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 others to have other 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?
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 life.
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