By Rev. Harold W. Anderson, Ph.D., LMFT
Last March we were bringing our vacation in Maui to a close. While packing our bags, Becky received a call from Becky’s youngest sister. Since we were busy packing, Becky let the call go to voicemail and thought she would call her sister back on the way to the airport. As we waited in traffic, Becky listened to her sister’s message. It was different from her usual messages, but Becky wasn’t able to put her finger on what was different. On the second attempt to reach her sister, her brother-in-law answered her sister’s phone. Her sister was in the hospital. She had started having strange symptoms and the night before had a grand mal seizure. Taking a CAT scan of her brain, doctors discovered several tumors. It didn’t look good. As soon as we were home, Becky arranged to visit her sister hoping to spend some quality time with her. By the time she reached the airport, however, her sister was back in the hospital, in a coma, and three weeks from her first symptoms, she died. Unfortunately, the tumors were one of the most aggressive forms of cancer. The silver lining is that she didn’t suffer long, but the anguish for the family, who obviously wanted her to live, was great.
That was a difficult time. Her sister was only 66 years of age. The last few years have confronted us squarely with end-of-life issues. In November of 2020, I was diagnosed with COVID-19, put in the hospital on 15L of oxygen, which if it got worse might have meant I may never have left the hospital alive. This was a frightening time when end of life issues loomed large. Several years before that, my brother-in-law lay in a hospital room suffering from cancer throughout his body. He eventually succumbed to his disease leaving my sister a widow at the age of 50. We just don’t know what tomorrow will bring. It could be a great day, but it could also be the beginning of a painful end. End of life issues address these possibilities and if we don’t want to suffer needlessly, we prepare advanced directives in a living will to inform our families of those desires. DNRs (Do Not Resuscitate) can prevent a lot of needless suffering.
The difficult issue is this: Our love for our family member may mean doing what we do not want to do.
As unbelievable as it may sound, we are once again facing what might be an end-of-life issue. Becky’s oldest sister was in the hospital for a procedure when she had a stroke. Despite the best efforts of her health care providers, she remains in a serious condition leaving her family in a wait-and-see posture. This is difficult and painful for all involved and during this time of uncertainty, they are in our prayers. All of this, however, has powerfully confronted once again with questions of: what to do? How do you make difficult and painful decisions about loved ones who suffer from serious illness? When and how do you make a decision about the extent of their care?
As mentioned, sometimes our loved ones have a “living will” instructing family and medical professionals’ what to do under such conditions. Presumably, these issues have been discussed with spouses, children, and other family members. In such cases, the suffering person may hope that their loved ones understand and will honor their wishes to not resuscitate, put in feeding tubes, respirators or other measures that allow our bodies to function while meaningful life is gone. Trust is placed in loved ones to honor their wishes. This, however, is very difficult and painful for those who survive. Where is the line drawn between meaningful effort and prolonging needless suffering?
These issues have been considered by all types of authorities throughout the modern period. Medical science has given us the ability to sustain life in situations where the person would have died without it. Some theologians might argue that taking a person off of life support, which will quicken their end of life, is wrong. When a person dies is something only God can determine. In addition, they might argue, sustaining life leaves the door open for a miracle. Some ethicists, on the other hand, might take a different tact. They may argue that a person has the right to die if their life has reached a place where quality of life is not possible and continued life will bring only greater suffering. The right thing to do, many ethicists argue, is not to prolong a person’s life using medical technology. Suffering and existence that lacks quality is the greater evil.
Enduring all of this is the family, one of whom suffers from physical illness, and the other family members who suffer from grief. What do family members do? First, the end of life is not an individual issue. While death is something we face alone, so to speak, in most cases death is surrounded by interested persons who have a stake in what happens. These persons are family members, medical staff, clergy, and friends. End of life is not a time for silence but requires difficult and painful discussions leading to tough and emotionally ladened decisions. Conversations with medical staff leads to more medically informed conversations with family, friends, and clergy. Conversations with clergy helps family members understand the role of faith at the end of life. Talking to other family members and friends who have also faced end of life issues tends to help validate decisions the family makes. The conversation needs to continue until a decision can be made.
Second, we need to take living wills seriously. If creating a living will is something people have not done, they need to do so sooner than later. Life is a gift, and its longevity cannot be determined with accuracy. We just don’t know what tomorrow will bring. Documents that stipulate the patient’s desire not to be resuscitated or have suffering sustained when life lacks quality and meaning should be discussed and at the end of life, should be honored. To some degree, this takes the burden off loved ones. It is not easy to turn off the machines or stop medications and nutrition, but if it is something a loved one desires, it should be done.
Finally, love needs to be our ultimate guide. This may sound like a truism, but it is nevertheless an important point. We love our family member and our love for them should be our guiding light as we sift through the information given by medical staff, the theological advice given by clergy and any input family members and friends may have. The difficult issue is this: Our love for them may not mean doing what we would like to do. We want them to stay alive. We want them to come home. We want our loved one to be the person they have always been. But if after discussion, this seems impossible, then love of them, not love of what we had, needs to be our guide. While we want them back, we do not want them to suffer needlessly or live a life devoid of meaning. While we don’t want the joy of our life to come to an end, sometimes love means letting them go. While we may pray for a miracle, loving them may mean allowing them to die. God’s grace and our love for them, not a machine, or medical technology needs to be the measure of life.
As philosophers and theologians have told us for millennia, life is difficult. It is filled with disappointments; challenges and it is finite. It will not last forever. When the time comes, the inevitable end is easy to deny, and we often allow our emotions to be our guide rather than our love for the one who suffers. In such times we may pray for grace and hope for miracles. No matter our belief system, though, our decisions need to be marked by an honest assessment of what we need to do based upon what we know our loved one would want, the information given by competent medical providers, the guidance of clergy, and the input of family members and friends. As we sift through all of this, however, the decision is ours to make and once made, we second guess it to our own emotional demise. Whatever our decision, we can be sure that if it is made at the end of an honest discussion involving all the persons involved, we will be less inclined to second guess the decision we make. Our focus can then be on cherished memoires and the blessings our loved one has brought into our lives.