End of Life Planning

To everything there is a season, and a time to every purpose under heaven: A time to be born, and a time to die.. .  Ecclesiastes 3:1-2.

The Bible says that for every person there is a time to die, as well as a time to be born.  One important medical issue in America today is the question of who should determine when your time to die has arrived—especially when you might be incapacitated and unable to speak for yourself.  Should that decision be made by God?  By your doctor?  By your family?  The Bible tells us that only God has the authority to determine every person’s time to die.  When people determine the time of their own death, that is suicide.  When another person establishes the time for your death, that is murder or manslaughter, which is today sometimes euphemistically referred to as euthanasia or “mercy killing.”

Modern Trend Towards Euthanasia

In our modern medical community, as well as in the legal community, the unfortunate trend today is to evaluate a person’s quality of life in order to determine the time for that person’s death.  Life can be untimely ended by denying necessary food and water or medical treatment, or by administering life-ending drugs.  All are methods of euthanasia.  It is important to mention, however, that when a dying patient chooses to decline “heroic” medical treatment, such as aggressive chemotherapy or a breathing or heart/lung machine, or when a dying patient experiences a natural loss of appetite, God’s authority to determine the time of death is still being recognized.  That is not euthanasia.

Refusal of heroic medical care is not euthanasia.  A patient or someone with legal authority to speak for the patient is both legally and morally permitted to make that choice.  The possibility of healing still remains under those circumstances.  If a patient declines a breathing machine or aggressive cancer treatment, God can still intervene to bring about natural or miraculous healing.  Even a gradual loss of appetite, which is sometimes the body’s natural reaction as God’s time for death approaches, is not euthanasia, since patients are not being denied food and water when they desire it or could still benefit from it.  God can still bring about natural or miraculous healing in that circumstance.  On the other hand, when all food and water is denied, or when death-inducing drugs are administered, God is no longer able to intervene to achieve His purposes.

Purpose for End of Life Planning

The important thing to remember is that God has appointed a time for each of us to die. Therefore, we must all seriously think about end of life issues while we are still healthy.  We must discuss our decisions and feelings about death with family members or friends so they will know our end of life wishes in the event that we become unable to speak for ourselves.  It is a great gift for a family or a legally designated friend to be assured they will be able to carry out the wishes of their loved one should that become necessary.  That is the purpose of End of Life planning.

Planning for your future medical needs and treatment in the event that you are unable to speak for yourself is the best way to protect not only yourself, but also your loved ones.  Such planning brings peace and confidence to everyone involved.

Legal Documents for End of Life Planning

Everyoneshould become familiar with the two most important legal documents that provide a means for affecting your medical treatment and care, including end of life care, in the event that you are unable to speak for yourself.  They are a Living Will and/or a Designation of Health Care Surrogate.  Both Living Wills and Designations of Health Care Surrogate documents contain instructions for your end of life wishes and medical treatment in the event you are unable to make health care decisions for yourself.

Living Wills

A Living Will is one type of advance health care directive, not only for end of life treatment, but also for treatment in the event of a temporary loss of ability to speak for yourself after an accident, sickness, disability or other temporary medical event.  Living Wills have increased in popularity over the last few decades; however, in most cases a Living Will encourages patients to forego end of life treatment and sometimes even to authorize their own death at the hands of medical personnel.

The Center for Life does not recommend the use of Living Wills for several reasons:

  1. Living Wills focus on death, not life. Living Wills, which were developed by pro-euthanasia groups, generally give doctors a license to refuse to treat the patient or to take other proactive steps to cause the patient’s death.  When you are unable to speak for yourself about your end-of-life wishes, a Living Will could allow medical personnel to withdraw life-sustaining care you might wish to continue receiving under the circumstances.
  2. Living Wills can be outdated by the time you need them.  Living Wills cannot anticipate advances in medical care that would make a directive to die obsolete. Medical advances are increasing today at a rapid rate. If your Living Will does not reflect these changes, you might be denying yourself treatment that would have a great chance of prolonging your life.  For instance, if you had indicated many years ago in a Living Will that you would not want to be kept alive after a heart attack, you would not have anticipated the almost routine modern heart surgery and even transplants that are now available. It is difficult for anyone to anticipate and determine what care they might want to have in a specific situation years after their Living Will is executed. Keeping a Living Will updated based on ever-improving medical advances is nearly impossible for the average person.
  3. It is difficult for a Living Will to accurately reflect your end of life wishes under every circumstance. There is no way for you to accurately predict ahead of time what your particular medical needs might be in any given situation.  If you have not provided for every option in your Living Will, such as anticipating every advance in medical technology, every change in laws regarding medical treatment, as well as every reason why you might be hospitalized and unable to speak for yourself, you might inadvertently be allowing medical personnel to withdraw life-sustaining care and end your life.
  4. Living Wills do not take into consideration the Will of God and His sole authority to determine the time of your death. Living Wills generally place life and death decisions in the hands of medical professionals, not God.  While many medical professionals are godly people, there is no way for any human being to know the end of every situation.  Only God knows the end from the beginning.  Therefore, only God has the authority to determine when your life will end.

Because of these potential deficiencies in Living Wills, the Center for Life recommends that you consider other means of designating your end of life wishes and who should make medical care decisions for you in the event of your incapacity or inability to speak for yourself. A Designation of Health Care Surrogate document is a good way to accomplish those goals.

Designation of Health Care Surrogate

In the multitude of counselors, there is safety.  Proverbs 11:14

The Center for Life does not recommend that people use Living Wills as a means of expressing their wishes regarding future medical treatment. Instead, NCLL recommends a Health Care Directive that designates a single health care surrogate to make ordinary medical decisions, but designates a “committee” (usually 3 or 5 people), a majority of whom must agree before any measures intended to result in your death may be taken. 

In today’s world, medical technology is constantly advancing and laws regarding end of life care are constantly changing. People will often find themselves in unforeseen circumstances when they are ill or hospitalized or reaching the end of life.  For instance, your state might have a law that favors life at the time you execute a Living Will or sign a Designation of Health Care Surrogate.  However, by the time you actually become incapacitated or unable to speak for yourself in a medical situation, the law in your state may have been changed to favor death or non treatment for certain types of patients.  There is no way to anticipate such changes and you may inadvertently be promoting your own death at the time you sign end of life documents.

The type of Designation of Health Care Surrogate document the Center for Life recommends is a written embodiment of the Biblical concept of safety in a multitude of counselors. A Designation of Health Care Surrogate legal document will allow you to designate either a trusted family member or friend to make ordinary health care decisions for you in the event you cannot make these decisions for yourself, but it will also designate a small group of close family members, friends, or even spiritual advisors, who will make decisions about your medical care in the event that a particular treatment is intended to result in your death.

Circumstances of life can change and a person you once trusted and designated to be your sole health care surrogate may not be trustworthy by the time you will need a surrogate to make your end of life decisions.  Therefore, designating a small group of family, friends or spiritual advisors you know and trust the most to make important decisions regarding your end of life care could be very important. Your Designation of Health Care Surrogate document should provide that any one person in this group, or a majority of the group, is able to veto any medical decision intended to end your life. Finally, your Designation of Health Care Surrogate should indicate a presumption for life in all circumstances.

If Terri Schiavo, for instance, had executed such a Health Care Surrogate document, her husband Michael could not have decided on his own to end her life without the concurrence of two or three other family members or friends.  Had her mother and brother, for instance, been included in a decision making group along with Michael, Terri would likely still be alive today.  As it happened, however, her husband, who she at one time trusted, was the only person with legal authority under Florida state law to make a decision regarding her health care or lack thereof. Unfortunately, a similar situation could happen to anyone.  It is best to prepare for every eventuality.

A second reason to consider a group Designation of Health Care Surrogate, especially for end of life situations, is that it can take some of the burden off a spouse or other lone surrogate designee who might be called upon to make difficult decisions under difficult circumstances.  You should instruct your surrogate group to prayerfully consider God’s will for your life and, along with consultations and the advice of your physicians, your surrogates should collectively make the best decisions for your life in your place.  This group should take into consideration your general wishes, which can be expressed in the document, and all medical advancements and issues that you had no way of knowing about when you initially executed your Designation of Healthcare Surrogate document.

Conclusion

We should glorify God both in life and in death.  Designating a Health Care Surrogate is one way to assure that you will be able to honor God’s authority in your life as well as in the timing of your death, even if you are no longer able to speak for yourself.