The Zion Blog > Ask the Pastors > Miscellaneous


Terminal Illness-Choose Treatment or Not

Question #1: Hey Pastor, I have a question!? My question pertains to how a person is to react when a doctor informs them that they have a terminal illness.? If the doctor indicates that there are treatments that may prolong his life, yet because the ill person will face days of illness and perhaps even loss of hair and more than likely spend time in the hospital, MUST the patient accept such prescribed treatment?? And, if the patient refuses these treatments, choosing instead to live out the time he has in comfort, is this decision wrong?? In other words, are we obligated to accept the help that we can receive from doctors who might be able to extend life?

Answer #1: Thank you for your questions.? In summary, it seems as if all your questions hover around this:? ?How is the Christian to act (medically and faithfully speaking) toward an illness, condition, or disease that is terminal, but perhaps treatable ? at least, treatable to the extent that death might be delayed for a time??

First of all, only God knows all the facts in every situation.? In His grace He has given the medical community (and therefore us) many tools, medicines, and procedures that may perhaps be used to delay the conclusion of a terminal illness.? But, as you note in your questions, sometimes the treatments can be heavy with pain and suffering ? which brings to mind the old adage of ?The cure is worse than the illness!?? (By the way, referring to your above written question, I must say that to have hair on top of one?s head is highly overrated!? One can live without it!)

The following is an excerpt from the national Lutherans for Life website (LutheransForLife.org):

Blurring the Distinction: Allowing to Die or Causing to Die?

There is a distinction between allowing to die and causing to die. We can and should allow dying people to die. This decision should be made based on the worth of a particular treatment not on the judged worth of the person. If a treatment has become a burden to the person and is causing more harm than good or is only prolonging death rather than sustaining life, it may be withdrawn.

It is quite a different matter to remove treatment or care in order to cause the living to die. This is what was involved in the Terri Schiavo case in Florida. Terri was not being kept alive by extraordinary means. She was being kept alive by very ordinary means?food and water?being administered by a small tube directly into her stomach. Terri was not dying. The removal of her feeding tube did not allow her to die. It caused her to die. Her case received national attention, but it was by no means an isolated case. Disability groups are rightly concerned about the increased use of withdrawing treatment and care to cause people who are disabled to die. When decisions about who lives and who dies start being based on arbitrary standards, how can we possibly draw lines? [The above quote was written when Ms Schiavo was still alive.? I edited this quote (inserting past tense verbs) to reflect the death of Ms Schiavo which happened after the article was written.? Pastor Rock]

In the first paragraph of the above quote we must note that it was assumed that the person who is ill is dying; that is, the person is, at that moment, in the state of dying.? He or she has been diagnosed as ?terminal? and there is no hope for their recovery.? It is THAT case that is addressed in that statement.

In all cases when the ill have been diagnosed as terminal, a good rule of thumb to abide by is to ?do no harm.?? By doing ?no harm? we do nothing to cause death or even speed it beyond the natural pace that God has set.

God calls us to honor life just as He honored it.? Remember, He gave His life, so that we might have life in His name.? It is only our Lord who has the authority to call the shots as to when a person?s life is completed.? Therefore, if we were to take action to cause death, we are out of bounds.

When facing the question that you ask, one must keep in mind St. Paul?s words that remind us that our bodies are no longer our own.? Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God?? You are not your own, for you were bought with a price.? So glorify God in your body. (1 Cor. 6:19-20, ESV) As Christians we face this question the same way that we face all questions.? We ask:? ?What action of mine will honor God?s call to ?glorify? Him??

We conclude this column with the following quotation from Lutherans for Life:

Many Christians? agree that the extreme (of euthanasia) is unreasonable. When outward signs of life are absent and it appears God (is calling) the soul from its earthly ?tent,? there is no point in artificially sustaining life signs. Therefore, when no hope of recovery exists, the dying process should be allowed to run its course. Loving care – including food, water and spiritual support – should be given to
the dying, keeping them as comfortable and pain free as possible. This is death with dignity.

Thanks again for your question.? However, we?re not finished yet!? Next month this column will consider your question from another angle.? In May we shall discuss the attitude of the Christian as he/she and their family decide whether to take on a difficult treatment when the doctors are not ready to diagnose the patient as ?terminal,? but do readily indicate that the possibility of recovery is minimal.? As a foretaste of next month?s discussion, the following survey result is provided: In a survey of nursing home residents, over 80% said they would want beneficial care or life support. But when the families of the residents were surveyed, only 30% said they thought their loved ones would want life support. (Source: Lutherans for Life website)

Question #2: The second part of my question regards a woman who died from complications of diabetes.? Her daughter was very angry with her because she did not follow instructions for those who are diabetic.? The diabetic pretty much went about her life as usual.? She took her medication yet, did not always follow the diet prescribed for her.? She later died of complications caused by diabetes.? She obviously made a choice.? The woman was a Christian; yet, in this case was this wrong in God?s eyes?

Answer #2: This month we tackle the second half of your question.? In this answer we shall consider a few things all of which seem related to your question above.? First, we?ll address your specific question about the diabetic.

Diabetes in most cases can be controlled.? My brother-in-law was diagnosed with this condition and it changed his life in a most dramatic way.? Yet, with his undergoing medication, getting plenty of exercise, AND watching his diet like a hawk, he continues to function quite well.? If he had ?let it go? he would be dead by now.? To not follow the directions given by the doctors (who are God?s agents for good whom He has equipped and raised up to be a blessing to us) is wrong.? Through trained medical professionals, God can and does show His mercy to us.? Once diagnosed with something like diabetes, and to do as the woman described in your question who ?pretty much went about life as usual?, is wrong.? Eating chocolate cake whenever one pleases, knowing that it could kill, is an offense to God.? Rather, the Christian is called to patiently take what has come his/her way, trusting that God cares and will provide strength and courage.

Now let?s look at the bigger picture.? In the April edition of this column we indicated that this month we would discuss the attitude of the Christian as he/she and their family decide whether to take on a difficult treatment when the doctors are not ready to diagnose the patient as ?terminal,? but do readily indicate that the possibility of recovery is minimal.

I quote the following from the book entitled Holy People, Holy Lives by Richard Eyer (CPH 2000), pp. 91-92:

?Perhaps the most heart-wrenching decision most of us will have to make at some point in life will be the decision to withhold or withdraw treatment from a loved one. There are surely times when this is appropriate. No one is required to receive treatment that is futile or which the patient considers burdensome, as Gilbert Meilaender [Note: Meilaender is another Christian ethicist and author. Pr. Rock] has so well articulated. Some will say that a treatment is futile if it does not offer cure; but a treatment cannot be called futile that sustains the life, a patient’s God-given life, even though we might all agree this is not the life anyone would choose for himself. Such may be those who are in a coma (persistent vegetative state) and receive food and water to live, or the demented Alzheimer’s patient who needs to be tube fed because she can no longer feed herself or eat by mouth. If the word futility is taken at face value as applying to treatment that offers little or no benefit, then such treatment may ethically be withheld. By contrast, it can only be withdrawn (having already been in place) if it does not cause death, for then such treatment could not be said to be futile, sustaining as it does the life the patient has been given by God to live.

?As a criterion for withdrawal of treatment, Meilaender’s understanding of what is burdensome is helpful. Treatment may be withdrawn, he says, if the patient considers the treatment to be burdensome. As subjective as this may be, the basis for this principle is that the burden of treatment ought not be worse than the burden of the illness itself (unless such burdensome treatment is transient and will soon lead to recovery). Nevertheless, Meilaender says that if the patient decides he can no longer bear a particular treatment and is not rejecting treatment so that he will die (even though death may come sooner rather than later), he is no longer required to bear the burden of the treatment.

?Meilaender clearly believes that the determination of what is burdensome must be the decision of the patient and no one else. It is impossible, given the subjective nature of what it means to be overburdened, for anyone to say for another what is or is not burdensome. It
follows, then, that the patient in a persistent vegetative state, or coma, cannot be said to be overburdened by the treatment of tube feeding or life support. Because a patient shows no evidence of pain or discomfort in a coma, treatment cannot be identified as burdensome.

?Assuming such definitions of futility and/or burdensomeness are understood accordingly, there are yet other concerns problematic for Christians in withholding or withdrawing treatment. First, it is problematic when a patient’s decision to withhold or withdraw treatment is
motivated by an unwillingness to live the life God has given him to live. Lives limited by disability or illness lived faithfully [remain] lives of ?worth? because of the Gospel. Jesus? attention to the disabled and sick is a sign to us of the importance of the cross for the worth of all lives. The life we have been
given by God in this fallen world may not be the life God originally intended us to have, but it is the life we are now called to live.

?We may, in the course of the hardships of life, need to lay out our complaint before God, but because this is a fallen world we cannot make God the cause of suffering and death, even though He allows it to go on until Christ returns. God’s delay in coming is part of the mystery of the Story God tells. The practical question is not, ‘Why has God allowed this?’ but, ‘What has God done about suffering and death, and how can I now live with my own problems?’ The great Story that gives answer to this is found at the foot of the cross. The lesser story of our own experiences may shake and confuse us at the moment, but as we are raised up by God in faith, there is also peace in the deeper mystery of God’s love in the midst of suffering and death.? [End of book quotation]

As was previewed in last month?s column, the following statistic is of great interest:? In a survey of nursing home residents, over 80% said they would want beneficial care or life support. But when the families of the residents were surveyed, only 30% said they thought their loved ones would want life support.? (Source: Lutherans for Life website)

This brings up an extremely difficult situation.? How do the patient and the family of the patient ?get on the same page? in regard to what efforts are to be taken to preserve the life of the patient?

Far from calling us to an earthly existence of constant pleasure and freedom from distress, God has called us to a life of service (Galatians 5:13) and at times that service involves sacrifice and adversity.? It can be difficult, expensive, and extremely trying to care for a person who is ill, dying, or handicapped.

When a person has been ill for a long time, the family members get to a point where they?ve ?had it.?? They?re exhausted physically; drained emotionally.? The question arises: ?Do we withdraw treatment, or not??? Christians must ask themselves: ?Is what I’m about to decide for the benefit of the patient or for me? Do I want to withdraw treatment because I can?t bear the burden anymore or because the treatment is a burden to my loved one??

The challenge for the Body of Christ is to learn how to bear burdens and to help others do so in ways that give glory to God, to learn how to grow in faith even in the midst of suffering, and to learn to live with and for each other as the family of God.? As we do this, we will see each
person who suffers not as a burden to be eliminated or avoided, but as a personal invitation to love with the love of Jesus Christ who “bears
griefs and carries our sorrows.” (Isaiah 53:4)

If we choose to endure suffering by the strength of faith in Christ instead of choosing to end our own life as a way to avoid pain, we give a testimony of the power of God to help us endure.? Consider the following verses:? 2 Corinthians 12:1-9, 1 Peter 1:5-7, John 9:1-3, Psalm 23:4.? Also, our Lord Jesus didn?t choose to ?avoid? suffering, and we will be eternally glad of that!? Luke 22:39-46 ? verse 43 especially.

Dr. Luther said that real theology is done through prayer, meditation, suffering, anxiety, and the like.? Those are the battlegrounds where theology is put into practice, where people struggle with their relationship with God, and where they are strengthened by the grace of God.

As Christian friends and family of one who is suffering, we are given a unique opportunity to demonstrate the love of Christ as we minister to the afflicted with God?s own words of comfort.

When I am called to counsel and visit with a family that is facing tough choices regarding life support questions, I always remind them that our Lord is the Lord of Life.? Because of that, and because we are His children, we seek to preserve life too.

Yet, sometimes we can perhaps get in the way of our Lord calling one of His own to live with Him in eternity.? Therefore our thoughts and actions are always motivated by what is pleasing to Him.? Granted, this is not always easy for us weak humans to determine; but we are called to make decisions.? So, after consulting His Word and imploring Him for wisdom in prayer, asking that He lead us in knowing His will, we make those ?tough decisions? with confidence, trusting that His Word has guided us.? I repeat the axiom stated in last month?s column:? ?We seek to do no harm? to the patient.

I hope that this is of some help to you.? Thank you for your questions.? May God guide and bless us with His wisdom in all matters.

Pastor Rock