Medicalized Dying: How to Make Wise Decisions for the End of Life

Dear Friends,

This month we tackle a tough but important topic. I had never heard the phrase “medicalized dying” until I began doing an independent study for my D. Min. program on death, dying, and eternal life. But when we think about it, we’ve all witnessed or heard stories of its impact—whether for good or for ill. You may know someone who died in the hospital, even though they wished to die at home. Or you may know someone who died at home with family and friends around them, singing them into glory. As you read this article, I hope you’ll learn some new things and begin to have conversations with your loved ones about wisdom at the end of life. I hope you’ll even consider preparing an advance directive to guide your loved ones. I truly believe that knowing how to think wisely about medicalized dying will benefit you, a family member, or a friend.

Here’s a question for you. Please respond in the comments or by emailing me directly. I’d love to hear.

Share about someone who “died well” from your point of view.

Medicalized Dying

The patient was an emaciated eighty-eight-year-old man whose late-stage cancer had spread to his bones and his brain. When his breathing stopped, a code was called, and a team of medical personnel—doctors, nurses, techs, social workers, and chaplains rushed to his room. Performing their choreographed tasks, they restored his breathing. But in order to do so, they had to insert a breathing tube into his airway, and he had to be placed on a ventilator and moved to the ICU. The team knew it was only a matter of time before his heart stopped again. He was dying. Dr. L. S. Dugdale, the attending physician and author of The Lost Art of Dying, asked the daughter if she would like to have a Do Not Resuscitate order in place so he wouldn’t have to endure the physical trauma of being resuscitated again. The daughter adamantly refused, saying that she was a Christian, and that she believed God would work a miracle. As Dr. Dugdale says, “It seems curious that the people who believe most fervently in divine healing cling most doggedly to the technology of mortals.”[1]

No doubt, many of us are alive today because of post-World-War-II medical advances such as antibiotics, surgery, and chemotherapy. We are grateful for modern medicine. And yet, modern medical advances have led to something doctors and theologians alike refer to as “medicalized death.” “In ‘medicalized’ dying death is regarded as the great enemy to be defeated by the greater powers of science and medicine.”[2]  A variety of life-sustaining measures such as CPR, dialysis, ventilators, artificial nutrition, and more, exist. In order to “glorify God in our bodies” (see 1 Cor. 6:20), we do want to seek and accept medical care which is likely to “maintain or restore health” by “ordinary means.”[3] At the same time, we recognize that “God’s Word…[makes] it possible to decline or discontinue life-sustaining treatment,” at the end of life.[4]

While we can make biblically and prayerfully informed decisions about which life-sustaining treatments to accept at the end-of-life, studies show that Christians tend to be far more likely to choose aggressive medical measures at the end of life than non-Christians. When we take the time in advance of crisis to educate ourselves about such measures and to understand the biblical principles which guide us, we will be better prepared to make wise and loving decisions in difficult moments. As we consider prayerfully what it looks like to glorify God at the end of life and what quality of spiritual life we want to enjoy, we can make advance directives that guide our loved ones about our wishes and bring them peace in painful moments.

Aggressive Measures at the End-of-Life: What We Need to Know

One thing we need to know about aggressive measures at the end of life is that TV does not portray them accurately. Consider TV CPR. On TV, the monitor shows that the heart has stopped, a code is called, people rush in, someone yells “Clear!” the heart is shocked, and the rhythm returns. By the end of the episode the patient is well and leaves the hospital. In reality, ribs are often fractured, blood is often spilled, the patient is always placed on a ventilator and moved to ICU, and only ten percent of hospital patients recover after CPR.[5]. This does not mean that we should never allow CPR; it does mean that a person near the end of life and/or with a terminal illness should pray about whether or not to have a Do Not Resuscitate order.

In the same way, mechanical ventilators, which “support breathing in the setting of respiratory failure,” dialysis, which “replaces kidney function, most commonly by filtering blood through a machine,” artificially administered nutrition, which is delivered “through tubes entering our gastrointestinal tract” or “via catheters placed in large veins,”[6] among other medical measures, are complex and need to be considered carefully at the end of life. While they may have much to offer a relatively healthy patient to restore health, they may act only to prolong death in a dying person. For this reason, we need to approach them prayerfully, armed with biblical principles. As Dr. Kathryn Butler explains, “Our path requires careful review of the factors influencing survival and reflection upon Scripture to do as God requires: ‘to do justice, and to love kindness, and to walk humbly with your God’ (Mic. 6:8). In short, we need to determine when to press on and when to relax into the embrace of our Lord.”[7]

Biblical Principles Concerning End-of-Life Measures

After educating ourselves about end-of-life measures, we can use biblical principles to guide us as we consider the options. In her book, Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care, Dr. Butler recommends considering four biblical principles:

1. Sanctity of Life

The Lord who created male and female in his image (Gen. 1:26), the Lord who “gives to all mankind life and breath and everything” (Acts 17:25), has written dignity into the very being and body of every human.

2. God’s authority over life and death

God rules over the life and death of something as ordinary as a sparrow (Matt. 10:29), and God rules over the life and death of his creation. When considering which measures to accept or refuse at the end of life, we must remember, “Sanctity of life does not refute the certainty of death.”[8]

3. Mercy and Compassion

We should be guided by compassion for the person at the end of life and should seek to bring comfort without inflicting further suffering. A compassionate approach takes into account a person’s wishes for the ability to connect with God and with others.

4. Hope in Christ

Because Christ has defeated death, and because we have the hope of resurrection (1 Cor. 15:52-55), we need not fear death but can anticipate the day of our homecoming.

In his book, Departing in Peace: Biblical Decision-Making at the End of Life, Dr. Bill Davis, philosophy professor, discusses over thirty biblical principles that help to guide us in a wide variety of end-of-life decisions.

Quality of Life Considerations

Armed with sound biblical principles, we can also consider the implications of choices we make at the end of life.

Hospital or Home

Many aggressive end-of-life measures require being in the hospital, often in the ICU, where limitations are placed on visits from family and friends. For this reason, the person is often isolated in their final days and moments. A 2017 Kaiser Family Foundation study showed that 71 percent of Americans would prefer to die at home.[9] If remaining at home with family and friends is our desire for the end of life, we need to know which measures would allow us to do so.

Financial Considerations

Although we struggle to accept this reality in America, the cost of some treatments can be prohibitive. Dr. Davis makes some excellent points about our responsibility to pay for treatments we choose and to take into account stewardship of our finances, particularly as it concerns end-of-life measures. Consider, for example, a woman who had already been through rounds of chemotherapy to survive breast cancer. Years later, when she was diagnosed with late-stage pancreatic cancer, the doctors gave her little hope for survival. They recommended a costly experimental chemotherapy, saying it might add two months to her life expectancy of five months. The woman didn’t wish to spend her remaining time suffering the effects of the chemotherapy, and she didn’t want to spend her children’s inheritance on something that gave her so little extra time. Yet, many Christians were advising her that she must try the chemotherapy. Dr. Davis encouraged her with this biblical principle: “God’s Word requires us to make faithful use of all our talents, opportunities, and resources: time, energy, attention, and money.”[10] For this reason, and because “earthly life is not the highest good,”[11] this woman could reasonably decline the costly chemotherapy.

Spiritual Quality of Life

It is not only okay, but it is good to take into account our desires for a spiritual quality of life at the end of life. As we prepare our advance directives, we will want to ask questions like, “Will this option allow me to take in the ordinary means of grace—prayer, fellowship, communion, meditating on God’s Word?” In considering end-of-life stewardship of our bodies and our resources, we should ask not only, “What do I want?” but also “How will this option allow me to receive God’s love and continue to glorify God?” In making spiritual quality of life a goal for the end of life, we will demonstrate to others that whether we live or we die, our chief end is to enjoy and glorify God.

Dear friends, it is not easy to think about the end of our lives, but it is wise, and it is kind. Decisions about end-of-life medical options fall to our loved ones 50 percent of the time.[12] Let us faithfully steward the good gift of our bodies by learning more about medicalized dying and deciding how to wisely employ medical measures far in advance of crisis.

What about you? Have you ever heard the phrase “medicalized dying”? What experiences with the death of a loved one and end-of-life measures have you had? How have they made you think about what you would want at the end of your life? (Please share any or all thoughts in the comments or by emailing me directly. We’d all benefit from hearing your experience and thoughts.)

Elizabeth Reynolds Turnage is an author, life and legacy coach, and speaker who helps you live, prepare, and share your practical and spiritual legacy.