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FOREWARD
Elizabeth Skoglund and I first visited in 1996 after
I read her book, Life on the Line, published by Billy Graham’s World
Wide Publications. The book became a powerful resource for me in my own
writing and speaking. Elizabeth’s understanding of God’s love for life
matched my own. Although we have yet to share a cup of coffee, we’ve
enjoyed a long distance friendship between California and Iowa which only
God can nurture.
Every now and then, Elizabeth and I confess that we
would gladly relinquish the burden of life issues such as abortion and
euthanasia so that we could direct our attention to happier topics. In
spite of our personal desires, the Spirit encourages us to speak up and
persevere. As a young girl, I was captivated by the stories of those who
survived the Nazi Holocaust. I believe that God was preparing me for the
pro life mission field in which I find myself today. Elizabeth’s knowledge
of the Holocaust is more personal than mine. Both of us, however,
recognize the significance of individual faithfulness.
It was, after all, not an organized church body that
stood up to defend life in Nazi Germany but members of the Body of Christ.
Before I Die is a
work of God. As He so often does, God brought together two of His children
and orchestrated a particular work for a particular time. His Word
transcends organized religion. I am a born and raised Missouri Synod
Lutheran. Elizabeth was raised by a Baptist and Moody Church mother and a
Mission Covenant Church father. Her aunt was a missionary in China.
Although Elizabeth has worshipped as a Plymouth Brethren and she attends
University Bible Church, I recognize the influence of her Swedish Lutheran
roots. In fact, her granddaughter attends a Lutheran school!
The relationship that Elizabeth and I share has
grown into the book you hold in your hand. It is a book written for those
who love the life that God has created and for whom Christ Jesus has died.
It is a book for individuals and families who seek to do God’s will when
faced with difficult decisions of life and death. Before I Die is a
tool for all who live, love, and serve in Jesus’ name. May yoube "joyful
in hope, patient in affliction, and faithful in prayer" (Romans 12:12).
Linda D. Bartlett, President
National Lutherans For Life
Dedication
To Beverly West,
For whom each day had deep meaning.
Whose transition to Heaven was seamless and in God’s
timing.
After our family moved to California from Chicago,
my mother’s three sisters and a brother-in-law moved here too. Within a
short while, Sunday afternoons began to be times when the whole family
would gather at one or another of the homes. For me as a child growing up
it meant lazy Sunday afternoons playing with pets, taking walks, picking
fruits and vegetables with my aunt Esther, and always having a special
Sunday dinner. At my aunt Lydia’s home I could play her organ, rummage
through her cedar chest of treasures, or get a Swedish massage from one of
my two aunts who had that training. Sometimes Aunt Lydia would wash my
long hair with a special shampoo. One time from the secrets in her cedar
chest she gave me a wonderful pendant watch which had belonged to her
sister Hannah who had died in childbirth many years earlier.
During these years, and even after I was grown up,
life seemed frozen in time. I along with several others in my family was
young. A few were older, or even old. The rest, like my parents, were at a
perfect age for me—old enough to be wise and helpful, young enough to be
steadfastly "there." And Death was not an issue, not for me. Aging wasn’t
either. On some superficial level I felt things would go on like they were
forever. Things would remain as they were for too long to worry about. Yet
paradoxically, my lifelong fear since childhood had always been the death
of my parents.
Then in 1973 the deaths started, each bringing with
it increasing ethical issues for me as the available technology escalated
and as I became older and more in charge. In 1973 two of my aunts died and
then my father. Others followed in the next few years. After the car
accident which killed my mother in 1980, my aunt Lydia barely survived.
She went on to live for five years as the last leaf on that generation of
the family tree. Starting before the accident, she had a total of three
hip fractures in her lifetime. Since she had severe Osteoporosis she had a
diminishing chance for ever walking again following each of these
incidents. After the last fracture, I asked the orthopedic doctor
directly: "Are you saying she can’t physically walk again or that she
won’t be able to push herself that hard?" "The latter," he replied. With
the help of a very good physical therapist Aunt Lydia walked once more.
Since the accident she had given up her apartment
and moved in with us. Once after the accident when she was close to death,
and again after the third hip fracture a couple of years following the
accident, Aunt Lydia told me she was going home to be with the Lord. "Not
yet" was our response. Each time, Aunt Lydia started walking and playing
her organ again. Sometimes she would stare out the window, commenting on
her favorite trees outside. She was back.
It was the summer of 1985, when she was
eighty-seven, that Aunt Lydia began to slip away. Somehow we all knew that
this time she would not recover. It was a slow process, imperceptible to
most at first. But then dehydration turned it into a crisis, with
paramedics and ultimately a young Emergency Room doctor. He meant well but
aggressively performed invasive tests on a woman who was dying, not from a
disease which could be arrested or cured, but from a gradual, systematic
shut down of her organs. I had just gotten my new computer which when
turned off died very slowly. She reminded me of that computer.
The next day when I came into her hospital room,
Aunt Lydia stated factually, "I’m dying!" I saw how dry her mouth was and
got up to get her water. She started to try to stop me. I reassured her I
was not going for help. I was just getting water to make her more
comfortable. She relaxed.
At this point my own crisis hit. A nurse walked in
and motioned me out of the room. "Do you want to put a ‘no code’ on her,"
she asked. "If they do a ‘no code,’" she explained, "with her severe
Osteoporosis every bone in her rib cage will break. And once we put her on
a respirator it will take a court order to get her off." (That was the law
at that time.) She showed me a room of patients just lying there, heavily
sedated, tubes protruding from their bodies. It was up to me to make this
choice. I was the only one left to speak for her. One thing was
reassuring. She and I had a deep faith in God and the Bible. She would
want what was right before God, and so did I. But I needed to get out of
the hospital in order to think.
As I walked out into the hospital parking lot I was
in agony. I remember thinking: "I’m just doing research on this very topic
for a book, and I can’t even face a real life situation in my own family."
I have a firm belief in the sacredness of life. Was what I was considering
passive euthanasia? The thought was unbearable.
I ended up at Bob’s Big Boy, a coffee shop which was
a throwback to my childhood. I even ordered our teenage after-school
choice: french fries and a cherry coke. And there in this unlikely
sanctuary for prayer, I prayed. Then with the suddenness of divine
inspiration I had my answer: only God has the right to choose the length
of a person’s life, and only God can choose the time of death. A Bible
verse impressed itself upon my mind: "...All the days ordained for me were
written in your book before one of them came to be." (Psalm 139:16, NIV)
If it is wrong to cut life short, I reasoned, it is also wrong to prolong
the dying process beyond God’s timing. Aunt Lydia was dying. Nothing could
prolong her life, just the length of the dying process. I was at peace.
One thing I learned from my decision regarding my
Aunt Lydia is that the right and wrong of medical ethics are not always
easy to discover. Many, on the far right and the far left both, make
everything into an absolute. Some things are absolute. But in the
gray areas in between, many times one must make a unique decision. For
every human being, every disease, every treatment, and every death are
unique in combination. For me, with my Aunt Lydia, without Divine guidance
I would have been lost.
After making my decision at Bob’s, I felt an urgency
about calling the hospital. On the phone I told the doctor to put a "no
code" on her chart. He brought two nurses to witness what I said. Then I
found out that Aunt Lydia was just going into a "Code Blue" when I called.
I raced to the hospital, ran to the elevator, and got there about five
minutes too late.
When my other relatives had died I had never viewed
their bodies because I wanted to remember the last images of life, not
death. This time I stood at the foot of her bed and looked at her. All
that made up her aliveness, her personality, was gone. She had left, and
only her body remained like an abandoned vacant house. I need not have
worried. My images are still of her alive as she was and as she is even
more in Heaven.
The Dilemma
Fifty years ago medicine had one clear-cut goal:
save lives. When a person went to a physician for treatment, he or she
knew that the physician would try to heal. There were virtually no gray
areas and certainly no reason to fear rationing of medical services or
even the suggestion that the patient might have a choice between life and
doctor-assisted suicide.
Today high-tech medicine, which by the use of
machines can provide the appearance of life to an otherwise dead body,
combined with the devaluation of human life presents a potentially
dangerous moral/medical dilemma to the average patient.
Since the Supreme Court decided Roe v. Wade
and Doe v. Bolton, taking a human life has become easier. If you
can abort a fullterm baby, or even one who is still in the first trimester
of gestation but already has his or her own unique set of fingerprints, it
becomes easier to contemplate euthanizing the old and depressed or those
who suffer from painful terminal diseases.
We are confused in our logic. We give a woman the
right to choose over her own body, forgetting that in so doing that little
being inside of her has no rights at all. We grant the right to choose
with regard to a woman’s body and abortion, but we still prosecute that
same woman for abusing her body in a way which hurts the health of that
unborn baby whom she could still abort. We permit a woman to choose
abortion because we grant her the right over her own body and yet we do
not grant her the right over her own body in heroin addiction. It is no
wonder that child abuse increases when before birth that abused child
could have been killed. Furthermore, how can we value life at any point in
its existence when we do not value it when it is in the womb?
At times even Christians seem uncertain as to
whether or not a child who is still in the womb is really a human being.
There is a striking statement on that subject in a paraphrase version of
Ecclesiastes 11:5. The interpretation in this paraphrase may well be based
on older Jewish commentaries. "God’s ways are as mysterious as the pathway
of the wind, and as the manner in which a human spirit is infused into the
little body of a baby while it is yet in its mother’s womb."(Living
Bible) Or, as quoted in God’s Word to the Nations: "Just as you
don’t know how the breath of life enters the limbs of a child within its
mother’s womb, you also don’t understand how God, who made everything,
works." To relegate that child to anything less than an eternal being is
dangerous, since such a distortion makes it easier to abuse or kill.
A diabolical statement by a German judge in the
October 1938 issue of Deutsche Justiz, relegating the Jews to a
category of non-human, further enabled the attempted annihilation of the
Jewish race. To decide that someone at any age is non-human is to open the
door to atrocities against them. Yet in spite of the illogic and
immorality of viewing any human being as non-human, we still face a moral
dilemma in the minds of many. Some still ask when is life valuable and
when and for what reasons can we take a life? And if we convince ourselves
that we can kill the very young, where are the boundaries at the end of
life?
In all fairness, it is not evil people who agonize
over the end-of-life issues. Evil people have ceased to see them as a
problem. It is more often the good, the innocent, the trusting, the
uninformed who face end-of-life decisions with more questions than
answers. What follows is an attempt to guide such a person through issues
which may arise for them, coupled with biblical principles which provide
help.
Principles for the Christian at Life's End
Because at times even the very definition of death
itself is blurred, the safety of black and white absolutes is not always
available. But for the Christian, biblical principles applied carefully
under the direction of the Holy Spirit provide the needed guidelines.
Years ago a wonderful, godly Bible teacher used to
come periodically from England and preach and conduct Bible studies. One
simple statement which he often reiterated was that along with its primary
function as the revelation of what God has done to accomplish our
salvation through Christ’s sacrifice on the cross, "The Bible is a book of
principles." Two of those principles which have been included already are:
1. God alone controls the length of our life.
2. God alone establishes the time of our death.
The logical conclusion from these principles is that
we as human beings are not free either to cut life short or to
artificially prolong the dying process.
The Old Testament figure Jonah is a good example of
how God views the idea of man choosing his own time of death. When Jonah
finally got to the city of Ninevah, he preached and they repented. Because
of their repentance, God turned away his wrath and did not punish them.
Jonah was not so quick to forgive, however, even though he had had his own
share of rebellion. The result? Jonah wanted to die and God patiently
dealt with him, not by granting his wish but by pointing out its
foolishness.
Furthermore, in the New Testament we are told that
we are not our own, but that we are the temple of the living God. (1 Cor.
3:16) If we belong to God by virtue of creation and redemption, it stands
to reason that we are not granted the right from God to choose when we
live or die. Nor is any other human being granted that right over us. We
are made in the image of almighty God Himself, and it is a terrifying
thought to deface or destroy that image. In speaking to Noah, well after
the Fall of Man, God says, "‘Whoever sheds the blood of man, by man shall
his blood be shed; for in the image of God has God made man.’" (Gen. 9: 6,
NIV) God says also, "All the days ordained for me were written in
your book before one of them came to be." (Ps. 139: 16, NIV) Your
life, and mine, are in His time and are not to be diminished by mortal
man.
Quality of Life
In today’s medical arena, however, "death" and even
"life" become blurred in definition. Some say that if the so-called
quality of life is "poor," the person isn’t really living in the true
sense of that word. Of course, those who think that way differ on what
they consider "good quality of life." Some believe that old age or
crippling diseases qualify as reasons to die. Others wait for life
sustained by machines or nutrition supplemented by feeding tubes.
Additionally, a definition of good or bad quality of life can change
rapidly as circumstances change. Many people have appealed to the courts
for a cessation of treatment or right to die only to change their minds
and decide to live by the time the court decision was made.
Giving up is not a 21st Century concept. In the Old
Testament of the Bible, when Elijah was tired, pursued by his enemies, and
worn out from his work, he sat down under a tree and told God, "I have had
enough, Lord. Take my life..." (1 Kings 19: 4, NIV) At that time
Elijah didn’t think much of his "quality of life." But he didn’t kill
himself, or get someone else to kill him. He prayed to the Keeper of Life,
God Himself, to take him. Then he slept. Later an angel fed him and he
slept again. Then the angel woke him again and fed him and sent him on to
do God’s work. What had seemed to Elijah like the right time to die was
not in God’s timing.
"But," you might argue, "Elijah could still work.
His life had value." God does not determine the length of a person’s life
by a human perception of the value of that life. He who notes each
sparrow’s fall and counts the hairs on our heads is very precise about the
length of life of each being whom He creates. He gives life and He takes
life. He is the Lord of Life. We, on the other hand, were originally
created for fellowship with Him. How do we know that our most glorious
moments from an eternal point of view might not be when we lie,
unconscious to the world, communing with and worshipping God in a way
which will have vast eternal implications. For God does not waste His
servant’s time—or his pain. "Will not the God of all the earth do right?"
(Gen. 18:25, KJV)
Sometimes a person who seems to have no meaning in
life may have profound meaning. A man sat in my office telling me about
the difficulties of taking care of his wife who was now in an advanced
stage of Alzheimer’s. "She doesn’t know you anymore," I responded. "Why
don’t you put her in a convalescent home in order to preserve your own
health?" A smile came over the man’s face. "No," he said. "When she goes
to sleep at night I lie there and look at her. She’s my wife again for
those few hours. I can’t give that up." His wife still had worth to a man
who was learning how to do without her. Then, in God’s perfect timing,
three month’s later she died quietly in her sleep. In His time.
Defining the
Moment of Death
Knowing when someone had died did not use to be
difficult to discern. When a person stopped breathing and was unresponsive
they were dead. Body temperature dropped and rigor mortis soon
confirmed the conclusion. Today, however, machines have an escalating
ability to keep the human body "alive." Hence the danger of prolonging the
dying process. Billy Graham cites the view of death expressed by Edith
Schaeffer, wife of the late Francis Schaeffer:
For years she and Francis had talked about the
preciousness of life and that even a few minutes could make a difference
if something needed to be said or done. "But," she said, "there is no
point in simply prolonging death. It is a fine line; it is not an
absolute one-two-three process. There are differences from person to
person, and it requires great wisdom."1
The usual standard for determining death is still
the one formulated by the Ad Hoc Committee of the Harvard Medical School
in 1968. This definition requires total brain death. More specifically, it
cites four main criteria:
1. Unreceptivity and unresponsivity
2. No movements or breathing
3. No reflexes
4. Flat electroencephalogram2
When artificial means are available to prolong life,
further definition of death may be required. Once again the standard has
remained basically the same. In 1972 it was proposed that
In the event that artificial means of support
preclude a determination that these functions have ceased, a person will
be considered dead if in the announced opinion of a physician, based on
ordinary standards of medical practice, he has experienced an
irreversible cessation of spontaneous brain function.3
Well meaning people often go to extremes on
end-of-life issues. Many think a little added morphine in the IV is okay
because, after all, don’t we shorten the life of the family dog when he’s
in pain? At the other end I have known of tiny, premature babies to be
kept on machines until their inner organs actually begin to decay and fall
apart. If we go to the latter extreme in our thinking, we actually defeat
our own intentions. To say that one must die as slowly as possible with
the aid of artificial means is to push people into desiring assisted
suicide or even euthanasia.
Guidelines for Making Decisions
From a layman’s point of view, there are some
guidelines which can assist in dealing with these end-of-life issues.
1. Respirators/Ventilators
When respirators (or ventilators as they are also
called) are used, a person can be brought back to independent breathing
after events like a surgical procedure or a drowning where the
individual has not stopped breathing long enough to cause catastrophic
brain damage. With the use of a tracheotomy some people live permanently
on respirators. But when a body lies unconscious, with flat brain waves,
attached to a respirator, to turn off the machine is not to kill the
person, but to allow the person to die more naturally. Sometimes, too, a
person who is taken off a respirator still lives, and that too is God’s
timing.
2. FeedingTubes/Intravenous Fluids
Feeding tubes and intravenous fluids are in a
different category. In contrast to turning off a respirator, to remove
food and water is to kill; and death by starvation and dehydration is a
slow, uncomfortable, painful process. There may come a time when a
person is dying when forced feeding is inappropriate, but fluids are
generally important to continue in order to make the patient
comfortable.
3. Wishes of Patient
While it is important, in my opinion, to make
known your wishes regarding your end-of-life treatment, it is vital not
to sign general statements or to leave loopholes in what you say. "Just
make me comfortable" could become a justification for euthanasia. "Don’t
ever bring me back if my heart stops" would mean that many people
walking around today would be dead. For if a person has a heart attack
or a drug reaction or a drowning experience he/she may well be brought
back to fully functioning life. On the other hand, to bring a person
back in order to die more slowly is once again to take the timing of
death out of God’s hands. It is also wise not to utter impulsive
statements like "Just let me die" or "I never want to end up like that."
In the current medical climate such statements may be taken more
seriously than you will desire.
Furthermore, people change their minds. "Studies
indicate that older persons and persons with disabilities often express
an intent to die when frustrated in their efforts to receive appropriate
attention and care. The wish to die may really be a cry for help in
living, and if carried out by the withholding of essential
life-sustaining care, the resulting death constitutes what some
researchers call ‘silent suicide.’" 4
4. Pain Management
Since pain can be a major reason for desiring
death, demand good pain treatment from a physician who is a specialist
in pain management if possible. Few people today need to die in extreme
pain. Here, again, we have a more dangerous situation than first meets
the eye. In controlling extreme, terminal pain the dosage of morphine,
for example, which is required can be close to lethal. As we have noted
before, if that line is crossed in good faith that is one issue, but the
possibility creates a situation where euthanasia can be performed
insidiously but willfully and effectively. Because of the potential
abuses and henceforth the legal implications, this puts physicians in a
difficult position for which they need protection.
Another important aspect of pain management is the
concern which some have over addiction to pain medication. Such a
concern seems a little ridiculous if the patient is terminal or if the
pain is completely immobilizing. Guidelines for physicians in these
areas are vital, but at the same time they need enough flexibility and
protection to function effectively. We can stop most pain. Once again,
if we do not treat pain effectively, we give good ammunition to the
proponents of assisted suicide and euthanasia.
If you are not satisfied with the level of pain
relief which you or your loved one is receiving, seek a second or a
third opinion, check out new techniques of pain relief, and look up
information on the Internet, but be sure to limit your research to well
known institutions and reputable sites, such as that of the Mayo Clinic.
5. Deceptive Language
Be careful of euphemisms. Be sure that you
understand what is being said. In the area of bioethics we can make evil
sound good. We dehumanize the unborn child by calling him/her a "fetus"
or an "embryo." We neutralize killing another human being by calling it
"physician-assisted suicide." This in turn makes euthanasia seem more
acceptable. "Quality of life" is a vague term which can justify much
that is evil. As far back as 1978, in their discussion of "quality of
life," the Encyclopedia of Bioethics stated that "life need not
be sustained or may be directly terminated if the quality of life is not
satisfactory." Furthermore, it goes on to quote a chilling statement by
ethicist Joseph Fletcher:
Human life has no value unless it produces
personal well-being, here interpreted as human happiness for the
largest number of people. The direct or indirect killing of a human is
good whenever it is justified by this highest value or whenever the
desirable consequences outweigh any disvalue in the action, according
to a cost-benefit analysis. 5
It would seem that not only is "quality of life" a
vague euphemism, but that there are those who are quite willing to tell
us what our own personal definition should be.
6. Support Systems
Ask for help when you need it. Talk to friends,
hospital staff, and church staff about your own unique needs, like
utilizing outpatient treatment, such as physical therapy; finding
clinical trials where you may be treated without payment in certain
areas of research; obtaining needed transportation and getting food and
medicine delivered to your home; and understanding your rights as a
patient and/or family of a patient. Another source of information could
be certain types of support groups where people share their resources.
7. Monitoring Treatment
Be involved enough in your own treatment or that
of a loved one to make sure that specific medications and their dosages
are given accurately. Question any medication which seems different than
before. Know the various treatments you should be expecting and make
sure they are not ignored. During all of this monitoring of treatment
try to be pleasant and to take as little time as possible to avoid
annoying the staff. Frankly, you need them to like you.
8. Taking Control
The doctor is not God. Doctors never were God, and
we have placed an unbearable burden on the medical profession by putting
that kind of responsibility on them. We always needed to get second
opinions and keep reasonably informed in order to get good medical care.
In this twenty-first century, however, we have an even greater urgency
to take control. With insurance companies making medical decisions on
treatment, with doctors given incentives to undertreat and underinform,
with a general societal attitude of meism which infiltrates the medical
profession as well as the rest of us, we have a critical need to be
aware, ask questions, demand treatment, and, in general, make sure we
are receiving the best medical care available to us. Be proactive.
Stopping Treatment
It is a principle of the
Scriptures that our needs will be met on a daily basis. When the children
of Israel were in the wilderness on the way to the Promised Land, they
were given daily supplies of food—manna. If they tried to hold the manna
over until the next day, it spoiled. The Bible says that as your days, so
shall your strength be (Deuteronomy 33:25), a promise which includes
guidance. As medical research creates high tech medicine and thus more
choices in treatment, we are left with difficult decisions. With those
choices God gives added wisdom upon which we can draw. The wisdom will be
proportionate to the day’s needs.
For example, certain tests are very invasive and
some even carry with them their own risk. If they are vital to treatment,
they are important; if they are performed for the enlightenment of the
medical community or to affirm what is already basically known, maybe they
can be ignored. When your life is at stake, do not become an interesting
but non-productive-for-you experiment.
More to the point, however, is the issue of how much
treatment is enough. If you are terminal and chemotherapy, for example,
will only give you a few extra days and no added physical relief, you
might want to choose less treatment in order to feel better during those
last days. Such a decision lies within the realm of one of those gray
areas we talked about. Even in non-terminal situations a person could
legitimately elect not to have a complicated back surgery which, if it
went badly, could create paralysis, and live instead with a certain amount
of discomfort which might be treated in part by medication and physical
therapy.
Usually, however, we should fight for the best
treatment available. If treatment is denied, and you feel strongly that
you need it, appeal to the insurance company, contact the State Insurance
Commissioner, write to or call your congressperson. Remember that the
issue may very well be a matter of money, not whether or not you need the
treatment. And the solution for that may be political pressure.
Furthermore, it is clear that as time goes on and medicine continues to be
a big money business, we will have to be far more concerned about getting
enough treatment rather than too much. And at that point the right to die
will most certainly turn into an obligation to die.
It is not inconceivable that the following situation
could occur in the not-so-distant future:
Imagine a family of five—a mother and father, two
children, and Uncle Joe, who is getting on in years and has therefore
moved in with the family after the death of his wife.
When he first joined the family, Uncle Joe was fast
living and hard drinking, but so full of wit and good humor that no one
minded his shortcomings. When he was drunk, he went to sleep. Besides, he
worked hard during the day, made a good salary, and contributed generously
to the family’s support.
Times are changing, however. The family needs the
money less now. With the father’s salary increases and the mother’s new
job, life has become relatively easy. More than that, Uncle Joe has ceased
to be fun. Rather than sleeping off his drinking bouts, he shouts and
demands. Furthermore, he is moving toward retirement age; and no one
relishes the idea of having him home all the time. The children are older
now, and they want separate bedrooms. The mother is tired of cleaning up
after him.
And then Uncle Joe has a stroke, leaving him
partially paralyzed and unable to speak. Uncle Joe has changed. The family
has changed. And nobody wants Uncle Joe around anymore.
A nursing home is not an option. The government no
longer pays for that. And it seems a shame to waste Uncle Joe’s life
savings when his quality of life is so poor anyway. Uncle Joe, as they had
known him, wouldn’t want that! Furthermore, the children need that extra
money for college.
One day the father asks Uncle Joe to go with him to
the doctor’s office for a flu shot. While Uncle Joe sits in his wheelchair
and turns pages in old magazines in the waiting room, the father has a
brief consultation with the doctor regarding the old man’s health and
state of mind. A few papers are signed, and Uncle Joe bares his arm for
his shot. Then the father returns home, alone.
It wouldn’t be that hard to do, with the right
mind-set. After all, why doom a nice man like Uncle Joe to an alcoholic’s
death? Didn’t we do as much for the family dog last year?
Yet if we’re honest with ourselves, as a 1991
editorial in The Journal of the American Medical Association points
out, there’s no evidence that the family pet appreciates our action. "Is
there any evidence that sick animals want to die?" asks Dr. James Goodwin.
"I cannot find in the literature or in folklore suicide by animals in a
hopeless situation ... We kill horses and other animals because they
cannot tell us not to." Continues Dr. Goodwin:
The concept of mercy killing, if not the reality,
is enjoying a renaissance of sorts, but with a new type of victim—the
patient with Alzheimer’s disease ... Once again we must ask: Whose
suffering is being relieved? In my years of caring for such patients, I
have known few who were chronically miserable ... But the families
suffer terribly ... What do we hear over and over from the interviews,
the docudramas, the analyses? "I couldn’t stand to see her suffer."
Mercy killing, like all killing, is the ultimate selfish act ... I do
not doubt the reality and severity of the suffering endured by the
relatives of Alzheimer’s patients, but it is their suffering,
their misery. There is nothing altruistic about mercy killing. 6
That great 19th Century divine, Charles Haddon
Spurgeon, goes one step further: "We have no business to pray that we may
die ... We shall die all in good time, unless the Lord shall come in the
splendour of his Second Advent. If you and I had the choice of the time of
our death, there would be just a tinge of the element of suicide about it,
and that is the very worst form of murder. This is clearly our duty, to
leave ourselves wholly and unreservedly in the hand of him to whom belong
the issues of life; it is certainly our best course."7
Again, we owe it to God to try to live. And, by the way, more than one
person has been pronounced terminal only to live years after that
pronouncement.
But let us be gentle with each other. Whether we
like it or not, there are uncertain, gray areas, and in these areas we
don’t always know the will of God for someone else’s life. Sometimes only
within ourselves do we hear the small voice of God leading us to limit or
stop treatment or urging us to attempt the impossible. For sometimes, even
today, there are miracles which go against all medical advice.
A woman who is not prone to emotional outbursts or
fantasies and is a real believer in Jesus Christ told me an amazing story.
When she was a child on a midwestern farm, she was injured in a farming
accident and lost her 1eg. In those first hours after the accident, she
lay in a hospital bed in a small country hospital with her mother sitting
helplessly by her.
As night approached, she started to hemorrhage
profusely. The doctor was called, and she overheard him say to her mother:
"She won’t last the night."
Shortly after that, she felt a comforting hand on
her forehead, smoothing her hair back. She heard a voice say reassuringly:
"Go to sleep, Pat. When you wake up in the morning you’ll be better." Only
her mother was in the room, and neither the hand nor the voice was hers.
The child asked her mother to turn back the sheet so
that the "angel" could sit there. The mother saw and heard nothing, but
she obeyed her daughter. Then the mother looked into the girl’s face and
saw color where there had been a deathly white only a few minutes before.
The child slept through the night, and when she
awoke the next morning she was better. Not healed, for she still lost her
leg. But she lived.
Another miracle which shows God’s transcendence over
all the laws of nature and man occurred in the life of a man named John
Noble, who was taken prisoner during World War II and came to know God in
a Soviet prison camp. During the course of his imprisonment he was put on
a starvation diet. Each day he was brought nothing but flavored water. For
nine days he declined physically until he was at the edge of death. In
fact, he asked God to take him. Then, according to his own story:
On the tenth day of starvation, I was stronger
than on the ninth, and on the eleventh day stronger than on the tenth!
To feel that I grew stronger, even though I was
still denied food of any kind, gave me renewed confidence in the Lord.
If it was the Lord’s will that I should live, and grow stronger without
even any human food for my body, it meant I no longer had to worry about
bread or about anything else. It was manifest that the Lord did not
intend that I should die at this time. I had asked for death. He had
given me life. Nothing could happen to me now, I knew, unless the Lord
permitted it. 8
When the miracle does not occur, in the difficult
decisions which all of us face to some degree in our own lives and/or the
lives of others, God promises to lead. In the words of Charles Spurgeon,
"...remember that he can recover our loved ones if he deems it wise, or he
can sustain them in their sickness if he does not see fit to recover them,
and he can give them a joyful exit from this world, and an abundant
entrance into his everlasting kingdom."9
There are practical helps which all of us can
utilize as we go through these difficult times.
Tips for Dealing With Your Own Mortality
1. Live now! Yesterday is secure with all of its
achievements and memories, bad as well as good. Tomorrow is unknown, no
matter what your age or condition. Today is yours to live and find
meaning.
2. Don’t waste your energy on "what ifs." More
often than not, the "what ifs" of the future don’t happen. That vast
future unknown is in God’s hand, and so it is safe.
3. Reach out! Try a support group at a church or
local hospital or at least open up to a friend.
4. Confront your fears. Write down your wishes for
everything from medical care and disposition of what you own to burial
wishes. Then forget it and live.
5. Remember—the length of years does not determine
the value of a life. Some choose to waste their lives regardless of
their age. Others have a great influence as small children.
6. Don’t quit. It’s always too soon to give
up—and—it’s never too late to let God make your life meaningful.
7. Don’t hole up. Have coffee with a friend. Talk
on the phone. Reach out to someone else who is hurting.
8. Pets make loneliness impossible. Consider the
possibility of a dog or cat—or even a bird or fish!
9. Use color. Paint, or have painted, a room. Use
fresh flowers. Make where you live a cheerful place to be—even if it’s
only one room.
10. Display pictures of those you love. Frame
some, and put others in albums. Even if they have died before you, don’t
forget about that great crowd of witnesses of Hebrews 12:1 who surround
us from Heaven and cheer us on.
11. Share memories/family history which should be
passed on. Tape or journal some of those memories. Above all, label
your pictures! You may not feel all this is important, but somewhere,
sometime down the road, a child, a friend, a niece, a grandnephew or
grandchild–or even a distant cousin—will thank you for this.
12. Find God’s meaning for each day. Do a concrete
task. Pot a plant. Make cookies. Call someone worse off than you. Give
the gift of a smile.
First Aid for
Caregivers and the Bereaved
1. Hydrate—Drink water, carry a bottle around.
2. Try to eat at least something—six small meals
are often better than three larger. Try easy things like yogurt, fruit,
a piece of cheese, a snack bar.
3. Take a Bible verse and make it your own by
memorizing it. Read in small pieces if more is too much.
4. Try to improve quality of food.
(Fight
Fat After Forty by Dr. Pamela Peeke.)
5. Talk. In retelling you heal, and you
relocate the deceased person in your life.
6. Keep active even when you want to quit or hide.
7. Never apologize for your grief.
8. Avoid negative people.
9. Let God use you in your grief to help someone
else.
10. When you feel tense, take several long, deep
breaths and slowly exhale. Focus on a simple positive thought or image
as you do this.
11. Talk to God about your feelings and your
needs—talk as though conversing with a friend. It’s possible to do this
and still stay reverent.
12. Reach out for help when you need it. The grief
process can have some desperate times. If the pain is too much, you
should not feel weak if you ask your doctor for medication or if you
seek counseling. You wouldn’t hesitate to treat physical pain. Don’t
ignore emotional pain.
The Next Step
As the complexity increases, so does the guidance.
We may not feel that we know what we are doing, but we will be being led.
As King George VI said in his 1939 Christmas Day message to his people,
quoting Minnie Louise Haskins:
I said to the man who stood at the gate of the
year, "Give me a light that I may tread safely into the unknown." And he
replied, "Go out into the darkness and put your hand into the hand of
God. That shall be to you better than light and safer than a known way!"10
Similarly, in the words of missionary Amy
Carmichael:
Once when I was climbing at night in the forest
before there was a made path, I learned what the word meant, Psalm
119:105: "Thy word is a lantern to my path." I had a lantern and
had to hold it very low or I should certainly have slipped on those
rough rocks. We don’t walk spiritually by electric light but by a hand
lantern. And a lantern shows only the next step—not several ahead.11
Glossary
Code Blue:
Means that a patient is going into the need for
cardiopulmonary resuscitation and needs what have sometimes been called
"heroics." Immediate, dramatic treatment is given to "bring the person
back."
Doctor Assisted Suicide:
When a patient receives help in committing suicide
yet performs the final act on his or her own. Oregon has the dubious honor
of being the first state to legalize doctor assisted suicide.
Do-Not-Hospitalize (DNH):
An order not to hospitalize a patient, usually one
who is dying and appears to be going into cardiopulmonary failure. This
could possibly be abused in a rest home where a patient is not immediately
dying but needs hospital care for palliative treatment or to cure
something like an infection. In other words, most decisions like DNH
should have room for exceptions. Both DNR and DNH need to be agreed upon
by the patient or the patient’s representative and then put into the
patient’s chart. The conditions for such decisions can be vague and thus
potentially dangerous. If a patient chooses a surrogate to make these
decisions for him/her if that need should arise, it is vital to choose
someone who can be trusted in all ways.
Do-Not-Resuscitate (DNR) or "No Code:"
An order which foregoes cardiopulmonary
resuscitation (CPR).
Durable Power of Attorney for Health Care:
A written directive regarding health care wishes
which a patient fills out and signs before need. These documents vary in
content. They can be helpful in allowing a patient’s wishes to be known,
but once again proceed cautiously and avoid certain broad generalities.
Euthanasia:
The active putting to death of a patient, usually by
a physician. The Netherlands has become the first democratic nation in the
world to decriminalize the act of doctors killing patients. During World
War II the Dutch doctors were unique in their refusal to obey Nazi orders
to kill certain patients, "useless eaters." It has taken only one
generation, observed Malcolm Muggeridge, "to transform a war crime into an
act of compassion." Ironically, in delivering his annual Berlin speech in
the year 2001, German President Johannes Rau criticized the decision in
the Netherlands, stating: "Where human dignity is affected, economic
interests don’t count."
Involuntary Euthanasia:
Euthanasia performed without the consent of the
patient.
Passive Euthanasia:
Death which comes through the leaving out or
neglecting of life-preserving measures.
Voluntary Euthanasia:
When a patient chooses to have a doctor perform
euthanasia.
Hospice:
An organization which provides care for the dying
and their families when the patient desires to die at home. Hospice care
is covered by Medicare if a physician certifies that the patient has six
months or less to live. But the patient must give up any curative
treatment.
Intubate:
To insert a tube.
Respirator/Ventilator:
An artificial breathing machine which takes in fresh
air and expels stale air.
Tube Feeding:
Providing nutrition and hydration through a plastic
tube when the patient is unable to or finds it difficult to eat or drink
by mouth. A tube can be inserted through the nose and into the stomach (nasogastric
or NG tube) or it can be surgically implanted through the abdomen into the
stomach or even into the small intestine. For short-term use nutrients can
be put directly into the bloodstream.
Words of Encouragement
"All that troubles is only for a moment. Nothing is
important but that which is eternal." 12
God Promises to
Guide Our Ways
"’But I tell you the truth: It is for your good that
I am going away. Unless I go away, the Counselor will not come to you; but
if I go, I will send him to you. ... But when he, the Spirit of truth,
comes, he will guide you into all truth. He will not speak on his own; he
will speak only what he hears, and he will tell you what is yet to come.
He will bring glory to me by taking from what is mine and making it known
to you." (John 16:7, 13-14, NIV)
"O Lord, you have searched me and you know me. You
know when I sit and when I rise; you perceive my thoughts from afar. You
discern my going out and my lying down; you are familiar with all my ways.
Before a word is on my tongue you know it completely, O Lord. You hem me
in—behind and before; you have laid your hand upon me." (Psalm 139:1-5,
NIV)
"’For my thoughts are not your thoughts, neither are
your ways my ways,’ declares the Lord. ‘As the heavens are higher than the
earth, so are my ways higher than your ways and my thoughts than your
thoughts.’" (Isaiah 55:8-9, NIV)
"’I will lead the blind by ways they have not known,
along unfamiliar paths I will guide them; I will turn the darkness into
light before them and make the rough places smooth. These are the things I
will do; I will not forsake them.’" (Isaiah 42:16, NIV)
"I will instruct thee and teach thee in the way
which thou shalt go: I will guide thee with mine eye." (Psalm 32:8, KJV)
"’The Lord will guide you always; he will satisfy
your needs in a sun-scorched land and will strengthen your frame. You will
be like a well-watered garden, like a spring whose waters never fail.’"
(Isaiah 58:11, NIV)
"Now we see but a poor reflection as in a mirror;
then we shall see face to face. Now I know in part; then I shall know
fully, even as I am fully known." (I Corinthians 13:12, NIV)
"For the Lord gives wisdom, and from his mouth come
knowledge and understanding. He holds victory in store for the upright, he
is a shield to those whose walk is blameless, for he guards the course of
the just and protects the way of his faithful ones. Then you will
understand what is right and just and fair—every good path. For wisdom
will enter your heart, and knowledge will be pleasant to your soul."
(Proverbs 2:6-10, NIV)
"In all thy ways acknowledge him, and he shall
direct thy paths." (Proverbs 3:6 KJV)
Taking the Life of Another is Wrong, According to
the Scriptures
"Whoever sheds the blood of man, by man shall his
blood be shed;
for in the image of God has God made man." (Genesis
9:6, NIV)
God Is Triumphant Over Death
"Like sheep they are destined for the grave, and
death will feed on them. The upright will rule over them in the morning;
their forms will decay in the grave, far from their princely mansions. But
God will redeem my life from the grave; he will surely take me to himself.
Selah. Do not be overawed when a man grows rich, when the splendor of his
house increases; for he will take nothing with him when he dies, his
splendor will not descend with him. Though while he lived he counted
himself blessed—and men praise you when you prosper—he will join the
generation of his fathers, who will never see the light of life." (Psalm
49:14-19, NIV)
"’Where, O death, is your victory? Where, O death,
is your sting?’ The sting of death is sin, and the power of sin is the
law. But thanks be to God! He gives us the victory through our Lord Jesus
Christ." (I Corinthians 15:55-57, NIV)
The Soul Does Not Stay in the Grave
"One of the criminals who hung there hurled insults
at him: ‘Aren’t you the Christ? Save yourself and us!’ But the other
criminal rebuked him. ‘Don’t you fear God,’ he said, ‘since you are under
the same sentence? We are punished justly, for we are getting what our
deeds deserve. But this man has done nothing wrong.’ Then he said, ‘Jesus,
remember me when you come into your kingdom.’ Jesus answered him, ‘I tell
you the truth, today you will be with me in paradise.’" (Luke 23:39-43,
NIV)
"Therefore we are always confident, knowing that,
whilst we are at home in the body, we are absent from the Lord: (For we
walk by faith, not by sight:) We are confident, I say, and willing rather
to be absent from the body, and to be present with the Lord." (II
Corinthians 5:6-8, KJV)
Heaven Is a Real Place
"Let not your heart be troubled: ye believe in God,
believe also in me. In my Father’s house are many mansions: if it were not
so, I would have told you. I go to prepare a place for you. And if I go
and prepare a place for you, I will come again, and receive you unto
myself; that where I am, there ye may be also. And whither I go ye know,
and the way ye know. Thomas saith unto him, Lord, we know not whither thou
goest; and how can we know the way? Jesus saith unto him, I am the way,
the truth, and the life: no man cometh unto the Father, but by me." (John
14:1-6, KJV)
" But
our citizenship is in heaven. And we eagerly await a Savior from there,
the Lord Jesus Christ, who, by the power that enables him to bring
everything under his control, will transform our lowly bodies so that they
will be like his glorious body." (Philippians 3:20-21, NIV)
The Faith of Loved Ones Who Have Gone to Heaven Before Us Offer Encouragement
" Therefore,
since we are surrounded by such a great cloud of witnesses, let us throw
off everything that hinders and the sin that so easily entangles, and let
us run with perseverance the race marked out for us." (Hebrews 12:1,
NIV)
Faith in Christ Is the Way to Heaven
"For God so loved the world, that he gave his only
begotten Son, that whosoever believeth in him should not perish, but have
everlasting life." (John 3:16, KJV)
"Therefore, if anyone is in Christ, he is a new
creation; the old has gone, the new has come!" (II Corinthians 5:17,
NIV)
"What good is it, my brothers, if a man claims to
have faith but has no deeds? Can such faith save him? Suppose a brother or
sister is without clothes and daily food. If one of you says to him, ‘Go,
I wish you well; keep warm and well fed,’ but does nothing about his
physical needs, what good is it? In the same way, faith by itself, if it
is not accompanied by action, is dead. But someone will say, ‘You have
faith; I have deeds.’ Show me your faith without deeds, and I will show
you my faith by what I do. You believe that there is one God. Good! Even
the demons believe that—and shudder. You foolish man, do you want evidence
that faith without deeds is useless?" (James 2:14-20, NIV)
Each Person’s Grief Is Unique
"...every one shall know...his own grief...." (II
Chronicles, 6:29, KJV)
"Each heart knows its own bitterness, and no one
else can share its joy." (Proverbs 14:10, NIV)
God Understands Grief
In Isaiah 53:3 our Lord is called "a man of sorrows
and acquainted with grief...." (KJV)
The Lord Jesus grieved at the tomb of his friend
Lazarus, even though He also knew that He would raise him from the dead
within a few minutes: "Jesus wept." (John 11:35, KJV)
Sometimes People Don’t Understand How to Handle Other People’s Grief
"Like one who takes away a garment on a cold day, or
like vinegar poured on soda, is one who sings songs to a heavy heart."
(Proverbs 25:20, NIV)
"If a man loudly blesses his neighbor early in the
morning, it will be taken as a curse." (Proverbs 27:14, NIV)
God Comforts Us in Our Grief
"He remembered that they were but flesh, a passing
breeze that does not return." (Psalm 78:39, NIV)
"The Lord is my shepherd; I shall not want. He
maketh me to lie down in green pastures: he leadeth me beside the still
waters. He restoreth my soul: he leadeth me in the paths of righteousness
for his name’s sake. Yea, though I walk through the valley of the shadow
of death, I will fear no evil: for thou art with me; thy rod and thy staff
they comfort me. Thou preparest a table before me in the presence of mine
enemies: thou anointest my head with oil; my cup runneth over. Surely
goodness and mercy shall follow me all the days of my life: and I will
dwell in the house of the Lord for ever." (Psalm 23, KJV)
"The Lord is close to the brokenhearted and saves
those who are crushed in spirit." (Psalm 34:18, NIV)
"Thou numberest my wanderings; put thou my tears
into thy bottle. Are they not in thy book?" (Psalm 56:8, KJV)
"Let your conversation be without covetousness; and
be content with such things as ye have: for he hath said, I will never
leave thee, nor forsake thee." (Hebrews 13:5, KJV)
"When you pass through the waters, I will be with
you; and when you pass through the rivers, they will not sweep over you.
When you walk through the fire, you will not be burned; the flames will
not set you ablaze." (Isaiah 43:2, NIV)
"For our light affliction, which is but for a
moment, worketh for us a far more exceeding and eternal weight of glory,
while we look not at the things which are seen, but at the things which
are not seen; for the things which are seen are temporal, but the things
which are not seen are eternal." (II Corinthians 4:17-18, KJV)
Joy and Sorrow Are Each a Part of All Who Live on
This Earth
"...a time to be born and a time to die…
a time to weep and a time to laugh,
a time to mourn and a time to dance…
a time to embrace and a time to refrain…"
(Ecclesiastes 3:2,4-5, NIV)
Footnotes
1. Billy Graham, Facing Death and the Life
After (Dallas: Word, 1987), 145-147.
2. Richard G. Benton, Death and Dying:
Principles and Practices in Patient Care (New York: Van Nortrand
Reinhold Co., 1978), 18-19.
3. Ibid.
4. Daniel Avila, Attorney at Law, quoted in
Elizabeth R. Skoglund, Life on the Line (Wheaton, Ill.: Tyndale
House Publishers, Inc., 1992), 181.
5. Warren T. Reich, ed., Encyclopedia of
Bioethics (New York: Macmillan, Free Press, 1978), 830, 835.
6. James S. Goodwin, M.D., "Mercy Killing: Mercy
for Whom?" JAMA 265:3 (January 16, 1991), 326.
7. C.H. Spurgeon, The Metropolitan Tabernacle
Pulpit 40 (1894): 164-165
8. John Noble and Glenn D. Everett, I Found God
in Soviet Russia (Grand Rapids, Mich.: Zondervan Publishing House,
1959), 44-45
9. C.H. Spurgeon, The Metropolitan Tabernacle
Pulpit 51 (1905): 484
10. Minnie Louise Haskins, God Knows.
Quoted by King George VI in a Christmas broadcast, 25 December 1939,
Oxford Dictionary of Quotations (Oxford Press, 1953)
11. Amy Carmichael, Candles in the Dark
(Ft. Washington, Penn.: Christian Literature Crusade, 1981), 43. © 1981
Dohnavur Fellowship.
12. Amy Carmichael, Kohila (Ft. Washington,
Penn.: Christian Literature Crusade, n.d.), 130.
13. Handley C.G. Moule, D.D., Messages from the
Epistle to the Hebrews (London: Elliot Stock, 1909), 81-83
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