Difficult Conversations, Difficult Decisions – Part 1

It’s a common scenario for too many pastors.  We’re called to the Hospital ICU to meet with a grieving family – grieving not because of a death that has happened but because of the death that seems immanent.  The patient, generally elderly and with a terminal illness, is being sustained by machines and tubes.  There is no practical hope for earthly survival beyond the confines of a weak and comatose body in a nursing home or care facility.  Adult children experience the gamut of emotions – from anger to guilt – as they consider “what mom/dad would want.”

In his New York Times best selling book, Being Mortal: Medicine and What Matters in the End, general surgeon Atul Gawande addresses how our medical system, with its technological and scientific advancements, has ultimately failed us when it comes to matters of death and dying.  We Americans have become afflicted with a deep arrogance that death is somehow a failure to survive.  We tell our doctors, “Do whatever you have to do,” or “I’ll do whatever it takes,” when, in reality, mortality is not something modern medicine can combat.

But that doesn’t stop us from trying.

We subject our loved ones to invasive treatments with gnarly and barbaric side effects – why?  Are we so afraid of death we’ve decided to sacrifice quality of life for longevity?  Gawande argues this is exactly the case with modern medicine.  Rather than provide palliative care – maintaining a person’s dignity and comfort at the end of life – doctors are too frequently tempted to pull out all the stops in treating a condition that ultimately can’t be treated: mortality.  And we’re all too tempted to let them.

Our bodies are temporal – they’re designed to last only a certain number of years.  This seemed abundantly clear to the author of Ecclesiastes:

For everything there is a season, and a time for every matter under heaven;

A time to be born, and a time to die…

Ecclesiastes 3:1-2 NRSV

We’ve forgotten the art of dying gracefully.  In our scientific and technological successes, we’ve come to imagine death as a failure of medicine rather than a natural part of the life process.  In our fear – fear of losing our loved ones, fear of pain – we avoid discussing the topic with our families and loved ones until it becomes too late.

“Would mom/dad want to live their remaining days in a state of unconsciousness, hooked up to any number of life-sustaining machines?” “Would mom/dad want to die at home in her/his own bed, aware of surroundings and situation?”  Aging adults are often just as hesitant to discuss these matters with their next-of-kin.


Young mothers are known to establish, with their care providers and partners, birthing plans – a plan of action outlying the mother’s desires for childbirth.  “What level of pain intervention (medication) would you want?”  “Who would you like to have with you in the delivery room?”  “Do you want to nurse or bottle feed?”  These and other very basic questions outline the general parameters for the event and everybody involved is made known of them in advance, leaving nothing to guess.  Why don’t we have the same types of conversations about our deaths?

In this first part (part 2 of this thought will be posted next week), I encourage you to have these difficult conversations with your family.  When it appears death is eminent, do you want “heroic measures?”  Do you even know what that means?  What level of consciousness/awareness do you want to be in?  Who do you want with you?

Making these difficult decisions and having these difficult conversations can be emotional and daunting; mortality is not something we’re generally comfortable contemplating, let alone discussing – especially when it’s someone we love.  And this is where our faith comes in to play.  Remember that, because of the resurrection, we have no cause to fear death.  Christ has provided eternal life!  Death is not the end – it’s the beginning of what’s next in our journey with God.

There is no easy way to decide when to aggressively treat an illness or when to begin palliative care.  Deciding when (or if) to utilize the specialty care of hospice is never a simple matter.  All the more reason to have these discussions with your family now.

May God’s peace be with you in this life, and in the transition to the next.



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