Back in the fall of 2018, I was processing feelings of grief after losing my grandfather. He passed away at home surrounded by family and friends. I remember cherishing these final moments with him. In the days after his memorial service, I remember encountering the work of Kathryn Butler on Oceans Rise. I honestly can’t recall how I stumbled upon this blog, but her forthcoming book Between Life and Death caught my attention. I was just completing my first unit of Clinical Pastoral Education at Wake Medical Center in Raleigh, North Carolina, and had become interested in the intersection between and faith and medicine, specifically related the ethics of life and death.
For those involved in ministry, we can see the effects of modern medical advances on the people for whom we care. However, are all these technologies ethical? Should certain life-prolonging measures be avoided? Such questions remind us that death is the final enemy (1 Cor. 15:26). Butler explains in her book, “When faced with the grief and uncertainty of life-threating disease, fear may drive us to resist death at all cost.”[1]
As daunting as this task can be, I appreciate Butler’s desire to provide careful and nuanced conversation on end-of-life medical care. Many approaches to the end of life are often hidden behind complex medical terminologies and moral dilemmas, making it difficult for patients and their families to honor God in these precious moments. Guidance in these areas should be thoughtfully articulated in a way that people can best understand how to honor God in their final moments.
Butler offers a distinctly Christian guide to ministering to patients during end-of-life care. She focuses on Biblical principles that are applicable in even the most complex medical issues. This approach echoes 2 Peter 1:3: “His divine power has granted to us all things that pertain to life and godliness, through the knowledge of him who called us to his own glory and excellence.”[2]
Between Life and Death is divided into three sections, each offering Scriptural wisdom to navigate critical decisions involving medical care. The first attempts to build a Scriptural foundation on how Christian theology informs modern medical ethics and includes reflection upon four key principles: (1) the sanctity of mortal life; (2) God’s authority over life and death (3); mercy and compassion; and (4) hope in Christ.[3] The second section explores detailed examples of organ-supporting measures such as resuscitation for cardiac arrest, mechanical ventilation, cardiovascular support, and dialysis. The last section offers analysis of comfort care measures, physician-assisted suicide, and advance directive planning.
All Things That Pertain to Life and Godliness
The strength of this book is how Butler provides Scriptural wisdom on every complex medical issue that she explores. Families may be tempted to disregard the truth that the Lord works through all things—even death. I say this with care and compassion, knowing the delicate nature of each critical illness and the feelings that may arise. Butler writes:
We must never convince ourselves that if we pray fervently enough, he must necessarily yield to our will. . . The Lord does not need a ventilator to save a life. Christ resurrected Lazarus with a word (John 11:43-44). He revived a dead girl with a touch of his hand (Luke 8:52-56). While the Lord has blessed us with medical advancements to combat death, their efficacy depends on his mercy.[4]
We may be tempted to think that God’s Word does not speak into areas such as brain death or advance care planning. However, “God’s Word illuminates the way for us, even through the dismal and echoing confines of the hospital corridor.”[5] These Scriptural references often show up towards the end of each chapter, but they all stem from the four Biblical principles outlined in the first chapter.
Along with Scriptural references cited throughout the book, Butler provides an appendix with “Scripture Passages for Comfort.” Some of the passages listed include Psalm 23, 46, 121, 2 Corinthians 4:16–18, and Revelation 21:4–5. This list is helpful in providing quick Scriptural references for any pastor visiting people throughout the week. As Butler points out, “Medical terms offer no solace when the soul thirsts for God (Ps. 42:1–2).”[6]
Coupled with substantial citations of Scripture, Butler also speaks with clarity and precision on certain difficult issues. This approach is vital for applying the Scriptures to areas of ethics of life and death. For example, situations surrounding artificially administered nutrition are delicate. The tragic case of Terri Schiavo captured the attention of many in the early 2000s and prompted debates of whether to remove feeding tubes for certain patients. About this matter, Butler writes:
In many cases, withholding tube feeds does fly in the face of our biblical call to love one another (Matt. 22:39; John 13:34-35). . . . Conversely, the tube is often ill-advised for a dying patient. The intestines shut down at the end of life. Force feeding as death nears creates painful cramping and bloating, and the tubes themselves are uncomfortable and fraught with complications. As our lives draw to a close, we may elect to simply feed ourselves as able, without artificial sources of nutrition. The Bible does not require us to lengthen our dying, and our view of the cross should coax us to loosen our grip on futile interventions.[7]
Brain Death and Advance Care Planning
In reading this book, I find that I benefitted the most from Butler’s careful discussion on the differences between brain death and a coma, as well as the consideration for advance care planning. The terms coma and brain death are often used interchangeably, which can create confusion, and these medical definitions need untangling. Butler explains, “Coma and vegetative state refer to severe brain injuries that impair consciousness but have the potential for improvement. . . .In brain death, the entire brain dies. This injury is irreversible, with no hope for recovery.”[8] Butler also reveals how both medical and Christian establishments have affirmed the stipulations of the Uniform Determination of Death Act (1980), which “legally recognized death by neurologic criteria in the United States.”[9]
This area is delicate because “even after death of the brain, spinal cord reflexes can trigger movements such as turning the head, flexing the fingers, and raising the arms.”[10] These scenarios can be overwhelming for many families as they try to decide how to care for their loved ones. I appreciate the way that Butler carefully defines each term in this particular chapter and seeks to explore how Scripture can guide us in such difficult circumstances.
While I appreciate the clarity with which Butler speaks in this area, I would have liked to see her to say more on how to minister to the families in these particular situations. What advice would you give to ministry leaders who are with a family going through this scenario? Furthermore, what kind of questions would you urge family members to ask trusted doctors upon receiving this kind of news?
I found Butler’s guidance on advance care planning towards the end of the book to be helpful. This is an area that is often ignored by many families, but the book can help families navigate difficult decisions before they arise. Butler encourages families to participate in advance care planning, citing studies that reveal “less depression, anxiety, and stress among loved ones when we provide instructions for them ahead of time.”[11]
To help even further, Butler offers four useful “guiding questions” for families setting up their advance directives. These questions include: (1) What are my goals for the end of life? (2) How can I continue to serve God at the end of life? (3) How much suffering is too much? and (4) What trials am I willing to endure to achieve my goals at the end of life? Lastly, Butler even has a sample advance directive in appendix 2. While this serves only as an example, it helps guide the reader to think about their own care planning.
Conclusion
As someone involved in the intersection of faith and medicine, I regularly find comfort in the sufficiency of Scripture. Kathryn Butler has put together a helpful resource rooted in the Scriptures that guides believers faced with difficult decisions between life and death. There were times that I would have liked to see her develop how processing grief and feelings play into certain situations. Given the seriousness of the issue and how brain injury is often involved, attention could have been given to opioid overdose and how it affects families. However, I highly recommend this book for anyone involved in healthcare ministry.
Ministry leaders will also find this resource helpful as
Butler carefully explains the nuances of medical terminologies on complex
issues. Pastors are often some of the first to respond to medical emergencies.
For this reason, they will need to be prepared to minister in these situations.
While we cannot anticipate every trauma in life, we can find comfort in the One
who is near to the brokenhearted (Ps. 34:18).
[1]Kathryn Butler, Between Life and Death: A Gospel-Centered Guide to End-Of-Life Medical Care (Wheaton: Crossway, 2019), 36.
[2]All Scriptural quotations and references come from the Christian Standard Bible.
[3]Butler, 32.
[4]Ibid., 37.
[5]Ibid., 142.
[6]Ibid., 15.
[7]Ibid., 90.
[8]Ibid., 121–22.
[9]Ibid., 119.
[10]Ibid.
[11]Ibid., 151.
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