“We need to discuss whether we should continue with this treatment.” The doctor’s words stun us. He might as well say, “There isn’t anymore hope.” Have you ever heard those words concerning yourself or someone you love? Are you struggling because you made a decision about removing treatment and still wonder whether or not it was the right one? If so, you’re in hope!
Hope in Death
You can confront life and death decisions in hope because of the hope you have in death. Martin Luther said, “The death of a man is, however, an infinite and eternal misery and wrath.” (1) That doesn’t sound very hopeful, but it was his prelude to hope! In order to understand the certain hope Christians have, Luther knew we needed to first understand the utter hopelessness of our situation. Death is a constant reminder of the wrath of God we deserve. Death is our deserved wages of sin (Romans 6:23). Death is our enemy (1 Corinthians 15:26).
But Luther also said, “We should be happy to be dead and desire to die,” pointing out that death is only “the narrow gate and the small way to life.” (2) Death as the way to life is possible because of Jesus. He destroyed death and brought life and immortality (2 Timothy 1:10). Jesus’ death and resurrection give us the certain hope that through faith in Him we will have eternal life (1 Peter 1:3-5). It is guaranteed! (2 Corinthians 1:21) It is okay for a Christian to say with Paul, “I desire to depart and be with Christ which is better by far” (Philippians 1:23). But in the same breath, Paul talks of the necessity of staying on in this life. The hope that we have in death gives us hope in life.
Hope in Life – Is God for Us?
Sometimes we forget about that big “if” in the verse, “If God is for us, who can be against us?” (Romans 8:31). The hope God gives in death addresses that “if” and assures you that God is for you. “He who did not spare His own Son, but gave Him up for us all–how will He not also, along with Him, graciously give us all things?” (Romans 8:32). Because God did something about death and wants you with Him in Heaven someday, you can be assured of His gracious presence in life. He wants to give you good things. Jesus said He came to give us life “to the full” (John 10:10).
The Full Life
“Yeah, right! That sure doesn’t describe my life.” Yes it does! Jesus’ “full life” statement was made in the context of shepherding. The full life for a sheep wasn’t the absence of difficulties; it was the presence of the shepherd and following him to green pastures and quiet waters and through dark valleys. (Psalm 23)
Hope for the full life for God’s sheep today is not in the absence of difficulties or difficult decisions. Your hope is in the presence of the Shepherd. He leads you to good places, and He leads you through dark places. God in Christ gives a whole new perspective on living life in hope because of the perspective He gives as to what makes life full and valuable.
The Valued Life
The world associates the value of life with quality. Diminish certain qualities–e.g., bodily functions, mobility, memory—and the world says you diminish in value. Diminish in value enough and the world says your life isn’t worth living. Think this way enough and a society begins to “eliminate” such “burdens.”
God’s perspective is quite different. The value of human life has everything to do with Him and nothing to do with “qualities.” Remember, He “did not spare His own Son.” Every human life is a life purchased by the blood of Jesus. Qualities may diminish but the value God gives to life never does. The grandma in the nursing home who must wear a diaper and no longer remembers her family is just as valuable to God as the grandma who works in her garden and is president of the Ladies Aid. We limit the power of God when we think He can work in and through the second grandma but not the first. We challenge the will of God when we take charge of when it is time for someone to die. Because of what He has done in Christ, we can be assured of His presence even in the darkest of times.
Hope in Life and Death Decision Making
Some of those darkest times are when you or a loved one is dying. Because of the effects of sin in this world, physical death is still our enemy. But he is a defeated enemy! The hope God gives in His victory over death and the hope He gives in the living of your life, gives hope when faced with dying.
Dying can be looked at in two ways. “I am dying,” someone might say who has just been diagnosed with a terminal illness. Death seems inevitable but may be months or more ahead. Dying in a medical sense is when the body begins to “shut down.” Organs begin to fail. The normal processes of life are coming to an end. The person may drift in and out of consciousness. There is no longer a desire for food or water.
Starting and Stopping Treatments
A variety of treatments exist for those with terminal illness depending on the nature of that illness. Radiation or chemo-therapy may slow the disease, extend life, and sometimes even cure or put the disease into remission. Medications may be taken to control symptoms or to alleviate pain. Although basic human needs, food and water are often defined as “medical treatment.”
Can a Christian refuse or stop treatment? The answer is yes and no! Much depends on the situation. In some cases, the hope you have in Jesus as the victor over death would enable you to answer, “Yes.” In other cases, the hope we have in Jesus as our Shepherd in life would move you to answer, “No.” Individual circumstances vary widely, and it is not possible or appropriate to provide a “one-size-fits-all” answer. There are some commonly held sayings among Christian ethicists that are helpful in determining our “yes” or “no.” One is from the Hippocratic Oath, “Always to care, never to kill.” The other is “We can and should allow the dying to die. We should never intend for the death of the living.”
There are also some guiding questions that may be helpful. Is the treatment excessively physically burdensome to the person and doing more harm than good? Does the treatment enhance living or prolong dying? Is the intent of stopping or not starting a treatment to allow the disease to run its course or is the intent to cause death? Wishing and even praying that God would bring release through death is not inappropriate. It reflects the hope we have in Christ’s victory over death. Intentionally causing the death of someone or turning to physician-assisted suicide is never appropriate. It reflects a lack of trust in the hope we have in Christ’s presence and power in our lives.
Examples of Decisions
Morphine is an effective drug in controlling severe pain. But it can suppress respiration and thus hasten or even cause death. In an effort to control pain, it is not inappropriate for a Christian to discuss increasing the amount of morphine. Even the knowledge that this may hasten death does not make this inappropriate. The intent is to relieve pain, not cause death. You are still trusting in the hope in death and life that we have in Jesus. However, it would be inappropriate to say, “Let’s get this over with. Turn up the morphine.” In this case, the intent is to cause death through your will rather than trusting in God’s.
On rare occasions, ventilators present difficult choices. Ventilators are often thought of only as “extraordinary” means of keeping someone alive. The fact is that ventilators are used frequently to temporarily assist people in breathing during surgery or to help the lungs recover from a disease like pneumonia. Therefore, to state emphatically, “I never want to be on a ventilator,” may not be in your best interest. Occasionally, however, a person on a ventilator reaches the point where the ventilator is no longer part of a healing process but is artificially prolonging dying. A Christian may decide to remove a ventilator from a loved one in such cases. They cling to the hope in death and life we have in Jesus.
Feeding tubes are small, very flexible tubes used to deliver food and water directly into a person’s stomach or intestine when these cannot be taken orally. Inserting a feeding tube is a minor surgical procedure. Feeding tubes do not keep someone alive “artificially.” They keep people alive naturally by providing food and water through artificial means. The vast majority of people with feeding tubes are not dying in the medical sense of that word. To remove a feeding tube from someone who is not dying would be inappropriate as it would cause their death. When the body begins to die, however, organs start shutting down and eventually the body is unable to process food and water. Indeed, continuing nutrition and hydration at this point may do more harm than good. It is not inappropriate, therefore, to remove a feeding tube in such cases.
Did I Make the Right Decision?
Articles such as this can sometimes burden people’s consciences. They look at all the “appropriates” and “inappropriates” and wonder if a particular decision they made in the past was right or wrong. That is what is so wonderful about living in the hope Jesus gives. Jesus’ victory over sin and death give hope, because it assures you of your tremendous value to Him. Jesus’ promise of His presence in your life gives hope because it assures you that nothing can ever separate you from His love.
Do you realize you made a wrong decision in the past? You live in hope! You can be certain of God’s forgiveness and that your value to Him and His love for you have not diminished. You may still “feel” guilty for a past decision even after you have received God’s forgiveness. Remember, feelings lie. Feelings do not negate the complete cleansing and guiltlessness you have in Jesus!
Are you not sure if you made the right decision? You live in hope! As much as we believe in God’s absolute truth, sometimes the line between right and wrong decisions on these issues is just hard to determine. Medical advice may not be conclusive or it may even be conflicting. “Was my loved one dying? Did I allow them to die or cause them to die?” Uncertainty over such questions need not burden you. The certainty of Jesus’ love and the hope He gives in death and in life upholds you.
Conclusion
The certain and guaranteed hope you have in Jesus’ victory over death gives you hope in living life! You can face death with hope because you know it is the door to life. You can face living and dying with hope because you know the true source of human worth and dignity. You can face and make difficult decisions in hope because you know God is present and at work. Nothing can separate you from His love. Nothing can diminish your hope in Him.
(Footnotes)
(1) Althaus, Paul, The Theology of Martin Luther (Philadelphia: Fortress Press, 1966) p. 405.
(2) Ibid. p. 408.