Christiansbelievethatmenandwomenaremadeintheimageof

Godandoneoftheresultsofthisisthattheirlivesarehighlyvaluable.
AconsequenceisthatGodprohibitsanyonefromdeliberatelytaking
thelifeofanotherhumanbeing.
Acombinationofthehospicemovementandadvancedmedical
technologynowallowpainanddistressingsymptomsofdiseasetobe
adequatelyalleviatedinallbutthemostextremecases.Experience
showsthatoncepeoplearecomfortabletheyoftenchangetheirminds
aboutwantingtoendtheirlives.
Thebestwayofgivingapersontruedignity,andrespectingtheirvalue,
istocareforthemandmaketheirlifeascomfortableandfulfillingas
possible.Thisisamuchstrongeractionthansimplygivinguponthem
andpromotingtheirdeath.
1.Humanbeings,eveninanagonyofsuffering,orinatwilightmentalstate,areGod
likebeings.AndanybeingmadeinGodsimagedeservesarangeofresponses:
wonder,respect,empathy,andaboveallprotectionfromabuse,fromharm,from
manipulation,andfromwilfulneglect.

Autonomyisfinesofarasitreflectstheuniqueindividualityof
eachhumanbeing,createdintheimageofGod,andultimately
accountabletohim.Buttouseourautonomyresponsibly,weneedto
balanceourrights(thethingswemaydo),responsibilities(thethings
wemustdo)andrestrictions(thethingswemustnotdo).Autonomyis
notthereforethesameassayingthatpeoplehavetherighttodo
whatevertheylike.
Dont play God, give the best effort
to care and to save the persons life,
if die then at least weve done our
best. Rather than not do anything
and watching the person die
Miracles exists. Some people wakes
up from coma after years. As evinced
by Dockerys case and this one-year-long
study, there are no 100% foolproof methods

of determining ones outcome.

Christianityistornbetweenseeingdiseaseanddeathasoutrages
againstGodscreation,andasmeansofmovingtowardscloser
relationshipswithGod.ManyChristiansjointhewriterCSLewisin
seeingpainasGodsmegaphonetorouseadeafworld.10Pain,illness
anddeathareseenasinevitableconsequencesofhumankindsdecision
toignoretheircreatorGod.
Whileoldagemayhaveitsfrustrationsashealthstartstofail,itisnot
anevil,butratherastageoflifetoberespectedandhonoured.
Death,however,doesprovidemercifulreleasefromlifetrappedina
damagedanddecayingbody.Christiansbelievethatlifecontinuesafter
thebodyceasestofunction,withthepossibilityofspendingeternityin
peaceandinanunimaginablycloserelationshipwiththeGodwho
createdeverything.
3.Humanlifeissacrosanct,andthereisastrictlinedrawnbetweenremoving
sufferingandremovingthesufferer.Euthanasia(homicide)andsuicide(whether
physicianassistedornot)arebothopposed.Thedeliberatedestructionofahumanlife
(whetherbyitsownhandorbythatofanother)desecratesGodsimage.

DoestheChristianfaithshedanylightontheDNRdebate?Ibelievethatitdoes,and
hereImustacknowledgemydebttoJohnWyattsbookMattersofLifeandDeath,andin
particulartohischapterten,Abetterwaytodie.12
Thebiblicalworldviewprovidesuswiththefollowinginsights:
2.Intheincarnation,Godreaffirmedonceandforallthevaluethatheplaceson
humanity,createdinhisimage.Everypatient,nomatterhowdeformedthebody,
derangedthemind,diminishedthepersonality,carriesthisdoublehallmarkof
divinevalue.
4.Notonlyiseachindividualhumanlifespecial,butweareallpartofthehuman
family,createdtobeincommunity.Tothinkthatmattersoflifeanddeathcanbe
decidedinisolation,byasingleindividual,isadangerousillusion.
5.Deathasaconsequenceofthefallisthelastenemy,13anevilandanoutrageto

befought.Similarly,thelossoffunction,infirmityandthedegenerativediseasethat
comewithagearerealevils.DylanThomasexpressedthisinstrikingtermswritingofhis
fathersblindness;
DonotgogentleintothatgoodnightRage,rageagainstthedyingofthelight.Oldage
itselfisnotanevil,butratherastageoflifetoberespectedandhonoured.Forthose
trappedinafallenanddecayingbody,livingaseverelylimitedandfrustratingexistence,
deathcancomeasamercifulrelease,asignofGodsgrace.Christianattitudestodeath
reflectthisstrangeambiguity:ononehanditisaneviltobefought;ontheotherhandit
mayattimesbeaccepted,evenwelcomed,asasignofGodsmercyandgrace.
6.Painandsufferingaretheinevitableconsequencesofmansrebellionagainst
God,ofourturningourbacksonobedientcommunionwithourcreator.Sufferingis
apainfulanduniversalrealitywhichwecaneitheracceptorreject.Ifacceptedfromthe
handofalovingGod,hecantransmutetheevilofpainandgriefintothegoodofdeeper
communionwithhimself.AsCSLewiswrote:14Thehumanspiritwillnotevenbeginto
trytosurrenderselfwillaslongasallseemswellwithit.Nowerrorandsinbothhave
thisproperty,thatthedeepertheyarethelesstheirvictimsuspectstheirexistence;they
aremaskedevil.Painisunmasked,unmistakeableevil;everymanknowssomethingis
wrongwhenheisbeinghurt....
Paininsistsuponbeingattendedto.Godwhisperstousinourpleasures,speaksinour
conscience,butshoutsinourpains:itishismegaphonetorouseadeafworld.
Christianityteachesustovaluehumanbeingsbecauseofwhotheyare,becauseofhow
theyhavebeenmade,becausetheyareknownbyGodandimmenselyvaluedbyhim,
ratherthanonthebasisofwhattheycando.
Medicinecannothopetoeliminateallsufferinganddeathbutmustalwaysseekto
eliminateunnecessarysufferinganduntimelydeath.QuotingWyattagain:12Theessence
ofbeingagooddoctoristoknowwhenenoughisenough.Buthowdoweknowwhen
weshouldwithdrawtreatment,orwithholdit?Itiswhentheburdensofanyparticular
medicaltreatmentoutweighitsbenefits....Thereis,however,afundamental
TRIPLEHELIX17

differencebetweenmakingtreatmentdecisions,andmakingvalueoflifedecisions.
Doctorsarequalifiedtomaketreatmentdecisions:todecidewhichtreatmentis
worthwhileandwhichisnot.Butdoctorsarenobetterqualifiedthananybodyelseto
makevalueoflifedecisions:todecidewhichlifeisworthwhileandwhichisnot.
Doctorsmaydeterminewhetheratreatmentisfutile,buttheycanneverdetermine
whetheralifeisfutile.Whenwewithdraworwithholdtreatment,weareexpressinga
beliefthatthetreatmentisvalueless,notthatthepatientisvalueless.
ApplyingtheseinsightstotheDNRdebatewecanconclude:

1.ThedoctorhastheresponsibilityofdeterminingthelikelihoodofsuccessofCPRin
theeventofanarrest.Avarietyofprearrestmorbidityscoringsystemsexistsandcan
beusefultoformaliseanassessmentoftheusefulnessorfutilityofCPR.
2.Valueoflifeinanyindividualpatientcanonlybeassessedbydiscussionwithall
thoseconcerned:patient,relatives,medicalandnursingstaff,thepatientsspiritual
adviser(ifknown).Inthepresenceofdepressionordementia,thepatientsviewsmaybe
unreliableorunobtainable.Surrogateviewsfromrelativesmaybeinfluencedbythe
vestedinterestsofphysicalorfinancialexhaustionorbycarersburnout.Butsuch
reservationsarenoexcuseforfailuretodiscussvalueoflifeissues,and,inmanycases,
theseissueswillneedtoberevisitedandupdatedatregularintervals.Failureof
communicationbetweendoctors,patientsandrelativesliesattheheartofthepresent
furoreoverDNRorders.
Inaneditorialentitled:Howtoimprovecommunicationsbetweendoctorsand
patients,15theauthorsdistinguishthreeapproachestotreatmentdecisionmaking:
Paternalistic.Doctorsusingthisapproachwantshortdescriptionsofphysicalsymptoms
easilytransformedintodiagnosticcategorieswhichinturnleadtotreatmentdecisions
consideredbythedoctortobeinthebestinterestsofthepatient,withouthavingto
exploreeachpatientsvaluesandconcerns.
Informed(orConsumerist).Thedoctorsroleisherelimitedtoprovidingrelevant
researchinformationabouttreatmentoptionsandtheirbenefitsandrisks,leavingthe
patienttomakeaninformeddecision.
Shared.Doctorscommitthemselvestoaninteractiverelationshipwithpatientsin
developingatreatmentrecommendationthatisconsistentwithpatientvaluesand
preferences.Forthistohappen,thedoctorneedstocreateanopenatmosphereinwhich
informationexchangehelpsthedoctorunderstandthepatient,andensuresthatthepatient
isinformedoftreatmentoptionsandtheirrisksandbenefits.Treatmentdecisionsare
madejointly(notsolelybyapaternalistdoctor,norsolelybyaconsumeristpatient),and
patientscanassesswhethertheyfeeltheycanbuildarelationshipoftrustwiththeir
doctor.
Thehighestformofinterpersonal(andthusofdoctorpatient)relationshipisacovenant
commitmentofrespectlove.ButasWyattpointsout:12caringforpeoplewithrespect
doesnotmeanthatweareobligedtoprovideintensiveandburdensomemedical
treatmenttoprolonglifeatallcosts.Asinallotherclinicalsituations,theburdensofany
proposedtreatmentmustbeweighedagainstitsbenefits...Withdrawingorwithholding
medicaltreatmentisnotthesameasintentionalkilling.Weretainthebasicattitudesof
wonder,respect,empathyandprotection.
MichaelWebbPeploeisaConsultantCardiologistatStThomassHospitalLondonand
ChairmanoftheCMFPublicationsCommittee.