Report of the

Study Committee on Advance Directives



[1996 Yearbook, page 190]



"A Biblical Perspective on Death, Dying,

and the Use of Advance Directives"



A Bible Fellowship Church Position Paper



Introduction



"When is it right to die? Who decides when it is time?" This is not an abstract problem, isolated to a specific elite group. It is not relegated to classroom discussions in medical training institutions. The answers to these questions are lived out daily in health care facilities. Families, loved ones, friends, and health care professionals are forced to make decisions literally between "life and death." The Christian's decisions in these issues must flow from a Biblical worldview, with careful consideration given to the sanctity of life as created by God (Gen.1:26). If, indeed, the Word of God is the Christian's "sole rule of faith and conduct," then it must be acknowledged that it does contain principles and precepts that will enable an individual to make decisions that honor God in all of life, and even death.

Several factors have contributed to the necessity for such a paper as this. Medical technology has enabled physicians to prolong life far beyond the expectations of the previous generation. Increasing economic pressures related to the cost of health care have generated new debate regarding that which is "normal" or "heroic" in life-saving measures. At the same time, our society has increasingly ignored absolute standards of right and wrong in favor of ethics determined by the situation. In this age of high technology and low morality, does it mean that dying must be endlessly prolonged, that due means of alleviating suffering are to be ignored, and that the total welfare of the patient and the family are not to be considered? The legislatures of our states have determined that it is a good thing for the individual to be given the opportunity to declare in advance his intentions concerning medical treatment in situations where the individual may no longer have the mental or physical capacity to make decisions and declare those decisions concerning health care. On December 1, 1991, the "Patient Self-Determination Act" became federal law. This law requires personnel at all hospitals, nursing homes, and hospices receiving Medicare and Medicaid reimbursement to advise patients upon admission of their right to accept or refuse medical treatment and to execute an Advance Medical Directive. Personnel must document whether patients have directives, implement medical directive policies, and educate staffs about directives.

God has called us to be good citizens of this world and we understand that He has ordained civil authority (Rom.13). One aspect of exercising good citizenship is understanding the laws and statues that are enacted by government. Whereas we are called to "obey God rather than men," we are compelled to apply Biblical principles in reaching conclusions on how we should live in light of present-day laws. The purpose of this paper is to guide the believer in Jesus Christ in determining how, in light of God's Word, he is to respond to issues regarding death, dying, and the use of the Advance Directives.



The Sanctity of Human Life



Man is different from all else in God's creation in that he is created in God's image and that he thinks God's thoughts after Him. Man, however, is a fallen creature. Though the image of God is marred, it is not destroyed. Man is responsible to his Creator and his Creator's revelation regarding his conduct. Therefore, as fallen but redeemed people, we must express both in life and in death our relationship to God. Being created in the image of God requires us to express the dignity with which we have been created. Modern man frequently describes dignity as something to be earned, developed, or bestowed by man. But man has been endowed with dignity by his Creator. The way a person lives enables dignity to be expressed, but it does not create dignity. Human responsibility for life is one of stewardship, not ownership. Life is, therefore, a gift to be cherished as a sacred trust.



Death and Dying



One factor which directly attacks man's God-given dignity is death (Gen.2:17b). However, Christ's death and resurrection became the death of death. His resurrection has been declared to have swallowed up death in victory (1 Cor..15:54-55). Therefore, death has been destroyed for the Christian and physical death only becomes, as it were, the means of ushering the believer into the presence of God (2 Cor.5:8). According to the Bible, death is not final (1Cor.15:12, 21-22). it is a direct consequence of man's sin (Gen.2:17; Rom.6:23). Death is the "last enemy" of man and will finally be overcome at the time of Christ's return and the final resurrection of believers (1 Cor.15:26,56). The Christian will reject humanistic philosophies that see death and dying as only a "natural" transition to either "oblivion" or to some higher stage of existence. According to the Bible, for the unbeliever death is in fact a prelude to final judgment in the presence of God (Heb.9:27).

The Bible also teaches that death, under the present conditions, is inevitable. There is a time to be born and a time to die (Ecc.3:2). Barring the immediate return of Christ, each individual must experience death personally. Given this inevitability, there comes a time point when certain medical measures may simply prolong the patient's dying agony. Medicine's death-resisting instincts must be tempered by ones that are in some sense "death-accepting." Both in medicine and in morals, it is the delicate balance between hope and resignation for the dying patient that must be sought. For the Christian, of course, death is not final, holds no ultimate terror, and is the doorway to eternal life (1 Cor.15:55,57).

There is a "sting" associated with death (1 Cor.15:55). Death hurts in the sense that human life, in the Garden of Eden, was originally designed as a unique opportunity for God to fellowship with creatures made in His own image. Spiritual death, therefore, is a horrible abrogation of what God had originally designed for the human race as it frustrates the opportunity for this unique Creator-creature fellowship. When a spiritually dead individual dies physically, that separation becomes permanent with no hope of restoration.

Death also hurts both the dying and the surviving because of the impending separation from loved ones at the point of death. For unbelievers, this hurt is keenly felt by the survivors because it involves hopelessness as well. For believers, this hurt is lessened by the fact that the believer looks forward to a time of great reunion with God and with fellow-believers who have gone on before (1 Thes.4:13-18).

Another "hurt" of death is the process of dying. Though death is not to be feared by the believer (Heb.2:15), the process of dying can be a source of turmoil for the patient and the loved ones. For believers, these "hurts" of death are truly felt but are buffered by God's covenant of grace in which He freely offers life and salvation through the Lord Jesus Christ. To those who respond by faith to His gracious offer, He grants eternal life, by which they can experience the blessed hope of the resurrection from the dead (1Thes.4:13-18). For those who in disobedience and unbelief reject His gracious offer, the ultimate end is the second death - separation from God in hell forever (Rev.20:14-15). Thus, we understand how one's spiritual state greatly influences how life is lived, death is perceived, and pain and suffering are accepted.



Pain and Suffering



Christians often falter when called upon to explain the nature of suffering. For some, it constitutes God's punishment for personal sin. For others, it is a mark of spirituality to be sought after as a "martyr." For some, the fact that "good" people suffer is simply beyond explanation and merely to be accepted.

A disturbing assumption, widely propagated, states that suffering is evil, or at least bad, and is to be avoided at all costs. The problem with this view is two-fold. First, it is unbiblical. Scripture clearly does not defend such a view of suffering; in fact, suffering is in God's plan and is not to be avoided at all costs (2 Cor.12:7-10). Second, it is unsubstantiated in the course of human history. Both in the Biblical record and in secular history, suffering has been an integral part of believers' existence.

Thus, it is dangerous to assume that all suffering is bad and is to be avoided. Suffering is part of human existence. Jesus taught that ". . . in this world you will have trouble. . ." (John 16:33). Suffering can also be seen as part of God's plan as it teaches obedience (Psa.119:67,71; Heb.5:8); produces Christ-like character (Rom.5:3-5; James 1:2-4); and provides an opportunity to glorify God (John 9:1-3; Phil.1:20,21). Suffering also provides an opportunity to strengthen and prove a person's faith (1 Pet.1:6,7), by leading to a greater dependence upon God (2 Cor.12:7-10), by enabling a person to know the comfort of the Lord (Heb.4:14-16), and by preparing a person to comfort others (2 Cor.1:3-7).

Since suffering is temporary, it will yield to eternal glory, and it must be viewed with an eternal perspective (2 Cor.4:16-18). For the believer, this life is not an end in itself, but a means to glorify God, his Creator and Savior. The sufferings in this life will fade in contrast to the glory that is to come (Rom.8:18). God does not intend suffering to be meaningless, haphazard, or cruel. When understood in the context of a sovereign God with an eternal plan, suffering can be faced with confidence and dignity.

The Biblical view of suffering must affect the believer's decisions regarding his own death and dying, and should be foundational in one's thinking. Suffering is not to be avoided at all costs. Life is not to be abandoned simply because of suffering. The premise that a life of pain and suffering is not worth living is unbiblical. It is on this false premise that doctor-assisted suicides are "justified." The concern becomes not the avoidance of suffering, but rather, the avoidance of "artificially prolonged" suffering. The believer's response to suffering also provides a significant opportunity for testimony to the world. Many care-givers and other observers have been greatly impacted by the believer's godly response to suffering, death, and dying. Equally important at such times, the community of believers has opportunity to demonstrate the love and care which God commands in the Body of Christ (John 13:35).

In addressing the issue of Advance Directives, one's intent is not to be the avoidance of suffering nor to hasten the death process artificially. Rather, the intent is to allow a person to face suffering, dying, and death with realism and readiness in such a way that God will be glorified (Phil.1:20,21).



Euthanasia: Active/Passive



Euthanasia might best be defined as any act of commission (active) or omission (passive) that intends the death of a person because of his or her suffering. Because it is ostensibly out of "mercy," the popular term "mercy killing" has been used. Unfortunately, there is much semantic confusion surrounding the subject. The term comes from the Greek, meaning "good death."

Deliberately ending one's life by acting to end that life in order to alleviate suffering or hasten the inevitable death is frequently referred to as "active euthanasia." This is often distinguished from withholding treatment and/or nutrition in order to hasten death, which is often referred to as "passive euthanasia."

"Active euthanasia" or doctor assisted suicide in any form cannot be condoned by Scripture. The Bible everywhere condemns unjust killing. In fact, God clearly declares capital punishment for anyone, who with premeditation, unjustly kills another person (Gen.9:6). The Sixth Commandment, "You shall not murder" (Exo.20:13) also carries the responsibility to perform all "lawful endeavors to preserve the life of ourselves and others by resisting . . . all . . . practices, which tend to the unjust taking away of the life of any." (Westminster Larger Catechism, Q.135).

Individuals in the Bible who either killed themselves or who sought to have themselves killed to avoid suffering are always seen as disobedient. The following examples are offered: Abimelech (Jud.9:54-57); Saul (1Sam.31:3-6; 2 Sam.1:9-16); Ahithophel (2 Sam.17:23); Zimri (1 Kings 16:15-19); Judas Iscariot (Matt.27:5; Acts 1:18). While suicide is not the "unpardonable sin," the command against murder includes "self-murder." It contradicts the legitimate self-love that Scripture assumes and commands (Matt.22:39; Eph.5:28). Our lives are not our own, to be disposed of when we deem advisable or necessary (1 Cor.6;19ff; 7:14).

Some opponents of "active euthanasia" look with favor upon the "passive euthanasia." C. Everett Koop exposes the inconsistency of such a position. He writes, "Starving to death a newborn infant with a congenital defect is given the name 'passive euthanasia', and somehow or other seems more acceptable in the minds of those who commit such an atrocity than taking an active step to kill the same child." (Whatever Happened to the Human Race, p.90). All forms of euthanasia, whether "active" or "passive" are to be avoided and actively opposed, as they involve the intentional hastening of death.

Today's medical and legal systems have allowed dying, which was once considered a simple process, to evolve into a complex dilemma. There is disagreement even on that which technically constitutes "death." Every day, patients and families are faced with complex decision of "when to hold on" and "when to let go." questions which are considered at such times include, "Is the ongoing medical treatment helping the patient, or simply prolonging the dying process?" C. Everett Koop states, "the emphasis on the right to die should never exceed the right to live." How can one decide when treatment should cease and death be allowed to take place?

Dr. John Frame, in his book, Medical Ethics, offers suggestions to guide the believer. In general, a patient may be allowed to die when resources to save his life are lacking - whether they be time, technology, finances, or skill. When an individual is under medical care, he may be allowed to die when he is "dying." "Dying" is used in the sense that "a patient is under medical care but for whom that medical care is not and will not be successful." The main emphasis seems to be that human observers have deduced that God is in the process of ending the person's life and have chosen not to prolong the process and suffering beyond the point that it would naturally occur. This is viewed as being different from withholding the essentials needed for life when one is not "dying". This principle does not justify withholding treatment from "bodies without persons", "people without persons", "people without a personal future", or "people with horrible burdens". It is not difficult to acknowledge the dangers which exist in this area, once the concept of "the right to die" is accepted.

The following expanded guidelines for termination of treatment may be considered. When a disease has advanced to the point where no known therapy exists and death is imminent despite the means used, then forms of treatment that would secure only a precarious and burdensome prolongation of life may be discontinued or not instituted. In such truly terminal cases, the use of certain means would not be therapeutic, but would only prolong an irreversible process of dying. Only palliative care is indicated. By "terminal illness" is meant a circumstance in which apart from intensive medical support, death would probably take place within two weeks. "Palliative care" means therapeutic measures designed to increase the patient's comfort and control pain, to provide food, water, and nursing care by normal means, and to minimize stress for the dying patient and his family.

To say that in certain cases palliative care alone is indicated is not to abandon the patient. An anencephalic newborn with other handicaps may have a life expectancy of only a few days or weeks. But even in such an extreme case, customary hygiene, normal feeding, clearing of nasal passages, providing warmth, etc. would be normally mandatory. The obligations of neighbor love still apply in such cases. Abandonment is always illicit. One has a constant obligation to show neighbor love to the patient in his dying, as well as in his living, and hope for recovery even when that obligation can only be expressed through measures designed to provide care and comfort rather than cure (Rom.13:9; Gal.5:14; Luke 6:31).

One of the most prominent and common distinctions in providing medical care is the distinction between ordinary and extraordinary means. Normally one is held to use only ordinary means - according to circumstances of persons, places, times, and culture - that is to say, means that do not involve any grave burden for oneself or another. On the other hand, one is not forbidden to take more than the necessary steps to preserve life and health. In general usage "ordinary means" are all those medicines, treatments, and operations which offer a reasonable hope of benefit and which can be obtained and used without excessive expenses, pain, or other excessive difficulties. "Extraordinary means" are all those medicines, treatments, and operations which cannot be obtained or used without excessive expenses, pain, or other excessive difficulties, or which if used, would not offer a reasonable hope of benefit. As thus defined, it was generally understood that "ordinary means" were morally obligatory, while "extraordinary means" were not.

Such terminology has a long history and dates back to moral theology in the sixteenth century, (Francisco Victoria). It has been suggested at times that the rapid progress of medical science in the twentieth century has rendered obsolete the distinction between ordinary and extraordinary means. Respirations, kidney dialysis, and other new forms of medical technology are so commonly available as to be "ordinary means". Consequently, the distinction is no longer meaningful. This criticism overlooks, however, the original meaning of the distinction. The terminology was never limited to medical technology per se, but took into view the total circumstances of the patient. A respirator might be "ordinary" under some circumstances and "extraordinary" in others. Whatever progress might occur on the technological front, it will always be necessary to consider the total circumstances of the patient and the family when making decisions concerning the possible termination of treatment. The classical distinction still has value in that it reminds the decision makers of the need to take all factors into account, not merely the medical ones.

The basic provision of food and water should not be denied to anyone. The provision of food and water by mouth is not medical treatment but a basic need, and therefore, should be given. An artificial feeding tube or intravenous therapy is medical treatment since it requires surgery, a physician's order and care, and can have considerable complications such as pneumonia, sepsis, stroke, gangrene, etc. Therefore, the decision to maintain nutrition through medical treatment may fall under "extraordinary measures" and require the same decision-making considerations as any medical treatment.



Advance Directives



In an effort to deal with the issues described above, the medical and legal communities have created "Advance Directives". An Advance Directive is a generic term for a form or document which expresses your preferences in the event you are physically and mentally unable to make medical decisions for yourself. An Advance Directive is a method of letting others know your wishes about treatment if you are unable to communicate those wishes at the time. The preparation of Advance Directives creates a forum where families talk about health care needs and death before an individual is unable to make decisions about his own care. In addition to providing personal peace of mind, Advance Directives can minimize or eliminate agonizing medical decisions for family members. Furthermore, Advance Directives compel communication between doctors and patients, in that the directive is an agreement that the patient's wishes will be respected should the patient ever become incompetent.

Two primary types of Advance Directives presently exist - the Living Will and the Durable Power of Attorney for Health Care. A living will is a specific kind of directive which is restricted to rejecting life-sustaining medical interventions when a person is terminally ill and unable to make decisions for oneself or that person is comatose. Living wills have been in existence for over twenty years. Developing medical technology, publicity about euthanasia and doctor-assisted suicide, and recent legislation have focused greater attention on living wills in recent years.

The second primary type of Advance Directive is a "durable power of attorney for health care". This medical directive enables a person to name a trusted relative or friend to make his/her medical decisions when he/she cannot do so for himself/herself. This includes the right to refuse treatment one would not want. This directive allows a person to designate someone as "attorney in fact", and empowers that person to make health care decisions on his/her behalf. The "attorney in fact" does not have to be an attorney or a doctor. He or she may be a spouse, relative, friend, neighbor, or fellow church member. The choice should be someone who is known very well by the individual, who shares the same values, and is comfortable with making such decisions.

Advance Directives are becoming increasingly popular. As time goes on, the impact of present laws governing Advance Directives may well become more pervasive. All health care facilities (hospitals, nursing homes, clinics, doctors' offices, etc.) may all but require a copy of such a document before admission or administration of health care. The believer must be informed and prayerful consideration must be given to insure a response that will honor God and reflect a Biblical world-view.

The following Biblical principles are included to assist the believer when making decisions regarding future medical treatment and Advance Directives:

1. Human beings are made in the image of God, and He has invested our lives with sacred value (Gen.1:26,27). Humans have a value and a unique place above all other forms of life on earth. "To sanctify" means "to set apart" as special. Since God has set human life apart above all life, we respect the sanctity of life.

2. The Bible teaches that God Himself is the giver and taker of human life. He is sovereign over human life (Rom.14:7,8). The Lord Himself is the giver of life and the One Who takes life (Job 1:21).

3. The Bible everywhere condemns unjust killing (Gen.9:6).

4. Christians have the assurance of eternal life and the promise of the resurrection and must not be enslaved by the fear of death (Heb.2:14,15; 2 Cor.5:6-8).

5. The Bible nowhere condones suicide in any form.

6. Christians facing death live with a tension between this present life and the life to come. On the one hand, the avoidance of suffering may never be a criterion by which death may be allowed (Heb.12:5-8,11). To use suffering as the reason to hasten death by any means is to thwart one of God's clearly stated means of sanctification. On the other hand, we are not to value continued physical life over death that brings "life" with Jesus Christ (2 Cor.5:6-8; Phil.1:21-23).

7. There is a time to die and for the believer such a death is called "precious" (Ecc.3:2; Psa.116:15).

8. Economics should rarely be the sole deciding factor, however, economics may at times be a limiting factor for continued life (2 Cor..12:14b). We are not required Biblically to preserve life at all costs. But while allowing a limitation of medical treatment for the above reasons we never limit medical care and the compassionate concern for all people.



Cautions and Concerns Regarding Living Wills



1. The standard living will documents refer only to the termination of treatment. Most living wills only allow you to designate that you want certain medical treatments withheld or withdrawn, and "that you be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide comfortable care or alleviate pain". Some standard forms only allow you to say whether or not you want nutrition and fluids or wish to donate your organs. When basic nutrition needs are limited we are at the edge of a slippery slope where demented, retarded, or physically handicapped are increasingly viewed as "useless mouths".

2. Living wills may not be specific enough. Even the best of the approved living wills do not allow for sufficient options or details regarding treatment. For example, antibiotics - living wills do not allow the kind of specificity that most patients' care will demand even in the terminal stage of their illness.

3. Living wills are vague. Phrases like "life-sustaining procedures", "treatments that prolong the process of dying", and "there is no reasonable expectation of recovery from" are very common in living wills. Other phrases and words like "imminent death" and "artificially prolong the dying process" are highly problematic and impossible to define with precision. Their meanings and applications will differ from case to case and even over the course of one patient's illness. The person who will interpret these terms and make decisions accordingly is the physician and not the patient's family.

4. A physician and patient are in an implied covenant relationship which demands consultation and negotiation. The physician promises to provide certain treatments under certain conditions, and the patient promises to comply under certain conditions. During the course of a normal illness, the covenant is revised as the patient's condition changes. Living wills make a nominal effort at honoring such a covenant, but are far too rigid. They do not allow negotiation and revision. In a word, they are not flexible.

5. Living wills tend to transfer authority from the family to the state. Biblical authority resides within the family primarily and the church secondarily (1Tim.5:8). What can the family do with a very ill family member without endless resources? They would provide that best care they could with the resources they have. What institution will better care for its own than the family? If family members do not exist, the church has a responsibility to work with individuals in deciding these crucial matters.

6. The primary mover behind the Advance Directive promotion has been the "Choice in Dying, Inc." organization. This organization was formerly known as "Concern for Dying and Society for the Right to Die". The agenda for such organizations is not simply to provide a vehicle to direct future personal health care, but ultimately, to legitimize and legalize a person's "right to die".



An Alternative to Living Wills



In light of the above cautions and concerns raised regarding living wills, and because of the potential for misuse presently and in the future, a more biblically consistent approach toward this issue seems to be the "Durable Power of Attorney for Health Care".



The following are suggested guidelines if one wishes to prepare an Advance Directive:



1. Obtain as much information as possible prior to preparation. Information can be obtained from your state government representative. This information will explain the law of your state and will probably include generic samples of these documents. Information can be obtained from many of the following sources: public libraries, personal family physician, hospital, nursing home, pharmacist, pastor, attorney, stationery stores which sell generic, legal type documents.

2. Carefully review the information. Talk with family members and the "to be named attorney in fact" about your values and wishes. Your pastor is often a valuable resource to include in such discussions. Make sure everyone is clear regarding your concerns and wishes.

Note: Your "attorney in fact" does not have to be an attorney or doctor. He or she may be a spouse, relative, friend, neighbor, or fellow church member. However, it should be an individual whom you know very well, one who shares the same values and is comfortable in making such decisions which you are requesting should the need arise.

3. Prepare an informal, generalized document which includes input from your family.

4. Choose a specific type of Advance Directive. We suggest that the "Durable Power of Attorney for Health Care" is more consistent with Biblical principles. Make an appointment with an attorney to have a legal document prepared.

Note: The conclusion in this paper is not that living wills are immoral, but rather, that there are serious concerns raised in their practical usefulness and implementation. As believers, we are responsible to not only promote righteousness, but also to refrain from practices which open the door to questionable and immoral actions. If you choose to execute a living will, do so with great precaution and knowledge of their limitations.

5. Take a legal copy of your Advance Directive to your physician to be added to your medical records.

6. Distribute copies of the document to the persons named in the document and to anyone else you think should have it, such as your pastor and key family members. Keep a copy stored in a safe place known by family members.

7. Upon entering a hospital, take a legal copy of the Advance Directive. Hospital personnel are required by law to ask you if you have an Advance Medical Directive, and it would be wise to provide them with yours at this time.

8. It is important to remember at all times that both the Living Will and the Durable Power of Attorney for Health Care do not become effective unless you become unable to make decisions for yourself. The Durable Power of Attorney for Health Care states, "To ensure that decisions about my medical care are made consistent with these wishes and my personal values, I appoint the following person my 'attorney in fact' to make health care decisions for me whenever I am unable to do so.



Conclusion



As we contemplate such issues, we are reminded that all life is ultimately in the hands of a sovereign God. For centuries, life and death issues were decided without the use of any vehicle such as the Advance Directive. Decisions were guided by a belief in the sanctity of life and a commitment to a Biblical world-view. Family members were called on to speak on behalf of one who was unable to speak for himself. Today, technology has intensified the need for life and death decisions. The family unit is disintegrating. Society no longer holds all human life as sacred. There is no longer a commitment to a Biblical world-view.

Biblically, the responsibility for making medical decisions lies with the family unit as God has ordained it. Ideally, in a context of love and trust, family members talk about these issues before the need for decisions arise. As a person nears the end of life and becomes unable to make decisions for himself, loved ones rightfully carry out that responsibility in light of the person's desires. No document can cover all the possible situations which may arise. Decisions are best made, not by medical personnel who are forced to "interpret" a document, but by loved ones who have known and loved the patient over time. The church can play a vital role in guiding families and individuals in these matters. If an individual within a church has no family members, it is the church's responsibility to insure that the individual's desires are carried out in a Biblically consistent manner. With all of the emphasis on Advance Directives today, the truth remains that there is no substitute for loving family members who can be trusted to make decisions in the patient's best interest when that becomes necessary.

Where Advance Directives are necessary, perhaps even required, it appears to be a more Biblically consistent approach to use the "Durable Power of Attorney for Health Care". Whereas the Living Will is not immoral, this paper has endeavored to show the inherent dangers, limitations, and potential for misuse by a secular society. All believers are urged to pray and seek the Lord's wisdom in making decisions regarding these matters.

Believers would do well to contemplate the words of C. Everett Koop, former Surgeon General of the United States. He wrote,

Do not dismiss contemptuously our concern about the wedge principle. When the camel gets his nose in the tent, he will soon be in bed with you! Historians and jurists are well aware of what we say. The first step is followed by the second. It is easy to see that if the first step is immoral, whatever follows it must be immoral. But even if the first step is moral, it does not necessarily follow that the second step will also be moral. We have to be consciously aware with each step as to what the next step is likely to be. (Whatever Happened to the Human Race).

As a church, we have a great responsibility to exercise discernment and express caution when a society begins to open doors that may lead to very dangerous places, particularly if unchecked by biblical absolutes and a moral foundation. The organizations behind the Advance Directives movement have their sights set on a society where every person ultimately exercises his "sovereign right to live or die", and even is able to make those decisions for others. The church must continue to hold all of human life sacred and do all it can to protect such life. It is the church's God-given responsibility.



Glossary



Advance Directive - A document which you create while you are feeling well and thinking clearly that explains to your family and your health care providers the extent of medical treatment you wish to receive - or not to receive - should you become terminally ill and unable to make decisions for yourself or you become comatose. The two primary types of Advance Directives are a Living Will and a Durable Power of Attorney for Health Care.

Durable Power of Attorney for Health Care - A document which appoints another person to make decisions regarding your medical treatment and to act on your behalf in regards to health care only should you meet the medical conditions described above. (This may be a part of a general Durable Power of Attorney that includes legal and financial matters, or it may be a document that deals only in health care decisions.)

Euthanasia - Any act of commission (active) or omission (passive) that intends the death of a person in order to eliminate patient suffering.

Living Will - A document which specifies your preferences regarding the extent of medical treatment you wish to receive - or not to receive - should you become terminally ill and unable to make decisions for yourself or you become comatose. It is important to understand that a Living Will becomes effective and operative only when the above conditions are met.

Medical Care - Any therapeutic measures that promote patient comfort, control pain (e.g. provide food, water, nursing care) and minimizes stress for a dying patient and his or her family.

Medical Treatment - Any medications, medical procedures, or surgical operations (including artificial feeding tubes and intravenous therapy) that require a licensed physician's prescription and oversight.

Ordinary Means - All medicines, treatments, and surgical procedures that offer reasonable hope of benefit and which can be obtained and used without excessive expense, pain, or other difficulties.



Note: Laws regarding Advance Directives differ from state to state, therefore, it is important to secure information from your state of residence and to update your Directive should you move to another state.







Study Committee on Advance Directives: James A. Beil, Chairman; William G. Schlonecker, Secretary; Phyllis Clapier, Carl J. Fischer, Jr., Donald T. Kirkwood, George A. Priestly, Ronald W. Reed, Glenn D. Ruoss

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