Episode #76—Dying Well: A Christian Perspective on Death and Medical Ethics

At its core, death is fundamentally about separation. It represents the separation of body from spirit, the spiritual separation of the soul from God. Scripture tells us that our days are numbered, but we don’t know when that separation will occur. This biblical understanding of death forms the foundation for how Christians should approach the end of life.

How do we die well? The answer begins long before our final moments. We die well by living well. This means ensuring we are reconciled to God because, regardless of earthly possessions or achievements, dying without Christ means losing everything in the end. Being right with God is the essential first aspect of dying well.

The apostle Paul exemplifies this perspective in Philippians 1, where he expresses his desire to depart and be with Christ, while acknowledging that remaining alive serves a greater purpose for others. Paul was content to die because he knew he would be with Christ. This attitude demonstrates what it means to face death from a position of faith.

As Guy Prentiss Waters writes in Facing Our Last Enemy, dying well involves showing your family that you are saved, giving them confidence to trust in Christ and assurance about where you are going. This witness to loved ones becomes an integral part of a faithful death.

Yet dying well in the modern age involves more than spiritual preparation. Medical advancements have introduced complex ethical questions that previous generations never faced. Heart disease that would have been fatal fifty years ago can now be treated. Life expectancy continues to rise due to medical interventions. This raises a profound question: If God has numbered our days and also provided medicine to treat diseases, how do we know when enough is enough?

Consider the case of a 94-year-old woman experiencing heart issues. When doctors recommended a pacemaker, one medical resident questioned whether this was wise for someone her age. However, upon examination, a heart surgeon declared, “This is no normal 93-year-old.” The woman had good quality of life, and the pacemaker allowed her to continue living well. This illustrates that the decision isn’t simply about age but about the quality and purpose of the life being sustained.

A crucial distinction exists between prolonging life and prolonging death. Christians must be careful here, as this is where questions of euthanasia arise. Euthanasia—the deliberate ending of a person’s life—is wrong. It is murder, a violation of the commandment, “You shall not kill.”

However, there is a difference between actively ending a life and choosing not to prolong the inevitable. People regularly make decisions about cancer treatment: Do I undergo chemotherapy that will make my remaining years miserable, or do I forgo treatment and live out my life to the fullest? These are personal decisions that individuals have the right to make.

Similarly, someone with a history of repeated heart attacks may choose to sign a Do Not Resuscitate (DNR) order. This is not the same as euthanasia. It’s better for individuals to make such decisions themselves rather than leaving this burden to family members who must make these difficult calls.

Medical advancements, while beneficial, can sometimes be cruel when taken to extremes. Doctors constantly face decisions about how far to go to keep someone alive when they know the person will remain in a vegetative state. A living will can be helpful in these situations, relieving spouses and children of the burden of making such decisions.

CPR provides an instructive example. While CPR can save lives, it often results in additional physiological damage—brain damage, broken ribs, spinal injuries. For someone with multiple serious medical conditions, CPR may not add health but rather prolong misery and cause additional suffering. A DNR in such circumstances isn’t euthanasia; it’s respecting a person’s decision to allow death to occur naturally.

Modern DNR orders have become increasingly complex, sometimes spanning multiple pages with different scenarios and conditions. This complexity reflects how medical technology has developed and potentially created situations where life is prolonged when it perhaps shouldn’t be.

One of the most difficult decisions families face is when a loved one is on life support. When should machines be switched off? This isn’t a decision doctors typically make—they place it on the family.

Consider the distinction: Euthanasia involves a person who is surviving on their own (in a sense), whose heart is beating and brain is functioning, but who is suffering terrible pain, and who requests an injection to end their life. This is fundamentally different from not prolonging the inevitable when machines are keeping someone alive who would otherwise die.

A real-life example illustrates this: A woman went into early labour and suffered an aneurysm. While doctors saved the baby, the mother was brain dead. Family members debated whether to turn off the machine. Before a decision was made, she died naturally within a day. In other cases, however, families must make the final decision. If God wants someone to survive, they can survive without a ventilator or heart machine.

The case of Karen Quinlan in the United States in the 1970s provides another perspective. Her parents fought to turn off her life support, and when they did, she lived several more years. God kept her alive without the machines.

The key is avoiding crossing the line into actively ending life. If a person is truly dead and machines are keeping the body functioning, switching off those machines isn’t playing God—it’s allowing God’s sovereignty to determine the outcome. If the person dies, that is the number of days God gave them. If they survive, God has kept them alive.

Sometimes medical heroics—the dramatic interventions we see glorified in television dramas—can lead to experimentation on people that ultimately makes their lives more miserable. There is a place for DNR orders and living wills. Taking a life is always wrong, but not prolonging the inevitable is not sinful.

This means that if someone is diagnosed with a heart condition, they can choose whether to take medication. It’s not sinful to decline treatment, because the Lord will sustain life as long as he has planned. This is a personal decision each individual must make.

Christians must be careful not to become so focused on clinging to this world that they resort to any means necessary to extend life. Some people even have their bodies cryogenically frozen, hoping future medical advances will cure them and bring them back to life. Walt Disney famously chose this option. Yet Christians already have a better hope—the return of the Lord.

Sometimes the decision to prolong life may be more about those staying behind than about the person who is dying. Many older Christians in churches express their readiness to depart and be with the Lord. They’re not going to take their own lives, but they desire to be with him. Yet family members—children and grandchildren—often resist, saying, “No, we don’t want you to go.” This perspective should be considered in end-of-life discussions. The focus should be on where the dying person is in their walk with the Lord, not solely on the grief of those remaining.

Planning for death is an important responsibility. Having a will is essential, particularly as we age and have dependents. Beyond legal documents, planning one’s funeral—selecting songs, choosing who will preach and what sermon texts to use, designating pallbearers and eulogists—removes this burden from grieving family members. When everything is arranged beforehand, loved ones can focus on grieving rather than making countless decisions.

These are complex ethical issues that require careful thought. Situations vary from person to person, and dogmatism should be avoided. Some decisions remain somewhat subjective, though certain principles are absolute: It is always wrong to take a human life.

Yet Christians have liberty in determining how far to go with medical technology. Should we keep a body functioning when the brain has ceased, when the inevitable outcome is death? Are we simply prolonging the inevitable? In such cases, DNR orders and living wills are legitimate options.

As believers, we must think through these issues, particularly as medical breakthroughs continue to extend life. We need biblical wisdom applied to bioethics and medical ethics. Most importantly, we must remember that, while life is precious, eternity with Christ is glorious. As Paul wrote, to depart and be with Christ is far better. This hope should shape how we approach both living and dying in a world of ever-advancing medical technology.