Wednesday, January 29, 2014

Hospice and the Dying Process

Elisabeth Kübler-Ross
Elisabeth Kübler-Ross (Wikipedia)
(Part of a series on death and the hereafter)

In Genesis 48, Joseph receives word that his father is ill, and fearing his imminent death, he goes with his sons to see his elderly father. Jacob musters his strength to see his son and grandsons. Notably, his mind is concerned with reviewing his life (Gen. 48:3-4), the future after he is gone (Gen. 48:5-6), and those who are waiting on the other side (Gen. 48:7). Despite his body’s deterioration (Gen 48:8), his focus is on his family (Gen 48:9-16), and their future provision (Gen 48:17-22).

Death is an enemy, not a friend (1 Cor. 15:26). However for those who are saved, death is no longer an enemy to be feared, for the Lord Jesus has conquered it and now controls its power in the lives of His people (Heb. 2:14-15; Rev. 1:18). Death is the way we leave this world, both unsaved and saved (Luke 16:22; Phil. 1:19-24). A few have avoided it (Gen. 5:24; Heb. 11:5; 2 Kings 2:11), and others will avoid it when the Lord comes (1 Thess. 4:13-17), but everyone else will die (Heb. 9:27).

For most of human history, death
has happened in the home with family surrounding a loved one, and at times on the battlefield. There are significant anecdotal stories passed down from family members and fellow soldiers of visions of heaven that faithful saints spoke about in their last moments, powerful witnesses to family members. They see family members who have passed on standing by dressed in white. They see angels and sometimes after long and debilitating illnesses they sit up in the bed, arms open wide, looking up with a smile, and then they are gone.

An officer with the 26th NC Volunteers, which was decimated in Pickett’s Charge during the third and final day of the Battle of Gettysburg, July 3, 1863, told of being in a hospital for the wounded on Gettysburg’s 2nd Day and hearing a Georgia colonel yell out in delirium, “Vicksburg has surrendered! Lee has been stopped! The South is whipped!” Days later, Lee retreated from Gettysburg, the turning point of the War, and news arrived from Vicksburg, Mississippi, that the last Confederate stronghold had fallen on July 4th.

Advances in technology and medicine and increased immigration and exposure to other cultures beginning in the last half of the 20th century have brought many new and difficult questions about death. With the advancement of medicine, death began to be more frequent in the sterile, sometimes lonely environment of the hospital or the nursing home. They had good care, but no one had time to listen to them when they needed to talk about the death they knew was coming. 

Hospitals also made it possible for researchers to study the approach of death with those who were dying. A young woman I know had experience in a nursing home and talked about some residents dying in peaceful sleep with a smile, some with a grand vision of heaven, some who were extremely hot and could not get cool as they approached death, and some who screamed with horror just before dying. 

Elizabeth Kübler-Ross in 1969 inaugurated the scientific study of death with her classic book, On Death and Dying from a clinical, non-religious perspective. Kübler-Ross called for a more thoughtful, more attentive, more humane response to the dying, inviting and listening to them talk about their fears. She presents a classic analysis of the stages of death and dying: denial, isolation, anger, bargaining, depression, and acceptance. She found that most reached acceptance more quickly when helped by someone who listened non-judgmentally as they talked their way through the stages. Kübler-Ross sought to be humanistic, objective, tolerant, and embrace religious pluralism.

Kübler-Ross’s book has value, especially for counselors, but there are theological problems. First, her recommendations are strange to the believer. She writes, “Once the patient dies, I find it cruel and inappropriate to speak of the love of God.[1] Rather, she advises the counselor to allow family members express their anger and/or grief. Instead, as believers we should accept them unconditionally and listen to them, but still sensitively offer them the love and presence of Christ in that situation by prayer or a kind word.

Second, our concern as believers is not to help someone come to an acceptance of death, but instead to an acceptance of the One who can transform death into life. Kübler-Ross’ advice may actually be detrimental. Our job as believers is not to help people go to hell comfortably. Perhaps death outside of a relationship with Christ should be scary. Perhaps God intended it that way to move us to seek Him. As believers, we cannot with good conscience let family members and friends simply be comforted in their sin only to feel betrayed that we did not share the way of Life Everlasting with them the entire time we sat with them in their final days.

One intriguing statement found in Kübler-Ross’s work is this one:  “We can say here, however, that we found very few truly religious people with an intrinsic faith. Those few have been helped by their faith and are best comparable with those few patients who were true atheists. The majority of patients were in between, with some form of religious belief but not enough to relieve them of conflict and fear.”[2] This pitiful statement says much about most Christians’ level of discipleship and walk with Christ.

Kübler-Ross’s work is the best attempt of modern, therapeutic, psychological solutions to spiritual problems. The impotent assignment is simply to help them cope with the imminence of death until they are gone. Studies like this one seem to focus on less important questions (What are the stages people go through in approaching death? How can we help them come to a psychologically healthy resolution?), and ignore the important ones (Is there an eternal destiny after I die? Will I be in heaven or hell? How can I know?) The assumption is that there is no access to the larger questions about life, so all we can do with religion is evaluate how it affected the patient’s life on earth and offer no opinion on the ultimate truth of the religion’s claims.

We see this therapeutic, moralistic, Deism manifested in the otherwise caring and good ministry of hospice. Notice this hospice philosophy: Hospice affirms life and focuses on the quality of life. Hospice exists to provide support and care for persons in the last phases of an incurable disease so that they might live as fully and comfortably as possible. Hospice recognizes dying as a normal process whether or not resulting from disease. Hospice neither hastens nor postpones death. Hospice exists in the hope and belief that through appropriate care and the support of a caring community sensitive to their needs, patients and families may be free to attain a degree of mental and spiritual preparation for death that is satisfactory to them.”

When it comes time for you to access the services of a hospice, take advantage of all the benefits of that service. Those who work with hospice are a wonderful group of professionals, caring and kind. Many are themselves committed Christians, but be aware that while there may be many wonderful Christian believers involved, the philosophy, that is, their way of looking at the world may not be the same as yours in regard to medications and Biblical counsel for your dying family member. Hospice views death as a normal part of life while the Bible views death as an enemy (1 Cor. 15:26).

Hospice will want to remove all fluids and food from your loved one when they come near death and administer large doses of pain medication to keep your loved one “comfortable.” But there are problems with this course of care. First, it is medically well-known a bag of IV fluid and a feeding tube will not prolong your loved one’s life, and the process of starvation and dehydration are painful. This is why they administer large doses of morphine and other pain reducing drugs. 

I do not recommend you allow hospice to remove fluids at the least from your loved one. Get your loved one’s doctor to write orders if necessary to keep the fluids for their comfort and so that their last hours and days will not be spent with minds muddled with unnecessary amounts of pain medication. This will give them the ability to talk with friends and family, to say goodbyes, and to “make things right” with anyone with whom they have some need of reconciliation, including the Lord Jesus Christ if they have not submitted their lives to him. Deathbed salvations are real, and I have been privileged to be part of them.

Your loved one has a spirit, a soul, and a body. Until that spirit and soul separate from the body, your loved one is alive. Because their spirit is not under anesthesia or the effects of pain like your mind or body, give your loved one the respect of not talking to them as if they are children or talking about them as if they are not present. They are present and deserve the dignity and respect of being treated like a person until death.

[1] Elizabeth Kubler-Ross, On Death and Dying, 156.
[2] Elizabeth Kubler-Ross, On Death and Dying, 237.