GOD WILL DECIDE WHEN LIFE WILL END:
WE SHOULD NOT 'PLAY GOD'


SYNOPSIS:

    Many religious people believe that
God chooses
when a human life will end.
Usually this view has not been worked out in explicit detail,
which would give guidance about end-of-life medical care.
But this objection to any talk of the 'right-to-die'
should be taken seriously.

    For people who believe in God,
how does their faith affect their decisions concerning terminal care?
Do religious people uniformly make different choices at the end of life
based on their religious beliefs?
And do different religious traditions advise different end-of-life choices?

OUTLINE:

1.  WHAT IS THE PRACTICAL MEANING OF "GOD WILL DECIDE"?
     END-OF-LIFE DECISION-MAKING IN RELIGIOUS PERSPECTIVE

    A.  Do Nothing but Pray.

    B.  Prayer plus Limited Medical Treatments.

    C.  Prayer plus All-Possible Medical Care.

2.  ALLOWING ALL RELIGIOUS PEOPLE TO MAKE THEIR OWN MEDICAL CHOICES


3.  MEDICAL PROFESSIONALS SHOULD NOT 'PLAY GOD'

4.  SAFEGUARDS TO PROTECT RELIGIOUS BELIEVERS




GOD WILL DECIDE WHEN LIFE WILL END:
WE SHOULD NOT 'PLAY GOD'


by James Leonard Park


1.  WHAT IS THE PRACTICAL MEANING OF "GOD WILL DECIDE"?
     END-OF-LIFE DECISION-MAKING IN RELIGIOUS PERSPECTIVE

    The assumption that God 'calls the shots' at the end of life
goes back as far as there was any belief in God or gods.
Long before there was any medical care in our modern sense,
human beings were born and they died.
And often these events were assumed to be controlled by the gods:
"God gives life and God takes life away."

    When people died, it was said that
"God took them" or that they "went to meet their Maker".
Whatever we individually might believe about such matters,
we ought to allow other people to have their own views
as long as their views do not interfere
with the
rights of all to believe and behave as seems best to them.

    A.  Do Nothing but Pray.

    At one end of the spectrum of religious beliefs,
some people believe that
no medical intervention is appropriate.
Such believers depend primarily on prayer.
(Or at least they seriously try prayer.)
When they get sick, they pray for God to cure them.
When they are dying, they decide
not to use medical care,
because they believe that all power to heal comes from God.
They will pray to be saved from death,
but they will accept death if it comes
as a decision made by God.

    Another, more secular, way to look at this orientation
is that it allows "nature to take its course".
Before medical science emerged, this was actually the
only option.
The friends and relatives could sit with the dying,
but there was nothing they could do to prevent the coming death.

    Doing nothing except praying or letting nature take its course
allowed natural dying to occur.
And some religious people expressed this as

God is deciding this life is over
.

    B.  Prayer plus Limited Medical Treatments.

    Some people of faith use
both prayer and medical science
when they face sickness and possible death.
Their first impulse might be to ask for divine intervention.
But next they call the doctor to set up an appointment.
Or they might go to the emergency room if necessary.

    Perhaps they say God gave us the intelligence to create medical science.
So, we are actually using our God-given talents to the best advantage
when we make reasonable use of whatever medical care is available to us. 

    In practice, the people in the middle group will use medical science
as fully as seems reasonable to them.
Some might say that doctors are good at setting bones
and removing cancerous tissue.
But when it comes to subtle diseases and other problems
that do not have obvious physical causes,
they might believe that
God's power is more appropriate.

    Different religious groups pull back from using medical science
at different points in the process of accepting health-care.
For example, Jehovah's Witnesses do not accept blood transfusions
or any other treatments that include significant amounts of blood products.
Here a religious belief trumps any scientific evidence.
And courts (when consulted) have usually agreed
that religious people may refuse treatment based on their beliefs,
just as all people have the right to accept or reject medical treatment.

     Should life-supports be used, and if so, which are most appropriate
from the perspectives of particular religious beliefs?
How long should life-supports be used?
And if we withdraw (or refuse) life-support systems,
are we closer to
letting God decide when life should end?

    C.  Prayer plus All-Possible Medical Care.

    The most liberal meaning of "let God decide" says:
All forms of medicine are part of God's plan for human health-care.
These believers do as much praying as they like,
but they will also consult as many medical specialists as they like. 
All possible efforts must be made to save the dying from death.

    And when the patient dies
despite all possible medical efforts
this is the practical meaning of "let God decide".

    People who profess no religious belief
might also expect
maximum medical care.
And the health-care system usually supports
the choice of all possible medical interventions.
Only when it has become absolutely clear
from the scientific point of view that this patient will never recover
do the doctors sometimes say "nothing more can be done".
Then (and only then) is it appropriate to 'let God decide'.

    And sometimes patients who have been declared beyond medical cure
do experience a 'miraculous' recovery. 
Religious people might easily thank God for such unforeseen outcomes.

    Thus, it seems that the
spectrum of religious choices
is very similar to the
spectrum of secular choices
People without religious beliefs
might also refuse most medical treatment (Option A)
and wait for whatever will happen without medical intervention.
Secular people might try medical cures up to a certain point (Option B)
and then decide to discontinue what does not seem to be working.
And secular people sometimes demand maximum medical care (Option C)
even care that might seem to be futile or harmful.




2.  ALLOWING ALL RELIGIOUS PEOPLE
            TO MAKE THEIR OWN MEDICAL CHOICES


    No effort here will be made to discuss how various religious beliefs
will have an impact on medical decision-making.
In open-minded societies with no state-established religions,
all people have the right to make their own medical choices
whether informed by religious beliefs or not. 

    Organized religions have a right
to attempt to influence the decisions of their members.
And religious leaders have a right to join in any
rational discussion
of all issues related to the end-of-life.
Also religious believers have a right to
vote on any public issues
based on their own religious beliefs.

    However, all secular systems of law should resist attempts
to put religious principles into the laws.

   
Wherever any form of government has an explicit religious basis,
then the established religious authorities
do have a right
to force their religiously-based principles on the people.
And if a hospital is owned and operated by an organized religion,
the religious authorities have a right to impose their principles
on all patients cared for on those premises.

    But some religious believers are open to using
rational discussion
to apply religious principles to each bedside situation.
For example, dialysis for patients who suffer from kidney failure
is well accepted by religious believers.
And most religious leaders and their followers
would also consider it reasonable to
discontinue dialysis
when the patient is dying
despite this treatment.

    Exactly how religious principles apply to each death-bed situation
will have to be decided by each patient and/or that patient's family.
If they believe that their religion
rejects a certain medical treatment,
then they will
not authorize that course of action.




3.  MEDICAL PROFESSIONALS SHOULD NOT 'PLAY GOD'

    Sometimes doctors seem to have God-like powers.
They can occasionally save people from death
when the objective chances were slim.
They are encouraged to 'play God' when it means
using the equipment in the emergency room to save someone from death.

    But many religious believers hold that doctors
should never declare a human life beyond hope:
"Where there's life, there's hope."
Such maximum use of medical science and technology
holds that we 'play God' only when we turn off the machines.
God (not the doctor) should decide the last moment of the patient's life.

    If we pay close attention to how the expression "playing God" is used,
we might observe that it is seldom or never applied
to situations in which medical science and technology are being used.
Attaching 'tubes and machines' to the patient is not called "playing God".

    Is "playing God" only used to describe situations in which
'tubes and machines' are disconnected?
Are we "playing God" only when we make life-ending decisions?

    Such religious questions will have to be worked out
between the believers and their religious advisors.
The practice of medicine should respect religious beliefs whenever possible.
But when medical principles and religious principles conflict
(as for example when religious believers demand futile medical care),
then the medical principles must ultimately prevail.

    However, with respect to life-ending decisions,
the exact timing of removing life-supports, for example,
can usually accommodate the religious beliefs of the patient and/or family.
Using their own religious principles, when is the best time to 'pull the plug'?




{The following section on Safeguards is the same as used for the worry called:
SUICIDE IS A SIN AND OTHER RELIGIOUS OBJECTIONS.}

4.  SAFEGUARDS TO PROTECT RELIGIOUS BELIEVERS

    The following 12 safeguards make sure that the consciences of religious believers
are not violated in making any end-of-life choices.
In open societies such as our own,
followers of any religious tradition are free
to apply their own moral principles to their end-of-life situations
in whatever ways seem best to them.
The following safeguards allow ample opportunity
for several different persons
to make sure that religious principles are not violated.

    These safeguards are arranged beginning with the safeguards
that would be most relevant and powerful.
The
blue title links to a complete explanation of that safeguard.
The
red comments explain how that safeguard respects religious beliefs.


A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS THE CHOICE FOR DEATH

    The patient and/or family members might consult their clergy-person.
If this professional religious leader says
that
all life-ending decisions are forbidden,
then that patient and his/her family might decide
not to choose even to consider such a practice
as disconnecting life-supports even when the case is hopeless.
On the other hand, the religious leader might say
that nothing in their faith tells them
that certain medical treatments are mandatory.

RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

    When the patient does in fact embrace a certain set of moral principles,
written statements can be created explaining how those principles
might apply to the medical decisions at hand.

ADVANCE DIRECTIVE FOR MEDICAL CARE

    Each comprehensive Advance Directive for Medical Care
has a section for religious beliefs
since one's faith is often very important for making end-of-life decisions.
When the patient has stated the most relevant principles in advance,
then there should be much less confusion at the bedside
when religious or moral principles might have some bearing
on the decisions that need to be made.

REQUESTS FOR DEATH FROM THE PATIENT

    When the patient makes a request for death,
he or she might express some relevant religious beliefs.
What implications do his or her religious beliefs
have for the patient's request for death?

INFORMED CONSENT FROM THE PATIENT

    When the patient is asked to give informed consent,
he or she might also bring religious principles to bear on the decision.
If, for example, no choices may be permitted that will lead to death,
then the patient will
never give consent for any medical procedure
that include any of those prohibited options.

UNBEARABLE SUFFERING

    Suffering might have some religious meaning for the patient.
This could lead to different decisions about the best pathway towards death.
How does
suffering figure in the patient's thinking about death?
When (if ever) does suffering become meaningless for the patient?
How does the patient's belief-system
deal with protracted, unbearable suffering?


UNBEARABLE PSYCHOLOGICAL SUFFERING

   
The patient might also be suffering psychologically or spiritually.
And this should be taken into account in all end-of-life decisions.
Sometimes the religious beliefs of the patient
will be a
cause of psychological suffering.
How will any such conflicts be resolved?
For example, is the patient worried about going to hell for some sin?
Can confession and absolution
resolve this form of psychological or spiritual suffering?


STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING THE CHOSEN DEATH

    When family members are asked to create their own written statements,
they also are free to mention any relevant religious beliefs or principles.
The family might have a
range of moral and religious systems.
In case of conflicts about end-of-life decisions,
the
patient or the duly-authorized proxies must make the final decisions.
But at least all points of view will have been heard
before the deciders go ahead with
whatever seems
wisest and most moral to them.

PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

   
The physician's summary of the patient's physical condition
will be the basic factual background for making end-of-life decisions.
In most cases, the physician will not express any religious views.

INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

   
A second physician will also issue a written statement,
giving an independent assessment of the patient's condition and prognosis.
This also will be taken into account by the deciders,
who are free to apply any moral or religious principles they wish.

PSYCHOLOGICAL CONSULTANT EVALUATES
           THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

   
A psychological professional will evaluate the patient's abilities
to make wise medical decisions.
And this consultant should not attempt to override any religious beliefs
or other moral principles that the patient and/or the family wish to use.

ETHICS COMMITTEE REVIEWS THE LIFE-ENDING DECISION

    The institution caring for the patient might have an ethics committee
that could be asked to review the plans for the last year of the patient.
And if this committee knows of any relevant religious or moral views,
they should not attempt to
override these principles.
Rather, the ethics committee should make sure
that all relevant ethical principles are brought to bear
on the final decisions for this patient.


   
If these safeguards do not seem sufficient
to prevent trampling on the religious beliefs of the patient,
then there are several other safeguards
that might be brought to bear on the end-of-life decisions.



Created January 17, 2010; revised 1-26-2010; 1-30-2010; 4-2-2010; 5-21-2010;
1-11-2011; 6-28-2011: 12-22-2011; 1-21-2012 ; 2-21-2012; 3-28-2012; 4-12-2012; 7-18-2012; 9-12-2012;
3-28-2013; 6-21-2013; 10-10-2014; 7-4-2015; 



The above exploration of the various meanings of "Let God decide"
is also Chapter 10 of How to Die: Safeguards for Life-Ending Decisions:
"God Will Decide When Life Will End: We Should Not 'Play God' ".

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discussing this book-being-revised?


See the complete description for this seminar:
http://www.tc.umn.edu/~parkx032/ED-HTD.html


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