Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care

By Kathryn Butler, MD

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Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care

By Kathryn Butler, MD

... Show All

“To prepare yourself to make difficult medical decisions in a distinctly Christian way, you won’t do better than to read Between Life and Death." 

Tim Challies

Modern medical advances save countless lives. But for all their merits, sophisticated technologies have created a daunting new challenge, namely a blurring of the expanse between life and death. The dying process is often hidden behind a complex web of medical terminology, statistics, and ethical decisions, making it difficult for patients and loved ones to know how to approach the end of life in a dignity-affirming, God-honoring, faith-filled way.

This book offers a distinctly Christian guide to end-of-life care. It equips you by explaining common medical jargon, exploring biblical principles that connect to common medical situations, and offering guidance for making critical decisions. In these pages, you will find the medical knowledge and scriptural wisdom you need to navigate this painful and confusing process with clarity, peace, and discernment.

Read Chapter 1


Kathryn Butler, MD

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 and the Gospel Coalition on topics such as faith, medicine, and shepherding kids in the gospel.

Product Details

Category: Culture & Social Issues
Format: Paperback
Page Count: 224
Size: 5.5 in x 8.5 in
Weight: 9.5 ounces
ISBN-10: 1-4335-6101-8
ISBN-13: 978-1-4335-6101-6
ISBN-UPC: 9781433561016
Case Quantity: 60
Published: April 30, 2019

Table of Contents


Part 1: Dying, but Alive in Christ

  1. Framing the Issue
  2. Wisdom Begins with the Word

Part 2: A Detailed Look at Organ-Supporting Measures

  1. Resuscitation for Cardiac Arrest  
  2. Introduction to Intensive Care
  3. Mechanical Ventilation
  4. Cardiovascular Support: Vasopressors, Inotropes, and Lines
  5. Artificially Administered Nutrition
  6. Dialysis
  7. Brain Injury

Part 3: Discernment at Life’s End

  1. Comfort Measures and Hospice
  2. Physician-Assisted Suicide
  3. Advance Care Planning
  4. Being a Voice: Surrogate Decision Making

Appendix 1: Summary Chart of Organ-Supporting Measures
Appendix 2: Sample Advance Directive
Appendix 3: Scripture Passages for Comfort
Further Reading
General Index
Scripture Index


“If I face a critical, life-threatening illness, I will want an experienced clinician who is well versed in the most recent medical studies, who is kind and compassionate, and who respects my faith in Jesus. I will want someone who can coach me on the right questions to ask my medical team and help me make practical decisions. In short, I will want Dr. Butler. She will guide me to come to the end of life in a way that commends the gospel and brings glory to God. If she is not available, I will want to reread this book.”
John Dunlop, MD, Internal Medicine, Geriatrics, Yale School of Medicine; author, Finishing Well to the Glory of God

“It is inevitable that at some point, each one of us will face difficult or even heartbreaking medical decisions. We may have to make decisions related to our own care or, even tougher, the care of someone we love. To prepare yourself to make such decisions in a distinctly Christian way, you won’t do better than to read Between Life and Death. It will inform, encourage, strengthen, and equip you to act in ways that honor our humanity while bringing glory to our God.”
Tim Challies, author, Seasons of Sorrow

“Some of our weightiest decisions wait until the end. When death draws close, what medical treatments will we embrace or reject? Even Jesus-loving Christians struggle to know how to answer these questions, and we need a seasoned doctor to educate us on the options and their pros and cons. Dr. Butler educates the mind, answers the questions, and takes the imagination on an unforgettable ride, made vivid with the descriptive prose only a gifted writer and experienced trauma surgeon could offer us. This remarkable, Christ-centered book is loaded with reality checks and soul checks, and it will serve Christians and pastors for many years to come as they make these final decisions out of faith and not fear.”
Tony Reinke, journalist; author, 12 Ways Your Phone Is Changing You

“Dr. Butler has written a remarkable, unique, and timely book. Combining her medical expertise with biblical compassion and moral evaluation, she lucidly explains what we need to know about life-and-death medical situations. She does not offer vague advice, but grounds her counsel in medical facts, legal realities, spiritual principles, and real-life illustrations.”
Douglas Groothuis, Professor of Philosophy, Denver Seminary; author, Walking Through Twilight: A Wife’s Illness—A Philosopher’s Lament

“This is a marvelous book. Dr. Butler, a Christian intensive-care specialist, has woven together a clear explanation of detailed and complex medical issues with an intimate knowledge of Scripture to bring forth a book of immense value for patients, loved ones, and clergy as they face the seemingly insurmountable questions of ICU and end-of-life care. It is well written, illustrated with real-life dilemmas, and oozing with compassion, both her own and that of our Savior.”
Robert D. Orr, MD, CM, clinical ethicist; author, Medical Ethics and the Faith Factor

“As a pastor’s wife, a parent, a daughter, a granddaughter, a friend, a neighbor, and a member of the church, the issues in this book regularly loom over my life and the lives of those around me. How do we best love the sick and dying? How do we know when to pursue medical interventions and when to allow our loved ones to, as Dr. Butler puts it, ‘relax into the embrace of Jesus’? These are complex questions without easy answers. But Between Life and Death provides a helpful framework of biblical wisdom to illuminate otherwise murky scenarios. Dr. Butler explains the dense medical terminology that can baffle already-overwhelmed caregivers. And, with unflinching (but not unsympathetic) clarity, she brings us to the bedsides of the suffering and tells us what it is like to experience CPR, a ventilator, or artificially administered nutrition. The actual impact and likely outcome of such treatments is far from the glamorous glow of TV medical dramas, but we need to know the stark reality in order to make God-honoring and merciful choices for ourselves and our loved ones. Thankfully, this book also has an expiration date. One day, gathered in the near presence of Christ, we will no longer need to know how to make decisions about death. But in the meantime, I’m glad to have this book on my shelf.”
Megan Hill, pastor’s wife; author, A Place to Belong; Managing Editor, The Gospel Coalition

“Dr. Butler has done a masterful job in giving us a clear and comprehensive guide to navigating the difficult and complex waters of end-of-life care. Although Between Life and Death is written with patients and their families in mind, this book is a welcome and valuable resource for guiding Christian healthcare students through these challenging issues, in addition to providing the necessary biblical grounding and foundations.”
Bill Reichart, Vice President of Campus and Community Ministries, Christian Medical & Dental Associations

“For all the blessings of modern critical care, we have not sufficiently reckoned with its dark underside: what happens when medical technology and intervention do not preserve life but prolong death? With her keen medical training and experience on display, Dr. Kathryn Butler parts the curtain on an array of life-threatening situations that might befall us or those we love. In Between Life and Death, Dr. Butler points us to the hope of the gospel, showing what Christian discipleship might look like in some of the most agonizing moments in life. May this book serve as a useful guide and conversation starter as we prepare for death and gaze on Christ.”
Ivan Mesa, Books Editor, The Gospel Coalition

“Dr. Kathryn Butler has taken her Christ-centered life as well as her experiences as a trauma surgeon to give the reader ways to assess end-of-life decisions to the glory of God in Christ Jesus. Her book emphasizes that we live by the grace of God in Christ Jesus. Dr. Butler has included numerous Bible references that are extremely helpful within the context of living and dying in Jesus Christ. It is a must-read for all Christians, church leaders, and medical professionals who are living through end-of-life dilemmas.”
Bob Weise, Professor Emeritus of Practical Theology, Concordia Seminary