2nd Opinion: Technology at the end of life

My friend Lee is a prime example of how a person can benefit from modern medicine. At 70, he serves many churches. He is able to do so because 30 years ago, bypass surgery kept his heart going. Since then, he has had another bypass and surgery to repair an aortic aneurysm. His service is testimony to God's gift of life-saving technology.

On the other hand, technology is not always a blessing. At age 92, Tom lived independently but closely connected to his church. One Sunday, he mentioned that when his time came, he wanted to die in church. Several weeks later, while in the sanctuary listening to the choir practice, he collapsed. Paramedics quickly shocked and restarted his heart. His emergency room physician greeted me with, "John, we have a save." But a "save" it was not. After a week in the intensive care unit on maximal life support, he died. This was not the death Tom would have chosen. Many would say Tom's final week illustrates technology gone awry.

Most of us will make difficult decisions as to how much medical care should prolong our lives. I suggest four guidelines:

• Be aggressive in the treatment of disease early, when it is most helpful. Delayed treatment may add a few weeks or months to one's life, but often at the expense of pain and suffering.

• Define the purpose clearly. Decide whether the treatment is to cure or to prepare for a comfortable and dignified death. Sometimes, this requires withdrawing or withholding treatment. While one patient might decide not to treat his life-threatening cancer, another patient might decide to stop treatment that has been keeping him alive. Most Christian ethicists approve either of these choices.

Unfortunately, a distinction between treatments designed to cure or to comfort is not always clear. A common struggle in intensive care units involves care of a patient with end-stage emphysema. If the lungs fail, a breathing machine is necessary to sustain life. But it never is certain a patient will be able to get off the ventilator and return to breathing on his own. He may become dependent on the ventilator. Many would not choose to be kept alive that way. One option is to use the machine with a limit in mind. For example, medical staff might use the ventilator for up to five days. But if the patient is unable to breathe on her own after that, the treatment would stop. This prevents survivors from saying, "We never even tried."

Leona, 86, suffers from severe emphysema. She uses oxygen around-the-clock and was hospitalized five times in the last two years. She required a ventilator to keep her alive twice—the first time for one day, but then for three days. She hated those experiences and made it clear she did not want a machine to keep her alive. Her doctor suggested she limit the treatment. Now, if Leona cannot get off the ventilator in seven days, her doctor will sedate her with appropriate doses of morphine and remove her from the machine.

• Weigh the burden against the potential benefit. Burdens we must consider include financial, emotional and physical (in terms of pain and suffering) costs, as well as risks. In my experience as a geriatrician, this cost counting is crucial when treating an elderly person who is acutely ill.

• Is the treatment considered ordinary or extraordinary care? Ordinary care is the minimal level we all deserve as humans created in the image of God, including such things as food and fluids, being kept warm and receiving loving compassion. Jesus refers to all of these in Matthew 25:34-40.

I consider extraordinary care to be anything that involves potentially life-prolonging treatment. We are not required to pursue such treatment. It may be wrong in the following contexts …

It violates the expressed wish of the patient.

It is generally felt to be futile.

It is presented as being more effective and less risky than it truly is.

It is an effort to defy God's will that the patient die.

I want to come to the end of life when God calls me home, not when technology fails. Doing so likely will require that, at some time, I say "no" to life-prolonging treatment.

Excerpted from Finishing Well to the Glory of God by John Dunlop, © 2011. Used by permission of Crossway, a ministry of Good News Publishers, Wheaton, IL 60187; www.crossway.org.