I could hardly blame the pastor. He meant well. The nurse called my office and said, “Mrs. Lavo is quite upset since her minister left. Could you see her? Mrs. Lavo and I had already spent several hours talking about her upcoming therapeutic abortion. The time was not spent making a decision, however. The options seemed clear: If she had the surgery, she would live; if she did not, she would die. Our hours together had focused on the sadness and understandable yet debilitating guilt that plagued her.
After much time spent reassuring her of God’s grace and the sad necessity of this surgery, I left, planning to see her the next day.
That night her minister bustled in, and after hurriedly checking out the legitimacy of the abortion, left her with the words “Well, it’s a good thing this is a therapeutic abortion. Otherwise it would be murder.” He left, she panicked, and I was called.
Mrs. Lavo’s pastor and I share at least one thing in common: We both are sometimes more attentive to the issues than to the person experiencing them.
I remember the time a frightened young patient said to me, “What do you think of this chemotherapy stuff?” After launching into a generic response, it occurred to me that possibly he was really asking, “Is it wrong to refuse treatment and die?” I was duped by the subject and didn’t listen to the patient.
There are ways to help, or hinder, parishioners when faced with what has come to be called “an ethical dilemma.” Some of these dilemmas are ethical, and some are not. Some situations begin as an apparent medical ethics dilemma, but when the issues are clarified, end up as something else. The pastor’s task is to help parishioners sort out what is and is not a moral issue, and help them through the maze of decision making in either case. This can be a frightening task, but there are guidelines.
The search for guidelines begins with the question, “What is Christian medical ethics?” The simplest answer is “making medical decisions in the context of faithfulness to Jesus Christ.” The word faithfulness pertains to what is true and right, as well as compassionate. The balance between rightness and compassion is where the dilemma lies for most Christians. When human sinfulness is acknowledged and the grace of God is discovered, we have taken the first step toward making a faithful decision.
For pastors, medical ethics most often deals with parishioners who are terminally ill, comatose, and/or elderly. Other dilemmas relate to abortion, organ transplants, genetic counseling, and artificial insemination. But pastors find their most common dilemmas facing a patient in the intensive care unit for whom decisions have to be made by family or friends. Here pastoral guidance is frequently needed and requested. What can we do? What can we say? What is our role?
Asking the Right Questions
One critical issue is to help the family ask the right questions. The right questions can greatly influence the eventual decision, or whether a decision is even necessary.
Ethel was brain dead. Her husband had been sitting in the lounge of the intensive care unit for a week and didn’t want to admit the end was coming. The physician was still hedging and talking about EEGs and “minimal responses,” which left the ambiguous message that she might still be alive. The husband thought he had to make a decision to withdraw life support equipment. To him that would mean ending her life.
When the pastor arrived, he acted as a supportive bridge between the physician and Ethel’s husband. It was finally the pastor who asked the physician, “Is she dead?” The doctor nodded. The husband wept. And the machines were turned off. No decision needed to be made.
The pastor had said what the other two dared not voice, because he bears the additional message that death is not the ultimate reality. The pastor had new hope to offer in the resurrection of our Lord.
Where it is not possible for us to be with the patient or family members when the physician poses a dilemma, our task is to encourage them to ask the right questions: “Will this treatment change the ultimate outcome of the disease?” Or, “Is this procedure expected to help cure or comfort?”
I’ve also found it helpful to ask the parishioner, “What is the hardest thing for you to bear in all of this?”
Weighing the Burden
On the mind of nearly everyone faced with the possibility of needing life support is the concern: I don’t want to be a burden. The one thing we all dread is having to live with suffering and with the burden such suffering produces. It is unfortunate that this aspect of medical ethical decisions gets such biased news coverage, reporting that another citizen must bear the injustice of a medical burden. Our hearts go out to those saddled with an invalid husband or a comatose child. The implied conclusion is that no one should have to suffer such things.
I am always amazed at how easily some people, when they hear someone has to suffer greatly, tend to sympathize with those who would solve the problem by “putting people out of their misery.” The church’s message used to be “bear one another’s burdens.” It is rapidly becoming “no one should have to bear a burden.” If the pastor conveys this message, his parishioners will not be far behind. No one wants to live with discomfort, inconvenience, or suffering in an age of instant gratification.
Making ethical decisions based on feelings alone is neither helpful nor complete, even when those feelings are labeled compassion or kindness. Emotive ethics, that tendency in all of us to make decisions based on feelings rather than right standards, is an extension of the 1960s slogan “If it feels good, do it!”
Nurses in our hospital sometimes tell me of some well-meaning pastor who gives a family or patient counsel I consider inappropriate. When they sense my disapproval, they usually try to defend the person with “Well, it made the family feel better,” as if this is the primary goal of pastoral care. The responsible and ultimately helpful pastor is one who can help the family or patient make a decision that not only “feels” good at the time, but one that lasts-a decision they can live with because it makes sense in the light of one’s calling in Jesus Christ, who is Lord of all life.
Mrs. Mengel was refusing surgery. Her doctor asked me to speak with her about the importance of bowel surgery to correct a blockage. Although she was seventy-five years old and lived in a nursing home, apart from this malady she was in fairly good health. With the minor surgery she could live many more years. But Mrs. Mengel refused on the grounds that she did not like the nursing home and wanted to die. Her granddaughter sat by her bedside daily and sobbed in affirmation of her grandmother’s wishes, “If that’s what she wants, that’s what I want.”
It became clear that what Grandmother wanted was someone to take her out of the nursing home. Refusing surgery was her form of blackmail. The naive, trendy granddaughter reflected emotive ethics and supported her grandmother’s decision on the basis that her life was a burden. The real issue was the relationship between grandmother and family. I told the family the problem of “burden” is best resolved, not by ending her life, but by bearing it with her. The family did not like my comment, but Grandmother did.
Examining motives, anxieties, and fears is an obvious role for the pastor dealing with medical ethics dilemmas. He possesses the broader picture of human nature and the needs only God can fill. The psychologist might champion the cause of patient autonomy in decision making, but the deeper need is for fellowship with God and those he has redeemed. A pastor is called to focus on those relationships, since all dilemmas are resolved only by trusting God’s grace, which reconciles us to himself and each other.
Letting God Work
A third key to pastoral intervention in medical ethics dilemmas is to keep parishioners from panic. When people are worn down by much waiting, they naturally tend to take matters into their own hands. That sometimes means taking things out of God’s hands.
Much waiting is frequently the lot of terminally ill, comatose, or elderly patients. The burdens may increase, but that doesn’t change the appropriateness of waiting. Patience is linked to the conviction that Jesus Christ is Lord of life. “Waiting on the Lord” has never been easy, but in so doing, we discover to whom we belong and where we are heading in life.
Some time ago a nurse stood at the bedside of a stroke victim. Three weeks had passed since the stroke, and as this nurse stood with the family, he heard their anguish. When the family left, he turned off the respirator, and a helpless, living patient died. Appropriate legal action was taken against the nurse, but most disturbing was the popular sentiment that “someone needed to do what he did.” What he had done was to take matters into his own hands rather than commend them to God.
As pastors, our job is to help people deal with feelings of helplessness by acknowledging them and identifying them as opportunities to trust in God’s actions for their good. Faithfulness means putting things into God’s hands, rather than grasping control ourselves. Jesus “emptied himself, taking the form of a servant.” We, too, in our helplessness learn to be servants rather than gods. Pastors who model helplessness yet faithfulness also model for their people how to bear burdens.
Facing Guilt
Then there is the matter of helping people face feelings of guilt when they have made the wrong, or even the right, decision. Few decisions are clearly one or the other. Many choices are made between two evils.
For that reason, one of our most important roles as pastors is to identify sin and grace as components of medical ethics. No one is perfect. Having determined what we believe to be the most faithful decision, we still must act under the grace of God.
When a parishioner is defensive about a particular decision, I look for guilt and unresolved issues in that person. When a parishioner seems to make a decision about himself or a loved one too easily, I try to draw out feelings by posing the right questions. My concern is to help the parishioner deal with the guilt that will be felt later on.
Mrs. Cleary’s husband had been transferred from a medical unit to the intensive care unit. A respirator had been connected to help him breathe, but it prevented him from talking to his wife. He was too weak to write. As it became evident that he might not survive, Mrs. Cleary asked that the respirator be removed so they might speak to one another before death came. The dilemma was that by removing the respirator, he might die immediately. Mrs. Cleary wanted to take the risk, hoping for some meaningful words with him before he died.
I felt it was important that she realize the consequences of her request. I knew his last words were vital to her, but I also realized she would be devastated by guilt if he died as a result of her decision, especially if he were still unable to communicate despite her effort. I advised her not to remove the respirator.
As it happened, her husband died before she could make the final decision. She never did hear him speak. But neither did she bear the guilt of his death. She did, however, appreciate everyone’s efforts to care for her and do what was right for her husband.
Praying Always
Mr. Lewis had been dependent on a respirator for weeks. He began to despair and motioned for it to be turned off so he could die. Since there was little else wrong with Mr. Lewis and he could live this way for some time, the physicians and nurses refused his request. He begged his wife to do it for him. She told him not to talk about it, and he withdrew into depression.
When I met Mr. Lewis, he was lying with his eyes closed, waiting to die of sheer lack of will to live. As I spoke to him, he ignored my words and pretended to sleep. I chose to speak as I would to a patient in a coma. He listened. I concluded with a prayer that God would allow him to die. Mr. Lewis opened his eyes and nodded in affirmation of my prayer. In the weeks that followed, I continued to pray for his death, and Mr. Lewis sank into a coma and died about a month after I met him.
Whether or not we should pray for death is not easily determined, but on occasion, I’m convinced it’s appropriate. Mr. Lewis and I had commended his care into the hands of God. Medicine could do nothing more for him. In praying for his death, the lines of communication and faith were kept open for Mr. Lewis. The grace of God will have to cover us both, since we cannot be certain either of us did the right thing.
Praying with patients and family members is the only way tension can be eased and patience provided as we hand over our worries to the Lord. Our helplessness is answered, and control is given to the one who rightly holds it. Pastors who listen carefully, take the time to observe the whole situation, and consult with other pastors in delicate situations, often find an effective ministry in praying boldly with people.
In 1 Corinthians 6:19-20, Paul says, “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.” Even thin, worn, and apparently lifeless bodies can give God glory because they are commended to Jesus Christ, who made them, sustained them, and now receives them to himself in death.
Pastors who keep the faith, who move beyond expediency, will use compassion to interpret faithfulness, not to twist compassion according to the wishes of society. In a fallen world, the easy way is not always the best way. The faithful way is always a burden worthy of being borne.
Richard C. Eyer is chaplain and director of pastoral care, Columbia Hospital, Milwaukee, Wisconsin.
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