Some patients fought a long, hard battle; some a short and unexpected one. As I saw each of them reach the final stage in life when the battle against death was clearly lost—when nothing effective could be done—I faced tough options in their continued care.
When a patient had lost the ability to make his own decisions, in particular, my heart’s desire was to choose the option that the patient would have chosen for himself. But how could I know that?
The advances in modern medicine over the past few decades are truly awe-inspiring. New medicines, new surgical techniques, and new diagnostic methods have benefited countless patients. Where many would have died before, there is now hope. However, despite medicine’s advances, death ultimately cannot be avoided.
So while the progress of medicine is in itself a good thing, it has also brought about some difficult ethical concerns. Physicians are increasingly faced with decisions about which interventions are appropriate in patients who are near death. Simply put, “How much is too much?”
This issue has spurred many patients to voice their desire not to be kept alive by “artificial means.” They most often express their concerns in “living wills.”
At first glance, a living will would seem to be an excellent method for a patient to maintain some degree of control of the circumstances at a very critical time in his or her life. So what’s the problem? Well, potentially there are several.
Withholding air, food, and water. First of all, living wills can contain terms such as “terminal illness,” “no hope of recovery,” and “life support.” These terms are not very specific and are often interpreted differently by different people.
For example, how do you define “life support”? A device such as a mechanical ventilator can be easily understood as life support, and people often express fear of being “kept alive by a machine.” However, mechanical ventilation is not necessarily an end-of-life decision, and the possibilities for recovery may be unclear at the time of the critical decision to safeguard the patient’s life with the ventilator.
Furthermore, in today’s medical environment, some physicians have come to view even food and water as “life support” in certain situations. Food and water hardly constitute advanced medical technology. Withholding food and water from anyone, healthy or terminally ill, would soon cause death.
No chance of recovery. Sometimes doctors can be relatively certain about the imminent nature of a patient’s death—at the end stage of an advanced cancer, for example. Quite often, however, the doctor cannot be sure of a patient’s likelihood of recovery or the extent of recovery. (Therein lies another dilemma. If the patient is not expected to recover fully, does that justify withholding treatment?)
No chance to change your mind. Patients often make decisions about their future health care when they are well, and then they completely change their mind when those decisions have to be implemented in real life. So, if a sudden catastrophic event or illness occurs, how can we be sure that an incapacitated patient would still want to abide by the terms of his living will?
Some of these dangers can be minimized by spelling things out in great detail. However, given the frequent leaps in medicine and its technology, even the most complete living wills cannot cover every potential scenario.
Along with these practical concerns, Christians need to weigh other biblical issues about right and wrong.
When Should a Christian Consider a Living Will?
Do we have a “right to die”? Are our lives really our own? The answer to both these questions is, “No!”
The lives we live here on this earth are not ours. They belong to God, who gives us the breath of life (Genesis 2:7). Paul told an Athenian audience, “In Him we live and move and have our being” (Acts 17:28). Our lives are a gift from Him.
1 Corinthians 6:19–20 asks, “Do you not know that your body is the temple of the Holy Spirit who is in you, whom you have from God, and you are not your own? For you were bought at a price; therefore glorify God in your body and in your spirit, which are God’s.”
There can be a fine line between comfort measures and euthanasia. We must be careful not to allow a living will to cross that line.
These verses clearly indicate that our lives do not belong to us.
Does that mean that we must suffer needlessly at the end of our lives? Can we ever say “enough is enough?”
God created us as rational beings. We have the ability to reason and understand circumstances in our lives. As we must all “return to dust” eventually (Genesis 3:19), there will come a time when the dying process is irreversible, a time when further medical intervention will not stop the inevitable.
We have the right to refuse heroic interventions that have little or no chance of altering the dying process. However, such decisions must be made prayerfully, with extreme care and thought, not hastily.
If you ultimately decide to prepare a living will, you must ensure that the instructions will not allow for actions or interventions to prematurely end your life. Such actions, known as euthanasia, are a form of murder and violate basic biblical principles about our unique position as beings made in God’s image (Genesis 9:6).
These actions can include a variety of interventions ranging from starvation to disconnecting life-sustaining equipment. Such actions may be sanctioned by a living will but nevertheless constitute murder. A Christian should neither sanction nor demand that his caregivers commit an immoral action on his behalf.
There is sometimes a fine line between comfort measures and euthanasia. The Christian must not allow his living will to cross that line.
What is a Living Will?
A living will (sometimes referred to as an “advance directive”) is a document that describes a patient’s wishes with regard to his health care in the event he is incapacitated and unable to make decisions. This document is designed to allow the patient to describe in advance which interventions he deems acceptable. Most often these instructions deal with the patient’s desire not to be kept alive by medical technology should there be no hope of survival, but they can also express the opposite desire—to receive all available care.
There are numerous forms of living wills. Some are quite complete while others are very basic. Also, the forms vary from state to state. A complete discussion is far beyond the scope of this article, but the Internet offers numerous sites where the reader can obtain more information.
An associated document called a “durable power of attorney for health care” (sometimes included in the forms for the living will) designates a person to make medical decisions should the patient become incapacitated. In lieu of this health care power of attorney, medical decision-making generally falls to the next of kin.