Today we’re going to switch gears and do something a little different. I’m doing this because this is such an important issue, one that so many face. Today I’d like for us to talk about end of life issues. If you’re getting older, this is something you yourself may have to face soon. But even if you’re younger, you may be involved in this because you may have a loved one facing these issues. This is a very important issue to consider because our religious beliefs will affect how we make end of life decisions.
Everyone dies. No matter how healthy you eat, no matter how much you exercise, no matter how often you go to the doctor for check-ups, one day you’ll die. My wife has a little plaque at home that says, “Eat well, stay fit, die anyway.” Death is a part of life.
The Bible itself seems to have that attitude. Death, especially the death of an older person, is seen as a part of life. It’s interesting to look at the times the Gospels show Jesus healing people. The people Jesus healed were not portrayed as older and dying of old age related illnesses; they were people who were younger, and what Jesus healed them of was something that would have taken them before their time. There’s not a specific case of Jesus healing an elderly person who is about to die from something related to old age.
The Psalms, found in the Old Testament, have a lot to say about aging and dying. Psalm 39 says, “Lord, make me to know my end and what is the measure of my days, that I may know how frail I am.” Life is limited; it’s going to come to an end; old age and sickness are a part of life. Psalm 90 says, “The days of our lives are seventy years, and if by reason of strength they are eighty years, yet their boast is only labor and sorrow, for it is soon cut off, and we fly away.” A good lifespan is 70 years, 80 if you’re very healthy, but even then it flies by, and before we know it, our life is over. Psalm 144 says, “Man is like a breath; his days are like a passing shadow.” Life is short; it comes to an end all too soon.
All of those passages look at it like the normal course of things is that our life is but for a limited time. It’s not seen as something you can do anything about. The Bible sees aging and death as part of the normal course of life. There’s no place in the Bible that speaks of preventing that or says it’s something to be fought against.
And for most of human history, there was basically nothing anyone could do about it anyway. However, just within the past 30 or 40 years or so, that changed in a drastic way.
Modern medicine began offering numerous ways to intervene, and it began to seem like death does not have to be inevitable. While it might not be possible to stop dying altogether, modern medicine offers numerous interventions that have the promise of delaying death, sometimes for a significant time.
As a result, when people get older and are faced with the health problems of old age, which in the past would have soon proved fatal, they are now offered numerous treatment options. So what do you choose? These are called end of life decisions.
Many people don’t like to think about these things ahead of time. While we know that we’ll one day die, we like to keep that in the back of our mind and live as if we won’t die. But then suddenly something happens, and we have to make spur-of-the-moment decisions about end of life care. Or even worse, our loved ones have to make those decisions for us, and they have no idea what we would want. And of course all this is complicated by having to make these decisions in the face of a confusing maze of treatment options most people don’t understand. Until the point where someone is unconscious and death is imminent within minutes, there’s always some other medical intervention that can be tried, and it usually will be, unless the patient or the family stops it.
So what is the Christian position on end of life care? From a moral standpoint, what medical measures are you obligated to accept, and what medical measures can you refuse?
Unfortunately, the Bible does not speak to these issues. Obviously, modern medicine did not exist in biblical times. These things were not an issue, so there is no clear biblical guidance on this. For that reason, the positions of various Christian groups on these issues do not come from anything the Bible says about them specifically but are derived from other, more general, Christian beliefs.
But before we go on, I want to emphasize that from a legal standpoint, unless you are judged to meet the legal definition of mental incompetence, you can refuse any and all kinds of medical treatments. So as long as you are mentally competent, you are not legally obligated to have any kind of medical treatment whatsoever. So we’re not talking about it from a legal standpoint; we’re talking about it from a moral standpoint.
Some of the big decisions regarding end of life care are associated with what’s called life support. Life support is a generic term that includes various medical interventions that do not treat a disease itself but without which a person would die. Life support includes things like feeding tubes, kidney dialysis, supplemental oxygen, urinary catheters, resuscitation if your heart stops beating, ventilators, and heart/lung machines. As far as life support is concerned, most Christian groups are in agreement that no one is morally obligated to accept artificial measures that simply prolong life. But there is disagreement within Christianity as to exactly which life support measures are artificial measures that simply prolong life.
In general, most all Christians agree that ventilators and heart/lung machines are artificial measures that Christians are not obligated to accept, and so most all Christians agree it is not wrong to refuse a ventilator or a heart/lung machine.
However, there is disagreement about whether other forms of life support, like feeding tubes and dialysis, are artificial measures to simply prolong life. Some Christians say they are, and that it is OK for a Christian to refuse them. You can refuse to have a feeding tube inserted, for example, and that’s OK. You can refuse to have kidney dialysis, and that’s OK.
Other Christian groups, though, say they are not artificial measures to simply prolong life, and you are morally obligated to accept them if you would die without them. According to these Christians, you are morally obligated to accept a feeding tube, for example, and you are morally obligated to accept kidney dialysis. However, these Christians do allow exceptions. The way it’s usually put is something like “if the burden would outweigh the benefit,” then you can refuse it.
For example, assume you’ve had a stroke and can’t swallow. If you don’t allow them to insert a feeding tube, you’ll die. According to this position, you must have the feeding tube unless the burden of it would outweigh the benefit. Unfortunately, though, the precise conditions of when the burden outweighs the benefit are not precisely defined, so it’s open to interpretation. What one person would consider “the burden outweighing the benefit” might not be the same as what another person would think, so with this position, you can have disagreements about whether, in any specific situation, the burden does indeed outweigh the benefit.
There’s another issue some people face. You will only face it if you live in one of the states where physician-assisted suicide. Physician-assisted suicide is when, at your request, when you are terminally ill, a doctor prescribes a course of medication that will hasten your death. That is legal in some states.
In general, the great majority of Christian groups in the United States officially oppose physician-assisted suicide. A few smaller Protestant denominations, though, like the United Church of Christ, support it, and some of the smaller denominations that officially oppose it, like the Presbyterians and Episcopalians, use language that can be interpreted as leaving the door open for the possibility. But in general, most Christian groups in the United States oppose physician-assisted suicide. Their position derives from the idea that suicide is wrong. Intentionally doing something for the purpose of hastening your death is seen as the same as suicide, which is seen as wrong. Most people, though, won’t have to deal with that issue, because it’s legal in only a few states.
However, an issue related to that, that people everywhere might have to deal with, is medication given near the end of life for comfort measures. Some medications commonly given near the end of life to relieve pain, ease breathing, or in general make a person more comfortable have the side effect that they might lead to an earlier death. Those medications tend to slow down the body processes, which can lead to an earlier death. Is it wrong, then, to take those medications?
In general, most Christians agree it’s OK to take them. Most forms of Christianity do not see that as intentionally hastening death. It might hasten death, but that’s seen as just a possible side effect. The intent is not to hasten death; the intent is to alleviate symptoms and provide comfort. Most versions of Christianity agree that medications for comfort measures are acceptable even though they might hasten death, because the aim is not to hasten death, the aim is to provide greater comfort.
But the issue of it being wrong to intentionally hasten death opens up another issue. Let’s say you go to the doctor and find out you have cancer. The doctor offers you treatments and tells you that you might have six months to live if you do nothing, but you might live two years if you have the treatments. Are you morally obligated to have them? This is a situation many people face.
Remember we saw earlier that most Christians, with few exceptions, say it is wrong to intentionally hasten death. So, if you have six months to live without treatments, but you might have two years to live if you have treatments, are you intentionally hastening your death if you refuse the treatments?
Some Christians say no. They make a distinction between actively doing something to intentionally hasten death and just passively allowing the normal process of a disease to run its course. To them, intentionally hastening death means actively doing something to make yourself die, like, for example, if you live in one of those states where doctor assisted suicide is legal, going to a doctor and asking for a prescription for medication that will kill you. But they see refusing treatments and just letting the cancer run its course as being different. By refusing treatments, you’re not actively doing anything to hasten your death; you’re just letting the cancer kill you naturally. So to these Christians, refusing treatments is not wrong. It’s not actively doing something to intentionally hasten your death; it’s just passively letting a natural cause kill you. And so, according to these Christians, you are not morally obligated to have treatments.
Other Christians, though, strongly disagree. They say that if you do not have the treatments, you are in effect committing suicide, so you are morally obligated to have the treatments. In general, though, these Christians do not say you are obligated to have every available treatment up until the moment of your death. They go back to the same thing we saw related to things like feeding tubes: You are obligated to have the treatments unless the burden outweighs the benefit. Just as we saw, though, with feeding tubes, the exact conditions under which the burden outweighs the benefit are not specified, and different people will interpret it differently. One person may genuinely feel that, considering the possible side effects of chemotherapy, having any kind of treatments at all imposes a burden which outweighs the benefit, while another person may feel that a burden which outweighs the benefit is not imposed unless the treatments have a 95% chance of killing you before the cancer would. So again, we see that the position about the burden outweighing the benefit is open to a wide range of interpretations.
So far we’ve seen only a little bit of agreement among Christians related to these issues. Mostly, we’ve seen disagreement. That’s because the real issue behind all of this is whether or not, from a Christian standpoint, you are morally obligated to accept medical treatments. It doesn’t have to be cancer. It could be anything. It could be installing a shunt in the brain, it could be an organ transplant, it could be coronary bypass surgery—any kind of medical treatments. Are you morally obligated, from a Christian standpoint, to accept medical treatments? That’s the real question Christians disagree on.
Some Christians say you are not obligated to accept medical treatments, even if those treatments would save your life and you would die otherwise. According to these Christians, medical treatments are an available option, and it’s up to you to decide if you want them are not.
But other Christians disagree and say that, from a moral standpoint, you must avail yourself, up to a reasonable point, of all the help medicine has to offer, and if you don’t, it’s the same as committing suicide. Why do they take that position? Well, let’s think about it.
What we know as modern medicine had its beginnings in the 1800’s in Europe and soon became connected with Christianity during what’s called the Foreign Missionary Movement. This was a great foreign mission push in Christianity that began in Europe in the 1800’s as an outgrowth of European colonialism. One of the main ideas behind European colonialism was that European society was superior to any other society in the world, and Europe saw its mission as to Europeanize the world—to export all of European society to the rest of the world.
The Foreign Missionary Movement reflected that. Christian missionaries did not just try to convert people to Christianity; they tried to convert people to the European way of life, and modern medicine was seen as part of the European way of life. The first Christian medical missionaries went to China, then to Africa, and eventually, medical missions grew to comprise one of the largest components of Christian missionary work.
This led to a linking of modern medicine and Christianity to the point where many Christians saw modern medicine as an arm of Christianity, and doctors were regarded as having almost ecclesiastical status within Christianity, status akin to, or even higher than, priests. People began to regard doctors as the very arm of God in the world, and many doctors began to regard themselves as the very arm of God in the world. Modern medicine began to be viewed as a part of Christianity itself, and medical work began to be seen as Christian work.
A number of years ago, I went to a class about a form of alternative medicine. People had come from all over the United States for this class. There was a man and woman in the class who worked for one of the largest evangelical organizations in the country, headed up by arguably the most well-known and best respected Christian evangelist in the world. As the day went on, it became apparent this man and woman were having trouble even listening to what the instructor was saying. They started asking questions, questioning the instructor at every turn. This went on for some time, and finally they ended up flatly telling the instructor that what he was saying was evil, pure evil.
But yet this was not a religious class at all, not connected to Christianity or any religion, and what the instructor was saying was not in any way connected to religion. Why were they convinced it was evil?
Then it finally dawned on me what was going on. This man and woman worked for this huge evangelical Christian organization, and one of the main things this organization did was medical missions. You see, they believed modern medicine was so much a part of Christianity that anything outside of modern medicine must be evil. Modern medicine and Christianity, to them, were so linked that anything that criticized modern medicine and went outside modern medicine was just plain unchristian. It had to be! Criticizing modern medicine was akin to saying that the Virgin Mary was a whore.
This linking of Christianity and modern medicine is the main reason some Christians take the position that we have a moral obligation, from a Christian standpoint, to avail ourselves of all that modern medicine offers, to the point where rejecting something modern medicine offers is seen to be morally wrong. In other words, the belief is that God is at work in modern medicine to the extent that if you reject a treatment modern medicine offers, you are rejecting God Himself.
According to this idea, if you get cancer, for example, you are morally obligated, from a Christian standpoint, to pursue every treatment option, within reason, that modern medicine offers, and not doing that is tantamount to suicide.
But as we talked about earlier, other Christians view what modern medicine offers as options. It’s there if you choose to use it, but you are under no moral obligation to use it.
There is disagreement within Christianity on this issue, but most Christians do believe you are under the obligation to accept any and all reasonable medical treatments. It’s only a very small minority of Christians who believe those medical treatments are options and it’s OK to refuse them. As we’ve seen, there’s nothing in the Bible that specifically addresses this issue, so there’s nothing specific in the Bible we can point to to clear it up. This makes it difficult for us, who one day may be faced with making end of life decisions. There’s no agreement within Christianity, and there’s nothing specific in the Bible.
In the end, I think we have to consider the Christian conception of death. A Christian conception of death is not that death means it’s all going to end; it just means life is entering the next, and most glorious, phase. Rather than orienting our entire lives around delaying death for a short time, we should orient ourselves towards our future beyond death. We should not place our ultimate trust in a system which, at tremendous cost, can only offer us the possibility of briefly delaying what is inevitable. We should place our ultimate trust in a God who has made death of no consequence. Do we want to orient our entire lives around possibly extending our life for a few more years, and possibly bankrupt our families and children in the process, or do we want to orient our lives around that which is able to make death of no consequence for all eternity?