Living with Dying

1
Living with Dying

• Theological and Practical Aspects of End-of-Life
  Issues

2
Hittites
3
Introduction

• I am leaving the land of the living and will
  soon be with the dying.

I am leaving the land of the dying and will soon
be with the living.
4
Theological Aspects of Living with Dying

• A. The God-given Value of Human Life

What is man that you are mindful of him, the son
of man that you care for him? (Ps. 84)
You made him a little lower than the heavenly
beings and crowned him with glory and honor.
(Ps. 85)
Just a bit of slime on the planet. Peter
Otkins, Oxford
A curious accident in a backwater. Bertrand
Russell
A fortuitous cosmic after thought, a tiny little
twig on the enormously obsolescent bush of
life. Stephen Jay Could (Harvard)
5
Theological Aspects of Living with Dying

• A. The God-given Value of Human Life

6
Theological Aspects of Living with Dying

• A. The God-given Value of Human Life

There are no gods, no purposes, no goal-directed
forces of any kind. There is no life after
death. When I die, I am absolutely certain I
will be dead. Thats the end of me. There is no
ultimate foundation for ethics, no ultimate
meaning to life. William B. Provine, Cornell
University
7
Theological Aspects of Living with Dying

• B. The Christian View of Death

The death of a man is, however, an infinite and
eternal misery and wrath.
We should be happy to die and desire death.
Death is only the narrow gate and the small way
to life.
8
Theological Aspects of Living with Dying

• 1. Death as Law

We are consumed by your anger and terrified by
your indignation. You have set our iniquities
before you, our secret sins in the light of your
presence. All our days pass away under your
wrath we finish our years with a moan. (Ps.
907-9)
9
Theological Aspects of Living with Dying

• 1. Death as Law

Our death is a more terrible thing than all
death not only of other living beings, but also
than the troubles and death of other men. What
of it when Epicurus dies? He not only does not
know that there is a God, but even fails to
understand his own misery and recognize the
disaster which he is experiencing. Christians,
however, and God-fearing men know that their
death, together with all the other miseries of
this life, is to be equated with Gods wrath.
(Martin Luther LW, 13, 112)
10
Theological Aspects of Living with Dying

• 1. Death as Law

LIFE!

• Faced with difficulties, majority of older adults
  60-100

LIFE!

• Kidney dialysis

LIFE!

• AIDS

• Quadriplegia

LIFE!
11
Theological Aspects of Living with Dying

• 2. Death as Gospel

Where, O death is your victory? Where, O death,
is your sting? The sting of death is sin, and
the power of sin is the law. But thanks be to
God! He gives us the victory through our Lord
Jesus Christ. (1 Corinthians 1555-57)
In the midst of life, we are in death. In the
midst of death, we are in life. (Luther LW
13,83)
12
Theological Issues of Advance Directives

• I am torn between the two I desire to depart
  and be with Christ, which is better by far but
  it is more necessary for you that I remain in the
  body.
• (Philippians 123-24)

13
Theological Aspects of Living with Dying

• C. The Theology of the Cross

God shows that He is God precisely in the fact
that He is mighty in weakness, glorious in
lowliness, living and life-giving in death.
(Paul Althaus. Theology of Martin Luther p. 34)
The well organized campaign for legalized
euthanasia cruelly exploits the fear of suffering
and the frustration felt when we cannot restore
to health those whom we love. Such fear and
frustration is genuine and deeply felt,
especially with respect to the aging. But to
deal with suffering by eliminating those who
suffer is an evasion of moral duty and a great
wrong. (Always to Care, Never to Kill)
14

• Gods love is at work even in our suffering.

Paul said I rejoice in my _____________
Paul said I rejoice in my sufferings.
Luther said ___________ is the best book in
my library.
Luther said Affliction is the best book in my
library.
C.H. Spurgeon said I venture to say that the
greatest earthly blessing that God can give to
any of us is health,
C.H. Spurgeon said I venture to say that the
greatest earthly blessing that God can give to
any of us is health,with the exception of
sickness.
15
Practical Aspects of Living with Dying
Educate
About the Value of Life  
16
Practical Aspects of Living with Dying
Educate
About the Theology of the Cross
About Pain Control
About the Right to Die Movement
17
Practical Aspects of Living with Dying
A Look at the Past
The Euthanasia Society of America (1938) hoped
to eventually legalize the putting to death of
non-volunteers beyond the help of medical
science.
Original Intent of the Movement
It started with the acceptance of the attitude,
basic in the euthanasia movement, that there is
such a thing as a life not worthy of life. (Dr.
Leo Alexander, Psychiatrist and Chief American
Counsel at the Nurmberg Tribunal)
Nazi Germany
18
Verbal Engineering Verbal engineering must
precede social engineering. (Rita Marker)
Americans against Human Suffering
Death with Dignity
Aid in Dying
Compassion in Dying
Compassionate Relief of Suffering
Assisted Suicide Act
Death with Dignity Act
Compassion and Choices
Hemlock Society
19
Practical Aspects of Living with Dying
Educate
About the Theology of the Cross
About Pain Control
About Right to Kill Movement
About Advance Directives
20
Be Careful of What You Say!
Jfakjdlfkjeijijflkdjlkajdlkjdaklsdjflkasjdkljsdl
kjfalsdkjlskjdfksjdlkasjdlkjaslkfjalskdjlaskdjlask
jflkajsdlkjldkfjaslkdjlaskjflksdjflskdjsakfdlasjdf
laskjdflskjdlasjflkjsdljasldfjalsfjlskjflasjdflsjd
lfjsdlkjslkfjlaksdjflaksjflkasjdlkjslfkjaslkdfjlsk
jflaksjdflkasjflaksjflksjlaksjdflaskjdflaksjlksjlk
asjlkjasldkfjlaskjdflaksdjlksjlfkajsdlfkjakslkdfjl
asdkjflaskdjflaskjflaskjflaskjflaskjflkasjflkajslf
kajslfkjasldkfjalskfjlaskdjflaksjdlaksjflaksjflkas
jflaksjflkajlkajflaksdjflaksjflaksjdflaksjdlksdjfl
ksjflkasjflkasjflkjslfkasjlf
21
Advance Directive
An instrument in writing whereby the person
signing the instrument, the principal, provided
direction in the document for future health care
decisions should that person become unable to
make their own health care decisions. Blacks Law
Dictionary Sixth Edition
22
Living Will
A document which governs the withholding
or withdrawal of life-sustaining treatment from
an individual in the event of an incurable or
irreversible condition that will cause death
within a relatively short time, and when such
person is no longer able to make decisions
regarding his or her medical treatment. Living
wills are permitted by statute in most
states. Blacks Law Dictionary Sixth Edition
23
Health Care Power of Attorney
An instrument in writing whereby one person, as
principal, appoints another as his agent and
confers authority to perform certain specified
acts or kinds of acts on behalf of the
principal regarding his health care only. Blacks
Law Dictionary Sixth Edition
24
Living Wills
Living Wills are deceptively namedthey have
little to do with living and everything to do
with dying. It is not wise to sign a document
which specifies conditions under which one would
rather be dead. (Mary Senader, Human Life
Alliance)
If we can get people to accept the removal of
all treatment and care, especially the removal of
food and fluids, they will see what a painful way
this is to die, and then, in the patients best
interest, they will accept the lethal injection.
(Dr. Helga Kuhse at a world conference of Right
to Die Societies)
25
Living Wills Example 1

• If I should have an incurable or irreversible
  condition that will cause my death in a
  relatively short time

arthritis
mental illness
days, weeks, months, or years
26
Living Wills Example 2

• I direct my attending physician

whoever happens to be near
Removes medical decisions from your family
27
Living Wills Example 3

• Withhold or withdraw medical treatment that only
  prolongs the dying process

food and fluids
28

• South Dakota Living Will
• LIVING WILL DECLARATION
• TO MY FAMILY, PHYSICIANS, AND ALL THOSE CONCERNED
  WITH MY CARE
• I, _________, willfully and voluntarily make this
  declaration as a directive to be followed if I am
  in a terminal condition and become unable to
  participate in decisions regarding my medical
  care.

29

• With respect to any life-sustaining treatment, I
  direct the following
• (Initial only one of the following optional
  directives if you agree. If you do not agree with
  any of the following directives, space is
  provided below for you to write your own
  directives).

30

• NO LIFE-SUSTAINING TREATMENT. I direct that no
  life-sustaining treatment be provided. If
  life-sustaining treatment is begun, terminate it.
  
• TREATMENT FOR RESTORATION. Provide life-
  sustaining treatment only if and for so long as
  you believe treatment offers a reasonable
  possibility of restoring to me the ability to
  think and act for myself.

31

• TREAT UNLESS PERMANENTLY UNCONSCIOUS. If you
  believe that I am permanently unconscious and are
  satisfied that this condition is irreversible,
  then do not provide me with life-sustaining
  treatment, and if life-sustaining treatment is
  being provided to me, terminate it. If and so
  long as you believe that treatment has a
  reasonable possibility of restoring consciousness
  to me, then provide life-sustaining treatment.

32

• MAXIMUM TREATMENT. Preserve my life as long as
  possible, but do not provide treatment that is
  not in accordance with accepted medical standards
  as then in effect.

33

• With respect to artificial nutrition and
  hydration, I wish to make clear that
• (Initial only one)
• _________ I intend to include this treatment
  among the "life-sustaining treatment" that may be
  withheld or withdrawn.
• _________ I do not intend to include this
  treatment among the "life-sustaining treatment"
  that may be withheld or withdrawn.

34

• (If you do not agree with any of the printed
  directives and want to write your own, or if you
  want to write directives in addition to the
  printed provisions, or if you want to express
  some of your other thoughts, you can do so here.)
  

35
What If I Have a Living Will?

• Do you know what it says?
• Contact your attorney
• They are revocable
• Start over

36
Health Care Power of Attorney

• Designate someone you trust
• More than one person
• Share values about the sanctity of life
• Discuss your wishes
• Do not be too specific

37
Refusing Medical Treatment

• Right to refuse treatment
• Does not sustain life,
• but prolongs the dying process
• Discuss if treatment is a burden
• Right to die patient is a burden

38
Once we have transgressed and blurred the line
between killing and allowing to die, it will be
exceedingly difficult in logic, law, and
practiceto limit the license to kill. Once the
judgment is not about the worth of
specific treatments but about the worth of
specific lives, our nursing homes and other
institutions will present us with countless
candidates for elimination who would be better
off dead. Always to Care, Never to Kill A
Declaration on Euthanasia by the Ramsey
Colloquium as published in First Things February
199245-47
Terri Schiavo
39
Dr. Gilbert Meilaender member of the
Presidents Council on Bioethics and Professor of
ethics at Valparaiso University.

• If she is a living human being, albeit a
  severely disabled one, then our responsibility
  was to ask what we can do to benefit the life she
  had. Its not within the scope of our authority
  to ask whether its a benefit to have her life.

We can and should allow the dying to die.
We must never intend for the death of the
living.
Terri Schiavo was not dying. Removing her
feeding tube did not allow her to die. It caused
her to die.
40
Focus on the treatment

• Is it useless?

• Is it excessively burdensome?

Focus on the person

• Is he/she useless?

Is he/she dying?

• Is he/she burdensome?

41
The Slippery Slope
Right to refuse treatment
Right to die
Right to assisted death (physician-assisted
suicide)
Duty to die
Euthanasia (Right to kill)
42
A Glimpse of the Future
The Netherlands has moved from assisted suicide
to euthanasia, from euthanasia for people who are
terminally ill to euthanasia for those who are
chronically ill, from euthanasia for physical
illness to euthanasia for psychological distress,
and from voluntary euthanasia to involuntary
euthanasia (called termination of the patient
without explicit request.) There is no way to
stop the slide once a society steps onto the
slippery slope by legalizing physician-assisted
suicide. (Dr. Herbert Hendin, 1996 report to
Judiciary Committee of House)
43
Practical Aspects of Living with Dying
Caring for and about
I have participated in the intensely human drama
that surrounds dying. Ive witnessed the
difficulties, Ive smelled the odors, Ive seen
the unpleasant liquids which assisted suicide
advocates claim make life at the end inherently
undignified, horrific, and hence worthy of a
death sentence. Yet, such conditions need not
diminish the inherent value of human life. Dying
people remain people, and when properly treated,
they usually transcend the limitations of their
physical conditionsespecially if they know they
are cared for and about. (Hospice Worker)
44
Concluding Parable

• There was an old woman
• who lived in the woods.

45
Great Theology Makes Great Practical Care

• We know the root cause of pain and suffering.
• We know the cure for that root cause.
• We know that pain and suffering will be part of
  this life.
• We know about Gods presence in suffering.
• We know where we are going.

46
Questions
? ? ? ? ?
47
Recommend Resources

• Protective Medical Decisions Document
• International Task Force
• on Assisted Suicide and Euthanasia
• Will to Live
• National Right to Life Committee
• Durable Power of Attorney
• Christian Version
• Christian Life Resources

48
Basics on Advance Directives
Brochures from LFL
49
Brochures from LFL

• Gods Love in Human Suffering
• Euthanasia and the Christian
• A Guide for Christians
• in Ethical Decision-Making at
• the End of Life

50
Brochures from LFL

• Gods Love in Human Suffering
• Euthanasia and the Christian
• A Guide for Christians
• in Ethical Decision-Making at
• the End of Life
• The Right to Die
• Rhetoric, Reality, Response

51
Before I Die