Choosing Life in the Face of Death

How to respond biblically and ethically to end-of-life decisions

In June of 1999, Kathy faced a difficult decision. Actually, it was just one more gut-wrenching decision in a long list of hard decisions she was having to make. In November of 1998 her husband, Ron, had been diagnosed with ALS—Lou Gehrig’s disease. There is no cure. It is always fatal.

Now Kathy had to decide whether or not to put Ron on a ventilator. What should she do? What was best for Ron? What was right? If she called you for advice, what would you say? Let the disease take its course and allow Ron to suffocate and die? His death was inevitable anyway. Or install a ventilator and prolong his life—or as some would say, his dying?

Ron and Kathy are real people. For over 30 years, Ron was a deacon in my church and Kathy taught scores of children in the Sunday School ministry. Hard things do happen to good people, God’s people. I do not think I have known anyone else with ALS, but I knew Ron. Kathy chose to have the ventilator hooked up so she could care for her husband until he went to glory in July of 2002. Would it have been wrong for her to let Ron die naturally of the disease?

More recently, the whole country followed the Terri Schiavo case. People argued passionately for her right to live while others argued as passionately for her right to die. Did the courts make the right decision in removing Terri’s hydration and nutrition? How do you know? Is it simply a matter of what someone feels is right or best? Are there bigger issues to consider? What principles should be used in deciding? Thankfully, we are not simply left to our own devices to muddle through life and death as best we can. God’s all-sufficient Word gives us the guiding truths and principles we need in order to respond ethically to end-of-life issues.

God is the sovereign Creator and Sustainer of life. This truth is clear throughout Scripture: “In Him we live and move and have our being” (Acts 17:28); “By Him all things consist” (Col. 1:17). Human life is incalculably valuable because it is a gift from God, because humans bear the image of God (Gen. 1:26), and because no one can restore life once it is lost. Life is a wonderful and valuable gift. Because this is true, efforts to sustain life are legitimate, and decisions to withhold or withdraw life-sustaining technology must be made prayerfully and carefully.

Death is the one inescapable reality we all face. Death and its various causes are the consequences of sin and of living in a sin-cursed world. We all know “It is appointed unto man once to die” (Heb. 9:27), but none of us likes to think about it, talk about it, or plan for it. Death is neither happy nor attractive. It is ugly, no matter how it comes. The inevitability of death should serve as an incentive for each person to prepare for it spiritually by trusting Christ for salvation, followed by a life of loving obedience to Him as Lord. Prepare practically by making sure you have a will and a durable power of attorney for health care. The durable power of attorney for health care gives direction to those who will have to make decisions about your care in the event you become incapacitated.

“Death with dignity” is a misnomer. Contrary to the continual message from the media and right-to-die activists, death with dignity does not exist. People may consider assisted suicide as death with dignity, but a person who chooses to end his or her own life ultimately does so as a final act of rebellion against the God who created man in His image and desires to give eternal life. If death with dignity has any meaning at all, it is only in the context of a life lived with integrity and devotion to the Giver and Sustainer of life.

Death is an enemy. Though death is not an enemy a believer needs to fear, it is an enemy nonetheless. Paul plainly declares death to be an enemy in 1 Corinthians 15:26. If death were good, Christ’s sacrifice on the cross to defeat it would have been senseless. What attitude should you have toward death and dying? The reality that death is an enemy does not imply that the finality of death should be avoided at any cost.

Making Decisions at the End of Life

Making end-of-life decisions must involve careful consideration of the truths identified above. Several primary principles may be identified and applied to the real and often distressing circumstances that confront an individual who has a terminal illness or injury and faces end-of-life decisions.

First, because life is God’s gift and He alone is Sovereign, He does not allow or condone the deliberate, intentional taking of human life (including suicide) to serve our own purposes, such as avoiding inconvenience, suffering, or sacrifice. Scripture supports the treatment of disease and illness, but gives no precedent or authority for taking the life of a person dying from illness or injury. As author Mark Blocher has observed, killing is not caring because caring requires commitment, sacrifice, and personal involvement.

Second, the preservation of life—not the taking of life—should be the goal of all medical treatment. Whatever can reasonably be done to treat the disease or injury and to minimize pain and discomfort should be done. (“Reasonably” here means treatments that are affordable, helpful, and do not place unacceptable burdens on the patient or his or her caregivers.)

For those facing death, there is no compelling reason to take medications or undergo procedures that are known to be ineffective or that will produce negligible or short-term results. A person dying from a disease or illness is not morally required to accept or be given medically provided respiration, nutrition, and/or hydration via invasive measures. The point may come when withholding or withdrawing food and water from a dying person is appropriate because the dying body can no longer process them, and their ingestion (e.g., via feeding tube) only increases the pain and discomfort of the dying process.

On the other hand, respiration, nutrition, and hydration are basic life needs that should be provided and continued as long as the individual benefits. Withdrawing these basic needs is appropriate only (a) when death is imminent and their continued provision increases or prolongs suffering, or (b) when the person has made it clear that he or she does not want these provisions continued by means of medically invasive procedures. Decisions about administering or withholding medically invasive life-support measures need to be made from a pro-life perspective, and those making the decisions need to consider the nature and cause of the individual’s condition, as well as the person’s wishes and directions. Because Terri Schiavo was not in the process of dying, her death by forced starvation was unethical, unnecessary, and contrary to the pro-life teachings of Scripture.

” I have set before you life and death . . . choose life”

Deuteronomy 30:19

Third, the amelioration of suffering (known as palliative care) is a legitimate medical goal. God may use suffering to build character, patience, and hope in a person, but these redemptive purposes of suffering seem intended primarily for those facing life, not death. Medication may be given to relieve pain but not to end life. Painkilling medication may hasten death, but if it is administered only to the extent necessary to relieve pain, no moral culpability exists. Death comes from disease or injury, not medication.

Finally, although death is an enemy, we have not been called to avoid it at any cost. In the final analysis, we cannot avoid it. Death is the only inevitable reality we all face. Scripture does not compel or forbid the use of extra- ordinary (medically invasive) means to sustain life. While an individual may have the right to request and expect the use of extraordinary means if he or she becomes incapacitated, the person also may stipulate that such means are not to be used, or are to be used only as long as they provide obvious and positive benefits. No two cases are exactly alike. Every situation needs to be treated prayerfully and carefully. If we are to err, then consistency with Bible principles would teach us to err on the side of preserving and sustaining life. Clearly, the intentional taking of life or hastening of death is never acceptable.

Sadly, it is easy to foresee a day when a person who is severely injured or terminally ill (or maybe just suffering the infirmities of old age) would have to somehow justify the right to life in order to avoid an involuntary death or being viewed as a burden to society or loved ones. Indeed, for some that day has already come. Due to deteriorating attitudes about the sanctity of human life in society, in the medical profession, and in the courts, prudence and good stewardship should compel every person to communicate his or her wishes about medical treatment in the case of incapacitation due to illness or injury. The best course of action for every person who is at least 18 years old is to execute a durable power of attorney for health care or a living will. Your local hospital may help you to do this at no cost, or you can pay an attorney. The cost is typically very reasonable.

Bocher suggests three promises we should make and keep to the dying individual:

1. To the best of our ability, we will not allow you to die in pain.

2. To the best of our ability, we will not allow you to die alone.

3. You will not be viewed or treated as a burden.

I would add a fourth promise:

4. To the best of our ability, we will make sure your wishes about medical treatment are carried out within the framework of biblical pro-life principles.

May God teach us to number our days so we may apply our hearts to wisdom. As we do so, let us become pro-actively pro-life and seek ways to minister effectively and compassionately to individuals facing imminent death, and to their loved ones who care for them and bear the burden of decision making.

Kathy and Ron made a reasonable decision, given their circumstances. Perhaps legally and morally, the extraordinary medical measure of a ventilator was above and beyond the call of duty. But Kathy and Ron are examples of incredible courage and persevering faith in the midst of trials: Kathy, because she chose to love and care for Ron at home through the advance of this terrible disease, and Ron, because he patiently endured as seeing Him who is invisible.

Tis article scrapes only the surface of the topic, but many excellent resources are available. Vital Signs (1992) and The Right to Die? (1999), both by Mark Blocher and published by Moody Press, are especially helpful. Two books that include helpful chapters on end-of-life issues are Ethics for a Brave New World by John S. Feinberg and Paul D. Feinberg (Crossway Books, 1993) and Moral Choices by Scott B. Rae (Zondervan, 2000). For an excellent treatment of the issue of physician-assisted suicide, see Final Wishes: A Cautionary Tale on Death, Dignity & Physician-Assisted Suicide by Paul Chamberlain (InterVarsity Press, 2000).

Originally published Winter/Spring 2005