Chaplains grapple with assisted suicide laws

Austin Fairchild served as an associate youth pastor during his first few years out of college. When he applied for a job with a hospice company out of curiosity, he quickly found a new personal calling: Spiritually supporting people during their final days.

“It’s not an evangelism role,” he said, “but if patients open the door then my job is to help.”

Earlier this year, one of Fairchild’s patients didn’t want to talk to him at all, and certainly not about spiritual matters. For a few weeks, they only talked about her family and her life. Then her condition worsened. “One of the first things that came out of her mouth was, ‘I’m scared,’” Fairchild said.

The patient told Fairchild she wasn’t ready to die and that she was unsure of where she would go after death. He offered to share the gospel with her. “I was able to tell her about Jesus, and we prayed together at the end,” he said. After they prayed, she fell asleep. She died the next day.

But under a new law, her story could have ended differently. Fairchild works in Illinois, where legislators last year legalized assisted suicide in a measure set to take effect this September. The bill will permit terminally ill adults to request lethal drugs from physicians to take their own lives.

Fairchild said his patient probably would have asked for assisted suicide if she were allowed to. “The people I experience that want to take their lives are the ones that are often isolating. They’re anxious. They’re fearful,” he said. “My job as chaplain is to come in and to help alleviate that. And there’s a fear that my job … is going to be replaced with a pill.”

Eleven states and Washington, D.C. currently permit physician-assisted suicide. A New York law allowing the practice goes into effect a few weeks before the one in Illinois, and lawmakers in another 14 states have introduced similar legislation for consideration this year. As assisted suicide increases in the United States, Christian hospice workers question what the trend means for their roles. Many Christian denominations have clearly stated their positions on the issue, but companies’ neutral policies and a lack of state conscience protections often leave many hospice and hospital workers to decide how much to work with clients who are dying by assisted suicide.

The care dilemma

After Illinois Gov. J.B. Pritzker signed the state’s assisted suicide bill late last year, the hospice company Fairchild works for informed staff that it would take a neutral approach to the practice, as it does in other states where it is already legal. Three of the largest hospice providers in the country have taken a similar approach, saying their staff will not encourage assisted suicide, prescribe lethal drugs, or administer the medication. But they say they will continue to offer palliative and bereavement care for patients before death and for their families after they die.

The companies have said they will not punish staff for refusing to participate in caring for a patient that chooses assisted suicide, and state laws do not force employees to do so. But Fairchild says these policies leave workers like him to decide if they will continue to care for their patients even if they make a decision that contradicts his beliefs. “I think I’ll be forced to express my convictions, not only to leadership, but also to patients because my job is to have person-centered spiritual and emotional care,” he said.

Medicaid requires social workers and chaplains to be part of interdisciplinary hospice care teams. Under certification requirements, chaplains must complete education and training and have an endorsement from the denomination or religious group they practice under.

Because of this requirement, chaplains serve as an extension of their endorser and adhere to their endorser’s views on moral issues, explained Richard DeFord, executive director of the Association of Certified Christian Chaplains. DeFord advises chaplains to look to their endorsing body for direction on issues like assisted suicide. “As an association, we support life until natural death as created and sustained by God,” he told me in an email. “But we also recognize the complexity of this issue for families and individuals who are suffering.”

In addition to his work with the ACCC, DeFord serves as a pastor and a hospital chaplain in Missouri and is endorsed by the Southern Baptist Convention. In 1996, the SBC passed a formal resolution denouncing the practice of assisted suicide. DeFord agrees with the position and says he would not help a patient choose assisted suicide or facilitate them obtaining the drugs.

But if a patient chose assisted suicide, DeFord said he would still offer support and counsel, though he would communicate that he disagreed with their choice and would not participate in their suicide in any way. Missouri currently prohibits assisted suicide, though lawmakers have for several years introduced bills to legalize the practice.

The National Library of Medicine published a survey in 2024, finding that nearly three-quarters of hospice workers were willing to be present during an assisted suicide. Those opposed to being present cited personal objections to the practice and beliefs that assisted suicide does not align with healthcare’s purpose to heal.

As more states consider legalizing suicide, lawmakers should also strengthen and clarify conscience protections, said Katy Roberts, senior policy manager of the Ethics and Religious Liberty Commission. According to Roberts, chaplains—along with doctors and nurses—can look to federal conscience protections to protect them from being required to participate in assisted suicide. “But the scaffolding for state conscience protections is fairly scant,” she said.

Hospital chaplain Fred Ouderkerken says he is not surprised that hospice workers would be willing to participate in assisted suicide, since many supporters of the practice view it as a merciful way to end someone’s suffering. Ouderkerken lives in California, where assisted suicide has been legal since 2015, and is the executive director of the training organization Healthcare Chaplains Ministry Association. He agreed that every chaplain and organization will have to decide for themselves the limits of their involvement with assisted suicide.

“From my perspective, and probably the training that we have for our chaplains is that we would recuse ourselves from that [patient’s care] once that decision was made,” he said. He argued that chaplains cannot appear to consent to or support someone’s decision to kill themselves.

Though chaplains cannot impose their views on patients, Ouderkerken said many people ask him for guidance because they view chaplains as spiritual leaders. He is willing to listen and offer opinions, but ultimately he said he never makes decisions for someone or their family, especially in life-or-death situations. “Really, you’re not asking for real spiritual hope at that point. You’re just asking for a blessing of you killing yourself,” he said. “That should not happen by any chaplain.”

Do no harm

Doctors and nurses often don’t have an endorsing body, as chaplains do, isolating them even more when it comes to ethical decision-making, such as whether to prescribe lethal drugs. Although the American Medical Association and the Christian Medical and Dental Associations have formally denounced assisted suicide, their guidelines are not binding.

For patients with terminal diagnoses and patients on hospice, a care team’s primary goal is to manage symptoms and help them be comfortable. Dr. Paul Bunge is a hospitalist in Washington state who has practiced palliative care medicine. As a Christian, Bunge does not prescribe or administer lethal drugs, but that doesn’t stop his patients from learning about the option.

Washington state passed its assisted suicide bill in 2008, and Bunge says he used to see patients request the lethal drugs to have on their shelf as a backup plan while they continued trying pain management options. But now, he says, assisted suicide supporters are encouraging patients to pick a firm date on which to die. “The philosophy is that death should be controlled by us and managed,” he said.

Carol McFarland, a hospice nurse in Washington state, said she has not felt pressured to participate in assisted suicide. But with an increase in patients who enroll in hospice and then die by assisted suicide, she says it is becoming more important for medical systems to decide where they stand on the issue.

Providers are careful to respect the decisions of their patients, McFarland said, adding that she and some of her colleagues are wrestling with how to balance their convictions with what the state has determined to be an acceptable form of treatment. Healthcare professionals are trained in suicide prevention and keeping patients safe—even as the state has sanctioned physician assisted suicide. “It’s just an interesting tension about those two things that kind of don’t go together,” she said. “There is a sense of moral distress in this experience, in this role. And I think it’s growing for some of us,” she said.

Moments of grace

Back in Illinois, hospice chaplain Austin Fairchild told me about another patient. The patient, who loved music, enjoyed talking with Fairchild about his faith, but his wife struggled with his terminal diagnosis. “The very last day, I went along with the nurse,” Fairchild said. “His wife was there just sobbing and having a really, really hard time.”

The nurse told Fairchild the patient would likely die that day so the group made a plan to listen to some of his favorite music, read Scripture he chose, and pray together. As they listened to “Amazing Grace,” the patient’s wife laid her head on her husband’s chest as his blood pressure dropped. “He raises up his head and looks down at her and puts his hand on her head,” Fairchild said. “His blood pressure was so low, this almost felt like a miracle.”

The patient died minutes later.

“It’s amazing the beauty that the Lord can bring, the grace He gives in the very last moments of life,” Fairchild said. “With this program, I wonder, will some of those be robbed?”