Life and Death

What happens in an individual with a terminal disease, who has been pursuing life prolonging measures, and suddenly decides they no longer want to continue? For instance a person who has had a G-tube to feed him, and comes to a place of wanting it removed, knowing he will die a lot sooner if this is done?

Is this person suicidal? Not necessarily. Should every measure be done to cause this person to continue the feedings, even against his will? Should he be considered imbalanced, or unable to make a valid and rational decision? Again, not necessarily. At least not in my thinking. As a hospice spiritual care counselor, I often have patients who come to a place of not wanting to continue particular kinds of treatment, knowing it will hasten their death. But they are completely rational about it. They are just as clear in their thinking as their original decision to have the G tube to be placed earlier in their treatment. It is merely a change of decision; a deeper clarity of the quality of life that has been diminished, and a readiness to let go.

One particular patient recently made this decision. He and his wife have discussed this for about a year. At one time, they talked about wanting to die together, a sentiment that many couples who have been married for many happy years make, when they cannot fathom life without the other. This particular patient has discussed it with his nurses, and with his wife, as well as his family, but he made the decision yesterday to act on the sentiments of his heart. He knows his children are coming this weekend, and he will have an opportunity to say goodbye to them. His wife is supportive and sad, but understanding. How could you not after 50+ years of marriage?

But one of the questions we must ask is: what happens in a person when they debate an issue about life and death, for a year or more, and then come to a sudden place of saying, "No More." And secondly, what is the responsibility for those who are the caregivers? Some might say we should do everything possible to change his mind. Some might say that only God decides when our time to die might be. Some others might say, it is his right to decide whether or not to continue with life prolonging measures. Those in the right to die movement, would say we just need to respect the decision and allow them to die with dignity.

I do believe there is a definite time within each of us when we are ready to let go. There is a time when one looks within and decides that there is no quality of life, and when they decide to discontinue life prolonging measures, and pursue comfort care only. It doesn't mean they are depressed, or crazy, or suicidal. In fact, it is often a very healthy decision. It is most certainly a very spiritual decision, because it has to come from within. And it is often different for each individual. As a spiritual care counselor, it isn't my job to try to talk them out of it. Rather, it is my job to help them to sort out those very personal decisions according to their own beliefs.

One could easily argue that the continuance of artificial feedings, is only prolonging the inevitable, and thus hindering the person from dying in the natural ways. One could also assert that as long as the life prolonging measures had not been used, it most likely would have been God's timing for a person's time to die. So in a sense, respecting one's right to stop life prolonging measures, in order to allow that person to die with dignity and without pain, is also enabling them to go on to the next life. While I know that there are many in our society who do not believe in a life after death, I have seen too many patients who indicate differently; who call out to loved ones who have died before them, who are with them as they die.

It is truly a spiritual sense from within each individual that says when one is ready to die. And that time can be a truly sacred time for the patient and family, to say their goodbyes, their thank you's, their possible need for forgiveness or reconciliation, and for the individual's family to finally give their loved one permission to go. What has been a scary and painful time, can often be a truly sacred time, if allowed. It is my prayer to enable this sacredness to happen, if at all within my power to do so.