A Thought Process to a Most Difficult Decision
(This should only be read by the strong with The Light and Spirit of Truth, Wisdom and Understanding – John 8:12; Isa. 11:2)
There are few good ways to begin addressing the subject of what to do when a loved one is near death or facing death. Concerning the following, yes I understand that David had the child out of sin, and that this is not the case of your loved one or my loved one, but it is to make a couple of points. (2 Samuel chapter 12:16-) David pleaded with God for the child. He fasted and spent the nights lying upon the ground. The elders of his household stood beside him to get him up from the ground, but he refused (he put aside all of his Kingship duties and all others AT THIS POINT in his life) and he would not eat any food with them (FOR THIS WEEK) and on the seventh day the child died…
And his attendants (and friends) were afraid to (speak to him – who wants to tell a loved one that their child is dead, or their loved one, and how many have, first the strength and courage, and second the wisdom and third the appropriate compassion to speak to that loved one – so most knowing their shortcomings say little, nothing or meaningless statements – not because they don’t care; but typically because they are human; ANYWAY) David noticed that his attendants were whispering among themselves, and he realized the child was dead (did not notice earlier because was neither on the ground fasting and praying or in a place of weak physical status – such that he was not able to notice before the attendants).
Then David discovered the truth that his child had died and he got up and went and washed and changed his clothes and went to the Temple and worshiped the Lord. Then he went to his own house and requested food and ate. And his attendants asked, ‘Why are you acting this way? While the child was alive, you fasted and wept, but now you get up and eat!’ David answered, ‘while the child was yet alive, I fasted and wept… who can tell whether God will be gracious to me, that the child may live? But now that he is dead, why should I fast? Can I bring him back? I will go to him (in death and the eternity), but he shall not (and cannot without a Lazarus miracle) return to me.’
Then David comforted his wife Bathsheba (and children)… (and continued life; and in the course of reasonable time David resumed his duties and obligations to his friends, family and people – Israel). If David was a man after God’s own heart; if Job said, “‘Though YOU slay me, i will trust You; shall we accept good from God, and not trouble?” In all this, Job did not sin in what he said.” Then considering their highest status among great faithful examples; their actions and input on the subject of near death and facing death should not be overlooked lightly.
Also, when talking about the subject of ‘temptation,’ Paul reminds Christians that we must endure or face what ‘is common to man, but God is faithful (1 Cor. 10:13).’ And of course the subjects of life and death are most common to all men and must be endured by all. But how is God faithful? Paul – who was martyred for the namesake of Christ – says, “Christ Jesus died for us and was raised to life for us, and He is sitting… at God’s right hand, pleading for us (our salvation). Can anything ever separate us from Christ’ love? Does it mean He no longer loves us if we have trouble or calamity (great tragedy), are persecuted, or hungry, or destitute, or in danger, or threatened with death? As the Scriptures say, ‘for Your sake we are killed every day (like those in Hebrews 11 who ‘all died in faith… some slain and afflicted and tormented, all of whom the world was not worthy’ because of their love and faithfulness to Almighty God and the King of the Universe); we are being slaughtered like sheep’.”
(Paul continuing Romans chapter 8 at v.37) “Despite all these things, overwhelming victory is ours through Christ, who loved us. I am convinced that nothing can ever separate us from God’s love. Neither death nor life… neither our fears for today nor our worries about tomorrow…” So i look at David and Job’s actions and words along with Paul’s and others. i consider all that military spouses and families must endure; i take love and emotions out of the equation lest i bias the truth and the Spirit of Counsel.
Being in both the Christian faith and insurance industry for more than 27 years; and having studied both for ten thousands of hours, they both have influences on my thinking process. Having engaged for years in debate and attending law school; these have influenced my logic and thought process. Being a serious studier of history and nations and cultures; and an occasional studier of anthropology, philosophy, psychology and numerous disciplines and subjects, depending on how they cross my paths in my writings, etc; they have influenced my thought process. The general talents that God blesses us with and gives us, and the people and educational systems that we encounter, influence us and obviously me as well.
i have seen personally the last breath of my mother, and felt her last grip and received a spiritual and temporal inheritance through her – and though in the general course of the day i don’t think of her, i never forget (and it is beyond my time and knowledge to explain how her life has intertwined into mine and still effects my decisions, but how she in no way would want to be an obstacle between me and God and me and other loved ones). i have seen all range of ages and all spectrums of righteousness and unrighteousness within families and their trials and struggles and tears and laughter. i still remember the prayers we spent for some with no avail, and the prayers for others, that yielded salvation, or healings, or answers, or actions; i have seen rain held back by prayer, a coma patient wake up, a blind person see, some live and some die and i hope all things and believe all things possible – but not all things are expedient.
i still remember from 22 years ago, the ten year old child of a humble pastor in Nicaragua laying in a hammock loving her family while she was twisted and partially paralyzed and dying and all of us in prayer and tears and wonder – why oh Lord – why – she is so innocent and loving and not evil? Why must the faithful endure such much? The Spirit will help aid us, but are we able to hear: Listen my servant; do you think I love this child less than another; did My Son not die for her? Has it not been plainly revealed that this life is fading and all flesh must die, and then the judgment, and then an eternity of glory for this child? If all endured the same trials and the same lifespan than you know nearly all would forsake Me until their last days and then cry out in repentance for salvation? Am I not due fear and reverence all your days?
A Thought Process to a Most Difficult Decision:
What to do with a loved one near or facing death?
|Step One: Remove love and emotions and seek the best available and pure Counsel and Truth
It is a fact that all humans are emotional; it is also a fact that some cultures value human life more than others. Some nations and cultures due to hardship or lack have not the medical facilities and physicians common to others. Some have not the assets to value humans to be worthy of million dollar legal settlements. i remember a time during war and disease that the nation of Malawi’s life expectancy had sunk to 37 years old (currently about 54). The killers, whether natural or native had no care for the lives they took. And what could the loved ones do but cry and pray and make choices and then go on with life? In developed countries we have been taught to value life and hang on to life and the pleasures of this world (both good – friends and families and duties; and bad – for lust, pride, etc.). According to the National Center for Biotechnology Information, PubMed Central (PMC 2007): “Between, 1960 and 1995, developing countries have added 22 years to their life expectancy while developed countries have added about 8 years. If Malawi experienced this trend, the life expectancy by 1990 would have been around 60 years. However, this has not been the case.” The Point is our emotions and decisions are moved by our education and experiences.
|Step Two: As you are able: ‘Be strong and take courage’ and allow reasonable help.
It is a fact that humans are imperfect and this present darkness we live in is both complex and trying. And when the storms of life hit – whether a house or human is affected; most have difficulty or need help or second guess themselves as to the previous preparations taken. Recently, i read that a significant % of American soldiers have died in parts of Iraq and Afghanistan that could have survived had they had more surgeons nearby, or their fellow soldiers had proper medicines and training to attend to basic procedures – such as knowing when to use ketamine instead of morphine. Sometimes loved ones have little time and options; and others have much time and a complexity of options and various certain and uncertain outcomes. In either and all cases, Christians are to bear one another’s burdens (Gal. 6:2); not just with the temporal care and cost, but with serious and sober understanding. Very few spouses and loved ones and friends are grossly neglect and or willfully intending to harm their loved one. No matter the outcome, it is the responsibility of friends and family, ‘especially unto those of the household of the faith – in Jesus Christ – Gal. 6:10)’ to lift up the poor and hurting and not to crush their spirits – especially for things that cannot be changed.
|Step Three: Consider many variables and to the best of your ability assign weight or proper consideration to each variable. These may not fall in exact appropriate step order, but until further edit i will do my best. In other words, i look at the decision as an algebraic expression:
C = M[(d + a) + (d + a x a) + R/S] x S[(b + s + p) (m / lf)] + (Ld/i + L2d)w3 + (Cd)w2 + (OFam)w1 + (Friends, etc.) +/- etc.
THUS: 100% CHOICE = Medical (+/- % of weight given to each) [(doctor(s) evaluations and inputs + current state of Loved one’s anatomy given most priority, ie… brain, heart, other internal organs) + (doctor(s) information + current status of Loved one’s secondary priority + third, etc.) + (Research and Studies concerning those areas)] x Spiritual decisions and influences [(biblical morals and instructions and counsel + spiritual insight + prayer) + (is it a Miracle situation / Lazarus miracle or not)] + (Loved one’s desires/instructions + L one’s Spouse desires/instructions)(x higher weight %) + (Children’s input)(factored %) + (other family)(lesser % factor) + friends, etc.
|A Thought Process to a Most Difficult Decision:
What to do with a loved one near or facing death?
|Step Four: Spiritual – obviously Spirit, emotions, prayers, seeking, etc. takes place during the entire process. But for weighted % purposes – it is covered later in the process|
|Step Five: MEDICAL – typically assigned the greatest % in making the Choice.
1. The doctor(s) instructions, evaluations, opinions, information, etc. as related to the first priority condition.
2. The Loved one’s diagnosis(es) of the second priority condition.
3. The doctor(s) instructions, opinions, information, etc. as related to the second priority condition… third… etc.
4. The Loved one’s status and future likely condition or status resulting from the combination and effects of all conditions.
5. Was Second opinion sought, given; is it needed; given all others variables… how far should one go and what burdens should be placed on the Loved one and their spouse and children in receiving a partial or complete second opinion?
|Step Six: MEDICAL – also assigned a great % in making the Choice.
1. Examining and understanding information from the physicians.
2. Researching and understanding the area of concern.
3. Using websites and texts, etc. to understand statistics, terms and conditions.
4. What is the likelihood of improvement to each of the SYSTEMS in concern?
5. Example: In dealing with diabetes and the loss of limb, what will happen if the surgery is not done; what will happen if it is done; and what are the odds of success?
6. Example: In dealing with heart surgery – obviously a common stint is different than a coronary artery bypass grafting (although common) or even pacemaker surgery and all these different than open-heart surgery with or without transplant; and age is a factor that should be highly addressed; with on pump or off pump, which facility… etc.
7. Example: Continued Hospice Care vs. taking off life support before or after hospice. (see step seven) Most people’s loved ones in developed countries like America go through the following process depending on their assets: Grow old, get medical care in a clinic, get medical care in a hospital or clinic, get medical care (from loved ones in their home) or go to some form of assisted living facility or Memory Care facility, then to a nursing home (or loved one’s home). However, many do not experience but a few of these and thus options and choices can be much harder for some than others.
|Step Seven: MEDICAL – Research and Studies:
1. Understanding what happens when the Loved one remains bed or chair-bound (and even these two are vastly different).
2. Depending on the condition: Conscious, semi-conscious, or persistent vegetative state, the Loved one may have different sleep-wake cycles or periods when awake and different abilities, pains and consequences relating their disposal of urine and waste. The urinary tract often will have recurrent infections. Infections can spread into the bloodstream and cause sepsis.
3. If in a prolonged bed bound state, understand the body is not functioning in a vacuum. The body’s systems are all being affected and effecting each other.
4. Muscles over time will waste away and limbs may become contracted and immoveable. Bones also lose density. Nerves are affected. Even in a matter of just a couple of weeks, strength can decrease as much as 20 to 30%. Weight loss, etc.
5. The Loved one will likely be pre-disposed to recurrent pneumonia, due to immobility and an inability to keep secretions out of the lungs. Lung may even collapse.
|A Thought Process to a Most Difficult Decision:
What to do with a loved one near or facing death?
|Step Seven: MEDICAL – continued (Bedridden Loved One)
6. Over time skin will breakdown and ulcers may occur. Also the effects from lack of sun and vitamin deficiency and periods of partial dehydration.
7. Since the loved one is typically unable to move and unable to control passage of urine or stool, they develop conditions in their intestines far beyond constipation. They can develop infections, and chronic intestinal obstruction(s) which can lead to pain and disease and even cancer.
8. The Loved one may bite their tongue or suffer other separate injuries.
9. The heart may beat more quickly and blood can clot easier; they become at risk to deep vein thrombosis and or pulmonary embolism.
|Step Eight: The LOVED ONE
1. The Loved one’s written desires (Living Will, etc.)
2. The Loved one’s express desires (to spouse, family, friends, etc.)
3. The Loved one’s implied desires (words, actions, experiences with them)
4. What the Loved one would say considering the previous Quality of Life (physical and mental abilities; occupation, expressions, goals) and their current and future status.
5. What the Loved one would say as to the burden on their spouse and or children and the fact that they also do not want to live under a certain level of Quality of Life.
6. My mother said, ‘…I am ready to go (to heaven)’ some say, ‘let me go.’
|Step Nine: The Spouse (or Parent of an unmarried child)
1. The Spouse’s decision process and input and experiences should almost always be given more weight than the children, and other family members.
2. The Loved one’s wishes for the spouse and the spouse’s future.
3. The age of the spouse (though many 60+ year olds remarry): most loving spouse’s desire for their (especially young or middle aged) spouses to go on with life.
|Step Ten: The Children (or siblings of an unmarried or widowed and childless sibling)
1. The children’s decision should almost always be given less weight than a competent spouse, but more weight than other family members.
2. The child(ren)’s opinions should be heard and if of age, they should be involved in the research and helping and talking about choices.
|Step Eleven: Other Family Members and Friends
1. It is most common for a mother or father of a married adult; or close friends of loved ones to want to help and even offer advice and opinions. And often their advice is helpful and prudent and maybe needed.
2. However, legally and spiritually (a child must leave their father and mother and cling unto their spouse) after God, should come spouse, child, then other family members and friends.
|Step Twelve: Spiritual
1. As stated earlier all prayer and fasting should be welcomed outside of the Loved one.
2. Then as guided by the Spirit of the Lord (and wisdom – so often by the medical facility) certain family and friends, etc… come in and speak and pray.
3. Common miracle or Lazarus miracle: (condition/ future status of the Loved one such that there is no difference in chance of great recovery or raising from the dead). Thus, (if decision made and death occurs) to ones believing more prayer time was needed, let them pray to raise the body – because both are equally as easy for God and as rare.
Now, in conclusion at this time, concerning making the most difficult decisions as to the life of a loved one, this typically will be in relation to surgery with low odds or statistical chances of success. And to some, the most difficult decision in their life will be deciding on continuing or discontinuing life support. In retrospect, i would advise healthy spouses to get their insurances and do their wills and power of attorneys (can be taken from free templates online and notarized for $ 20 in most cases) before going into clinic exams.
A holistic view must be applied. If the situation arises and you find yourself and your loved one in this place where there is no reason to expect improvement, but great reason and statistics and nature supporting a most difficult fact of decline or great pain and likely serious future complications likely leading to premature death; then remember listen to the doctors, get your second opinions, assess and reassess; then do not look at them in a single light or as to a single period in time. Doctors and experts evaluations and opinions and experience must be reviewed and given weight individually and corporately. Present percentage of system functions, future chances, and how each will affect each other must be given significant weight in the decision choice. Also, welcome what creditable experts and studies and texts reveal relating to the situation – to aid in the decision process and to help others understand the complexities of the situation. If the decision is still unclear pray for the Lord’s Spirit of wisdom and knowledge and understanding and counsel (Isa. 11:2). If still unclear, imagine and give great weight and care as to the wishes of the loved one and what they would say if able. At this point, after you weigh in on the situation, if they have child(ren) hear what they have to say. Then, consider what other family and friends have to say, all the time welcoming their prayers.
Lastly, remember this life is often frail and always temporary, and millions are undergoing the same struggles and decisions. As i write this, i personally know many dealing with such situations this June 2016: a couple in ministry who i have known for years, whose son in his thirties is in last stage of internal cancer; another couple i have known about 20 years, a wife whose husband went in for what seemed a routine heart matter at about age 50 and within days had massive brain damage and became unconscious; and my sister’s sister-in-law and her husband, who after performing a marriage ceremony were on their way home on his motorcycle and hit by a drunk driver, both suffering many broken bones and long-term life altering injuries; and all these and seven billion others in need of Christ and prayer.
When I had no words to answer concerning these things, the Spirit gave me wisdom and words: to the weak, say little or nothing; and to the strong, let them hear what the Spirit and the Word says. And the Spirit give me this message for some: What great loads some must carry in life; what millions of sorrowful images millions of children must bare; what oceans of tears some must not only swim, but endure through for the sake of family and brethren; what banners we must carry – faith, love, endurance and a hundred others… sometimes it seems not enough to hear Moses say, ‘may the Lord bless you and keep you; may His face shine upon you and give you favor and peace;’ nevertheless, who knows the mind but God, who sees into to the minds of men – whether they sleep or whether they speak – it is God who speaks to the soul; and like Stephen’s the soul and the mind ‘full of the Holy Spirit’ can still look up into the heaven and experience the glory of God – who can understand the mysteries of God and all the ways He speaks to mankind – so i pray that He continues to speak to your family; and when you feel you have not the strength, that you may simply rest in the living waters remembering and hearing things that Wisdom and Counsel (Isa. 11:2) bring to the faithful.