The Bible and End-of-Life Care

My father was 79 when he fell while moving from his wheelchair to his bed. In the fall, he tore his rotator cuff and had a minor heart event. He was rushed by ambulance to the hospital. The tests on his heart were encouraging; but other tests revealed that he had multiple problems with his lungs.

My father’s aim was simply to be a faithful steward of the resources God had given him of time, talent, energy, money, and spiritual opportunities.

Over the next four days his ability to breathe went downhill and he was put on oxygen. On the fourth day he was asked if he wanted to be intubated and put on a ventilator. A tube down his throat and into his lungs would deliver oxygen more efficiently, making it possible for him to sleep.

A year earlier, my father had decided that he did not want to die hooked up to a machine. He asked the doctors if they had reason to believe he would eventually get off the ventilator and return home. They said that it was unlikely. On it, he might live as much as six weeks more in the hospital. He would not be able to communicate easily with those around him or join with others in worship; but he would be alive. Without the ventilator, he would probably die within six days.

My father said “No” to the ventilator.

He and I had discussed what the Bible taught about life-sustaining medical treatments like CPR and ventilators. Together we had concluded that God’s Word permits us to decline life-sustaining medical treatment that is either ineffective or excessively burdensome. The ventilator would be effective at keeping him alive; but the burdens imposed would far outweigh the benefit of remaining alive a little longer in a hospital bed. We also had determined that God’s Word does not require us to suffer merely in order to stay alive.

My father’s aim was simply to be a faithful steward of the resources God had given him of time, talent, energy, money, and spiritual opportunities. He said “No” to the ventilator because he was confident that he could serve his Master, Jesus, best by living what would likely be a slightly shorter life, able to communicate with his family and join them in praising God. Saying “No” to the ventilator would also mean he was able to leave more of his modest estate to his children.

All of my father’s decisions conform to the principles about end-of-life medical treatment in the 1988 Presbyterian Church in America Report of the Heroic Measures Committee. Here is the full text of the Report, along with an “Appreciation and Update” I wrote on the 25^th anniversary of its adoption. Some of the terminology in the report needs to be brought up to date, and quite importantly, the Report’s advice against preparing “living wills” needs to be reconsidered. A lot has changed since 1988 in the way Advance Directives are handled in the hospital. Now it is wise to prepare a state-approved Advance Directive to express your wishes. But even without updating, the Report deserves to be read carefully by church leaders today, paying special attention to the steps churches should take to prepare believers to make biblically sound decisions for themselves and their loved ones.

The Report argues from Scripture for four principles.

1. God’s glory is our ultimate aim. So extending our physical life is not an ultimate good. Numerous passages are discussed in support of this principle, including Paul’s confident assertions about life and death in Philippians 1:19-26 (“…For to me to live is Christ, and to die is gain”) and John’s teaching (in John 15) that Jesus laid down his life for his friends.
2. There is a time to cease resisting death, for the glory of God. Ecclesiastes 3 says there is a time to die. The Report concludes that in the light of all of Scripture, this can be extended to include a time to stop resisting death by means of measures that are minimally effective or have frequent, serious side effects.
3. The Bible does not require that we suffer merely to extend our physical lives, but life is not to be abandoned simply on account of suffering. Jesus’ words to Peter in John 21 (“but when you are old, you will stretch out your hands, and another will dress you and carry you”) and Peter’s own words in I Peter 2 (“For to this you have been called, because Christ suffered for you…”) are used effectively to support this principle.
4. When death is likely to occur within a short period of time, it should be faced with realism and readiness. Both Jacob and Joseph (Genesis 49-50) took steps to be reconciled to others and to speak of God’s covenant promises to their children as they neared death. The Report notes that heroic measures can interfere with following their example and anticipates its recommendations about the need for discussions and planning with loved ones well before choices must be made about end-of-life treatment.

Up to the very end, my father was calling the shots. None of us should count on being able to think clearly and communicate our wishes as we approach death. To prevent his family from having to guess about his wishes when he could not make the decisions, he had taken steps ahead of time. He had explained what he wanted to his family; and he had left it in writing to help us remember. My father is now with Jesus. I am sad that he is not with us, but I can look back on his passing without regret because I know the decisions were his and not mine. His preparation for the end was a great gift to me.

Bill Davis is professor of philosophy at Covenant College and a ruling elder at Lookout Mountain Presbyterian Church. He is also adjunct professor of systematic theology of Reformed Theological Seminary, and has been an ethics committee member of Memorial Hospital in Chattanooga, Tennessee, since 1999.