A Godly Perspective on End-of-Life Decisions (Part 1 of 2)

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Imagine you're sitting in a hospital room and declining for months on life support. You wonder if it'll ever leave ICU you wonder what should we do are we prolonging the inevitable. This is Focus on the Family with your host focus president and author Jim Daly and on John Fuller, John. That's a heart-wrenching situation no one can prepare for it. You know you don't do this over and over again like going to work. These are one time event sometimes where your loved one is in difficulty and you don't know what to do. Sometimes 100 years ago most people spend their final days at home that was normal today. I think only about 20% will die in their home.

Most of them are in ICU or in hospice or some other facility to take care of and if you're not really a medical expert.

There are so many overwhelming options for decisions ventilators feeding tubes dialysis technologies are abounding in what you do to help that spouse or loved one that John the searcher and then you look at the covert situation. These decisions have become even more difficult that we have staff members who tragically were barred from visiting their loved ones at the end of their lives and work with them to hold their hand and be present as they went from this life to the next. Today will hear from a medical expert. I'm so glad that she is with us to talk about these things don't pull back. Don't go off the YouTube channel don't turn off the station don't close the gap. These are really important discussions that I think it's one of the unique ways Focus on the Family is here to help you think about these things, yet our guest is Dr. Catherine Butler, a former trauma surgeon with a decade of experience in critical care and she has a really terrific book that can help you think through these difficulties.

It's called between life and death, a gospel centered guide to end of life, medical care and we have copies of that here.

I just checked the episode notes for details.

Dr. Butler, welcome to Focus on the Family, thank you so much for having me. I'm looking at you thinking wow this could be my daughter now you are trauma surgeon for 10 years.

I look like punky Brewster is amazing and the and you accomplish so much, give us a little bit your background to help the listeners understand where you're coming from your experience, so I'm sure so I completed my medical school training at Columbia. I went on to training in general surgery and surgical critical care, which is ICU care at Mass General Hospital and then I joined the staff and was involved in taking care of patients after trauma in the emergency room and basically any kind of emergency that brings you into the ER for which you need urgent surgery right is my role and I was also a specialist in taking care of people in the ICU. In that context, I mean medicine has made remarkable gains.

I mean, you can measure them almost every couple years. There's some great advancement that occurs in being a scientist being a doctor. This has brought some confusion may use that term into end-of-life issues. So from that perspective. How did you see that firsthand experience as a trauma doctor i.e. I am and what you allude to the fact that these measures are actually a gift from God, and they allow less in the right circumstances to usher people back to health. She withdrew me to the field. I can remember when I was on my pediatric surgery rotation as a medical student. We had this one little boy who was brought in after being kicked in the abdomen by his mother and he suffered a crack to his pancreas and I watched in the ICU as he and the setting of this had so much information surgeon throughout his body or his extremities ballooned up in his kidney started to fail and his lungs were failing and so I helped with the ICU team as a student I didn't do much but I witnessed how ventilators and bays, oppressors, and all these things we use the ICU.

They're very aggressive intensive help to keep him alive long enough for him to go to the operating room, his pancreas was prepared and it was remarkable to see that. Then a few weeks later I saw him using his IV pull the scooter down the hallway completely recovered and that wow this is just an incredible way to help people, but then over the course of my time actually working as an attending in the unit. What I would see so often was that these measures that when we use them with discernment for people who have recoverable illness right so it's making them so sick is something we can fix pneumonia and we have the right antibiotics for heart attack and we can open up the blood vessels with a stent, then these measures would help for people at the end of life who were actively dying, who had multiple medical issues that were in there and stages and already causing some degree of organ failure and for which we had no treatments. These measures would prolong death cause suffering and just pitch families into some agonizing situations over wondering what to do and what I saw two is that appropriately. So many of us were in when rainy scenarios lean into our faith and we try to separate what does the Bible teach me what would God want me to do, but the reality of what we see at the bedside with all this machinery is so far removed from the truth that we could proclaim every Sunday in church that we really struggle to reconcile our faith and what we know of Christ in the hope we have with numbers on a monitor that are indecipherable right and so it just puts people into so much confusion and grief and anguish. Let me ask you about that immunity rolls right to my next question. Many families are sure if their loved one is recovering or dwindling.

At that state right were talking mostly end-of-life scenarios here and it can confuse people and sometimes the doctors are extremely helpful on their moving pretty fast.

They're looking for directives they're looking for things at the family or the person lying in the hospital bed have declared beforehand what have you seen in that regard that confusion you're talking about and and what about is this recoverable or is this helping the person in well yeah the problem is that from the doorway. It's impossible for a layperson to see if someone hit us in the ICU on this level of care is recovering and on the verge of coming off everything going home or actually is dying. There's no way for them to tell that from the doorway because people in this case will both be on a ventilator. They'll be tightening attached to monitors they'll have lots of IV poles they might have a dialysis unit at the foot of the bad running continuously but to be able to understand whether or not all these things are really going to get someone home or whether it's just prolonging the inevitable in a pretty awful and cruel way. You need to understand the underlying illness causing this in the first place. The trajectory of whether or not people's organ function is getting better or worse, and whether or not we have any measures that can reverse the underlying illness and I think this is really confusing for people because we don't explain it as doctors, we really do a very poor job of explaining that life-support measures are supportive. They're not curative, so if you come to the hospital with trouble breathing and you need a ventilator. Whether or not you come off that ventilator is not about ventilator at South ventilator is meant to by time she was doing a friendship port your lungs until we can reverse the underlying problem so if you come in with pneumonia and it's a simple pneumonia in your otherwise healthy and robust and we can getting antibiotics and treat the pneumonia your lungs or cover and you'll be off the ventilator in a few days, but if you come into the hospital with respiratory failure from end-stage emphysema.

That's now intractable to all of our treatments.

Plus lung cancer.

This metastatic plus a fungal pneumonia. It's much harder to treat that ventilator may keep your lungs going, but it's not going to reverse your respiratory failure is likely to be something that you eventually passed away on and that's something that is really hard to understand coming to the table. Never having seen this kind of technology before but I think it emphasizes why it's so important to have conversations with our doctors about whether or not these measures are going to save life or prolong death and suffering exactly.

I think that's what I meant in the opening there than you know we don't encounter these decisions but maybe once or twice in a lifetime right for our love right right that usually are parents or grandparents. It's not to the point where you become proficient at it as a layperson exactly issues that rare and you don't really go through it and let me ask you, you mention this but you encounter families who struggle to apply those biblical principles in their medical decisions. It sounds like those things are very distinctive right to separate categories, but you certainly can be informed by Scripture. You had a story in your book about a patient's wife and son who came to different conclusions which I think illustrates the point beautifully apps and is happened so commonly I took care of the gentleman who is in his 80s and my role is to care for him after he undergone a very intensive surgery. His story over the past year was that he was at the end of life. He was suffering from multiple medical conditions in there and stages.

He already had some degree of organ dysfunction and his he become so debilitated that the things that normally brought him joy visiting with friends, reading the Bible, which about him so much solace on a regular basis exhausted him and became laborious and he underwent the surgery at the behest of his family. He did not want to undergo it, but did it because they urged him to when he made his wife promised him if I decline after surgery. Do not put me back on a ventilator because he had been on one before for a prolonged period of time found it intolerable and he said I know I'm going to be with the Lord soon, and his words to her were when he calls me home. Let me go home to be with him. Sure enough postoperatively. He did develop a pneumonia.

We talked with his wife. He talked with his primary doctor. We look through his advanced directive, which thanks be to God.

He had filled out and so it was very clear that even though he couldn't speak for himself that he could answer for himself, he would decline ventilator and so we we did was we transition templates call comfort measures. So instead of aggressively trying to do all we can to keep someone alive. Instead, focus on symptoms with focus on comfort. Make sure anyone's in pain. We try to make sure that people aren't struggling with air hunger and when I left that evening, his wife is holding his hand speaking to him softly and said to me. Thank you. I know he'll be with with the Lord now and so she was at peace and what was a horrible situation. Sure. A few hours later, and their son from whom they been a strange for many years arrived in the hospital furious with our decision and he stormed into the ICU room and threatened to call the police if we didn't put his dad on a breathing machine and he addressed his father's Christian faith to justify his argument and said my dad was a Bible believing Christian who went to church every Sunday until his sickness prevented him from doing so he would not be okay with Esther killing and that the high this scenario was so heart-wrenching.

I think it demonstrates what we see so often is that did landscape is so familiar and the situations are so highly emotionally charged people try to draw from their faith to inform their decisions, but you had the situation where the wife was resting in the sovereignty of God also seen her husband is an image bearer of God and seeking to honor his wishes and the sun drawing from the sanctity of life, those are all biblical principles, but they arrived at diametrically opposed conclusions now so even while we try and struggle to say I want to be God honoring whatever I do, what is the Bible allow me to do. We can really falter because the situation is so foreign and if and what happened, what was stored so we had a long discussion with him and try to discuss with him the fact that even though yes the Bible calls us to protect life by eight the sanctity of life, and I need to protect it also doesn't refute the inevitability of death and that will come to all of us in his dad was at that point where anything further that we did was not going to bring him home to a life where he could pray and read the Bible and commune with friends he was. He was an organ failure and we were likely just to prolong his suffering and he very clearly stated that that was not acceptable for him now, so we had a discussion but we upheld wishes that we could perceive his father would've wanted all were talking about some tough stuff some gray areas through the lens of Christian filter if you will. The Christian perspective of what the Bible might say, but between life and death, a gospel centered guide to end-of-life medical care is the book were discussing Dr. Catherine Butler is our guest on Focus on the Family reach out to us if you'd like a copy of the book. It is a really essential resource for you and your family a Dr. Butler you offer for biblical principles. I think the time is right, given below so we can unpack them to guide families through difficult decisions. First, the Bible teaches that human life is sacred. You touched on that. How have you seen people misapply what you're saying their support for us to learn from that show our source of first floor diving to the principles I need to emphasize that their dynamic. I think a lot of times we stumble in the situations we cleave to one of them without looking at the whole biblical narrative that we are fallen in sin redeemed in Christ and and that we are made for the Lord. I want you to be my doctor. I like this. My kids right now the action on yes I think it's important that we not hone in on just one, but we really consider them all together in the first dimension is yes, that mortal life is sacred.

We are all made in God's image and have inherent dignity and value and God gives us life as a gift for us to steward and you know the sanctity mortal life which takes us back to Mount Sinai in the 10 Commandments and the mandate to not murder, is what also prompts us to protect the unborn and also prompts us to resist physician-assisted suicide to the home of the topic. I will talk about labor and in the case of of end-of-life care what it should prompt us to do is to accept these kinds of aggressive treatments. If there is hope of cure. If what is making us sick is something that's recoverable so the correct question is in so much yes ventilator Noah ventilator, but ventilator under what circumstances the second principle, and this is one that I think people can really stumble because it seems at first glance like it's intention with the first is that even though we are called to protect life, God is still in authority over life and death. We think about from Isaiah chapter 40 like the grass that is here today gone tomorrow so are we. And we are dependent upon the breath of the Lord throughout and so even though we are called to protect life, the sanctity of life doesn't refute the inevitability that death will come to us all and so as a result, when we are clearly at the end of life when were very elderly and infirm with multiple conditions that drives us away from care that's futile so and and it's important spiritually because when we sell fight against our own mortality. We actually deny God's grace and power in the power of the resurrection and the truth that he can work through all things, even our death for the good of those who love him. The third one is that we are called to mercy and compassion you think about that fact that Christ tells us that the second greatest commandment is to love neighbor as ourselves and Mica tells us that were called to act justly and love mercy and walk humbly with our God. And when it comes to the end of life scenarios that are so hard, that means we need to have concern for the suffering that our treatments inflict in this matters because I see measures do cause suffering CPR inflicts chest trauma, and 90% of cases, including broken ribs is not quite what you soon to be no it's not at all, and at a enlargement large proportion of people who suffer through intensive care for a prolonged period of time struggle with PTSD after its post dramatic stress disorder at rates that are comparable to those suffered soldiers who fought in the Iraq war meshes the physical. That's just from being in the ICU. Having no ability to communicate being tied down being stuck with needles constantly. It causes psychological trauma and and that's worth it.

If we do these things to bring someone home. Sure, but if were doing this in the setting of someone not going to be able to return then it looks a lot like cruelty so part of of having mercy and compassion is recognizing that these measures cause suffering and not voicing them upon people. When that suffering is not without benefit. Okay, that's the third and then the fourth is the one that I think supersedes them all, which is our hope in Christ right that said so vast as God's love for us that nothing can wrench us from his love right, not even the not even death. You know I love Romans 838 to 39 it's actually this inspection for the title for the book because through Christ. Neither life nor death, nor angels nor rulers or anything else in all creation, can separate us from his love and so while death was never our original purpose and it is wrong and its importance in us.

The wages of our sin. The cross transforms death from something to be avoided at all costs to something that promises us hope because we know that death for us means eternal communion with God through the cross. And so while these situations agonize us. We need not sink into despair, because we have hope in Christ that is so good I want to go back and kind of big in the future. The person will do this for the first want to do in respect of your mortal life you have a patient the nearing death and his son felt obligated to pursue aggressive treatments describe that illustration. Yeah, he his dad had been in the ICU for a long period of time and was really failing and we met with his son in and said listen, you know your your dad we not be able to get him better when I can be able to get him home but he was stalwart because he really thought that the Bible mandated he do everything at all costs.

And I think it's an easy trap people to fall into to think that because were called to protect life, we have to always pursue everything that full matter the situation has to all that that full measures are is always the right answer and just as an aside, this actually plays out in research what we found is that people with high religious coping so those of us who go to church and and look to our spiritual community for solace actually are less likely to accept hospice care are more likely to accept aggressive measures during the last week of life and are more likely to die in the ICU.

We see this this do. Having all costs mentality that initially and so we proceeded with everything all costs and what that meant was that when his dad had a cardiac arrest. So, his heart stopped. We jumped in with CPR and placed in a breathing tube and were pounding on his chest, and shocking him, and he found it so upsetting to see that he ran to the room and said please stop. He's had enough.

You know, so it's in seeing and believing on the one hand that the Christian faith mandates. We always do everything and then seeing the reality but everything was positive realize this might not be the right thing you mentioned in the book that clinging to medical interventions can be a form of idolatry or touching on that just put it on the table is that idolatry to try so hard to avoid the it can be. If we are clinging to medical technology as the answer irrefutably and not considering that the Lord is sovereign even over this technology and and I say that thinking about people, which is very common who will say, even against the family's wishes say you know I I I know my mom would not want to ventilator right now and would not want all these aggressive things done but I'm praying for a miracle which is a very understandable thing you know as someone who's following Christ to set and say I know I know God can do all things.

I'm just paying for miracle. But the thing is, doesn't your ventilators you know of miracle by definition is something that's beyond our natural means that he does just out of his mercy, and so we can pray for a miracle. But when we decided were going to continue technology that causes suffering against someone's wishes and hoping that he will perform that miracle that veers towards idolatry because were clinging so tightly to this technology instead of resting in this bigger issue. And I think that's principle to God's authority over life and death that bigger principle of how technology can prolong the inevitable and the where do we as Christians begin the survey were relying on technology… I have family members who have been diagnosed with cancer and you know that the going on in different directions. One is saying you know what I don't want the chemo which can cause me difficulty with end-of-life. It's not to be a good quality end-of-life. It's their decision, so they're gonna go into a glide path and die with the cancer or die from the cancer and that others are more aggressive than really going after it. Speak to that. You know sometimes treatments as you're saying can be very destructive to your quality of life and I think there's a book out.

It's not a Christian book called being mortal and it speaks to that issue of how you need to assess the cost of that aggressive treatment and what it's gonna do to you right right absolutely and and what your honing in on two is that suffering is something that subjective and so what's maybe suffering for one individual is not for another, and so are answers to this will vary just important that we consider them right. I don't mean to offend anybody know very personal decision. Yeah exactly and I think as unique image bearers of God. We are all going to have our own back stories and despair are understandings of what we can tolerate what's meaningful to us what really matters and sore answers are going to vary and so it when were having these discussions with family members is critical to sit down and to think about what matters to me. When I look back at my own history and Isaac consider men walk with the Lord. What's okay and what's not differ in that it's the reason we wanted to do this broadcast to inform people to be thinking about these things lets in Scripture.

You've done a wonderful job weaving in the Scripture to the discussion today and were to have you come back tomorrow if you can do that in Philippians 1 pulses. His reason for persevering. I think this is really good persevering is to serve God and you speak to that in your book about the reason you want to continue is that you can have enough quality life to continue to serve the Lord. That's like the number one goal right that speak to that and how you can apply the passage in the life decision so we'll talk about advanced directives but I would just encourage as your thinking about these topics are so hard and no one wants to think about them, but it's important to think about the moments in your life when you have known from the Westminister catechism arch the chief end of man is to know God and to enjoy him forever to glorify God and enjoy him forever. One of you been able to live out as it been when you've been able to pray and read the Bible and when you been able to serve when you been able to love on your family members. One of those things that are crucial to you in your walk with him and help that to guide you and sometimes the answers are simpler as a result. So hard for us on the side of eternity to think of these, 80, 85 years before blessed with the to not feel like that's the whole enchilada, but were talking about eternity right. So much looks good happen after this right in the presence of God being in heaven will return. It's hard to wrap your mind around that and to not be fearful that this is it.

This is all I have just what this is not all you have is a Christian and that's what excites me. Thank you for opening this discussion up having it with us today and we will have you come back tomorrow will continue to talk about advanced directives and some other things people need to know about.

Yes, this can be a painful topic, but I hope I hope for conveying the spirit of discussion in this regard, to help equip you to have the most information possible to make good decisions and if you're in that place where you're a caregiver for an elderly grandparent or parent or someone in your life and you don't know what to do. Call us will be able to help give you some import.

We have turned Christian counselors that can help.

It's free of charge were not going to charge you for that. I'd love to invite you to come into ministry with us and if you can make a gift of any amount to focus will send you his wonderful book, tough subject: between life and the gospel centered God end-of-life medical care will send that to you as our way of saying thank you. Reach out to schedule a time to talk to one of our counselors or to donate this great resource between life and death of the number is 880 family or stop by the episode notes for all the pills on behalf of Jim Daly and the entire team here. Thanks for joining us today for Focus on the Family I'm John Fuller inviting you back once again help you and your family thrive