Pastoral Psychology

, Volume 66, Issue 3, pp 335–351 | Cite as

The Moral Deliberations of 15 Clergy on Suicide and Assisted Death: A Qualitative Study

  • Karen Mason
  • Esther Kim
  • W. Blake Martin
  • Rashad J. Gober


Given the relationship between moral objections to suicide, physician-assisted suicide (PAS), and euthanasia and religion, it is important to understand under what conditions clergy have moral objections to suicide, ending futile medical treatment, PAS, and euthanasia. This study used thematic analysis to explore the moral deliberations of 15 clergy and the right- and wrong-making properties of nine death and dying scenarios. Fifteen Catholic, Jewish, and Protestant clergy completed semi-structured interviews. Data analysis generated eight themes: sanctity of life, preservation of the natural course of life, pastoral care, support of the faith community, referral to professional services, end-of-life decision in community, consultation with medical professionals, and a shift to a hopeful narrative. Respondents consistently endorsed the priority of pastoral care, demonstrating a deep concern for the well-being of suffering congregants. In conclusion, respondents were consistent in the application of eight themes to end-of-life scenarios but differed in their approach to the removal of a feeding tube and being present for a PAS death. Every respondent objected to suicide.


Clergy Moral objections Suicide Physician-assisted suicide Euthanasia 



The authors gratefully acknowledge the invaluable contributions of Dr. Patrick T. Smith and Dr. John J. Davis for input into the development of the nine scenarios and of Dr. Monica Geist for input into the study design and implementation.


  1. Amit, B. H., Krivoy, A., Mansbach-Kleinfeld, I., Zalsman, G., Ponizovsky, A. M., Hoshen, M., & Shoval, G. (2014). Religiosity is a protective factor against self-injurious thoughts and behaviors in Jewish adolescents: Findings from a nationally representative survey. European Psychiatry: The Journal of the Association of European Psychiatrists, 29(8), 509–513.CrossRefGoogle Scholar
  2. Aquinas, T. (1966). Summa Theologiae. New York: McGraw-Hill.Google Scholar
  3. Baeke, G., Wils, J., & Broeckaert, B. (2011). ‘There is a time to be born and a time to die’ (Ecclesiastes 3:2a): Jewish perspectives on euthanasia. Journal of Religion and Health, 50(4), 778–795.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Bledsoe, T. S., Setterlund, K., Adams, C. J., Fok-Trela, A., & Connolly, M. (2013). Addressing pastoral knowledge and attitudes about clergy/mental health practitioner collaboration. Social Work & Christianity, 40(1), 23–45.Google Scholar
  5. Bollig, G., Gjengedal, E., & Rosland, J. H. (2016). They know!—do they? A qualitative study of residents’ and relatives’ views on advance care planning, end-of-life care, and decision-making in nursing homes. Palliative Medicine, 30(5), 456–470.PubMedCrossRefGoogle Scholar
  6. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.CrossRefGoogle Scholar
  7. Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sehr (Eds.), APA handbook of research methods in psychology: Vol. 2. Research designs: Quantitative, qualitative, neuropsychological and biological (pp. 57–71). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  8. Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68(3), 371–377.PubMedCrossRefGoogle Scholar
  9. Centers for Disease Control and Prevention [CDC], National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online] (2005). Leading causes of death and fatal injury reports [Data file]. Accessed 2 June 2016.
  10. Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Los Angeles: Sage.Google Scholar
  11. Creswell, J. W. (2014). Research design: Qualitative, quantitative and mixed method approaches (4th ed.). Thousand Oaks: Sage.Google Scholar
  12. Danyliv, A., & O’Neill, C. (2015). Attitudes towards legalising physician provided euthanasia in Britain: The role of religion over time. Social Science & Medicine, 128, 52–56.CrossRefGoogle Scholar
  13. Dervic, K., Carballo, J. J., Baca-Garcia, E., Golfalvy, H. C., Mann, J. J., Brent, D. A., & Oquendo, M. A. (2011). Moral or religious objections to suicide may protect against suicidal behavior in bipolar disorder. Journal of Clinical Psychiatry, 72(10), 1390–1396.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Domino, G., & Miller, K. (1992). Religiosity and attitudes toward suicide. OMEGA—Journal of Death and Dying, 25(4), 271–282.CrossRefGoogle Scholar
  15. Douglas, C. (2014). Moral concerns with sedation at the end of life. Journal of Medical Ethics, 40(4), 241.PubMedCrossRefGoogle Scholar
  16. Ganzini, L., & Back, A. (2003). From the USA: Understanding requests for physician-assisted death. Palliative Medicine, 17(2), 113–114.CrossRefGoogle Scholar
  17. Ganzini, L., Silveira, M. J., & Johnston, W. S. (2002). Predictors and correlates of interest in assisted suicide in the final month of life among ALS patients in Oregon and Washington. Journal of Pain and Symptom Management, 24(3), 312–317.PubMedCrossRefGoogle Scholar
  18. Gergen, K. J. (1985). The social constructionist movement in modern psychology. American Psychologist, 40(3), 266–275.CrossRefGoogle Scholar
  19. Gergen, K. J., Josselson, R., & Freeman, M. (2015). The promises of qualitative inquiry. American Psychologist, 70(1), 1–9.PubMedCrossRefGoogle Scholar
  20. Goodhead, A., Speck, P., & Selman, L. (2016). ‘I think you just learnt as you went along’—community clergy’s experiences of and attitudes towards caring for dying people: A pilot study. Palliative Medicine, 30(7), 674–683.PubMedCrossRefGoogle Scholar
  21. Goy, E. R., Carlson, B., Simopoulos, N., Jackson, A., & Ganzini, L. (2006). Determinants of Oregon hospice chaplains’ views on physician-assisted suicide. Journal of Palliative Care, 22(2), 83–90.PubMedGoogle Scholar
  22. Hamdan, S., Melhem, N., Orbach, I., Farbstein, I., El-Haib, M., Apter, A., & Brent, D. (2012). Protective factors and suicidality in members of Arab kindred. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 33(2), 80–86.CrossRefGoogle Scholar
  23. Hanford, J. (2006). The pastor and bioethics. Pastoral Psychology, 55(2), 175–182.CrossRefGoogle Scholar
  24. Helman, S. (2012, April 29). Should people have the right to die? The Boston Globe.Google Scholar
  25. Hendin, H. (1997). Seduced by death: Doctors, patients, and the Dutch cure. New York: W. W. Norton.Google Scholar
  26. Joiner, T. (2005). Why people die by suicide. Cambridge: Harvard University Press.Google Scholar
  27. Jylhänkangas, L., Smets, T., Cohen, J., Utriainen, T., & Deliens, L. (2014). Descriptions of euthanasia as social representations: Comparing the views of Finnish physicians and religious professionals. Sociology of Health & Illness, 36(3), 354–368.CrossRefGoogle Scholar
  28. Kaplan, K. J., & Schwartz, M. B. (2008). A psychology of hope: A biblical response to tragedy and suicide. Grand Rapids: Eerdmans.Google Scholar
  29. Keown, J. (2002). Euthanasia, ethics and public policy: An argument against legalisation. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  30. Larson, D. B., & Larson, S. S. (2003). Spirituality’s potential relevance to physical and emotional health: A brief review of quantitative research. Journal of Psychology and Theology, 31(1), 37–51.Google Scholar
  31. Leane, W., & Shute, R. (1998). Youth suicide: The knowledge and attitudes of Australian teachers and clergy. Suicide and Life-threatening Behavior, 28(2), 165–173.PubMedGoogle Scholar
  32. Mason, K., Polischuk, P., Pendleton, R., Bousa, E., Good, R., & Wines Jr., J. D. (2011). Clergy referral of suicidal individuals: A qualitative study. Journal of Pastoral Care & Counseling, 65(3), 1–11.Google Scholar
  33. Mason, K., Geist, M., Kuo, R., Day, M., & Wines, J. D. Jr. (in press-a). Clergy as suicide prevention gatekeepers. Journal of Pastoral Care and Counseling.Google Scholar
  34. Mason, K., Geist, M., & Clark, M. (in press-b). A developmental model of clergy engagement with suicide: A qualitative study. OMEGA—Journal of Death and Dying.Google Scholar
  35. McKeon, R. (2009). Suicidal behavior. Advances in psychotherapy—Evidence-based practice. Cambridge: Hogrefe & Huber.Google Scholar
  36. McPherson, M., Brashears, M. E., & Smith-Lovin, L. (2006). Social isolation in America: Changes in core discussion networks over two decades. American Sociological Review, 71(3), 353–375.CrossRefGoogle Scholar
  37. Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. San Francisco: Jossey-Bass.Google Scholar
  38. Miers, R., & Fisher, A. (2002). Being church and community: Psychological sense of community in a local parish. In A. T. Fisher, C. C. Sonn, & B. J. Bishop (Eds.), Psychological sense of community: Research applications and implications (pp. 123–140). New York: Plenum.Google Scholar
  39. O’Reilly, D., & Rosato, M. (2015). Religion and the risk of suicide: Longitudinal study of over 1 million people. The British Journal of Psychiatry, 206(6), 466–470.PubMedCrossRefGoogle Scholar
  40. Osman, A., Gifford, J., Jones, T., Lickiss, L., Osman, J., & Wenzel, R. (1993). Psychometric evaluation of the reasons for living inventory. Psychological Assessment, 5, 154–158.CrossRefGoogle Scholar
  41. Stack, S. (1983). The effect of the decline in institutionalized religion on suicide, 1954–1978. Journal for the Scientific Study of Religion, 22(3), 239–252.PubMedCrossRefGoogle Scholar
  42. Tomlinson, E., & Stott, J. (2015). Assisted dying in dementia: A systematic review of the international literature on the attitudes of health professionals, patients, carers and the public, and the factors associated with these. International Journal of Geriatric Psychiatry, 30(1), 10–20.PubMedCrossRefGoogle Scholar
  43. Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. J. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Verbakel, E., & Jaspers, E. (2010). A comparative study on permissiveness toward euthanasia: Religiosity, slippery slope, autonomy, and death with dignity. Public Opinion Quarterly, 74(1), 109–139.CrossRefGoogle Scholar
  45. Wang, P., Berglund, P., & Kessler, R. (2003). Patterns and correlates of contacting clergy for mental disorders in the United States. Health Services Research, 38(2), 647–673.PubMedPubMedCentralCrossRefGoogle Scholar
  46. White, M. (2014, August 1). What makes Jesus mad as hell? Huffington Post. Accessed 30 Apr 2016.
  47. Williams, M. (1997). Cry of pain: Understanding suicide and self-harm. London: Penguin Books.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Gordon-Conwell Theological SeminarySouth HamiltonUSA

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