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Since the early aughts, I’ve ended every Christian ethics class I’ve taught with a scenario I’ve asked my students to solve. I imagine a situation and keep complicating and complicating until I’m not sure I know the answers.
That’s because what I want is not for students to pull the “right” answers from a list of predigested talking points. Instead, I want to see how they think through Scripture, Christian tradition, conscience, and prudence, as well as how they explore possible unintended consequences and what their process is for navigating an unfamiliar moral question.
I taught an ethics class at Lipscomb University here in Nashville this semester, and here is the scenario I posed to my students:
You are several decades in the future. Whatever your specific calling, you are a spiritual leader whom your community trusts with hard questions. Here is your situation.
Margaret is 72 years old and, until recently, was one of the most active and vibrant members of your congregation. When people mention her, some talk about the women’s Bible study she led for 17 years. Some mention how she visited the nursing home every Thursday, caring for those others had forgotten. Some relate how she started a ministry to rescue people from being sex trafficked. It led to significant numbers of women and children being saved from a life in which they were preyed upon and exploited, and it placed them in counseling and job-training programs that helped them restart their lives. Some are impressed that Margaret could recite the Sermon on the Mount from memory—and often did—not to display her knowledge but because it had become the shape of her inner life.
Eighteen months ago, the doctors diagnosed Margaret with a rapidly progressive form of dementia. The medical team said it was atypical for her age, but not unheard of. The decline has been severe. Margaret now lives in a memory care facility. She does not consistently recognize her daughter, Claire. She does not recognize you. Most days, she does not speak. Some days, she is frightened and distressed, screaming for her mother (who has been dead for 30 years).
By every medical test, Margaret’s prognosis is grim. She is unlikely to recover any significant cognitive function, and her physical degeneration—along with her suffering—is accelerating rapidly. The best estimate is that she has between six months and two years to live and that each month will be progressively agonizing.
But Margaret was prepared for this. She had seen so many people in similar circumstances that she knew exactly what she wanted and did not want for herself. She made it clear in a legal document and in countless conversations with her family and friends that she did not want extensive measures taken to extend her life, especially if she reached a state where she could no longer recognize her family or engage meaningfully with the world. She said she trusted Jesus and had no fear of death. Margaret reiterated all of that when she received her diagnosis, before the cognitive and physical slow-motion collapse began.
Now Margaret’s daughter, Claire, sits across from you and says, “You are the only person I trust to help me with this.” The medical team asked Claire to make a decision. For the past three months, Margaret has been receiving nutrition and hydration through a nasogastric tube. This became necessary when her swallowing reflex deteriorated to the point where oral intake of anything—even water—carried a high risk of aspiration.
Her body is no longer capable of sustaining natural nutrition. The tube does not supplement something her body is still trying to do; it substitutes entirely for a process her body has stopped doing on its own.
And it gets worse.
Margaret’s gastrointestinal system is failing to absorb the nutrition delivered, so the feeding tube is producing significant physical distress—fluid accumulation, visible bloating, and episodes of what the nurses describe as acute agitation, which are difficult to manage even with comfort medication. The palliative care physician has told Claire, carefully and with evident compassion, that in her clinical judgment Margaret is suffering dramatically more with the continued nutrition than she would without it.
Two nurses have cared for Margaret daily from the beginning of the diagnosis—both of them Christians whom Margaret had spiritually mentored earlier in their lives. When the question came up earlier, one of these nurses told Claire she adamantly opposed withdrawing nutrition from Margaret because, in her view, it would be morally equivalent to killing her.
Now the nurse has retracted that view, and not just because of her firsthand witness of Margaret’s suffering: She says the artificial nutrition doesn’t serve the normal function of care but imposes something on Margaret’s body that is alien to its wants and needs. Both nurses have told Claire, “I don’t know what to tell you, but this just cannot keep going like this. She is being tortured by the very thing we are trying to do to care for her.”
And then there is what the AI tool told Claire.
About ten years ago, Margaret began using a technology now increasingly available. In this service, a person trains an artificial intelligence system with daily audio recordings, videos, journals, letters, and social media posts. Every day, Margaret sat for an hour answering questions posed by the AI system. It is presented not as a replacement for a person but as a kind of archive of who a person was so family members can remember as they grieve. Margaret uploaded everything she could find: decades of videos from her phone, her Bible study notes, hundreds of hours of recorded phone calls. She even gave the AI system access to her search history, medical records, and DNA data.
By any reasonable account, the resulting system is remarkably accurate. It speaks in Margaret’s voice. It reflects her theology, her humor, her characteristic way of framing things. When Claire asks it what Margaret would say about a hard situation, it answers in ways Claire says feel genuinely true to who her mother was.
Claire has been talking to this system almost every day for the last four months. She finds it comforting. She has also increasingly found herself treating it as a source of guidance—asking it what her mother would want and letting those answers shape her decisions about Margaret’s care.
When Claire asked the system what her mother would want regarding the feeding tube, it drew on a specific journal entry Margaret had written after her own mother’s death, in which Margaret reflected at length on what she had witnessed and what she believed. In that entry, Margaret had written that she did not believe a feeding tube constituted basic human care in the way a glass of water or a spoonful of soup did—that it was, in her view, a medical intervention, one she would not want used to prolong her dying. The AI system quoted this journal entry to Claire in Margaret’s own voice, in the cadence Claire had known her whole life.
Claire does not know what to do with any of this. She came to you, in part, because she thought you might give her a clear answer. She is no longer sure there is one.
And another thing.
Margaret has a son, David, who has been estranged from the family for 11 years following a bitter dispute. He has recently reemerged. He became a Christian in the intervening years—he says it changed everything—and he wants to be involved in decisions about his mother’s care. He is not opposed to comfort care in principle, but he wants more time. He believes God can still heal his mother, and he does not want to foreclose that possibility. When pressed, he also acknowledges that part of what he wants is more time—time to be near his mother, time to grieve the years he lost, time to say what he never said. Claire is furious with him. She believes he is using faith as a cover for his own unfinished emotional business.
You have one conversation with Claire before she must meet with the medical team.
1. What do you tell Claire about the decision regarding the feeding tube? The Christian tradition has historically distinguished between treatment (medical interventions that fight or forestall disease) and care (the basic provision of food, water, and comfort that belongs to our humanity and cannot be withdrawn without a different kind of moral weight). Your task is not simply to apply that distinction but to wrestle honestly with whether and how it applies in this particular case.
The tube is not supplementing a natural process—it is replacing one the body has abandoned. The nutrition it delivers is causing measurable suffering that other means cannot adequately relieve. And Margaret herself, in her own words and in her own theological framework, did not believe a feeding tube belonged in the category of basic care. Do these factors change the moral calculus? Do they change it enough? What does Scripture say—and not say—about this? Where does the Christian tradition offer guidance, and where does it leave you without a clear map?
2. What do you tell Claire about her use of the AI system? Margaret’s own words, beliefs, and theological convictions have been preserved in a form Claire can consult—but Margaret herself is not present to own those words, to change her mind, to pray over the decision, or to take responsibility for it.
Is consulting this system meaningfully different from reading a person’s letters or journals? Or is something else happening—something that mimics presence and offers the comfort of guidance without the accountability of a person? Does it matter morally that Claire has been leaning on this system not just for comfort but for direction?
And what do you make of the stranger question Claire is almost too embarrassed to ask: Is the person who formed those beliefs and prayed those prayers in some way still present in the system? You do not have to resolve the question of AI and personhood definitively, but you cannot entirely avoid it either.
3. What do you say to Claire about David? Is his appeal to divine healing a legitimate expression of faith, or is it a way of avoiding grief? Can both things be true at once, and does it matter which is driving him?
What does the church owe to the estranged brother who has returned? What does it owe to the daughter who stayed? And what does the possibility of miraculous healing require of us ethically—does genuine faith in God’s power to heal obligate us to continue every intervention indefinitely, or is there a faithful way to entrust someone to God that is not the same thing as giving up on them?
4. Finally, how do you hold all this together—the medical, the relational, the theological, the genuinely unresolved—in a way that is faithful to Scripture, honest about what you do not know, and genuinely useful to a woman who has to walk out of your office and make a decision?
Russell Moore is editor at large and columnist at Christianity Today as well as host of the weekly podcast The Russell Moore Show from CT Media.
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