2 Principles for Formulating Advance Directives

Decide and Discuss

There are two important things to think about when equipping those you love to act on your behalf. Number one: we must discern for ourselves what matters most to us at the end of life. Number two: we must make sure that we have open communication and dialogue.

The reason this is important is because Intensive Care medicine and aggressive measures at the end of life often steal our voice. Breathing tubes have to pass through the vocal cords and by default we can’t speak. We usually will require sedating medications even to tolerate the breathing tube in the first place. Often, even illness itself (if it’s severe) or medications can completely disorient us so we’re very ill-equipped when it comes to making these kinds of decisions.

Suffering is very subjective and God can use it to refine us and to discipline us.

What to Consider

So, it’s very important to consider our priorities ahead of time—ideally with a primary doctor or another practitioner who knows you very well. The kind of questions that you need to be asking when you’re formulating these kinds of directives are:

What are the things that matter to me most in life?
In looking back across the corridors of time in my life, what have I needed to serve God well?
What is too much suffering for me?

Suffering is very subjective and God can use it to refine us and to discipline us, but he doesn’t mandate that we be crushed and endure things that are going to completely crush our spirit and make life unendurable. Think about What constitutes suffering for me? What would I be willing to endure and how much suffering would I be willing to endure to attain my goals at the end of life?

If it’s very important to you to be able to pray and to focus on God’s work in your life, to live out your faith at the end of life, to be at home—are you willing to do that with a ventilator if it means you can be at home?

Talk with Loved Ones

Those are the kinds of questions that you want to have in a discussion with your physician, thinking also about your own medical history and how that comes into play. The way that this is usually documented is through an Advance Directive—an umbrella term for any document that records your wishes so that caregivers and loved ones have an idea of what you want.

Between Life and Death

Kathryn Butler, MD

This book aims to equip Christians facing end-of-life decisions by simplifying confusing jargon and exploring biblical principles families need in order to navigate the transition from this life to the next.

It can come in the form of an order for life-sustaining treatment—which is a black-and-white checklist approach that is really only appropriate when you are already very much at the end of life. Or, it could be in the form of a healthcare proxy form which designates one person as your surrogate decision maker. The most helpful one, in my opinion, is a living will because it allows you to expound upon your values with a narrative.

Forms aside, the most important thing is that you dialogue with your loved ones about what is important to you. Help them to understand your faith, what matters, and how Jesus matters in your life. Talk about it openly, talk about it repeatedly, and in very specific ways. That dialogue matters more than any individual form.

Kathryn Butler (MD, Columbia University) trained in surgery and critical care at Massachusetts General Hospital and Harvard Medical School, where she then joined the faculty. She left clinical practice in 2016 to homeschool her children, and now writes regularly for desiringGod.org and the Gospel Coalition on topics such as faith, medicine, and shepherding kids in the gospel.