by Bob Wheeler


Rembrandt: The Anatomy Lesson of Dr. Nicolaes Tulp

Death is an existential question that calls out for an answer.  Why do people have to die?  To an atheist the question is pointless – everything in nature dies; that is just the way things are.  But there is something inside of us, an ingrained part of our humanity, that will not settle for an answer like that.  To have known and loved someone, to have seen that person as a living, breathing person, full of life and energy, and now to see that person as a lifeless corpse, is to feel a profound sense of loss.  And if we live in a universe that was created by an intelligent Supreme Being, then the philosophical question inevitably arises, why death?  Death would seem to run against God’s creative purposes.

The biblical answer is that death is a judicial punishment for man’s rebellion against God.  “Therefore, just as through one man sin entered the world, and death through sin, and thus death spread to all men, because all sinned . . .” (Rom. 5:12; NKJV).  And so, “For dust you are, / And to dust you shall return” (Gen. 3:19).

But the Sixth Commandment says, “You shall not murder,” and this raises some serious questions about the medical care of dying patients.  What specifically concerns those of us who are not medical professionals is giving informed consent to various treatment options.  People are often asked to prepare living wills or advance medical directives that give instructions on how they would like to be treated if they are incapacitated.  Among the issues frequently addressed in these documents are resuscitation, feeding tubes, IVs, mechanical ventilation, and antibiotics.  Most of us dread even being in a situation where such measures are possibilities, and our natural inclination is to not want any of it.

But we must always ask the question, what would God want?  We are morally responsible creatures, and are ultimately accountable to Him.  What, then, is the moral thing to do?

The Sixth Commandment forbids the taking of innocent human life.  That means that there should be no action our part to shorten someone’s life or to hasten death.  On the other hand it does not mean that we should artificially prolong the process of dying.  Ultimately it is God who determines the time of our death.  “You take away their breath, they die and return to their dust” (Ps. 104:29; cf. Job 34:10-15).  Or, as the apostle Paul put it, “For if we live, we live to the Lord; and if we die, we die to the Lord.  Therefore, whether we live or die, we are the Lord’s” (Rom. 14:8; cf., II Cor. 5:9,10).

On that basis I think that we would have to say that it is wrong to remove a feeding tube from a patient while he is still alive.  Every living person needs both food and water to sustain life, and they must be delivered to the body by some external means, whether baby bottle, knife and fork, or feeding tube.  To deprive a person of food and water is to starve him to death – the immediate cause of death is humanly induced starvation.  That, then, would constitute an impermissible taking of human life.

But what sort of medical treatment should be given to persons who are terminally ill?  Obviously a disease that is treatable should be treated.  But there are two opposite tendencies that should be avoided: the tendency to prolong life as long as possible and the tendency to shorten the process of dying.

The first tendency is to resort to heroic but futile attempts to prolong life because the patient is simply unwilling to accept the fact that he is dying.  Death is a terrifying thing, and the natural tendency is to resist it as long as we possibly can.  But if the patient has been diagnosed with stage four cancer (cancer that has spread to other organs) the value of radiation therapy and chemotherapy is questionable.  The therapy is expensive, destroys good cells as well as bad, and in the end is futile.  There comes a time when we must accept our mortality.  When your time has come your time has come.

On the other hand there is a natural desire in some cases to want to hasten death.  When a patient is stricken with a painful and debilitating disease, it is only natural to want to end the suffering.  It is also tempting to argue that a person’s “quality of life” is so poor that there is no point in keeping him alive.  But the Sixth Commandment still applies – we are not permitted to take human life.  We were created in the image of God, and there is something sacred about human life.  Obviously every effort should be made to ease pain and suffering, but any idea of “mercy killing” should be avoided.

This is not to day that end of life decisions are always easy.  There is a wide variety of possible circumstances, and it is impossible to anticipate exactly how one’s life will end.  Thus great care should be exercised in filling out living wills and advanced medical directives.  When they are good health many people will say that they would not want the use of artificial means to prolong life, but they often change their minds when faced with the actual prospect of death.

Much depends on the overall condition of the patient.  If a patient is terminally ill, or is elderly and in failing health, cardiopulmonary resuscitation (CPR) and mechanical respiration may not make much sense.  On the other hand, for a younger person who is the victim of an accident or heart attack, aggressive intervention may save his life and spare his loved ones the grief of a loss.  For a person with a long-term disability measures to enhance functionality may be appropriate, even if the disease itself is incurable.  And for a person who is at the end of life, palliative measures are appropriate even if they have the effect of minimally shortening life.  If death is immanent it is best to accept the fact and make the patient as comfortable as possible.

But above all else, let us make sure that we are spiritually prepared for death.  We must all face death sooner or later; we must all reckon with eternity.  We all have an appointment to meet our Maker.  Let us settle our accounts with God now before it is too late, so that we can face the hour of death with calm equanimity.

There is something about the awful finality of death that is truly terrifying.  It is for good reason that the Bible calls it “the king of terrors” (Job. 18:14).  But for the Christian it is nothing to fear – death is but the gateway to paradise.  “For me to live is Christ, and to die is gain” (Phil. 1:21).

“When I tread the verge of Jordan,

Bid my anxious fears subside;

Death of death, and hell’s Destruction,

Land me safe on Canaan’s side . . .”

William Williams