The sixth Commandment, “You shall not murder” (Ex. 20:13), prohibits any act that would intentionally, or through carelessness, take the life of another human being (see note on Deut. 5:17; the exceptions of capital punishment, killing in war, and self-defense are not in view here, nor are they implied by the meaning of the Hebrew terminology in the passage). The expression most frequently used for violating the sixth Commandment is “shedding innocent blood” (cf. Ex. 23:7; Deut. 19:10, 13; Ps. 10:8; Prov. 6:17).

This prohibition against murder applies to all human beings, including: the elderly, those who are terminally ill, and those who wish to die. Intentionally taking the life of any of these people would break the commandment, “You shall not murder” (cf. also 2 Sam. 1:10, 14–15). Nations that have allowed for physician-assisted suicide find that a society can quickly move from merely allowing “the right to die” to the belief that there is “an obligation to die” on the part of the elderly and the very ill people who are “draining resources” from the society. In such situations it becomes likely that a number of elderly people will be put to death against their will.

It is important, however, to maintain a clear distinction between killing a person and letting someone die. Killing in the wrongful sense of murder, as prohibited in Exodus 20:13, means actively doing something to a patient that hastens or causes his or her death. But “letting someone die” means allowing someone to die without interfering with the process that is already taking place. In cases where it is clearly known to be the patient's wish to be allowed to die, and when there is no reasonable human hope of recovery, and where death seems imminent—then it does not seem wrong to allow such a person to die, rather than either to initiate an artificial life support system or to prolong the natural dying process by artificial means. For such situations, nothing in Scripture would prohibit a dying person from praying for God to take his life. On the other hand, where there is a reasonable human hope of recovery, and where there is a realistic, practical ability to help, the obligation to “love your neighbor as yourself” (Matt. 22:39) implies that active measures should be taken to save the person's life. In the parable of the good Samaritan, Jesus indicated that the priest and the Levite were both wrong for neglecting to do what could be done to save a badly injured man, who with care was able to recover (Luke 10:30–37).

The hardest end-of-life decisions are often related to removing a dying patient from artificial life support, which can involve various measures from an artificial lung to simply providing artificial hydration and nutrition. Christians hold different positions over exactly when in such cases the moral line is crossed from letting someone die to killing. When considering the proper course of action, Christians should remember that while death is an enemy to resist (1 Cor. 15:26), natural mortality is still part of living in a fallen world (cf. Gen. 2:17; Rom. 5:12; Heb. 9:27). There is therefore nothing wrong with accepting natural mortality by removing a dying patient from artificial means that are only slowing the natural death process.

There are more complex cases where medication given to alleviate a patient's pain may also have a secondary effect of hastening a person's death. In such cases, some Christian ethicists say that the two most important considerations are: (1) the primary purpose for giving the medication and (2) the patient's own wishes regarding the alleviation of pain. Other Christian ethicists claim that, in such cases, the moral value of improving life quality is always less than the moral value of honoring the sanctity of human life, and, while doing what they can to alleviate pain, Christians should never give higher priority to improving the quality of life (reducing pain) over honoring the sanctity of life (not killing a person).

Wherever possible, it is both wise and loving for people who are still in good health to complete the appropriate legal and medical forms to make known their wishes regarding medical care at the end of life. These decisions should also be verbally communicated to those who will likely have to make end-of-life decisions about each person.