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Entering the Twilight Zone: Making Hard Decisions at the End of Life · Centrally Speaking

• 0:01
  SPEAKER_00: Centrally speaking, it's the Central Schrockfeller Church's podcast.
• 0:05
  SPEAKER_00: It speaks about issues that would be of interest to our society.
• 0:09
  SPEAKER_00: In particular, it addresses how a Christian worldview intersects with Western secular culture.
• 0:15
  SPEAKER_00: In the spirit of the church's founder, we take the perspective of the middle way, which is in agreement with the historic Christian church.
• 0:24
  SPEAKER_01: I'm Dr.
• 0:25
  SPEAKER_01: Drake Williams, Minister of Mission and Theology of the Church.
• 0:28
  SPEAKER_01: Our website is www.cstfamily.org.
• 0:33
  SPEAKER_01: Our topic today is entering the twilight zone, making hard decisions at the end of life.
• 0:39
  SPEAKER_01: And we're very fortunate to have with us today Dr.
• 0:41
  SPEAKER_01: Brad Mellon, who is a graduate of Houghton College, who's also graduated from Biblical Theological Seminary, now Mystio, as well as having a PhD from Westminster Seminary here in the Philadelphia area.
• 1:34
  SPEAKER_01: He is co-founder of the bioethics section of the Evangelical Theological Society, together with Dr.
• 1:40
  SPEAKER_01: John Kilner.
• 1:41
  SPEAKER_01: He lives here in Harleysville with his wife Marilyn and his dog Max.
• 1:45
  SPEAKER_01: He has two daughters and a granddaughter.
• 1:47
  SPEAKER_01: Brad, welcome to the show.
• 1:48
  SPEAKER_02: Thank you, Drake.
• 1:49
  SPEAKER_02: It's really a pleasure and an honor to be here with you today.
• 1:57
  SPEAKER_01: And you've been associated with Dr.
• 1:59
  SPEAKER_01: John Kilner, who's at the Center for Bioethics and Human Dignity at Trinity University.
• 2:04
  SPEAKER_01: Can you share about the projects that you worked on with him and the project that you're working on with him now?
• 2:11
  SPEAKER_02: John and I co-founded the bioethics section of the Evangelical Theological Society back in 2008-2009.
• 2:17
  SPEAKER_02: We put together a steering committee.
• 2:20
  SPEAKER_02: We formed the section in New Orleans that year and then rolled it out in Atlanta in 2010.
• 2:26
  SPEAKER_02: It continues to this day.
• 2:28
  SPEAKER_02: John and I were co-chairs for about 10 years, and now it's under some real capable hands, younger bioethicists that are taking the mantle, so to speak.
• 2:38
  SPEAKER_02: In 2015, John wrote a book on the image of God.
• 2:40
  SPEAKER_02: You may remember it's called Dignity and Destiny, Humanity in the Image of God, and how the divine image is related to bioethics.
• 2:47
  SPEAKER_02: So later that year, in the fall of 2015, John and I, together with Dennis Hollinger, who was the president of Gordon Conwell Theological Seminary, but deeply involved in bioethics as well.
• 2:59
  SPEAKER_02: The three of us conducted a panel discussion in Atlanta on John's book.
• 3:04
  SPEAKER_02: So that was another project that we collaborated on together.
• 3:07
  SPEAKER_02: John gave a summary of the book.
• 3:09
  SPEAKER_02: Dennis related John's concept of the divine image to the world, and I related it to the church.
• 3:15
  SPEAKER_02: And then two years later, 2017, Christian Bioethics Journal, which is published by Oxford Publishing, decided to devote an entire issue to John's book.
• 3:25
  SPEAKER_02: That year, John invited me to write an article for that issue, which I did.
• 3:30
  SPEAKER_02: It was related back to the work that we had done on the panel a couple of years earlier.
• 3:34
  SPEAKER_02: Now, the current project, I'm writing a book on, as you mentioned, the ambiguity that's related to disorders of consciousness.
• 3:41
  SPEAKER_02: Those are coma, brain death, a couple of different levels of that, locked-in syndrome, minimally conscious state.
• 3:48
  SPEAKER_02: But then probably the most prominent one, and the one that's been in the news a lot, is what has been called persistent vegetative state or unresponsive wakefulness syndrome.
• 3:57
  SPEAKER_02: A number of people don't like the word vegetative anymore.
• 4:00
  SPEAKER_02: It sounds pejorative, so they've gone to this UWS.
• 4:04
  SPEAKER_02: And so some of you may remember Otto Warm Beer of a few years ago, who was in a North Korean prison, had gone into this unresponsive wakefulness state for about a year, was sent home in that condition.
• 4:16
  SPEAKER_02: And then probably the case that many people will remember even more, and it illustrates the uncertainty, the ambiguity related to especially this condition, is Terry Shivo in Florida, about a little over 15 years ago.
• 4:33
  SPEAKER_02: You may remember that after about eight years in that condition, her husband said, Terry's gone.
• 4:40
  SPEAKER_02: I think we should let her go.
• 4:41
  SPEAKER_02: Her parents said, No, wait a minute.
• 4:43
  SPEAKER_02: We think she's minimally conscious, we think she's looking at us and talking to us.
• 4:48
  SPEAKER_02: The husband went out in court and they they withdrew the life support and Terry died.
• 4:52
  SPEAKER_02: But when the autopsy came in, this is debatable.
• 4:55
  SPEAKER_02: We don't really know completely how definitive autopsy is for this, but the autopsy came back with her brain was half the weight of a normal brain size for a woman her age.
• 5:07
  SPEAKER_02: It had experienced massive damage and trauma, and that she had been blind for a considerable amount of time.
• 5:15
  SPEAKER_02: So the uncertainty revolves around how do we know whether this person is actually trying to look at us and talk to us.
• 5:22
  SPEAKER_02: We can't really criticize her parents and others because of another quick story.
• 5:27
  SPEAKER_02: There was a young man named Martin Pistorius in South Africa.
• 5:30
  SPEAKER_02: And at 12 years old, Martin was diagnosed with this unresponsive wakefulness state.
• 5:36
  SPEAKER_02: His doctors said to his parents, take him home, we can't do anything more for him.
• 5:40
  SPEAKER_02: Take him home, keep him comfortable.
• 5:42
  SPEAKER_02: So they did, but thankfully they kept him on the feeding tube because two years later he regained consciousness and he couldn't walk, he couldn't talk, but he could respond to them.
• 5:52
  SPEAKER_02: Ten years later, he came back completely.
• 5:56
  SPEAKER_02: He woke up, he could walk, he could talk, he was married, he became a web designer and web developer, and he wrote a book about his experience called Ghost Boy.
• 6:06
  SPEAKER_02: And it was at that point that doctors realized he wasn't on responsive wakefulness, he was in what's called locked-in syndrome.
• 6:14
  SPEAKER_02: And locked in is an even worse condition because a patient, although the patient cannot move or respond at all, is completely conscious and aware.
• 6:25
  SPEAKER_02: He was aware and conscious the entire time.
• 6:28
  SPEAKER_02: Can't criticize people for keeping patients going longer because we don't know.
• 6:33
  SPEAKER_02: It could be a Martin Pistorius kind of situation.
• 6:36
  SPEAKER_02: The connection back to your question with John Kilner is that he helped me at the beginning of this project, and now he's one of my reviewers prior to publication.
• 6:47
  SPEAKER_02: Drake, you publish extensively.
• 6:49
  SPEAKER_02: You know how important it is to have someone qualified to look at your material and give you feedback before you send it in.
• 6:56
  SPEAKER_01: Very much so.
• 6:57
  SPEAKER_01: Well, we're glad for this project.
• 6:58
  SPEAKER_01: I'm wondering uh for those who are listening, if you might share uh when you first started to get interested in the field of biomedical ethics.
• 7:07
  SPEAKER_02: It actually started back in 1993 when I met Jim Drain, who is one of the founders of Modern Bioethics.
• 7:14
  SPEAKER_02: He was one of several, includes Bob Vetch from Harvard and Dan Callahan of Yale.
• 7:18
  SPEAKER_02: You may remember Ed Pellegrino, who was down at Georgetown.
• 7:21
  SPEAKER_02: You have Beecham and Childress and Triss Engelhart, who edited the Christian Bioethics Journal.
• 7:27
  SPEAKER_02: Jim's interest in this or his career really piqued my interest.
• 7:30
  SPEAKER_02: And then in 1996, I became the chaplain at the Frederick Living Community, a long-term care community, and I was asked to form an ethics committee.
• 7:38
  SPEAKER_02: So I called Jim and I said, help.
• 7:39
  SPEAKER_02: He sent some really excellent material to me very graciously.
• 7:43
  SPEAKER_02: And that started me on the path to a presenting papers, giving talks, writing articles.
• 7:48
  SPEAKER_02: 2001, I gave a presentation at Center for Bioethics and Human Dignity for the first time near Chicago.
• 7:54
  SPEAKER_02: 2007 in San Diego with some UCLA medical people and so on, really kind of moved that along.
• 8:01
  SPEAKER_02: So that's how I started to become interested.
• 8:04
  SPEAKER_01: These papers, though, are tied to real life examples where you've had to be with families as they've, I guess, as you say, enter the zone of uncertainty.
• 8:14
  SPEAKER_01: Perhaps some of these have been at the uh Frederick Living community, maybe maybe elsewhere, but maybe you could share a few stories of what it's like to go through this time of uncertainty.
• 8:23
  SPEAKER_01: Some of our listeners might be wondering, they might need to do it at this point, the friend or relative who's unresponsive.
• 8:30
  SPEAKER_02: Yes, I can share a few with you.
• 8:32
  SPEAKER_02: I had a patient come in with terminal cancer and he was a great deal of pain.
• 8:37
  SPEAKER_02: And he misunderstood something I said to him pastorally.
• 8:40
  SPEAKER_02: I said to him something like, When the Lord is ready for you, he'll come and take you to the other side.
• 8:45
  SPEAKER_02: And I was being a little bit vague because I didn't really know where this gentleman was in his faith journey.
• 8:51
  SPEAKER_02: The next day, when I came back to see him again, his friend came over to me and said, Well, he's ready for you to take him to the other side.
• 8:58
  SPEAKER_02: Right away, I realized he thought I was talking about doing an assisted suicide.
• 9:02
  SPEAKER_02: I had to say to him right away, he said, That's against Pennsylvania law.
• 9:06
  SPEAKER_02: And it's very much against my own personal ethics.
• 9:09
  SPEAKER_02: So that was one.
• 9:10
  SPEAKER_02: The second one was interesting.
• 9:11
  SPEAKER_02: A resident who was in his early 80s, he went into kidney failure.
• 9:16
  SPEAKER_02: He was on dialysis for about three and a half years.
• 9:18
  SPEAKER_02: And then one day in the nursing center, he looked over at me, having just come back from dialysis, and he said to me, My wife doesn't know this yet, and my doctor doesn't know it, but this was my last day.
• 9:28
  SPEAKER_02: So I went over to him right away and I said, Bob, are you sure?
• 9:31
  SPEAKER_02: And he said, Yes.
• 9:32
  SPEAKER_02: I said, Do you mind if I talk to your wife and your doctor about this?
• 9:35
  SPEAKER_02: He said, Oh no, absolutely, please do.
• 9:38
  SPEAKER_02: So that his permission gave us the wherewithal to where we could put together a care committee meeting, not only with his wife and his doctor, but with our medical staff at Frederick.
• 9:48
  SPEAKER_02: We all came up with the conclusion that he was perfectly competent to make that decision.
• 9:52
  SPEAKER_02: It was legal and ethical too, because when you withdraw life support from a patient who has a terminal illness and his kidney failure was a terminal illness, it's the condition that causes death, not the act of withdrawing the support.
• 10:07
  SPEAKER_02: It's very much like a terminal cancer patient who says, I'm not going to do chemo anymore.
• 10:12
  SPEAKER_02: So we had that.
• 10:13
  SPEAKER_02: We did have an unresponsive wakefulness syndrome patient.
• 10:17
  SPEAKER_02: She persistent vegetative state.
• 10:19
  SPEAKER_02: She had been in this for several years and all of a sudden developed multiple complications medically.
• 10:26
  SPEAKER_02: Brittle bones, the nurse's aides, as they were repositioning her, were concerned that they might be actually breaking small bones.
• 10:33
  SPEAKER_02: And then her feeding tube was malfunctioning.
• 10:36
  SPEAKER_02: So we called the committee together.
• 10:37
  SPEAKER_02: Her niece, who was her power of attorney, asked with her doctor if we could withdraw the tube.
• 10:43
  SPEAKER_02: And we all agreed because of her situation.
• 10:46
  SPEAKER_02: So her doctor came to me the next day and he said, you know, I agree to this, but I just can't get past the idea that we're starving her to death.
• 10:53
  SPEAKER_02: And I shared with them again that ethical principle that when you remove a life support from someone who has these very serious, complicated life-threatening things, it's that condition that causes death.
• 11:06
  SPEAKER_02: Even courts have said this over the years.
• 11:09
  SPEAKER_02: Those are the three stories that I think of, I think, the most when you ask that question.
• 11:15
  SPEAKER_01: Now, having been with families who have had to make that decision uh in the life of the church, I guess that'd be a helpful perspective of instead of thinking of taking the life of a loved one, it's different.
• 11:27
  SPEAKER_02: There's a major difference.
• 11:28
  SPEAKER_02: So this is uh I go back to Dr.
• 11:29
  SPEAKER_02: Drain for really helping me with this.
• 11:31
  SPEAKER_02: There are acts of active killing, which are not ethical, and then there's allowing someone to die who's dying.
• 11:37
  SPEAKER_02: And I'll talk about this more, but where we want to preserve life, where life is there, we don't want to prolong the dying process because we really can't keep death from coming once it comes.
• 11:49
  SPEAKER_01: But these are very heavy times when one is with a family and has to walk through these decisions of when were we prolonging death that's on its way?
• 11:58
  SPEAKER_01: Uh, should there be an alternative treatment, uh, like a dialysis that could be used.
• 12:03
  SPEAKER_01: Since you've been involved with counseling during that time, I'm wondering if you could suggest a few biblical texts that come to mind with end of life issues.
• 12:12
  SPEAKER_02: The scriptures that really come to the fore in end of life are those that talk about sanctity of life and reality of death.
• 12:19
  SPEAKER_02: So human life in God's image is sacred, Genesis 1, 26 to 28, Exodus 19, 6, and 22 to 31.
• 12:27
  SPEAKER_02: God gives the breath of life, Genesis 2, 7, Acts 17, 25.
• 12:33
  SPEAKER_02: We have human life is protected by God, and the unlawful taking of life is subject to his judgment.
• 12:39
  SPEAKER_02: That's Genesis 4:15, Numbers 35, 11, and 12, Jeremiah 22, 3 in the Old Testament.
• 12:44
  SPEAKER_02: The Bible upholds the sanctity even of young lives, and I firmly believe of the unborn.
• 12:50
  SPEAKER_02: I know that's controversial, but in the Old Testament, you have Jeremiah 1.5, Psalm 127, 3 and 4, Psalm 139, 13 to 16.
• 12:59
  SPEAKER_02: In the New Testament, the passages in Luke, the infancy narratives about Jesus and some other passages there.
• 13:05
  SPEAKER_02: I know our mutual friend Howard Marshall from Scotland wrote this when he was talking about Genesis 25, where you have Rebecca with the unborn twins.
• 13:15
  SPEAKER_02: Verse 22 says they jostled one another.
• 13:18
  SPEAKER_02: And so Howard wrote, he said, although it's not really clear that there was the thought of conscious movement, yet the rabbis did interpret the text that way.
• 13:26
  SPEAKER_02: And what's interesting is the rabbis, even ancient rabbis, interpreted that at the Exodus, the unborn infants at that time were singing along with the others.
• 13:35
  SPEAKER_02: So you also have the story of Moses in Deuteronomy 30, verse 19, where he stands before the community and says, I set before you life and death, choose life.
• 13:44
  SPEAKER_02: So you have these.
• 13:45
  SPEAKER_02: However, the Bible also is very clear about the reality of death.
• 13:49
  SPEAKER_02: Our dying relates to our relationship to Adam, which is 1 Corinthians 15, 22, and that death comes to all of us at some point.
• 13:56
  SPEAKER_02: Romans 5, 12.
• 13:58
  SPEAKER_02: Uh Edmund Clowney, almost 50 years ago when he was president at Westminster, wrote, Life is only a breath, and that breath is a sigh.
• 14:05
  SPEAKER_02: Life is short, death is sure.
• 14:07
  SPEAKER_02: And there are some very dark passages in the scripture about dying, something like that.
• 14:12
  SPEAKER_02: Psalm 115, 17 says, The dead do not praise the Lord, nor do any who go down into silence.
• 14:19
  SPEAKER_02: Very dark picture there.
• 14:20
  SPEAKER_02: And then Ecclesiastes 9:5.
• 14:23
  SPEAKER_02: The dead know nothing, they have no more reward, the memory of them is forgotten.
• 14:27
  SPEAKER_02: And in verse 10, there is no work or thought or knowledge or wisdom in the grave to which you are going.
• 14:33
  SPEAKER_02: So Derek Kidner, I think you know Derek, he wrote a commentary on Ecclesiastes that says, Ecclesiastes unsettles our most secure assumptions and has a sting in its tail.
• 14:44
  SPEAKER_02: But here's the thing the scripture doesn't leave us there.
• 14:47
  SPEAKER_02: It goes on to a very pronounced series of teachings that talk about the fact that life does continue beyond the grave as the reality of heaven, a being within.
• 15:00
  SPEAKER_02: So even Ecclesiastes in chapter 12, to get to the end, it says the dust returns to the earth as it was, the spirit returns to God who gave it.
• 15:08
  SPEAKER_02: And then we could go to uh one of many passages like John 11.
• 15:12
  SPEAKER_02: I am the resurrection of the life.
• 15:13
  SPEAKER_02: Whoever believes in me will never die.
• 15:16
  SPEAKER_02: So we have this series of scriptures, fairly large number of scriptures, that discuss the sanctity of life, the importance of preserving life at the end, as much as we possibly can when life is there, but balancing that with the reality of death.
• 15:33
  SPEAKER_02: When death comes, we should not try to stop that at a certain point.
• 15:38
  SPEAKER_02: The scripture was very important to the family, especially the mother of a young man by the name of William.
• 15:44
  SPEAKER_02: William at age 23 had been in an unresponsive wakefulness state all of his life.
• 15:51
  SPEAKER_02: Sorry, very, very young as an infant having seizures, and that brought about that state.
• 15:55
  SPEAKER_02: And he lived in that state.
• 15:57
  SPEAKER_02: And at 23, he was diagnosed with life-threatening abdominal condition, would have required, again, a life-threatening surgery every three weeks.
• 16:09
  SPEAKER_02: So it brought his mom to the place of where she had to decide what to do.
• 16:13
  SPEAKER_02: The scripture was very important to her at that point as a woman of faith and a woman of God.
• 16:19
  SPEAKER_02: I would like to maybe just share a couple of these with you.
• 16:22
  SPEAKER_02: We talked about the sanctity of life and preserving the importance of life.
• 16:27
  SPEAKER_02: Genesis chapter 1, verses 27.
• 16:30
  SPEAKER_02: God created man in his own image, and the image of God he created him.
• 16:33
  SPEAKER_02: God blessed them and said, Be fruitful and increase in number.
• 16:36
  SPEAKER_02: And so you have the image of God.
• 16:39
  SPEAKER_02: And then in Genesis 2.7, the Lord God formed the man from the dust of the ground and breathed into his nostrils the breath of life.
• 16:47
  SPEAKER_02: And that's when human beings became living beings at that point.
• 16:51
  SPEAKER_02: And so you have the importance of preserving life.
• 16:54
  SPEAKER_02: I think for me too, Psalm 139, what's been extremely important, not just to myself, but to many others, has been this verse that says, He says, You have created my inmost being, you knit me together in my mother's womb, praise you.
• 17:08
  SPEAKER_02: I praise you because I am fearfully and wonderfully made.
• 17:12
  SPEAKER_02: Your works are wonderful.
• 17:13
  SPEAKER_02: I know that full well.
• 17:14
  SPEAKER_02: My frame was not hidden from you when I was made in the secret place.
• 17:18
  SPEAKER_02: When I was woven together in the depths of the earth, your eyes saw my unformed body.
• 17:22
  SPEAKER_02: All the days ordained for me were written in your book before one of them came to be.
• 17:27
  SPEAKER_02: That's pretty exciting, certainly that way.
• 17:29
  SPEAKER_02: And then I had read for you earlier a few passages that discuss the reality of death, but also the importance of looking toward beyond death into eternal life.
• 17:42
  SPEAKER_01: And that's certainly a Christian perspective and not something that would be a secular perspective.
• 17:47
  SPEAKER_01: That's correct.
• 17:48
  SPEAKER_01: Where there is no God.
• 17:50
  SPEAKER_01: I'm just wondering if you could say a little bit more how faith intersects with people who have to make difficult end-of-life decisions.
• 17:58
  SPEAKER_01: What do you say?
• 17:59
  SPEAKER_01: What have people of faith said to you when they've had to let a loved one go?
• 18:05
  SPEAKER_02: Yeah, I I think one of the real blessings of having been at the at the Frederick Living community for me was to hear these testimonies of faith from folks who were way up in years and some who were actually on their deathbed and yet, or who were terminally ill and who were sharing with us what they really believed.
• 18:25
  SPEAKER_02: If I go back to this man who I mentioned who was on dialysis, one of the big reasons why he decided to stop was that he firmly believed in life after death and going to heaven.
• 18:37
  SPEAKER_02: He said, When I close my eyes in death, I will see my Lord and I'll see my loved ones.
• 18:42
  SPEAKER_02: So there's very strong, very strong faith that the promise of eternal life was very real to him at that time.
• 18:50
  SPEAKER_02: And you know how it is in life.
• 18:52
  SPEAKER_02: We sometimes hold a kind of an intellectual or mental ascent to doctrine and theology.
• 18:59
  SPEAKER_02: But when you're down in the uh in the trench, uh, isn't there the old expression there are no atheists in foxholes?
• 19:06
  SPEAKER_02: I have felt, even you know, as a man who is now aging, you know, with COVID and so on, it's really brought a lot of these things more real uh to me.
• 19:14
  SPEAKER_02: So, yes, that was one what a pastor of mine, friend of mine, called holy coincidence.
• 19:19
  SPEAKER_02: I'm sure many of us had these holy coincidences.
• 19:22
  SPEAKER_02: I had gone down to the Norristown area to uh a morning seminar on end-of-life ethics.
• 19:29
  SPEAKER_02: And when I left the seminar at lunchtime, I realized that there was a Frederick patient right next door in the hospital.
• 19:35
  SPEAKER_02: So I'll go over and visit with her.
• 19:37
  SPEAKER_02: When I did, her family said, Wow, this is timely because she has gone into kidney failure.
• 19:42
  SPEAKER_02: She has to decide if she's going to accept dialysis or not, whether she wants to continue living.
• 19:47
  SPEAKER_02: And so and then we talked with her, we talked about her faith, we went through some of these scriptures, and you know what?
• 19:53
  SPEAKER_02: She decided that she was going to take dialysis and continue living for for the most part for her family, but it was her strong faith in God that gave her the strength to do that.
• 20:07
  SPEAKER_02: And I think that's the other aspect of faith that I found from uh uh folks in these conditions is that faith gives the strength and the hope uh to carry on, even if it's a a difficult thing.
• 20:19
  SPEAKER_01: Let's talk about the quality of life decisions, unless you just talked about someone who made the decision to go on dialysis with kidney failure.
• 20:28
  SPEAKER_01: But some have chosen not to go on dialysis with kidney failure, and others have said quality of life uh decisions should perhaps uh make it easier to let somebody go when they're in this unresponsive state.
• 20:43
  SPEAKER_01: Can you say something about quality of life decisions?
• 20:46
  SPEAKER_02: Sure.
• 20:47
  SPEAKER_02: Quality of life is uh is a highly controversial subject.
• 20:49
  SPEAKER_02: How do we deal with that?
• 20:50
  SPEAKER_02: I share with you about a woman almost 25 years ago.
• 20:54
  SPEAKER_02: She had been in California and she had executed a living will.
• 20:57
  SPEAKER_02: I think everybody understands what an advanced directive or a living will.
• 21:00
  SPEAKER_02: It's when you write in advance or put down somehow in advance that if I were to be in an end-of-life situation, this is what I would want or not want.
• 21:10
  SPEAKER_02: Then often normally you select someone to be your power of attorney to uphold that for you because you may become incapacitated.
• 21:17
  SPEAKER_02: The gentleman I had talked about in kidney filler, he was still competent to make the decision, but oftentimes that's not the case.
• 21:23
  SPEAKER_02: This is a woman who put together in her living will, out in a state where this was permitted, I think it might have been California, that if my quality of life ever diminishes, that you shouldn't really do much for me, let me go.
• 21:35
  SPEAKER_02: So years later, she had moved to Pennsylvania and she was in a life care community, and she was in a state of advanced dementia where she no longer was competent, could no longer communicate, and she developed a very serious sore on her leg.
• 21:51
  SPEAKER_02: Doctors said we think we might be able to heal it using non invasive means like uh whirlpool and antibiotics.
• 22:00
  SPEAKER_02: But if that they don't work, it will become gangrenous, and the only way to save her life would be to amputate.
• 22:05
  SPEAKER_02: So here's a woman in advanced dementia, you know.
• 22:08
  SPEAKER_02: So her daughter said, Well, you know, mom was very strong on the right to die issue.
• 22:13
  SPEAKER_02: Mom said, if my quality of life ever goes down, you should just let me go.
• 22:18
  SPEAKER_02: I said, Well, we can't do that in Pennsylvania, but this is what we will do.
• 22:21
  SPEAKER_02: Went to court, went before a judge.
• 22:23
  SPEAKER_02: The judge said this, uh, I'm going to require the whirlpool and antibiotics treatments just to see if they work.
• 22:30
  SPEAKER_02: They're not invasive.
• 22:31
  SPEAKER_02: If they don't work, the daughter is power of attorney, you will have the right to say no to amputation.
• 22:36
  SPEAKER_02: I thought that was pretty fair in a state that doesn't, and I think to this day, really doesn't allow quality of life to be the thing.
• 22:44
  SPEAKER_02: So I would like to make a couple of recommendations.
• 22:46
  SPEAKER_02: First of all, and I researched this for the book, my understanding is that scripture doesn't really overtly allow or forbid quality of life when it comes to end-of-life decision making.
• 22:57
  SPEAKER_02: So we're kind of on our own in a way to sort that out and figure that out.
• 23:02
  SPEAKER_02: However, there are two things.
• 23:03
  SPEAKER_02: The first one is if we are going to bring that in and introduce that, it should be with much prayer and wise counsel.
• 23:10
  SPEAKER_02: And I bring that up often in the book because we're not on our own.
• 23:14
  SPEAKER_02: We don't have to be.
• 23:15
  SPEAKER_02: We have church people, we have medical people, we have ethicists, we have the scripture, we have ethical principles to draw upon.
• 23:24
  SPEAKER_02: And so are many things we can go to.
• 23:26
  SPEAKER_02: And if anyone really wants to discuss that further, I'd be happy for you, Drake, to give out my email address, or I can.
• 23:34
  SPEAKER_02: And if anyone really wants to contact me, I'd be happy to talk further with them.
• 23:38
  SPEAKER_02: But the other thing is don't make it the sole consideration, don't make quality of life the sole consideration for withdrawing or withholding life support.
• 23:49
  SPEAKER_02: And I think that may still even be the law in Pennsylvania.
• 23:52
  SPEAKER_01: You mentioned an email, maybe you give it out now, uh, and uh I'll ask at the end uh as well for our listeners.
• 23:58
  SPEAKER_01: But uh your email?
• 23:59
  SPEAKER_02: It's Diaz and David, ours and Ralph.
• 24:02
  SPEAKER_02: My name, B-R-A-D, D-R Brad 1996 at outlook o-t-l-o-o-k.com.
• 24:12
  SPEAKER_02: Please feel free to get in touch with me if you if you are going through this, if you have a family member, that's what I'm here for, is to help.
• 24:20
  SPEAKER_02: So and if I can't help, I will refer you on to someone who can.
• 24:24
  SPEAKER_01: We've talked about scripture texts to read or viewpoints of how God sees end of life or life in general.
• 24:31
  SPEAKER_01: Have you counseled people on how to pray during the time of deciding when to whether to let someone, a loved one, a friend, or family member go?
• 24:42
  SPEAKER_01: Uh and if so, how would you encourage people to pray?
• 24:46
  SPEAKER_02: Yeah, it's interesting because again, you have sanctity of life and reality of death, and we don't often really know right away what we're facing, whether it is a a situation.
• 24:56
  SPEAKER_02: So I know I had a sister who was uh who died in her 30s of uh cancer, and we prayed for a long time that God would heal her.
• 25:04
  SPEAKER_02: But then it came to a point to where we came to understand that wasn't going to happen.
• 25:08
  SPEAKER_02: That's when we began to pray that the Lord would give her grace in her final days, which he did.
• 25:14
  SPEAKER_02: One of the things that comes up, and I don't know if I'm gonna have a chance to share this with you or not, but there was a woman who was comatose, she had a about a week to live, and uh, she was going through I I will share this with you in a few minutes, but part of the dying process for some people, some people die in a great deal of pain, they have to realize that.
• 25:34
  SPEAKER_02: There are others where if the body is shutting down and fluids build up, often the kidneys raise this level of what are called creatinins.
• 25:43
  SPEAKER_02: And for a person who's young, you go on dialysis to get rid of that.
• 25:48
  SPEAKER_02: However, if you're dying, a buildup of creatinins creates a sense of euphoria and peace.
• 25:54
  SPEAKER_02: And so it's one of the ways I think in which God allows certain people to die in a with a real sense of peace, you know, and quietness.
• 26:01
  SPEAKER_02: So I think we pray that the Lord might bring about a healing, or like a Martin Pistorius, to where the doctors misunderstood his condition and to bring him back, but that's not always the case.
• 26:13
  SPEAKER_02: So then so our prayers do change, I think.
• 26:15
  SPEAKER_02: The focus of prayer changes.
• 26:17
  SPEAKER_01: But then it's a matter of trying to, I guess, listen to the Lord as to when he is saying it's time to let someone go.
• 26:25
  SPEAKER_02: Yeah, not only that, but also listening and watching your loved one and listening to the medical people very carefully.
• 26:32
  SPEAKER_02: They don't always have all the right answers, but uh often, more often than not, they're giving us their best.
• 26:38
  SPEAKER_02: There are situations where if my loved one, especially if it's one of these states like the woman who is eight or ten years and an unresponsive young man who's 23 years and unresponsive uh wakefulness.
• 26:51
  SPEAKER_02: Actually, can't you see the ambiguity even in that title?
• 26:54
  SPEAKER_02: If you have something like that, is my loved one experiencing severe physical decline?
• 27:01
  SPEAKER_02: Or are there comp are there medical complications that are just making it impossible for my loved one to continue?
• 27:09
  SPEAKER_02: That too.
• 27:09
  SPEAKER_02: So a lot of listening to the Lord, listen to the doctors and and watch your loved one very carefully.
• 27:16
  SPEAKER_02: And if your loved one is still awake and alert and confident, listen to them.
• 27:20
  SPEAKER_02: How are they feeling?
• 27:22
  SPEAKER_01: Think of a text in James uh chapter one about praying for wisdom during a time.
• 27:26
  SPEAKER_01: Would you have any comment on that?
• 27:29
  SPEAKER_02: Oh, yeah.
• 27:29
  SPEAKER_02: I include that in the book.
• 27:31
  SPEAKER_02: Wisdom, and this is what several other theologians have written about is that the will of God in these cases to determine really requires wisdom.
• 27:39
  SPEAKER_02: We need wisdom to understand as much as we can about the end of life.
• 27:44
  SPEAKER_02: There was so much conflict in, for example, the the Shaivo case and others, people just opposing and going at each other.
• 27:51
  SPEAKER_02: Where I think if they had just perhaps if we can pray for a little more wisdom in those types of situations, I think we can reduce that.
• 27:58
  SPEAKER_01: We talked about prayer and reading scripture and uh waiting, all these are good faith practices.
• 28:05
  SPEAKER_01: But my guess is with all of your experience in these areas, uh Brad, you've seen uh faith abuse and end-of-life issues.
• 28:12
  SPEAKER_01: Might you share a story or two?
• 28:13
  SPEAKER_02: Sure.
• 28:14
  SPEAKER_02: I have a good story and starting to tell it, and I'll I saved it a little bit.
• 28:17
  SPEAKER_02: We had a nurse at Frederick, whose aunt was in another faith-based community.
• 28:22
  SPEAKER_02: She was comatose, totally unresponsive, and her skin was paper thin, elderly.
• 28:27
  SPEAKER_02: Two doctors gave her one week to live, which at the time was the ethical standard in the state for withdrawing everything, terminal illness.
• 28:35
  SPEAKER_02: But that community required her to receive IV fluids and a feeding tube up to the moment she died.
• 28:43
  SPEAKER_02: They said that their position was air, food, and water are everyone's right up to the moment of death.
• 28:49
  SPEAKER_02: Now that sounds right, doesn't it?
• 28:51
  SPEAKER_02: It sounds good.
• 28:52
  SPEAKER_02: However, it misses some of the medical realities and the concept of mercy.
• 28:58
  SPEAKER_02: I shared with you a moment ago that when the organs shut down, which is what was happening in this woman, your organs build up a tremendous amount of fluid.
• 29:06
  SPEAKER_02: You know when a person has heart failure, they always check the ankles.
• 29:09
  SPEAKER_02: Why?
• 29:09
  SPEAKER_02: The ankles swell, right?
• 29:11
  SPEAKER_02: That's what happens.
• 29:12
  SPEAKER_02: And so if you start pumping water and food into that, is that a good thing or a bad thing?
• 29:19
  SPEAKER_02: So thankfully, we were able to get that community to send this nurse's uh aunt to our place where we were able to take everything off and allow her to die because death was definitely coming.
• 29:33
  SPEAKER_02: And she died a week later.
• 29:35
  SPEAKER_02: I mean, it was just perfect timing.
• 29:36
  SPEAKER_02: So I think we can abuse faith, especially in that statement.
• 29:42
  SPEAKER_02: You know, that's come up over and over again, and it sounds good, it sounds right.
• 29:46
  SPEAKER_02: Now, if I'm out in the middle of the wilderness right now as a healthy 71-year-old, and I starve to death, terrible thing, to die in a tremendous lot of pain, and it might have been unnecessary.
• 29:58
  SPEAKER_02: But a person who is actively dying like that does not need food and water and might need to actually have those things taken off to have a peaceful death.
• 30:11
  SPEAKER_02: Certainly, yeah, we could we can abuse our beliefs in a variety of ways.
• 30:14
  SPEAKER_02: That's the one that came to mind.
• 30:15
  SPEAKER_01: I'm sure you can think of other times where people have assumed that their faith would heal somebody and they weren't.
• 30:22
  SPEAKER_02: I actually did have a situation at Frederick where I was on one side of a patient and her daughter was on the other side.
• 30:28
  SPEAKER_02: Her daughter was up at her mom's face, going, Oh, mom, you know, and crying.
• 30:32
  SPEAKER_02: And then as I looked more at mom, I thought, mom's not here anymore, mom's gone.
• 30:35
  SPEAKER_02: So I slipped away and I went down to the nurse's desk and I said, You need to get down and pronounce for this daughter's sake.
• 30:40
  SPEAKER_02: So I think her strong faith was trying to keep mom there and pull her back.
• 30:44
  SPEAKER_02: You know, that's another thing we can try to do, is try to keep people with us too long.
• 30:47
  SPEAKER_01: I appreciate you sharing these stories as a chaplain, as someone who's a thought about end-of-life issues.
• 30:55
  SPEAKER_01: In the church, we have a number of people who are dealing with end-of-life issues.
• 30:59
  SPEAKER_01: And I'm wondering if you might share how a church community can be a help for those who are dealing with uh end-of-life issues.
• 31:07
  SPEAKER_02: Yeah, Drake, it's mainly to be supportive, as supportive as we can.
• 31:11
  SPEAKER_02: And one of the things we can do in advance of that is to become as knowledgeable as possible.
• 31:15
  SPEAKER_02: One of the reasons why I really wanted to write this book was because of cases like the Shivo case, I think where we're not knowledgeable enough about certain medical realities.
• 31:26
  SPEAKER_02: Again, like this pumping fluids into this woman, the same thing.
• 31:30
  SPEAKER_02: So let's become as knowledgeable as we can.
• 31:32
  SPEAKER_02: Let's bring in the medical people.
• 31:34
  SPEAKER_02: There are good Christian people in the medical professions, all the professions, and they're highly knowledgeable about these things.
• 31:40
  SPEAKER_02: And they're more than willing to come and talk about it.
• 31:42
  SPEAKER_02: And then the ethicists, you know, like the drains and the kilners and others.
• 31:46
  SPEAKER_02: Hold seminars, hold workshops, become personally engaged with the end-of-life decisions in your church, uh, with the conditions and so on.
• 31:55
  SPEAKER_02: Be as supportive as possible.
• 31:57
  SPEAKER_02: Encourage your church people to execute an advanced directive and to select a power of attorney.
• 32:05
  SPEAKER_02: It's not always foolproof, certainly.
• 32:08
  SPEAKER_02: Do everything that you can in advance.
• 32:10
  SPEAKER_02: Hold the hard conversations with your family.
• 32:14
  SPEAKER_02: Sit down with them, even over the dinner table, and say, I know you don't want to hear this, but there could come a time when I'm not able to tell you anymore, you know, what I want.
• 32:24
  SPEAKER_02: I have it in writing, but you need to know, you need to know exactly where I stand on these things so that you can help me.
• 32:31
  SPEAKER_02: And I think too, is to go to your pastor and sit down with your pastor and just share, hey, you know, pastor, this is how I feel about these things.
• 32:39
  SPEAKER_02: Maybe you can help me, share with me some of the scriptures and that I need to know and help me to become more knowledgeable.
• 32:46
  SPEAKER_01: And if somebody is having to make those types of decisions, it's nice to have a community where there are others who have gone through that, uh, as the church does.
• 32:56
  SPEAKER_02: Yeah, I mentioned that earlier, is that we're not alone.
• 32:58
  SPEAKER_02: That's uh that's the important thing uh for folks to remember.
• 33:02
  SPEAKER_02: And we've had, you know, this William's mother was a single mother at that point that he was 23, you know, and she might have felt very alone, but she didn't.
• 33:09
  SPEAKER_02: She she counseled with me, she counseled with her pastor, she brought in good friends to pray with her, family members.
• 33:16
  SPEAKER_02: We all met with the medical people at the hospital where William was.
• 33:19
  SPEAKER_02: That's what you need to do is bring in and engage your church, engage all of the people that can help you through this.
• 33:27
  SPEAKER_02: There's a tremendous amount of help.
• 33:28
  SPEAKER_02: Yeah, and and as we said earlier, we go in prayer, we go directly to the Lord as well.
• 33:32
  SPEAKER_02: The Holy Spirit is a tremendous amount, and he's you know, the call spirit's the comforter, right?
• 33:37
  SPEAKER_02: So we look to the spirit uh to bring us comfort.
• 33:40
  SPEAKER_02: We have that, but we also have other human beings just really be a tremendous help at a time like this.
• 33:46
  SPEAKER_01: But we have these support groups through the life of the Central Schwank Elder Church, and we're very glad to know, Brad, that uh you two are willing to be of assistance for those who are uh dealing with end-of-life issues.
• 33:57
  SPEAKER_01: Whenever you give your email one more time, if uh you don't mind.
• 34:01
  SPEAKER_02: Please contact me if you have news.
• 34:02
  SPEAKER_02: It's D R Diaz and David, Rs and Ralph, Brad, D-R-A-D, 1996 at outlook.com.
• 34:10
  SPEAKER_01: And your book will be out when?
• 34:12
  SPEAKER_02: Well, don't know yet.
• 34:13
  SPEAKER_02: I I have the proposal pretty much together.
• 34:15
  SPEAKER_02: Uh, and I've had Dr.
• 34:16
  SPEAKER_02: Kilner, Dr.
• 34:17
  SPEAKER_02: Drain, and a good friend Dr.
• 34:19
  SPEAKER_02: Eric Clary out in Oklahoma, who's uh something of an expert on responsive wakefulness.
• 34:24
  SPEAKER_02: They've done a lot of reviewing uh for me, and so I'm finishing the final edits on the draft.
• 34:31
  SPEAKER_02: I have the proposal together.
• 34:32
  SPEAKER_02: I have a good working relationship with Oxford Publishing at this point.
• 34:35
  SPEAKER_02: I'm reviewing articles for them, so I'm it might be a good starting place.
• 34:40
  SPEAKER_02: Also, I've done a seminar with InterVarsity Press.
• 34:44
  SPEAKER_02: So there are a number of possible publishers we can go to and just see uh what happens.
• 34:49
  SPEAKER_01: Well, great.
• 34:50
  SPEAKER_01: Well, we wish you success in that, and thank you for uh sitting with us to talk about these uh difficult issues today.
• 34:55
  SPEAKER_02: Thank you so much, Drake.
• 34:56
  SPEAKER_02: Again, it's been an honor and a pleasure not only to be with you as a fellow colleague and our time in Tyndale together years ago, but also all of you who are out there and who are listening.
• 35:06
  SPEAKER_02: Thanks for joining in with us today.