PreacherLanny

Amid all the debate about health-care reform itself, one small proposed provision in the House version of the bill has sparked significant controversy. That is the measure that would have Medicare pay doctors to do end-of-life counseling with patients who desired to have it.

It is not my intention contribute to the political aspects of the debate, but to consider end-of-life planning itself from a biblical perspective and from the viewpoint of our faith. So that will be our topic.

May God bless you as you study God’s Word this week.

In the News

One minor provision in the health-care bill currently before the House of Representatives is drawing heated debate. That provision would require Medicare to pay doctors for consultations with patients about advance-care planning, which could include such things as living wills, options about palliative care, hospice and how patients can ensure that their own wishes regarding their care are carried out when they are in the end-of-life stage.

There is significant support for the idea of advance-care planning in general among people of differing political persuasions. But the inclusion of this provision in health-care reform legislation has raised concern among some that the measure could result in rationed care, pressure on critically ill people or those with disabilities to settle for less-expensive substandard care, denial of services to sick people who were judged by “death panels” to be no longer “productive” and even government-sponsored euthanasia.

None of those things, however, are included in the provision as it is proposed. It allows Medicare to compensate physicians for voluntary conversations with their patients on the range of options available should the patient go through a period of physical decline prior to death. It would enable patients to specify where and how they would receive care for their physical needs, how pain would be managed and what medical interventions, if any, the patients wanted as death neared. As written, the measure is aimed at helping people take control over their end-of-life stage with advance planning.

The American Medical Association, which has endorsed the bill, points out that the provision does “not mandate that patients take advantage of this benefit.”

Supporters of the provision also say that it would lower health-care costs by reducing end-of-life treatments that patients don’t want.

While some opponents of the measure apparently believe the rumored claims, others who understand the provision’s intent accurately nonetheless oppose it on the basis that they don’t want to give government any participation in life-and-death discussions when, as former House Speaker Newt Gingrich put it, “there clearly are people in America who believe in establishing euthanasia.” Sen. Charles Grassley, an Iowa Republican, said he has no problem with living wills, “but they ought to be done within the family.”

Because of the furor, several key lawmakers are now leaning toward not including any end-of-life counseling provision in whatever form the health-care legislation finally takes.

More on this story may be found at these links:

http://online.wsj.com/article/SB125012322203627701.html

http://www.cnn.com/2009/HEALTH/08/14/blayney.death.discussions/index.html?iref=newssearch

http://politicalticker.blogs.cnn.com/2009/08/12/cnn-truth-squad-say-goodnight-grandpa/#more-64338

http://www.foxnews.com/politics/2009/08/06/end-life-counseling-intensifies-health-reform-debate/

http://www.foxnews.com/politics/2009/08/14/gop-backs-away-promoting-end-life-counseling/

http://blogs.tnr.com/tnr/blogs/the_treatment/archive/2009/08/18/two-conservatives-take-a-stand-for-decency-and-honesty.aspx

http://www.factcheck.org/2009/08/palin-vs-obama-death-panels/

(Please note: These links are for further information and are not to be construed as bias.)

The Big Questions

• Studies show that only 13 percent of Americans have a living will, a document that lays out their desires for treatment as they near death. Why do you think that number is so low?
• While people who are part of strong families have caring relatives to help them in making end-of-life decisions, what about people who have no such support group? What support is available for them?
• Is end-of-life planning in any way an expression of lack of trust in God?

Confronting the News with Scripture

Here are some Bible verses to guide our discussion:

As the time of his death drew near, Jacob called for his son Joseph and said to him, “Please do me this favor. Put your hand under my thigh and swear that you will treat me with unfailing love by honoring this last request: Do not bury me in Egypt.
Genesis 47:29 (NLT) (For context, read 47:27-31.)

Here’s an example of a biblical person (Israel/Jacob) doing some end-of-life planning. Because people lived in extended families and clans in those days, the aged were cared for within their family circle. Also, the “heroic” measures used to revive the dying today were unavailable. Thus, there was no need for the kind of advance-care planning that’s done today. Nonetheless, Jacob’s solicitation of a promise from his son Joseph as to where his final resting place would be indicates that Jacob had been thinking about his eventual demise and understood the importance of making his wishes known.

Question: What makes it so hard to talk about one’s own dying?

“Soon I will die, going the way of everything on earth. Deep in your hearts you know that every promise of the Lord your God has come true. Not a single one has failed! Joshua 23:14 (NLT) (For context, read 23:1-16.)

Here’s another biblical person speaking about his impending death. In this case, Joshua seems less concerned about his final care or his place of burial, but more concerned that the message of God’s care, which he had declared to his people and lived by as their leader, continue to be heard and relied upon. In stating that he is “about to go the way of all the earth” (that is, die), he is, in effect, asking those who survive him to carry the message forward. He is also declaring to them that he is dying “in the faith,” trusting God to the end.

Question: How can your end-of-life directives also testify to your faith in Christ?

And now, in my old age, don’t set me aside. Don’t abandon me when my strength is failing. Psalm 71:9 (NLT) (For context, read 71:1-21.)

Psalm 71 is a prayer for God’s protection throughout one’s life. It speaks of trusting God from youth (v. 5) and includes the plea for God’s continued care right through old age.

Presumably, at the time of writing the psalm, the author is not yet old or in failing health, so why would he think he needed to pray ahead of time about when he would be near death? Perhaps he was thinking in terms of his usefulness to God. He could easily understand why God would help him when he was young enough and strong enough to serve the Lord in concrete ways. But he might have wondered what incentive God would have to aid him when he could no longer actively serve him. Thus his prayer may reflect an assumption that anyone’s life only has value while that person is “productive.” Such an outlook could easily account for an uneasiness about growing old.

Question: If the value of human life is not tied to “usefulness,” how is its value derived? (Hint: See Genesis 2:7 and Acts 17:24-25.)

That is why we never give up. Though our bodies are dying, our spirits are being renewed every day. For our present troubles are small and won’t last very long. Yet they produce for us a glory that vastly outweighs them and will last forever! So we don’t look at the troubles we can see now; rather, we fix our gaze on things that cannot be seen. For the things we see now will soon be gone, but the things we cannot see will last forever. 2 Corinthians 4:16-18 (NLT) (For context, read 4:16–5:10.)

Here the apostle Paul speaks of the toll life takes upon us and the wearing-out of our bodies. But when he calls that physical and energy decay a “slight momentary affliction,” he is speaking comparatively. Compared to the eternal life that awaits those who follow Jesus, the time of illness that often precedes death and even the weariness of life that may come long before, are but “momentary.” They are something to be passed through but that should not be given more weight than the unending blessing that comes afterward.

Of course, it’s quite one thing to take the long view when one is not actually in an end-of-life stage and quite another thing to pass through such a stage en route to death. Certainly, it is no lack of trust in God and eternity to do what one can to make one’s final passage before death as comfortable as possible.

Questions: How do you think Paul would view end-of-life planning? Why?

Questions for Further Discussion

• Ought the church offer counseling for advance-care planning? Why or why not?
• What ought the church do to help those who don’t have the necessary health-care coverage to receive adequate end-of-life care?

Note:

I have adapted this study from a subscription that I have called The Wired Word.