We close out the week with a question from an international listener, a young woman. “Hello, Pastor John, and thank you for this podcast! I’m a medical student in Romania, preparing to be an oncologist. I want to care for bodies, but even more I want to serve souls. I want to be wise in serving terminally ill patients, including children, as they face pain, helplessness, and eventual death. From your pastoral experience, what tools should I have available to minister to the terminally ill?”
I’m going to assume that you are not in a position where you will be penalized for sharing the gospel or sharing the promises of God or for praying and encouraging others to pray for those in your care. It’s tragic when, for political reasons or other reasons, medical professionals and even chaplains or pastors are instructed not to help people in the most critical hour of their lives with the most important issues they face — namely, the issue of faith in Christ. That’s tragic. So, I’m going to assume that’s not your situation but that you have freedom.
I’m also going to assume that you’re not asking about the practicalities or the legitimacy of palliative care — that is, the biblical lawfulness of reducing pain. I assume you agree with me that even though pain was God’s righteous judgment for sin after the fall, his redemptive call on his people is to do good and to bring merciful relief, not judgment.
So, how should we then think about ministering to the terminally ill, especially those who are so near the end that they may be bedridden and even mentally or physically unable to use some of the means of grace that have sustained them, perhaps, in faith for their whole lives — like reading the Bible or being part of worship or regular fellowship?
Faith’s Good Fight
In 1992 during the summer Olympics, I preached a sermon called “Olympic Spirituality,” and I tried to connect biblical passages about fighting the good fight, running the race, and mastering the body with the Olympics. And I challenged our people to treat the Christian life with as much seriousness as athletes treat their relatively insignificant competition.
Now, one of the grand old saints in our church, who had been part of the staff for 62 years — Elsie Viren was her name — was in the hospital with a broken hip and near the end of her race. And I realized that my sermon “Olympic Spirituality” might sound utterly unrealistic for a dying woman in a hospital bed with a failing memory. What on earth could Piper mean by “Olympic Spirituality” for someone who can’t even get out of bed?
“Every hour you hand over your suffering to Jesus and bear it in the strength he supplies, your reward is increasing.”
So, I wrote an article for our church newsletter to try to show that Olympic spirituality is just as valid for a dying saint in bed as it is for a healthy twentysomething taking risks for Jesus on the mission field. In 1 Timothy 6:12, Paul said to Timothy, “Fight the good fight of the faith. Take hold of the eternal life to which you were called.” So, the fight, the spiritual Olympic boxing match, is, Paul said, a fight of faith. It’s not a fight to get out of bed; it’s a fight to rest in God, to be satisfied in God. It’s not a fight that depends on mature, muscular legs, but on childlike trust. It’s not a fight to keep the powers of youth, but to trust in the power of God.
The race that terminally ill people are running — in bed they’re running — is not a race against wind or hills or heat or burning muscles; it’s a race against temptations that would make them doubt God’s goodness, God’s love. It’s a fight to stay restful and content in God through broken hips and cancer and lost sight and failed memory. It’s not an easy race. They may not be moving their legs or even their arms, but oh, the difficulty of this race! It’s harder than the Olympics, and it may have to be run flat on your back. For most of us at the end, it will be run that way. And Paul says in 2 Timothy 4:7, “I have fought the good fight, I have finished the race.” And then he defines it: “I have kept the faith.”
That’s the goal for those who minister to the terminally ill: helping them finish the race and fight the fight. And Paul makes explicit what kind of fight it is. It’s the fight of keeping faith. “I kept faith. I didn’t stop believing. I didn’t throw in the towel of faith at the end of my life through all my troubles.” We win if we keep believing. It’s a race against unbelief, not against time.
Content No Matter What
Sometimes we use the language of battling cancer. You hear that a lot. What we ought to mean by that mainly is the battle to keep cancer from destroying our faith. That’s what we ought to mean. Whether cancer kills us or not is not the main issue. That’s not the main battle. It’s not wrong — don’t hear me wrong here — it’s not wrong to want to be well and to fight to stay alive. That’s not wrong. But that’s not the main warfare. The main fight, the main race is this: Will we keep trusting? Will we keep resting? Will we remain content in Jesus no matter what? That’s the main fight and battle.
Paul says in Colossians 1:22–23 that Christ will “present you holy and blameless . . . before [God], if indeed you continue in the faith . . . not shifting from the hope of the gospel.” Finishing the race at the end of our lives means “not shifting from the hope of the gospel.” It’s a race, a fight, against hopelessness.
So, the great challenge for ministering to the terminally ill is to keep Christ before their eyes, to help them and help others keep Christ before their eyes with all of his blood-bought gospel promises that remind us, “To live is Christ, and to die is gain” (Philippians 1:21). The banner flying over every hospice bed should be Hebrews 10:35: “Do not throw away your confidence, which has a great reward.” Weakening saints need the constant reminder that the finishing line is crossed not by a burst of human energy but by collapsing into the arms of Jesus.
Final Push with Gospel Promises
And of course, we must realize that as people come near the end, they are often not mentally or physically able to feed themselves with the promise-sustaining word of God, so we need to do it for them. I hope my family, I hope the Piper family remembers that when I’m in my final weakness. The last caregivers should be speaking, maybe even singing, gospel-sweet promises into the life of the dying person, whom they may think no longer can hear us. You don’t know that. I sat beside my dying father counting his breaths, wondering when the gaps would stop. I was there at midnight when they stopped, and I never stopped speaking God’s word into his ear. I have no idea whether in the five seconds before he was in heaven he was hearing the word of God. Maybe he was. I hope he was.
And since their next stop is heaven, we’re not going to promise them a prosperous life on earth. We’re not stupid. We have to reach for the ultimate promises, the most glorious promises, and one of them is 2 Corinthians 4:16–17:
We do not lose heart. Though our outer self is wasting away [oh my, is it ever!], our inner self is being renewed day by day. For this light momentary affliction is preparing for us [working for us, producing for us] an eternal weight of glory beyond all comparison.
The reason this promise is so precious is because it gives meaning to final suffering. It doesn’t say that the suffering is going to produce a new, sanctified walk with God on the earth. That’s what suffering is for for those who have more life to live. These people don’t have any more life to live on earth. Instead, here’s what the verse says: this affliction is preparing for you — this final affliction, one hour before you die, or one week before you die, or one month before you die — an eternal weight of glory. In other words, every hour that you hand over your suffering to Jesus and bear it in the strength that he supplies and for the glory of his name, your reward is increasing in heaven. There is meaning to what looks to the world like absolutely meaningless final suffering.
So, my answer is this: Spare the dying as much pain as you can. Use the prayer-soaked word of God to keep Christ before the dying, to help them fight the fight of faith, to keep believing that even this final, painful push will be rewarded by God’s grace.