End of Life Issues

We all understand that people don’t live forever in this mortal body.  Some people die suddenly under tragic circumstances.  Other people die of natural causes at an age that makes it somewhat easy to accept.  Then there are the other deaths that occur after long illnesses that are sometimes physically debilitating to the patient and emotionally draining to those loved ones going through the illness with the patient.  These deaths are often harder to deal with than the sudden tragic losses.  What’s usually seen in these terminal cases is a decrease in the “quality of life.”  Patients decline physically and cognitively and all those involved begin to wonder what is in the “best interest” of the patient.

It’s around this time that the loved ones have to make decisions.  These decisions are about whether or not to continue life-saving treatments, medications, and other “heroic measures.”  People know it as having to decide whether or not to “pull the plug” on a loved one.  That is certainly a hard decision to make at such an emotional time, so maybe a discussion about these end-of-life issues during a moment of calm and reason would serve us well.

If you’re the person facing a terminal illness such as cancer, Lou Gehrig’s Disease, advancing multiple sclerosis, end-stage liver disease, and many others, there are some things you need to consider as far as what your wishes are once you become too incapacitated to make your own decisions.  For example, deciding not to take chemotherapy for your cancer, when you weigh the prognosis against the other health problems and side effects of chemotherapy, may be a decision you feel is what will give you the best quality of life for the remaining time you have.  That’s different than choosing to end your life via physician-assisted suicide (legal in Oregon and some countries), or self-inflicted suicide.

You may ask what the difference is between choosing not to take treatments that may prolong my life versus hastening my death.  Well, for one thing, it is God that gave you life in the first place (Genesis 2:7; Isaiah 44:2).  We all have an appointed time to die (Hebrews 9:27).  If you look at the account of the fool in Luke 12 who stored up for himself many years worth of harvest to which he decided to “eat, drink, and be merry,” God said, “Thou fool, this night thy soul shall be required of thee” (Luke 12:19-20).  The context of that story is having a wrong focus on materialism, but what I want to highlight is the fact that no one knows the time of their death, so opting for suicide versus letting the Lord progress your disease as He sees fit is arguably hastening your death.

So let’s say, for example, you discover you have a terminal illness and your physician explains to you that the course of the disease is aggressive, and taking treatments will not cure the disease, but may “buy you more time.”  If you choose to allow the disease to take its course, you need to make that perfectly clear to family, especially next of kin.  Go to a lawyer and develop a Living Will and assign someone to be your Durable Power of Attorney.  A Living Will explains to the medical community what your wishes are beforehand so that when the time comes that you are unable to communicate those wishes, they are still able to be carried out.  This Living Will can explain that in the event of respiratory or cardiac arrest, you do (or do not) wish to be revived.  The Living Will can state whether or not you want a feeding tube placed once you become unable to eat.  The courts have continuously upheld the patient’s rights to refuse or discontinue such things as ventilators and feeding tubes.

The importance of a Durable Power of Attorney is that this document goes into legal effect once you become incompetent to make your own decisions regarding, but not limited to, medical decisions.  This is where the difficulty arises for family.  Suppose someone suffers a cardiac arrest and is revived after 45 minutes.  There is brain death now because of the lack of oxygen.  All of a sudden, a healthy individual suffers a catastrophic event, but is still alive, but lacking the ability to make decisions like remaining on the ventilator, and what to do if the person goes into another cardiac arrest.  Does the person want to be revived or not.  Those are questions no family member wants to make at that time, especially not knowing the wishes of the patient.  Not only that, but add to the equation the fact that the decision to “do everything possible” would mean this patient living in a “vegetative state”  for an indefinite number of years going forward.

Here’s a true story that speaks to the need for planning for such occasions.  In 2002, an 82 year old lady from Washington State developed pneumonia.  She already had emphysema, probably from years of smoking.  She rapidly declined in her health.  She soon became unresponsive and unable to make her own decisions.  Some in the family told the medical staff that it was the patient’s wishes to die without any “heroic measures” being taken.  The staff took the patient and put her in a room where the family could hold vigil privately until she passed.  She received no medication, no IV fluids, no oxygen (remember she has emphysema and pneumonia), she ate and drank nothing.  Days later, she rallied and recovered.  She recovered so much that at 83 years old she published a biography.  Now catch this…she was upset when she discovered her family believed she wanted to die.  She most certainly wanted to live.

The problem with putting your family in the position of having to guess what your wishes are is that medical science is not infallible.  There are literally hundreds of cases that have baffled medical doctors.  So to decide to end life-sustaining measures in a comatose or unresponsive patient is a decision based on a medical staff’s best estimation of how the patient will (or won’t) progress.  Do you want to know how heart-wrenching that decision is?  A girl had suffered a traumatic brain injury from a car accident.  She was in a coma for about seven years.  She had been able to breathe on her own all these years, but she had a feeding tube.  With her physical body contorting because of lack of use and her muscles wasting away, for whatever reason, the parents fought in the courts for the right to stop her feedings.  This court battle took three years.  Finally, the parents were granted permission to stop the feedings (her only source of water and nourishments), and twelve days later, she died.  Now here’s the unfair toll it takes on family members.  Knowing that there are some people who recover from comas and traumatic brain injuries, her father was NEVER sure he did the right thing in stopping her feeding and letting her die.  He was so distraught that he hung himself six years later.

I’m not going to give you a definitive answer about the end-of-life issues and how to make those decisions, but I will give you a few of things to think about that may help in deciding what to do, should you find yourself as either the patient or the family member.  The first thing to look at is the “quality of life” issue.  The other thing to look at is the resilience of the body that God created.  Lastly, just what is the role of suffering in the Christian’s life?

What is “quality of life?”  Well, it can’t be quantified because it’s extremely subjective.  People like Christopher Reeve (before his passing) and Congressman Jim Langevin (D-Rhode Island) enjoy a high quality of life even though they are confined to wheelchairs.  In the case of Christopher Reeve, now deceased, he headed foundations, took up causes, acted, and directed.  He was also on a ventilator.  At any point, he could have called it quits.  Ever hear of Stephen Hawking?  He is probably the world’s leading authority on physics and space and advocated combining Einstein’s Theory of Relativity with Quantum Theory (I have no idea what all that means, except that the man has intelligence).  He still uses his intelligence while confined to a wheelchair because he is suffering from Lou Gehrig’s disease.  So, in some instances, quality of life has to do with a person’s perception of whether or not they are still productive in some way.  Some infirmed fear becoming too much of a burden to their caregivers.  If you’re a Christian, who’s going to decide if you’re still useful and productive?  God will decide that.  I’ll cover that in the last portion regarding suffering.

Now, what makes medical science so fallible is that God has created a body that is resilient and can overcome some problems.  Not only that, but He created the body so intricately that we have yet to know everything about the body, especially in the realm of the brain and how it works.  Here are a few examples of the resilience of the body.  The liver is an organ that can actually regenerate itself to a certain extent after being minimally damaged.  The heart is amazing in that, if a coronary artery is blocked, and blood can’t supply the heart with adequate oxygen, over time, new blood vessels will grow above the blockage and reach into the areas of the heart that are affected.  This is called collateral circulation (God’s version of bypass surgery).  Lastly, in the case of patients in comas, or “vegetative states,” the brain can, over time, grow new neuron pathways.  People in comas, who have recovered, have stated they heard everything that was said by their bedside, and can recount stories with amazing accuracy.  They are sometimes trapped inside their bodies, unable to respond, but fully aware…some…not all.  And not all will recover.  Annually there are 10,000-25,000 adults and 6,000 to 10,000 children in the US alone diagnosed as being in “vegetative states,” most never awaken and the majority of them die within six months…but you never know…

Let’s look at the final point of end-of-life issues…suffering.  Here’s the truth about suffering.  You can suffer gracefully or you can be absolutely miserable to everyone around you.  Suffering can belong to the patient as they progress through their disease, but it can also belong to the caregivers who face life-changing decisions to care for a loved one unable to care for themselves.  First of all, if you’re the patient who is suffering, consider this; how you handle the suffering during this terminal illness may prove to be the testimony that brings someone else to the Lord.  If you’re a Christian and walk around with a woe-is-me attitude, and you don’t show your desire to lean upon God and draw strength from Him, why would unsaved family or friends want to trust in your God?  And as the caregiver, if you bemoan daily the stress and incredible personal sacrifice you have to make to care for a debilitated stroke patient in your home everyday, it again doesn’t make those around you want to get to know your God.

I don’t want to have a terminal debilitating disease, nor do I want to have to be caregiver for a debilitated loved one, but I’d like to think I would at least recognize that the grace to get through it is available.  Paul tells us in Romans that we have a comforter in the person of the Holy Spirit to find grace in times of suffering.  Paul later, in Second Corinthians explains the source of comfort in times of suffering and why it is so important to find that comfort.  The reason is because as God comforts us in our suffering (our terminal illness or our caring for a debilitated loved one) and we get through it with His help, we are then to comfort others with the same thing that comforted us (the Lord).  This is how we can still be productive and enjoy a satisfactory quality of life despite our current condition…by helping others get through it.  For a more eloquent exposition on this subject, read Second Corinthians 1:3-7.

In a 1992 edition of the Baptist Bible Tribune, the magazine tackled the subject of end-of-life issues, and mainly cautioned the readers to consider the ethics of “pulling the plug.”  But I wanted to show you that there are many more considerations needing to be made BEFORE you reach that point.  What are your wishes and why?  Who knows what those wishes are?  Are those wishes legally spelled out?  What are the ethics and morals of such decisions?  Are you going to go and “pull out all the stops” and display grace during suffering?  Are you ready to die?  Can my loved one in a coma be witnessed to and accept salvation?  If so…what then?  All these questions are difficult questions with answers rooted in philosophy, humanism, social mores, popular opinion, and Biblical truth.  I guess, within the context of the trials that come our way regarding end-of-life issues and the grace we seek to get through them, we must claim James 1:5, “If any of you lack wisdom, let him ask of God, that giveth to all men liberally, and upbraideth not; and it shall be given him.”  The Word of God does not so easily spell out the answer for every question that befalls man, but God’s Word is filled with the principles we need to apply to end-of-life issues to make true, biblical, and Godly decisions as God leads us.

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