4 biblical principles for end-of-life dilemmas

February 1, 2021

In a recent ERLC film, Eric and Ruth Brown privileged us with the story of Pearl, their daughter born with severe congenital malformations. When doctors doubted Pearl’s survival outside the womb, the Browns clung to their faith, and chose life. In the poignant film, the Browns share the joy Pearl infused into their lives, and also their grief when she died after removal from a ventilator before her sixth birthday. God’s love, so clear to the Browns while Pearl was alive, seemed elusive in her absence, and they felt ill-equipped for the reality that children like Pearl often grace the earth only briefly. “I think,” Eric reflected, “we need to be equally as invigorated with learning how and helping each other know how to say goodbye.”  

In an era when intensive care medicine blurs the line between life and death, the dilemma of how and when to say goodbye pitches so many families like the Browns into anguish. Fifty years ago death occurred within homes and communities, where families could witness and understand it. By contrast, current medical technologies, although they’ve empowered us to save life in many circumstances, have also transformed death into a prolonged and painful process, steeped in unfamiliar jargon that confuses and unsettles us. 

Our faith clearly emboldens us to pursue life for the unborn, but when faced with a loved one dying on a machine, suddenly the path forward seems nebulous. We yearn to love our neighbor, but can’t discern how to proceed when care involves a mechanical ventilator, chest compressions, and feeding tubes. Such dilemmas can saddle us with guilt and despair long after we’ve said goodbye, with studies showing that a year after a loved one dies in the ICU, up to 40% of family members grapple with generalized anxiety, depression, post-traumatic stress disorder, and complicated grief.1Danielle 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): 387-393; 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. 

How do we honor God in such harrowing scenarios? How do we cherish life, and love our neighbor, and accept God’s will when dying involves ventilators and resuscitation? How do we know how and when to say goodbye?

Every situation is unique, and counsel from trusted physicians and pastors is essential with such delicate matters. Prayer, likewise, is paramount, as is immersion in God’s Word. When hard questions stir us to sleeplessness, reflection upon four key biblical principles can guide us through end-of-life dilemmas with peace and discernment:  

1. Sanctity of mortal life 

As beings created in God’s image, we each possess irrevocable value (Gen. 1:26), and stewardship of God’s creation requires special concern for human life (Gen. 1:28; 1 Cor. 6:19-20; Rom. 4:18). The Lord entrusts us with life and commands us to cherish it through the commandment, “You shall not murder” (Ex. 20:13). The sanctity of mortal life mandates that we advocate for the unborn and safeguard against physician-assisted suicide, and also requires that when struggling with an array of decisions about life-supporting measures, we consider treatments with the potential to cure.  

2. God’s authority over life and death 

Although God directs us to honor the life he has created, he also reminds us of its fleeting nature (Isa. 40:7-8). Death persists in this earthly kingdom as the wages of our sin (Rom. 6:23), and it overtakes us all (Rom. 5:12). When we blind ourselves to our own mortality, we ignore that our times are in his hands (Ps. 31:15), dismiss the power of his grace in our lives through Christ’s resurrection, and disregard the truth that the Lord works through all things—even death—for the good of those who love him (Rom. 8:28). Sanctity of mortal life does not refute the inevitability of death and God’s work through and authority over it.

3. Mercy and compassion 

Loving one another at the bedside requires attention to suffering. God calls us to love our neighbors as ourselves (Matt. 22:39), and especially to extend mercy toward the downtrodden and afflicted (John 13:34; 1 John 3:16-17; Luke 6:36). Mercy doesn’t justify active euthanasia or physician-assisted suicide, but it does guide us away from aggressive, painful interventions if such measure are futile. 

4. Hope in Christ 

So vast is God’s love for us, that in Christ nothing—not even death!—can pry us from him (Rom. 8:38-39). Even as we suffer, we rejoice that Christ has relinquished us from the permanence of death (1 Cor. 15:54-55). We savor the promise of the resurrection of the body and the hope of eternal union with God (1 Thess. 4:14). The gospel transforms our view of dying, and chases away our fear; although we die, we are alive in Christ (John 11:25-26)!

In summary, in end-of-life dilemmas the Bible guides us to seek cure when recovery is possible, but also to accept death when it arrives, and to alleviate suffering, all the while cleaving to our hope in Christ, our Redeemer. 

Preservation of life or prolonged suffering?

Distinguishing between these principles, which appear stark on paper, but tangled and messy at the bedside, depends on a key question: “Will life support in this scenario constitute preservation of life, or prolongation of death and undue suffering?” It’s crucial here to clarify that life-sustaining measures are supportive, not curative. Ventilators, dialysis, blood pressure support, and similar interventions don’t cure disease, but instead buy time, buoying organ function while physicians work to treat the underlying illness (with antibiotics for pneumonia, chemotherapy for cancer, coronary stents for a heart attack, etc). If the inciting disease is treatable, then life support is indeed “life-saving,” because it maintains our body systems long enough for us to recover. However, if the core illness is irreversible (e.g., end-stage emphysema or metastatic cancer without treatment options), life support prolongs dying, and can inflict suffering without ever ushering us to recovery. 

Questions about whether to pursue or decline life support for our loved ones, then, depend less on the technology itself, and more on whether the life-threatening illness is treatable. Asking a medical care team the following questions can provide insight:

When coupled with biblical principles, answers to the above questions can help us to discern when the Lord urges us to press onward, or when he beckons a loved one home. “When it seemed as though God was wanting Pearly to thrive, we supported her,” Eric Brown commented a few days after Pearl’s death. “And when it came time to send Pearl home, we had to support that, as well.” 

When the time comes to send our loved ones home, grief can cripple us. Yet even in our anguish, we rest in the promise that for those in Christ, death is a temporary parting, but not a farewell. By grace, we have been saved (Eph. 2:4). And nothing—not a ventilator, not an incurable illness, not even death itself—can wrench us from God’s love for us in Christ Jesus (Rom. 8:38-39). 

Kathryn Butler

Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma surgeon who is board certified in surgical critical care and served on the faculty at Massachusetts General Hospital and Harvard Medical School. After a decade of experience in surgery, she left clinical practice in 2016 to homeschool her … Read More