LIFE SUPPORT
By David Feddes
But I trust in you, O Lord; I say, “You are my God.” My times are in your hands. (Psalm 31:14-15)
Grandma was over 90 years old, and she still lived in her own house. She had some help with the yard work, but other than that, Grandma handled things herself. She had a hearty body, a sound mind, and a kind heart. She often went to “visit the old people,” as she put it. (I guess she figured those old folks in their seventies and eighties needed a visit from a youngster who was only in her nineties!) Grandma loved people, she loved life, and she loved her Lord. One night Grandma crawled into her bed and went to sleep and woke up in heaven. Her body was found the next day, still resting peacefully in bed.
Most of us would rather not face death, but if we must, we’d like to go the way my Grandma did: physically healthy, mentally sharp to the end, and then a painless departure in our sleep. But not everybody is like Grandma. As people grow old, some of them suffer crippling arthritis or get hurt in a fall and end up in a wheelchair. Others come down with Alzheimer’s or other forms of dementia, and their minds and personalities deteriorate. Some suffer strokes that leave them disabled. Some get cancer and slowly waste away, often with a lot of pain.
When things like that happen, it’s hard not to wish for death, and it’s hard not to ask whether there’s any reason to go on living. It’s hard not to ask the question Job asked in the Bible: “Why is light given to those in misery, and life to the bitter of soul, to those who long for death that does not come?” (Job 3:20-21). Why such deterioration and helplessness? Why such pain? Why does life go on for people who long for death?
Those questions are as old as the human race, but in our time, there’s a new factor that makes the questions even more pressing: the power of modern medicine. Because of improved medicine, fewer people die young, which is good. But everybody still eventually has to die of something, and that means cancer, stroke, and Alzheimer’s are becoming more common ways to die.
What’s more, modern medicine has given us new technologies of life support: feeding tubes, ventilators, dialysis, and so forth. Sometimes we’re grateful for these things, but we dread the thought of lying in a hospital, attached to various machines and tubes and taking a long time to die. Life support can be a wonderful blessing when it helps to save a life, but it can be a dreadful curse when it merely slows down the process of dying.
Difficult Decisions
My family knows both sides of life support technology: its power to sustain life and its power to prolong death. My wife, Wendy, and I had identical twin girls who were born prematurely. Both babies were on ventilators that breathed for them. Both babies had several emergency surgeries. Both babies were fed intravenously and through feeding tubes. Both babies suffered and cried a lot. But our daughter Rachel eventually grew healthy and came home with us, while our daughter Rebekah remained in the hospital and became weaker and weaker.
Rebekah lived for more than five months. There were times when she got a little better, and we would get our hopes up. But then, finally, she began to go downhill rapidly and irreversibly. As long as there had been any hope at all for Rebekah’s recovery, we and our doctors wanted to continue life support and other treatments. But when it became clear that the ventilator and all the other measures were not going to succeed in saving her life, that our little one was going to die no matter what the doctors did, we knew the time had come for a decision.
We wanted any treatment that would save Rebekah’s life, but we didn’t want any treatment that would only prolong her dying and make it more painful. She had clearly reached that point. So we detached her from the respirator. My wife and I cuddled Rebekah and sang to her as she quietly died in our arms.
You can understand, then, that I have mixed feelings about life support. Without life support, Rebekah would have died the day she was born. She would have been spared all the pain she went through during those five months in the intensive care unit. However, without life support, Rachel would also have died. She wouldn’t be the bright, healthy woman she is today.
Life support technologies bring us blessings, but they also bring problems and confront us with decisions that previous generations never had to face. Years ago nobody had to make decisions about restoring a heartbeat or using feeding tubes and ventilators and intravenous antibiotics because there were no such things. But now more and more of us are forced to ask: When should we use such treatments? When do they go from blessing to curse? When is it best simply to let death take its course? Sometimes it’s hard to know.
Along with this type of question, another question is becoming more common. Some go beyond asking when we should withhold technology and allow death, and they suggest that we should use technology to cause death. If someone is suffering and is going to die anyway, why not just end it all with a lethal injection? Euthanasia and physician-assisted suicide seem like sensible options to more and more people.
We could just ignore these matters if everybody were like my Grandma. But not everybody lives long and strong and dies at home in their sleep. Changes in medical technology and in the legal system force almost all of us to deal with life support questions at one time or another. These days, when you’re admitted to the hospital for even the most routine procedure, you’re likely to have to face questions and maybe sign advance directives about life support. And if you or someone you know has a terminal illness, or is in a nursing home, you have to think in advance about whether you want certain kinds of life support or not. Also, even if you don’t face these things at the moment, you may be one of the growing number of people who want a living will just in case you’re ever in a situation where you’re not conscious or competent to express your wishes. And if euthanasia advocates get their way, it may not be long before your doctor has the authority to ask whether you’d like him to help you kill yourself. In light of all these realities, you and I very much need a framework for making end-of-life decisions. How do we know what’s best?
Not My Own
As we think about this, we need the right starting point. We need to know who is ultimately in charge. We need to know that our times are in God’s hands, as the Bible puts it. Scripture says, “For none of us lives to himself alone and none of us dies to himself alone. If we live, we live to the Lord; and if we die, we die to the Lord. So whether we live or die, we belong to the Lord” (Romans 14:7-8).
“What is your only comfort in life and in death?” The Heidelberg Catechism, answers that question by saying, “That I am not my own, but belong–body and soul, in life and in death–to my faithful Savior Jesus Christ.” That’s our only comfort, and that’s the proper context for making life and death decisions.
“I am not my own.” Do those words comfort you, or do they offend you? After all, what is more appealing than being your own person, pulling yourself up by your own bootstraps, being your own boss, making your own decisions? The watchword of the euthanasia movement is “autonomy,” which is shorthand for saying “I am my own.” I have the right to make my own decisions, including the right to kill myself or to have a doctor help me do so, if that’s what I happen to want.
If your only comfort in life and death is that you’re free to have as much fun in life as possible, and then end it all when you’re not enjoying it anymore–well, then, you’ll want nothing to do with God, and you won’t see any reason not to destroy yourself if you don’t enjoy your life anymore. However, the trouble with insisting you are your own is that you’re also on your own. You’re alone, with no heavenly Father to comfort and carry you through your suffering, and no Savior to welcome you into eternal glory after you die.
But if you give up your insistence on being your own person, if you hand your life over to God and confess that you are not your own but belong to Jesus, it changes everything. You’re not your own; you’re his. You’re not on your own. God is there to help you. God says in the Bible, “I will never leave you nor forsake you.” Jesus says, “I am with you always.” When you put your faith in Christ, you can be sure that the Lord is with you every step of the way, in your living, in your dying, and in your life after death.
In Psalm 31, the Bible records a prayer of King David, a prayer he wrote when he was facing some enemy attacks. Our situation is different from David’s, but his prayer can help us as we face the enemies of sickness and death. David begins by praying. “In you, O Lord, I have taken refuge” (v. 1). We need to count on God, not our own autonomy.
Then David pours out his heart and says, “Be merciful to me, O Lord, for I am in distress; my eyes grow weak with sorrow, my soul and my body with grief. My life is consumed by anguish and my years by groaning; my strength fails because of my affliction, and my bones grow weak… I am forgotten as though I were dead” (v. 9-10, 12). Anybody who has severe disabilities or languishes in a nursing home or lies suffering on a deathbed could echo those same words.
However, after pouring out his grief and frustration, David says, “But I trust in you, O Lord; I say, ‘You are my God.’ My times are in your hands” (v. 14-15). My times are in God’s hands, and that means I can’t simply take matters into my own hands. As long as God gives me life, I don’t have the option of ending my life. God says, “Thou shalt not kill.” That makes euthanasia unacceptable. God also says, “I am with you always.” That makes euthanasia unnecessary. We can’t think about life and death decisions until we know that our times are in God’s hands, and that the Lord Jesus Christ is our supreme life support.
Life Worth Living
Another basic fact to remember is this: All human life is sacred. In the Bible, God’s command against killing is based on the fact that God created each of us in his image (Genesis 9:6). The unborn baby, the mentally disabled teenager, the quadriplegic adult, the confused Alzheimers patient, the suffering cancer victim–all these are people made in God’s image, and God alone has the right to end their lives. Human life is sacred. We have no right to deliberately end a human life, whether our own or someone else’s.
There are some gray areas when we think about certain kinds of life support, but don’t let the gray areas make you think there aren’t any black areas. When a doctor deliberately acts to kill a patient, or when a patient deliberately acts to kill himself, there is no gray area. Withdrawing life support sometimes involves shades of gray, but giving a lethal injection is as black as midnight.
As I said earlier, my wife and I made a decision to withdraw our daughter Rebekah’s respirator. It wasn’t easy to do, but Rebekah was dying. The respirator could not prevent her dying. It would just make her dying more miserable. Once the treatment had clearly become painful and pointless, we thought it right to put a stop to it.
However, it would have been terribly wrong to give Rebekah a lethal injection. There’s a great difference between allowing death to take its course and actively killing someone. It’s okay to withhold treatment that is no longer best for a person, but it is murder to actually kill that person whom God created in his image and whom God alone has the right to call out of this life.
But here’s another question: What if continued life support would have given Rebekah a chance to recover and live, but with high risk of blindness or retardation or other disabilities because of all that she’d been through. Would it have been right to withdraw the respirator to keep a potentially handicapped child from surviving? Absolutely not. If we had done that, we would have been weighing the value of a life, not the value of a treatment, and that is wrong.
It’s one thing to refuse a useless and burdensome treatment when someone in the process of dying anyway no matter what the treatment. It’s quite another thing to refuse treatment for a life that treatment might have saved, just because that life was considered not worth saving. We sometimes have to make decisions about whether a treatment is worth giving, but we have no right to decide whether a life is worth living. Any life created in God’s image is worth living.
Those who want to legalize mercy killing talk a lot about “quality of life.” “Quality of life” is sometimes given as a ground for aborting Down’s Syndrome babies, and in some cases, for withholding treatment from handicapped newborns or even for actually killing them. But whose “quality of life” is at issue? Many people who have Down’s syndrome or other mental disabilities are very cheerful and happy and affectionate people. They enjoy being alive. Their “quality of life” is high. Sometimes “quality of life” is just a way of saying that such people aren’t appreciated by the people around them.
Joni Eareckson Tada, a Christian quadriplegic, says that the message which comes through in all this is that some people are better off dead than disabled. “Instead of making it easier for people with disabilities to die,” she says, “I would like our society to make it easier for them to live.”
Support One Another
Scripture urges, “Carry each other’s burdens, and in this way you will fulfill the law of Christ” (Galatians 6:2). The Bible refers to God as “the Father of compassion and the God of all comfort, who comforts us in all our trouble, so that we can comfort those in any trouble with the comfort we ourselves have received from Christ” (2 Corinthians 1:3-4). God calls us to support others in their living and in their dying.
In concrete terms, this means we must continue to remove any barriers that prevent people with physical disabilities from enjoying the freest and fullest life possible, and we must listen to the many things these people can teach us from their unique situations. We must value and love those who have mental handicaps but are nevertheless image bearers of God and people with very special and sacred lives. We must offer them support and every appropriate form of education and opportunity. And again, if we are wise, we will try to learn things from them that so-called “normal” people might not be able to teach us.
We must treat those who are aged or institutionalized with respect and kindness. Our calling is not to question whether their lives are worth living, but to use every resource and opportunity God gives us to make them feel that their lives are worth living.
And when people are terminally ill, when a cure is beyond hope, we must not abandon them. At that point, we can’t cure, but we can still care. We must support hospice agencies that provide pain control and medical support to dying people right in their own homes. And we must give personal encouragement and kindness to dying people that we know. We must comfort them and help them carry their burdens, and at the same time, realize that they may have as much to offer us as we have to offer them. A person facing death, especially a Christian facing death, is often in a position to offer an insight and perspective that no one else can.
Made Perfect in Weakness
Some voices tell us that weakness and suffering have no point. For example, one prominent advocate of euthanasia has said, “I have found that there is no purpose in suffering. People who suffer never become better people as a result of it.” This man even said, “The sufferings of Christ were meaningless.”
But the Bible shows that the sufferings of Christ mean the salvation of the world, and the Bible also shows that our own sufferings can serve a high and holy purpose. The apostle Paul found that in a time of suffering, God was saying to him, “‘My grace is sufficient for you, for my power is made perfect in weakness.’ Therefore,” says Paul, “I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me… For when I am weak, then I am strong” (2 Cor. 12:9-10).
Our times are in God’s hands, even our times of pain and weakness. God can use these times to draw us out of our self-sufficiency and into deeper dependence on the Lord Jesus Christ. I’ve seen it. And I’ve also seen God use difficult times to draw us closer to each other. Those who suffer and those who support them can grow in appreciation for one another and sense the Lord touching them, each through the other.
Be Prepared
Once we realize all these things, then we can begin to address the particulars of life support, and we can make the decisions we need to make. Some of the decisions are hard, and we don’t feel wise enough to make them, but the Bible says, “If any of you lacks wisdom, he should ask God” (James 1:5). Pray to the Lord for wisdom, and then seek to do what is best.
There’s no legal or moral obligation to force every form of life support on dying people just because the technology is there. In prayerful dependence on God, in consultation with doctor who will be clear and honest about the medical realities of a situation, and with openness to the feelings and insights of friends and family members and a pastor, you can makes choices which forms of life support to accept and which to refuse.
You may want to consider preparing an advance directive. Your directive can outline which forms of treatment you would want, and which ones you don’t want. However, it’s very hard to know every circumstance in advance. You can make your wishes known to some degree, but you can’t anticipate every development, it is wisest to designate a health care proxy, someone who has powers of attorney over your health care. In effect, you designate a person you trust with your life to make decisions about life support just in case you’re unable to make your own decisions at a critical time. A good lawyer can help you work through such details.
I don’t want to end on that note, however. For some people, thinking about sickness and death means thinking about the end. But when your faith is in the risen Lord Jesus Christ, you believe in the reality of life after death. You believe in the resurrection. Death doesn’t have the last word. Jesus does.
Decisions about life support are important, but we need to keep all this in perspective. The most important part of preparing for death has nothing to do with advance directives or medical technology. The most important part of preparing for death is that you be ready and eager to meet the Lord. My prayer is that you can say to God, “I trust in you, O Lord. You are my God. My times are in your hands. And so is my eternity.”
For further study:
Kathryn Butler, Between Life and Death: A Gospel-Centered Guide to End of Life Medical Care
David Van Drunen, Bioethics and the Christian: A Guide to Making Difficult Decisions