Between Life and Death

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