How Should We Then Die?

Ewan C. Goligher

Reviewed by: Calvin R. Goligher

How Should We Then Die?: A Christian Response to Physician-Assisted Death, by Ewan C. Goligher. Lexham, 2024. Paperback, 160 pages, $18.99. Reviewed by OP pastor Calvin R. Goligher.

In the year 2022, Canadian doctors deliberately and legally killed more than thirteen thousand patients, accounting for 4.1 percent of all deaths in the country that year. These numbers represent a spiritual crisis that must be met with discernment, compassion, and firm resolve. Ewan Goligher is well positioned to help us face this challenge. Besides being my elder brother, he is a Presbyterian ruling elder and an experienced physician. His writing weaves together moving personal recollections with insight honed through years of addressing these issues for himself.

After introducing the issues, the book sets out in the second chapter to clarify terms. Physician-assisted death (PAD) occurs when a doctor intentionally kills a patient. That intentionality distinguishes it from merely withdrawing life-sustaining treatment that is no longer effective. Surprisingly, most people do not seek PAD out of pain or poverty, but out of a sense of purposelessness (14).

The basic point of the third chapter is that PAD undermines the intrinsic value of humans. Telling patients that they are eligible for PAD means telling them that they might be better off dead. Advocates of PAD frame this as a win for personal autonomy and dignity. The fact remains, though, that approving PAD implies that it is better for certain people to be dead. This chapter concludes by showing how the gospel proclaims the intrinsic value of humans, made in the image of God, and worth “more than many sparrows” (Matt. 10:31 NIV).

Chapter 4 argues that PAD is unscientific because it depends on an unprovable idea of what death is like. Advocates of PAD assume that death is nothing but the absence of life. This fits well with the materialistic premises of modern thought, but it is without evidence. Ironically, PAD leads physicians to act “as priests of a modern, secularized religion that . . . offers death as the means of salvation from suffering” (65). This is the most philosophical part of the book, and it will repay careful reading. The chapter concludes with a lovely meditation on the Christian view of death, which in Christ is a way to eternal life.

Chapter 5 moves from refuting PAD to showing “a more excellent way” (1 Cor 12:31 KJV) of caring for those mired in suffering and despair. People seek PAD because of meaninglessness, so we must learn to point them to what is meaningful. This meaning must depend on something bigger than ourselves. Creation itself is filled with such wonder and meaning, but even deeper meaning is offered in the gospel. “In the kingdom,” Goligher writes, “our suffering is not useless” (108). His exposition of Jesus’s ministry to Lazarus’s family in John 11 is moving and soul-satisfying. Whereas PAD is all about avoiding suffering, the gospel reveals meaning even in the middle of suffering. “Through suffering, we see more clearly our need for God, and we discover meaning and satisfaction in God himself” (108).

The final chapter summarizes the book’s argument in ten theses. This is a helpful distillation of the book’s content and will provide a useful reference. Pastors, elders, and teachers could use these ten points to structure lessons or discussions.

The final thesis thoughtfully moves from nature to Scripture. “We know by nature that we matter, but we only clearly behold the true meaning and significance of our lives in the life, death, resurrection, and ascension of Christ” (134). This movement from nature to grace is found throughout the book, and it is a big part of making the argument work in a pluralistic, multicultural society. Goligher’s arguments from natural reason show that he is not just writing for already-convinced Christians. On the other hand, by linking these natural arguments to the gospel, he takes them farther than nature could go on its own. As Goligher says at the end of the book, “Christians are those who have discovered that Christ reveals the true logic behind all things” (135). Nature finds its proper home in the grace of Christ, who satisfies us in life, suffering, and death, with a Creator’s love.