Ministering to the Terminally Ill

Rev Michael DeVries

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"Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me, thy rod and thy staff they comfort me." Psalm 23:4

In a talk given in our Protestant Reformed Seminary several years ago on the subject of "Sick-Visiting", Rev. C. Hanko, a veteran pastor, remarked regarding terminal cases, "You walk with them down the valley. You must stay behind. Sometimes you'll envy them. The grace of God will amaze YOU." To a student, the truth of those remarks did not really "sink in." But now, having served as minister of the Word and as pastor to the dying for several years, I can say that the truth of those remarks has struck me again and again.

Though our entire earthly life is a walk through that valley, the consciousness of that is most emphatically realized when one is confronted with the reality of terminal illness. It is then that the valley is the darkest, the most lonely, the most dangerous. Especially then the sheep need Christ their Shepherd. Especially then they need to be able to confess with the Psalmist, "I will fear no evil: for thou art with me!" That means, very simply, that the undershepherds of the Good Shepherd must be there. The officebearers of the church, minister, elders, and deacons must be busy visiting the dying. They come as representatives of Christ in the service of the Good Shepherd.

The Essentials

We will not belabor what ought to be obvious - that the undershepherd and ambassador of Christ must only and always come with the Word of Christ. The sheep, especially the dying sheep, need to hear the voice of the Good Shepherd! We must be there to bring the Word! Our ministering to the terminally ill is not a series of social visits, not a series of medical consultations, not a series of psychiatric sessions. Briefly, pointedly, simply, bring the Word! Usually five to ten verses are enough. In some instances just a verse or two maybe sufficient. But bring the Word, a specific passage, and briefly explain and apply it. We ought not lecture or sermonize, but rather authoritatively, yet with compassion and sensitivity, open and expound the Word for them. Bring the good news of Christ, and Him crucified and risen again!

The other essential in ministering to the terminally ill is prayer. Come

to the dying with the prayer of faith which saves the sick (James 5:13). Always pray! The needs of the dying must be brought to the throne of grace. The dying usually want us to pray, and often need us to pray. It can be difficult for them to pray for themselves. In prayer lead the dying in the confession of their sins; lead them to the cross of Christ and forgiveness; lead them to the riches of the salvation we have in Christ; lead them to the grace and mercy of our sympathetic Savior who is there to help in time of need; lead them to the victory we have in Christ even over death and the grave.

Effectiveness in this Ministry

Bring the Word! Pray! Indeed, these are basic, indispensable in ministering to the terminally ill. Never despair of the Word and prayer even if the dying saint has lapsed into a coma or has sustained brain damage. God never leaves His saints without the consciousness of His Word. Jesus promises: "My sheep hear my voice."

But it is my conviction that much more is necessary to make that Word and prayer more effective by the grace of God, in the working of  His Spirit. Consider the following:

1. Sensitivity

Officebearers ought to realize that the dying saint probably knows he is going to die, whether he has been told or not. We ought to be sensitive to their struggle in that connection. The dying person always has a struggle! After all, death is the last enemy. But rest assured that the Lord never fails to give dying-grace to the dying.

We must strive to be sensitive to the fears and feelings of the termin- ill There are fears of being useless. There is the realization, almost surely disappointing that his work, his contribution is ending. He has achieved as much as he will ever achieve, whether in vocation, or raising children, or forming relationships. There can also be a growing understanding and fear of the separation death will bring There is the fear, too, of becoming a burden. Serious illness is seen as imposing inconvenience on family and friends. Prolonged illness may be feared as being financially disastrous to survivors. There may be the fear of pain, which is inseparably linked to dying in most people's minds. There may be fears of personal indignity, of being subjected to medical procedures, to paraphernalia in the body, etc.

Be sensitive to what the dying says both verbally and non-verbally. Tears, turning to the wall, not wanting to talk -each of these says something.

To minister effectively to the terminally ill saint, one should try to understand the emotional stages they may pass through. It is striking that the terminal patient's grief before death is very similar to the grief experienced by the survivors after death. Dr. Elisabeth Kubler-Ross has given the classic description of the coping patterns of patients who know their diagnosis is terminal, in her book On Death and Dying (New York: Macmillan, 1969).

The first stage is denial. "No,not me." "There must be a mistake of some kind."

Next comes anger or resentment. "Why me?" "Why now?"

The third stage is bargaining. "Yes me,but-" "If You just give me five years, I'll…" "I'll be a better father if you just give me another chance."

The fourth stage is depression. Now he says, "Yes, me." "I'll never feel good again." "I'll never see my grandchildren grow up."

Finally comes acceptance, a time of facing death calmly, of quiet submission to the Lord's way. "I am at peace." "I'm ready."

During visits we must strive to be sensitive to where the patient is, with respect to these stages, after a few minutes of conversation. But bear in mind that these stages are not like climbing a ladder. One does not necessarily go up one rung at a time. And the lines between them are not clearly drawn. Further, the dying saint may fluctuate from day to day - anger on Monday, accepting on Wednesday, and back to anger on Friday.

Be sensitive too to the fact that the family, loved ones, are going through their own stages of anticipatory grief and may not always be in synchronization with the terminal patient. In this connection, the loved ones also need the pastor's care and must not be ignored. As much as or more than the ill, they need to be prepared for the reality of death.

Finally, be sensitive to sin; that is, recognize that the need of the sick, also the terminally ill, is fundamentally spiritual. Sickness and dying are inseparably connected to sin. There may be instances where a concrete sin may and must be pointed out - for example, drunkenness. But beyond this we cannot go. Generally it must be left between the individual and God. But be sensitive to a need there might be to talk about a sin. And lead the dying into the comfort of the gospel of our salvation.

2. Preparation

This sensitivity with regard to the dying saint and his needs means that preparation for the visit is essential for the officebearer of Christ. Prayerfully prepare. Decide what to read and what to say. Take time to collect your thoughts, whether it be in the study or in the car. Focus on your purpose for visiting. Determine how the Word you are bringing will meet the need of the dying saint. Especially for lengthy illnesses, keep careful record of the visits, passages read, etc. Above all, pray! Be conscious of your dependence upon Christ in this difficult labor.

Then, having prepared, be flexible. Being sensitive to the needs of the dying saint, determine the situation that day (is it an "up" day or a "down" day), and minister to him with the Word and prayer. You may decide to bring an entirely different Word from that for which you prepared.

3. Listening

Though this is an aspect of being sensitive to the needs of the dying saint, it deserves separate emphasis. G. Clarke Chapman, Jr. writes in the foreword of Albert J.D. Walsh's book Reflections on Death and Grief, "When we are called to minister to the dying and/or bereaved, many of us who count ourselves as servants of God too easily prejudge the matter and rush in with words and a trite formula. Words have become our trade, jargon our bane, and verbiage our downfall." Perhaps it seems a harsh jjudgment, but in some instances it is undoubtedly deserved. This is one occasion in which we ought to "be swift to hear, slow to speak." After greeting them, listen! Let them tell you how they feel and what is going on with them. Do not assume anything. You may ask leading questions, you may guide the conversation to keep it on a spiritual level, but be sure to listen. Listening does not come easy. Walsh puts it this way in his book, Reflections on Death and Grief (Grand Rapids: Baker Book House, 1986): "When we truly listen to the dying and the bereaved, we will bear their pain in our heart, as though it were our own. Listening implies an honest, heartfelt, and courageous response to genuine suffering and the deep sense of loss death brings in its wake."

4. Touch

Though the pastor or elder must always remember his office and maintain a ministerial dignity as the representative of Christ, he ought not overlook the power and significance of touch, especially with the terminally ill. A firm handshake, a gentle touch, a hand on the arm can say much more than many words. Feeling increasingly isolated from the world and people, the dying saint often desires and appreciates touch. Walsh writes, "I stress the importance of these expressions of affection and concern because my experience has been that the dying often feel untouchable, as though death were a contagious disease. We who would minister to the dying experience a curious sense of discomfort, making it difficult for us to reach out and touch and embrace. And this is the place for candor: death has a certain sight, smell, and sound that can be distasteful." In "Help, I Have Cancer-My personal thoughts on what people can do for me," Pete Meulenberg writes, "Touch me as you leave. The isolation of having cancer makes the power of your touch sweet with love."

5. Availability

The dying need their pastor! No matter how busy you are, take the time to visit. And let the dying saint and his family know that you are available at any hour, day or night, and that you want to be with them in times of crisis. Visits may need to be frequent. But the undershepherds of Christ must be with the sheep especially in their dying. The dying must be assured that you will be with them as they walk down the valley.

Life Support

It used to be much simpler, this whole business of dying. For the most part people used to die at home, often surrounded by their children and grandchildren. Now it may well be in the intensive care unit of the hospital, surrounded by tubes and needles, respirator, heart stimulator, etc. It was not long ago that the lack of heartbeat was considered final evidence of death. Because of modem medical technology the attention has shifted from heart to brain for a reliable criterion of when death has occurred. It is my conviction that there are no easy, pat answers as far as life support is concerned. Each case must be considered on its own merits.

As God's children we struggle along with the apostle Paul who was "in a strait betwixt two, having a desire to depart, and to be with Christ; which is far better: nevertheless to abide in the flesh is more needful for you" (Phil. 1:23, 24). Our testimony then must also be, "For to me to live is Christ, and to die is gain" (Phil. 1:21). The pastor must emphasize, in that light, that the main question for the child of God is not his recovery, not something physical, but spiritual. Is the dying content and even happy in the way of the Lord? Is he able to testify of that? Or are we assured of that?

Many factors must be considered with regard to life support, both its use and its removal. Obviously the medical condition is at the forefront. Many aspects must be weighed: prognosis, risk, treatments, success rate, pain,benefits. I believe it is wise to get a second medical opinion in most cases. Certainly legal aspects must be considered. State regulations, as well as hospital policy, are involved. Even financial factors ought not be ignored.

It is my conviction that the pastor and elders ought to refrain from "playing God" in any sense. They ought not seek to impose their will or opinion upon the dying or his family. As much as possible the under-shepherds of Christ must be sympathetic and supportive of both patient and family. At the same time, the patient (if possible) and the family must be led to see and to be submissive to the will of God. They must be led in the Scriptures and through prayer to commit their way unto the Lord. And I believe that the Lord will make His will plain in due time. His grace will be sufficient both for the patient and for the family.

In conclusion, undoubtedly mimistering to the terminally ill is some of the most difficult, yet at the same time some of the most spiritually edifying and rewarding, of an officebearer's labors. It is indeed blessed to walk with the saints down the valley. The grace of God is, indeed, amazing! To Him be the glory!

March 1, 1993 / Standard Bearer / 259

Rev. DeVries is a minister in the Protestant Reformed Churches of America

First Protestant Reformed Church
15911 107A Ave.
Edmonton, AB, Canada
Phone: (403) 489-6470
e-mail: 75323.675@compuserve.com

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Death's Triumph

Rev. Cornelius Hanko

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As I share some of these experiences with you, let me assure you that there is nothing morbid about this. All I can say is that death is victory for the saints. The hour of death is their Coronation Day.

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I recall an occasion when the time of departure was plainly drawing near. This man lay in a coma, seemingly no longer conscious of the affairs of this life.

Yet there came a moment when he began to mumble, evidently talking to himself. Shortly thereafter he made motions with his hands, as if he were brushing something aside. There upon he folded his hands and audibly prayed: "Forgive us our many transgressions in Jesus' blood."

Then his soul seemed to have come to rest, and soon it departed to join the heavenly throng.

"0 death, where is thy sting? 0 grave, where is thy victory? The sting of death is sin; and the strength of sin is the law. But thanks be to God, which giveth us the victory in our Lord Jesus Christ" (11 Cor. 15:55-57).

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It was shortly after noon that I visited a young mother who knew that the time of her departure was rapidly drawing near.

She was very concerned as she complained, "I cannot leave my family, these young children. What will happen to them?"

I tried to assure her that God had always taken care of them even until now, and would surely continue to do so in the future. In fact, He could do it better than we ever are able.

She asked me whether I would do all in my power to keep an eye on them, and I assured her I would. What more could I say?

That same day she peacefully entered into the Rest.

"I had fainted, unless I had seen the goodness of the Lord in the land of the living. Wait on the Lord: be of good courage, and he shall strengthen thine heart; wait, I say on the Lord" (Ps. 27:13, 14).

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This aged couple had seen many winters, had weathered many storms, experienced many trials and afflictions of all sorts. They had suffered many heartaches and griefs together, but had also experienced that the Almighty was their Refuge. They knew what it was to be poor, but they also knew that the Lord provided in every need.

The time had come that they would experience the meaning of the words, "... until death us do part."

She stood at his bed and saw him gradually going deeper into the valley of death, where she could no longer follow.

As he breathed his last breath she said: "It is hard to part. But God is good."

" And now, Lord, what wait I for? my hope is in thee" (Ps. 39:7).

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A man 75 years old began through a chain of circumstances to attend our services. When he was a young man he had come to America, but had not bothered to take his church membership papers with him. In fact, he and his family had not attended church all those years until the Lord brought him into our midst.

Before long he desired to make confession of faith. He said that he was deeply aware that he was a sinner and could not die without seeking peace with God.

A few years later I stood at his deathbed. I asked him: "Is all well?" To which he answered: "I am going home."

"... as a firebrand plucked out of the burning" (Amos 4:11).

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It was a few weeks before she died. She told us that she felt she was dying. It was, she said, like a gradual falling. It seemed as if, as she fell, a light shone, growing brighter and brighter. The light she saw was not an ordinary light, like daylight or like a bright neon light, but far whiter, brighter.

Then, she said, she heard some one calling her, urging her to come back. She was reluctant to do so; but yet, the light faded, and when she opened her eyes the doctor stood over her. He apparently was the one who had called to her.

A week or two later she did pass on into eternity. One wonders whether she again saw the light that grew brighter, and this time did not fade away.

"And the city hath no need of the sun, neither of the moon, to shine in it; for the glory of God did lighten it, and the Lamb is the light thereof" (Rev. 21:23).

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I was called to the hospital one Sunday night. The nurse asked whether I would come to quiet a woman who was greatly disturbed.

That day the doctor had told her that she had only six months to live. This came as a shock to her, because never before had she been sick or seen a doctor, not even when she had her children. Now she really was not so sick, and yet the doctor gave her these tidings. She simply did not believe it.

From then on she had the problem of submitting to the inevitable.

It is true, that it took a struggle. Yet the amazing fact is that the Lord is mighty and merciful to His children.

At times she still tried to maintain that she was getting better, but it was obvious that this was not the case.

Gradually the wonder of grace became more and more evident in her life. She became more submissive, more complacent.

Would you believe that the last time I visited with her she insisted on talking about nothing but heaven? The reason: "I'll soon be there." And she was. The next Sunday it happened.

"Let not your heart be troubled: ye believe in God, believe also in me. In my Father's house are many mansions: I go to prepare a place for you. And if I go and prepare a place for you, I will come again, and receive you unto myself; that where I am, ye may be also" John 14:1-3).

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She was a comparatively young girl who had the responsibility of supporting her aged parents, with whom she lived. Suddenly she was stricken with bone cancer, which was extremely painful.

For some time her one concern was her parents. How will they get along? Who will care for them? She wanted somehow to be spared for the sake of her parents.

Soon the excruciating pain demanded all her attention.

A few weeks before she died I asked her: "If the Lord were to perform a miracle, would you like to be made better?"

Her answer was: "Oh no,I am so far now,I want to go all the way." The Lord granted the desire of her heart and also cared for those who were left behind. In fact, within a year they followed her into their everlasting abode.

"And I heard a voice from heaven saying unto me, Write, Blessed are the dead which die in the Lord from henceforth: Yea, saith the Spirit, that they may rest from their labors; and their works do follow them" (Rev. 14:13).

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This had been a God-fearing woman, whose walk was always exemplary for her family and for all acquaintances.

Now that her husband was retired she looked forward to a few years of quiet life with him.

But it was not to be. Soon it became evident that her strength was failing. She seemed to suffer from no particular ailment, but she was, nevertheless, fading away, so that before long she was completely bedridden.

The time came when she and her family realized that the Lord would soon take her home.

She remained conscious, her mind was clear, and she continued to speak of the blessed hope, even as her voice weakened. Then she closed her eyes, to open them in glory.

"Precious in the sight of the Lord is the death of his saints" (Ps. 116:15).

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Cancer is a dread disease that takes many to their grave. It attacks the old, but it also attacks the young. It is no discerner of persons. It takes also those who fill an active, even important place in the church and in God's kingdom, as was the case with a young woman who called me aside one day to inform me that the doctors had discovered cancer and had told her that she had a half year to live.

Although this had come as quite a shock to her, she was able to surrender herself to the way God was leading her. She spoke freely of God's promises that can never fail. She patiently bore the suffering that was part of the breaking down of this earthly house of our tabernacle as she looked forward to a house not madewith hands, eternal in the heavens. She cherished the hope that never dies.

By the power of a living faith the desire to live became an ever stronger desire to be with the Lord, which is far better.

Our God, who has begun a good work, will surely finish it.

"I have fought a good fight, I have finished my course, I have kept the

faith: henceforth there is laid up for me a crown of righteousness, which the Lord, the righteous judge, shall give me in that day" (II Tim. 4:7, 8a).

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A young girl had suffered all her life. The drawn lines of pain and suffering were evident on her face even as she approached death.

Yet when the Lord sent His angel to take her home, that shadow of pain was lifted away. A smile came to her lips as her whole face seemed to light up with heavenly peace and joy. Is it true that the dying sometimes get a glimpse of glory as their soul departs to be with the Lord? We can only surmise.

"For I reckon that the sufferings of this present time are not worthy to be compared with the glory which shall be revealed in us" (Rom..8:18).

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What shall I add to this?

"Wherefore God is not ashamed to be called their God: for he hath prepared for them a city" (Heb. 11:16).

"Wherefore comfort yourselves together, and edify one another, as also ye do" (I Thess. 4:11). January 1, 1994/ Standard Bearer/

Rev. Hanko is a minister emeritus in the Protestant Reformed Churches.

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I Greet Thee, My Redeemer Sure

I greet Thee, my Redeemer sure,

I trust in none but Thee,

Thou who hast borne such toil and shame

And suffering for me

Our hearts from cares and cravings vain

And foolish fears set free

Thou art the king compassionate,

Thou reignest everywhere,

Almighty Lord, reigh Thou in us,

Rule all we have and are:

Enlighten us and raise to heaven,

Amid thy glories there

Thou art the live by which we live;

Our stay and strength's in Thee;

Uphold us so in face of death,

What time soe're it be,

That we may meet it with strong heart,

And may die peacefully.

The true and perfedt gentleness

We find in Thee alone;

Make us to know Thy lovliness,

Teach us to love Thee known;

Grant us sweet fellowship with Thee,

And all who are Thine own.

Our hope is in none else but Thee,

Faith holds Thy promise fast;

Be pleased, Lord, to strengthen us,

Whom Thou redeemed hast,

To bear all troubles patiently,

And overcome at last.

Children of Eve and heirs of ill,

To Thee Thy banished cry;

To Thee in sorrow's vale we bring

Our sighs and misery;

We take the sinners' place and plead;

Lord, save us, or we die.

Look thou, our Daysman and High Priest,

Upon our low estate;

Make us to see God's face in peace

Through Thee, our Advocate;

With Thee, our Saviour, may our feet

Enter at heaven's gate.

Lord Jesus Christ of holy souls,

The Bridegroom sweet and true,

Meet Thou the rage of Anti-Christ,

Break Thou his nets in two;

Grant us Thy Spirit's help, Thy will

In every deed to do.

John Calvin, 1560

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Victors Over Death

"0 death, where is thy sting? 0 grave, where is thy victory ? The sting of death is sin, and the strength of sin is the law. But thanks be to God which giveth us the victory through our Lord Jesus Christ". I Corinthians 15:55-57

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0 Death! Thou fearful monster with thy deadly sting!

We and our dear ones live all our lives in the awareness of thy presence.

A mother takes her newly born infant in her arms, holds it close to herself, and is immediately aware of a tremendous responsibility placed upon her. Her child must not be too hot or too cold, must have enough food but not too much, must be covered at night but very carefully.

As the tot grows older there are new threats on its life. Drafts, germs,diseases seem to hover all around.The little tyke is warned, "Don't do this," and "Don't do that."

As he goes out to play or is sent off to school, other dangers threaten his fife. He must learn to look both ways before he crosses the street, and must be alert for automobiles and for all sorts of dangers everywhere.

Actually the threats on our.lives only increase. As we grow older, health problems increase, sicknesses and diseases threaten our lives. In one word, we live in the midst of death, for sooner or later the grim reaper takes us as its prey, and soon our place knows us no more.

0 Grave! Thou hungry receptacle of the dead!

A father and his children stand beside you grieving over the loss of a wife and mother. A mother pours out her sorrows over you in the loss of a precious daughter. Many come to visit you, but find no comfort here. No one can fill the empty spot left by the loss of a dear one. I know.

Here lie the dead of all the ages, for it is appointed for all men to die, and afterward follows the judgment. The grave is the portal, as it were, to hell, for accursed is every one who does not abide in all that is written in the book of the law to do it.

We must all appear before the judgment seat of Christ, that everyone may receive the things done in the body, according to that he hath done, whether good or evil (II Cor. 5:10).

Dying we all die!

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"The sting of death is sin!"

I was conceived and born in sin. The guilt of Adam was my guilt from the moment of my conception. Therefore I am by nature incapable of any good, depraved, corrupt, inclined to hate God and my neighbor.

How readily I adjust to sin round about me. I adapt myself to the company of sinners and willingly I set myself in the company of the scornful (Ps. 1:1).

The trouble is that sin breeds sin. One sinful deed occasions another, even worse than the former. There is no turning back. It is impossible to call a halt. He who sins becomes the slave of sin and falls into the bondage of death, according to the righteous judgment of God. For the soul that sins must die.

"The strength of sin is the law."

God is God, the righteous Judge of heaven and earth. He is our Creator, our Sustainer, sovereign Ruler of our lives. He justly demands of us: Love Me. Serve Me with your whole being, heart and mind and soul and strength. God blesses those who love and serve Him with eternal, glorious blessings of intimate fellowship and life.

But, on the other hand, God justly condemns all those who transgress His commandments. For "accursed is every one who abideth not in all that is written in the book of the law to do it."

The righteous God punishes sin already in this life, but not only in this fife, even in everlasting condemnation of hell fire.

God's justice demands that the soul that sins must die everlastingly under His consuming wrath.

Left to ourselves we can only cry out:

In Thy wrath our spirits languish,

Sinful 'neath thy searching eye;

All our days are passed in anguish,

In Thy wrath we pine and die.

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"0 death! Where is thy sting?"

God is merciful! 0 yes, His mercy is a just mercy! He has in the far reaches of eternity chosen unto Himself in sovereign good pleasure a people whom He takes unto Himself, saying, I will be a Father unto them, and they shall be My sons and My daughters to dwell with Me in My house forever.

To make this possible, God was willing to sacrifice His most precious possession to redeem His people from the power of sin and death. He chose His Son, the Christ, to be their Redeemer. And the Son willingly surrendered Himself unto the curse of everlasting divine wrath to bring His people to glory. The Shepherd was willing to lay down His life for His sheep.

Therefore in the fullness of time God sent His Son into the world, born of the virgin Mary, born under the law, to bear the curse of the law and deliver us from the bondage of sin and death into the glorious liberty of the sons of God.

Who will ever fathom that great love whereby the Father cast the Son of His bosom from Him, cast Him away in wrath, declared Him accursed to utter desolation for your sins and mine? Who will ever comprehend the love of Christ that He manifested all His life in bearing the curse that should have fallen upon us, and that while we were still sinners?

Why should God have done that for me? Do not ask: "Were you there when they crucified my Lord?" But rather confess through your tears: "I was there as part of a fallen human race when we cried: 'Crucify Him! Crucify Him!' And we still make ourselves guilty of rejecting Him with our sins!"

Yet God was in Christ reconcil- us unto Himself, not counting our sins against us. Christ died in our stead. For as in Adam all died who were in Adam, so in Christ all those are made alive again who are included in Him. Amazing grace! Boundless love!

Up from the grave He arose

With a mighty triumph o'er His foes.

He arose a Victor over death's domain

And He lives forever with His saints to reign.

He arose! Hallelujah! Christ arose!

By Christ's resurrection our salvation has become an accomplished fact. When He suffered agonies of hell, we suffered those agonies in Him. When He died, we died. When He arose, we arose! And now we are seated with Him at the right hand of God in His glory (Eph. 2:4-6)

"0 Grave, where is thy victory?"

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"But thanks be to God, which giveth us the victory through our Lord Jesus Christ!"

Law! You cannot touch me, you cannot condemn me, for there is now no condemnation to those who are in Christ Jesus. Through faith in Christ we are as completely righteous as if we in our own bodies had atoned for all our sins. God sees no sin in Israel, no transgression in Jacob, but deems us worthy of eternal life and blessedness.

Sin! You no longer have dominion over me. For the law of the Spirit of life in Christ Jesus has made us free from the bondage of sin and death. We are new creatures in Christ, born again, not of corruptible seed, but of incorruptible, by the Word of God that liveth and abideth forever.

We are washed, sanctified as saints in Christ Jesus, dedicated to our God, to live unto Him even as we live through Him. In our hearts we have the beginning of eternal joy a joy unspeakable and full of glory! No sorrow, no pain, no loss of dear ones can deprive us of that joy.

We can confess with our fathers of former times, "The eternal Father of our Lord Jesus Christ ... is for the sake of Christ His Son, my God and my Father, on whom I rely so entirely, that I have no doubt, but He will provide me with all things necessary for soul and body: and further, that He will make whatever evils He sends upon me, in this valley of tears, turn out to my advantage; for He is able to do it, being almighty God, and willing, being a faithful Father" (Heid. Catechism, Lord's Day 9).

It may not seem so now, yet it is so very true that the moment of our death is better than the moment of our birth. In fact, it is the greatest moment of our lives, for it is the realization of God's eternal purpose with us. Great day! Glorious day. For this is our coronation day!

Besides all that, we have the blessed hope that when this earthly house of our present tabernacle collapses, we have a house, not made with hands, but eternal in the heavens. Christ is there preparing a place for us. When that place is ready and we are ready for that place, He is coming to take us unto Himself, that we may be with Him in His glory.

And, as if all that is of minor importance, our bodies will rest in the grave in anticipation of the coming of the of our Lord. When He appears, this mortal will put on immortality, and this corruptible will put on incorruption. Death will be swallowed up in victory!

More than conquerors are we, through our Lord Jesus Christ!

0 death, where is thy sting? 0 grave, where is thy victory? I thank God in Jesus Christ our Lord! / Standard Bearer / March 15, 1996

Rev. Hanko is a minister emeritus in the Protestant Reformed Churches.

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Is It Morally Justifiableto Terminate Ordinary Medical

Treatment for Dying Persons?

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"So when artificial nourishment provides no detectable benefits but does cause various sorts of hardships, one can argue that withdrawing it signals covenantal concern, not abandonment. We conclude, then, that withdrawing artificial feeding should sometimes be permitted and even recommended. "

Christian Faith, Health, & Medical Practice, Bouma et al.(Eerdmans, 1989)

The phone call came about 4:00 P.m. on a melancholy March afternoon as I was concluding a routine day at my office. "We're calling an emergency meeting of the Board's Ethics Committee at 5:00 P.m. today at our South building" said the Rest Haven's Executive Director. "Can you be there? Dr. DeJong is going to chair the meeting."

Later, hurrying across the wet asphalt parking lot in the light drizzle toward the offices on the west wing of Rest Haven convalescent home, I had a premonition that this was to be a difficult meeting. The resident director introduced our Ethics Committee to the family two middle-aged daughters, one from Iowa and the other from Indiana. They had demanded this meeting with the Board members, the resident director explained, because Rest Haven was failing to comply with the family's demands to terminate medical treatment for their 83 year old mother who was suffering from advanced stage Alzheimer's disease.

The family explained that their mother, a total care patient for almost ten years, had recently contracted a mild pneumonia (often caused by aspirating food) and was also temporarily unable to swallow food or water. The director had contacted a doctor who prescribed penicillin to combat the pneumonia and a nasal feeding tube to provide nutrition and hydration. With angry tears, the irate daughters implored our Ethics Committee to overrule the resident director and comply with their written request to terminate the penicillin and withhold all nutrition and hydration. It was God's will, they insisted, that their mother die from the natural consequences of advanced Alzheimers, even if this entailed malnutrition and dehydration. "She is not dying because she's starving," said the Iowa daughter, "but she's starving because she's dying." Also their mother's "quality of life" was minimal, the daughters reminded us, since she had been incoherent, unresponsive, and totally bedridden for several years. To prolong her life now by "artificial" feeding and medication, they argued, would be interfering with God's will that she die in this way.

The resident director calmly responded that since the penicillin medication and the tube feeding were "ordinary" and not "extraordinary" or "heroic" means, such rudimentary forms of medical treatment were the minimal moral obli

gation of a Christian long-term care facility.

After a two-hour discussion, the resident's family was excused from the meeting and our committee faced the profoundly difficult ethical, religious, and legal question: Do we advise the resident director to comply with the fan-dly's wishes to withhold penicillin, food, and water from this dying woman, or is the nursing home ethically compelled to provide "ordinary" care to all residents, including nutrition and hydration?

Ethics, medicine, and law converge

In contrast to the early 1900s when two-thirds of the people in the United States died before age fifty in the family home setting, nowadays 65% of an ever aging population dies in medical institutions and nursing homes. Advancng medical technology, rapidly changing laws regarding patient's rights (including the so-called "right to die" and "advanced directives" legislation), and diverse religious ethical views have made death and dying issues extremely problematic for dying patients, their families, and Christian nursing homes and health care providers.

The perennial controversy over withdrawing "ordinary" medical care (see box) has recently focused on the controversial practice of withholding food and water from a dying patient unable to swallow. Evangelical Christians are now divided over whether the termination of nutrition and hydration is tantamount to euthanasia, a practice condemned by Reformed ethicists.

But in their recent book, Christian Faith, Health, and Medical Practice, the authors (fellows at Calvin College's Calvin Center for Christian Scholarship) conclude that withholding food and water can "sometimes" be "recommended" (see lead quote above), but readily admit this view has "possibilities for abuse":

We conclude, then, that with drawing artificial feeding should sometimes be permitted and even recommended. Our toleration for and cooperation with it, however, require the satisfaction of two im portant provisions: (1) safeguards must ensure that the welfare of the terminally ill or permanently un conscious patient is the primary consideration, and (2) appropriate means must be used to minimize the negative psychological side ef fects. For some, however, these provisions may seem infeasible. The possibilities for abuse and the powerful symbolic nature of withdrawing what is universally accepted as necessary to sustain physical life make us respect the stand of those who find it morally impermissible to cooperate in acts

of withdrawing artificial means of providing nourishment.

The dangers

The author's concern about the dangerous implications of withholding food and water is real. A recent issue of the National Right to Life News reports the case of Marjorie Nighbert in northern Florida. In 1992 Nighbert signed a power of attorny for health care (see box), giving her brother complete control over her medical decisions, and allegedly instructed him she did not want a feeding tube should she be unable to swallow.

Early in 1995 she suffered a stroke and was admitted to a convalescent home. Because her doctor and family feared she would aspirate food, they withheld all nutrition rather than place her on a feeding tube. Two weeks after one nurse had been disciplined for giving her a little milk, Nighbert touched another nurse on the arm and asked: "Would you please give me a little something to eat?" After this nurse reported the "starvation" to the authorities, a Florida court ordered that she be placed on a feeding tube until a full hearing could be held. But soon thereafter at the hearing the Judge ordered that her feeding tube be removed. He ruled that because of her stroke she was not competent to revoke her 1992 power of attorney given her brother, and her pleas for food were to be ignored.

Is tube feeding "extraordinary" medical treatment?

Many states now treat withholding of food and water no differently than withholding medical treatment. In fact, in a 1987 North Dakota case spoon-feeding was held to be beyond normal medical procedure. And reportedly many states permit withdrawal of nutrition and hydration if a patient cannot communicate and has not previously made his wishes known.

Death and dying issues often turn on terminology open to vigorous debate. But a crucial distinction nearly universally accepted is the difference between "ordinary" and "extraordinary" means (see box). It is generally agreed by ethicists that "ordinary means" are morally obligatory, while "extraordinary" means of medical treatment are not.

But in the context of modern medical technology, how do we employ that classical distinction today? Are respirators ordinary or "extraordinary" means? What about antibiotics and penicillin? What about nasogastric tube feeding or IV hydration?

Biblical perspective on death and dying

But because contemporary medical science has provided us with a seemingly endless and bewildering array of therapeutic instrumentalities, when does the Reformed Christian family terminate treatment of the dying loved one? John Frame in his excellent book Medical Ethics, Principles, Persons and Problems (Presbyterian and Reformed, 1988), notes that "medicine's death-resisting instincts must be tempered by ones that are in some sense death-accepting." He reminds the reader that Christians know there is a time to be born and a time to die (Eccles. 3:3). Moreover, the believer knows that death is not final, it holds no ultimate terrors; it is the doorway to eternal life.

Frame then suggests the following guideline for termination of treatment for the dying patient (which I shall call Principle One):

Principle One: When a disease has advanced to the point where no known therapy exists and death is imminent (within two weeks without intensive medical support) despite the means used, then forms of treatment that would secure only a precarious and burdensome prolongation of life may be discontin- or withheld. In truly terminal cases the use of certain means would not be therapeutic, but only prolong an irreversible process of dying. By "terminal illness' is meant an incurable, irreversible, and hopeless illness.

To this general principle must be added the two additional death and dying guidelines that have been suggested by certain Roman Catholic scholars and ethicists:

Principle Two: Nutrition and hydration may not be withdrawn or withheld from a patient if to do so would result in death from starvation or dehydration rather than from the underlying terminal illness or injury unless the provision of such would cause complications or exaggerate the compromising conditions of the terminal illness.

Principle Three: A dying person must always be afforded palliative care including pain management, normal nursing care, and the Christian love, compassion, and understanding needed when death is imminent.

It is suggested that these broad guidelines may be helpful for Reformed Christian families confronting death and dying issues in today's culture where the secular principles of medical economics, so-called "quality of life" issues, and euthanasia considerations are gaining frightening influence. Standard Bearer/ July 1995

Mr. Lanting, a member of South Holland Protestant Reformed Church, is a practicing attorney.

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