When his elderly father suddenly fell ill in 2014, Bill Davis found himself in the hospital making end-of-life decisions with his family. Though he grieved seeing his father’s life ebb away over a matter of days, he did not experience gnawing anxiety that he was making ill-informed choices for his dad’s care. He and his father had discussed his wishes in advance, so Davis was able to honor those wishes when the time came to discontinue the use of his father’s breathing machine.
“I’m extremely thankful I had talked with my dad about what he wanted,” said Davis, professor of philosophy at Covenant College and author of the recently released “Departing in Peace: Biblical Decision-Making at the End of Life.” “Even though he couldn’t speak easily, he made a decision, and his decision was clear.”
Davis empathizes especially with Christians who struggle to make end-of-life choices that honor their faith.
The Complexity of End-of-Life Care
Davis has been studying the issues surrounding end-of-life care for the past 25 years through his volunteer service on several hospital ethics committees. “I initially got involved to find a new way to serve,” said Davis, who has a master’s degree from Westminster Theological Seminary and a Ph.D. in philosophy from the University of Notre Dame. “What can professional philosophers do with their training, besides teach?”
He was struck by the disproportionate amount of end-of-life cases before hospital ethics committees. So many patients neglected to discuss their wishes with family members before they became too incapacitated to make decisions themselves. And sometimes laws were unclear as to who should make decisions for the sick, leaving it up to committees to help families and medical personnel find a way forward.
“If there was a family member confident in what the patient wanted we could proceed,” said Davis. “But if not, we were stuck. While the law says the power to choose goes to the children, it often doesn’t say how. Usually there is more than one child and they may not agree.”
And even those who tried to make plans often found that medical technological advances outpaced their planning, further complicating the process.
Davis empathized especially with Christians who struggled to make end-of-life choices that honored their faith. Some felt that if they were pro-life at the beginning of life they should be pro-life at the end of life too, and should avail themselves of every life-prolonging measure.
“Non-Christian doctors have always been sure that this isn’t the way to think about it — and many were frustrated by Christians,” said Davis.
Using his seminary training and philosophy background, Davis decided to study this fraught topic from a biblical perspective, with the goal of crafting a decision-making framework that would establish clear principles while also being responsive to the recommendations of medical professionals.
Early in the process, he discovered a 1989 PCA study committee report on medical treatment decision-making that provided great insight into the topic. The report determined that using life-sustaining treatment is not biblically required. And patients are not compelled to use life-prolonging treatment that is ineffective, medically burdensome, or creates unnecessary financial hardship.
Further, the report concluded that Christians are biblically forbidden to go into debt for life-sustaining treatment unless it holds forth the possibility that the person will revive and be able to repay the debt.
At first, Davis felt he should simply author an article urging Christians to read the PCA report. But he found that the report’s language was outdated and that the section on biblical justification could benefit by being expanded.
He eventually decided to write “Departing in Peace,” with the goal of providing case studies and outlining key biblical principles to guide decision-making.
The book explains that while the Bible says our lives belong to God, there are some things more important than living as long as possible. Davis cites Stephen in Acts 6 and 7, who could have prolonged his life simply by ceasing to speak. Or Solomon in 1 Kings 3, who pleased God by choosing wisdom rather than long life or victory over his enemies.
Ultimately, Davis says, serving Jesus is our top priority — not pursuing long life at any cost. All the gifts we have, including time, energy, talent, and finances, come from Him and we want to be mindful of serving Him in all these areas, even as we approach the end of our lives.
While he remains firmly opposed to hastening death through medication or taking one’s own life, Davis feels it is appropriate to weigh the costs and benefits of extraordinary measures when we are either permanently unconscious or permanently confused.
Currently, only 6 or 7 percent of people come to the hospital having thought through end-of-life issues. “It would be greatly helpful to doctors and nurses if that number were higher,” Davis says.
“There are noble and good reasons why people are devoted to making life last, like attending a wedding or seeing a grandchild born,” said Davis. “Others say we should use technology to give God time to work a miracle. But God doesn’t need us to buy Him time. An appropriate way of using technology is to determine whether there is a medical likelihood of recovering. It can give physicians time to determine an exact prognosis and to give the family time to adjust to that reality.”
His primary goal is for Christians to gain more confidence that they can say yes or no depending on what would serve Jesus’ interests best.
The Courage to Make a Plan
Currently, only 6 or 7 percent of people come to the hospital having thought through end-of-life issues. “It would be greatly helpful to doctors and nurses if that number were higher,” says Davis.
Unsurprisingly, Davis has found that most people are reluctant to ponder and discuss death and end-of-life issues, except for those who are close to death themselves or have a loved one who is. But he feels much is to be gained from such proactive efforts, especially when done within the context of relationship.
Davis has designed a four-week Sunday school curriculum that introduces these issues, and culminates in participants filling out advance directive forms together and serving as one another’s witnesses.
“I urge everyone to think deeply about these issues in advance, write them down in an advance directive, and explain your decisions to your family so they will be unified,” said Davis. “The best place for this discussion to start is in the context of church education. You can talk with other believers and discuss what you have seen and experienced in your own lives. It helps us to think deeply about it when we discuss our experiences with each other.”
Ultimately, he hopes to guide others toward the same closure and sense of peace that he had after walking through the process of his father’s death. “When doctors said he needed a tube in his lungs and he didn’t want it, I knew his wishes,” said Davis. “I have no regrets about the way things went.”
ILLUSTRATION BY Eleanor Taylor
To obtain a free copy of the “Departing in Peace” four-week Sunday school curriculum, follow the “Leaving Instructions” links at prpbooks.com/book/departing-in-peace.