Not as Those Who Have No Hope

When Roger, a gentleman in his late 80s, arrived in the ICU, he was already suffering from the end-stage effects of multiple diseases. His health had so declined that even reading the Bible proved difficult. Already worn from illness, he agreed to an attempted resection of his cancer only to please his family, and he urged his wife not to allow CPR or a ventilator if he worsened after the operation. “I want you to let me be with God when he calls me,” he told her.

Tragically, after the surgery his lungs failed. In accordance with his wishes, rather than proceed with a ventilator, his care shifted to a focus on comfort. His wife spent that evening by his side, caressing his hand, praying over him, and singing to him softly.

But later that night, the couple’s estranged son stormed into the ICU. “You’re not going to kill my father!” he shouted at the staff. “I know my dad. He was a God-fearing man who until six months ago went to church every Sunday. He would not be okay with this!”

The heart-wrenching situation of Roger’s family is frightfully common. The shroud of medical technology that surrounds death increasingly confronts families with baffling dilemmas about end-of-life care. Up to 70 percent of people cannot vouch for themselves at the end of life, and in such cases the burden of decision-making falls to loved ones, many already reeling with fear and grief. The toll on families is heavy; loved ones often suffer from depression, anxiety, and even PTSD for up to a year after making end-of-life decisions.

As only one-third of Americans have an advance directive, most families navigate these conflicts rudderless. Those of us who follow Christ instinctively lean into our faith to guide us through such tempests, but the landscape of dying in the hospital is so foreign that, as with Roger’s family, we may struggle to apply the truths we proclaim every Sunday to the harsh realities at the bedside.

How do we honor both God and our loved ones in end-of-life decisions, when every path seems fraught with heartache?

Although the Bible doesn’t mention ventilators or CPR, it remains a lamp to our feet and a light to our path (Ps. 119:105). An approach to end-of-life care through a Christian lens mandates reflection on the following key principles:

1. Sanctity of Mortal Life

As beings created in God’s image, we each possess irrevocable value, and the Lord entrusts us with life and commands us to cherish it (Gen. 1:26–28; Ex. 20:13; 1 Cor. 6:19–20). The sanctity of mortal life mandates that we advocate for the unborn and safeguard against physician-assisted suicide. When struggling with an array of decisions about life-supporting measures, out of concern for life we should consider treatments with the potential to cure.

2. God’s Authority over Life and Death

Death persists in this earthly kingdom as the wages of our sin (Rom. 6:23), and until Christ returns, it will overtake us all (Isa. 40:6–8; Rom. 5:12). When we blind ourselves to our own mortality, we risk dismissing the power of his grace in our lives through Christ’s resurrection. Sanctity of mortal life does not refute the inevitability of death or God’s work through and authority over it.

3. Mercy and Compassion

As Christians reflecting on God’s grace toward us in Christ, we’re to extend mercy toward the downtrodden and afflicted (John 13:34; 1 John 3:16–17; Luke 6:36). While ventilators and CPR can rescue people with reversible illness, at the end of life such measures risk suffering without life-saving benefit. Mercy does not justify active euthanasia or physician-assisted suicide, but it does guide us away from aggressive, painful interventions if such measures are futile.

4. Hope in Christ

So vast is God’s love for us that in Christ nothing—not even death!—can pry us from him. Even as we suffer, we savor the promise of the resurrection of the body and the hope of eternal union with God (John 11:25–26; 1 Thess. 4:14). Rather than the last enemy to be feared at all costs, through Christ death is an end to our sins and an entrance to eternal life. Although we die, we are alive in Christ.

To summarize, in end-of-life dilemmas, the Bible guides us to

1. seek cure when recovery is possible but also
2. accept death when it arrives,
3. have concern for suffering, and
4. all the while cleave to our hope in Christ, who transforms death.

These principles appear stark on paper but tangled and messy at the bedside. A key question can help decipher them: Is the process threatening my loved one’s life reversible? Phrased another way, does treatment promise preservation of life or prolongation of death and suffering?

It’s crucial to clarify that life-sustaining measures are supportive, not curative. Ventilators, CPR, and similar interventions don’t cure disease but rather buy time, supporting organ function while doctors work to treat the underlying illness. To achieve discernment about whether such measures promise to be life-saving or death-prolonging, ask the medical team the following questions:

• What is the condition that threatens my loved one’s life?
• Why is it life-threatening?
• What is the likelihood for recovery?
• What about my loved one’s previous medical conditions influences the likelihood for recovery?
• Can the available treatments bring about cure?
• Will the available treatments worsen suffering with little chance of benefit?

When recovery is possible, pursuing treatment is appropriate. In contrast, when a disease cannot be cured or even improved, aggressive measures can prolong dying and inflict suffering needlessly.

When the efficacy of treatment is ambiguous, the task is even more difficult. The key question to ask is What would my loved one say about the options? Such an approach requires that we view our loved one as God sees him or her: cherished, forgiven, wonderfully made, and unique, with no precise equal on earth (Ps. 139:13–14; Eph. 1:7) As the responsibility staggers our minds, another series of questions can guide us:

• What matters most to my loved one? What drives him in life?
• What comments has she made in the past regarding end-of-life care, if any?
• What are his goals in the short term? For his life in general?
• What is she willing to endure to achieve those goals? What would she be unwilling to face?
• How well in the past has my loved one tolerated pain? Dependence? Disability? Fear?
• If he could speak for himself, what would he say about the current situation?

Such questions aim to bring a loved one’s personality, experiences, and values to light so that, as you make these shattering decisions, you speak for him or her, not for yourself.

Even as you wrestle with grief and uncertainty, when you give your dying loved one a voice, you offer a parting gift. You honor him or her as worthy of love, and in so doing, you serve as Christ’s instrument (John 13:34–35). Remember you serve the One who has already swallowed up death in victory (1 Cor. 15:54). And although for now we groan (Rom. 8:22), he is making all things new (Rev. 21:4–5).

Kathryn Butler, MD (Columbia University) retired from practice as a trauma surgeon to homeschool her children, and is the author of multiple books, including Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care and Glimmers of Grace: A Doctor’s Reflections on Faith, Suffering, and the Goodness of God.