counselling the terminally ill

An article in Christianity Today brings to mind some thoughts concerning illness, especially terminal illness and the way Christians should approach them. The article is entitled, “Does Faith Prolong Suffering for Cancer Patients?

A key quote:

Because religious patients often trust in God’s sovereignty and an afterlife, “one might expect them to be more accepting of death and let nature take its course at the end of life, rather than pursuing very aggressive treatments,” said Dr. Andrea Phelps, lead author on the study and senior medical resident at Beth Israel Deaconess Hospital in Boston. Such a view, she said, reflects a commonly held assumption about how religious patients approach the prospect of imminent death.

But, Phelps added, a few reasons might help explain why religious cancer patients commonly opt for aggressive care in their final days. Among the possibilities:

—faith leads to optimism, even when a prognosis is bleak;

—faith gives purpose to suffering, and in turn helps patients muster stamina for invasive treatments;

—beliefs about sanctity of life may give rise to a quest to prolong life at almost any cost.

“We were concerned” by the study’s findings, Phelps said. “We are worried because aggressive care, at least among cancer patients, is a difficult and burdensome treatment that medically doesn’t usually provide a whole lot of benefit.”

My question: should Christians ‘fight’ when it comes to disease? Often when someone gets very ill, believing family members will talk about ‘let’s fight this’ or ‘you’re going to fight this, aren’t you?’

In recent months I have witnessed, directly or indirectly, well-meaning family members encouraging terminally ill believers to keep on fighting, even in cases that are virtually impossible of survival (from the human perspective).

  • The recurrence of a very aggressive cancer where treatment involved the very nauseating chemo therapy treatments and debilitating radiation, only to end in death after a miserable last 10 to 12 months of life.
  • The death of an elderly believer who led a full and fruitful life of ministry, but in dying days was encouraged by a zealous doctor to ‘have hope’ and ‘fight’ for one or two more years of life. This gave false hope to family members only to end in death after about eight weeks.
  • A dying saint who was urged by family members to just fight, and keep trying, even though a debilitating cancer simply sapped her of energy and will to live – a cancer that was untreatable by any therapy, and ended with the saint in heaven.

I realize that there is a culture of death in the medical profession in some circumstances. I am not talking about some kind of ‘quality of life’ issue here, i.e., arguing that we shouldn’t be aggressive simply because so-and-so doesn’t have good ‘quality of life’ prospects. I am talking about cases where the actual prognosis is death, even with heroic measures by doctors and vigorous attempts to prolong life at all costs. Should our ‘pro-life’ beliefs include a fanatical attempt to defy the odds by medical means?

Certainly God can cure anyone. But in the cases I mentioned, it clearly was not His will to do so. It was His will to bring these saints home.

Suppose the individuals in these cases, rather than pursuing radical treatments, simply left the case in the Lord’s hands. Suppose they lived a while longer? Well, praise the Lord, if so. But suppose they died without anguish and suffering in the last months of their life? Wouldn’t that be better for them and their families?

These are not easy questions and I am not proposing a ‘one answer fits all’ for any individual case. But we must use wisdom in our own decision making and counselling ministries.

don_sig2

UPDATE: I promised an update in the comments below. On the CT blog (all disclaimers apply!) a member of the research team mentioned in the article responds. It is worth reading, but here is a quote:

Based on this, we hypothesize that there is a gap about formation of death for religious communities. It would appear that Christians as a pattern do not talk about death, model a good death, or articulate the characteristics of faithful dying. Terminal patients and their families are left alone in making these decisions — and there is a significant minority (we are guessing between 10-30%) who are receiving aggressive care at the end of life because they do not know how to navigate the spiritual intersection involved in the complexities of medical decision making.

Comments

  1. Don,

    Thanks for the good thoughts about very difficult events when they hit home. There is a daily devotion by Spurgeon that your article brings to mind. The text is “Father, I will that they also whom Thou hast given me, be with me where I am.” He came out of it all saying that sometimes we pray at cross purposes with our Lord, since He desires to bring His children home. I think aggressive measures might be a similar thing, also working at cross purposes with our Lord.

    Also, (I can say it now, since I don’t have any knowledge of myself being terminally ill), isn’t it really far better to depart and to be with Christ? What is there in this world that we really want to fight that hard to keep?

    MC

    • Hi Marty, the older I get (approaching ancient), the more I feel less at home in this place.

      I do think we should be pro-life in the sense that we don’t just dismiss medical intervention altogether, but at times we need to be discerning and trust the Lord for a happy homegoing. I recently observed just such a case and while the individual was not well in the last months of life, she was not unduly uncomfortable. Those around her essentially accepted the Lord’s will for her … and there really was nothing that could be done. If the Lord would have willed so, he could have healed her. We prayed for it, but also for the Lord’s will to be done. And it was. She is in glory and we are stuck here.

      For now.

      There is an update to the CT article that I want to add, but I am in a bit of a rush. Maybe later tonight.

      Maranatha!
      Don Johnson
      Jer 33.3

  2. I am not opposed to surgery (for example, to remove a cancerous growth), nor directly against cancer treatments – but I have seen people, including my Mom, go through far more problems from the treatments than the cancer originally caused (my Mom died of the damaged liver and kidneys from the treatments and not from the original cancer, which did go away).

    In light of various relatives and friends dying of cancer, I have thought long and hard about what I would do if I ever got it myself.

    First I would trust the Lord that it was in His perfect will for me (whether chastisement to bring me back to Him, to draw me closer to Him, or even to do something in myself and my life that might not otherwise have happened without that experience and growth that would result as I cling to the Lord during that trial).

    I want to make sure that I am not giving up and taking the easy way out (ie. getting depressed and choosing not to fight the cancer directly because of losing my will to live). However, I really have decided I would leave it in the Lord’s hand as to whether He chooses to heal me or not (apart from any kind of radiation treatment, etc.) – let Him work through me during that time, and let Him use my situation and witnessing/glorifying Him to make a difference in the lives of others.

    I am not speaking from the perspective of someone who absolutely has no clue what it could be like to live with chronic pain and health problems, and therefore am just spouting words. For most of the last 11 years, I have dealt with chronic daily muscle (anywhere on my body) pain (some reprieve in the last 2 years, though more health problems and different kinds of pain resulting from that).

    Personally, I much prefer the times I am forced to lean upon the Lord daily for strength than the days where I do not – I am prone to wander, and the daily pain is so often a check on my straying. Plus, if I had cancer, how much more could I do for the Lord in my walk with Him when I am not having to have worse health and being worn out because of some treatments. The peace, trust, and joy we can show to others in the midst of even trials like this is what will glorify the Lord, strengthen the brethren (through being a Christlike example), and bring the lost to Him (wow, the Lord is in control even in this, and I can trust Him with my soul and my eternity!).

    Even In This

    Even in this, the Lord is in control;
    Even in this, He is guarding my soul;
    When I cannot imagine how I can cope
    Even in this, I have reason for hope.

    Even in this, this trial that I dread;
    Even in this, I can still bow my head;
    Praise my loving Father for being near;
    Even in this, I have no need for fear.

    Even in this, I have Your peace of mind;
    Even in this, You are tender and kind;
    Your touch, Your gentleness has made me great;
    Even in this, You see my low estate.

    Even in this, a trial I didn’t plan;
    Even in this, I see Your loving hand!
    My heart has comfort that was sorely missed –
    You fill my heart with joy – even in this.

    Even in this.

    October 6th/08
    Jerry Bouey

    • Thanks, Jerry.

      Over 5 yrs ago, my mother had surgery for cancer. The doctors wanted to do radiation as well, but at 78, my mother would have none of it. Without radiation she had a 50/50 chance of another five years. With it she had 65/35 chance, plus misery from the radiation. She said, “No thanks.” Thankfully, she is still with us and cancer free. She is a great optimist and a great encouragement to me.

      Maranatha!
      Don Johnson
      Jer 33.3

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