End of Life Decisions

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,800-2,000-word ethical analysis while answering the following questions:

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?

What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

Given the above, what options would be morally justified in the Christian worldview for George and why?

Based on your worldview, what decision would you make if you were in George’s situation?

Remember to support your responses with a minimum of 4 citations and references from the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Topic: Death, Dying, and Grief

Case Study: End of Life Decisions

George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS.

ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing.

George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia.

1. PHI-413V Topic 4 Overview

PHI-413V Topic 4 Overview

Death, Dying, and Grief

Introduction

Death and dying are a bitter part of the reality of life, in general, and a particularly common experience for those called to health care. The nature and meaning of death is not simply biological or scientific, but rather involves deep philosophical and religious questions. Once again, medical technology has changed the scope, quality, and experience of death (or at least the dying process). It has even prompted a changing of the very definition of death.

Death in the 21st Century

One of the incredible benefits of modern science and its application in medical technology has been the ability to extend physiological life. In the 1960s, the development of CPR, ventilators, and the like allowed never-before-seen intervention in the process of dying, such that a “millennia-old general understanding of what it meant to be dead” was transformed (Veatch, Haddad, & English, 2010, pp. 390-391). In the field of biomedical ethics, the very definition of what it means to be dead is a controversial topic. In continuing with a fundamental theme running throughout this course, it should be noted that while the pathophysiological and scientifically detectable signs of death are crucial in this debate, they should not be taken to be determinative or comprehensive. This debate still crucially depends on the philosophical background of one’s anthropology (i.e., view of personhood) and in the resulting interpretation of these scientific and physiological signs. The medical definition of death is not a purely or irreducibly scientific question.

Worldview and the Meaning of Death

Two of the more controversial issues in bioethics are euthanasia and physician- assisted suicide. As you read and research the ethics surrounding these issues, consider how the Christian worldview would analyze the ethics of such actions. On a worldview level, the question of the medical definition of death is just the tip of the iceberg in terms of the broader significance and ultimate meaning of death. Whether or not there is any meaning to death and what it might be is a question of one’s worldview. Questions regarding whether or not there will be ultimate moral accountability for the way one lived life and whether there is an afterlife are key questions in this regard. The very phenomenon of the loss of (at the very least) physiological and perhaps conscious integrity and activity is a fact of life that calls for explanation.

Once again, an accurate understanding of religion and worldview is required. Furthermore, the distinctions among each religion must be appreciated and not collapsed into one another. The way in which both technology and religious background color the experience and meaning of death (both in dying and grieving) must also be appreciated. Whatever rituals or practices a religious or cultural group engages in are informed by a view regarding the nature and meaning of death that fits within an overarching worldview narrative.

Death in the Christian Worldview

Death takes on a particular meaning when seen within the Christian narrative. It is, in fact, not the greatest evil that could befall a human being and is furthermore transformed in the light of the resurrection of Jesus Christ. The Christian teaching that “God died” essentially transforms the way in which death is seen and experienced (Sanders, 2007, pp. 6-8). Death is certainly a tragedy and an evil, but it is now a conquered enemy. It is a conquered enemy because in the Christian biblical narrative, death is a perversion of God’s original design plan. And yet, the Christian God constantly redeems that which is broken.

Loss and Grief

Death is a particularly traumatic and difficult experience for both family and caregivers. Understanding the process and stages of grieving is immensely beneficial for caregivers to assess the well-being of patients and families. There are numerous resources that can be of tremendous benefit for both caregivers and family. One of the most influential is the work of American psychiatrist Elizabeth Kubler-Ross. Perhaps the most influential insight of her work was to notice certain patterns or stages in the human experience of grief, especially after the loss of a loved one in death. She called these the five stages of grief. Briefly, they include the following: (a) denial, (b) anger, (c) bargaining, (d) depression, and (e) acceptance (as cited in HealGrief, 2016).

Expectations regarding an afterlife will in large part determine the manner in which patients and families welcome or spurn the prospect of death. Furthermore, the way in which a person experiences the stages of grief will be in the context of his or her worldview. Christian theologian Nicholas Wolterstorff’s (1987) memoir, Lament for a Son, is a personal reflection of his own personal grief after losing his 25-year-old son in a mountain climbing accident. As he engages with his own grief and experience, it becomes clear that everything is ultimately seen in the light of God’s loving control and the ultimate hope found in the life, death, and resurrection of Jesus Christ.

Why Did God Become Man? Incarnation, Atonement, and Resurrection

Jesus was the Son of God before he was born into our world. The event of God taking on flesh and dwelling among us–the incarnation–is amazing and is celebrated all over the world at Christmas. The incarnation is proclaimed clearly throughout the New Testament (Luke 1:35; John 1:14; Phil. 2:5-7).

So why did God become man? The most famous verse in the Bible clearly tells us, “For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life” (John 3:16 NIV). And Jesus knew what this would require of him. He stated in Matthew 20:28, “The Son of Man came not to be served but to serve, and to give his life as a ransom for many.”

God is both holy and just, so although he created humanity to be immortal, he could not accept them into his holy kingdom in their sinful state. So from the beginning God enacted and unfolded his plan for humanity, to redeem a people for himself (Titus 2:11-14), requiring that justice be upheld and sin punished. Therefore, a sacrificial lamb was needed–one that could atone for the sins of the world. Only the perfect and sinless Lamb of God would be sufficient. Yes, God himself would have to be the sacrifice somehow.

So the incarnation led inexorably to the cross, the torturous experience that had been prophesied nearly a thousand years earlier by David in Psalm 22. All four Gospels give vivid accounts of the crucifixion of Jesus, the most unjust execution ever to be carried out, as testified by the centurion there who said, “Certainly this man was innocent!” (Luke 23:47). But as unjust as the crucifixion was, Jesus willingly accepted it, for as the Son of God he could easily have been rescued (Matt. 26:53). Instead, Jesus bore the sins of the world on the cross. This is called the atonement–the reconciliation of humanity with God through the sufferings and sacrificial death of Christ.

It is interesting that the clearest account of the atonement is found in the prophecy of Isaiah 53: 5-12 (NKJV) where the atonement is specifically stated seven times:

He was wounded for our transgressions; he was crushed for our iniquities…and the Lord has laid on him the iniquity of us all…stricken for the transgression of my people…when his soul makes an offering for sin…and he shall bear their iniquities…yet he bore the sin of many.

God went out of his way to make the extent he would go to bring about reconciliation clear.

The resurrection of Jesus Christ is by far the climax of his life. .All four Gospels provide vivid accounts of this amazing miracle that conquered death. There have been many who looked at the history of the times, read the many accounts of what happened both in the Bible and in other sources, and came to the inevitable conclusion that there is no other explanation for what happened except that Jesus surely rose from the dead. After the crucifixion, the disciples gave up and went back to fishing–the 3 years of exhilarating ministry were over. But then the resurrection changed everything. It was not long before the disciples were accused of turning “the world upside down” (Acts 17:6). This world-changing event was not just a historical miracle, it was a sign of the promise that God gave to those who put their faith in him. Death is a conquered enemy because Jesus’s resurrection from the dead made a way of salvation, and also was a sign of the future that God has for those that have died “in Christ.”

The phrase “in Christ” is very common in the New Testament and crucial to understanding the gospel. To be “in Christ” means to place your “hope in Christ” (Eph. 1:12), or in other words, making Christ the object of your faith. Paul expresses the gospel message most succinctly in Galatians 2:16 where he says, “a person is not justified by works of the law, but through faith in Jesus Christ.”

Conclusion

Christianity is unlike virtually every other religion in the world. Other religions show you what they believe is a way to God by living in a certain manner, praying certain prayers, and many other religious customs. Christianity teaches that people are not capable of being good enough, which is precisely why God sent Jesus to be the Savior of the world. Other religions offer good advice, whereas Christ offers good news, the gospel–which is that by trusting in what he has already done for you, you are restored.

Other religions offer possible salvation (eternal life in heaven) through trusting in one’s own good works, while Christianity offers certain salvation through trusting in Christ’s good works. Paul makes this clear in Ephesians 2:8-9, “For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast” (ESV). The final chapter in the biblical narrative will involve a restoration of all creation, and those that died in Christ will be resurrected and receive imperishable bodies.

References

HealGrief. (2016). Understanding grief and loss: An overview. Retrieved from http:// http://healgrief.org/understanding-grief/

Sanders, F. (2007). Chalcedonian categories for the gospel narrative. In F. Sanders & K. Issler (Eds.), Jesus in trinitarian perspective (pp. 1-41). Nashville, TN: B&H Academic.

Veatch, R. M., Haddad, A., & English, D. (2010). Case studies in biomedical ethics. New York, NY: Oxford University Press.

Verhey, A. (2011). The Christian art of dying: Learning from Jesus. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.

Wolterstorff, N. (1987). Lament for a son. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.

Additional Resources

2. The 5 Stages of Loss and Grief

Read “The 5 Stages of Loss and Grief,” by Axelrod, located on the PsychCentral website.

http://psychcentral.com/lib/the-5-stages-of-loss-and-grief/000617

3. Understanding Grief and Loss: An Overview

Read “Understanding Grief and Loss: An Overview” located on the Healgrief website.

4. Why Hospitals and Families Still Struggle to Define Death

Read “Why Hospitals and Families Still Struggle to Define Death,” by Singh, located on the NPR website (2014).

http://www.npr.org/blogs/health/2014/01/10/261391130/why-hospitals-and-families-still-struggle-to-define-death

5. Defining Death: Medical, Legal and Ethical Issues in the Determination of Death

Read the Introduction and Chapters 1-3 of “Defining Death: Medical, Legal and Ethical Issues in the Determination of Death” by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1984). https://repository.library.georgetown.edu/bitstream/handle/10822/559345/defining_death.pdf?sequence=1

6. Invoking Shared Beliefs in End-of-Life Decision-Making

Read “Invoking Shared Beliefs in End-of-Life Decision-Making,” by Hogan and Velez, from AMA Journal of Ethics (2013).

https://journalofethics.ama-assn.org/article/invoking-shared-beliefs-end-life-decision-making/2013-03

Rubric

Case Study on Death and Dying

70.0 %Content

12.0 % Suffering and Fallenness of the World

Analysis of how the man would interpret his suffering in light of the Christian narrative and the fallenness of the world is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.

70.0 %Content

12.0 % Suffering and the Hope of Resurrection

Analysis of how the man would interpret his suffering in light of the Christian narrative and the hope of resurrection is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.

70.0 %Content

12.0 % Value of Life

Analysis of how the Christian worldview of the man might inform his view about the value of his life as a person with ALS is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.

70.0 %Content

12.0 % Euthanasia

Evaluation of which values and considerations the Christian worldview focuses on when deliberating the option of euthanasia for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.

70.0 %Content

12.0 % Morally Justified Options

Evaluation of which options would be justified in the Christian worldview for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.

70.0 %Content

10.0 % Personal Decision

Reflection hypothesis of which personal choices would be make if faced with ALS based on personal worldview is clear, relevant, and insightful.

7.0 % Thesis Development and Purpose

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

30.0 %Organization, Effectiveness, and Format

8.0 % Argument Logic and Construction

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Writer is clearly in command of standard, written, academic English.

5.0 % Paper Format (use of appropriate style for the major and assignment)

All format elements are correct.

5.0 % Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.