A Biblical Perspective on End of Life Issues
How should Christians come to the end of life? What is the appropriate use of technology to prolong life? How can we assure that when our time to die comes we will do it in answer to the call of God rather than because all of the technology of modern medicine has been exhausted?
I was about ten years into an internal medicine practice. I had just completed my boards in Geriatrics and was beginning to slant my practice in that direction. The net result was that I was helping a lot of people through the end of life. Many of my patients were Christians. They were teaching me what it meant to come to the end of life well. I recall three situations specifically.
First was Howard Hawkinson, a godly man whom I had known for a number of years. He had spent his life serving the Lord. Howard was a founder of the Awana movement. He had been a diabetic for years and had a failing heart. One Sunday he had one more in a series of heart attacks; by Monday afternoon it was clear that he could not live much longer. I went down to see him that evening in the intensive care unit. I told him that I felt the Lord was taking him home and that it may well be that night. Weeks earlier he had made it clear that he did not want any life saving or prolonging interventions. He was not interested in another bypass surgery and did not want CPR. He said that he had three simple requests. First, he told me “Your visiting policies stink here. You tell me I am dying and my wife and daughters are out in the waiting room.” Second, he had followed his diabetic diet for years but wondered if we could get him a piece of chocolate cake with chocolate icing. Third, with his bad heart he had stayed off all caffeine, but could I get him a cup of real coffee?
We did all three; his family joined him and the nurses ran out to get the cake and brew a fresh cup of coffee. He had the cake and coffee, said good-bye to his family, lay down, and within minutes was in glory.
There was no need for CPR or ventilators; he was ready to go and wanted to do so peacefully. When it was all over I came away saying, “Yes, that is the way I myself want to go.” It seemed like this was living life to the very end to the glory of God. It was an affirmation of the gospel. It was not embracing death as a friend but, yet, at the same time it was not the sort of fight to the finish that can practically deny the fact that in Christ death has been defeated.1
Second was a man we will call “Tom.” Tom was in his nineties and a bit of a recluse. He would walk down the street periodically to attend the neighborhood church. One Sunday late in the year he mentioned to the pastor that when his time came he wanted to die in church, a curious statement to say the least. About a month later Tom showed up in the back of the sanctuary on a bitterly cold Sunday afternoon when the choir was practicing and proceeded to collapse in cardiac arrest. “911” was called, and after some delay he was “resuscitated.” I was called later from the E.R. by the doctor working there who told me “John, we have a save for you!” I heard the story and inwardly groaned. Tom was in the ICU for a week. No family, no advance directives, and in the early ’80s no clear direction as to how to terminate life support in a situation like that. He eventually died in a way that I felt was tragic. It was a fight to the finish and then some. It was hardly an affirmation of the gospel. It was not what Tom wanted.
The third event was a cartoon that appeared around that same time. It depicted an old codger arriving at the Pearly Gates with a tube hanging out of every orifice telling St. Peter, “Sorry I’m late but they kept me on life support for two weeks.”
How should Christians come to the end of life? What is the appropriate use of technology to prolong life? How can we assure that when our time to die comes we will do it in answer to the call of God rather than because all of the technology of modern medicine has been exhausted? These are difficult questions. We will not find easy answers. We must never trivialize them. Nevertheless, I believe that if we immerse ourselves in the Scriptures and truly begin to think biblically, we will emerge with some perspectives that will help us through these quagmires.
I would like to share some perspectives I have gained through studying the Scriptures and learning from a number of godly patients:
1. We can live our lives to the very end to the glory of God.
Paul desired that “…now as always Christ will be exalted in my body whether by life or by death” (Phil. 1:20). Paul had a passion to end his life to the glory of God. I believe that can occur when we help people to slowly give up on the things and values of this world and begin to embrace the values of eternity. People can lose the self-focus that seems to be the default for our culture and focus more on the Lord. So much of the fear and worry associated with the end of life is, at heart, an inordinate focus on self. Focusing on God will diminish fear.
2. All of the “downers” of the end of life, including pain, suffering, dementia, and the losses associated with age are under God’s sovereign control and will be used to accomplish his glory.
The Psalmist wrote: “One thing God has spoken, two things have I heard: that you, O God, are strong, and that you, O Lord, are loving.” (Ps. 62:11-12). If we believe that God is able to deal with all situations (he is strong), and that he cares for us (he is loving), we are forced to conclude that he has purposes that go beyond our understanding.
God’s purposes must be seen from an eternal perspective. He is using the difficulties of the end of life to discipline us and to transform us into his own image. God may call us as Christians in medicine to help in this process as we minister spiritually to those who are hurting. We need to pray for his wisdom to appropriately reinforce the spiritual lessons that he is teaching our brothers and sisters who are suffering.
3. End of life decisions must preserve the biblical tension between death as an enemy and a defeated enemy in Christ.
Scripture presents death as an enemy. It is a result of the fall and belongs to the domain of Satan. However, the good news is that Satan and death were both defeated at the cross. Christ has redeemed death and can now use it to accomplish his glory.
Life is precious and death must never be embraced as a friend. Nevertheless, it must never be feared as an undefeated enemy. We have been blessed with wonderful technological advances that allow us to preserve life. We must use that technology wisely. Paul longed to die to go to be with the Lord. He recognized, however, that he was still able to serve others. He was quite happy to be kept alive “For your progress and joy in the faith” (Phil. 1:25).
Perhaps we see in his life an example of when we should use technology to pursue life. I desire to prolong my life so long as I am able to serve others. Someday that may mean I will be in a disabled condition and my service will be praying for others. Once my life is no longer able to serve others, I desire to “depart and be with Christ” (Phil. 1:23).
4. Death for the believer must never be viewed as an end; rather, in the context of resurrection, it is only the beginning.
Our true home is in heaven. The Lord will one day call us to our final home. We will continue the eternal task of enjoying the glories of an infinitely great God who has made us for himself. He will be glorified throughout eternity as we find our joy in him.
As physicians, many of us are daily interacting with dying people. This is a spiritually sensitive time where we can, through the Holy Spirit, significantly impact them for the glory of God. We must develop a vision to help people live the end of life to the glory of God.
Certainly this can be done with the individual patient and her family as life draws to an end. This is typically, however, not the time to teach deep theology. The end of life is when we should be offering our quiet presence and compassion. The church must equip people to make God-honoring end-of-life decisions long before they have to be made. This is an ideal way for Christian physicians to be involved in their churches. This is our “turf” and an area where we can comfortably be involved to the glory of God.
1 The family of Mr. Howard Hawkinson has given permission for this story to be shared.