Departing in Peace: Biblical Decision-Making at the End of Life

Have you thought about whether you want to be kept alive on a feeding tube? More importantly, have you thought about what God’s will in that situation would be? Have you thought about having to make end-of-life medical decisions for an incapacitated loved one? The book Departing in Peace: Biblical Decision-Making at the End of Life discusses the choices people face in major medical circumstancesDeparting in Peace

Author Bill Davis begins by laying out principles that can be applied to situations of medical care. For example, the Word of God has complete and final authority over our decisions. It teaches that “human life is precious” and yet “earthly life is not the highest good” and “there is a time to die.” Everyone has a duty to protect the weak. We each have the duty of stewardship of the body God made for His glory and not our comfort and, therefore, the authority to make medical choices for oneself. While we are “called to suffer for Christ’s sake,” we are “not obligated to suffer only to stay alive.” We are not required to try to live as long as possible no matter the cost, but neither may we choose a shorter life for our own sakes, like because we are tired of life. Stated in reverse, we may not commit suicide but neither are we obligated to sustain a body that is clearly dying.

An important principle the author rehearses is that when making end-of-life decisions for a loved one, we do not have the right to choose what we would want. Our own preferences are not the issue or standard. Rather, we are obligated to choose what we believe our loved one would choose. This is how to love and honor the person who will be receiving the treatment.

Using many real cases to illustrate, Mr. Davis applies the principles to conditions that force hard choices.These include people with permanent unconsciousness, permanent confusion, terminal illness, and dependence on others for basic daily care such as feeding, bathing and dressing. Regarding permanent unconsciousness, he reminds us that while God has all power to heal people and we are certainly to pray for healing, we are not to presume upon God and wait endlessly for a miracle. Trusting God, we must go ahead and make decisions based on the information God has already providentially provided. As to dependence on others he states, “Declining life-sustaining medical treatment merely to avoid being a burden to loved ones is to reject God’s design for our life together.” If people are to bear one another’s burdens, then someone has to be the burden that provides opportunities for others to practice caring. (86)

Along with challenging conditions come the kinds of modern treatment options that would preserve life in those conditions–CPR, mechanical life support, treatment of new conditions, and artificial nutrition and hydration. He describes in some detail what each involves and then circumstances in which it might be good stewardship or poor stewardship to receive the treatment. For example, resuscitation in a hospital involves breaking of ribs, electric jolts, drugs, and/or intubation. If it even works, these all require a recovery process in addition to what provoked a hospital visit in the first place. If you’re thirty years old with possibility of many years of productive and happy living, it is worth it. If you’re 95, full of cancer, and content with the years you’ve had, you can choose resuscitation but it is not a sin if you do not want it.

One discussion that changed my view was on the realities of feeding tubes. I used to think that it would be sinful and cruel to remove a feeding tube. Mr. Davis agrees that when used temporarily to help recovery a feeding tube is good stewardship before God. However, long-term, it risks infection. It risks a very unpleasant death by aspirating food into the lungs. A dying body loses the desire to eat, and if it is not processing food then the forcing of food into the system can be painful. In addition, long-term use prolongs the suffering and spiritual deprivations of the person. What about the possibility of the pain of thirst if the tube is removed? As long as the mouth is kept moist, a person dying without a feeding tube will not feel thirst.

Another difficult, often guilt-inducing topic is money. This is a tough one because God’s prohibition against unpayable debts may mean we must withhold treatment that we desperately want our loved one to have. This principle clashes against the assumption that we deserve medical care no matter the cost, even that it is morally wrong to withhold treatment due to money. Families will often agree to medical care they cannot afford because they feel guilty refusing it simply for the sake of money. 

In the chapter devoted to this topic, Davis says that because we are commanded to pay our debts, we must not make promises of repayment that we cannot keep.

“God’s Word forbids accepting medical services for which we cannot reasonably expect to pay out of resources that we possess, that we can expect to earn, or that we have been explicitly promised by reliable people.” (199)

Davis takes extra care to back this position with several Bible passages, then answers objections to the prohibition. He also brainstorms how repayment might be made. On the flip side, even when plenty of money is available there are situations in which the person is not obligated to take the treatment but may devote his money to other God-honoring purposes.

The chapter “Hospital Realities: Making the Most of Them” is aimed at correcting false assumptions about what life in a hospital is like. It offers practical suggestions on a number of issues. The last chapter is well summarized by its title, “Things to Do Now.”

If I had to find fault with the book, it would be at two points. I don’t fully agree with Mr. Davis’ interpretation of the sheep and goat judgment of Matthew 25:14-26 in chapter 2. Also, I couldn’t find any sources to confirm the idea that some ancient kings sent deformed people as “image-bearer/ambassador” to test the loyalty of their subject people. It doesn’t make sense to me. I would think it would convey a sense of weakness or ineptitude in the represented king, just as our faulty image-bearing misrepresents God, or just as the Philistines who believed that since they captured the ark then their god was stronger than Israel’s God. In a brief search, I found that many Egyptian commoners had deformities, but I saw not even one who was an ambassador for a king. It would be helpful if the source had been cited. In any case, there are certainly other passages in the Bible that teach principles of caring for the weak and being ambassadors for Christ, so the principles Mr. Davis highlights are biblical.

At the end of each chapter are questions for study and discussion and a list of further reading. On the book website Davis offers two further types of resources–for free! One is sets of lesson plans to download and use in teaching others on issues in end-of-life decision-making.

The other is a link to download advance directives from all fifty states. In addition, there are duplicates of each directive which Mr. Davis has partially completed, explaining critical points. The way I used this resource was to first download the Tennessee form (because the book follows that order of thought) and used it to write out for my loved ones what I want and why. Then I compared it with Mr. Davis’ completed form for my state and then completed my own forms. My state is less specific, so now my loved ones have my state forms plus extra instructions on the side to help them understand my reasons for choosing as I did.

This is an excellent book. No matter how young an adult you are, go get a copy. Read it and think through the issues. Then complete an Advance Directive. It will help you practice stewardship of your body to the glory of God and it will be a service of love to your loved ones.

About Linda

Wifing, Singing, Studying, Counseling M.A. in Biblical Counseling Certified by Association of Certified Biblical Counselors
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