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

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That's focusonthefamily.com/family traditions. I think that hospitals have a way of driving us to her knees as patients as caregivers as physicians and really turning up some very profound and cutting spiritual questions and we have very little support for in the hospital environment that's Dr. Catherine Butler describing the turmoil that many families experience with loved ones in the ICU. Dr. Butler joins us again today on Focus on the Family your hostess focus president and author Jim Daly and on John. John last time we began an insightful conversation with Katie on a godly approach to end-of-life decisions and I realize that you probably don't talk about this often, but it's important. This is a heavy topic and a good topic to have within the family, particularly today were going to hear additional painful stories like we did last time. And if you missed it, get the download the app and you can listen that where get a hold of us will give you Linker will get you somehow. A highlight of our discussion yesterday was the reminder of the hope we have as believers we don't have to have a heavy heart about this transition from this life to the next. That's the whole point is not that we have eternal life in Jesus. And I'm so grateful to Katie wove that into the discussion yesterday.

She's an impressive young woman that Dr. trauma physician and she's now a homeschooling mom which I think is probably the most important job and I was so delighted to talk with her last time. If you missed part of it again get the download were to continue the discussion on advanced directives and those things the trauma surgeon see every day.

He had last time a gym for those who watch on YouTube. They saw me writing some notes I do that during interviews and and one of the notes I wrote down was sweet touched on advanced medical directives, and I thought, oh I need to make sure ours are up-to-date and I thought oh we have elderly parents. I need make sure that we know what their wishes are now before something happened.

So really practical, very helpful conversation. More to come today. Let me just say that Dr. Butler has captured so much of her wisdom and insights in the great book it's called between life and death, a gospel centered guide to end-of-life medical care.

Of course we have that here at Focus on the Family just checked the episode notes for details at Katie last time you mentioned these four core principles which really is the basis for the book. Can you refresh us and those that didn't hear yesterday's program tells what the four principles are still at a biblical approach, end-of-life care focuses on the fact that life is sacred and something of a call to protect and accenting in end-of-life scenarios.

It prompts us to try to seek after treatments that have the potential to cure to bring about full recovery. However, also God ultimately has authority over our life and death, and death is something that will come to all of us and he can work even through our death for the good of those who love him and still while we are called to protect life and should pursue treatments with the potential for cure at the end of life when our measures don't promise recovery.

We should be very careful about foisting treatments that are potentially futile on people. The third is that we have mercy and compassion and love our neighbor as ourselves. And when it comes to the bedside in the scenarios. That means having an awareness of the fact that our treatments can cause suffering, sometimes very market suffering in the fourth which is the most important of all is that we have hope in Christ that transforms data from something to be feared at all costs to something that through the cross brings us into eternal communion with the Lord, and those are great principles. We cover them again in pretty good detail last time. So get the download let's talk today a little bit more but I see you you mentioned yesterday, I can imagine that environment not come to work.

We have a program we talk to people we help people your own form of triage with people call us that need help in this rewarding. I can imagine being a doctor in the ER like you did for 10 years where you have people with tremendous physical issues, broken bones, car accidents, gunshot wounds. All those things going on. The intensity that you experience as a Dr. special is a Christian doctor trying to bring healing to people in that moment describe that ICU environment like that in the ER really I think that's hospitals have a way of driving us to our knees as patients as caregivers as physicians and really turning up some very profound and cutting spiritual questions and we have very little support for in the hospital environment and and part of my concern in talking about end-of-life care is because I think that there's very little support for patients and their families in wrestling through some of these spiritual issues in in one study looking at terminally ill patients with cancer talking about what they anticipate the questions they had about end-of-life 85% said they had spiritual concerns but only 1% said they then referred to chaplaincy doctor in a very underutilized another station that I in conferences between family members and doctors about end-of-life care that 80% of them brought up spiritual questions and the most common response and the doctor was silence and rarely a platitude button but never coming alongside and digging deeper and engaging which is concerning because they the care we received the choices you make depend upon our faith in our spiritual concerns so it's an environment that's ripe with suffering, and I think the gospel and the cross lends meaning to it because when you know who God is and when you know what he's done for us in Christ and that Jesus came and laid down his life for us who are so undeserving you see glimmers through of his love even in the heart ache I and my most recent book is coming out one of those instances that still restless me so heavily was a gentleman who had been in the ICU for months and months and what happens when you're in the icy for a long period of time is you start to accrue complications and it gets harder and harder to get better.

You start to go into wasting you devalue your own muscle tissue and you then start to stack on infections from the measures we give you notes every line he put in Congress to write risks giving you an infection along on the ventilator, the harder it is to get off because your respiratory muscles atrophy is over.

The longer you are in the IC, the harder it is to get out and he had been in that position, and finally after months and months he was at the point where we had nothing more to do for him and he was actively dying. His wife had been at his side, praying over him, holding his hand communicating with us for months. Throughout this and it had so many discussions with her some, during which she was appropriately angry at us somewhere.

She was still ask someone should be tearful, but I called her on this one particular evening, and she knew from the semi-voice right away that this was different that he was dying, and so I said can you please command and she could tell from this on my voice, and she took a breath and she says I'm 40 minutes away. How much time do we have in this gentleman was bleeding into his lungs couldn't control it is oxygen levels had gone from the 90s which is normal down 10 to 70%, which is incompatible with life and his lips were blue and we were doing.

We cover the ventilator but could not get his optional was back up and I looked at this and I said he's gonna probably pass in the next 10 minutes, so I just said please just come and so his nurse and his respiratory therapist and I worked just nonstop at his bedside had 19 of the patients I was having my other colleagues to carry them because I couldn't leave his bedside. He was that sick and I'm suctioning him in doing bring up camera down his Airways and try to section a blot out the respiratory therapist is doing what he can and finally to salsa back with her arms are sides and said there's nothing more we could do at that point I all I could do is pray and I just said, Lord, please. They've been through this ordeal. Let them hold onto. She gets here you please whatever you need to do if you need to part the cars like the Red Sea on Commonwealth Avenue. Whatever. Please let her get here and I watch the motor and was stunned because for the next half hour.

His heart continue to go with with oxygen levels that were not compatible with life he should've arrested right away and then the moment she comes rushing into the ICU. She's got her coat zipped up to rich and still it was November in Boston and she rushes to the bedside. She holds his hand moment his heart stopped and so this was this lease, I would see this often, but I would see it only because the Bible convicts us and shows us about how God is good, even in calamity and it was this horrible situation.

And yes, I would've wanted him to still live and I wish you could've done more for him but what a point of grace that he would answer that prayer and allow them one last handhold so you see terrible suffering and you see horror but when you really lean into Scripture and see that God's steadfast love for us endures forever. Then you also see glimmers of his his love and mercy.

What a beautiful illustration of the bigger picture or human existence is just that what's here right spiritual dimension so much more. But God would hold on exactly what them have the last moment and you know those heartbreaking situations like the one you just prescribed. I've heard of stories were some people who are struggling with her health of end-of-life beliefs on how they interpret that the have sinned against God is not answering prayer and I'm sure you saying that as a Christian doctor. How do you how do you cancel that person. That's really heaping on the guilt in the midst of their dying. I had one mother of a teenage girl, for whom I cared and she had just awful awful course she been in a car accident and we got her through all the injuries, but she had horrible complications from feeding tube replaced and ends basically had her abdomen was locked in infection that we never got a handle on and after three months in the ICU.

She very clearly was dying and I had a conversation with her mom and her mom broke down and said teaching God's punishing me because I don't go to church anymore. Think that's why she's dying just like you said, the kind of grief that you can bear in the guilt that I think the Bible points us in another direction that we don't know always why we suffer. Why awful things happen, but we see so many examples throughout the Bible of God affecting good that we can't comprehend even through our suffering.

I think of John 11 when Lazarus is dying and Jesus received word and our expectation from the outside to be the only good thing to be for Jesus to go and heal him to rewrite the delay's and he tells his disciples delaying so that God's glory might be shown to you and he arrives Lazarus has died, his delay and Mary and Martha save you pain. Here he would left is that that kind of grief. I went to hear that he raises Lazarus from the dead in the company of all these mourners regather you can see God's glory in Christ, or I think of Genesis 50 verse 20 where Joseph was thrown into a well and sold into slavery and enjoyed all the suffering at the hand of his brothers but when he finally meets and afterwards he says you met this for evil but God meant it for good suffering. I endured he met for good to save many lives, because then he was in Egypt and he was able to save the nation of Israel by providing food for them. You know so you see all these ways, the most beautiful manifestation of that is the cross where God worked through suffering. He worked to the suffering of his son to bring about the greatest gift. He's given to all of mankind. You know, and so what you see is that we might not know the answer for suffering, but we do see that from Romans 828. He works through all things for the good of those who love him even the bad moments and because something bad has happened doesn't mean that we've done something to earn that punishment Kitty were in the last quarter over two days together. Fourth quarter. Now let's let's talk about physician-assisted suicide, we reference to I think right now it's legal in seven states was probably two or three more states are considering sanctioning. 11 now 11. So already, it's moved to 11 so that context, what as a physician.

What is your attitude when it comes and is a Christian.

More important, what your attitude with physician assisted suicide given. Even some Christians can rationalize this. This is humaneness the right thing to do because were prolonging life beyond what they would normally live so this is actually a good thing, speak to that hole that we need to be really careful and and eight I think it's unfortunate that physician-assisted suicide is now reaching more widespread approval because I think people can then misconstrue what were talking about in terms of limiting harmful treatments right when a person is that when it was actively dying right with physician-assisted suicide which is actively ending someone's life. They're very different but II worry that in terminology of its use. People can misconstrue them and I actually I understand the compassionate people have in the stance that people can have looking at this in single was this a way to love other people in the show them dignity and I have all people how to reason a personal reason to actually advocate for PAS essay. Right now I don't but I had a family member who suffered from image of lateral sclerosis, Lou Gehrig's disease and see he was very fiercely independent and proud and aloof and saw suddenly, his ability to eat, speak, feed himself, clean himself gone and in the setting of the turmoil that thrust him into. He took his own life before he took his own life. He wrote a series of letters one to his wife, encouraging her one telling her to call 911 because he planned ahead of time and knew she would find him in the last team, but a note and said support Kevorkian Kevorkian was the doctor from 20 years ago.

Yes, he was an advocate for euthanasia which is a close cousin, physician-assisted suicide, so that was very present in my mind when I went to medical school and I would see the kind of suffering, we would inflict and and sympathize and and wonder.

But as I would walk through the hallways and see my patients. I could never give them pills to help them in their life. How could I do that, you know. And so it inwardly before I was a Christian, even though I had a reason. Personally, to advocate for I knew it was wrong and when you look at what the Bible teaches us. You know there is a difference between refusing treatment that Seneca suffering and not help and actively ending your life with medication.

Physician-assisted suicide is that the doctor gives you medication. Usually a high dose of the barbiturate that you take. And that is what ends your life, not the underlying illness. It's troubling you. Euthanasia which is not legal in Canada is actually giving a lethal injection physician. She gives a lethal injection to someone to end their life very different and that's actively taking life and brings us right back to Mount Sinai with do not murder. There is a very clear distinction between the two and is important for us to be clear on this, because the movement in favor physician-assisted suicide likes to soften terms so there was a Gallup poll but about 10 years ago in which they phrased. Do you think it's okay for a doctor to help someone and their life without suffering and 64% said yes. Right.

74 changed with the right when you change the term to suicide their approval went down to 15%. People know it's wrong when you monkey with the language. Suddenly, it sounds more acceptable. And that's what has happened is, there is an active debate that physician-assisted suicide which is the appropriate terminology should be changed to medical aid in dying that just important for people to be aware this is not the same as transitioning to comfort measures or withdrawing from life support.

It's something active. The active taking of a life right is so important and I hope people hear the clarification.

Again, there's more in your book, but they can read let's move to those directives that you mentioned throughout yesterday and today. Let's give it another quick recap of the advanced directives and then wonders some of the best examples that you saying that really have helped you as a doctor and the hospital were families have thought this through. And really, really given you the direction you need is a nobody likes to talk about these issues.

You can is no quicker way to shut up conversation during dinner than to bring up death party talk talk about it and ended questions make us uncomfortable now, but the problem is that when we don't talk about it with their families.

We risk straddling them and abandoning them to us in some really hard situations.

So what I mean by that 75% of us will not be able to vouch for ourselves at the end of life either because the interventions were on wobble. Rob us of the voice or were going to be too sick to actually speak our wishes. However, only one in four people in America has an advanced directive on file guiding loved ones what they should do so.

It's actually absolute in verse yes yes so so most of us will not be able to speak for ourselves and will rely upon our and our loved ones next of kin to make decisions on our behalf, but only about one fourth of us is actually giving them instructions to do so. So, advanced directives are and are to try to guide our loved ones when we can't speak for ourselves and also to ensure that our own wishes are respected and they come in a number of flavors. The first thing is appointing healthcare proxy or a durable healthcare power of attorney which is someone that you appoint to advocate on your behalf and make decisions when you can't speak for yourself, and it's very important to do this because number one you want to make sure that you have discussions with that family member and that they are comfortable making decisions for you and that they know your wishes and also because if you have one that you specifically designated a can alleviate some of the turmoil between family members when disagreements come up.

So if you had a discussion with your skier son or daughter and another son or daughter disagrees with what's decided upon that person you designate can only say I know this is what mom or dad would want.

We talked about it, so it helps to equip them. You have a powerful story about a woman who was prepared to make decisions for her sister and I think your express is one of the better examples of how to do this would happen so I had to help out a colleague in the operating room who was in crisis.

He was caring for a woman you had large tumor in her pelvis and in trying to exercise it. It was a network of blood vessels adherent to it and they all tore into she spilled her blood volume into her pelvis. The span of a few minutes so he called for help I arrived, and the anesthesiologist was doing CPR and we work together and packed the pelvis and gave several units, several several leaders of blood stabilized turnoff center to interventional radiology to see we could stop the bleeding with catheters could not do it connect to the operating room packed again brought her up to the intensive care unit where I had to 1/3 time go in and try to stop the bleeding and it had been hours and hours of us trying us to save her. It was very clear that we were losing we were not going to be able to and I had talked to her sister.

Throughout this and she understood and was very nervous and asked appropriate questions, but I called and she could hear from the tone of my voice that we were at the end so I said please come in now and when I went to see her in the waiting room. She looks like her sister shook my patient. She said in her jangling her keys and for what I had this one every moment why my mind did a flip on me and I thought maybe she's okay but sat down and was trembling because we been working so hard and it's hard to admit that no we can't. We can't save her and she stopped me midsentence and said my sister wouldn't want any what you're doing right now and I was so surprised by the conviction which she said it in the, which she said it and she had tears in her eyes and she said I don't want to let my sister go I don't want to lose her but we talked about this so many times we watch my mom died in the ICU and he was horrible and we so clearly talked together about will be okay for us and what wouldn't and she wouldn't want anything what you're doing right now she has faith in God and just let her go to be with God, can I see her before you let her go into she went and she spent her last moments with her sister but she said she's like you know I don't want to lose you.

But at least I know what she wanted and so it just shows that the power if you have these discussions is difficult to say are eking equip our loved ones in moments that are going to be horrendous for them that are going to be sad.

They're going to cause in grief and fear, but at least they have the solace to say I know what my love one would've wanted and I've respected that and it can bring peace in a situation is otherwise horrible. This is been so good. I mean we have flown by two days. I hope people have appreciated maybe not enjoyed but appreciated the discussion.

I appreciate your courage in writing as a physician. Let me let me end with this question because I'm so impressed by who you are, brings me to tears. Or you just are such a phenomenal individual in the know. Becoming a physician in the way you've applied it in the way you work Scripture and everything. It's really refreshing that your science is not voided your faith. So let me give you the last word to talk to people about that intersection. Faith, I would just say that these situations are so harrowing and they can bring us to just the deepest anguish and afterwards whether or not things have gone smoothly when you make a decision for a level I you can beast struggling afterwards with questions of why did I do the right thing and gilts and I would just say in all things just turn to Christ because he is the founder perfecter of our faith, and he reminds us, even in these horrible situations were dealing with death and illness that although our hearts and our flesh may fail.

He's the strength of her heart and her portion forever. And no matter what the sales us have forgiveness and hope in him as well said Kitty Butler, Dr. Butler, thank you for being with us is so informative. Thank you again for the listeners and the viewers.

This is a kind of resource you on your shelf and you need to be looking at it reading it together as a couple and talking about what it is you need to plan for.

For those end-of-life issues.

Or maybe it's something you need to help again with your grandparents or your parents there Adrian, you need to make decisions.

Maybe sooner rather than later and as we often do you know we want to make this available to you so if you can make a gift of any amount of the part of the ministry so we can help families who can't get this resource but make a gift of any amount will send you Katie's book is our way of saying thank you if you can afford it.

We often say this with marriage advice and parenting tools just get in touch with us that will trust others will cover the cost of that.

If you need this resource and you can't help us in ministry. We want to minister to you some good in touch with us and will get it in your hands, you and the Dr. Butler's book once again is called between life and death, a gospel centered guide to end-of-life medical care. We'd love to get a copy to, and one more thing that we say often here Jim is that we have curing Christian counselors.

We talked through some tough stuff here and if you need to talk with someone about your circumstances schedule a time with one of those counselors forget the book and donate as you can call 800 K word for next time Chante felt on offers encouragement for your marriage based on lessons she's learned after interviewing hundreds of couples work truly happy in the relationship is a simple here is important about looking for the bright spots and seeing what those role models.

The people that marriages have to teach us on behalf of Jim Daly and the entire team. Thanks for joining us today for Focus on the Family I'm John Fuller inviting you back. As we once again help you and your family thrive in Christ, I'm here asking people how they could both give and get to know you love you give and get through body. It's also possible with a charitable gift annuity you get a secure source of fixed income and a charitable tax to decks and class giving a charitable gift annuity to Focus on the Family family thrive for generations to come.

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