Belief and Practice at the End of Our Lives

Should belief in Jesus’ resurrection change how Christians approach end-of-life care? And if so, does our belief mean we should try to live as long as possible or that there may be a time to stop fighting and let a disease run its course?

A survey published in the most recent issue of Journal of the American Medical Association found that terminally ill cancer patients who say they find comfort in religion are the ones most likely to undertake “aggressive, life-prolonging care.” Those who identify themselves as religious persons are far more likely than those who do not find comfort in their faith to ask the doctor to do everything possible to keep them alive.

“People think that spiritual patients are more likely to say their lives are in God’s hands — ‘Let what happens happen’ — but in fact we know they want more aggressive care,” said Holly G. Prigerson, the study’s senior author and director of the Center for Psychosocial Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston.

“To religious people, life is sacred and sanctified,” Dr. Prigerson said, “and there’s a sense they feel it’s their duty and obligation to stay alive as long as possible.”

Medicare pays out about a third of its money on the last year of a patient’s life and much of that on the last weeks. But that is at the dollar cost level. There is also the increase in suffering patients take on in order to prolong their lives.

The study noted that “A vast majority of patients, religious or not, did not want heroic measures taken. But in some indicators, those of faith varied substantively. For example 11.3 percent of the most religious patients received mechanical ventilation during the last week of life, compared with only 3.6 percent of the least religious.”

Faith in God was a more influential factor than the recommendations of their family doctors, their spouses and children, and even information about whether treatment would cure the disease.

It’s that last statement that gives me pause. After all, I certainly believe that we should do whatever we can when medical care can return us to health. I am not writing about whether or not we should try to be healthy. We have the ability to fight against diseases and win, or to hold back the tide for many years of reasonably good health.

These decisions about receiving treatment designed to return someone to an active life are not at issue. The question is what do we do when medicine can never return us to health and no matter what course of treatment we take; we will be dead in six months or less?

Prolonging life at any cost makes an idol out of our lives as if living longer is the greatest good in all situations. Can’t having a better quality of life for a shorter amount of time be a faithful option for Christians? When is no medical care or limited medical care the best option?

For most of human history, options including chemotherapy and various surgeries, etc. were not available. But now that there are options to consider, must a person of faith always opt for the maximum care possible? I say “No.” In saying no, remember that I certainly am not in any way addressing those for whom care has a chance of returning the person to health. As I wrote above, when there is a chance of being returned to health, that is the right choice. I am addressing only end of life care when a return to full health is not possible and it is only a matter of how long one will live.

In that setting, I do think taking less extreme measures to assure a better quality of life. So, for example, a person can be lucid and have less pain and suffering for three months rather than to go through a very difficult final six months. I have seen the gift of palliative care, such as that offered by Hospice, in allowing a person to stop fighting the disease. With the body no longer trying to fend of the progress of an illness, there is more energy to spend time with loved ones before dying. The best Christian witness I have seen is when a person has the wherewithal to see that death is coming and to reach out to those being left behind to let them know that it is alright and the one dying is at peace.

That’s my take, but then I am not currently making this decision for myself and so do not seek to judge someone who is in that position. I know that there have been many faithful believers who have opted to take advantage of all medical options for remaining alive longer and I do not intend to judge those folks as I can not know what they were going through or how God might have been leading them.

But as I have walked with families making the journey at the end of life, I have been continually amazed at the grace and love found in difficult circumstances. I am not looking at this with specific cases in mind, but with the total numbers in view and asking this week following Easter whether those of faith should not show their belief in the resurrection in their practice of making end of life decisions.

If you do prefer to avoid extreme medical care keeping you alive at all costs, be sure to make your wishes known to your family both in conversation and in writing. You can use a tool like the Five Wishes booklet available at our hospital or online at www.agingwithdignity.org/5wishes.html You can also write up a living will with an attorney.

However you do it, putting your own thoughts on end of life care in writing long before you think you will need to do so, will be a gift to those having to make decisions under difficult circumstances. No matter what your views on medical treatment at the end of life, you owe it to your loved ones to let them know what your wishes are for yourself.

(The Rev. Frank Logue is pastor of King of Peace Episcopal Church in Kingsland.)

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