As Christians, we make the best judgments we can based on what we know. We are guided first, however, by our faith in God as our Creator and Redeemer. For that reason, faith-based decision-making involves constant spiritual nurturing with God’s Word and the valued input of our pastors and other strong spiritual acquaintances who help us check our motives to assure our decisions remain laser-focused on glorifying and honoring God.
Medical decision-making involves facing sometimes difficult choices regarding an individual’s medical treatment due to advanced age, accident, or a chronic or degenerative health condition.
Christians approach medical decisions with a clear understanding that God owns human life, and we are stewards of it on his behalf. We make decisions to care for and protect life as caretakers of this precious commodity belonging to God (1 Corinthians 6:19). The following information provides an overview of choices from a faith-perspective by approaching end-of-life care and decision-making from a Christ-centered frame of mind.
“DNR Order”; “Pulling the Plug”; “; “Nutrition and Hydration”; “Artificial Nutrition and Hydration”; “Food and Fluids”; “On a Machine” – in reference to being placed on a ventilator; “No Code” – in reference to a DNR Order: “Dying Process”; “Imminent Death”; “Terminal Illness”; “Terminal Condition”
Autonomy: The capacity to decide for oneself and pursue a course of action in one’s life, often regardless of any particular moral content.
Brain Death: The “official” definition used to describe the cessation of all measurable brain activity in both the cerebral cortex and brain stem of a patient. The term is sometimes wrongly used to describe a lack of measurable activity in the cerebral cortex, even though the brain stem shows activity.
Christian Bioethics: Only ethical construct in which motive is the first determinant of right or wrong decisions. Before it asks, “What should I do?” it requires a self-examination by asking the question, “Why should I do it?” and compares that reasoning with God’s Word.
Contraindication: Opposite of “indication” in that there is a health care reason to withhold or withdraw treatment.
CPR (Cardiopulmonary Resuscitation): Effort to rapidly compress the chest to “pump” the heart for the expressed purpose of providing a continuous flow of oxygen in the body. Administering CPR is not intended to restart a stopped heart.
Do-Not-Resuscitate (DNR) Order: Medical order written and signed by a physician instructing health care providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating.
Ethic, Quality-of-Life: Subjective term that evaluates a person’s happiness and level of satisfaction in life (opposite of “Sanctity of Life Ethic”). Sometimes referred to as a “Qualitative View of Life.”
Ethic, Sanctity-of-Life: Biblical teaching stating, since human life was created in God’s image, every human being from conception to natural death is sacred, possessing inherent dignity and worth. The “Sanctity of Life Ethic” calls for Christians to respect, value, and protect all human life. Sometimes referred to as “Quantitative View of Life.”
Extraordinary Means: Those treatments, medicines, and operations which can be especially burdensome or experimental for the patient as a type of “last try” to bring healing or comfort. It is important to understand how this term is used. Some have confused this term with “futility.”
Futility: Term used to describe medical treatment that is no longer able to do what it is supposed to do. For example, consuming food orally or by mechanical means is supposed to sustain life. It requires the body to be able to process the food. If, however, the body cannot process food for whatever reason, then eating would be futile. Futility does NOT refer to a treatment that fails to do other things it never was intended to do. In other words, eating does not cure, or heal, or reverse the damage. It sustains health. Some people confuse life-sustaining treatment as “futile” because, while it actually sustains life, it does not improve or heal life. Such treatment is NOT futile, because it is doing what it is supposed to do.
Hospice Care: Program model delivering care to individuals who are in the final stages of a terminal illness. The goal of hospice care changes from cure to comfort for patients in their last six months of life. Hospice includes support for the patient’s family while the patient is dying, as well as support to the family during their bereavement.
Imminent Death: Pattern of symptoms and signs in the days prior to death. Death is considered “imminent” when it is reasonable to assume death will occur within a few days.
Intubation: Process of inserting a tube, called an endotracheal tube (ET), through the mouth and then into the airway. Intubation is done so that a patient can be placed on a ventilator to assist with breathing during anesthesia, sedation, or severe illness.
Life Support (or, “Life-Sustaining Treatment”): Combination of medication and machines that replace or support a failing bodily function. Life support is intended to be temporary until the illness or disease is stabilized and the body resumes normal function. Some patients’ ability to regain function is never restored without life support.
Motive: The primary guide in making difficult end-of-life decisions, reflecting one’s faith in attitude and actions. A Christian seeks to preserve life yet does not fear the prospect of death.
Palliative Care: Specialized care for people living with a serious illness, focusing on providing relief from the symptoms, side effects, and stress of the illness. This type of care is based on the patient’s needs, not on the patient’s prognosis. It is NOT only used when the prognosis is death. A patient can receive palliative care at any stage of the illness and can pursue curative treatment.
Palliative Sedation: The intentional drug-induced method of sedating a patient so that he or she loses most or all awareness for the purpose of alleviating suffering. Palliative sedation is considered a method of last resort and can result in the unintentional cause of death.
Prognosis: The likely course or outcome of a disease or condition.
Resuscitation, Full: Full resuscitation efforts involving aggressive combinations of cardiopulmonary resuscitation using CPR (the rapid compression of the chest to “pump” the heart for the continued flow of oxygen in the body) and defibrillation (an electrical shock applied to restart a heart).
Resuscitation: An effort to revive someone from unconsciousness or near death. Its most typical application is as a medical order placed in one’s medical chart or as an instruction provided in a medical directive statement.
Terminal Sedation: The act of administering pain-relieving medication for the specific and intentional purpose of shortening life. Terminal sedation is practiced when a patient is drugged into unconsciousness (palliative sedation) and intentionally medicated into a deeper state with the purpose of causing the end of life.
Tube Feeding: The act of administrating nutrition in an artificial or mechanical manner when a person has trouble eating in a typical fashion and cannot get proper nutrition. The most common types of feeding tubes are the gastrostomy tube (or, “gastric tube” or “G-tube”) which is inserted into the stomach through the abdomen; and, the nasogastric tube (“NG-tube”) which is inserted through the nasal cavity and fed into the stomach.
Ventilator: Machine that helps a person breathe when normal breathing is compromised by illness or accident. A person placed on a ventilator needs a tube placed down the throat (intubation) or through a hole in the throat (tracheotomy).
“Getting one’s affairs in order” should not wait until a person is approaching death. An advance care planning process articulates and clarifies one’s values, beliefs, and preferences for future medical care. It offers family and friends peace of mind knowing what is wanted when a loved one is still able to communicate those wishes – in other words, plan now for your care in the future.
Begin with a “family meeting” (or several meetings) which might include a general understanding of one’s financial matters, details on funeral arrangements or burial wishes, and the location of pertinent papers such as one’s will or trust. It is especially important to inform family/loved ones about desired medical treatment preferences in the event of a life-threatening illness or injury. This discussion can lead to the completion of a medical directive statement. The best time to create this type of document is before one is needed.
Christian Life Resources strongly advises completing and signing CLR’s Power of Attorney for Health Care – Christian Version medical directive. It documents choices about the type of treatments one wants – or doesn’t want – in the event of incapacity, allows the person to appoint someone as a “health care agent” to make medical care decisions when those wishes cannot be communicated on one’s own, and serves as an important Christian witness tool by providing clear and God-pleasing direction for such care within a state-recognized document.
Our FREE downloadable Christian medical directive statement is available here.
ANSWER: To arrive at an answer we must clarify some points in your questions:
There is no simple answer that can be given to “plug pulling” questions because the medical circumstances vary greatly from one patient to another. Sometimes there are intestinal problems that prevent the processing of food and/or fluids no matter how naturally or artificially they are provided. If the condition is inoperable there is neither the need to continue or even start tube feeding. It would be futile. This and other circumstances compel us to always act first out of our allegiance to God, recognizing we are stewards over his gift of life.
ANSWER: The problem here is with definitions. Everyone is a dying person. As one approaches the end of life, however, dying can become more tightly monitored and estimated. The medical community uses two terms frequently to describe this: 1) terminal (used to describe a medical condition that will eventually cause death); or 2) imminent (meaning there is a reasonable expectation that, because of any variety of conditions, death will come within a few hours or a few days).
“Life support” is a term used loosely with little regard for context. Feeding of any kind, even administered with a spoon and fork, is “life support.” Medication to control blood pressure, prevent blood clotting, and to mediate the effects of various diseases can be considered “life support.”
Speaking in generalities can often be confusing or even misleading. There are times when continued medication, ventilation, and feeding of a dying person may not be necessary. In each of those circumstances, the keyword is “futile.” Specifically, ask yourself, “Is this treatment futile?”
It is important to understand what futility is. Something is futile when it no longer does what it is supposed to do. For example, if the human body cannot process food any longer, then it would be futile to provide food.
In the case of a terminally-ill patient (as described in the question), continued feeding may still do what feeding is supposed to do; namely, provide nutrition to sustain life. Feeding is not intended to cure lung cancer. It would be illogical to discontinue feeding (which is doing what it is supposed to do) simply because cancer and the alertness of the sedated condition patient are not improved. In other words, the feeding form of “life support” is not futile and could be continued.
Caring for someone who is rarely able to respond and who has a diminished quality of life is difficult. We tend to compare it to the good times when health was great, conversation flowed, and all were happy. The contrast is sharp and painful. Yet, now is also the measure of our love – a willingness to give with little to receive, to sacrifice when there is little energy to even offer a word of thanks.
It is important at a time like this to see a purpose that goes beyond the circumstance. The Apostle Paul reminds us of the ever-present desire to “be with Christ, which is better by far” (Philippians 1:23). As the hardship of life increases so also does the believer’s awareness of God increase and what he has in store for eternity (Romans 8:18; 2 Corinthians 12:9ff; 1 Peter 2:19). Through it all, we are still lights shining in a sin-darkened world (Matthew 5:16; Philippians 2:14-16). Others observe our love, hear our words, and see our faith and hope in action. Hopefully, such displays of faith prompted onlookers to ask us for the reason for our hope (1 Peter 3:15).
In summary, your display of love is a testimony not only of a child’s love for a parent, but of one’s desire to do God’s will. Your respect for God’s dominion over life and death (Deuteronomy 32:39) compels you to help, care, feed, cleanse, comfort, and visit the ailing and dying (Matthew 25:35ff). You will not want to do anything to hurry death by stopping care that is working (i.e., feeding, antibiotics, etc.). At the same time, when these measures prove genuinely futile, and you have death being truly imminent, these measures can be stopped. Until then, continue to love and care by sustaining and protecting life.
ANSWER: While suffering serves a purpose (Romans 5:3-4) we are also obliged to ease the suffering and hardships of others where we can (Matthew 25:31ff).
For the most part, the medical profession claims to be able to alleviate pain. When a patient complains of being in continual pain and not finding relief through the current doctor, then it is advised that the patient find a different doctor more equipped to provide pain relief. The challenge is finding the medical professional with that skill. That is why seeking a different doctor is in order.
The area of some controversy is the application of pain relief medication to such a point that it causes death. When done intentionally to cause death it is often called “terminal sedation.” It is contrary to God’s command to intentionally cause death (Exodus 20:13).
Medicating to relieve pain always carries with it an element of risk. If you have ever gone into the hospital it is customary to receive a phone call the night before warning you of the risks related to your surgery and particularly related to receiving anesthesia. So, taking pain medication, and especially undergoing aggressive pain relief therapy has an increased risk of death. A Christian will want to weigh the risks and benefits carefully.
The area of concern, however, is when a Christian decides to reject God’s command not to take life (including one’s own life) and to seek aggressive pain management with the specific intent to shorten life. Then you clearly have sin and a risk to the soul. Otherwise, seeking pain relief is something to be encouraged.
In summary, a Christian can serve God and others by seeking medication for relief from pain and suffering but never with the ultimate intention to cause death.
Because of our faith-perspective, we approach end-of-life care and decision-making differently than the rest of the world.
Our Role: Each of us is a steward over the many blessings that all come from God. One of those blessings is life. It is given by God and He, alone, reserves the right to terminate life (Deuteronomy 32:39). As we rightfully wrestle for how best to manage our time, talents, and resources to the glory of God, so also do we make decisions regarding the care of life with that same concern (1 Corinthian 10:31). Simply put, even decisions like “pulling the plug” are first and foremost a stewardship question of managing God’s blessings to his glory.
God Gets His Way: Our times are in God’s hands (Psalm 31:15). It is easy in the highly emotional setting of making “plug” decisions about someone to think we have all authority over life and death. There are many times when plugs have been pulled and the patient lived or when all the right medical things were done and the patient died. God always gets his way. God does have a time of grace for all of us to live in this life not just to come to faith but to also live that faith (Hebrews 9:27; Philippians 1:23-24) and in our role of caring for each other (Philippians 2:1-5) the obstacles and challenges we encounter provide opportunities for us to demonstrate our love for God (1 John 5:3).
Pain: Today most pain can be managed. A standard mantra in medical circles is, “If your doctor cannot control the pain then find another doctor.” It is increasingly rare that pain cannot be managed.
Life Support Technology: Don’t forget that many people whose lives we enjoy are living because of the blessing of life support technology. There is our cousin who was “put back together” after the terrible car accident and is now doing great. There is Grandma who takes her blood pressure pills every day to sustain her life. There is the surgery your wife had to deliver your child because there was a problem with the way the baby was situated in the womb. Technology is one more blessing God gives to help us in our stewardship over other blessings.
How Far Do We Go?: This is the BIG question. When can we tell if God is seeking to take this life home, or is it a challenge placed before us to manage? It is often easier to tell when God is taking someone home than you might think. In the dying process, there is generally a cascading series of events that occur with organs failing. The doctor may advise you that ventilator support makes it easier for your loved one to breathe, but his kidneys and liver have begun to fail and it is adding strain to his weakened heart. Those are the kinds of signs that strongly suggest this person’s time on earth is coming to an end.
Quality of Life: What increasingly becomes the issue is concern about the quality of life a patient would have if he or she continued living. This may be a stroke patient who suffered oxygen deprivation to the brain that resulted in some brain damage. Tube feeding has been used because the stroke left him unable to orally eat or drink at this time or perhaps permanently. The doctor might advise “letting him go” because of the brain damage. A good question to ask at this time is, “if we do not withdraw the tube feeding what would happen?” If the doctor believes the patient would still die in a few days then he is suggesting there is a declining condition here in which the tube feeding isn’t even doing anything to sustain his life. Death will come shortly with or without it. The doctor, however, may instead say, “if we keep feeding him like this he could live weeks, months, or even years.” Then you have your answer because the patient is not dying. Rather, the patient has suffered a decline in the quality of his life. We are not permitted to hurry life’s end simply because it has lost quality. The patient may prefer to be dead rather than to live like this. The family may prefer the patient dead rather than live like this. But we are never permitted to bring death simply because we are dissatisfied with the quality of our lives. Even for the bedridden person who cannot communicate there is a purpose to that life. Sometimes that purpose to life is to be a witness of acceptance of the challenges that come into life (Psalm 46:10) and sometimes that purpose in life is to be the object of concern and care for others so that they might learn or demonstrate their love for God by caring for the patient. We must be ever-mindful of how differently God presents us with circumstances that might allow us to share our faith and hope in Him (1 Peter 3:15).