Medical Ethics: When Can I Say, “No”?

Case Study: You’ve been diagnosed with a disease that requires medical attention. Without it, your life will be significantly shortened. With it, you will live longer, but the treatment does have drawbacks and the quality of life may diminish. “Pastor, can I say no?” As a pastor, I am drawn into these conversations with people having to make life and death decisions. It is a rare and precious invitation that must never be taken lightly but handled with pastoral care, personal integrity, biblical principles and deep respect. It begins with listening: What are your fears? What are your questions? Who would you like to be a part of this conversation? What resources do you need to make your decision? How can I best help? When confronted with that difficult question, “Pastor, can I say no to the treatment,” we begin with an even more important question. With this decision, are you choosing life or are you choosing death? That is, in refusing treatment, are you choosing to die or are you choosing how you want to live your remaining time? There’s a difference. How do we unravel that answer? I find it best to place each unique situation on a spectrum. On the one side, you have a 16-year-old healthy teenager with a burst appendix. The procedure (at least in 2020) is fairly routine, the recovery is quick, and the prognosis is a full recovery. To refuse treatment is a decision to die. On the other side of the spectrum, imagine a 93-year-old person in a nursing home diagnosed with stage 4 pancreatic cancer. The treatment will be brutal, the quality of life will be greatly diminished, and the prognosis is poor. To refuse treatment is a decision on how one would like to live the remaining time they have. Based on that spectrum, where would you place your disease and treatment protocol? My Parkinson’s Disease, and the regiment of medication, perhaps a brain probe? My diabetes and the daily use of insulin along with dietary restrictions? My kidney failure and the need for dialysis? My heart disease and a bypass operation? Certainly, the advances in medical science skew our answers as to which end of the spectrum we place our ailment. What was experimental surgery with mixed results two generations ago has now become outpatient routine surgery. Side effects have been greatly mitigated through additional medication. The average life expectancy has increased over the years. All of these must be taken into consideration in deciding treatment. What else needs to be considered? Are there any other medical/emotional issues that may impede your ability to think clearly, such as clinical depression or anxiety? Are there any life circumstances that may cloud your judgment such as divorce, financial loss, the death of a child, or the lack of emotional support? Do you have stories or images of a loved one who suffered greatly with a similar diagnosis and you don’t want to experience the same? Are there issues of anger or despair towards God for “allowing” or “causing” this disease to happen? End of life decisions must not be made quickly. The Bible always affirms life as a rare and precious gift from our God. In making that all important decision about treatment, we begin first with choosing life. This can be life with the help of medical treatments, or it can be refusing treatment and choosing the best quality of life with the short time that remains. Either way, the choice is life. Even in the face of death, the choice is life. . .both now and the eternal life yet to come. Let me know if you want to talk. Peace, Pastor Scott