What Are the Christian’s Obligations as it Relates to Life Support Treatments at the End of Life?

We are all made in the image of God and human life is therefore inherently valuable.  Murder is strictly forbidden in the Bible and suicide falls under this scriptural prohibition.  So, what are the Christian’s obligations at the end of life when terminal illness or plain old age and infirmity comes to claim the life of one who knows that an infinitely better life is in the offing?  Are we obligated to consent to ventilators and other life support treatments to prolong our lives no matter the cost?  Are we to voluntarily participate in every experimental drug trial no matter of how unlikely the benefits may be?  And is the refusal to do so tantamount to suicide? 

More perplexing still are questions surrounding the end of life for loved ones.  If parents or loved ones desire that we not put them on ventilators or other life support treatments are we permitted to abide by those requests knowing that without such life prolonging treatments they will surely die sooner?  Would abiding by such requests be tantamount to assisted suicide or, worse yet, murder?   

The ethical issues at the end of life are perhaps the most difficult to unravel due, in large part, to the fact that they are so emotionally charged.  Rational arguments are difficult to grasp when the debate is so intense and the outcome so personal.  But, it is precisely in this debate where biblical parameters must be established upfront and implemented objectively where decisions are to be driven not by emotions, but by faith.  This is especially true for the family of the one who is passing.  It is true that human beings are persons made in the image of God and intrinsically valuable.  Life is a sacred gift from God and innocent life is never to be taken intentionally and there is a moral and biblical obligation to protect the most vulnerable. 

However, the obligation for the Christian to a terminally ill loved one who is also a Christian and who has opted to die rather than being placed on life support treatments must be understood in their context as those who are looking forward to a city whose builder and maker is God.  Though death entered as a result of sin and was not original to God’s plan (Romans 5:12; 1 Corinthians 15:21-22), death is now a natural part of human life (Ecclesiastes 2:14-16), but it need not be feared or avoided at all costs as death has been defeated and its sting extinguished.  A loved one’s desire within that context must be honored and, though we may grieve, it is imperative that we do not do so as those without hope. 

It is morally acceptable to remove or withhold a ventilator or other life support treatments in the case of terminal illness.  Withholding or withdrawing life support treatments is morally acceptable when competent patients request it in situations where further treatments would be futile and where the burden outweighs the benefits.  If a patient is competent to make the decision then it is their inviolable right to refuse any form of medical treatment that they do not want.  Especially in light of the fact that the treatment contemplated is futile and of no benefit insofar as life support treatments will not reverse an imminent and irreversible downward spiral towards death, nor will these treatments return the individual to an acceptable quality of life.  Moreover, the burden does outweigh the benefit.  Many have seen friends die on life support in hospitals and they have no desire to die the same way.  The psychological burden on loved ones in such a predicament, the financial burden to the family, and the emotional carnage wrought by a prolonged procession into death far outweighs any benefit that life support treatments could possibly render. 

Objections to Removing or Withholding Life Support

Nevertheless, there are a multitude of objections to removing or withholding life support treatments at the end of life and many utilize these objections to deem such actions immoral.  However, none of these arguments are persuasive. 

First, there is the objection that removing or withholding life support treatment is “playing God” and therefore morally unacceptable.  This is not true.  “Playing God” contemplates scenarios where human beings usurp a divine prerogative belonging to God alone.  Being the direct cause of the death of an innocent person made in the image of God is one such example.  However, being the proximate cause of an innocent person’s death by intentionally causing their demise is qualitatively different than allowing a loved one’s terminal illness to take its natural course.  The truth is that all of humanity has a terminal diagnosis and delaying what is appointed unto every man is more akin to “playing God” than is the removal or withholding of life support treatments and entrusting to God the care of the one who is dying. 

Second, people often object that the withdrawal or withholding of a ventilator or other life support treatments violates the sanctity of life.  This is unconvincing.  There is no biblical mandate that requires society to prolong the life of everyone no matter the cost.  The argument that society is so obligated betrays priorities that have become badly skewed towards a temporal existence.  This life is not all there is and desperately gripping an earthly existence signifies a fundamental misunderstanding of the character of the life to come.  Eternity in the presence of God is the ultimate good and allowing a believer to die through the natural course of their disease is not loss, but gain (Philippians 1:21).  An end to this life for loved ones who are believers marks the beginning of another – one wildly beyond imagination.

Third, allowing a terminal illness to take its natural course unhindered does not preclude a miracle contrary to what many believe to be true.  This is perhaps the most difficult aspect for the family of the dying to accept.  Unbearable loss has a way of forcing loved ones to find hope wherever they can.  But, prolonging the life of one who is dying while breathlessly hoping for the miraculous is not biblical for two reasons primarily.  God does not need medical assistance to do the miraculous and the true miracle is in resurrection, not in the delaying of a death that comes to us all. 

Fourth, many object to the removal or withholding of life support treatments at the end of life because of this notion that all suffering has redemptive value.  This is not true.  Suffering for one’s faith (1 Peter 2:20-24) has value and God does call us to suffer in this lifetime.  But, it is an altogether different category of suffering when it is initiated and prolonged by human ingenuity and a refusal to let go.  The one who is dying is suffering and has suffered.  Prolonging that suffering for the palliative benefit of those who desire to avoid the loss of a loved one has no redemptive value. 

Finally, some would object to the removal of the ventilator or other life support treatments as complicity in the death of the dying.  In other words, there is a morally quantifiable and significant difference between withholding life support treatments and removing them once they have begun.  Removing a ventilator or other life support treatments, as the argument goes, is tantamount to killing a loved one.  This argument is not persuasive.  Removing a ventilator or other life support treatments in a situation where a loved one is terminally ill is not the equivalent of killing that person nor would such a removal make anyone complicit in their death.  There is no significant moral difference between withdrawing life support treatments and withholding them because of the lack of an intent to kill that is common to both.  Intentionally causing the death of an innocent person is morally unacceptable.  The removal or withholding of life support treatments does not intentionally cause the death of an innocent person.  The proximate cause of the death of a loved one in this scenario is the underlying illness which is being allowed to take its natural course unhindered.  In fact, for the loved ones who have to make this unbearable decision to remove life support treatments, the last thing they want or intend is for their loved one to die.  And there is a massive difference between intending death and foreseeing it with acceptance and it is this difference that is dispositive. 

What about Feeding Tubes?

If a dying loved one requests to not have a feeding tube inserted for their nutrition and hydration should they lose the ability to swallow, should we abide by such a request?  Yes, so long as they are competent to make that decision.  There is no difference between a feeding tube and a ventilator or other life support treatment.  Feeding tubes at the end of life are medical treatments where technology is performing an essential function the body is no longer able to.  And as a medical treatment the patient has every right to refuse it.  People often categorize feeding tubes and ventilators separately as if feeding tubes provide more basic care and are more closely aligned to patient comfort and dignity.  This compartmentalization is unconvincing. 

First, aid in breathing is arguably the most basic care that can be given to a patient and therefore categorizing nutrition and hydration as more basic or fundamental to human life than breathing is unpersuasive and frankly confusing. 

Second, nutrition and hydration are not the most fundamental aspects of patient comfort and dignity.  A patient’s dignity is best protected when their right to refuse medical treatment is acknowledged and honored.  Additionally, a patient’s comfort goes beyond nutrition and hydration and a holistic perspective on comfort must go beyond the merely physical.  Patient comfort must consider the psychological toll that unwanted medical treatment exacts and any physical discomfort from honoring the wishes of the dying can be alleviated with medical intervention in terms of palliative care. 

Additionally, the removal of feeding tubes is not the same as starving someone to death.  Again, the removal of feeding tubes is not the direct cause of the death of an innocent and vulnerable person.  The disease or underlying condition is the proximate cause of death.  Acceding to the wishes of the dying and allowing a terminal illness to take its natural course is not complicity in the death of a loved one because the removal of the feeding tube is neither the cause of the death nor its intention. 

In his book Being Mortal, Atul Gawande wrote about various patients at the end of life, including his own father, and the choices they made regarding their medical care.  Some chose hospice care while others chose experimental treatments or other invasive and harmful procedures in the hopes of exchanging quality of life for quantity.  It is natural to fear death as it is the unknown and it is human to want to prolong life.  But, what the book laid bare is the fact that fearing death and prolonging life no matter the cost are two entirely different things and those who readily exchange quality for quantity betray perhaps a fundamental misapprehension of what this life is and what death represents. 

Death for the Christian is merely a threshold to something infinitely greater and yet, sadly, this grotesque fear of death has infected some even in the church.  The old adage is true: Everybody wants to go to heaven, but nobody wants to die.  And so what seems to motivate much of the debate on the ethical issues at the end of life with regard to withholding or removing life support treatment is this unremitting fear that has caused many, if not most, to value death as something that is no longer provisional, but permanent.  Consequently, society’s prevailing opinion on death seems to be that it is irredeemably horrific, to be avoided at all costs, and acceptance of it a nonstarter.  Maybe.  But, only if God has nothing to do with it and only if this life is all there is.