Rev. Robert Fleischmann, National Director, Christian Life Resources
I have been actively involved in end-of-life decision-making for more than four decades. This process becomes more complex with the advancement of technology.
The easy answer to the treatment question at the end of life is, “We treat and care until it is clear that God is calling someone home.” Although true, this response sidesteps the difficult question of how we know when God is calling someone home. This article explores the nuances of these decisions and offers a framework for navigating tough decisions in end-of-life care.
Understanding “Preserving Life”
Preserving life can mean different things depending on the situation. We are called to preserve and care for life in three main contexts:
- Curative Objective: This is the most straightforward scenario. When a patient is injured or ill, medical care aims to restore health with a reasonable expectation of success. Treatments, including a willingness to participate in experimental medical studies, are pursued to heal and improve the patient’s condition. Generally, there is little hesitation in taking these steps, provided they align with medical ethics and our Christian convictions.
- Status Quo Objective: Sometimes, medical intervention aims to maintain the patient’s current condition rather than improve it. This occurs when damage, such as brain injury or stroke, has already been done, and full recovery is not expected. The goal is to prevent deterioration and maintain a stable quality of life, even if it is diminished from before.
- Terminal Condition: When an illness or injury is incurable and death is expected within months or years, the focus shifts to preserving life, emphasizing comfort rather than cure. No known medical intervention is expected to change the outcome in these cases, and care prioritizes relief and dignity.
In these circumstances, preserving life means acting with the intent to help the patient continue living without hastening death or worsening the condition. Preserving life can involve accepting a reduced quality of life, which raises additional considerations.
Understanding “Prolonging the Dying Process”
From a broad perspective, all medical care can be seen as delaying death, since death is inevitable. Everything from having surgery to simple eating and drinking can be viewed as “kicking the can down the road.” Yet, in this discussion, “prolonging the dying process” refers to a specific scenario: when death is imminent, and continued aggressive treatment ignores this reality. It involves expending substantial resources and subjecting patients to burdensome care that may cause suffering or even accelerate dying without reasonable hope of recovery.
As Christians, we recognize death’s inevitability but often wrestle with the desire to “beat the odds.” The challenge is to discern when to continue treatment and when to shift focus to comfort and dignity, recognizing that comfort is always a goal but becomes paramount when healing is no longer possible.
The Bigger Picture: Why We Exist
Understanding the bigger picture helps frame end-of-life decisions. The Apostle Paul explained to the philosophers at the Areopagus that God, the Creator of all, gives life and breath and has appointed the times and boundaries of our lives (Acts 17:24-28). Science describes the laws of nature, but God established those laws and life itself with a purpose: that we seek Him.
In our sinful world, life often becomes consumed with personal happiness, careers, and accomplishments. It is easy to forget that our ultimate purpose is to glorify God. Being faithful to our calling, our choices and motivations must be rooted in faith, not personal preference or worldly values.
Introspective Motivation Rooted in Faith
Motivation is the “why” behind our actions. Outward actions can be misleading if not grounded in sincere faith. True faith is confidence in what we hope for and assurance about what we do not see (Hebrews 11:1). It enables us to trust God even when circumstances seem contrary.
Living by faith means surrendering worldly standards and fears and focusing instead on glorifying God. This transformation is supernatural (Romans 12:2; 2 Corinthians 3:18) and shapes how we view life and death. Because of Christ’s sacrifice and resurrection, believers live with the certain hope of eternal life, making death not the end of existence but a transition to a better home (John 14:1-3; Philippians 3:17-21).
Glorifying God Through Life and Death
Everything about our lives should reflect God’s love and purpose. Preserving life, therefore, is not an end but a means to glorify God. Life preservation is a tool or opportunity God gives to fulfill His greater purpose, bringing glory to His name through our thoughts, actions, and service. We approach life and death not to earn favor but to demonstrate gratitude for God’s salvation. Living this way often looks peculiar in a world where love grows cold (Matthew 24:12), but it opens opportunities to witness and serve as God’s ambassadors (1 Peter 3:15; Matthew 5:16).
Applying This to End-of-Life Decisions
As we approach the end of life, family, friends, and caregivers often watch us closely. Their reactions to our faith and attitude can influence their own understanding of death and hope. Instead of focusing on what is lost, Christians can view the end of their lives as a shift in their mission field, an opportunity to share faith and demonstrate God’s love even in suffering.
Worldly perspectives often prioritize “quality of life” in making treatment decisions, sometimes leading to rejecting life-extending care or choosing assisted suicide when life’s pleasures diminish. However, for Christians, even a diminished quality of life can still serve God’s purposes. The goal is not to prolong dying but to live faithfully until God calls us home, confident in the hope of resurrection and eternal life (1 Corinthians 15; Philippians 1:23).
The Gray Areas of End-of-Life Care
End-of-life decisions are rarely clear-cut. Medical knowledge is imperfect, and emotions can cloud judgment. Fear of making the wrong choice is common. In these gray areas, remember:
- Glorifying God is the ultimate purpose of life, whether actively serving or passively receiving care.
- God already knows our hearts and the future; He is sovereign and will accomplish His will despite our imperfections.
- Seek clarity from Scripture and wise counsel, especially from pastors, to guide decisions.
- Trust that God’s timing and authority prevail, even when human decisions err.
Heavenly Minded-Always
Jesus reminds us that life is more than physical needs (Luke 12:23). Our earthly existence is temporary and imperfect, but we are made for a perfect eternal home (Revelation 7:16-17). C.S. Lewis famously wrote
If I find in myself a desire which no experience in this world can satisfy, the most probable explanation is that I was made for another world.
Trying to create heaven on earth leads to disappointment. Instead, surrendering to God’s will and living for His glory transforms our perspective. We persevere through trials, seeing them as opportunities to realign our priorities with God’s (Romans 12:2).
Accepting Death with Faith and Hope
Death is unavoidable, a consequence of sin (Romans 6:23). God’s solution is Jesus Christ, whose resurrection guarantees our own resurrection and reunion with Him (1 Thessalonians 4:13-14; 1 Corinthians 15:12-22). This hope distinguishes Christian mourning from despair.
When faced with terminal illness and the temptation to pursue all possible treatments, Christians must remember that death cannot be defeated by medicine alone. Life is transitory, and death is inevitable. Our intent in preserving life is to serve the Lord, and our deepest sorrow is the pain of separation, which only the resurrection can heal.
Sometimes, it is unclear when to stop treatment or when God calls someone home. Faith enables us to make decisions calmly, trusting God will work all things for good (Romans 8:28), even our mistakes.
The distinctive nature of Christian decision-making is that it begins with faith (Hebrews 11:6). Our focus is to glorify God throughout. Our love for him drives decision-making, and it is that love which endures into eternity (1 Corinthians 13:13).
Summary
The tension between preserving life and prolonging the dying process is complex. While we are free to make choices, not all choices are correct. Assisted suicide is never right, as it challenges God’s authority over life and death (Deuteronomy 32:39). Likewise, living in fear of death ignores God’s promises (Psalm 23:4; 1 Corinthians 15).
Sometimes it can be clear that God is calling us home; sometimes it is not. Our imperfect knowledge and sinful hearts complicate decisions. Those difficult times also reveal the condition of our faith. The biblical definition of faith is telling:
“Now faith is confidence in what we hope for and assurance about what we do not see.” (Hebrews 11:1, NIV)
Sometimes, we find ourselves standing helpless in life’s complexities. Even then, and especially then, God stands with us, always assuring and never failing (Deuteronomy 21:8; Hebrews 10:23).
As Christians, we live to glorify God in all things, including the end of life, confident in the resurrection and eternal life that await us.
This article is adapted from a longer article, “Extending Life or Prolonging Death,” found on the CLR website: tinyurl.com/29bxm7sz
