I have written three blog posts on suicide. In the first, I looked at what the catechisms said on suicide. In the second, I explored some of the basic principles concerning suicide.In the third, I answered some difficult questions about suicide. In this post I want to look how Christians should approach the prolonging of life using treatment and medicine.

If you look at the post on catechisms you will see that they teach we should do whatever we can to prolong our lives. Thomas Watson calls it indirect suicide when we do not take our own life explicitly, but we do knowingly create circumstances where we die. The Roman Catholic Catechism because it modern addresses this matter more carefully than the older catechisms. Is the refusal to take medicine or treatments to prolong our lives the equivalent of suicide? Are Christians obligated to do whatever they can to live as long as they can? If we say, “no” to the previous question aren’t we drifting towards the place where doctors will be letting patients die unnecessarily instead of saving them?

What I am Not Talking About?
I am not talking about taking a drug to end your life because you are in pain, have been paralyzed, or have experienced some traumatic event. That is suicide and is never justified. Doctors and family members should not help their loved ones die. Any treatment given that is intended to kill the patient is murder. We should not kill ourselves nor should others help us kill ourselves. This also means that just because a patient wants to stop treatment does not mean the doctor must agree to the request. If stopping the treatment is the equivalent of suicide the doctor should not agree to it no matter what the patient wants.

But what about when we reach a point where all you are doing is putting off the inevitable? What happens when death is certain? Who gets to decide whether to “pull the plug” or not? When should we allow nature to run its course and when should we intervene? The question in this  post is, given the ability of modern medicine to prolong life almost indefinitely in some cases, how do we decide to stop treatment? First, though let’s look at some factors that have complicated this issue.

Complicating Factors

There are several factors that make this type of decision more complicated than it was in the past. These are not in order of importance. I am not expert on any of these, so if I am wrong please correct me.

• Technology has advanced so much in the last one hundred years and will continue to advance. In 1898 a person could not be kept alive with a machine. Now they can be.
• Doctors and hospitals do not want to be found guilty of negligence and face a lawsuit. Therefore they can feel pushed to prolong the life of the patient no matter the situation.
• Some people come out of long comas and there are miraculous recoveries from situations that look like certain death. This is rare. But one of the problems the “pull the plug” people have is that sometimes people do survive. Here is a man who was in a coma 48 days and then came out. Every family reads that on the Internet and says, “Johnny can survive. I know he will pull through.” And the problem is sometimes he does.
• Money is not an issue. I don’t mean to be callous here, but there would be less extending of treatment if the patient or their family had more of the financial burden. I am sure there are situations where money is a problem. But in many cases, for various reasons, treatment can go on for a long period of time with little consideration of the costs.
• A large part of our medical industry is devoted to death and money. This complicates things because you want to trust your doctor’s decision about when to stop treatment. But this might be the same doctor who thinks abortion is fine or who makes most of his decisions based on finances. The moral compass of the medical industry is off. Of course, not all doctors are like this, maybe not even most. But as Christians it does give us pause.  Christian doctors need to remember this as well.
• Our government does not care about the weak, therefore we cannot count on them to pass laws to protect the weak and elderly from being killed off. This is not alarmist. A country that slaughters its infants at the behest of its government and the medical industry is not a country that can be trusted to care for grandma when she is 85 years old. Why would a government that thinks it is fine to kill babies in the womb not think it is fine to kill off unproductive members of society who are costing too much?
• Many family members have an inflated sense of the patient’s ability to survive. If the survival rate of a disease is only 5% among those under 50 and the patient is 89 years old the family will still insist that grandpa will pull through despite all signs to the contrary.
• Many view death as unfair. I don’t deserve to die. Grandma doesn’t deserve to die. Death is not natural. It is an enemy. But that does not mean you have been ripped off because Mom got in a car wreck and went into  a coma.

There are other complicating factors as well, such as the belief that unless you extend life as long as possible you are not pro-life. The point is that when the time comes to stop treatment and let someone die there are often conflicting ideas about what is right and wrong, as well as hidden motivations, some good and some bad, for the different parties doing what they want to do.

How Then Shall We Die? 

Here are some suggestions on how to prepare for and go through a situation where you or a loved one is dying. I am not an expert in this area, so I am open to suggestions or corrections.  I am assuming a Biblical concept of life as precious and that all human beings bear the image of God.

First, surround yourself with godly people whom you can trust. After studying this for a bit I realized that answers to when to stop treatment are rarely simple. You cannot anticipate every possibility. You need people with wisdom who properly value life, but understand that dying is part of the package. Wise counselors will help you more than anything else. I would encourage surrounding yourself with pastors and elders, as well as doctors whom you can trust and who value life. This is why pastors need to continue to study these things. We need to help our folks think these things through in a way that honors Christ.

Second, I would recommend a medical power of attorney/advanced directive. This will give your wise counselors some guidance should you be incapacitated.

Third, know the difference between basic care and treatment. Basic care is hygiene, food, water, shelter, blankets, etc. Treatment is things like antibiotics, chemotherapy, surgery, etc. There is an moral obligation to provide those dying with basic care. But treatment is not always a moral obligation.

Fourth, know the difference between ordinary treatment and extraordinary treatment. Ordinary treatment is treatment where the benefit outweighs the burden. It is a moral obligation. An easy example is setting a bone and getting a cast. You can have six weeks of a cast or walk with a limp your whole life. Many cancer treatments, such as mastectomies, fall into this category.  Extraordinary treatment is where the burden of the treatment is greater than the benefit. There is not a moral obligation to take extraordinary treatment. A patient can take it, but does not have to and is not committing suicide should they refuse. I have a relative who is 97 and found out he has cancer. He refused treatment because the burden would be too great. He is not committing indirect suicide. Many dialysis patients eventually find the burden of dialysis greater than the benefit and choose to go off of it. The line between these two types of treatment are not always clear, hence the need for wise counselors. Just because something can be done does not mean it should be or must be.

Fifth, if the doctors agree that death is imminent and inevitable then make the patient comfortable and let them die naturally. If possible, the patient should die at home.

Sixth, understand the different situations. A child with a feeding tube because of a degenerative muscle disease is not in the same category as a 89 year old woman who has dementia and needs a feeding tube. That is why simple answers that are intended to cover all situations are foolish. There are basic principles, such as life is precious, basic needs should be met, and we don’t kill people or let people kill themselves. But beyond that each situation will need to be addressed individually.

Seventh, what about situations where someone is in a coma for a long period of time, they are on some type of life support, are being fed through a tube, or similar type scenarios? When should you decide to stop sustaining their life and let them die naturally? There are no cookie cutter answers to this. The variables are too great. Some questions to consider are the age of the patient, not because some life is more important than others, but because a younger patient might have a greater chance of survival. Are there major organs that have ceased functioning and will not recover? What type of brain activity is there? Are there other medical complications ? Did the patient express any desires in this area?  A decision to stop or refuse treatment that will probably result in the death of the patient needs to be made with the doctors, the patient (if capable), clergy, and family. Obviously, this is why you surround yourself with wise counselors you can trust.

Finally, a life of  pain and difficulty is not a worthless life. The quality  of life argument put forward is usually unbiblical and dangerous. Just because someone is suffering does not mean they need to die. One of the best things pastors can do is remind our people that suffering is one of the tools God uses to make us holy , witness to the world, and glorify Him.  I have a friend whose grandson has a degenerative muscle disease. Most babies with diseases like his are aborted in the womb. Despite his slow physical decline he has been a great blessing to his family and friends. Is it hard? Well sure. Does he suffer? Yes. But is it worthless? By no means. As Christians we understand that all “things comes not by chance, but by His fatherly hand.” Therefore we can approach suffering with patience, trusting in our good Father. Suffering has value.

Other Resources
Being on this list is not a wholesale endorsement of all that is said.
Clearnote Pastors’ Conference on Death and Dying
Pastor Tim Bayly on Euthanasia
Presbyterian Church in America Heroic Measures Report 
Catholic Medical Association
Center for Bioethics: Assisted Suicide
Center for Bioethics: Withholding Artificial Nutrition (This article presents both perspectives. Their resolutions are not solid.)