 All right, well it's a fitting topic to come back from lunch when you're already the lapse into coma land and talk about how to die well. Isn't that special? But that's precisely what we're going to do. What we're going to do is put a little case study up on the screen for you to look at. And what I want you to do is I want you to read it and do exactly what you did last time, get with a buddy and I want you to talk about how you would advise this person. The setup is simply this, someone in your church contacts you about what to do about her husband who is dying of cancer. And you are leadership in the church and she needs help. She wants to know what the biblical response should be to her questions. So I'm going to let you read the case study. Then I want to hear from you and what we're going to do because it's after lunch and if I just do straight lecture, we're going to have a real bad time. So we're going to keep you engaged. And then what we're going to do, I'm going to talk about, we'll take a break after Dr. Assisted Suicide. Then what we're going to do, we're going to talk about biotechnology for a very short period. I will cover it so you know enough to get the biblical parameters on that. And then we're going to go to Q&A earlier than we had planned. The reason is, I haven't given you a chance to ask any questions. So this way you get a chance to ask questions of anything you want me to comment on and I'll interact with you and we'll go as deep as we want to go and we'll take as long on the Q&A as we want to go. Does that sound like a fair way to go to keep you awake for the rest of our time? Okay, so let's go ahead and throw that up on the screen. And her email to you is in italics, the block print above it gives you the context. And while you're looking that over, I'm going to go see the sound guys and see if I can't figure out what's wrong with me. I might need to euthanize this mic. Maybe now it's on, there we go. My guess is you have faced decisions like this. So you've read the case study, we've got a member of the church approaching, oh, not on? That helps. Okay, there we go. Rewind, our case study involves a member of the church who's contacted you as a leader in the church. Her husband is dying. In fact, not only is he dying, he wants to die. He's ready to go. He doesn't want any further treatment. It's not going to help him. In fact, his pain has ratcheted up and he is going to be requesting increasing dosage of morphine to control that, which, as you know, might hasten death. So what did you come up with in your group as how you as a church leader would advise this church member about her dying husband? And the reason why I wanted you to wrestle with this case decision, these are things we need to help our brothers and sisters work through. This is part of what it means to love the brothers. It means walking them through decisions like this. It's not just, hey, come on over and watch football. It means you walk through it with them. And I know I walked through it with my own sister five weeks ago and I had brothers who walked through it with me. And it meant all the difference in the world. So, talk to me. Tell me what some things you came up with in your group. Yeah, now that's a new one. I'm gonna raise my hand, have the speaker note me and say, no, take that guy's question. It's kind of like that, Bill. What was that comedy sketch word? Nevermind, go ahead. Yeah, okay, so your advice to her would be, give the morphine, okay? Okay. Did you say, are you a physician? No, I'm not a physician. Okay, who else? Yes. So you're going right for the juggler, man. We're just gonna go straight to the word of God, bring on the drugs. Here they are, you know, I'm kidding. Go ahead. Yep, good. What are your dreams like when you're on that stuff? I mean, that sincerely, I'm curious. Does anybody else take a different view about the food and water? But is him simply having a desire to die mean he has a right to die? Okay, no, fair point. Yeah. Well, but in this, no, your point is a fair one. In this case, death is imminent. He's there, all right? And as stipulated in the case study, the food and water no longer help him. In fact, they prolong his suffering and cause him undue agony. Now, you make a very good observation here. What about Terry Shiva? How was Terry Shiva's case different than this? She wasn't dying. She was in what we call a persistent vegetative state. She wasn't dying. So what killed her was what? Exactly what you said, withdrawing the food, withdrawing the hydration. In this case, what's killing this patient? His underlying pathology, the cancer, correct? So what does that mean then? Where did you land then with withdrawal of the feeding and water? We got one vote say no, can't do it. Go ahead. Now, is it enough to say we can withdraw the food and water simply because he's not comfortable or is there another element to add to this? Unnecessary burden. Okay, unnecessary burden, all right. Okay, okay. Now, let me play devil's advocate for just a minute. Isn't taking penicillin also kind of pushing back against what someone could say is God's will? But we take it. I mean, when I got strep throat, bring on the mold, I'm ready for it, right? You know, penicillin's mold, you know that, right? Okay, I think it is, I don't know what it is now. In this case, yeah, go ahead. Well, suppose I played devil's advocate. That's my job. And I said, okay, we wanna see a miracle. Let's unplug everything and let God work a miracle. See, that could cut both ways, right? Okay, yes. The food and water, though, keep in mind the stipulation does not help him at this point. It does no good to his body. He is at the point where the body is shutting down. He is dying. He's in the dying process. This is not a sick patient who is prognosis poor. He is dying. And the water does not help him, and I'll give you an example. In the case of my sister, by hydrating her, she died of liver disease. My sister died of pancreas failure and liver failure. And what happened was, at the end, when they hydrated her, her stomach swelled up, causing her enormous pain, and the liquid was not distributing through her body. It was just damning up in her abdominal cavity. And, I mean, literally her stomach looked like one of those children you see in Africa. And they'd have to take her in, then, and drain all that, an incredibly painful procedure for her. Her body couldn't take another one of those. That procedure alone would have killed her. And so we made the decision to withdraw it. And on grounds that, we were not helping her by doing that. Would that change the equation a bit in your mind? Not that you have to agree with me. Yeah. Well, what about this guy? Where food and water don't help him? Well, in this case, we're saying that the food and the water is only just, it is making him worse. It's making his suffering worse. Yeah. It's harming his body to do this. And you asked a great question. How do they know with certainty? I will say this. There's very little we know with certainty, absolute certainty. But that doesn't mean we're irrational to go ahead and claim knowledge based on the evidence we have. So in my sister's case, they told me on Monday evening, we're in the final lap here. We're talking, we think 24 to 72 hours. And they called it exactly right. When my mother-in-law passed away, the hospice care workers, they're very good, by the way, at knowing these things. You wanna meet some really cool people. You should meet some of these hospice people. They are very, very good at what they do. And they told us, we're looking at 12 to 16 hours here. And they called that one exactly right. So I think they can call that. Now, you have raised an incredibly important point here that our culture has lost. And I'm so glad you raised it. A doctor is qualified to tell you when a treatment is no longer valuable to the patient. He is not qualified to tell you the patient's life is no longer valuable. A doctor can tell you that a treatment is worthless. He's in no position to tell you the patient is. Because he's not a philosopher. He's not a theologian. He's no more qualified than you are to make a value judgment on the patient's life. He is qualified to tell you that a treatment is no longer beneficial. He is not qualified to tell you the patient's life is no longer beneficial. Does that make sense? And so, I can listen to a doctor tell me this treatment that we've been giving your sister is doing no good to her body. He is qualified to tell me that. And his knowledge is better than mine on that question. But if he starts making value judgments about her life, he then is wandered into an area he's not qualified to comment on. And what happens sometimes, not in every case, but sometimes doctors morph into philosophers when they're not qualified to wear that hat. They are no more qualified than you are to wear that hat. So no doctor should be making a value judgment about the patient's intrinsic value, though he is very qualified to make a judgment call about a particular treatment. Go ahead. Yeah, yeah, let's role play it. Let's say I'm, let's say this is your dad. I would say to you, you know, we have run our course with chemo. We have run our course here with radiation. It has not worked. We are now in the final lap here. Your dad's body is shutting down. He is dying. There is nothing more treatment wise we can do. And I am recommending as your physician that we move to hospice care immediately where the goal will now shift from trying to heal your father's disease to making him as comfortable as possible as he walks this final chapter. And that's what that would sound like. That's what it sounds like as a biblically informed Christian. That's how I think it should sound. Yeah, yeah, okay. The doctor, in other words, makes no judgment on the value of your dad's life. He does not say his quality of life is no good. It's better off he just die. He makes no quality of life judgment. In fact, the doctor who respects the dignity of the human person and respects the image of God and the man, by the way, do dying people still have the image of God in them? Of course they do. That doctor who respects that Amago Day in that dying person will look at that patient and he will not say is his life valuable to the patient? He will say this, what can I do to make this patient's life as comfortable and as dignified as I can, given the life he has? You catch that part at the end there? Where doctors run astray and I ran into one doctor with my sister this way. He was just like, dude, I mean, she's gone, you know, look, let's just start making decisions here. He was just a cool calculus. That's all he was. But I mean, I was aware that he could be that way so it didn't throw me. So I accepted his medical diagnosis and he was the sharpest doctor she had. I accepted his prognosis. I accepted his point that there wasn't anything more we could do for her. I did not accept his value judgment on the quality of her life. If that, that's a fine line, but that's the line I walked, if that makes sense. Does that help? Yeah. By the way, just to fill in the blanks, what happened with my sister? She died at age 46. My sister was a drug and alcohol addict for 20 plus years. As hardcore as you could get. And we are talking, it's a very sad story, but I'm here to tell you, I think God pulled a fast one over on the devil at the last minute. I'll tell you about that. The story goes like this. About 15 years ago, my sister was no longer capable of living on her own so she moved in with my parents who my dad's now 83, my mom's in her late 70s, and they lived next door to me. And my sister lived with them. And I kind of knew last year we were moving toward that end zone. And she had been estranged from her daughters. And this is something, this is God because I don't think I just woke up one day and said, I think I'll just decide to do this because I'm a cool dude. I think God really did this for me. A thought came to me, how can I help her die well? And I said, okay, there's a couple of benchmarks I'd like to hit. Number one, I'd like to have some very direct conversations about the gospel with her because eternity's riding on things here. Secondly, I'd like to see her reconciled to her daughters. And thirdly, I don't want her to die alone. I don't want her drunk passed out in the basement of the house. We just don't want to go that way. So those were the kind of the three things I aimed at. A year ago, this September, we got a reconciled with her daughters. They flew out from Denver, spent four days, and it was tremendous. Then I had a conversation with her about the gospel and the way I did it, you had to know Jen. Jen was very hard headed, very stubborn, very, I mean, not easy to be around. But her big thing was, it's too late for me. So I was drawn to the parable of the workers in the vineyard where Jesus tells the parable of the workers who start in the morning and they get paid and then the people come in at the last minute and they get paid the same thing. And the ones that have been there all day are ticked. And I said, Jen, the point of this whole parable is there are going to be people who come in at the last minute and God saves them at the last minute. That's the point. I said, that's you. And she talked to my mom about that. She didn't talk to me about it, but I guess that really got her attention. And then when she went and started crashing in March, by March 10th, we had her hospitalized and we knew we were coming to the end. I went to see her on Good Friday and she was very loopy, very, I mean, just not really with it. And I stayed for a little while and then I said, listen, I'm gonna go now, but I'll pray with you. So I prayed for her. And then I mean, out of the blue, the most lucid I'd seen her in weeks, she says, now I'm going to pray. I mean, that assertively. And she said, dear God, thank you for forgiving my sins and for my brother who comes to visit me and for being here with me. I mean, I'm like, what? And inside I thought, that sounded to me like possible spiritual life starting there. And so I went home and by the time I'm driving home, of course, I'm doubting the whole thing. Ah, nah, that can't be. So I emailed my friend, Todd Freel. How many of you know Todd Freel? Now, when it comes to people professing faith, is Todd a skeptic or is he well? Oh, I'll take anything they say. What kind of guy is he? You know it. And so I said, Todd, here's what just happened. I don't know. It doesn't sound too good to me. I mean, he didn't, I didn't wait two minutes for his reply. Dude, that is a prayer of faith. Would you shut up and receive it and rejoice? And I thought to myself, yeah, that's true because when I was listening to that, I thought, and I know it's subjective, but I thought, man, that sounds like new life starting there. That's not something that would come out of her naturally if you knew her. And by the early next week, we had lost contact whether she was permanently unconscious and died two days later. But I kept talking to her even after she was no longer conscious because hearing's the last thing that goes. And I kept talking to her about the gospel and I feel like I did the best I could with what I had. It wasn't perfect, but at least I showed up. At least I showed up. And of course in my mind, I'm thinking, oh, there's all kinds of things I should have done years past. I mean, we can play that game all day long. But I did set a goal for her to die well. And I had to face these very decisions about when is the doctor right about the treatment but wrong about her value. And I stuck to her being valuable and being an image bearer and I would not let anybody talk me out of that. But I did listen to him about treatments. And it's a real line, but that's the line you walk. And I think it, I don't know, I'll tell you, I'm just choosing to believe that there was a work of grace in her heart at that point. I'm choosing to believe that. And if I find out I'm wrong, well, then I'm wrong. But I'll tell you what, if you knew her, you would not believe that was coming out of her mouth. So I'm gonna take it and it's great comfort to my parents and you know, how many times have we heard that Satan's got somebody and then at the last minute, surprise! Well, the thief and the cross didn't even get that many words out. And Jesus said, today you're with me in paradise. So I'm gonna go ahead and roll with that. And the reason why I think this topic is important, God may use you in one of those moments too. He may use you. And you also may need to be the strong person for the family that is reeling and doesn't know what to do. I wanna talk about pulling the plug. I realize this lecture, I've kind of just, we're doing stream of consciousness here rather than me just banging through my points, but that's okay, it's after lunch. Somebody brought up pulling the plug, who was that? One of you did. I said it's someone's been at home often. That's what, okay. Yeah, okay. I wanna draw a distinction between a terminally ill patient who's clearly dying and pulling the plug on someone who is no longer with us, okay. Pulling the plug can mean a couple of things. It can mean you disconnect life support from someone who is brain dead, already dead. And the only thing the machines are doing is keeping the body from decomposing. Are you with me? And there are situations where there may be reasons why they do that. Liver transplants being one. In our town, we had a boy who died at age 19 who wasn't supposed to live to be age nine but he did and he managed to graduate high school or almost and they wanted his death certificate to read after graduation so the program would read that he went through graduation at the local high school. So they left him on life support, pulled the plug day after graduation and body immediately begins decomposing. There is nothing wrong with unplugging a person from technology that is doing nothing more than preventing the body from decomposing. The person is already gone. And by the way, physicians can generally do a very good job at measuring brain death. There are tests for it. Teri Schaibow was not brain dead. People like her are not brain dead. They are incapacitated but here's the principle we need to mark down. A damaged human is not a non-human. So Teri Schaibow was a damaged human but still an image bearer, still alive and what killed her was removing her food in water. What kills the cancer patient here is his underlying disease, not withdrawing treatment that no longer benefits him. What's killing him is his disease. When you unplug the brain dead person, he's already gone. You haven't killed him. He's already dead. So you're just no longer keeping the organs from decomposing. Now, having said that, there are some gray areas where, well, do we have brain death or do we not? So it's going to take a physician who is committed to intellectual credibility to make these kinds of decisions. But generally speaking, I think our physicians are fairly level-headed at making these calls. And if you unplug somebody and they die immediately, I think you have your answer at that point. So unplug can mean a couple of things. It can mean Teri Schaibow unplug, which would be wrong, or it can mean withdrawing apparatus that is just keeping the body from decomposing. Everybody clear on that distinction? Okay, so anybody else wanna add some things before we zap through some biblical principles here? Yeah, the question is, given the culture around us, is it becoming more difficult to find physicians committed to intellectual integrity? Yes, in some cases, yes. Because what we have since the 1970s is a new quality of life ethic that has replaced the image of God ethic that we used to operate under. There was a journal article that I meant to quote last night when you talked about abortion. I skipped it because it was longer. But it's from the California, it's from the Journal of California Medicine from 1970. And it's called a new ethic for medicine. I think it's called, anyway, here's what this editorial says, written by people favorable to doctor-assisted suicide, favorable to abortion. And I'll paraphrase it, they say basically this, everybody knows you have human life from conception. Everybody, and we know it too. But because we're going to use language to change people's perception of reality, for the moment, we're gonna have to live with that uncomfortable fact that they know that. But soon enough, we'll be able to change it. Because we will soon be able to make it look like the quality of life is the only way to look at this. That's the essence of the article. So yes, you have hundreds of doctors being trained in bioethics and medical ethics who have been taught to believe that there's no intrinsic value to the human person only functional value. And by the way, if we're not teaching intrinsic value in our churches, you tell me where are our people going to hear it. TV, we better be teaching it here. Again, kudos to your staff for taking this on. Yeah, yeah. What about a patient who has cancer? They're not dying yet. I mean, they will die from the disease, but they're clearly not in the final stage. And they tell the doctor, I just wanna die and I want you to help me die. That would be immoral. That's what we call either euthanasia, where the doctor intentionally kills the patient with an injection, a lethal injection, or doctor-assisted suicide, where the patient is given a prescription by the physician that the patient then takes on his own, but it's a lethal dose. So in doctor-assisted suicide, he doesn't kill you with an injection, he gives you the drugs you take on your own. And the drugs kill you. Both cases, we are intentionally killing an innocent human being. So let's go back to our syllogism. Why is doctor-assisted suicide wrong? Here's your syllogism and I think you're gonna see it's familiar to you. Premise one, it is wrong to intentionally kill an innocent human being. Premise two, doctor-assisted suicide in euthanasia intentionally kill innocent human beings. Therefore, they are wrong. Biblical case against doctor-assisted suicide and euthanasia. All humans bear the image of God. Because they bear the image of God, they have intrinsic value. Because of that intrinsic value, we are never to intentionally kill innocent human beings. Doctor-assisted suicide and euthanasia do that. Therefore, they are biblically condemned for the same reason abortion would be biblically condemned. You can see how these issues now relate, correct? In each case, your syllogism is your guiding force to discover the right way to think here. It's easy to see that if it's wrong to intentionally kill innocent human beings and doctor-assisted suicide does that, then we're not gonna go there. So what about that patient, though, who is suffering, they're not yet in the final stages? We can control, in most cases, we can control their pain. In the final stages, it gets a little trickier, because it really can, their pain can ratchet up. So let's just jump into the morphine part of this right now. As a physician, I could foresee that dialing up the morphine could hasten death, but I don't intend death. Did everybody just catch that distinction? There's a distinction between foreseeing something and intending it. Let me give you an example from pregnancy. How many of you have heard of ectopic pregnancy? This is where the embryo implants on the inner wall, the fallopian tube instead of the uterine wall. It's an extremely dangerous situation for a mother, because as that embryo grows in that tube, what's gonna happen in that narrow tube is that embryo grows. It's gonna rupture, she hemorrhages to death. If you think I'm kidding, go to the CDC website. Type in ectopic pregnancy, see what comes up. You're a pro-life doctor. You believe that embryo has intrinsic value. However, if you do nothing, you're going to lose two human beings. Is that what you should do? Or do you act in such a way that you save one life, even though the unintended but foreseen result is the death of the embryo? What's the right call? You act in such a way that you save the one life, that's the greatest good you can do, given the hand you've been dealt. You didn't choose this hand, it was given to you. You foresee the death of the embryo, but do you intend it? No, therefore it's not what? It's not abortion, because abortion is what? The intentional killing of an innocent human being. You didn't intend it. You could foresee it, but you did not intend it. A general in a just war can foresee the deaths of innocent civilians. Does he intend them? No, but he can foresee it. In his move to prosecute a just war, he can foresee that innocent civilians may die, but he doesn't intend their deaths. That's the difference between foresight and intention. So in this case, the doctor sees the patient in the final stages of cancer. The patient is dying from the underlying disease. That's what's killing him. The patient is in much pain, very uncomfortable. So rather than give the patient a lethal dose of morphine aimed at intentionally killing him, he instead does this. He gives the patient a carefully calibrated dose of morphine that allows the patient to sleep before he dies. There's no sin in letting people sleep before they die. So he foresees that death might be hastened, but he doesn't intend it, and he does his best to calibrate that dosage to make the patient comfortable but not be lethal. He'll do his best to do that. Even though he foresees death might come a little earlier, but again, let's keep the big picture in mind. The patient's dying from the illness, and the physician isn't intending to kill him. Everybody clear on that distinction? Okay, couple of biblical principles. Number one, intentionally killing innocent human beings is wrong. We've already looked at that with abortion, already looked at that with doctor-assisted suicide. Principle number two, just because it's wrong to intentionally kill an innocent human being does not mean death must always be resisted. We are all going to die sometime in this room. And by the way, what is the ultimate good for the Christian? This life is a good, but is it the ultimate good? Our ultimate good is a resurrected body. Now I want you to imagine a loved one who you know who died from a debilitating illness. Get their picture in your mind for a moment, or a friend. I want you to imagine that person with a body, and let's be clear what the resurrection teaches. The Greeks taught your soul went on. Now, that's not Christian resurrection. Here's Christian resurrection. You go through death, come out the other side with a resurrected and glorified body. That's the resurrection doctrine. That's what Paul's talking about in 1 Corinthians 15. That's what we get one day. That's our ultimate landing spot. Imagine that person with none of the brokenness emotionally, physically, with a restored body, with none of those liabilities. Is that up in the game a little bit? Yeah, that's our ultimate landing folks as believers. That's where we land. So although we should never intend death, it is not true we must always resist it at all costs. My mother was scared to death that they would take my sister and put her on a ventilator and make her uncomfortable for weeks on end, forcing air down her throat, drying out her airways, and she can't even communicate at that point. My mother was scared to death that was gonna happen. So when we were able to arrange for a DNR, I mean my sister's body could not have handled CPR. She was down to 89 pounds, it would have just destroyed her. Broken bones, it would have been awful. Resisting death at that point would have been cruel. It was time for her to go home. And our loved ones are going home if they know Jesus. They are going home. And they are going to meet their Lord. And two seconds in heaven is better than 20 of the most glorious years you've ever had here. So while we never aim at death, it's also true we must not always resist it. So that's a biblical principle. A third biblical principle. We need to help people die well. Well there's a sermon series. What would happen to attendants if you put a billboard out there, how to die well, 1045 Sunday? You know all the people would show up. I know what that means. The one with the most toys, right? Not exactly. People who are dying need us to help bring closure to them, and let me tell you how we helped them bring closure. Number one, we're honest with them. We tell them, you know what? Your time, it's coming. I talked to my sister and I told her, Jen, you're dying. The doctors can't do anything more for you. This is it. And I mean I said it gently, but I told her. And at first she was like, well I just need to come to terms with that. But then she seemed to accept it. But she needed to know. Dying people need to hear some things. Here's some things they need to hear. I forgive you. I hope you'll forgive me. I love you. I hope you love me. They need to hear those four things. And we can be there to help them hear those words. They need to have some perspective on what their life meant. And oftentimes family may not be the best people suited to do that. An outsider might actually have a better hand at helping clarify that and bring that through. But there needs to be in our churches a ministry to dying people and their families as part of our pro-life ethic. Where we help them finish well. By the way, the Apostle Paul and Second Timothy did not resist death at all costs. In fact, do you remember his words? I have fought the good fight. I have attained the crown. He was ready to go home. He knew it was coming. He was ready. And I think we need to help people be ready to go home. They need to understand that their death can bring God glory. Boy, there's a thought. How do you die to bring God glory? There's a theology waiting to be written on that. Because our culture says this is all we get. This is it. And as Christians, it's real easy to lapse into that as a worldview to where we cling to this life with an unhealthy attachment, making a good thing, an ultimate thing. And we forget about heaven. We forget about what's waiting us.