by Between Life
4 Yan S. Kim, Gabriel J. Escobar, et al., “The Natural History of Changes in Preferences for Life-Sustaining Treatments and Implications for Inpatient Mortality in Younger and Older Hospitalized Patients,” Journal of the American Geriatrics Society 64, no. 5 (2016): 981–89.
5 David Wendler and Annette Rid, “Systematic Review: The Effect on Surrogates of Making Treatment Decisions for Others,” Annals of Internal Medicine 154, no. 5 (2011): 336–46.
6 Melissa A. Z. Marks and Hal R. Arkes, “Patient and Surrogate Disagreement in End-of-Life Decisions: Can Surrogates Accurately Predict Patients’ Preferences?” Medical Decision Making 28, no. 4 (2008): 524–31; David I. Shalowitz, Elizabeth Garrett-Mayer, and David Wendler, “The Accuracy of Surrogate Decision Makers: A Systematic Review,” Archives of Internal Medicine 166, no. 5 (2006): 493–97.
7 Ursula K. Braun, “Experiences with POLST: Opportunities for Improving Advance Care Planning,” Journal of General Internal Medicine 31, no. 10 (2016): 1111–12; Susan E. Hickman, Elisabeth Keevern, and Bernard J. Hammes, “Use of the Physician Orders for Life-Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the Literature,” Journal of the American Geriatrics Society 63, no. 2 (2015): 341–50.
8 Braun, “Experiences with POLST,” 1111–12; Hickman et al., “Use of Physician Orders,” 341–50.
Chapter 13: Being a Voice
1 Maria J. Silveira, Scott Y. H. Kim, and Kenneth M. Langa, “Advance Directives and Outcomes of Surrogate Decision Making Before Death,” New England Journal of Medicine 362, no. 13 (2010): 1211–18.
2 Elizabeth K. Vig, Helene Starks, et al., Journal of General Internal Medicine 22, no. 9 (2007): 1274–79.
3 David Wendler and Annette Rid, “Systematic Review: The Effect on Surrogates of Making Treatment Decisions for Others,” Annals of Internal Medicine 154, no. 5 (2011): 336–46.
4 David I. Shalowitz, Elizabeth Garrett-Mayer, and David Wendler, “The Accuracy of Surrogate Decision Makers: A Systematic Review,” Archives of Internal Medicine 166, no. 5 (2006): 493–97.
5 Danielle R. Probst, Jillian L. Gustin, et al., “ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms,” Journal of Palliative Medicine 19, no. 4 (2016): 387–93; Mark D. Siegel, Earle Hayes, et al., “Psychiatric Illness in the Next of Kin of Patients Who Die in the Intensive Care Unit,” Critical Care Medicine 36, no. 6 (2008): 1722–28.
Further Reading
Books
Card, Michael. A Sacred Sorrow: Reaching Out to God in the Lost Language of Lament. Colorado Springs, CO: NavPress, 2005.
A beautifully-written and theologically rich exploration of biblical expressions of lament, with extrapolations to modern struggles with grief.
Dunlop, John, MD. Finishing Well to the Glory of God: Strategies from a Christian Physician. Wheaton, IL: Crossway, 2011.
Dr. Dunlop offers believers a beautiful, tenderly written guide to resting in the arms of Christ at the end of life. He weaves medical advice throughout a narrative that at some points reads like a memoir and at other times like a devotional.
Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Reprint ed. New York: Picador, 2017.
Although he does not write from a Christian perspective, Dr. Gawande offers invaluable insight to aging, nursing-home care, hospice, and care goals in his best-selling book.
Jacobs, Martha R. A Clergy Guide to End-of-Life Issues. Cleveland, OH: Pilgrim Press, 2010.
An accessible, clearly written, and practical guide to end-of-life care, with clergy as a target audience.
Moll, Rob. The Art of Dying: Living Fully in the Life to Come. Downers Grove, IL: InterVarsity Press, 2010.
Christianity Today editor Rob Moll offers a candid survey of how medical advancements have changed our experience of death, and explores how to face life’s end with our eyes on the cross.
Orr, R. Medical Ethics and the Faith Factor: A Handbook for Clergy and Health-Care Professionals. Grand Rapids, MI: Eerdmans, 2009.
Comprehensive, thorough, thoughtful; an excellent resource in medical bioethics, with attention to Christian theology.
Van Drunen, David. Bioethics and the Christian Life: A Guide to Making Difficult Decisions. Wheaton, IL: Crossway, 2009.
A survey of multiple issues in bioethics, this thoughtful book includes a chapter on end-of-life care, with an emphasis on broad principles.
Websites
Christian Medical and Dental Association (CMDA), https://www.cmda.org.
A site geared toward medical and dental professionals who follow Christ. The “Issues and Ethics” page includes helpful statements on various ethical dilemmas, with an emphasis on the Bible.
Christian Medical Fellowship, http://www.cmf.org.uk/advocacy/end-of-life/.
The UK correlate to the CMDA. A site geared toward Christian medical professionals; however, the end-of-life page includes helpful links and resources for laypeople.
Five Wishes Program, https://www.agingwithdignity.org/five-wishes /about-five-wishes.
A program that guides individuals through drafting a living will. Offers helpful prompts and has clear, understandable language.
GriefShare, https://www.griefshare.org.
A Christian support group for people grieving the death of a family member or loved one, with thousands of meetings occurring weekly worldwide.
National Hospice and Palliative Care Organization, https://www.caringinfo.org.
Includes information on hospice and palliative care, as well as a repository of downloadable advance directive forms from all states in the US.
National POLST Paradigm, http://www.POLST.org.
An online repository of orders for life-sustaining treatment from every state.
General Index
acute respiratory distress syndrome (ARDS), 77–78, 193
advance care planning: advance directives, 17, 24, 26, 70, 97, 134, 149–69, 185–88, 193, 214; healthcare proxies, 26, 149, 153–54, 164, 168, 185, 195; living wills, 149–64, 185, 195, 214; surrogate decision making, 28, 149–64, 165–74, 185, 193
aggressive treatments: may cause suffering, 15, 29, 32, 34, 38, 41–43, 67, 122, 183; may prolong dying, 58, 63, 77–80, 96–97, 101, 109, 118, 130, 151, 160, 169, 173–75, 185
Alzheimer’s disease, 56, 97, 194
American Academy of Neurology, 119, 208n7
American Geriatrics Society, 97
American Medical Association, 141–42
antibiotics, 60, 62, 64, 94
anxiety: of family members, 42, 66–67, 129, 151, 164, 172–74, 196; of patients, 23, 41–42, 67, 75, 127, 132–37, 196
arrhythmia, 53, 88, 181, 193, 197
arterial lines (A-lines), 85–88, 183
artificially administered nutrition: advance directives for, 89–90, 98, 118, 163, 187–88; overview of, 89–100; potential harm of, 25, 90, 92–99, 183
autonomy, 31–32, 141–47, 157–58, 168, 177, 193
Being Mortal, 145, 213
Bible, the: suffering in, 35–37, 39, 66–67, 172; teaching of, 31–43, 90, 120, 142, 144; wisdom of, 15, 31–43, 90, 142, 169, 214
BiPAP, 69–80, 182, 196
blood pressure: and brain injury, 116–20; and kidney disease, 102–6; medications for, 81–88, 183, 195, 197; overview of, 56–68, 84–88
brain death, 113–122, 207n1
brain injury: aggressive treatments for, 116, 118–19, 122, 186; caused by CPR, 56, 115, 117–19, 122, 181; overview of, 113–18, 122; treatments for, 53–56, 72, 85, 92, 94, 97–98, 118, 122
breathing machines. See ventilation, mechanical
Canadian Geriatrics Society, 97
cancer, 34, 56, 64, 107, 130–31, 155
cardiac arrest: cause of brain injury, 56, 115, 117–19, 122, 181; and CPR, 47–58, 181, 194; and defibrillation, 55, 81, 187, 194; overview of, 52–58, 193, 196
cardiovascular disease, 96, 106–7, 110, 155, 119, 181
caregivers: a
nxiety of, 42, 66–67, 129, 151, 164, 172–74, 196; gospel hope for, 36–37, 42–43, 57, 177, 213–14; grief of, 15, 66, 114–15, 128–30, 165–74; guilt of, 15, 57, 125, 129, 137, 153, 167, 172–74
catheters: arterial lines, 60, 85–88, 150, 166, 183; central lines, 60, 64, 85–88, 95, 105; for dialysis, 102–5; for nutrition, 64, 92–99; for urinary function, 63–64, 102
Catholic Church, 89, 119, 208n9
Christian Medical and Dental Association (CMDA), 119, 208n8, 214
Christian Medical Fellowship, 214
chronic obstructive pulmonary disease (COPD), 61, 72–73, 109
clergy: counsel from, 32, 120, 120, 129; guidance for, 17, 213–14
coma, 56–57, 104, 110, 113–24, 163, 187
comfort measures, 125–37, 142, 147, 157, 194
communication: with family, 134, 137, 153–55, 164; goals for end of life, 162–64, 185–87; impairment, 29, 65, 80, 75–77, 134, 140, 153–55, 185–87; with physicians, 26–29, 31, 42, 153–55, 164
compassion: Christian view of, 16, 28, 32, 38–39, 43, 118, 160; and comfort measures, 23, 132, 141–47; critical care as expression of, 28, 32, 175–76; food as expression of, 89, 97, 118
Compassion for Choices, 141
congestive heart failure, 56, 104, 130
continuous venovenous hemofiltration (CVVH), 42, 60, 82, 101–11, 194
CPR (cardiopulmonary resuscitation): advance directives for, 16, 22, 54–58, 154, 163, 187, 196; and cardiac arrest, 47–58, 181, 194; cause of brain injury, 56, 181; overview of, 52–58, 181, 194; potential harm of, 15, 41, 53–57, 155
CT (computed tomography) scan, 48, 194
death: and dignity, 33, 39, 108, 141–46, 157–59, 169, 214; fear of, 22, 26, 40, 133–36, 188–89; God’s authority over, 15, 32, 35–37, 40, 43; is not the end, 57, 120–21, 131, 136, 177, 191; Jesus Christ defeated, 16, 18, 35, 40, 57, 67, 82, 110, 121, 169, 177; speeding of, 92, 118, 130, 132, 135, 139–64; spiritual nature of, 15, 24–29, 31, 42, 129, 131, 146; spiritual preparation for, 146, 152, 161, 175, 195
defibrillation, 48, 53–58, 181, 187, 194
delirium, 21, 25, 59, 64, 92–94, 101, 104, 135, 194
dementia, 48, 56, 96–97, 99, 107, 163, 183–87, 194
depression, 64–67, 75, 106, 129, 151, 172, 174
diabetes, 56, 104, 109, 155
dialysis: advance directives for, 163, 187–88, 193–95; aggressive treatments for, 106, 163, 187; overview of, 101–11, 184; refusal of, 103, 106–11, 134, 163
disability: and advance directives, 160–161, 170–71, 187; and brain injury, 54, 116–18; and suffering, 64, 133, 145, 158, 161
do-not-resuscitate orders (DNR), 48–49, 57, 201n4
durable power of attorney. See healthcare proxy
electrical cardioversion, 55, 194
electrolytes, 103–11, 120, 194–95
emergency settings, 16, 48, 50–56, 97, 134, 143, 154
emphysema, 72–73, 109
encephalopathy, 26, 194
endotracheal intubation: advance directives for, 23, 80, 187; overview of, 75–77, 182, 194; potential harm of, 25, 75–76, 80, 114, 134–35, 158, 182
enteral nutrition, 89–99, 194–95
ethics. See medical ethics
euthanasia: Kevorkian, Jack, 141, 209n3; mercy killing, 23, 62, 128, 132, 147, 166; murder, 23, 62, 128, 132, 147, 166; physician-assisted suicide (PAS), 34, 38, 132, 135, 139–47, 196; voluntary active euthanasia (VAE), 38, 139–40, 143, 197
faith: and end-of-life decisions, 15–16, 24, 28–29, 40, 114, 145, 152, 176–78, 214; in God, 31–43, 96, 98, 158–59, 176–78, 191; in Jesus Christ, 36–37, 40, 51, 114, 117, 131, 172
feeding: by mouth, 92, 95–97, 163; by tubes. See artificially administered nutrition
Five Wishes Program, 155–56, 214
freedom, 15, 144–46, 152–53, 157, 169, 177, 193
free will, 39, 98, 144–45, 155
gastrostomy tubes (G-tubes), 89–99, 195
Gawande, Atul, 145, 210n12, 213
goals of care, 32, 83, 108, 136–37, 152–53, 160, 188, 195, 213
goals at end of life: fellowship, 79, 146, 158, 162–63, 168, 173, 177, 186–88; prayer, 39, 131, 136, 162–63, 186–88; service, 38–39, 79, 129, 133, 136, 158, 161–64, 185–88
God: authority of, 16, 28, 31–43, 108, 115, 144, 159, 172, 185; the Creator, 33–37, 120, 131, 144, 157, 177; faith in, 31–43, 96, 98, 158–59, 177–78, 191; glory of, 31–43, 67, 82, 110, 131, 157, 190–91, 213; grace of, 18, 36, 40, 61, 67, 70, 98, 121, 172, 177, 191; hope in, 31, 134, 136, 146, 159, 190, 207n1; joy in, 39, 67, 158, 161, 188; mercy of, 14–15, 29, 36–43, 67, 108, 129, 159, 172, 175, 191; trust in, 23, 33, 36–37, 79–80, 147, 176, 190; worship of, 37, 39, 65–66, 121, 152, 177
gospel, the (way of salvation), 25, 93, 108, 159–60, 177
grief: of caregivers, 15, 66, 114–15, 128–30, 165–74; gospel hope for, 36–37, 42–43, 57, 177, 213–14; and hospice care, 128–30, 136–37
GriefShare, 173, 214
healthcare proxy, 26, 149, 153–54, 164, 168, 185, 195
heart attack, 15, 52, 61–62, 75, 86–88, 195. See also myocardial infarction
heart failure, 56, 84–85, 101, 104–9, 130, 155, 182
hemodialysis, 101–11, 194–95. See also dialysis
Holy Spirit, the: eternal nature of, 57; fruit of the, 79; indwelling of, 32, 67, 159, 190; walk with, 39, 65–66, 98, 161
hope: in God, 31, 134, 136, 146, 159, 190, 207n1; in the gospel, 25, 93, 108; in Jesus, 32, 39–43, 65–67, 80, 88, 120–21, 131, 136, 146, 159, 168, 188, 190; for recovery, 15, 37, 41–43, 50, 65, 79, 87, 118–22, 146, 151, 159–60, 170; in the resurrection, 40, 80, 120–21, 131, 146, 177, 188, 190
hospice, 28, 64, 66, 125–37, 195, 213–14
hospitals: ability to leave, 56, 102, 109, 130–34, 154, 157; mortality in, 50, 53–56, 61, 64, 75–76, 104–7, 130–33, 146, 182; shift of death from home to, 16, 23–29, 104, 109, 130, 134, 145; transfers to, 145, 154, 164, 206n18
humility, 29, 37–38, 55, 70
hypertension, 56, 155
ICU (intensive care unit): aggressive treatments in, 15, 32, 61–67, 75–76, 95–99, 118–19, 165, 175; difficulties for family members in, 22, 38, 66–67, 129, 151, 171; mortality in, 28, 61, 76, 134–137; overview of, 15–18, 22–28, 31–43, 59–67, 195; potential harm of, 62–67, 75–76, 104–8, 111, 134–35, 156, 175
idolatry, 37, 87, 157
infection, widespread. See sepsis
inotrope, 81–88, 183, 195, 197
intubation. See endotracheal intubation
Jesus Christ: assurance in, 18, 28, 40, 82, 121, 131, 159–60, 172–73, 177; Bread of Life, 98–99; cross of, 36, 51, 57, 67, 90, 95, 110, 120, 144, 172, 177, 188, 213; faith in, 36–37, 40, 51, 114, 117, 131, 172; hope in, 32, 39–43, 65–67, 80, 88, 120–21, 131, 136, 146, 159, 168, 188, 190; identity in, 32–33, 43, 145, 156–57, 177; resurrection of, 35–37, 39–40, 57, 63, 121, 131, 160, 177, 188, 190–91; salvation in, 33, 36, 136, 147, 159, 171–73, 188–91
Job, 35–37, 67
Kevorkian, Jack, 141, 209n3
kidney failure: causes of, 84, 87–88, 104, 108–9; overview of, 103–6; treatments for, 16, 41, 60–62, 101–11, 195
lamentation, 36, 60, 172–73, 213
Lazarus, 36–37, 66, 172
legal issues: advance care planning, 153, 164, 185–88, 195–96; determination of death, 119–22
euthanasia. See euthanasia
life: eternal life with God, 25, 33–36, 40, 82, 110, 147, 178, 190–91; is a gift from God, 33–35, 43, 120, 159; preservation of, 34–35, 40–43, 79, 101, 109, 118, 134, 174, 185; purpose of, 31–43, 57, 66, 144, 162, 186; sanctity of, 32–35, 120, 159
life-sustaining measures: advance directives for, 27, 107, 149, 154–55, 164, 196, 214; overview of, 16–17, 31, 41, 47; potential harm of, 29, 35, 41, 62, 106
liver failure, 13, 60, 83, 87–88, 101, 104
living wills, 149–64, 185, 195, 214. See also advance care planning
loneliness, 75, 82, 127, 173–74
love of God: in sending Jesus, 57, 67, 80, 177; is steadfast, 18, 39–40, 121, 136, 147, 158–60, 190; in suffering, 66, 158–59, 168
love of Jesus Christ: in his death, 38, 66–67, 96, 110; in our grief, 168–69, 172, 177; is steadfast, 18, 121, 136, 190
love for others: as Christ loved us, 96, 133, 169, 178, 110; commandment to love one another, 38, 41, 90, 118, 162, 169; in end-of-life decisions, 29, 43, 98, 109
McMath, Jahi, 115
media, role of, 50, 62, 89, 115–17, 121
medical ethics, 17, 31–32, 90, 95, 119, 140–44, 157, 214
mercy killing, 23, 62, 128, 132, 147, 166. See also euthanasia
miracles, 36–37
morphine, 135
mortality: Christian view of, 36, 57, 136, 159–60, 213; in dialysis patients, 105–7, 111; in hospitalized patients, 50, 53–56, 104–7, 130–33, 145–46, 182; in ICU patients, 61, 64, 76, 203n2; in ventilated patients, 75–76, 182
murder, 23, 62, 128, 132, 147, 166. See also euthanasia
myocardial infarction, 52, 195. See also heart attack
narcotics, 72, 132, 135
nasogastric (NG) tubes, 93–94, 96, 195
National Hospice and Palliative Care Organization (NHPCO), 155, 209n7, 214
Nightingale, Florence, 61
noninvasive positive pressure ventilation (NIPPV), 77–78, 182, 196
organ failure, 16, 83–84, 87, 101
organ-supporting measures: discontinuation of, 60, 132, 139–47, 163, 193; effect on cure, 17, 34–35, 41, 62, 67, 125, 129
oxygen, 51–58, 71–73, 84, 113, 115–18, 183, 194–97
pain: of aggressive treatments, 22–25, 32, 35, 38, 64, 75, 96, 132–37, 181; of death, 15, 32, 35, 135, 142–47, 155–64, 171; medications for, 85, 132, 135, 137; of terminal illness, 22, 41–42, 97, 106, 135, 142–47, 155–64, 187; of unconscious patients, 97, 118, 122
palliative care, 27, 96, 125–37, 142, 146, 155, 194–96, 214
panic, 15, 41, 63, 71, 74, 76, 96, 134
Parkinson’s disease, 94
Paul (the apostle), 18, 32–33, 39–40, 65, 121, 144, 152
percutaneous endoscopic gastrostomy (PEG), 94
