For weeks, the pastor began the service with an update about a gravely ill congregation member and a prayer that the Lord would restore the man to full health. I didn’t know the man, but I knew he meant a lot to the congregation, and I knew the doctors and the family were doing all they could to keep him alive.
Then, one Sunday morning, the pastor began by saying something unexpected. “Isn’t it funny how our prayers for a loved one sometimes change?” he said, his voice cracking. “What starts as ‘Lord, heal him!’ turns into ‘Lord, please take him home.’ It’s time to pray that prayer.”
In 2009, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives. That’s more than the Department of Homeland Security budget. Twenty to 30 percent of these medical expenses may have had no meaningful impact.
– CBS News, Aug. 8, 2010
There is wisdom in this, in knowing when to change the pleadings of the heart, when to let go, when to say goodbye. But it’s hard to do, and not just because we want to hold on, perhaps selfishly, to someone we love. It’s hard because science and medicine — to their credit — make it hard. Every day, the best and brightest among us use their God-given talents to hold back what Paul called “the last enemy,” death. Their default bias for life is good. Often it gives life a chance — a chance simply to be born, a chance to survive some horrible accident, a chance to beat cancer or heart disease, a chance at a second chance.
But there are times when the struggle against our last enemy merely — and painfully — delays the inevitable. At those times when our prayers change from “heal him” to “take him,” what does God want us to do?
Shouting at Death
Those who have prayed those schizophrenic heal-him-take-him prayers are in good company. David did the same thing. At first, he fought to keep his dying baby boy alive. Hoping the Lord would be “gracious … and let the child live,” David “pleaded with God for the child,” [he] spent the nights lying in sackcloth on the ground, and [he] fasted and wept (see 2 Samuel 12).
But when God’s answer became clear, David let go. “He will not return to me,” the broken king grimly said of his son. Yet David believed in the resurrection, holding out hope that one day, “I will go to him.” One day, David would be reunited with his boy.
Jesus, too, dealt with death during His life on earth. In fact, death was all around Jesus, stalking Him, mocking Him, lunging at Him.
A 2010 Study in the Journal of Palliative Medicine found that only 15 to 22 percent of seriously ill elderly patients had their preferences in their medical records.
It pays to recall that Jesus was under a death sentence from the moment He was born. Herod’s mad death decree erased uncounted baby boys in and around the town of Bethlehem. But Herod’s henchmen were not finished; they murdered John, the one who officially introduced the world to its Savior. Later, Jesus had firsthand brushes with death in Nazareth, when a mob tried to throw Him off a cliff, and in Jerusalem, when religious leaders tried to stone Him (see Luke 4:29, John 5:18, John 8:59).
Moreover, when Jesus unleashed His healing power, the sick and suffering and dying flocked to Him. Before long, as a sign — a proof — of His authority over death, He was raising the dead back to life.
Let’s look at three of these resurrection miracles.
“My daughter has just died,” Jairus lamented to Jesus. “But come and put your hand on her and she will live” (Matthew 9:18). When Jesus arrived at the girl’s deathbed, He held her hand and shouted across the great chasm separating this life from the next: “Little girl, wake up!” The response came immediately, and “the girl stood up and began to walk around.”
On another occasion, Jesus watched as a funeral procession made its way through town. “A dead person was being carried out — the only son of his mother; a widow,” Luke’s account tells us. In other words, death had left the woman all alone. “When the Lord saw her,” Luke writes, “his heart went out to her.” He told her, “Don’t cry.” And then, touching the casket, He declared, “Young man, I say to you, get up!”
Notice again the use of an exclamation point. Jesus is issuing an order. He’s shouting at death. It’s as if He is angry at death, contemptuous of it. As with Jairus’ daughter, death obeyed, and life flooded in.
Finally, there’s the story of Lazarus. John tells us he was gravely ill. As his condition worsened, Mary and Martha (sisters of Lazarus) turned to Jesus for help, sending word that Lazarus was dying. The problem was, Jesus was in another city and wouldn’t return for another four days.
By the time Jesus arrived on Bethany’s outskirts, Lazarus was dead and buried.
The Limits of Life
Not long ago, Dr. Ken Murray let the world in on a little secret. Most physicians “make sure that, when the time comes, no heroic measures are taken” to extend their life. The reason: They understand “the limits of modern medicine,” Murray explained in a Wall Street Journal essay. “They know exactly what is going to happen” at the end of life.
Hence, almost two-thirds of doctors have “an advance directive specifying what steps should and should not be taken to save their lives should they become incapacitated.” Only 20 percent of the general population has such a document on file.
“It is an enormous blessing for the person dying to have left an advance directive concerning end-of-life care,” says Covenant College professor Bill Davis, Ph.D., who teaches bioethics and advises hospital ethics panels. Davis emphasizes the importance of “clearly identifying an ‘agent,’ a person empowered to speak for the one dying when medical decisions are needed” and “talking through” end-of-life situations with the agent.
“My own advance directive,” Davis explains, “instructs my wife to decline medical treatment that will extend my earthly life unless it will maintain or restore my ability to receive the Word of God (read or preached), to pray, and to partake in the Lord’s Supper.”
Dr. Carolyn McClanahan encourages people to “plan to die like a doctor.” The first step is “a change in how life and death are viewed” — an “understanding that we all get sick and die.” When a person grasps that, she argues, “death isn’t so scary.”
The next step, according to McClanahan, is to prepare your loved ones financially and emotionally long before you’re on your deathbed. “Good financial planning gives people great peace in end-of-life situations,” she explains.
“When everyone is healthy,” she adds, “talk about how you want to be taken care of, what type of funeral you want, and how you want people to celebrate your life.
“If you had been here,” Martha said, after racing to meet her Savior, “my brother wouldn’t have died.” Her next sentence underscores that her words weren’t meant to wound Jesus, but rather to acknowledge His authority and power. “I know that even now God will give you whatever you ask,” she cried.
Jesus was “deeply moved” by Mary’s and Martha’s sadness, this time to the point of weeping. Through His own tears, He made Martha a promise: “Your brother will rise again.” He prayed to the Father, turned toward the grave and with “a loud voice” — there it is again, an exclamation point falling like a hammer onto death — shouted, “Lazarus, come out!” And the dead man, now alive, walked out of the tomb.
These miracles demonstrate that death has no power over the Author of Life. Jesus, straddling the expanse of eternity, could see beyond the little girl’s deathbed, beyond the widow’s heartache, beyond her son’s casket, beyond Lazarus’ grave and Martha’s tears, to a place where all of them were fully and truly alive.
They demonstrate something else, something more subtle. Notice what Jesus didn’t do: Though He raised the widow’s son, He didn’t raise her husband. He promised that Lazarus’ sickness would not end in death, and He awakened Jairus’ daughter from “sleeping.” But He didn’t promise either that they wouldn’t taste death again. Similarly, He didn’t stay death’s hand at Bethlehem or Golgotha.
By pulling back the curtain on eternity — for a moment — Jesus wasn’t saying to Jairus, Mary, the widow, or to us that this life is so important that we should cling to it or prolong it indefinitely. Quite the opposite, He was saying that this life is a shadow of what’s to come, “a mist that appears for a little while and then vanishes,” (James 4) that death is not an end but a beginning, that believing in Him is the key to real life, eternal life.
This isn’t hard for followers of Christ to embrace. “For we know that if the earthly tent we live in is destroyed,” as Paul explained, “we have a building from God, an eternal house in heaven, not built by human hands” (2 Corinthians 5). Ponder that imagery. Paul was a tentmaker; he knew the difference between a tent and a house. One is temporary, rudimentary, weak, and can barely stand up to the elements. The other is permanent, strong and sturdy and safe, complete, a refuge. One represents the essence of being away from home; the other is home.
This earthly tent is perishable, decaying, and can be downright ugly. But one day it will be transformed; it will become eternal and glorious and beautiful (1 Corinthians 15).
Wisdom: Consulting With Doctors and Pastors
A few important caveats are in order as we wrestle with the life-and-death issues we face today.
First, there are times for heroic measures, times to struggle against our last enemy. Doctors and pastors can guide us through this murky territory. In this regard, it pays to recall that Paul, the Spirit-filled evangelist, and Luke, the physician-turned-follower of Jesus, worked together and healed together.
“I don’t think there is a rule or formula that covers making these choices,” says professor Bill Davis, who teaches bioethics at Covenant College and has served on hospital ethics panels. “As with many choices requiring wisdom, the most important thing we can do is obey James 1 and pray that the Lord will give us wisdom,” he explains. But Davis is quick to add, “It is impossible not to rely heavily upon the physicians’ recommendations. Only the medical personnel, and especially the doctors, can speak confidently about the medical likelihoods regarding benefits and burdens” of a particular course of care.
I remember how my father leaned on pastors and doctors in the last weeks of his father’s life. My grandfather had been preparing to leave the hospital when he lost his balance and fell after treatment for a series of mini-strokes. He seemed fine at first; it was just a bump, he thought. But it quickly became clear that this was more serious. A CAT scan revealed a hemorrhage on his brain.
In the span of just a few minutes, my grandfather had gone from packing his bags for home to emergency brain surgery. There was no debate whether or not to operate; the man was healthy, and the doctors rushed to save him.
After the surgery, the doctors allowed us to see him. We couldn’t touch him, so we prayed over him — that the Lord would restore his health. What Jesus did for Mary and Martha, He did for us. At first, my grandfather just smiled and used sign language to communicate. (He had two sons who were deaf, so it came in handy.) A few days later, the bandages came off, his eyes opened, and he talked. He was sharp. He hugged and laughed and cried. He and I watched the NCAA basketball tournament together in his hospital room. He was the grandfather I’d always known.
But his body was weakened by the trauma, the surgery, and the hospital stay itself. Slowly, it began to shut down. It was then we began to pray “Lord, take him home.” And Jesus answered.
Through it all, from the extraordinary measures taken after his fall to the difficult decision to authorize a “do not resuscitate” order, my grandmother, my father, and my uncles consulted with doctors and pastors, and did what was right for this man they loved.
Time to Say Goodbye
That brings us to a second end-of-life caveat: It’s not cold or uncaring for doctors to tell a family, “It’s time to say goodbye.” And it’s not selfish or unfeeling for a family to allow its loved one to pass from this life to the next. A “do not resuscitate” order is not a death sentence. Resuscitate, after all, means “to revive from death.”
As Davis puts it, “Declining treatment that might forestall a disease or dysfunction that is killing someone, is not causing death.” However, there is a bright line between allowing life to end naturally and “mercy killing.” We’re not to hasten someone’s death without cause — that is murder. We don’t decide that someone is unfit to live — that is euthanasia. We don’t allow others to bring about their own deaths — that is suicide. But we must recognize that “There is an appointed time for everything,” as Solomon explained in one of the Bible’s most beautiful passages. There’s a time to be born and to live, and there’s “a time to die” (Ecclesiastes 3).
“The Christian pursuit of holiness,” as Tristram Engelhardt Jr., a physician and Rice University professor of philosophy, and Ana Iltis, a Wake Forest University bioethics professor, conclude, “prohibits using medicine in an all-consuming pursuit of health and postponement of death; the attempt to save life at all costs is thus forbidden.”
“The Bible does not value extending our earthly life over every other consideration,” Davis adds, pointing to the example of Stephen and other martyrs, who are “praised for choosing a shorter earthly life that included testifying to Christ’s Lordship over a longer earthly life without that spiritual good.”
Those of us who believe in the sanctity of life often quote from Psalm 139 to make our case: “You knit me together in my mother’s womb,” David gasped. “Your eyes saw my unformed body.” But we sometimes overlook another passage from this life song: “All the days ordained for me were written in your book before one of them came to be.” In other words, we are allotted a finite number of those days. The days in this world, in these temporary bodies, in these “tents,” come to an end.
Making Decisions that are Humane, Honoring, and Humble
A third caveat: Our actions and decisions in end-of-life situations should be humane, honoring, and humble.
Engelhardt and Iltis note that a great deal of controversy exists, even within the Christian community, “about the appropriateness of withdrawing artificial hydration and nutrition at the end of life and for people in a persistent vegetative state.”
An injunction from Proverbs 3 may quiet the controversy: “Do not withhold good from those who deserve it, when it’s in your power to help them.” To deprive a human of water and food — no matter his or her state — is to hasten death. It pays to recall that even on the cross, Jesus was offered a drink, and by his executioners no less.
End-of-life decisions should honor the dying person’s wishes, so long as they are in line with Scripture. “The family may not be emotionally ready to say ‘goodbye,’ and yet if the one dying would not choose the longer life of pain, distress, or spiritual deprivation, the family should honor what the patient would want,” Davis advises.
More importantly, end-of-life decisions should honor the Author of Life. Genesis tells us that God created man in His image and blessed humanity with a part of Himself — “the breath of life.” By taking on this temporary tent and entering into our humanness, God made an unequivocal statement about the sacredness of human life. To dishonor or degrade human life at any stage is to dishonor and degrade the Author of Life.
If we don’t approach life and death with a humble attitude, they will certainly humble us. We cannot defeat this last enemy — no matter how many vitamins we take, miles we run, Big Macs we avoid, medicines we ingest, surgeries we have — but Christ can. Indeed, Christ already has. “I am the resurrection and the life,” He promises. “The one who believes in me will live, even though they die” (John 11).
That promise should give us the peace to recognize those moments when the struggle against our last enemy doesn’t really extend life, but instead only delays it.
Alan Dowd, a writer and researcher in Fishers, Ind.