End-of-Life Medical Intervention — or Not?
Today’s email is from a friend of ours, a listener named Matthew who lives in San Antonio. He has thought up a creative way to get us into the tricky thicket of end-of-life decisions. Here’s what he wrote: “Pastor John, thank you for this podcast. I know from listening to the podcast for years that you are very hesitant to speak to specific end-of-life decisions because they require so much wisdom from medical professionals and because every life is so different. But we have nearly endless medical advances we can take advantage of now to prolong life. So I’d like to ask my question strictly within a hypothetical I made up:
Imagine a forty-year-old, middle-class Texan who is a regenerate, Bible-believing Christian man and has been married to a godly Christian woman for eighteen years. He’s diagnosed with aggressive terminal cancer and has two options before him, neither of which he likes or favors, but one of which he must choose.
1. If he does nothing, he lives a relatively normal life for one more year.
2. With aggressive treatment and three surgeries, he will live for four years, and those years will be less than pleasant.
He has modest life insurance. His gracious employer will continue to employ him and pay his salary, plus one year after he passes. So he will have two to five years of income. He has two kids, ages sixteen and twelve, and it’s unclear if they’re believers. What, if any, biblical principles would inform your own choice between these two options?
As I have reflected on this hypothetical, I think it sounds very plausible, very real. I’m sure it’s happening multiple times every day like this. I have seven observations or principles to take into account when facing these two scenarios that he laid out.
1. Pray for Healing
First, I would pray. I would ask my friends to pray in either the one-year scenario or the four-year scenario. I would ask them to pray for my healing. I would not ask for this, probably, if I were eighty-five, because in this fallen world the death of an octogenarian is more or less normal — that is, it’s God’s plan that we die rather than live forever in this age. But at forty, death is much more unnatural and intrusive, and therefore it is more fitting, it seems to me, to seek God for the miracle of healing.
The decision to pray for healing does not dictate whether I choose to get the aggressive treatment or not, because God can heal me without it, and he can heal me through it. So the choice to pursue aggressive prayer for healing does not decide which option I go with. I would pursue prayer for healing in either case.
2. See Prognosis as Probability
Then I would keep clearly in mind that both scenarios — the one-year and the four-year — are human probabilities, not certain destinies. If you choose the one-year scenario, you might feel miserable instead of good for the entire year. If you choose the four-year scenario, you might feel better than you ever dreamed you could for those four years, in spite of all the surgery and chemo. You are only dealing with human probabilities.
“Prayer is the glorious wild card, and God may answer in dozens of ways we don’t expect.”
And when you stir in prayer, you are opening yourself to the fact that God may turn the one-year scenario into a four-year scenario, and he may turn the four-year scenario into a one-year scenario. Prayer is the glorious wild card, and God may answer in dozens of ways we don’t expect. So when I say that both scenarios are only probabilities, I am saying that not only may humans be wrong, but doctors may be wrong. But God has infinite options at his disposal for how you spend those years.
3. Face Death with Trust
Next, I would remind myself that both death and suffering for the Christian can be for our good. They are evil in themselves in the sense that they are contrary to God’s original perfect design, but in God’s providence both death and suffering serve his children.
Death serves his children by introducing them to immediate fellowship with Christ, which Paul says is far better (Philippians 1:23). And not only that, but facing death joyfully, square in the face, may be a compelling witness to our family, to our children, and to others. It might bring them to Christ.
“Facing death joyfully may be a compelling witness to our family, to our children, and to others.”
Suffering, like Paul’s thorn in the flesh, can serve us by keeping us humble, deepening our reliance on the Lord Jesus, and enabling us to glorify his power in our weakness (2 Corinthians 12:7–9). Like death, suffering endured with deep, joyful, tearful confidence in Christ may be a compelling witness to our family and to others.
So, it’s important not to play death and suffering against each other, as though one is intrinsically more likely to be a blessing than the other. We don’t know that. Either one may be a greater blessing than the other in our lives and in the lives of our family.
4. Commend Christ’s Sufficiency
Both the one-year scenario (feeling good and dying early) and the four-year scenario (feeling bad and living longer) could be used by God for the salvation of our children, the strengthening of our wives’ faith, and the magnifying of Christ among medical professionals, church members, and lost neighbors.
We cannot predict with any certainty whether our willingness to face death early or our willingness to suffer long will have the greater force in commending the all-sufficiency of Christ to sustain us. We don’t know. God could use either one to save our children and others.
5. Fight Satan with Grace
Neither the one-year scenario nor the four-year scenario need be presumptuous, as though we are taking God’s prerogative into our own hands by choosing. We will need God’s help in both scenarios.
Satan will threaten us in the shorter scenario with fear, anger, and worldliness in how good we feel. He will cause us to focus on the coming day of our death next year. He will tempt us to be bitter and angry, and our faith will not survive without the sovereign help of the grace of God.
And if we choose the longer scenario, more life could mean more misery. Satan may have a field day causing our bodily and mental weaknesses to make it almost impossible for us to do the kind of spiritual warfare we have to do in order to persevere to the end. We will not make it through this suffering to the end without the sovereign grace of God sustaining us and carrying us.
6. Be Fed by Friends
In both scenarios, I would mobilize a team of trusted and loved Christian friends who would pledge, as much as they’re able, to walk with me through either scenario to the end. I have in mind not only daily prayer for me — that my faith not fail, the pain not overwhelm me, the absence of pain not result in my worldliness — but also that these friends would feed me the word of God regularly, whether through emails, mail, texts, phone calls, or visits.
As Matthew 4:4 says, “Man shall not live by bread alone, but by every word that comes from the mouth of God.” That’s especially true as we walk up to the edge of eternity. I will need the word of God. I need somebody to look me in the eye and say to me, in the name of God: “God has not destined [you, John Piper,] for wrath, but to obtain salvation through our Lord Jesus Christ, who died for [you] so that whether [you] are awake or sleep [you] might live with him” (1 Thessalonians 5:9).
7. Treasure Christ in Life
And finally, I would keep in mind that neither of these choices is a choice to hate life, or to commit suicide, or to allow anyone else to perform euthanasia on me. Life is a glorious thing — now and after death and, best of all, after the resurrection in the new world with Jesus.
But even so, I would cherish the gift of life now, and I would seek not to waste it. Whether for one year or four years, whether I’m feeling good or feeling miserable, whether death is tomorrow or years away, I would seek to treasure Jesus Christ above all things and to bring as many people with me as I can into the everlasting enjoyment of his presence.