End of life issues

What things should we consider when making decisions about end of life issues for ourselves and for our loved ones?

This is an important question, and one that affects us all very deeply, seeing as how we are all going to die. More than this, we are all likely going to be called upon at some point in our lives to help make such decisions for others whom we love, whether an aging parent or a terminally ill spouse.

It’s an issue which is greatly complicated by the advance of medical science. A hundred years ago the question was much simpler because there were not the artificial means that are available today to keep people alive. Now we have respirators and IV’s and feeding tubes and pacemakers and a plethora of other mechanisms that can cause organs to continue to function when in previous generations they would have ceased to do so on their own. This has had the effect of blurring the line between life and death, so that there is some question among medical and ethical experts as to how to even define death.

A discussion of these issues could fill many volumes. To deal with them adequately we’d have to talk about the patient’s age, his overall health, whether or not he has dependents, the likelihood (or not) of effective treatment, whether the negative side-effects of the treatment are worth the potential benefits to be received, etc. There are a great many things to discuss and a great many specific scenarios we could imagine, but we can do more today than to give some general guidelines.

First of all we should say that in general there should be a presumption in favor of life. In other words, under normal circumstances, whenever it is possible to preserve life, life should be preserved. This should be our instinctive response. I say “under normal circumstances” because sometimes there are other considerations that have to be taken into account.

The second thing to keep in mind is that, ever since the fall, death has been inevitable. We know by painful experience that “there is a time to be born, and a time to die” (Ecc. 3:2). Life is a gift from God, and death is his judgment upon sin, a judgment that will be visited on everyone. As we read in Hebrews, “it is appointed for man to die” (Heb. 9:27). Medical means are limited by this unalterable fact.

Thirdly, when considering end of life issues a distinction has to be made between killing and letting die. Under certain circumstances it’s permissible to omit the use of extraordinary means to save life; but it is never permissible to administer treatment that is specifically designed to hasten death.

Suppose, for example, that a terminally ill cancer patient goes into cardiac arrest (his heart stops beating). It is permissible to forego treatment that would resume normal heart function. Why is this permissible? Because if the patient is terminal, one is not so much sustaining life as he is prolonging the process of dying, and thereby prolonging his suffering.

The decision to forego this treatment, however, should have been made by the patient beforehand. If this has not been done, it ought to be presumed that the patient wishes life-saving treatment, unless someone entrusted with durable power of attorney decides otherwise.

But what if the patient is not terminal? That is, what if he is not near death? Say a cancer patient who prefers to let nature take its course rather than suffer the negative side-affects of chemo. Is it morally permissible to refuse treatment? Or instead of cancer, perhaps it’s a heart condition, that requires bypass surgery. Is it permissible for a patient to refuse treatment?

It depends on a number of factors. If the patient is relatively young, and there is a good chance of the treatment being successful, and he has dependents, then no, it is not morally permissible to refuse treatment. He should seek to prolong his life in order to continue his service to God and his family in this world.

If, however, the patient is elderly, and has no dependents, and deems the side-effects of treatment to be worse than the symptoms of the disease, then yes it is permissible for such a patient to refuse treatment. It is permissible to refuse treatment that simply prolongs suffering when there is no reasonable hope of recovery.

This is quite a different thing than taking active measures to end life or giving treatment designed to hasten death. This is not permitted. Both euthanasia and assisted suicide are clearly contrary to God’s law. If someone is suffering from an incurable disease, rather than taking active measures to hasten death, we should make every effort to provide palliative care. Wonders can be done today with pain management.

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