Question: "In end-of-life decisions, when should quality of life be a consideration?"
Answer: The advancement of medical technology has saved lives and the quality of life for many, but it has also created new questions that previous generations did not have to answer. A century ago, end-of-life options were few, and death came more quickly without machines to keep organs functioning when the brain wasn’t. But, now that medicine can prolong vital signs, the presence of life is not the only consideration. Quality of life presses to the forefront when we see loved ones suffering or lingering longer than anyone wants them to. The ethical question arises: biblically speaking, should quality of life be a consideration in end-of-life decisions?
Quality of life is a privately determined decision. Every individual should have the right to decide for himself or herself what he or she deems “quality.” Some people cling tenuously to every ounce of life, pursuing every possible medical intervention to prolong earthly existence as long as humanly possible. Others, especially Christians, may accept their impending death more quietly and even express eagerness to enter eternity as soon as God calls them home. The right to decline medical intervention should be available to every mentally stable adult and can often be documented by living wills or other forms of written instruction. However, such documents can cross ethical lines when end-of-life choices include hastening death or assisted suicide. Just as suicide is not considered a human right, neither is assisted suicide due to a medical prognosis.
While each individual should have a voice in determining his or her own definition of “quality of life,” human beings are not the final judges. Life is a conglomeration of good and bad experiences, and there are times in everyone’s life when quality seems low. Depression, anxiety, heartbreak, or financial crisis can seem to limit the quality of life for a season. Injury, illness, or disability can greatly impede a person’s quality of life, but that does not imply the right to end that life. God is the determiner of life and death, not our opinion of its quality (Deuteronomy 32:9; Psalm 139:16).
Filling out a living will or assigning durable power of attorney to a trusted family member is a great alternative to last-minute decision-making by families trying to determine a patient’s wishes. Withholding certain medications, treatments, or life-saving measures may be in the patient’s best interest, and, if that has been previously discussed, the family is relieved of that moral responsibility. Establishing a trusting relationship with the doctor in charge of a dying patient can also eliminate miscommunication and later regrets. Fortunately, it is still illegal in most countries for physicians to prescribe medications that will actively end a life. The potential for abuse of that option makes it a dangerous one to leave to human discretion. However, palliative care can be increased to the point of allowing the body to die without causing the patient undue pain. When all possibility of cure is gone, increasing palliative medications allows the body to shut down naturally, and death can occur without unnecessarily prolonging the dying process.
Quality of life cannot be defined by external factors. The quality of one’s life is deeply personal and yoked oftentimes to that person’s relationship with God. Healthy, successful Americans may have a low quality of life due to emotional unrest and poor moral decisions, while a handicapped person in a developing country may live a joy-filled life. Physical sickness also does not determine a person’s quality of life, so trying to evaluate it is not within our power. Our responsibility before God is to provide the best loving care we can for those who are suffering and trust that their Creator will decide when life ends.