, 1988, p. 27.