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

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.

A Prayer about the Hope for Our Bodies

A Prayer about the Hope for Our Bodies

And the Word became flesh and dwelt among us…John 1:14

Lord Jesus,

As we celebrate your incarnation, 

which literally means “enfleshing”, 

may we not miss the wonder 

that you became a human body. 

May we see the beauty of the bodies 

our Creator God formed for each of us to inhabit, 

and may we thank God for this precious gift. 

May we see how the fall broke our bodies, 

making us know shame 

in our minds, spirits, and bodies (Genesis 3:1-8).

May we marvel at the truth 

author John W. Kleinig describes:

you “took on a human body 

to reclaim us bodily 

for fellowship with God the Father” 

and because you did, 

“our bodies once again become 

what they were meant to be.” 

In union with you, 

we share your holiness 

as we are filled with the Holy Spirit. 

In union with you, 

we “share in God’s hidden glory 

and display it by word and deed 

to the world.” * 

Throughout this season, 

every time we think of the incarnation, 

may we rejoice in the hope 

of the full redemption of our bodies 

we will experience when you return.

In your embodied name. Amen. 

Read John 1:14-18; Genesis 3:1-8; Romans 8:23. 

Quotes from John W. Kleinig, Fearfully Made: A Protestant Theology of the Body

Get Elizabeth’s Advent devotional for free here: https://dl.bookfunnel.com/34no8c805q.

A Prayer about Missing People and Places at the Holidays

A Prayer about Missing People and Places at the Holidays

“My soul longs, yes, faints for the courts of the Lord; my heart and flesh sing for joy to the living God. Psalm 84:2

Gracious and Hospitable Lord,

As Thanksgiving comes around, 

our family misses my mom and her home. 

For many years, we visited her there, 

but her home now belongs to another; 

her new home is in heaven with you.

I know many face a similar sorrow. 

It will be their first holiday without their loved one. 

In a season when we may feel exiled from familiar places, 

draw our hearts to your ever-present 

and always abundant hospitality. 

You make homes for sparrows and nests for swallows (Psalm 84:3),

and you have invited us to be your sons and daughters. 

Even as we limp through the Valley of Weeping,

You make it a place of springs (Psalm 84:6), 

refreshing our hearts with your gentleness and joy.

When we tend to believe the lie that we are bereft, 

remind us that you are our “sun and shield,” 

bestowing “favor and honor”, 

assuring us, “No good thing 

do I withhold from those who walk uprightly” (Psalm 84:11).  

In the name of your Son, 

who came to walk this earth with us 

that we might live in heaven with you. 

Amen.

Read Psalm 84.

 

A Prayer about Lamenting Chronic Illness

A Prayer about Lamenting Chronic Illness

For he has not despised or scorned the suffering of the afflicted one; he has not hidden his face from him but has listened to his cry for help. Psalm 22:24

 Good Father,

Today we lift up our friends 

who have searched and searched and searched,

 who have waited and waited and waited

…for health, for wholeness, for healing. 

We join in their lament 

using the words of David:

“My God, my God, 

why have you forsaken me? 

Why are you so far from saving me?”

[Don’t you hear my groaning?]

“O my God, I cry by day, 

but you do not answer, 

and by night, but I find no rest” (Ps. 22:2).

How we thank you, Heavenly Father, 

that you have given voice to our lament 

in your Word.

As David names his grief to you, 

he remembers his reason to trust in you, 

and he asks boldly and persistently for help. 

We join him on behalf of all of our friends 

who have suffered for years:

“In you our ancestors put their trust;

 they trusted and you delivered them” (Ps. 22:4).

“Be not far from me, for trouble is near, 

and there is none to help” (Ps. 22:11).

As we raise our cry for help, 

may we remember that you are the good Father, 

and may we join with David in praising you, 

for we have even more reason to hope: 

your Son, our Savior was forsaken on the cross 

that we might be forgiven, 

that we might one day live with you 

in eternal glory, 

in whole and healed bodies forever and ever. 

Read Psalm 22.

 

A Prayer about Affliction

A Prayer about Affliction

I know, O Lord, that your rules are righteous, and that in faithfulness you have afflicted me. Psalm 119:75

Faithful Lord,

The truth is, we don’t like to think that you afflict us. 

And then, when we do think you afflict us, 

we don’t always remember that it is 

“in faithfulness” that you do so. 

Today, I can more easily see how and why 

you might allow what feels like affliction in our lives. 

We have had to withhold food

from our beloved dog-who-thinks-she-is-a-person 

since last night at 8 p.m., 

because she is getting her teeth cleaned today. 

She has begged, 

she has nudged, 

she has barked her displeasure 

at not getting her morning treats, 

her morning meal, 

and her second round of morning treats. 

(I know, maybe we’re too extravagant with her?) 

(But not any less so than you are with us!).

To her, this feels like affliction. 

But we know that if we fed her, 

she might aspirate while under the anesthetic. 

Finally, she has settled, 

choosing to take a nap, 

choosing to trust 

that we have a good reason 

for “afflicting” her. 

Today, Lord, we pray that we would do the same—

that we would settle, 

that we would trust you, 

that we would know any affliction we experience 

is faithfully, sovereignly, lovingly 

administered by you. 

In the name of our afflicted Savior we pray. Amen.

Read Psalm 119:67, 71, 75. 

 

A Prayer about Wisdom for Caregivers

A Prayer about Wisdom for Caregivers

For the Lord gives wisdom; from his mouth come knowledge and understanding. Proverbs 2:6

 

Wise and Gracious Lord,

Thank you for the wisdom you give 

for all of life’s hard stories and tough decisions. 

Today we think of our caregiving friends, 

who face weighty decisions daily 

concerning their loved ones’ care. 

Which medicine to try, 

how to get their loved one to comply with doctor’s orders, 

whether to take the car keys or not, 

how long to continue trying new treatments….

the list goes on and on. 

We pray for them, 

that they would hear you answering their prayers, 

perhaps in the form of helpful and wise counselors 

who have been there before them 

or in the form of gentle and kind social workers 

who understand the situation. 

We pray that you would deploy us 

as answers to their prayers, 

simply by offering respite 

or picking up mail while they’re at the hospital, 

or performing a simple task 

like walking the dog or delivering a meal. 

We pray that you would show them 

your deep compassion and forgiveness, 

especially if they are feeling a sense of failing their loved ones. 

Lord, in their hard caregiving days, 

may they truly know the rest and kindness of Jesus, 

our constant and caring companion.

Amen.

Read Proverbs 2:6; Psalm 91:1, 16; Isaiah 25:6-8; Ecclesiastes 3:1-8.