ROUGHLY EDITED COPY LUTHERAN PASTORAL THEOLOGY & PRACTICE LPTP-40 Captioning Provided By: Caption First, Inc. P.O. Box 1924 Lombard, IL 60148 800-825-5234 www.captionfirst.com *** This text is being provided in a rough draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings. *** >> NICK: As long as we're talking about this, I want to ask a very important question. Medical practice and contemporary science have given rise to an enormous number of possibilities with regards to how to manage end-of-life issues. Now we find ourselves struggling with living wills, advanced directives, whether to cease life support for a parent in the ICU, et cetera. What principles assist the pastor to give sound guidance to patients and their families facing crucial decisions at life's end? >> DR. WARNECK: Nick, I'm glad that you put a rather challenging question in terms of the principles with which we want to work in giving counsel and reflecting with our people about end-of-life care issues. The principles. Things are moving so fast, and the medical profession and all of its auxiliaries are seemingly in such control of this whole matter that a pastor might conclude well, I really don't have to give a lot of attention to that because all those things are happening and decisions are made and I really won't be consulted. I want you to understand, Nick, many Christian people want to check in with their pastor when they are making decisions, crucial decisions about the care of a seriously ill, critically ill, or critically injured member of their family. Or they may want to consult the pastor in the development of a living will, a matter which has been highly emphasized since the Terry Schiavo incident in Florida in spring of 2005. Christian people may come to you and ask, "How should I word a living will?" In other words, what directives should I give those who are responsible for my care if I find myself in a position where I'm not able to make those decisions myself, those who have power of attorney or doctors and specialists in hospitals and so on. Now, what kind of guidance should I give? So on these two counts, the pastor will likely be consulted now and then by their people. A Christian person does not want to wrest from the hands of God his or her own life in these extreme circumstances. A Christian believes what the psalmist declares, "Our times are in Thy hand," in the Lord's hands. Psalm 31. Surely it is God our father who has created us we always want to acknowledge. We confess in the creed, and we want to be responsible in the care and disposition of this life. We work all the work of God's hands. And He is the creator of all things. Revelation 4. That God is the author and creator of human life is well to remember with respect when these issues surface in the lives of God's people. Helping us to discover those principles guiding our counsel to the parishioner is the February�1993 CTCR report, "Christian Care at Life's End." I want to refer you to that document, Nick. Particularly, it is worth careful study on this issue. And the value of this report from the CTCR is that it enunciates basic guiding principles that will help us give the guidance that people seek from us. The applications follow the principles. But first those principles. It goes like this: In making healthcare decisions, we do care for life, means hydration, nutrients or food, oxygen, possibly also pain relief and even helpful medical care. We do not support killing, hastening to death, being quick to kill. Secondly, on the negative side, we do not, by contrast, support delay of imminent death by radical intervention keeping body parts alive. So the essential principle operative here is we aim at life and we care for life; we do not aim at death nor kill. To put it another way: Christian ethics demand that we care for life and protect life. Though we shall not place roadblocks in the way of a person who clearly is dying, whose vital systems are shutting down�-- circulatory, respiratory renal or excretory, nervous systems. When all of that is going down, the person is, as some physicians put it, in their death work. And we do not intervene radically in that process. So those are the basic principles stated so clearly by the document, "Christian Care at Life's End." And I commend them to you for further and additional studies. What the principles seem to say is that we owe it to the very sick and critically ill person to see that he or she receives all the help that the patient can obtain and undergo without imposing excessive burdens on himself, herself, or even others. The document calls this ordinary care, and it's certainly required by Christian ethics. When medical treatment or procedures, the good effects of the same are not deemed proportionate to the difficulty and inconvenience involved, such is not required by Christian ethics. Now I'm saying a lot in very few words, and this is something well to study in greater depth on one's own and perhaps with the help of mentors and so on. Ordinary care, Christian ethics requires. Extraordinary care, my last reference to those extraordinary means is not necessarily required by Christian ethics. So we are weighing in the balance here the good effect of treatment versus the difficulty or inconvenience involved, that is, protracted, complicated, intensified, suffering, and prolonging of dying. We would not want to put a patient through those straits. We want to avoid that. We understand that these circumstances may mean medical care to a point, but foregoing some of the overpowering and overwhelming science and technology that is out there. But those are real decisions which doctors must make and must assist the family to make in their walking with their physicians. Our point is that we want to help our families not -- basic point is not to aim for the death of an individual, what is called euthanasia, a euphemism to be sure. The acute question since the Terry Schiavo incident is to what extent food and hydration should be available to a person as had he are described in a permanent vegetative state. I'm not certain that this is the forum to discuss these very delicate and complicated issues. But maybe we should just reserve a few words on this subject. Having gone through this time and trying to stay abreast of what was happening there in Florida early in spring of 2005, it just seemed that many in the public media were not able to distinguish between medical care and the administration of food and water, possibly also oxygen. Please understand that medical care is a judgment that the physicians make. But, relative to food and hydration, if those are removed from a patient, that's not really in the realm of medical care. That's just basic life support. Medical care can be adjusted. But removing food and water from a patient, that patient will surely die, as the whole nation witnessed in the Terry Schiavo incident. And that is something which Christian ethics opposes. And we have to help Christians in their thinking on this point. I suppose the only exception, at least in my own limited medical knowledge, would be when the administration of food and water would create a burden of extreme suffering for a patient, for instance who has kidney failure. It's the one instance I can think of. Because, when the body cannot handle the body's wastes and deal with that, the upshot is that continuous application of food and water results in uremic poisoning, which is a very, very difficult thing to impose on a patient. But really should not go any farther beyond our own knowledge of the medical aspects here. It's our intention here to urge you to counsel people to support the life that is still there and leave the taking of life in the Lord's hands according to the principles. Maybe we better kind of stay with the principles. All right. There is one subject here that pastors will confront. And that is when families are not together on decisions which they have to make relative to a critically ill or critically injured member of their family. Occasionally, pastors get in the middle of these things, these matters. And you find yourself, Nick, in the middle of a conflict. You can have one side of the family in favor of making one decision and another part of the family wanting to take a different tact and make a different decision. Families will not always agree. And just because they do not agree does not mean that always that one is right and the other wrong and vice versa when decisions are not clear and when the situation is such that it's very difficult for any member of a loving family to arrive at that firm decision. Nevertheless, the family has to decide, and they do. And a course of action is taken. But our ministry to these folks after these delicate and stressful situations is to say to all of them that we tried our best in our intentional care for our loved one. Possibly even some of our attempts were in error or askew. That may or may not be the case. But, whether we were right or wrong, God's word witnesses that our righteousness comes from Christ. And we want to leave things right there. It's entirely by His grace that we live at all times. And thanks be to God. If you find yourself in a stressful situation such as we've described, I hope, Nick, that the end will be that you can rally these people at the foot of the cross, following a situation, an event and decision and help them go forward in their life together as fellow Christians as well as members of the same family. *** This text is being provided in a rough draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings. ***