This week:

Are Young Men Lost or Returning to Faith?
A deep dive into seemingly contradictory studies on young men: while many are falling behind in education and mental health, others are returning to church and discovering faith through the Bible, not institutional religion.

The Role of Fathers and Masculinity
Sean and Scott discuss how the absence of fathers, misapplied cultural expectations, and lack of male mentorship contribute to young men's struggles today.

Exposing Pornhub’s Dark Secrets
A disturbing New York Times report reveals internal documents from Pornhub detailing massive amounts of child sexual abuse material and corporate negligence.

What Does It Really Mean to Die with Dignity?
The hosts reflect on a physician’s critique of assisted suicide laws, arguing true dignity comes from care, community, and affirming the worth of the vulnerable—not offering them an early death.

Listener Q&A: Eastern Medicine and Cohabitation
Thoughtful responses to audience questions on the ethical use of alternative medicine (book mentioned) and how to lovingly address adult children who are cohabitating.



Episode Transcript

Sean McDowell: [upbeat music] Young men are both returning to church and read their Bibles more, but also falling behind. What's going on with young men today? Private documents are accidentally released from a major porn company, and they reveal a massive cover-up of child pornography. And what does it really mean to die with dignity? These are the stories we'll discuss, and we'll also address some of your excellent questions. I'm your host, Sean McDowell.

Scott Rae: I'm your co-host, Scott Rae.

Sean McDowell: This is the Think Biblically weekly cultural update, brought to you by Talbot School of Theology, Biola University. Scott, this week I saw a ton of stories from publications on the left to the right about the state of young men and boys today. I think some major studies were released from Pew and from others, and they seem to show conflicting data. Let's start with this piece that's in The New York Times, and it says, "It's not just a feeling. Data shows boys and young men are falling behind." And they show this is true for educational achievement, mental health, and transitions to adulthood. So in terms of education, they say across the US, girls score better on reading tests than boys, they earn higher GPAs, and boys are more likely to be suspended. And yet, on the positive side, boys [chuckles] tend to do better on math skills, which is interesting. Math tests, so to speak. Mental health among boys ages three to 17, 28% have a mental, emotional, behavioral, or developmental problem, compared with 23% of girls. Now, what's interesting is girls are more likely to struggle with anxiety and depression, and boys with ADHD or autism. The, number of boys who commit suicide has doubled since 1968, and it's four times, four to five times the size of young women. And then finally, they say transition to adulthood. Among men... This is pretty significant. Among men 25 to 34, so they are almost entirely out of college, in the beginning stages of a job, owning a home, traditionally, getting married, 19%, roughly one out of five, still live with their parents, up from 14% in 1983, and it's less for women. And the number of men in the labor force is down. This New York Times article is very concerned. But then Religion Unplugged has this other article that's so fascinating, Scott, where it's talking about the UK, but this is also true in the US, about how young men, it says, according to the UK Bible Society, "Where we once saw aging congregations and a steady decline in attendance, we see dramatic growth, led by the young," an increase in church attendance, Bible reading, et cetera, in England and in Wales. And then there's a quote that says, "They're not necessarily interested in, quote, 'church or religion,' but in spirituality and Christ's teaching." Last quote, then I wanna know how you make sense of this, Scott. This is a person who, works there, last name is Dubnik, so to speak, and I guess works on the studies as well. And he says, "In my 18 years serving in the UK and Ireland, every person I've seen come to faith in Jesus has done so via studying the Bible. People are not interested in church-organized religion, but the Bible and Jesus are topics they are more willing to engage." How do you make sense of this seeming [chuckles] conflicting data?

Scott Rae: Well, Sean, let me speak to the first story first-

Sean McDowell: Okay

Scott Rae: ... About young men, young men falling behind. And my immediate takeaway from this is that boys need dads who model what it's like to be a man.

Sean McDowell: Amen.

Scott Rae: And who model what it's like to be a mature adult man. What this points out is that boys and girls are different in general. I mean, there's some exceptions, lots of nuance to that, but the, and the expectations for boys and girls are still somewhat stereotypical in the culture. Boys are... The article points out, boys are expected to be stoic and to stuff their feelings, and, you know, real men don't cry, things like that. And this is- this can actually be really harmful if boys don't have healthy ways to get some of their aggression out. This is why you and I are such fans of youth sports, but there are lots of other things besides sports that help boys do that. You know, my middle son played basketball for a while until the, [chuckles] you know, he realized he got his mom's genes for height, and the growth, the growth curve caught up to him. But he spent a lot of his high school years in a drumline, his high school marching band, and it was just- it was, it was just a different avenue for getting out some of the aggressions that boys naturally have. The encouraging thing that I found in this, physical fighting, drug use are declining among boys. Very encouraging. Here's what I wonder, Sean, on this: How much of the struggle that boys have has to do with the spread of this notion of toxic masculinity? I think boys are caught in a dilemma. They're sort of- they're damned if they do and damned if they don't. Because if they hear- adhere to expecta- cultural expectations of masculinity, they can be described as toxic, but if they don't, they can be derided as not being masculine. And I think the big, the big, I think, takeaway from this for me, besides having dads, is that most boys don't have a close friend that they can lean on for emotional support. Whereas girls, it's totally different for girls on that. And we've pointed out, on several occasions in the past, how important it is for adult men to have friendships outside their families for the, you know, for the benefit of their mental health overall. And that's why I, you know, I have a group of guys that I play tennis with every week, and those guys are important, not just for my physical activity and because I love tennis, but they're important for my mental health.... To keep me in touch with guys outside of my family members, to provide, you know, the encouragement and emotional support that I need. The other part of this, you know, having to- you mentioned, boys living at home longer, [lips smack] with their parents longer. The launch ramp for transition to adulthood, I think is just longer than it used to be. I mean, Sean, when I, when I graduated from college, everybody got a job. Everybody.

Sean McDowell: Right. Right.

Scott Rae: I mean, nobody... And nobody went, moved back in with their parents. I mean, that-

Sean McDowell: Yeah

Scott Rae: ... That was unheard of, and it was, it was almost a source of shame if you did. I think economic conditions are different than they were when I, when you and I graduated from college. Uh-

Sean McDowell: That's true

Scott Rae: ... It's, it's different. It's just, it's harder, you know? And I've had, you know, I- all three of my boys, we've mentioned before, are artists. Launching them, I think, took a little bit longer. And I think part of the reason for that is that many state laws, in California especially, have statutes on the books that prevent adolescents from working while they are in school. [lips smack] And I know teenagers... I- this was true for me. Teenagers will often hear things from their employers that they've tuned out from their parents. I started, Sean, I started working when I was 12.

Sean McDowell: Wow!

Scott Rae: And I, in my, in my dad's, you know, in my dad's, printing plant, and I'm not... I don't wanna comment on how many labor laws might have been broken to do that, [laughing] when I was growing up.

Sean McDowell: That's true.

Scott Rae: But I, you know, I m- I mowed lawns as a kid. I umpired youth baseball as a kid. You know, I authored a, you know, a sports column for the local paper as a kid. I was running a printing press when I was 16.

Sean McDowell: Wow!

Scott Rae: And all those things built the conf- the confidence that I needed, that I could actually accomplish things, and that I was growing and maturing and becoming a more self-sufficient person. And this, and I think this reflected biblical times, because boys worked alongside their fathers. Boys were mentored by their fathers in the workplace.

Sean McDowell: That's right.

Scott Rae: And I think one of the most, one of the most damaging things that happened, that's happened for the mentoring of young boys and their relationships with their fathers, is the separation of the workplace from the home. That took place, you know, probably 100 years ago. And it was, it was just standard practice for boys to be in touch and be mentored by their fathers as they were growing up. Now, when it- as it concerns the UK, I'm, I'm super encouraged by this, though that's a bit of a mixed bag. It's... I think it's encouraging about young men coming to faith, because they need belonging and purpose. [gentle music] not so much for church involvement. They're coming to faith through the study of the Bible, and the article points out it's often, mixed with other forms of religious practices, a form of sync- what we would call syncretism, where a Christian faith is combined, conflated with other religious views and practices. And sometimes the people who say, "I'm not, I'm not so big about church, but I'm, I'm interested in spirituality," that sometimes is code for this kind of syncretism that I think we need to be very careful about. But I think overall, that trend is very encouraging. What I would like to see, the connection made, is from coming to faith, have translating into emotional maturity and helping that transition to adulthood. That's the part I don't... I don't see anybody connecting those dots quite yet. And it may be that some of the, some of the things that people wrestle with from not having dads, it just takes a while for coming to faith to have an impact on some of those, some of those wounds that they experienced, growing up. That's my best shot at putting those two things together. I would hope that spiritual maturity would also contribute to emotional maturity. I'm not always sure that those are connected quite as, quite as directly as we'd like to see.

Sean McDowell: That's a great take. I think that makes total sense, and [chuckles] my first point was your first point. I wrote down, "Boys and girls are different." And I'm always asking, when I read an article, "What are the assumptions built into this article?" 'Cause even if the person has a different worldview than I have, they're made in God's image, they live in God's world, and that truth is gonna bubble up. So in this article, the whole assumption is that boys and girls are equally human, but different ways of being human. There's an objective difference between boys and between girls, which just resists so much of the gender narrative we've heard recently. And in fact, the reality is, boys and girls will only flourish when we recognize the differences between boys and girls. That's why, as a whole, in education, sometimes it's wired in a way that favors girls and not boys, and just doesn't recognize their differences, and hence leads to some of the suspension and other troubles. At least that's a piece of it. So boys and girls are different. But the larger thing that really jumped out to me here is, this article is not trying to fix it. It's just suggesting the problem at bay. But very early in the article, it suggests poverty as disproportionately hurting boys. I thought, "Well, that's interesting." And poverty certainly can and does affect somebody's sense of dignity, and that's a serious issue that can affect somebody's self-image, but it doesn't mention at all, like you said, fathers, and how profound that is, just statistically speaking.... More significant than socioeconomic status for the health of boys. So if we're concerned about the problem, we have to diagnose it correctly if we're going to fix it. I think these two articles go together, because really, what's at the root of why boys are struggling? And I would suggest there's both a relational root to this, the loneliness, the behavior we're seeing as a lack of healthy relationships, in particular with the father, but also a lack of meaning, a lack of purpose, a lack of that my life stands for something. And boys and young men have been beat down so much and told they're toxic and had bad examples in the media so many times of what it means to be a male, that they've lost a vision of fighting for something or being something. So I think the fact that boys are struggling here, and some are turning to church, not all of them, not most, and finding meaning, finding purpose, finding identity, finding some structure in their lives, is how these two stories go together. So I think some boys are drawn to, like, Joe Rogan and kind of the way he talks about [chuckles] masculinity. They're drawn to Jordan Peterson. Of course, that's not the same as the church. But when you have boys that are struggling, and then you have people, and voices, and institutions saying, "You mean something, you have agency, you can make a difference," we see both of these happening at the same time. So I think both these phenomena are real, and we just have to make sure that our churches are wired in a way that are attractive to boys, so to speak, and men, and feed into their desire to really make a difference.

Scott Rae: Yeah, and I think without, facilitating cultural stereotypes that I think are misleading. You know, churches sometimes celebrate Father's Day with all these sort of, you know, really macho types of activities-

Sean McDowell: Fair enough

Scott Rae: ... That don't, that don't, you know, appeal to a certain kind of person, but not to everybody. And so I just wanna- I would wanna be careful that, we structure this in ways that are as inclusive as we can be. The other thing I hope young men get from the church is other men- ... Who can mentor them and who can disciple them, and who they can look up to in the, maybe in the absence of their own father.

Sean McDowell: Well said. That's a good word. And in some ways, this brings us to our next story, which, to be honest with you, Scott, this second story is about as disturbing to me as any story we've talked about. So in some ways, if, you know, you have children in the car, you might hit pause and think twice before we talk about this, although we'll keep it-

Scott Rae: Sure

Sean McDowell: ... You know, as, I don't know, as sanitized as we can. But this is a, this is an opinion piece in The New York Times by Nicholas Kristof, and apparently, there were internal documents that were accidentally released from Pornhub. Now, you and I talked about whether we should mention the name of a specific porn, you know, site, and one of the largest in the world. But I wanna do so to draw attention to what I think is the evil, vile behavior, in particular, lurking beneath the surface of this company that has just been, in particular, found out. Now, these documents mostly date from 2020 and earlier, and there's quotes of employees laughing off what's on their site. So, for example, a quote, an employee says: "I hope I never get in trouble for having these vids on my computer. Lol," like laughing. Another one says: "There's a lot of very obvious and disturbing child sexual abuse material here." One internal document indicates that Pornhub, as of May 2020, had 706,000 videos available on its site that had been flagged by users for depicting rape or assaults on children or for other problems. They have a policy that they don't even review a video for possible removal until it's been flagged at least 16 times. Now, Pornhub apparently doesn't make sex videos themselves, but they're a platform that people can load onto it, and the revenue is somehow shared between Pornhub and between the individuals. So it creates kind of a pursuit of market share, rather than concern for the well-being of these individuals. One private memo acknowledged that videos of the parent-child sex abuse had been viewed 684 million times before being removed. 684 million times. And then one note said a person who posted a sexual video of a child shouldn't be banned because the user made money. There's a few stories in here, Scott, that are just... I mean, they're so heartbreaking, about how people were just terrorized by having videos loaded onto this against their will, unbeknownst to them. So one individual, she had a video loaded, and classmates started just shaming her. I guess when she was younger, in eighth grade, she released a video of herself without her clothes on to another boy, just a foolish move, an eighth grader, and then it went on Pornhub. Classmates were shaming her. She dropped out of school, self-medicated with drugs, ended up homeless, while Pornhub profited from the video, which amassed more than 2.7 million views. And this author, Nicholas, said he talked to a lot of people who were just in tears over the videos that were released of them and how damaging it was. I guess what Pornhub does is they have, like, a search optimization of people search for certain videos that they're able to get more views on.... They tell a story about a girl who'd never even kissed a boy, and she had grew up in a conservative Christian household. Went to a stranger's house, wakes up the next day, and was just raped and assaulted, drugged on some fashion or another, raped by four men. She doesn't know who they were. They were never held accountable. The video had more than a million views, and she sent a note to Pornhub pleading that it be taken down. Nothing happened at all, and it was a minor being raped. Now, Pornhub has said by July, it will have verified every video in all of its library and assume that it's... And prove that it's a consenting adult. I have zero confidence that that's the case, but that's what they're actually saying. A lawsuit was filed last year, to give one more example, by somebody by the name of Rocky Franklin, who, had filmed abuse of a 12-year-old boy. It was posted on Pornhub. It, it attracted 188,000 views. Now, he was imprisoned, but Pornhub won ad revenue as they shared the abuse with people around the world. Now, I've got a lot of thoughts about this, Scott, but give me your takeaway.

Scott Rae: Well, Sean, I admit that this story turned my stomach. And I li... I literally had a slight bit of nausea when I was reading it, 'cause it- ... It just, I don't know, I don't know how else to describe the evil that we see here. Now, to be fair, the author of the Times piece, Nicholas Kristof, points out that, the documents were from 2020, and that, there have been, quote, "significant improvements" since then. But I share with you, and I share the author's skepticism about the companies actually, you know, having turned a corner on these. And even the things that they describe as changes that they made, verifying for age and consent to the sexual activity, I'm not quite sure how you'd do that on the videos. I mean, how do you know if the sex is entirely consensual? But that's a really low bar, for-

Sean McDowell: That's right

Scott Rae: ... Pornhub to, you know, to adhere to. And here, Sean, my- the question I, you know, you cited all these figures about, you know, the hundreds of thousands, if not millions of people who've, who view these things. I wanna say, who's watching all this stuff?

Sean McDowell: [chuckles]

Scott Rae: What kind of... W- I mean, and this is where, you know, I say, what kind of person watches this? Underage child pornography, rape, abuse, sadism, sex trafficking of children, non-consensual sex that actually ruins somebody's life, that gets hundreds of thousands, if not millions of views. I mean, to be honest, what we're doing here, we should tell it like it is. We're enabling pedophilia- ... On this. Now, I think that, you know, you can, you can make the argument that if, well, if they're watching some of this stuff, then that may be s- that may satisfy those urges enough. But as you know, from, our discussions on pornography, the counterargument is just as strong, that this actually enables pedophilia, that this stokes the fires of those desires. And I think we're, we're entering an age where we may have, instead of, you know, non-consenting adults, we may have AI-produced depictions of all these things, and far worse, that we see. And so I wanna but I wanna be careful here. Before we get on our moral high horse, I have to remind myself and our listeners that the Bible is clear that all of us have the capacity for any and every kind of sin, that can be actualized under the right conditions. This is one of the things that is meant by the theological term total depravity. Not that we are as bad as we could possibly be, but that all of us have, as what we've inherited in our inclination to sin, that is the inclination to every kind of sin that can, that can come to fruition under the, under the circumstances that, give rise to that. And, Sean, this, what struck me on this, I think this has echoes of what Paul is describing in Romans 1. And here's... I think this is- this, in Romans 1, they talk about... Romans 1 talks about how people abandoned God for the worship of idols. They, "Although they knew God, they neither glorified him as God nor gave thanks to him, and become futile in their fool, foolish hearts were darkened." And here, "Therefore, God gave them over in the sinful desires of their hearts to sexual impurity for the degrading of their bodies with one another." I think that's a pretty good description of what's going on at Pornhub.

Scott Rae: And I think this may be... You know, I don't, I don't often say things like this, that God has sort of removed the restraints on our inclination to sin in this area, but Pornhub looks to me like some evidence that maybe some of the restraints of common grace have been removed, and that God, and that God is giving humanity over to their basest desires, so that people can see where this, you know, where this leads, and might be, and might s- and they just might be horrified at some of the stuff that is, i- you know, that people are watching and producing, in the event that we might, we might realize this, we've gone way over the line here. Even for, even for somebody who's not a believer, you've gotta think that they hold that... You know, this isn't just harmless adult entertainment.... This is stuff that enables some of the worst sin that we can imagine.

Sean McDowell: Scott, I always appreciate that you try to look at both sides, try to look at ourselves and our sinfulness first, and try to recognize that Pornhub, for lack of a better term, maybe has made some improvements in the sense of minimizing the damage. But I gotta be honest, for this one, I just feel-

Scott Rae: Well, I don't, I don't have a lot of trust in that.

Sean McDowell: Agreed. But even if they say that, I feel, I feel no moral, like, conjunction to give them much grace, if any latitude, on this. This was inevitable, and they benefited from it. I will start to give them grace when they say, "You know what? All the revenue that we receive from this, we're gonna donate it to care of victims of sexual abuse."

Scott Rae: Hear, hear.

Sean McDowell: When they start to make amends, then I'll take seriously any of these improvements. The-- Pornhub is responsible. I don't know the numbers, but if 654 million views, tens of thousands, hundreds of thousands of views of children being put on here against their will, and many of them, they were harmed even if they didn't find out about it. But those who find out about it, the devastation this article shows in their lives, it... I mean, it reminds me of Matthew 18:6, where [chuckles] Jesus says, "If anyone causes one of these little ones, those who believe me, to stumble, it will be better for them to have a large millstone hung around their neck and be drowned in the depths of the sea." That's what should happen to Pornhub. It should be forever shut down, and the people who started it and ran it should be publicly shamed for their vile behavior towards kids. That's what I think about it. Now, I'm aware of my own sinfulness and that I fall short, and I'm not pretending not to do so, but call a spade a spade. This is as evil as it gets, and I don't buy any of these so-called improvements. It's all for the bottom line, and it's all to just keep the money moving forward and convince people that they really care. I'm not convinced for half a second. I think it's horrifying what they've done, and the blood is on their hands, built into the way Pornhub was made from the beginning. That's how I see it. I also would argue, look, I think people who use Pornhub have some complicity in this. [chuckles] They do, and here's what I mean by this. It says in James 4:17, "Whoever knows the right thing to do and fails to do it, for him it is a sin." Now, there's a ton of people who are aware of this and might have said, "I'm not loading child porn onto the site. I'm just working at a company," and justified it in a million ways, but they refused to speak up, kept it silent, and they're the ones who knew about it and were will- unwilling to sacrifice themselves to help these kids. Imagine if some of these people, these memos, had spoken up and said something. They might have gotten attacked. Nicholas Kristof said when he wrote an article about this in 2020, he got death threats from it. That would've come at a cost. But as far as I'm aware, none of them, or very few of them, spoke up because of their jobs, because of a range of different reasons. I'm sorry, but they have some blood on their hands working there. On top of that, I think if somebody looks at Pornhub, they're contributing to the revenue that Pornhub receives, contributing... That's through advertisements or however they get revenue. Contributing to data that Pornhub has to expand their business, contributing to clicks that somebody has. So I think the makers of it, those who loaded it, those who watch it, those who didn't speak up, all have some complicity here. That's a fact. So it's really weird to think about this, Scott, but when you say, "Where are the people watching this?" I mean, it's kind of eerie. Some of them are in our churches.

Scott Rae: They are.

Sean McDowell: Some you walk by in the mall. They're around us. They're hiding it, and that's what Pornhub enables people to do, is to hide it. But it's all around us. It's all around us. So this article just... I mean, it made me so angry to think about the victims. And last thing I'll say is, I think, I think two things can be true at the same time. Some people could be attracted to kids and, rather than act it out, look at child pornography and not physically harm another child and act it out, but still contribute to it by watching-

Scott Rae: Right

Sean McDowell: ... The damage of this child. But it's also true that what porn feeds on is it's different than a drug. If you take a drug, if you wanna get the same high, it's a harder drug or greater quantity. With porn, it's variety, looking at something different. And for so many people, they can only look at it so much before they act it out, so it contributes to the actual physical abuse of kids. So I hate that we have to talk about this, but we do because it's in the Church, it's in the public, and it's just, I think, one of the great evils of our day.

Scott Rae: Appreciate you not sugarcoating it-

Sean McDowell: I just- [exhales]

Scott Rae: ... As I've come to expect.

Sean McDowell: [laughs] I can't, man, it just-

Scott Rae: I know.

Sean McDowell: This one bothers me a lot.

Scott Rae: This is a hard one. Yeah, well, rightly so, and I'm... I would be troubled if we weren't troubled by it.

Sean McDowell: And you know what? There's probably some people listening to this, Scott, who have looked at or do look at pornography. I'm not saying this to beat up on anybody and to shame them. I'm saying now's a chance to hit pause and get on your knees-... And pray out to the God who forgives anyone who will humbly ask, and who restores and makes us new. I'm more concerned, first and foremost, for the bride of Christ and for the Church and our witness, and how different we are from the world. So if you listen to this podcast, we are not here to shame you. That's not our point. But this is to think biblically, and how we think about this biblically is to first look within, confess our own sins. And amazingly, the Old Testament says, "God separates our sins as far as the east is from the west." It's not north from south, 'cause if you go north, eventually you're going south. If you go east, you're eternally going east.

Scott Rae: Right.

Sean McDowell: And John says, you know, "If we confess our sins, He's faithful and just and will forgive us." I'll stop preaching, Scott, but, yeah.

Scott Rae: That's a good- that's a good word, and a tough story. But I think we, I think we owe it to our listeners to, bring these things to their attention and to tell them what we think about it. And-

Sean McDowell: Well, I think-

Scott Rae: ... I-

Sean McDowell: You did that. [chuckles]

Scott Rae: Yeah, we, yeah. We, and we'd encourage your- we'd encourage your thoughts and comments to write back to us on this.

Sean McDowell: Amen. Good word. Now, this last one you sent to me, Scott, and I love this. I'm so glad you found this story. This is by Dr. Doug Dale, a physician and ethicist at Columbia University, interestingly enough, and he's author of a new book called The Lost Art of Dying, and this is a guest essay in The New York Times. And essentially, he says, "We've lost the art of dying well." And he hopes that he could create communities where there's- they're more accepting, less feelm- less fearful, and more community-based approach to the end of life. "In many cases," he says, "it's wise to forgo life-extending interventions for the sake of a higher quality of life and a better death." Now, what precipitated this article is a bill in New York called the Medical Aid in Dying Act, and it was passed by the New York State Assembly. It's similar to one bills in Oregon and in Canada, but he says, "It's not about dying well. It's about relieving society, government, medical systems, even families, of the responsibility to care for those who need the most help: the mentally ill, the poor, and the physically disabled." So in this bill, if a patient qualifies, the doctor can prescribe a legal dose of drugs that the patient may self-administer to end his or her life, which of course, is physician-assisted suicide as opposed to euthanasia. The New York bill is modeled on the Death with Dignity law that was enacted in Oregon in 1997, when I was a junior at Biola, interestingly enough. It doesn't require a mental health professional to screen patients for depression, and this is exactly what concerns the author of this piece. He says, "This is a major oversight that fails to protect depressed people from making flawed decisions." So in 2024 alone, 607 Oregonians who received lethal prescriptions, of the 607, only three were referred to psychological or psychiatric evaluation. So in one year alone, 607 people who were given this drug 'cause they had cancer or some debilitating sickness, only three of them were told to see a psychologist or a psychiatrist. So he says, "The concern is this mental illness, and depression, which is a part of it, is overriding their decision-making, and we're doing what's convenient rather than what's best." He raises the same concern for many people with disabilities. He says, for example, in Canada in 2023, 432 Canadians who received assisted suicide said they required but did not receive disability services. And so he's just profoundly concerned about where this is headed. The last thing he says to give contrast is, he says, "The art of dying well cannot be severed from the art of living well, and this includes caring for no- one another, especially when it's hard, inconvenient, or costly. It's not enough to offer the dying control," which is what motivates more than anything else, requesting physician-assisted suicide, is the desire for autonomy. He says, "We must offer them dignity." And I love that he says this, 'cause usually we're told, "death with dignity," and he's saying this is not really dignity. He says, "We must give them dignity, not by affirming their despair, but by affirming their worth, even when they are suffering, even when they are vulnerable, even when they are, in worldly terms, a burden." I thought this was a beautiful article. Give me your take.

Scott Rae: Well, I think it's a, it's a new argument against euthanasia and assisted suicide that taps into something that's thoroughly biblical, and that is the obligation to care for the least among us. And that's why what the article describes here is instead... He puts it like this: "Instead of investing in the infrastructure of support for lonely, depressed, disabled, and poor, we offer them a prescription for death. We call it autonomy, but it's actually abandonment." And I think, you know, the part that you read a li- a little earlier, it- that it's more about relieving society of the obligation to care for those who most need help among us. And here's... This is b- this is magnified almost exponentially by the number of people in both the United States and in Canada who are over the age of 65. Sean, we have record numbers of elderly and terminally ill people in our culture, and we have, we have lots of t- people that have terminal illnesses, who, for whom advanced life support technology is keeping them alive long past the point that they would've died 30 years ago.... And not to mention in biblical times, I mean, in- Yeah ... For most of the history of civilization, physicians, I think were moderately useful. [chuckles] Because most people, if they got seriously ill, they either got, they either got well on their own or they died. And physicians were there primarily to provide aid and comfort to people while they were dying. And part of the Hippocratic Oath was that physicians would not facilitate the death, the intentional-- be the intentional cause of death for their patients. Now, I think to be clear, I think the author rightly makes a distinction at the beginning that I wanna make sure our listeners are clear about. He makes an important distinction, both morally and legally, between killing and allowing to die. And I think that's, that's an important one that the Supreme Court upheld more than 30 years ago. And the Bible maintains here that death is a conquered enemy. That's Paul's message about the cross and resurrection of Jesus. That means that it need not always be resisted, and under the right conditions, we can say, "Stop," to medicine, and remove treatments, and entrust that person back to the Lord, for Him to give them whatever days He has left remaining for them. And I think the point he makes there, that to-- that for some people, forgoing treatments at the end of life under the, under the notion that better quality of life and shorter span of life is better than longer and worse. And I don't, I don't think there's anything particularly wrong with that if it's done under the, under the right conditions. Now, what the, what the State of New York passed was a comprehensive, basically, assisted suicide bill. And I think it's r- you're, you're absolutely right to point out the importance of a psychiatric assessment, because what a surprise that when people get a diagnosis of a terminal illness, they get depressed. Of course. And in many cases, serious, seriously so. That's not exactly rocket science to figure that out, but yet they're so... It's, it's so rarely done. The assessment is so rarely done, and depression is so rarely treated among the elderly today. I think the assumption is, that's just part of growing old. And it really is-- it really, assisted suicide is not about mercy, it's, it's more about autonomy, giving people the right to make their own decisions at the end of life, according to their own values. But what it's really doing is, it's failing to realize that the disabled, the poor, the lonely, those people have lost-- they've lost a good bit of their autonomy anyway, just to deal with life in general, and so this is not enhancing their autonomy at all. It's a way, I think, for the state to say, essentially, "We've, we've got an easy way out." They can do an end run around some of the losses that come with the end of life. There's no dignity in doing an end run around it. The dignity in dying is dying well and tr- and facing your losses with courage and with grace and with trust in the Lord to do that. And here's-- Sean, here's what I wonder about this: if the vulnerability of the poor and the disabled, and the elderly, and the sheer numbers of them will lead to euthanasia without consent. That's the part that is really frightening about this, because it's not-- I mean, it's not enough that you are elderly and vulnerable. And, I mean, if you think about it, you know, if you and I, you know, if we take my-- if my elderly dad was-- had a terminal illness, but he wanted to keep going and keep going with treatments, we could, we could twist his arm and essentially coerce him into signing an assisted suicide declaration that he's not consented to, not because he's tired of living, but because we're tired of him living. And Sean, here's the thing, nobody will ever know that we've coerced him into doing that- ... Because those are private conversations. We could even bring his physician into cahoots with us, and that's protected by patient-physician confidentiality. And so the idea that assisted suicide and euthanasia will be forever permanently voluntary, is an impossible standard to enforce, because many of those conversations, nobody will ever know about. And that's the part I think that is so troubling to me about this, and I think what our author is so right to point out. And, and you can multiply that vulnerability exponentially if they are poor, if they are disabled, or if they have a specific terminal illness that leaves them debilitated. Now, that doesn't mean that we have to treat everything that everybody wants, you know, for no matter what the cost. Because if we say that, if I say we're obligated to give everybody all the treatments that they need, you know, no matter, no matter, no matter what, then what we're, what we're making is a theological statement that I don't think we wanna make. And that is, we're, we're making a statement, essentially, that earthly life is the highest good. If we're obligated to do everything at all costs and all times to keep people alive, that's basically what we're saying about the status of earthly life. But we know theologically that's, that's not true, that earthly life is not the ultimate good, it's a penultimate good.... And our, and our highest good is our eternal fellowship with God. And that because death is a conquered enemy, under the right conditions, it need not always be resisted.

Sean McDowell: Amen. Good word. I'm curious, when you say this is a new argument, it strikes me as just an old Judeo-Christian kind of argument. From the perspective of a Christian, there's nothing new. Now, to hear it in The New York Times, first off, I give them credit for publishing this. I was surprised. Maybe what's new is the argument has been death with dignity for so long, and what this author is, I think, brilliantly doing, is saying, "Oh yeah, we wanna give the death dignity, but it's not what you think. Here's what dignity really looks like." So he's saying euthanasia and physician-assisted suicide is not really motivated by giving dignity to people who die. It's motivated economically, it's motivated financially, it's motivated for ease, and it's not motivated by humanizing people who are in pain. Here's what it really means to give dignity. So when you can take your opponent's terminology and what they're trying to argue for and say, "Actually, we agree with your language, we agree with your approach, we agree what you're trying to do, but you actually don't do it. It's found here, treating people with compassion and care and community," and like you said, not finding death the ultimate enemy. We're all going to die. I think it's brilliant, but it also doesn't strike me as being new. So tell me what you mean by it being a new argument.

Scott Rae: Well, I think it- well, the what's new is the focus on the poor, the disabled-

Sean McDowell: Okay

Scott Rae: ... And the depressed, and the l- the, sort of, what I would call those suffering from terminal loneliness- ... From just having been abandoned by family or society or their communities. That, the focus on those particular vulnerable groups as being a significant reason why we ought not legalize euthanasia or assisted suicide, that's the part that's new.

Sean McDowell: Okay.

Scott Rae: And I think it's, it's, it's absolutely right, because we've, we've, we've-- it's a, it's a logical extension of the vulnerability of the elderly now to other groups that are equally vulnerable, if not more so. And I think what it, what it reflects, I wanna be really careful about this, but I think it does reflect an erosion of respect for essential human dignity at the ending edge of life. And they are... You know, the people who, you know, w- they, we've used, we've used terminology, that, you know, years ago, the then governor of Colorado described the elderly as having a duty to die and get out of the way. And the, you know, one of the most prominent, people in medical ethics in the UK, described, des- s- put it like this. She said, "If you, if you are, if you have severe dementia, you are wasting the resources of the National Health Service."

Sean McDowell: Amazing.

Scott Rae: And so, I mean, you know, so, you know, I'm, I'm one of the baby boomers who's over 60. I'm one of that generation who, you know, g- I, you know... Now, f- thankfully, at this point, I have good insurance and can provide good care for myself, but, you know, what about the person, you know, in my shoes that doesn't? You know, I remember, Sean, I took a-- when I was a doctoral student, I took a course at USC on medical ethics, where we made rounds at all the different, stations, w- all the different specialties. And we did the course was in conjunction with an honors-level, undergraduate, pre-med course.

Sean McDowell: Oh, yeah.

Scott Rae: All these students, all- they were all going to medical school after, or hoping to. And what was so striking was almost every one of them favored assisted suicide and euthanasia. And the argument was basically a utilitarian one, that we don't have the resources to care for all these people like they want, and therefore, we're gonna give them sort of an easy way out. And I thought, "God help us if those folks end up- [chuckles] ... Being my physician-

Sean McDowell: Exactly

Scott Rae: ... Managing my care at the end of life."

Sean McDowell: Gosh.

Scott Rae: And I think that... Well, the other thing that the article is s- I think is sort of new, and right to point out, is how being poor or disabled, not to mention depressed, can alter your decision-making capacity.

Sean McDowell: Yep.

Scott Rae: You know, we assume that somebody who's not on pain medication or not, n- you know, severely neurologically impaired or a minor, is competent to make their own decisions. I think what this article is pointing out, that's not really true. I mean, you can, you can have competence in a strictly psychiatric sense and have, still have, like, have significantly compromised ability to make your own decisions. So I'd, I'd wanna be really careful about, a law that would allow for assisted suicide without a mandatory psychiatric assessment, and, a period of time where you actually treat the depression and or other symptoms that may be a result of mental health being compromised, by some of these conditions.

Sean McDowell: And the reason they don't is because the end goal is not really to care for patients and to give them dignity, it's another bottom line that is motivating it.

Scott Rae: Without a doubt.

Sean McDowell: I think that's in part-

Scott Rae: Yeah... Yeah, and I don't wanna paint physicians with too broad a brush-

Sean McDowell: Sure.

Scott Rae: 'cause I, you know, you and I have both been around lots of physicians who, you know, they care deeply for their patients. They would never dream of abandoning them and never dream of doing something like this.

Sean McDowell: Sure.

Scott Rae: But the f- the financial pressure on hospitals and on the public health, like in Medicare and Medicaid, we're already seeing financial pressures being brought to bear on Medicaid today, is j- is only going to grow significantly more over the next decade. As the, you know, the, as they put it, the baby boomers become the geezer boomers. And I think that's, you know, we are- I mean, this generation of baby boomers is aging. There's no denying that. But I think the assurance that we will be well cared for in our dying days, that's, that's pretty important.

Sean McDowell: This argument is brilliant because it takes the desire for dignity, flips it on its head. It also recognizes that in our culture today, increased attention has been paid to the marginalized. Now, sometimes marginalized in a biblical framework is different than in critical theory.

Scott Rae: Sure.

Sean McDowell: And if people are like, "What's the difference?" We've got an interview coming up soon with Carl Truman. [chuckles] In the next few weeks, we will explain what we mean. But the other brilliant thing is our culture is paying attention to those with mental illness-

Scott Rae: Right

Sean McDowell: ... Is paying attention to those who are disabled or who have disabilities, and this argument is saying, "Actually, if you care for them, you would make sure that they're actually cared for with the right psychiatric psychological care, rather than rush them towards, physician-assisted suicide." And by the way, again, this isn't really new in the sense that James 1:27 says, "Religion that our God and Father accepts as pure and faultless is this, to look after orphans and widows in their distress, and to keep oneself from being polluted by the world." Why care for widows and orphans? They can't add instrumental value to culture. Because they're made in the image of God. I don't know the worldview of this doctor, I imagine, who wrote this article. We could find it online. But in the second to last line or third to last, it says, "We must offer them dignity, not by affirming their despair, but by affirming their worth." In other words, people who have mental illnesses, people with disabilities, have intrinsic worth because of the kinds of things they are, human beings made in the image of God. I don't know how secularism can possibly drown that. It can't do so. So this argument is rooted in a biblical worldview, and I welcome it.

Scott Rae: Now, what... You are absolutely right about the trend toward treat- if we treat people's, if we treat their conditions, they will likely be less likely to want to die.

Sean McDowell: That's right.

Scott Rae: And we've sh- we've, we've already shown this to be true, that if we treat people's pain effectively, for the most part, they don't wanna die. They wanna continue to live. And in many cases, when they're asking for assisted suicide or euthanasia, they're asking for their pain to be alleviated. And once, and once that happens, what a surprise, they actually want to live. And I think the same, I think the same will bear itself out in treating some of these other things.

Sean McDowell: Good stuff, my man. Let's take some questions that have come in. And this one, I've never asked you about this. I'm [chuckles] super interested in your take, Scott. They said, "How should Christians think about non-traditional medicines or Eastern medicines, such as acupuncture? Is it ethically permissible for Christians to use such medicines, particularly when there's no treatment in Western medicine for certain ailments?"

Scott Rae: I think it's o- I would say it's only problematic, Sean, if it involves the worship of, you know, other religious practices, the worship of other gods, the adoption of other religious doctrines or tenets, which I think most of these alternative medicines do not require that. So I think things like, you know, acupuncture, other things like that, the non-traditional medicine, it's been employed for thousands of years, and I don't, I don't see any problem with it per se, as long as there's... It doesn't also include that syncretism element, which brings in- brings into the room, maybe unwittingly, other religious doctrines or practices that you have to engage in.

Sean McDowell: I think that's a great take. I think the key is how to do so, because lies are often so subtle. So stretching, that's maybe learned from yoga, in principle, the stretching is not problematic. But when it becomes tied to the worldview of Hinduism, then it's hugely problematic. But practically speaking, if somebody practices that in certain ways and certain places, can it begin to shape and affect them? Yeah, we've got to be very careful and very wise about doing so. But in principle, with discernment and care, there's nothing wrong with, say, acupuncture or stretching. Just be wise and discerning how we approach it, I think is the, is the takeaway, and we could do a full episode on what [chuckles] that would look like.

Scott Rae: Yes, we could. Well, actually-

Sean McDowell: It's-

Scott Rae: ... There's, there's actually quite a lot in the medical literature-

Sean McDowell: Oh, interesting

Scott Rae: ... In the, in the Christian medical literature about alternative medicines and treatments. In fact, a good friend of mine, from the bioethics community has written quite a bit on this. And I'll, I'll... What we can do, Sean, is we can post, an Amazon link to the title of his book on this if people wanna read a little bit more about it.

Sean McDowell: You know what? That's a possible show for a Tuesday episode.

Scott Rae: Yeah, it is.

Sean McDowell: We've never covered it. That would be-

Scott Rae: Yeah, no, that-

Sean McDowell: ... Really interesting, but-

Scott Rae: It's a great idea

Sean McDowell: ... Let's, let's talk about that.

Scott Rae: Good.

Sean McDowell: Thinking biblically about Eastern medicine would be- [chuckles]

Scott Rae: How about that?

Sean McDowell: -a great one. I love it. All right, one more question for you. Somebody's asking for advice on a follow-up episode we did on cohabitation. Says, "My children grew up, got saved in church, adopted our fifth child. Was quite a handful, and really disrupted the rhythm of our family. Long story short, my son moved out during university to live in his girlfriend's house, mainly for convenience. But the slippery slope began. They've been living together since COVID." Basically, the bottom line is, what can us as parents do to approach this with other kids, and also with their kids now? You have any thoughts, advice on this one, Scott, or do you want me to jump in on it?

Scott Rae: I... Yeah, I think that depends on what kind of relationship you have with your son or daughter.

Scott Rae: And I, you know, I think my- I suspect, I could be wrong about this, but I suspect that this person's, you know, this person's child already knows what they think about it.

Scott Rae: That would be my guess. And I th- I think... I don't think there's anything wrong with pushing them to get married. I think that- I think that's fine. You know, that, a lot of that depends on how open the kids are to hearing it, which they, which they may not be, and this could, this could actually strain a relationship. But if they're, if they're not clear about what you think about it, then I think the conversation is warranted. And I think that, you know, rather than, you know, other alternatives, I think that's the best alternative, is if you're living together and sleeping together, you ought to be married. End of story. That'd be my advice. I'd say, you know, do it, you know, do it carefully, do it, do it with grace, and but with also with a, you know, a fairly clear expression of what the truth is, too.

Sean McDowell: I think that's really wise. As far as other kids, it's important to start young. I mean, just yesterday [chuckles] I was traveling with my 12-year-old. We were watching a show where this couple lived together, and I just hit pause. Normally, I talk with my kids and ask them questions. I said, "Buddy, don't live with somebody before you're married. It's not only not according to God's design in the Scripture, but it's actually gonna put you at a disadvantage if you wanna have a happy marriage. Don't do it." And then I hit play, and we moved on. It was just a quick word from a dad. [chuckles] But typically, it's in conversation, but we gotta start young, and I think you're right. It depends on their openness and the level of a relationship, and just done with care, because this person is an adult. And my daughter's graduating high school in a few weeks. She's going to Biola in the fall, and I just... I know my influence is there, but in a very different way than it was when she's younger. So if I were to do it with my little kid, I'd say, "Are you open to just hearing your mom or your dad's heart about this? Can we get coffee? Would you be willing to hear me out?" If they say, "Mom, I just don't wanna talk about it," don't force it. If they say yes-

Scott Rae: Right

Sean McDowell: ... Then you just graciously and kindly lay out your concern in a way that's respectful and caring, that's likely to be heard. And of course, praying for your son and daughter to see this, is huge as well-

Scott Rae: Yeah

Sean McDowell: ... For their hearts and for your own.

Scott Rae: Every day.

Sean McDowell: Amen to that one. [chuckles] Good word to end on. Good discussion, Scott.

Scott Rae: Good stuff.

Sean McDowell: This has been an episode of the podcast, Think Biblically: Conversations on Faith and Culture, brought to you by Talbot School of Theology at Biola University. We have master's programs online and in person in theology, Bible, apologetics, spiritual formation, so many more. We'd love to train you and partner with you for the kingdom. Please keep your comments and questions coming. You can email us at thinkbiblically@biola.edu, and we ask you to please take a moment and give us a rating on your favorite podcast app. I'm not exaggerating when I say each rating, if it takes you two minutes, really helps us in the analytics to equip more people to think biblically. We so appreciate you listening, and we'll see you Tuesday when we have a discussion, one of my favorite in a while, about how to think biblically about exercise. In the meantime, remember to think biblically about everything. [upbeat music]