A writer looks at biblical principles to plan her end-of-life care if and when she loses her mental capacity, and discovers why this should matter to us as believers in Christ.
Eliza Tan
I may be in my early forties, but I’ve already registered my
This means that if I ever lose my mental capacity, my brother, whom I’ve appointed as my proxy decision-maker, can act on my behalf. He can do so in the two broad areas of personal welfare, as well as property and affairs matters.
Perhaps the decision-making woes that my family faced while caring for my mother with Alzheimer’s disease ignited the thought to sort out my affairs. And I guess hearing horror stories of families unable to tap the finances of their incapacitated breadwinners fuelled the desire to avoid a similar predicament.
The government’s waiver of LPA application fees till March 2026, and a lawyer-friend’s generous offer to certify my application for free, certainly accelerated my application.
There was just one problem.
After registering the LPA and telling my brother that he would be responsible for making decisions on my behalf if I couldn’t, he asked, “So, how do you want me to decide?”
I had no idea.
Key Principles to Think About
As I considered different scenarios where I would not be able to make my own medical decisions, or might require care near the end of life, various questions popped into my head:
Should I instruct my surrogate decision-maker to exhaust all possible medical options where possible?
Is it OK to decline certain medical treatment if this would certainly lead to death? Would this be considered suicide?
Am I faithless if I did not prolong my life, or permitted my decision-maker to do so such that God could miraculously heal me?
Honestly, I wasn’t sure of how God’s Word should guide my care preferences. Thankfully, I came across some helpful books on this subject, which helped me to glean the following biblical principles:
Because we are given life in God’s image to glorify Him (Genesis 1:26; 1 Corinthians 10:31), we are to treasure the life that God has granted us, and to strive to glorify Him in everything, explains medical doctor Kathryn Butler. This requires us to prayerfully consider treatments with “reasonable potential to cure” when considering the array of end-of-life options.
While considering such treatments might seem straightforward, people can interpret this very widely, with some choosing to do anything at all costs to save a loved one. However, pursuing such medical interventions may improve the patient’s condition minimally—but also prolong suffering.
As such, what might be more important is that we live the “right kind of life, not necessarily the longest life,” suggests Dr. David VanDrunen, professor of systematic theology and Christian ethics. This means examining our intentions in seeking to continue a medical treatment, to see whether we are hoping to achieve a “spiritual good” or “human good”.
The spiritual goods of salvation and maintaining a relationship with Christ, says Dr. VanDrunen, should be kept in mind when one is incapacitated. For example, what are the chances that he or she is able to experience the means of grace, such as worship, fellowship, and serving after receiving treatment? He argues that “if a treatment keeps one from continuing their religious devotion, forgoing such treatment may be the righteous decision for the Christian”.
Aside from spiritual goods, human or earthly goods can be defined as—but isn’t limited to—“physical comfort, the fellowship of family and friends, and the ability to work and play”, explains Dr. VanDrunen. Could treatment reverse a temporal, incapacitating condition so that one can continue to fulfil familial and community responsibilities, or complete a meaningful project? If so, human good can be worth pursuing.
Hence, not only should decision-makers weigh the spiritual and human goods they hope to achieve, but they should also ask their medical team to explain the patient’s disease and recovery in layman terms. Then, they can determine if aggressive treatments offer hope of life, or prolonged suffering and death.
With this in mind, the decisions that my brother might make would be different depending on the scenario. If an accident renders me unconscious in intensive care but with a good chance of recovery, I hope he gets the doctors to treat me! But if I have an incurable disease and become demented, I wouldn’t want him to choose to prolong my life.
Recognising the sanctity of life, however, does not refute the certainty of death, says Dr. Butler. As David acknowledged, “My times are in [God’s] hands” (Psalm 31:15). She urges us to pray for healing and for miracles, but to also pray like Jesus, “Your will be done” (Matthew 6:10, 26:42).
Dr. Bill Davis, a philosophy and theology professor, echoes, “Just as God does not need us to find the faith to unlock his power to heal, God does not need us to buy time for him to find room in his schedule or to recharge his batteries.” In other words,
Both encourage readers to pray for healing because God is able to heal. But, we can also pray for healing without planning for a miracle. We can pray for what our hearts desire, while submitting to God’s superior will and our good.
Because my brother and I worship in the same congregation, I’m confident that he would rally everyone in our church to pray for my healing if I’m in an unconscious state. But I hope that they would also pray for the Lord to grant my brother discernment in deciding my medical care.
On top of recognising the sanctity of life, and God’s authority over life and death, we should also bear in mind God’s command to love our neighbours as ourselves (Matthew 22:39). This means that we should extend empathy and mercy to others—in this case, the patient. Dr. Butler opines that this principle should guide us “away from aggressive, painful interventions if such methods are futile, or if the torment they inflict on the patients exceeds the anticipated benefit”.
At the same time, we should distinguish between palliative measures that ease one’s symptoms, and mercy killing or euthanasia, where drugs are given to intentionally end life, say both Dr. Butler and Dr. Davis. Declining or discontinuing burdensome medical interventions that prolong suffering without benefit, and transiting to measures that ease pain and give comfort, have a different intent, which is to
honour the sanctity of life and God’s authority over life and death.
Some of us may be turned off by the idea of “pulling the plug”, or discontinuing organ-supporting measures on a loved one. We might feel guilt and grief in choosing to do so. But I reckon if I’m kept alive through these measures or artificially-administered nutrition with close-to zero prognosis for recovery, I would rather be eased into comfort measures that treat my pain and anxiety, if any.
This brings me to the point of sharing with my brother my end-of-life care preferences, to alleviate his worry and stress.
Making My Intent Clear
Documenting our preferences can help to relieve our loved ones of the burdens of decision-making, freeing them up to spend more time with us.
Dr. Butler proposes going through this list of questions to help us outline our advance directives:
1.
What are your goals for end-of-life care?
Where would you like to be—would you prefer to remain at home, or can you accept being in a hospice or hospital?
What or who matters as your life ends?
What would help you fix your gaze heavenward?
2.
How can you continue to serve God at the end of your life?
When did you feel nearest to Him? Recall moments when you revelled in the joy and fellowship of the Lord.
What do you think you might require for faithful service?
3.
How much suffering is too much?
What in your mind is undue suffering?
What outcomes are unacceptable to you, no matter the gain?
4.
What trials are you willing to endure to achieve your goals at the end of life?
Would you accept treatments that impair consciousness to prolong life, or do you need to maintain control of your mental faculties even if refusing treatment hastens the end?
Answering these questions alone would not suffice without talking to our loved ones, especially the decision-makers who would be advocating for us. Not only will the process of sharing with and hearing from them alleviate their doubts, it would also enable them to
honour our wishes without guilt.
As I consider these questions and biblical principles, I’m clear that I revel in the ability to think, pray, and fellowship with others, which I hope I can continue to do at the end of my life.
I am willing to endure discomfort and dependence on others if I can still reason and communicate meaningfully. But if I’m in a persistent coma, vegetative state, or minimally conscious state, I would not accept organ-supporting measures and artificially-administered nutrition.
I hope to capture these in a signed advance medical directive, and tell my brother my considerations in due time. Then, he would know how I would want him to decide if such a time comes.
Planning for my end-of-life care now gives me some control over how my last days may be spent. But one day, my body will break down and I may no longer have control then. I pray that in those last days, my spirit can say with conviction,
References:
Dr Kathryn Butler, Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care
Dr Bill Davis, Departing in Peace: Biblical Decision-Making at the End of Life
Dr David VanDrunen, Bioethics and the Christian Life: A Guide to Making Difficult Decisions
Although Eliza Tan eats to live rather than lives to eat, she still enjoys her food and wholeheartedly agrees with Ecclesiastes 3:13, "That each of them may eat and drink, and find satisfaction in all their toil—this is the gift of God."
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