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Help for the Dying in Our Modern AgeAwake!—1991 | October 22
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Help for the Dying in Our Modern Age
THE woman, a doctor herself, had just been through a most painful ordeal. She had watched her 94-year-old grandmother die in the hospital intensive-care unit following cancer surgery that “she never wanted.”
“My tears at her funeral were not for the fact of her death, for my grandmother had lived a long, full life,” the doctor wrote. “I cried for the pain she had endured, and for the lack of fulfillment of her wishes. I cried for my mother and her siblings, for their sense of loss and frustration.”
You may wonder, though, about the possibility of helping such a seriously ill person. This doctor continues:
“Mostly, I cried for myself: for the overwhelming guilt I felt at not being able to save her from pain and indignity, and for the woeful inadequateness I felt as a physician, unable to heal, unable to relieve suffering. For nowhere in my training had I been taught an acceptance of death or dying. Illness was the enemy—to be fought at every turn, with every last resource. Death was a defeat, a failure; chronic disease a constant reminder of the physician’s impotence. The image of my little grandmother staring at me with frightened eyes while on a ventilator in an ICU haunts me to this day.”
This loving granddaughter crystallized a complex ethical, medicolegal issue that now is being debated in courtrooms and hospitals around the world: What is best for the hopelessly ill in our technologically advanced age?
Some have the view that everything medically possible should be done for each person who is sick. This view is expressed by the Association of American Physicians and Surgeons: “The obligation of the physician to the comatose, vegetative, or developmentally disabled patient does not depend upon the prospect for recovery. The physician must always act on behalf of the patient’s well-being.” This means providing all the treatment or medical help that can possibly be applied. Do you feel that this is always best for a person who is gravely ill?
To many people that course certainly sounds laudable. Yet, in the past few decades, experience with technologically advanced medicine has given rise to a new and different viewpoint. In a 1984 landmark paper entitled “The Physician’s Responsibility Toward Hopelessly Ill Patients,” a panel of ten experienced physicians concluded: “A decrease in aggressive treatment of the hopelessly ill patient is advisable when such treatment would only prolong a difficult and uncomfortable process of dying.” Five years later the same doctors published an article of the same title that was styled “A Second Look.” Considering the same problem, they made an even plainer statement: “Many physicians and ethicists . . . have concluded, therefore, that it is ethical to withdraw nutrition and hydration [fluids] from certain dying, hopelessly ill, or permanently unconscious patients.”
We cannot dismiss such comments as simple theorizing or as a mere debate that has no real bearing on us. Numerous Christians have been faced with agonizing decisions in this connection. Should a hopelessly ill loved one be kept alive on a respirator? Should intravenous feeding or other artificial feeding methods be applied to a terminally ill patient? When the situation is hopeless, should all the financial means of a relative, or of an entire family, be expended to pay for treatment, perhaps involving transportation to a distant center to receive the most advanced treatment?
You no doubt appreciate that such questions are not easy to answer. Much as you would want to help an ill friend or loved one, if you had to face these questions you might wonder: ‘What guidance does the Christian have? What resources are available for help? Most important, what do the Scriptures say on the subject?’
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What Care for the Terminally Ill?Awake!—1991 | October 22
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What Care for the Terminally Ill?
IN RECENT times people’s approach to death and dying has been undergoing change in many parts of the world.
In times past physicians accepted death as the inevitable end of their ministrations for some patients—an end to be eased, and often to be handled at home.
More recently, with the emphasis on technology and cure, medical personnel have come to regard death as a failure or a defeat. So the primary goal of medical practice has become that of preventing death at all costs. With this change came the development of a whole new technology to keep people alive longer than would previously have been possible.
Medical technology has brought undeniable advances in many lands; nevertheless, it has given rise to some serious misgivings. One doctor commented: “Most physicians have lost the pearl that was once an intimate part of medicine, and that is humanism. Machinery, efficiency and precision have driven from the heart warmth, compassion, sympathy and concern for the individual. Medicine is now an icy science; its charm belongs to another age. The dying man can get little comfort from the mechanical doctor.”
That is just one person’s opinion, and it certainly is not a universal indictment of the medical profession. Yet, you have probably seen that many people have developed a fear of being kept alive on machines.
Gradually another view began to be heard. It was that in some cases people should be allowed to die naturally, with dignity, and without being subjected to the intervention of heartless technology. A poll recently conducted for Time magazine revealed that over three quarters of those contacted felt that a doctor should be allowed to withdraw life-sustaining treatment for a terminally ill patient. The study reached this conclusion: “Once reconciled to the inevitable, [people] want to die with dignity, not tethered to a battery of machines in an intensive-care unit like a laboratory specimen under glass.” Do you agree? How does that compare with your view on the subject?
Proposed Solutions
Depending on one’s culture or social background, there is great variation in approaches to the subject of death and dying. Yet, people in many countries are showing increased interest in the plight of the hopelessly ill. In the last few years, ethicists, doctors, and the public in general have promoted efforts to adjust the care for such unfortunate ones.
Among the many measures being explored to address this issue, the one most commonly implemented in some hospitals is the policy “Do Not Resuscitate,” or DNR. Do you know what this involves? After extensive discussions with the patient’s family, and preferably also with the patient, specific advance plans are made, and these are noted on the patient’s chart. This focuses on what limitations will be imposed on efforts to revive, or resuscitate, the hopelessly ill patient should his or her condition worsen.
Nearly everyone recognizes that the overriding consideration in such difficult decisions should be “What would the patient want done?” What makes it a serious problem, though, is that often the patient is unconscious or otherwise incompetent to make informed personal decisions. This has given rise to a document that may be called a living will. It is designed to allow people to specify in advance what treatment they would desire in their last days. For example, such a will might read:
“If I should have an incurable or irreversible condition that will cause my death within a relatively short time, it is my desire that my life not be prolonged by administration of life-sustaining procedures. If my condition is terminal and I am unable to participate in decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw procedures that merely prolong the dying process and are not necessary to my comfort or freedom from pain.” Such documents may even specify what sort of therapies the individual does or does not want applied in a terminal situation.
Such living wills, though not legally binding under all circumstances, are recognized in many places. An estimated five million people in the United States have drawn up medical living wills. Many authorities in that land consider this to be the best means available to ensure that one’s wishes are respected and followed.
What Type of Treatment or Care?
What about the actual care of the terminally ill? Perhaps the most significant innovation has been the concept called hospice, increasingly recognized worldwide. Just what is “hospice”?
Rather than meaning a place or a building, hospice in this sense refers really to a philosophy or program of care for the terminally ill. It is derived from a medieval French word for a place of rest for pilgrims. Hospice concentrates on a team approach (doctors, nurses, and volunteers) that works to ensure that a terminally ill patient is kept comfortable and relatively pain free, preferably in the patient’s own home.
Though some hospices are based within hospitals, many are independent. Most avail themselves of community resources, such as visiting nurses, nutritionists, ministers, and chiropractors. Rather than employing heroic medical measures, hospice care emphasizes heroic compassion. Rather than aggressive treatment of the patient’s disease, it focuses on aggressive treatment of the patient’s discomfort. One doctor put it this way: “Hospice isn’t less care or no care or cheap care. It’s just a totally different kind of care.”
What is your reaction to this concept? Does this approach seem like one that you feel should be discussed with any of your loved ones who might be diagnosed as facing a terminal condition, and perhaps with the physician involved?
Even though hospice care may not be available in your area now, chances are it will be in the future, as the hospice movement is growing worldwide. Originally viewed as an antiestablishment effort, hospice care has gradually entered the mainstream of medicine, and it is now considered an accepted alternative for the terminally ill. Through its techniques, especially proper use of painkillers, hospice has contributed some notable advances to health care.
In a letter to the New England Journal of Medicine, Dr. Gloria Werth described the death of her sister in a hospice: “At no time was medication, food, or liquid forced on my sister. She was free to eat, drink, . . . or take medication as she wished . . . But the best thing about the hospice is that our memories of Virginia’s death are unusually reassuring and happy. How often can this be said after death in an intensive-care unit?”
[Blurb on page 5]
“Medicine is now an icy science; its charm belongs to another age. The dying man can get little comfort from the mechanical doctor”
[Blurb on page 6]
Hospices focus on aggressive treatment of the patient’s discomfort rather than aggressive treatment of the disease itself
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The Best Help Is Available!Awake!—1991 | October 22
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The Best Help Is Available!
FOR the Christian the choice and extent of care for the terminally ill might raise profound questions. For example:
Would it be unscriptural to do less than everything possible to preserve life? And if it is morally acceptable to allow someone to die naturally, without heroic intervention to prolong life, what about euthanasia—a deliberate, positive act to end a patient’s suffering by actually shortening or ending his life?
In this day and age, these are important questions. However, we are not without help in answering them.
An inspired writer aptly said: “God is for us a refuge and strength, a help that is readily to be found during distresses.” (Psalm 46:1) That is true for us too in considering the present matter. Jehovah God is the source of the wisest, most experienced help. He has observed the lives of thousands of millions of people. He knows—better than any doctor, ethicist, or attorney—what is best. So let us see what help he makes available to us.—Psalm 25:4, 5; Hebrews 4:16.
A Right View of Life
We do well to realize that the philosophy of preserving life at all costs is not confined to medical technologists. It is a natural product of modern secular philosophy. Why is that so? Well, if this present life is all there is, then it might seem that our personal life should be preserved under all circumstances and at all costs. But this secular philosophy has in some cases resulted in technical nightmares—unconscious people being kept “alive” on machines for years.
On the other hand, there are those who believe in immortality of the human soul. According to their philosophy, this life is but a way station on the path to something better. Plato, one of the originators of this philosophy, held:
“Either death is a state of nothingness and utter unconsciousness, or, as men say, there is a change and migration of the soul from this world to another. . . . If death is the journey to another place, . . . what good, O my friends and judges, can be greater than this?”
A person having such a belief might regard death as a friend, to be welcomed and perhaps even to be hurried. Yet, the Bible teaches that life is sacred to Jehovah. “With you is the source of life,” the inspired psalmist wrote. (Psalm 36:9) Should, then, a true Christian agree to share in euthanasia?
Some feel that there is Scriptural reference to the subject when King Saul, severely wounded, begged his armor-bearer to kill him. They have viewed this as a type of euthanasia, a deliberate act to hasten death for someone who was already dying. An Amalekite later claimed to have complied with Saul’s request that he be put to death. But was that Amalekite thought of as having done good in ending Saul’s suffering? Far from it. David, the anointed of Jehovah, ordered that this Amalekite be slain for his bloodguilt. (1 Samuel 31:3, 4; 2 Samuel 1:2-16) This Biblical event, then, in no way justifies a Christian’s having any part in euthanasia.a
Does this mean, though, that a Christian must do everything that is technologically possible to prolong a life that is ending? Must one extend the dying process as long as possible? The Scriptures teach that death is, not a friend of man, but an enemy. (1 Corinthians 15:26) Further, the dead are neither suffering nor in bliss, but they are in a sleeplike state. (Job 3:11, 13; Ecclesiastes 9:5, 10; John 11:11-14; Acts 7:60) The future prospects of life for the dead are totally dependent on God’s power to resurrect them through Jesus Christ. (John 6:39, 40) So we find that God has provided us with this helpful knowledge: Death is not something to be longed for, but neither is there an obligation to resort to desperate efforts to prolong the dying process.
Christian Guidelines
What guidelines could the Christian apply in a situation where a loved one is in a terminal state?
First, we must acknowledge that each situation involving a terminal illness is different, tragically different, and there are no universal rules. Furthermore, the Christian should be careful to consider the laws of the land in such cases. (Matthew 22:21) Keep in mind, too, that no loving Christian would advocate medical neglect.
Only when there is undeniably terminal disease (where the situation has been clearly determined to be hopeless) should consideration be given to asking that life-support technology be discontinued. In such cases there is no Scriptural reason to insist on medical technology that would simply prolong a dying process that is far advanced.
These often are very difficult situations and may involve agonizing decisions. How is one to know, for example, when a situation is hopeless? Though no one can be absolutely certain, reason needs to be exercised along with careful counsel. One medical paper advising doctors comments:
“If there is disagreement concerning the diagnosis or prognosis or both, the life-sustaining approach should be continued until reasonable agreement is reached. However, insistence on certainty beyond a reasonable point can handicap the physician dealing with treatment options in apparently hopeless cases. The rare report of a patient with a similar condition who survived is not an overriding reason to continue aggressive treatment. Such negligible statistical possibilities do not outweigh the reasonable expectations of outcome that will guide treatment decisions.”
In such a predicament, the Christian, whether patient or relative, would rightfully expect some help from his physician. This medical paper concludes: “In any case, it is unfair simply to provide a mass of medical facts and options and leave the patient adrift without any further guidance on the alternative courses of action and inaction.”
Local Christian elders, being mature ministers, can also be of great value. Of course, the patient and his immediate family must make their own balanced decision in this very emotional situation.
Finally, reflect on these points. Christians very much want to stay alive so that they can enjoy serving God. They realize, though, that in the present system, all of us are dying; in this sense all of us are terminally ill. It is only through the ransoming blood of Jesus Christ that we have any hope of reversing that situation.—Ephesians 1:7.
If death does come to a loved one, hard as this is, we are not left to agonize and grieve “just as the rest also do who have no hope.” (1 Thessalonians 4:13) Rather, we can take comfort that we did the best we reasonably could for our sick loved one and that any medical assistance we employed was at best of temporary help. We do have, though, the happifying promise of the One who will free us from all such problems when ‘the last enemy, death, is to be brought to nothing.’—1 Corinthians 15:26.
Yes, ultimately the best help for the dying will come from the God who gave life to the first humans and who promises a resurrection for those who exercise faith in him and in his Son, Jesus Christ.—John 3:16; 5:28, 29.
[Footnotes]
a For additional comments about so-called mercy killing, see Awake! of March 8, 1978, pages 4-7, and of May 8, 1974, pages 27-8.
[Picture on page 8]
Does the death of Saul support euthanasia?
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