As a hospital chaplain, I watch people almost every day.
However, I think you might be shaken if you saw how those deaths are sometimes painfully delayed through the conflicting wishes of family.
For example, an 82-year-old farmer came to our ER with a failing heart. Doctors twice restarted his heart and transferred him to ICU on a ventilator. After a few days, his doctors saw little hope and asked our palliative care team to talk to the family about options.
Palliative care is a philosophy that encourages quality of life over quantity of life. The Mayo Clinic website says the approach “…offers pain and symptom management and emotional and spiritual support [in the] face of a chronic, debilitating or life-threatening illness.”
Our team, composed of a chaplain, nurse, social worker and doctor, met with the farmer’s three grown children in a conference room. For 20 minutes, the doctor outlined two choices.
First, the family could ask us to do “everything.” Meaning, if the farmer’s heart stopped, we would do chest compressions and electric shock. If he stopped breathing, we’d put a tube down his throat and help him breath. And if needed, we’d even insert the breathing tube through an incision in the windpipe. Later we might add a feeding tube through the stomach.
“But for what purpose? To make him better?” the doctor said. “He won’t get better.”
The doctor was voicing what our team was thinking – namely that the patient should meet two requirements for this option. He has to want it and it has to be helpful – neither was true.
The second option presented was for the family to allow the natural process of dying to take place with dignity and without pain.
The family studied their laps as they insisted they couldn’t make that decision. “Please,” they said, “just keep doing everything. We are leaving this in God’s hands.”
The doctor turned a glance in my direction, like a soccer player heading the ball to a player who had a clearer shot at the goal.
I cleared my throat as I considered my best approach.
“Leaving it up to God” in this context is often an expression of procrastination rather than faith. The saying conveys a fear that God can’t answer the tough questions. It quickly becomes a religious coin toss between denial and faith.
But worst of all, it highlights a contradiction: If we’re really “leaving it up to God,” why do we need these machines to keep the ball in play? If we truly left it up to God, we wouldn’t be playing tug of war with the patient’s soul.
It was this second point I stressed the most. “Might God’s will also be expressed in your father’s dignified death just as it was in his venerable life?”
They looked further under the table as the oldest repeated the request. “Please do everything possible, including CPR.”
In an article that went viral in 2011, “How Doctors Die,” Dr. Ken Murray says this is no option at all. He says “when a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.”
Sadly, this family’s was a case of misguided expectations of God. The farmer endured two more weeks and three chest-pounding episodes of CPR. Finally, on day 15, the family truly turned it over to God, life support was removed and the farmer was welcomed into the green fields of heaven.
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Situations like this might be avoided with an advance directive. Do you have one? More info at www.caringinfo.org.
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Send comments to ask@thechaplain.net or P.O. Box 247, Elk Grove, CA 95759. Twitter @chaplain. Leave your recorded comments at (843) 608-9715. Visit my website at www.thechaplain.net where you can download a free chapter from my new book, “Hero’s Highway.”
