Life is Worthwhile Questions Surrounding the Nursing Profession
One of the gifts which the Lord distributes among the members of his congregation is the gift of doing acts of mercy (Romans 12:6-8). Everyone is exhorted in the Bible to show love and charity: “Contribute to the needs of the saints, practise hospitality. Bless those who persecute you; … rejoice with those who rejoice, weep with those who weep … take thought for what is noble in the sight of all (Romans 12:13-17).
Those who in character and aptitude have received this gift have the calling to practise that charity “with cheerfulness” (Romans 12:8). Such cheerfulness has long dominated the Christian care for the weak and the infirm. There is a rather unobtrusive, but at the same time heartwarming, history of Christian charity. One should not forget that institutions for the care of the sick have evolved from a Christian culture.
The necessary strength to continue this cheerful work among the sick has time and again been derived from faith in the Lord who created and governs life. To Him life belongs. Therefore, manslaughter is not an option open to us and neither is neglect of our neighbor. Rather, we are called to tend God's creation. While so engaged we may hope for the eventual healing of all the world's wounds and look forward to the time of unblemished growth when Christ has returned.
Presently the Christian tradition is losing its impact on civilization. That is also becoming noticeable in the work of charity. Doctors and nurses become worriers instead of thinkers. Courage is being exchanged for uncertainty. The clear prescriptions of God's Word are being rejected; consequently, many situations become tangled up and hidden by fog. The complexity of the issues of life and death, rather than own blindness, are then blamed for a lack of vision. A renewal of medical ethics and a concerted effort of teams of experts in the field of abortion and euthanasia is now being called upon to bring clarity to this muddled state of affairs. But, then, ten blind men see no further than one blind man. The fog does not lift.
The doubts expressed in the world about the value of life, be it unborn or unproductive, have claimed their toll on many who still have the habit of consulting their Bibles. An early symptom of that effect could be found back in the “pastoral advice” issued by the General Synod of the Dutch Reformed Church (Netherlands Hervormde Kerk = NHK) in 1972 under the title Euthanasia: perceptions and perimeters of medical activity. In this pastoral advice the synodical horn gave a most uncertain sound; nothing for anybody to get up and salute and begin with new courage. The synod's advice came down to this: charity is not always desired and doctors and nurses should not be too pushy in offering it. This applies for children who are badly malformed at birth and who will not be capable of living a “communicative life.” It also applies for the very old who are “full of days” and who no longer desire – or, on account of senility, can no longer desire – that their lives be further prolonged. Also included in this application are patients where the possibility of “communicative life” is totally absent. In all such cases the pastoral letter claims that “boundaries are reached.”
This synodical document also deemed acceptable the opinion that active euthanasia be permitted in extreme conditions, if a handicapped child has a life expectancy which has been termed “extremely primitive,” or if old people begin to deteriorate mentally and become a burden for others. Mind you, those who insist on continuing with care and treatment are not condemned. No, these matters are open for discussion.
One should realize what impact such an approach has. How careful is the wording, how almost-tiptoeing-around-the-issue are the guarded expressions of this modern church jargon! Still, in 1972 already, it was suggested that there is room to seriously question whether the “primitive life” of handicapped children and of demented old people is worthwhile. If you answer “yes” to that question, you may continue with the care, if you so desire. But you are not compelled to, certainly not if the patient has given a timely indication that he wishes to have his life terminated.
It becomes extremely difficult to carry on one's work with Christian cheerfulness if people and churches that call themselves Christian have taken the stand that this work is no longer a bounden duty of Christian charity, but more a pastime for hobbyists.
It does not take much imagination to understand that such terms as “very malformed” or “very old” can be stretched, depending on the subjective judgment of very well-formed and very youthful people. Such questions bring the very sense and meaning of nursing into jeopardy. If it is true, as some say it is, that the consideration “becoming a burden” may be used by one who is “full of days” as a reason for asking assistance to “depart from this life,” then why should that same reason not be used more often and in other circumstances?
Nursing, intended as an institution to bear one another's burdens, will cause its own demise if it rids itself of its heaviest burdens by untimely delivery to the grave or to the crematorium.
Does the Bible justify that such issues are made questionable? The approach is often taken that in Biblical times there were no such things as transfusions and reanimation, and that therefore the Bible does not address today's problems, since they are essentially new. But that, obvious as it may sound, is a fraud! Just think: What was not there in the past of the things existing today? Were there no diseases? No doctors? Was there no demonic possession, leprosy, epilepsy, blindness, deafness, deaf-muteness, dementedness? Where there no fractures, lesions, infirmities, impotencies? Is abortion something new, or the abandoning or killing of so-called non-productive human beings? Did one return less maimed from ancient battles than from modern traffic?
Surely, there are differences, but people should learn to make proper distinctions. Suffering has received a different form: it is less intense but longer lasting. Suffering is not heavier but nursing takes longer, and thus it undergoes a considerable change in form, but not in essence. Too often people think that a change in form inaugurates something totally new.
The complexities of nursing are drastically different from what they were in the past. But if somebody says it is hard to care for a child with an “extremely primitive life,” we could reply that it was not easy in the past to amputate a leg without anesthetics. Such a change in form is very impressive because it is so highly visible. It also has a great impact on the actual nursing practise. But it has nothing to do with the question whether or not we must care for someone who is in need of help in any older or newer form.
People refer to cases in which the physician can hardly discern the borderline between life and death. Such examples are used as justification for the contention that the call to nursing and caring must be determined by other criteria than the boundary of death, because that standard is no longer usable. Instead we are told now to speak of “no longer functioning” or “not communicative.”
A value judgment of the patient's life is to replace the clinical establishment of his death. Here again we must object that a change in form may never be used to introduce a change of norm. A physician reaches the boundary of treatment when the patient's death is imminent, and no sooner. A Christian who maintains that standard will promote a renewal of the definition of death which will involve a great deal of experience with modern technologies. And the sooner this is accomplished, the better, so that the old norm can be applied without hesitation in modern practises. Vagueness has a depressing effect. Incidental uncertainty can cast doubt over an entire undertaking.
But there is no essential change in the problematic issues. We must take heed that we do not allow a barricade to be placed between our time and the situation in the Bible. God's Word is alive for all times because the times are God's. Those who suggest that there is an abyss between our time and the Biblical situation will find that they are losing the Bible as a resort. To them only a few Biblical motifs remain.
The first they use is the term “being full of days.” Of some it is said in the Old Testament that they died “old and full of days.” From that expression some then derive the notion that a Christian can see that the time for his own departure has come. When a very old person is “full of days,” his life should not be made any “fuller” against his own wishes.
However, is that conclusion justifiable? It is remarkable that those who are described by the Bible as being “full of days” (Abraham, Genesis 25:8; Isaac, Genesis 35:29; Job, Job 42:17) only departed from this life when God called them. Job had indeed desired his own death in his dismal conditions (Job 3), but his wish had not been granted. Besides, the Bible, in those texts, is not at all attempting to establish the boundaries between life and death. It only described the status-in-life of Abraham, Isaac, and Job when they finally died. It is not proper to take fragments of Scripture out of context and give them a different meaning.
More attention should be given to another Biblical motif that is being used: “communicative life.” God created man as a social being, they say; the functioning of life within the God-given relations is central. And because life is communicative, people begin to hesitate when the question is posed whether that life must be continued if communications have been disrupted. If an extremely malformed baby cannot live “communicatively,” then it really should not continue to live.
Against this contention the following: It is certainly true that the Lord created man for and in social relations. But one should not confuse the purpose of life with the root of its existence. Man is created because God so desired and to the end that he would communicate with all of God's creation. That a man's capacity to be something for others is limited or even non-existent, does not alter the fact that it was God's decision to allow him to enter into this life. The world is not a closed shop where you are only allowed to stay if you join the union. The world is a creation, where God's act of creating, however unsearchable and unfathomable, decides in sovereign authority who arrives and how. Man has no right to nag his Creator with phrases like “very malformed” or “extremely primitive.” Scripture says:
Woe to the one who quarrels with his Maker – An earthenware vessel among the vessels of earth! Will the clay say to the potter, 'What are you doing?' Or the thing you are making say, 'He has no hands?'Isaiah 45:9, NASB
Does God, then, give senseless lives? Does He take apart the being and the purpose of being? Certainly not. But since the fall into sin that purpose is pursued in a different manner than before. God created man to live and communicate indeed, but He also pronounced that this “communicative life” would be broken by death if man were to rise up against the Lord.
And that's what happened. By nature we are all, since our birth, on the way to losing that communicative life on earth. God's punishment for our rebellion is death.
A fundamental error is made when it is assumed that death was inherent in creation. The good death has become a bad death as a result of sin, but it was supposedly there from the very beginning. This proposition is in clear conflict with Genesis 2-3. We do not know whether the Lord, had there been no sin, would have made people pass through some kind of transformation. But we must accept most certainly that death entered into the world on account of sin, and not one moment earlier (Romans 5 and 12).
What do people actually want, speaking about “communicative life?” Is not a child that requires lifelong care and attention, extremely communicative? Is not the entire community involved with this infant? Where is communicative life closer than in the performance of charity? We fear that the sweet sounding phrase “communicative life,” seemingly so full of concern over abilities to live, are, at bottom, little else than a “nothing for nothing” expression, leading to the callous consequence that those who are of no service to us, we need not serve either. That is a plausible consequence of this term. Its harshness should encourage us to drop it as being un-Scriptural.
Another remark made with respect to Biblical references deals with the question how we get to know the will of God. God's will is written down in His Word (commands), but it is also revealed in His acts. The revelation in commands always prevails over the revelation by God's acts, since it is not always clear that God's toleration – for example, of sinful deeds of men – gives us permission to act.
Thus it is argued that the very fact that someone is somehow still “alive” cannot in itself be interpreted as God's desire that we work to keep it that way. The fact that a child continues breathing is indeed an act of God, but we can only know from the Bible what we must do with such a life. And when the Bible then speaks in restricted terms about “communicative life,” we should not undo such written revelation of God's will with a reference to what we surmise to be God's will from His acts. But in this argumentation the sinful acts of men taking place within God's will are placed on a line with things that happen apart from man's action, even though man is involved. Think of life, the weather, calamities, diseases. These things do not come by chance but by God's Fatherly hand (Heidelberg Catechism, Lord's Day 10). What is done by God directly will surely tell us something and guide our actions. And life is one of those works of which not man, but God, is the maker. We fear that a changed mentality is claiming victims here.
The changed view of death in recent years was preceded by a changed view on life. More and more people are beginning to claim that life was their own work, and so a change of attitude towards death could follow. The combination of these two is evident from the following quote: “Man is responsible before God in his choice for or against conception of life and also for or against the termination of life.” The error of this sentence is in its beginning. Is man indeed responsible for the choice to conceive or not? Is it not God who forms life? Keeping that in mind will help us to speak less about “family planning” and more about the ethics of marriage. It will also teach us to stop speaking about “deciding to have a child.” He who so “takes” a child, to use such pagan expression, encourages a mentality that just as readily will give that child away again, either for adoption or by abortion or by murder.
The Bible teaches us to love our neighbor and not to kill. In His direct acts, working life and death, the Lord shows us who our neighbor is. The will of God as revealed in His acts does clearly indicate how the will of God revealed in His Word is to be fulfilled, because life results from God's direct creative power. If He leaves someone alive, then He tells us something!
The Bible on the Issue of Life and Death
Those Biblical question marks which many would want to place around a certain aspect of the nursing profession appear, upon further investigation, to be no questions at all. In those contentions the Bible is not really given the floor and, to a certain extent, is even contradicted.
What, then, does the Bible teach us about life and death? It is clear from the very beginning that life is a creation of God: He alone gives breath and no one else. Death came after the fall into sin as a punishment for sin. The Bible teaches us also about the bitterness of this punishment. It is not confined to the moment of death but lies like a veil over all of life (Isaiah 25:7-8). Life has become a constant death. The bitter taste of this death is, by faith, taken away from God's children, but yet they experience the deterioration of their bodies. And the unbelievers experience the menace of God's punishment; they know no peace. If one would look at the reality of suffering, of boils and leprosy, of insanity and marriage breakdown, as unpleasant and inconvenient side-effects of being on this earth, to be eliminated as soon as possible, without realizing that they are the result of the curse of God over sin, then the task to heal and to care can never be undertaken with any hope of satisfaction. The first requirement is the recognition that God the Creator is for real and that His righteous judgment is deserved by us all. No one can be taught to “show mercy with cheerfulness” if he has not first made this confession his own:
As all men have sinned in Adam, lie under the curse, and are deserving of eternal death, God would have done no injustice by leaving them all to perish and delivering them over to condemnation on account of sin.Canons of Dort, I, 1
We may pour oil on the wounds, but we must realize that on this earth we will never reach the stage when the last wound has been healed. And as our understanding of the guilt becomes deeper, our amazement will grow that God still gives life, albeit sometimes very badly damaged. And then the Bible gives us this surprising message that there still is hope for all those who are yet alive, who have become mortal. God's grace is over all who believe in His Son. Jesus Christ has offered Himself up and laid down His own “communicative life” that we may once receive it back without blemish. Although the children born of woman all die, her name may yet be Eve, “mother of the living,” through faith in the Christ.
Against this background we now receive the sixth commandment: “You shall not kill.” If God had been finished with us, such a commandment would have been superfluous. Why not do each other a favor and shorten this “constant death?” But God prohibits manslaughter because in life there is still hope. Life is still worthwhile! References to the sixth commandment are often too negative, as if it were a clear but cold rule, a fence around life. But it is different. It can only be fulfilled in faith. For people who no longer believe in God, the sixth commandment becomes a faceless rule, and an inconvenient one at that. But the stronger our faith is in God and in His work for this world, the better we will be equipped to do as He requires from us: Let My living ones live and place all things in My hands. That faith was encouraged with the coming of Christ into the world. There were at that time many hopeless lives in Israel. They let the wretches be; but why really? Some were devoid of any “communicative life” and they were a real burden to society: how unprofitable and unapproachable was the man with the legion of demons and how cut off was the man with the deaf and dumb spirit! And what about the paralyzed man who had been on a stretcher for thirty-eight years? But they kept them alive and cared for them as well as they could, because: “Thou shalt not kill.” And their faith was not put to shame. “Legio” was cast out and the man never needed to be fettered again; the deaf and dumb man no longer stared with an empty gaze but took active part in the conversation. The lame and the crippled one danced through the streets, and the man who had been flat on his back for thirty-eight years was seen walking around on the sabbath day, his sleeping bag under his arm. Unexpected outcome. People filled with awe. Not because these were healings; that happened more often and by others as well. But what struck the people was that Jesus treated the hopeless cases, the people who really had been written off. When Jesus takes these and treats them and gives them back to the communion of the Church, He therein displays His divine powers. Enemies tremble: Who is this? But believers rejoice.
In Jesus Christ God shows that He has something better in store for us. Because we believe the resurrection of this maimed, crippled, and dying body, and the life eternal as the final outcome of a world in which death has full dominion, therefore we will hear the apostle's instructive call:
You shall love your neighbor as yourself and Rejoice in your hope, be patient in tribulation, be constant in prayer, contribute to the needs of the saints, practise hospitality.Romans 13:9; 12:12, 13
Why do we face a euthanasia problem of such dimensions? Not because of a change in medical treatments and in the patterns of diseases. It is because of unbelief, because of uncertainty that questions whether all things do indeed come to us from God's Fatherly hand. It is no longer so certain that the dead will be resurrected. Sinfulness and guilt are no longer acknowledged. The world no longer knows how to kneel. It stands up straight and from that height lets the neighbor drop. First those who aren't born yet. And then the ones who no longer protest. Unbelief preaches murder with velvet gloves in soft, melodious tones.
The Christian Way of Nursing
Because the basis of Christian care for the infirm is faith, nurses and those who care need to equip themselves more than ever before with the weapons of faith for the performance of their task. When you are deemed worthy to look after others, you must begin by looking after yourself. When you are given the opportunity to “practice charity with cheerfulness,” you should not neglect the training of your own faith.
Daily reading of the Bible is essential. If you hear nothing all day but callous conversations about life and death, then your own thinking can wear down and your life as a Christian can lose its keen clarity. It is then necessary to breathe again the pure atmosphere of the Bible, where life and death, birth and dying, are related with proper respect. There the road to God is shown again. He is the One who on that road instructs us for all good work, including the work of nursing. On that way we may pray to God through Jesus Christ every day. And our Father in heaven hears prayers, also the prayer of the student nurse in her tiny room. When you begin with God, you can carry on with people. Where would you go without God? After all, the end of all treatment is death. Only when you trust in the Lord do you see not only tombstones beyond the sickbeds, but, in faith, a new heaven and a new earth. That faith is manifested, first of all, in a devoted care for the patients. A Christian need have no fear of death and its forebodings. Therefore he will receive strength to provide love and mercy to the sick and the dying.
It is the first duty of a nurse to give care, not to preach. But a care rendered in love can be a message without words; a most effective way of preaching. The patient should be able to notice from the nurse whether he or she lives by faith in God, to show His love. Sometimes this love cannot be noticed because the patient cannot respond. It may be a demanding task to extend care for a long time to someone who may possibly receive, but does not respond in any way. One must then give without receiving, a one-way street. This requires a great amount of patience. Yet even then we may be certain that our labors are not in vain in the Lord. He will look after response. Most often, however, the patient can respond. Is there then a task also to witness of the Savior in words? In such a case a Christian must be careful not to abuse his job surroundings to evangelize. But when the Lord gives an “open door,” your daily vocation can include possibilities to evangelize. Listen intently if patients really desire to talk about something, but don't get held up by idle talk. Sometimes patients like to engage in a bit of religious chit chat, trying to draw a nurse from her corner. In such a case, you can give a curt reply and carry on with more important work. But sometimes there is a patient who really wants your help and counsel. Be then not ashamed of Christ. Such a talk should always begin on a positive note. The first thing an unbeliever hears from us should not be: against abortion, against euthanasia. Before that he should have heard from us that through God's grace life is worthwhile. When we bring the message of the gospel we must be straightforward and to the point and not deal in generalities. You are speaking to that particular man, that specific woman. Choose your words with that in mind. If you have asked God to give you wisdom, you will be able to do it (Colossians 4:2-6).
If you perform your task as a nurse in faith, you will be responsible in your work. How is it with this sense of responsibility as it regards other people? A Christian must respect his fellowman in the functions and positions which God has given him. This affects one's attitude towards a supervisor, the administration, and the doctors. Some nurses accumulate enough medical knowledge to enable them to observe the physician critically. It would be un-Christian to take advantage of such a situation. Leave the doctor his dignity and don't act like a know-it-all. Even if a physician's instruction is not immediately comprehended, one should not start out with suspicion. Proper work can be done only in an atmosphere of mutual trust and respect for one another's functions.
But that does not mean that a nurse should do her work like a robot. Accommodation does not mean suspension of judgment. Nurses have their responsibility. If they are called upon to do things which are prohibited, then they may not execute such orders. A Christian can therefore, per definition, not be engaged in an abortion clinic. But even if one is most careful in the choice of employment, one cannot go out of the world. Therefore you must be able to give your “no” loudly and clearly. To cooperate in an abortion is out of the question if the life of the mother is not really and directly at stake, so that it is a choice between the mother and the child.
Cooperation is impossible with a team where it is an open question whether a patient who is not dying should be given any further treatment and care. The “how” question of treatment may be discussed. But the “whether or not” question may never come up in the mind of a Christian as long as death has not arrived. One who goes along with such a practise sins with “a high hand” (Numbers 15:30), defiantly. Soon after the first surrender, he or she will lose all resistance.
Therefore, resist at the very beginning.
Flee all evil.
Find a different hospital, or ask the administration for a change in working conditions, not financially but morally.
Call upon the help of fellow believers within the nursing profession.
Those who clearly stand for their principles will often be given the chance to do their work accordingly.
We shall not be able to force the world to stop sinful practices, but we may protect each other from becoming accomplices in such sins. Not that we would do so, inspired by the haughtiness of a clan mentality, but rather because of our veneration of the Lord.
A nurse will also have contact with colleagues on the job. If everything is proper there will be contact and room for discussion. Christians at work should be loyal colleagues. In these talks your principled view of the daily task will come up as well. In such discussions you must always be on guard that you do not get caught by the isolating questions of an opponent. Try to stick to the main issue of life and death, of faith and unbelief. You don't have to be able to furnish a fitting response to each and every challenging case that is held up in front of you. It is sometimes better to admit that your own practical wisdom is limited, while you hold fast to the clarity and the validity of the norms. Avoid discussions which are only for the fun of the game and which lack the real interest and commitment of the participants. But do not hesitate either to serve others by saying a bit more than they had asked. You can point to the fact that a society which continuously boasts of its technological progress, is reminded of its limitations by the very fact that the institutions are getting more and more crowded with people who cannot really be cured. The cases where the medical world is powerless are not becoming fewer. Thorns and thistles continue to choke what we are planting in this earth. But man won't accept that fact. He is quite willing to accept the positive effects of modern medical inventions, but the shadowy sides he wants to remove, if necessary, with the use of violence.
Yet, in the middle of this world which is ever more concerned with its own self-glorification, there is a message from God in the institutions of the chronically ill and the elderly. And we may not suppress that message. Christians have the prophetic duty faithfully to put that message into words for the people, so that they may repent and serve God.
But for a good conversation it is necessary that there is a unity in your life and that there be no conflict between your words and your works, no contrast between your working hours and your spare time. If that unity is lacking, then we had better work on ourselves before we address others.
Examples are better than precepts!
The profession of nursing has not become any easier these days. If you want to practise it in a Christian manner you will often experience more opposition from healthy people than from the diseased. But the Lord hears it all. He knows of the often horribly brutal statements modern man dares to utter. He shall judge good and evil. And so, all shall still be well. That is the reason why those who believe in God and in His Son Jesus Christ can continue to practise charity and to do so with cheerfulness. For those who believe, life is worthwhile.