When does the moment come for an incurably sick cancer patient to stop chemotherapy?  Does it make sense to go to the hospital for further testing when, as an older person, you already have multiple chronic illnesses?  What do you yourself want?  Does a Christian have different desires from a non-Christian?

Being sick and becoming older are not agreeable topics of conversation. We would sooner talk about the latest thing and “being healthy in a healthy body” than about handicaps, becoming less mobile and being dependent. Thankfully, the media has recently been giving attention to this.  It is good that conversation about health, sickness and dying is becoming more normal. That applies to everyone: healthy people, patients, and caregivers.  Caregivers are used to thinking about action plans for care, but must learn to give priority to the desires of the patient. Patients and doctors should discuss these things with each other. In the last part of your life, your doctor can not cure you, but can still do much for you. He can give you the care that is important to you and that suits you. In order to do this, he must know what is important to you and what you do and do not want. Speak about this also with your partner and your family. 

On All Levels⤒🔗

In order to determine whether there is a question of overtreatment, reference is made to four principles:

• Respect for autonomy:  that is, to respect the desires of the patient as far as possible.  Some patients can no longer express their desires in the last phase of life.  Then a written declaration of their will is helpful, or, as an alternative, the ability of their representatives to interpret their desires. 
• Do no damage: Do not cause damage.  If the medical decisions no longer work to bring healing or stabilizing of the patient’s functions when administered, the continuance of such administration can lead to damage.  In the science of healing, doing damage is morally justified only if it brings about greater well-being.
• Doing good:  As far as possible, the well-being of people must be promoted, including, naturally, the protection of life.
• Justice:  One person should not be treated differently from others with the same problem.  This is also about an honest distribution of scarce remedies.  It is unjust when patients without realistic options for treatment are still being treated when we know that other patients are waiting for treatment, caregivers and/or scarce beds.

Every day, and at all levels, these are the founding principles for care, in the doctor’s office, in the distribution of money in hospitals, and at the political and national levels of health care.

After His Time←⤒🔗

For Christians, the fear of euthanasia can cause them to desire that everything will be pulled out of the medicine cabinet in order to extend their own life, or that of people they love, to the uttermost limit, even when there is no longer hope for life.  In doing so, the possibility exists that the patient dies, not “before his time,” but rather “after his time.”

Chance of Success←⤒🔗

Resuscitation literally means “bringing back to life.” In the case where the heart stops beating or where breathing stops, through heart massage and resuscitation it is endeavored to restore heart and lung function. This is therefore about a life saving intervention. The chance of success depends on the age and health of the patient. It is a given that in accordance with the higher age of vulnerable older people and the presence of preconditions, chances decrease that the patient will survive the treatment without damage. A few statistics: On average, eight out of a hundred people above the age of 70 will survive a resuscitation outside of the hospital.  Four of those will have no or minor residual complaints; the other four have serious residual consequences.

It is necessary to make a decision “to resuscitate or not to resuscitate” in the relationship between doctor and patient.  For this decision, all medical and personal arguments can be weighed and considered.  The point of departure is that every person is responsible for the life he or she has received from God.  Medical interventions are means to sustain this life.  There must be good reasons in order to not make use of these interventions.

A “do not resuscitate” decision is justified when

• an attempt at resuscitation has no real chance of success
• an attempt at resuscitation is out of proportion, so that the severity of the process and the complications brought about by it outweigh the outcome that can be expected.

On Paper←↰⤒🔗

Thinking about the end of your life is not easy.  It is important to do it and to talk about it with those you love.  What would you like to happen to you when you yourself can no longer make your wishes known,  or if you end up in a coma after an accident?  You can make your wishes known in conversation with those close to you, but it is at least as important to put those wishes on paper in a written declaration of will.  In such a declaration, you can also appoint someone as your legal representative, giving him or her power of attorney.  This person is entitled to consult with the doctor on your behalf.  It is important to give the declaration to your family doctor and to speak with him about it.

Fields of Tension←↰⤒🔗

Carlo Leget has written a book which has headings to reflect on when faced with questions about life and choices when there is little hope of healing.  His goal is to make room within yourself, so that you can live towards life’s end in freedom, rest and well-being.  For example, if you live in the grip of anxiety about the approaching end of life or its decreasing lustre, it can so overwhelm you that there is hardly room left for other feelings.  When you dare to confront the anxiety, it can have its own space without blocking all other experiences and awareness.

Space is made when you find a balance between the two poles in five fields of tension.

• I and the other one:  For Christians, the relationship to yourself is changed by faith.  Also at the end of your life’s course, you may entrust yourself to the Other, to God’s love.  Through a daily relationship with the Bible and through prayer, your relationship with the people around you also changes; your neighbour, the church, and so on.
• What to do and what to leave:  Which interventions do I still want, which not anymore?  Our culture and health care system are often inclined to “doing”  Christians may know that suffering comes upon us, not by accident, so that suffering acquires meaning.  Then “leaving be” can stand, not only for “not doing,” but for “letting happen” and “enduring.”
• Holding fast and letting go:  When life is coming to its end, finding the balance between these two is not so simple.  Letting go of all that is beautiful and good, but also of all negative feelings, such as guilt that can continue to plague us, is not simple.  In order to be able to let go, surrendering is necessary.  Then there is space, also for dying with an eye on the new future.
• Forgive and forget: When adding up your life’s balance sheet , there is also  the column of mistakes, guilt, damage, and shame.  In the field of tension between remembrance and forgetting, forgiveness is a special gift.  But this can certainly not be taken for granted when brought about.
• Believing and knowing:  Faith is a “sure knowledge and firm confidence” in God’s promises of love, forgiveness and faithfulness.  That gives perspective in life and death.