The Right of Death, The Gift of Life
These are my raw notes, not intended for publication, or really to be seen by anyone but me, but I no longer have time or typing ability to polish them, so I'm just posting them as-is. Perhaps they will spark thought or discussion.
These notes are out of date in some ways:
The Terry Schaivo case is no longer "recent." Millenials have likely never heard of her, and older folks have likely forgotten.
California passed its "End of Life Options Act" several years ago, as have several other States, so some of you may have legal rights you did not in 2005, which makes the subject all the more important.*
But I don't think the Biblical principles have changed.
So here I post my study. Feel free to respond with additional thoughts.
--------------------------
Recent events have focused the nation’s attention on issues regarding end of life decisions.
Florida woman, Terri Schaivo, after 15 years in a severely brain damaged condition, had her feeding tube removed, causing complete death. Her husband fought her parents through State courts, the Florida legislature, Congress and Federal courts for 7 years to have the tube removed.
At the present time, the California legislature is considering a bill to permit a form of physician assisted death for terminal patients. This is part of the so-called “right to die” movement. Actually, we all have an inalienable right to die, so we needn’t worry about that right. We will all die.
This case has raised to our attention, issues that most of us would rather not have to think about. Yet death is something that faces all of us. It has been the fate of all humans since Adam and Eve were sentenced to return to the dust from which they were made. Sooner or later, many of us will have to face the same sorts of issues as did Terri Schaivo’s family, and the decisions are exceedingly difficult ones.
I do not propose to discuss the Schaivo case in terms of whether the actions in that case were right or wrong. None of us knows all the facts. The facts are disputed. We know only what we see in the news media, which is often confused, confusing, distorted or inaccurate.
Rather, I would like to use this time to discuss
1st) What the issues are as they affect us
directly
2nd) What the legal options are – what CAN you
do.
3rd) What the Scriptural principles are –Does the
Bible tell you what SHOULD you do.
4th) What should you do to prepare for your
death, and for the possibility of life beyond death.
One of the major factors in publicizing the Schaivo case was that many so called right-wing Christian organizations took up the case as a moral crusade, contending that removing the feeding tube was murder, and should not have been permitted by the State. I would like to look at the basis for their viewpoint, and discuss whether or not that view is Scriptural.
The Bible has a lot to say about life and death. I think we will find that it has less to say in detail that would dictate the exact decisions we should make.
Medical science and technology has progressed tremendously in the last century. 100 years ago, many of the situations we face today did not exist. Medicine has given doctors the ability to sustain some form of life well beyond what was possible in previous history. While we are grateful for he medical care that enhances and extends our lives, this is not an unmixed blessing. It also presents dilemmas that previous generations did not have to deal with.
Terri Schaivo – brief summary.
1990 Cardiac arrest (heart and breathing stopped), probably as a result of bulimia – severe loss of oxygen to her brain. Resuscitated.
3 years of attempted rehabilitation therapy
Husband studied and became qualified as a respiratory
therapist, in part to better care for his brain damaged wife.
After 8 years, Terri’s husband Michael Schaivo was told by
her physicians that Terri was in what is called a Persistent Vegetative State,
from which there was no hope of recovery, and that the thinking part of her
brain was either entirely, or almost entirely, gone. Michael Schaivo asked the Florida court to
act as the surrogate for Terri to make a decision as to whether Terri would
have wished to continue to be maintained with the feeding tube. He did not make the decision himself, but he
did advocate to the court that in his view, she would not have wanted her life
(such as it was) continued. The court
agreed with Michael, disagreed with Terri’s parents, and ordered the feeding
tube removed. The parents continued to
fight this decision in every judicial and political way they could for another
7 years.
Nothing unusual medically or legally about this case.
The legal issues were all settled – no new legal precedent.
The medical issues are all very common – nothing medically
unusual
These things happen every single day without publicity or
fanfare.
The only thing unusual was that the family could not agree
and took their disagreement to such lengths of legal and public dispute.
Lack of previous written instructions from the patient,
which could have simplified things.
The Brain:
Brain Stem controls automatic functions: Respiration,
Circulation, sleep and waking.
The Cerebral Cortex, the folds that form the outer top and front of the brain contain consciousness, rational thought, memory, awareness, and everything that we would usually describe as thinking.
Types of incapacity:
persistent vegetative state: persistent vs permanent – not a specific physical explanation of the condition of the brain, but may be caused by several sorts of brain damage. Vegetative state that lasts for more than a month. Can occur when the brain stem is functioning, but the cortex is severely damaged.
anacephalic infants are born without a skull, scalp or forebrain cerebellum. They cannot survive.
Coma: Profound or deep unconscious state – sort of continual sleep. Completely non-responsive. Rarely lasts more than 2 to 4 weeks. May recover partially or even completely.
locked in – rare condition. fully conscious and aware, but completely paralysed. Able to move only the eyes or eyelids. May be fully aware of all that is going on around them, aware of pain, but unable to speak or communicate, except possibly by eye blinks. There have been a very few famous cases where such people were thought to be vegetative, but turned out to have mis-diagnosed.
Partial paralysis – anything short of total. May lose ability to speak or eat. May lose ability to some or all limbs, usually able to communicate in some ways. Sometimes able to recover partial function.
Brain death means total loss of all brain function, including stem and cortex.
These conditions may be brought on by trauma, by sudden internal causes (stroke, cardiac arrest) or by progressive deterioration due to various diseases, including Parkinsons, Alzheimers,
Terminal illness: Not yet completely incapacitated, but in the last stages of an inevitably fatal illness, with no further real hope of effective treatment.
The diagnosis of these conditions is not always exact. The outcome of Coma, locked in condition, or vegetative state cannot be immediately predicted with certainty in all cases. In some cases, it may be apparent what portion of the brain has been damaged. In other cases, it may take a wait-and-see approach. Time is part of the diagnosis. The longer the condition lasts, the less likely there will be recovery.
Three horror scenarios:
1) “locked-in”
conscious and aware, but unable to move or communicate, yet wanting to live and
keeping hope alive. Watching as your
feeding tube is removed, and you slowly die of dehydration.
2) In
discomfort and pain, maybe even extreme agony but unable to say so. Wanting and
praying for death, but kept alive against your will, unable to stop it.
3) Brain
is just gone, unaware, unconscious, no possibility of recovery, but body keeps
breathing for decades, while your relatives don’t know what to do. Essentially dead, yet having to be maintained
at great expense.
Issues:
1) Definition
of Life and Death. When is a person
really alive?
a. Until
the last century, it was simple. Heart
and breath. Stopped hearts could not be
restarted. If you didn’t breath on your
own, you were dead. Breath and pulse
defined death.
Until as recently as 1968, the definition of death
was the cessation of respiration and circulation. First proposal of “brain death”, adopted in
the 1970’s. Other definitions were
proposed, but not generally accepted.
What exactly defines whether a body being artificially supported is
actually still alive. Definition depends
on what we have the ability to detect.
2) Uncertain
Diagnoses – How much do we really know?
a. Doctors
are not always sure
b. Sometimes
even when they think they are, they are wrong.
3) Unclear
wishes, if not put in writing beforehand.
a. How
far can we go in making a life/death decision for someone else?
4) Different
types of assistance: Where do we draw a
line?
a. Ventilator. If they can’t breath on their own, when do we
stop helping.
b. Cardiac
defibrillation. Restart your heart after
it stops?
c. Intravenous
feeding
d. Feeding
tube Many argued that a feeding tube is
simply a more convenient way of feeding a patient, and to deny then food was
barbarically starving them.
e. Antibiotics. Do we want to keep curing other problems which only prolong the agony of dying? When is it OK to just give up and die, ending your own suffering?
5) Hope for Miracles.
As long as there is any life at all, we can pray for a cure that is
beyond the purely natural expectations. On the other hand, even death does not prevent a miracle.
6) Is it Scriptural to ever end one’s own life? Suicide in Scripture (discussed later)
7) Is there a Biblical command to sustain life by all
available means against a patient’s wishes?
Should we force life sustaining measures on someone who doesn’t want
them?
8) Who should make these decisions: Family? Doctors? Courts? Laws: Should the government dictate decisions on
these matters?
9) What about the doctrine of the “Sanctity of Life”?
10)
Can we be dogmatic? How clear are Scriptural
instructions on the subject?
You have the legal right to choose. Putting it in writing ahead of time, and
designating an agent, is the best way to assure that your wishes will be
carried out if you become incapacitated.
Look at the form:
·
Part 1, page 2 Power of Attorney for Health
Care. Note last section, 1.2 including
withholding artificial nutrition and hydration.
·
Page 3, details of the agent’s authority.
·
Anatomical gifts
·
Need to carefully consider who would be a
suitable agent, able and willing to make decisions if you can’t. May be spouse, may be someone else. May need an alternate, if the first choice is
not able to act.
·
Need to talk to our designated agent, make sure
they are willing, and let them know in detail what you want. Make sure they have a copy of the completed
form.
·
Part 2.
Your instructions: Under what
circumstances should care be stopped.
What kinds of care should be tried.
·
Understand that this means that you may be
alive, possibly even conscious, and be allowed to die under some circumstances
where you could be maintained alive for some period of time.
·
Part 3, Organ donation Which parts of your body, if any, are you
willing to donate, and for what purposes.
·
Part 4.Page 5, designate a primary
physician. If you are in a HMO or
medical plan, this may already be taken care of.
·
Part 5.
Signature and witnesses. Requires either two witnesses, or a notary.
·
Give copies to agent, physician, other family
members, other health care providers.
List who you have given it to, in case you wish to change it later.
You have the right to end your
life by various natural means if you wish.
You can stop eating or drinking and refuse food or water. You can choose to stop breathing assistance,
or whatever treatment is offered. Some
may consider some of these actions virtually suicide, in that you could be
maintained alive for a considerable length of time. You do not have the right to be put to death
by artificial means.*
1) The
Doctrine of the Sanctity of Life not truly Biblical. Defenders of this doctrine
usually refer to Genesis 9:6 “Whoso sheds man’s blood, by man shall his blood
be shed, for in the image of God made he man.” Command not to murder. Commanded to love one another, and to treat
others as we would wish to be treated.
2) Biblical
Suicides: Ahithophel (advisor to
Absalom), King Saul, Samson, Judas, Jesus.
No example truly similar. Scripture provides no commentary, either approval or disapproval. There is no
a. Judats
clearly lacked faith in the mercy of God.
To commit suicide because of problems or depression, when you are still
capable of living and serving God and your fellows is to give up on faith, to
avoid your duty to serve, to hurt others that love you. Clearly wrong.
b. Saul
was about to be killed anyway, and Scripture makes no comment as to whether
falling on his sword was right or wrong.
c. Samson: "And Samson called unto the LORD, and said, O Lord GOD, remember me, I pray thee, and strengthen me, I pray thee, only this once, O God, that I may be at once avenged of the Philistines for my two eyes. 29. And Samson took hold of the two middle pillars upon which the house stood, and on which it was borne up, of the one with his right hand, and of the other with his left. 30. And Samson said, Let me die with the Philistines." Samson prayed to die, and God gave him strength to cause his own death.
d. Job
wished he could die, but took no such actions.
Consider Philippians
1:21-23"
I eagerly expect and hope that I will in
no way be ashamed, but will have sufficient courage so that now as always
Christ will be exalted in my body, whether by life or by death. 21For to
me, to live is Christ and to die is gain. 22. If I am to go on living in the
body, this will mean fruitful labor for me. Yet what shall I choose? I do not
know! 23. I am torn between the two: I desire to depart and be with Christ,
which is better by far; 24. but it is more necessary for you that I remain in
the body. 25. Convinced of this, I know that I will remain, and I will continue
with all of you for your progress and joy in the faith, 26. so that through my
being with you again your joy in Christ Jesus will overflow on account of
me."
This passage seems to suggest that Paul was seriously considering ending his
life, and appeared to think that under some (other) circumstances, it would be
right to do so. He concluded that he still was of service to the church and was
still needed, so he decided that he should remain.
3) Scripture
emphasizes that this life is a fleeting vapor, a passing thing,
4) It
is not this life that we should be concerned about, but about the life to come.
5) We
need have no fear of death if we are in Christ.
6) We
should look forward to being rid of mortal flesh, and being re-clothed in
righteousness.
7) Mortal
life is not to be sanctified or revered, but used wisely.
8) One
thing I would most certainly NOT want to do is to suggest that suicide is an
acceptable course of action under most circumstances. Suicide is a terrible,
awful thing in most cases. My point here should in no way be taken as excusing
or suggesting it. If anyone sometimes feels it would be a way of decreasing
emotional pain, get help.
I think that a person in good health who commits suicide out of psychological
depression, stress and mental pain is evading issues and giving up faith. He is
causing suffering to those he leaves behind. He has the ability to serve God
and to serve others, and he is avoiding his duty. He is denying the power of
God to help him overcome his problems. I think that suicide for that reason
violates principles of faith, love, and service. But more importantly, if anyone is actually
considering it, you should realize that there is help, there is hope, things
can get better, do not despair.
Our present mortal bodies are described not with reverence at all, but as vile:
"Who shall change our vile body, that it may be fashioned like unto his glorious body, according to the working whereby he is able even to subdue all things unto himself." (Phil 3:21)
The Bible speaks strongly against an emphasis on the saving of mortal life:
John 12:25 "He that loveth his life shall lose it; and he that hateth his life in this world shall keep it unto life eternal."
Psalm 90:10-12 "The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away."
I John 2:16 "For all that is in the world, the lust of the flesh, and the lust of the eyes, [u]and the pride of life[/u], is not of the Father, but is of the world."
Matt 6:25, 33: "Therefore I say unto you, Take no thought for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on. Is not the life more than meat, and the body than raiment? . . . But seek ye first the kingdom of God, and his righteousness; and all these things shall be added unto you."
We need have
no fear of death,
for:
I Cor 15: 47-49 "The first man was of the dust of the earth, the second man from heaven. As was the earthly man, so are those who are of the earth; and as is the man from heaven, so also are those who are of heaven. And just as we have borne the likeness of the earthly man, so shall we bear the likeness of the man from heaven."
2 Corinthians 5: 1-5
“Now we know that if the earthly tent we live in is destroyed, we have a
building from God, an eternal house in heaven, not built by human hands.
Meanwhile we groan, longing to be clothed with our heavenly dwelling, because
when we are clothed, we will not be found naked. For while we are in this tent,
we groan and are burdened, because we do not wish to be unclothed but to be
clothed with our heavenly dwelling, so that what is mortal may be swallowed up
by life. Now it is God who has made us for this very purpose and has given us
the Spirit as a deposit, guaranteeing what is to come.”
From which I conclude that mortal life is not to be reverenced nor counted of infinite value. Quite the opposite. Our mortal life is to be counted as vile, as dust, as nothing, of no value at all. Reverence should be reserved for God alone.
Based on Biblical principles of treating others as we would want to be treated:
1) If a patient (any patient of sound mind) wants a feeding tube, it should be
given to them.
2) If a patient (any patient of sound mind) does not want a feeding tube, it
should not be forced on them.
3) If a patient beforehand expresses their desire in writing, that expressed
desire should be followed if they become unable to communicate their desires.
So if they say "no feeding tube" in advance, then no feeding tube
should be installed.
4) If the patient has not expressed their desire in advance in writing (which
is probably true of most people), and they become unable to communicate, then
is it reasonable for the family to attempt to determine what the patient's will
would be if they could express it, though this will be a very difficult
decision. It would be hard to withhold the feeding tube if we thought they
might want it, but it would be equally hard to force it if we felt that would
be against their wishes.
I don't think the Bible gives us clear direction on a requirement that a
patient must endure torturous incapacitation indefinitely. It would be require
a considerable chain of indirect inference to get to that conclusion.
Consequently, these decisions appear to me to be personal matters, at the
prayerful discretion of each individual.
The Bible does not give us sufficient direct detailed instruction to tell us exactly what we should do in such cases. It is up to you to make up your own mind. But the more important thing than preparing to die is preparing to live – God’s promise of the gift of life – resurrection.
What we do know is that whatever we decide regarding the end of our mortal life, it does not have to be the end of our existence. As we have read, the Bible emphasizes the hope of the resurrection, with a new body no longer subject to the mortality, the pain, the suffering and the temptation of our present bodies.
Jesus gave up his life to secure for us the way to everlasting life. He said in John 10:17 Therefore doth my Father love me, because I lay down my life, that I might take it again. 18No man taketh it from me, but I lay it down of myself. I have power to lay it down, and I have power to take it again. This commandment have I received of my Father.
And
in John 10:13 3Greater love
hath no man than this, that a man lay down his life for his friends.”
We know that Jesus looked forward to the resurrection that God promised him, and we know that this resurrection has been promised to us as well.
We
have been offered the opportunity to join with Jesus through baptism Romans 6:3 Know ye not, that so many of us as were
baptized into Jesus Christ were baptized into his death? 4Therefore
we are buried with him by baptism into death: that like as Christ was raised up
from the dead by the glory of the Father, even so we also should walk in
newness of life. 5For if we have been planted together in the
likeness of his death, we shall be also in the likeness of his
resurrection: 6Knowing this, that our old man is crucified with him,
that the body of sin might be destroyed, that henceforth we should not serve
sin. 7For he that is dead is freed from sin. 8Now if we
be dead with Christ, we believe that we shall also live with him: 9Knowing
that Christ being raised from the dead dieth no more; death hath no more
dominion over him.
