Between Life and Death

A Gospel-Centered Guide to End-of-Life Medical Care

Kathryn Butler

• Publisher: Crossway
• Year: 2019
• Print ISBN: 9781433561016
• eBook ISBN: 9781433561047
• Topic: Theology & Religion
• Subtopic: Christian Ministry

"To prepare yourself to make difficult medical decisions in a distinctly Christian way, you won't do better than to read  Between Life and Death." — Tim Challies

Modern medical advances save countless lives. But for all their merits, sophisticated technologies have created a daunting new challenge, namely a blurring of the expanse between life and death. The dying process is often hidden behind a complex web of medical terminology, statistics, and ethical decisions, making it difficult for patients and loved ones to know how to approach the end of life in a dignity-affirming, Godhonoring, faith-filled way.

This book offers a distinctly Christian guide to end-of-life care. It equips readers by explaining common medical jargon, exploring biblical principles that connect to common medical situations, and offering guidance for making critical decisions. In these pages, readers will find the medical knowledge and scriptural wisdom they need to navigate this painful and confusing process with clarity, peace, and discernment.

Part 1

Dying, but Alive in Christ

1

Framing the Issue

She reminded me of a sparrow buffeted by wind. Her diminutive frame trembled, and a nurse placed a hand on her back to steady her as she teetered beside her husband’s bed.

Her husband watched through glazed eyes. His chest rose and fell with a sickly cadence, like that of a maimed bird beating its wings to take flight. He seemed remote, his mind wandering through forgotten country. He had developed pneumonia after a difficult surgery, and as infection clogged his lungs, delirium seized him. His bleary gaze searched a space none of us could see.

“He doesn’t want it!” his wife insisted.

The surgeon drew nearer to her. “I don’t think you understand me. He’s already gotten through the surgery. He’s made it this far. I think he would want the breathing tube.”

“No, doctor, he wouldn’t,” she retorted, her voice cracking. “We talked about this so many times, and he was crystal clear. He’s always said, ‘When God calls me home, let me go.’”

The surgeon folded his arms. “But how can you be so sure that God is calling him home right now? You realize he’ll die without the tube, right?”

Her face reddened. She opened her mouth to speak, but for several moments words failed her. Veins swelled in her neck. “No tube!” she finally managed.

The nurse’s eyes met mine, and she pleaded with me to intervene. I urged the surgeon to allow me to speak with the patient’s wife in private.

“Please, help her to understand,” he urged me as he left the room. He shook his head as he walked toward the ICU double doors.

I sat beside my patient’s wife and cupped one of her hands in my own. With her free hand, she clutched her husband’s fingers. In contrast with her broken spirit, her grasp seemed forged from iron.

“Please,” I ventured, “can you tell me about your husband? What is he like?”

A thin smile graced her face, and her demeanor softened. She described for me their sixty-year marriage, the partnership they shared, the tenderness, the trust. She outlined his declining health over the last year and his inability to engage in the things that set his mind and heart afire. Pain, immobility, and shortness of breath confined him to the house. Visits with friends, once life giving, now exhausted him. The fog of pain and medication so clouded his thinking that he could no longer concentrate long enough to read, not even to skim the Bible that sat on his bedside and which for decades had steered him through tempests. His own father had suffered a slow, painful death in the ICU, and he had pleaded with her to shield him from the interventions he witnessed. The very idea of a ventilator horrified him.

“He didn’t even want this surgery,” she related to me. “I persuaded him to go through with it because I wasn’t ready to give up time with him. On the way to the hospital, he made me promise I’d say no to tubes or CPR or anything like that. He couldn’t stand the thought of it. He’s always said, ‘Let me go home to God.’” Her voice cracked again. “He’s going through all this out of love for me. The breathing machine would be too much.”

I squeezed her hand. “I think he’s made the decision for us.”

Afterward, we reinstated the do-not-intubate order that he had established prior to surgery.1 His breathing would fail without a ventilator, but to force him onto one against his wishes, when its efficacy was dubious and his suffering certain, lacked all semblance of compassion. We changed our focus from cure to comfort. His surgeon, although disappointed, understood.

His nurse remained at his side around the clock to provide medication to alleviate pain and anxiety. When I left the ICU that evening, his wife rested beside him with her head in his lap. Although his gaze remained distant, he stroked her arm with his hand.

The following morning, I again found his wife in tears. Overnight their son had rushed to the hospital in a rage over the decision against a breathing tube.

“You’re not going to kill my father!” he had bellowed at the staff. “I know my dad. He was a God-fearing man who until six months ago went to church every single Sunday. He would not be okay with this.” He threatened to call the police before he stormed out.

When I entered, I found the patient’s wife crumpled and broken at her husband’s bedside, his hand still clasped in her own.

“Doctor, I don’t want to upset anyone,” she said. “Maybe I’m not supposed to argue about this, and just do what everyone else says. But I promised him. I know he wants to go when God calls him. He trusts in God, not in all these machines. What else am I supposed to do?”

A Foreign Landscape

As dramatic as it may appear, the turmoil this family endured occurs commonly in our era of intensive-care medicine. Next of kin find themselves in the unfathomable position of advocating for their loved ones in a foreign environment, complete with an undecipherable vocabulary. Among themselves, families bicker and disagree. Nurses fight tears as their patients grimace with yet another turn, yet another dressing change, yet another needle stick. At the center, heavy within the room but often unspoken, is the question of how faith informs the heart-wrenching, convoluted process. Openly, healthcare practitioners, patients, and families debate about prognosis, percentages, and advance directives. Inwardly, we all cry, How long, O Lord? (Ps. 13:1)

The tumult seems incongruous with our vision of life’s end. For centuries, Western culture has conversed about death in euphemisms and poetry. We all long to “go gentle into that good night,”2 and “to die, to sleep.3” We soften the vulgarity of death with the phrase “pass away,” as if life were a gauzy breeze, a zephyr that pirouettes in the air before vanishing into silence. Literature, philosophy, politics, and next-door neighbors depict death as a subdued stepping over a threshold, replete with quiet resignation, as subtle as a passing whisper.

Even while we cling to such metaphors, the landscape has shifted beneath us. In 1908, 86 percent of people in the United States spent their final days at home, among family and cherished friends, in the spaces that forged their memories.4 The particulars of dying reflected its spiritual reality as a passage from captivity to sin to renewal in Christ. It was profoundly personal and relational.

A century later, Americans still treasure this understanding of death and cite the home ...

Table of contents

• Cover
• Newsletter Signup
• Endorsements
• Title Page
• Copyright
• Dedication
• Contents
• Introduction
• Part 1 Dying, but Alive in Christ
• 1 Framing the Issue
• 2 Wisdom Begins with the Word
• Part 2 A Detailed Look at Organ-S upporting Measures
• 3 Resuscitation for Cardiac Arrest
• 4 Introduction to Intensive Care
• 5 Mechanical Ventilation
• 6 Cardiovascular Support
• 7 Artificially Administered Nutrition
• 8 Dialysis
• 9 Brain Injury
• Part 3 Discernment at Life’s End
• 10 Comfort Measures and Hospice
• 11 Physician-A ssisted Suicide
• 12 Advance C are Planning
• 13 Being a Voice
• Conclusion
• Acknowledgments
• Appendix 1
• Appendix 2
• Appendix 3
• Glossary
• Notes
• Further Reading
• General Index
• Scripture Index