Our Father, who art in heaven, hallowed be Thy name. Thy kingdom come, Thy will be done, on earth as it is in heaven.
Matthew 6:9-10
This reflection will be one of the trickier ones to write because there isn’t an exact, correct answer for every person and every situation. This reflection focuses on the decision to fight for life or to stop treatment. We’ve already discussed why it is important to fight for life, and why it is necessary to surrender. The challenge is how long to fight and when to surrender. The other challenge is the temptation to put our will in front of God’s will as concerns the end of life. Do we allow the talents of doctors that have been called by God to be His vessels to fight to extend life? On the other hand, if all signs point to God calling someone “home”, at what point do we discontinue treatment? There are no easy answers. The purpose of this reflection is just to give some ideas.
Very early on in my priesthood, I was visiting a parishioner in the hospital, when a nurse came bursting in the room I was in and told me that they needed a priest in the next room “for the last rites,” because someone was “coding.” After telling her I was not Catholic and we don’t have last rites (see future reflection with comments on that), she said there was no time and that I should come and do something. Upon entering the room, I saw an elderly man (I was later told that he was 84) having a defibrillator used on him to try to revive him after his heart stopped beating. I’m not a doctor, but my understanding of a defibrillator is that it can be used every couple of minutes for a period of time, after which, if it has failed to restart the heart, then a person is declared dead. There was a man in the room, who I was later told was the elderly man’s son. Every two minutes or so, the medical personnel asked him if they should administer another shock, if he wanted them to keep trying. He would say “yes” each time. Each shock would cause the man to elevate off the bed. The sheets had fallen off of him. There were several tubes coming out of various parts of his body. Each shock looked very painful. I remember thinking “just let him go” after the third shock. But the man insisted they keep trying, until after about five or six shocks, they told him that the window for reviving the man had closed and he had passed away. The son nodded his head, each medical person took a tube out of the man’s body and then they left the room. (This was in 1999, so some medical practices no doubt have changed since then). I remember thinking as he was literally saying “hit him again,” “are you out of your mind, letting them do this repeatedly to your father?” And when it was finally over, I remember thinking “are you happy now?” and “there has to be a better way than this.”
As I have already mentioned, I am a big proponent of parents telling their children their wishes, specifically regarding do not resuscitate orders (DNR) and making very clear which measures they are comfortable with and which ones they are not. I have watched people in their 80s who have a feeding tube, a trach tube for breathing, a catheter in order to void, and dialysis in order to clean toxins from the blood. Literally, everything is being done artificially to support life. I don’t think I would want any of these things, not in my 80s. If I was in a car wreck in my 50s and some of these things were needed as temporary measures to let an otherwise healthy body recover, that would be fine. If they are needed to keep an otherwise unhealthy body going, I would not want that. Realize I said “I would not want that,” there are other people who would. It is important for us to ask our parents what they want, and it is important for parents to tell their family what they want, and for those of us who are getting older and have children, it is important to tell them what we want.
One word I have learned over my years of ministering to people in very serious condition is “recoverability.” People who have been in a car accident, or who have had a serious heart attack or stroke, may not recover and be the same people they were before. How much will they recover? This plays a role, I believe, in how much critical support they are given. Again, speaking for myself only, if I had a serious accident or medical episode and had only a small chance to recover, I would hope to just be “let go.” On the other hand, if there was a great chance to recover, I would want to try any means to recover. The question then becomes what to do if one can only recover 40 percent, or 20 percent, what to do then? I’m not giving an answer here, these are things to be discussed with doctors and with family members, but they should be discussed, and in most cases, people do not want to have these discussions.
Regarding life support, it is often a very difficult decision on whether to stop life support, because a family member might think they are killing someone, even if they have no recoverability. It is important to talk specifically about this, because if there is no clear decision, medical personnel will do everything including putting someone on life support, unless they are told not to. In my experience, there is one specific time when support should be discontinued and this is when brain functioning has ceased, in other words when someone has been declared “brain dead.” A scan can tell how much, if any, brain functioning there is.
In the Orthodox Church, we believe that the human body is composed of body, mind and spirit (soul) and the spirit is tied to the mind, because we are “rational” people. We believe that the soul is present in the body from the moment of conception, until the time that the soul departs the body, which coincides with the death of the mind. Sometimes body and mind stop working at the same time. Sometimes the mind stops working but “life support” keeps the body breathing artificially. We believe that the soul leaves with the mind, since once the mind has gone, there is no ability to believe, comprehend, repent or do any of the things we do as Christians. It is possible for a person to be “brain dead” but with life support, the chest still rises and falls, and people think the person is still “alive” because they look alive. Once brain function ceases, it does not come back. Thus, once brain function ceases, the preferable course of action is to remove support and let the body stop. This usually happens quickly, because the brain has stopped working and with it, the rest of the body functions cease. Again, the challenge is what to do if there is limited brain function, and this is where a discussion on recoverability needs to happen with doctors, where the family needs to have discernment through prayer, and also the understanding that life will end for everyone at some point.
A popular country song from my youth had the lyrics “You gotta know when to hold ‘em, know when to fold ‘em.” (‘The Gambler” by Kenny Rogers) And even though this song talked about gambling and life is certainly not a game, there oftentimes comes a critical moment as relates to the end of life when it’s time to fight and a moment when it is time to stop, and many times it is hard to know what to do.
Thy word is a lamp to my feet and a light to my path. I have sworn an oath and confirmed it, to observe Thy righteous ordinances. I am sorely afflicted; give me life, O Lord, according to Thy word! Accept my offerings of praise, O Lord, and teach me Thy ordinances. I hold my life in my hand continually, but I do not forget Thy law. The wicked have laid a snare for me, but I do not stray from Thy precepts. Thy testimonies are my heritage forever; yea, they are the joy of my heart. I incline my heart to perform Thy statutes forever, to the end. Psalm 119:105-112
It is important to talk about and write down wishes for end of life and level of care that we want. It is important to understand recoverability. And it is important to discern where the line is for “fighting” for life to continue and for when it is time to let a person go to God.
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