Christians affirm that human beings are creatures of God. As such, we are not the authors of our own existence, but receive our lives as gifts from God, who has made us as embodied spirits, capable of transcendence but also vulnerable to illness, accident, and death. God has endowed human beings with capacities for freedom, knowledge, and love, so that we might freely enter into the communion with God and each other for which we were made. The Creator's gift of liberty has been abused and distorted by sin. In Jesus Christ and the Holy Spirit we meet God as Savior, Redeemer, and present Advocate, who has acted in love to free us and all creation from captivity to the power of sin and death. To know God in these ways enables us to receive God's sovereignty over life and death not just as a limit or a neutral fact. It is a source of comfort and peace, as we wait for the final victory over death which is the hallmark of the finished work of redemption.
Therefore, Christians gather as forgiven sinners, redeemed by Christ and empowered by the Holy Spirit to discern and to choose the path of faithfulness to God and one another, as a community seeking to know and to do the truth. It is within the framework of these affirmations, and within the context of these relationships, that we grapple with the questions of faithful care for the sick and the dying.
Through the examples and command of Jesus Christ, the church receives the task of ministering to the sick, relieving what suffering can be relieved and undertaking to share and to lighten that which cannot be eliminated. This mandate calls upon us to address all the needs of the sick. These needs include relief from pain and other distressing symptoms of severe illness, but they also embrace the need for comfort and encouragement and companionship. These needs are expressed particularly by the very ill and the dying who confront fear and grief and loneliness. They are in critical need for emotional and spiritual care and support. The duty to care for the sick also calls upon us to work to reform the structures and institutions by which health care is delivered when they fail to provide the comprehensive physical, social, emotional, and spiritual care needed by those facing grave illness and death.
Care for the dying is an aspect of our stewardship of the divine gift of life. As human interventions, medical technologies are only justified by the help that they can give. Their use requires responsible judgment about when life-sustaining treatments truly support the goals of life, and when they have reached their limits. There is no moral or religious obligation to use them when the burdens they impose outweigh the benefits they offer, or when the use of medical technology only extends the process of dying. Therefore, families should have the liberty to discontinue treatments when they cease to be of benefit to the dying person. However, the withholding or withdrawing of life sustaining interventions should not be confused with abandoning the dying or ceasing to provide care. Even when staving off death seems futile or unreasonably burdensome to continue, we must continue to offer comfort care—effective pain relief, companionship and support for the patient in the hard and sacred work of preparing for death.
Historically, the Christian tradition has drawn a distinction between the cessation of treatment and the use of active measures by the patient or care-giver which aim to bring about death. If death is deliberately sought as the means to relieve suffering, that must be understood as direct and intentional taking of life, whether as suicide or homicide. This United Methodist tradition opposes the taking of life as an offense against God's sole dominion over life, and an abandonment of hope and humility before God. The absence of affordable, available comfort care can increase the pressure on families to consider unacceptable means to end the suffering of the dying.
Health Insurance in the United States
(While this section explores this topic in the United States context, we encourage further understanding and knowledge of practices and traditions around the globe.)
In the United States today, many millions of people have either no health insurance or grossly inadequate coverage which gives them no reliable access to medical treatment. Even for those who do have basic access, good quality comfort care—including effective pain relief, social and emotional support and spiritual counsel—is often not available from a medical system geared toward cure and rehabilitation rather than care for the dying. Such circumstances leave people with a distorted choice between enduring unrelieved suffering and isolation, and choosing death. This choice undermines rather than enhancing our humanity. When cost control measures and for-profit health care institutions bring economic pressures directly to bear on treatment decisions such as the cessation of care, the United States system of health care financing and administration has distorted and corrupted the practice of medicine. We as a society must assure patients situations where their desire not to be a financial burden does not tempt them to choose death rather than receiving the care and support that could enable them to live out their remaining time in comfort and peace.
The church's unique role for persons facing suffering and death is to advocate for and provide care in all of its dimensions to the very sick in the form of pastoral care. Such pastoral care is the calling of the whole community of faith, not only pastors and chaplains. Because Christian faith is relevant to every aspect of life, no one can cope successfully with life's pain and suffering and ultimate death without the help of God through other people. In Pastoral care God's help and presence are revealed. Persons offering and receiving pastoral care include the patient, the community of faith, family, friends, neighbors, other patients, and health-care teams.
Those offering pastoral care empathize with suffering patients and share in the wounds of their lives. They listen as patients express their feelings of guilt, fear, doubt, loneliness, hurt, and anger. They can provide resources for reconciliation and wholeness and assist persons in reactivating broken or idle relationships with God and with others. They can provide comfort by pointing to sources of strength, hope, and wholeness, especially reading Scriptures and prayer.
This same pastoral care must be provided to the family and friends of those who are suffering and dying. They too, must have an opportunity to share their feelings of guilt, hurt, anger, fear, and grief. Grieving persons need to be reminded that their feelings are normal human responses that need not cause embarrassment or guilt. Families have long-established patterns of relationships and attention to the entire family unit must be incorporated into pastoral care. Religious, cultural, and personal differences among family and friends must be considered with special sensitivity.
Health care workers also need pastoral care. Doctors and, especially, support staff have intimate contact with dying persons in ways experienced by few others. They live in the tension of giving compassionate care to patients while maintaining professional detachment. Pastoral care for health-care workers means helping them take loving care of themselves as well as their patients.
Pastors and chaplains are called especially to sustain the spiritual growth of patients, families, and health-care personnel. They bear witness to God's grace with words of comfort and salvation. They provide nurture by reading the Scriptures with patients and loved ones; by Holy Communion; by the laying on of hands; and by prayers of repentance, reconciliation, and intercession. They provide comfort and grace with rituals of prayer or anointing with oil after miscarriage, or after a death in a hospital, nursing home, or hospice. They develop rituals in connection with a diagnosis of terminal illness, of welcome to a hospice or nursing home, or of return to a local congregation by persons who have been absent for treatment or who have been in the care of a loved one.
In all these ways, pastoral-care givers and the community of faith are open to God's presence in the midst of pain and suffering, in order to engender hope, and to enable the people of God to live and die in faith and in holiness. They assist persons in coming to peace with themselves and others as they accept the realization that death is not always an enemy. They affirm that there is only one possible ending to the Christian story. Regardless of the tragedies and triumphs, the youthfulness or the age, the valleys of doubt and despair, the suffering and loss, and the soaring as things turn out all right—we come to the only one certain end: "I am the resurrection and the life. Those who believe in me, though they die, will live, and every one who lives and believes in me shall never die" (John 11:25-26, NRSV).
In addition to offering comfort and hope, pastoral-care givers are trained to help patients understand their illness and can assist families in understanding and coming to grips with information provided by medical personnel. Pastoral-care givers are especially needed when illness is terminal and neither patients nor family members are able to discuss this reality freely.
The complexity of treatment options and requests by physicians for patient and family involvement in life-prolonging decisions require good communication. Pastoral-care givers can bring insights rooted in Christian convictions and Christian hope into the decision-making process. If advance directives for treatment, often called "living wills," or "durable powers of attorney" are contemplated or are being interpreted, the pastoral-care givers can offer support and guidance to those involved in decision-making. They can facilitate discussion of treatment options, including home and hospice care.
Decisions concerning faithful care for the suffering and the dying are always made in a social context that includes laws, policies, and practices of legislative bodies, public agencies and institutions, and the social consensus that supports them. The social context of dying affects individual decisions concerning treatment and care and even the acceptance of death. Therefore, pastoral-care givers must be attentive to the social situations and policies that affect the care of the suffering and dying and must interpret these to patients and family members in the context of Christian affirmations of faithful care.
United Methodist Response
To insure faithful care for the suffering and dying it is recommended that United Methodists:
1. Acknowledge dying as part of human existence, without romanticizing it. In dying, as in living, mercy and justice must shape our corporate response to human need and vulnerability.
2. Accept relief of suffering as a goal for care of dying persons rather than focusing primarily on prolonging life. Pain control and comfort-giving measures are essentials in our care of those who are suffering.
3. Educate and equip Christians to consider treatments for the suffering and the dying in the context of Christian affirmations of God's providence and hope. This should be done especially through preaching and adult Christian education programs addressing these issues.
4. Train pastors and pastoral care-givers in the issues of bio-ethics as well as in the techniques of compassionate companionship with those who are suffering and dying.
5. Acknowledge, in our Christian witness and pastoral care, the diverse social, economic, political, cultural, religious and ethnic contexts around the world where United Methodists care for the dying.
See Social Principles, ¶ 161M and ¶ 162T.
From The Book of Resolutions of The United Methodist Church — 2004. Copyright © 2004 by The United Methodist Publishing House. Used by permission.