End-of-Life Decision-Making

1996 Church of the Brethren Statement

Contents:


Introduction

This foundational statement is to assist members of the Church of the Brethren in relating end-of-life decisions to faith. Taken into account are biblical teachings, Christian principles, Brethren traditions, and contemporary realities. The statement is to be augmented with periodic study papers detailing specific issues and concerns.

Biblical Affirmation

"We do not live to ourselves, and we do not die to ourselves. If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord's. For to this end Christ died and lived again, so that he might be Lord both of the dead and of the living" (Rom. 14:7-9).

Christ is, indeed, Lord of both our living and our dying. As Christians, we believe that life will continue after death. Yet, since death represents the end of life as we know it, we often are perplexed and fearful of dying and death.

The good news of the New Testament, however, affirms that in Christ, death is overcome and becomes the prelude to new and everlasting life.

The Contemporary Context

Our Christian faith develops out of such biblical affirmation. Brethren are urged to draw on that faith as modern health care presents them with end-of-life dilemmas for which clear answers are elusive. Some examples:

An 85-year-old woman suffers a stroke that leaves her comatose and unable to swallow. The living will, signed by the patient five years before, requests that her life not be maintained by artificial nutrition and hydration, yet family members are divided. Should they honor that request or grant permission to place a feeding tube into her stomach?

An 18-year-old man has sustained multiple gunshot wounds, including severe head injuries. Diagnostic tests indicate that his brain is severely damaged, and that he exists in a "persistent vegetative state." Should his parents allow life-sustaining treatment to begin, recognizing that later they may need to decide whether to remove the ventilator that maintains his breathing?

A child is born with multiple physical problems that are incompatible with life. How can the parents decide whether or not to pursue an expensive and painful series of surgeries when the physician informs them that, at best, the child's life will be extended by a year?

A 60-year-old man has bone cancer. The pain he experiences is unendurable. He tells his family and his physician, "I just want to die and get this over with," and asks for "something to end all of this suffering." How do compassionate caregivers respond to such a request knowing that the illness is terminal and the pain unbearable?

A woman of 70 is in the late stages of Alzheimer's. She no longer recognizes her family nor can she communicate meaningfully. The expense of her care in a nursing facility is exhausting the family's life savings. The emotional and financial strain is taking its toll on her family. Amidst declining resources, what level of ongoing care can be provided? Where does her family find needed support?

Brethren tradition

The Brethren, out of commitment to the Lord Jesus Christ, the study of the scriptures, and life together, have developed traditions that continue to guide them in dying and death. Brethren seriously and joyfully embrace the understanding that death is the door to eternal life with God. Brethren are called to live in readiness because the exact timing and circumstances of death are not ours to determine. A consistent life of faithfulness and obedience to God, not deathbed conversion, is the way to prepare for death.

The Brethren commitment to simple living is to be expressed also in dying. In past generations the deceased person was remembered in a simple worship service of hymn-singing and preaching of the Word. Many congregations maintained cemeteries for the use of their members, and it was not unusual for church members to build the plain wood coffin that they carried to the grave they had prepared.

In Brethren tradition, the family of faith has often gathered around those who were dying and grieving with ministries of care and support. The church community, past and present, offers both spiritual support through anointing, special times of prayer, and compassionate presence, and practical assistance, such as preparation of food and, in rural settings, help with seasonal tasks.

Decision-making complexities

Many factors besides our faith influence us as death approaches for ourselves or our loved ones. Our own fears, guilt, grief, cultural attitudes about death, funeral customs, different ways family members understand end-of-life issues--all of these complicate our decision-making.

Medical knowledge and modern technology that have the capacity to alter the process of dying, and the increasing costs of health care, make end-of-life decisions even more difficult.

It is impossible to develop definitive answers to all the questions surrounding dying and death. However, out of the perspective of our faith as Christians and our tradition as Brethren, there are guidelines to assist us.

Guiding Christian principles

Faith Values to Assist in End-of Life Decision-Making

Some Christian values, important to the Church of the Brethren, that sustain a lifetime of obedience to God also become faithful guides for end-of-life decision-making.

Community. How do we surround and uplift people who are dying or grieving so that death does not break the bonds of Christian community?

The service of anointing, a powerful symbol of healing and hope, offers the compassion and care of the faith community. Through regular visitation and prayer the church includes those who are dying or grieving, heeding the advice to "bear one another's burdens." Following death, through the funeral, memorial services, the meal prepared by the congregation, and story-telling, we remember those who have been important in our faith community.

Integrity. How can we speak the truth in love and act with compassion in end-of-life situations?

As death approaches, open, honest, and complete communication is very important. The person who is dying, family members, and caregivers need to communicate honestly and compassionately with each other. Clear information about diagnosis and prognosis will help the terminally ill person make responsible, informed decisions. Family and caregivers need to hear, respect, and honor the integrity of those decisions. They also need to communicate honestly among themselves, recognizing that people approach end-of-life issues with different understandings and rates of acceptance.

Humility. How do we accept human limitations and affirm the goodness of God?

Medical technology and expertise, though helpful, may not adequately address the spiritual, social, emotional, and relational dimensions of life and death. Medical practice looks primarily at the physical and biological factors of disease, only a small part of the total illness. Medical technology is further limited by its inability ultimately to prevent death. Despite the best of medical care, every person dies. Allowing death to occur is a faithful and humble acknowledgement of the power and goodness of God who gives healing beyond death.

Reverence for Life. How do we live life to its fullest as death approaches?

Every life is important and precious in the sight of God, as affirmed by numerous Annual Conference statements. The active and intentional taking of life, including assisted suicide, is unacceptable. Also unacceptable, however, is allowing human pain and suffering to go unrelieved, or prolonging the dying process with extraordinary medical interventions. When death approaches, relief of pain and suffering is a higher value than simply prolonging life. Every available resource for relief, such as prayer, meditation, pain management techniques, pain clinics, hospice, and medication should be considered. The spiritual, emotional, relational, and physical nurture offered in love and compassion by family, friends, congregations, and professional caregivers, assists people to die with dignity and respect.

Mutual Respect. How do we respect the wishes, values, and decisions of people who are dying or bereaved?

There is no one right way to die or to grieve. Those who seek to be caring will not force their own views on those who are suffering, dying, or grieving but will remember that the ministry of presence is most important, and that listening is more helpful than giving advice. The wishes and values of those who are dying and grieving, including their decisions about medical care or other approaches to health care, are to be valued and respected.

Stewardship and Simplicity. How do we most faithfully use and care for God's gifts as death approaches?

Death and dying raise issues of the stewardship of our resources and our bodies. The preparation of a will directs survivors to distribute property and assets in accordance with the wishes of the deceased. This perpetuates the values and stewardship of the individual even after death. Advance care directives, a living will and durable power of attorney, for example, instruct care providers about preferred treatment choices, especially when a person is too ill to state his or her wishes. Choosing to donate organs and/or tissues at the time of death is another act of stewardship, which serves others who have special needs. The Brethren concern for simplicity extends to decisions regarding funeral services, memorial services, memorial gifts, burial, cremation, and other practices related to remembering and caring for persons who have died. Decisions discussed and recorded in advance can greatly simplify and humanize the care of those who are dying.

Justice. How can we best serve God and others amidst the economic realities surrounding death?

Because health care resources are limited and expensive, the use and distribution of care and medical technology becomes a justice issue. For instance, some have access to expensive medical procedures to forestall death while others are unable to secure basic health care. Or some may shift financial assets to family members to avoid paying health care costs. Recognizing that justice issues are a part of end-of-life decision-making, the church is called to assist people in making these decisions with accountability, affirming the well-being of all.

Resources for decision-making

Making decisions related to end-of-life issues is complex and difficult. Good judgment may be clouded by fatigue, grief, fear, or other emotions. For most of us, knowledge of medical terms and the nature of diseases is limited, and often we must depend on information supplied by others in arriving at decisions.

Health care providers, such as physicians and nurses, are a primary source of information about the physical condition of the patient. These professionals, along with chaplains, pastors, and social workers, are extremely valuable in giving information and clarifying issues for wise decision-making.

It is within the family and the congregation, however, that personal feelings, dilemmas, and decisions can best be explored. A caring congregation that provides ministries of visitation, presence, counsel, Bible readings, worship, and prayer is a primary resource. Trusted brothers and sisters may be called to serve as a support group to walk with people in their end-of-life decision-making. A congregational ethics committee could also provide guidance for complex end-of-life decisions. And for Brethren, the anointing service following the counsel of James is upheld: "Are any among you sick? They should call for the elders of the church and have them pray over them, anointing them with oil in the name of the Lord."

Recommendations for Action

Along with this faith statement, additional resources and opportunities are recommended to assist people and congregations in making informed decisions on end-of-life issues:

  1. Study materials on specific issues, such as biblical perspectives on death and dying; services of remembrance and burial; advance care directives; hospice care; family dynamics amidst loss and grief; estate planning; and stewardship of life and death. The development of at least one study document a year should be facilitated by the Association of Brethren Caregivers over the next several years.
  2. Guidelines and assistance to congregations in the formation of congregational ethics committees, provided by the General Board in consultation with the Association of Brethren Caregivers.
  3. Articles on decision-making carried by national, district, and congregational communication channels.
  4. Promotion and assistance in the preparation of advance care directives for people of all ages through appropriate agencies such as Brethren Homes, Brethren Benefit Trust, Association of Brethren Caregivers, Mutual Aid Association, and Brethren colleges.
  5. Courses and workshops at Bethany Theological Seminary and in other pastoral education settings on end-of-life issues and decision-making.
  6. Distribution of the Annual Conference Resolution on Organ and Tissue Donation and assistance to congregations in its promotion.
  7. Supportive relationships and information provided by pastors and deacons.
  8. Congregational files of end-of-life documents important to members, such as advance care directives and funeral or memorial service plans, to be maintained by the pastor and/or deacons.
  9. Intentional inclusion of end-of-life issues and decision-making in denominational, district, and congregational programming.

Conclusion

As people of faith, members of the Church of the Brethren, let us support one another in the difficult task of end-of-life decision-making. Let us encourage one another with the assurance that--even in this age of technology--it is Jesus who is the Resurrection and the Life, Lord of both the living and the dead.

Adopted by the General Board at its meeting of March 11, 1996, for recommendation to the 1996 Annual Conference.

Katherine E. Hess, Board Chair
Donald E. Miller, General Secretary

Action of the 1996 Annual Conference: John Henry, a Standing Committee member from the Southern Pennsylvania District presented the recommendation from Standing Committee that the End-of-Life Decision-Making Statement be adopted. The delegate body adopted the recommendation of Standing Committee.

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