Life-Sustaining Technologies and WSC 68

Discussion in 'The Law of God' started by PaulCLawton, Oct 16, 2012.

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  1. PaulCLawton

    PaulCLawton Puritan Board Freshman

    WSC 68: What is required in the sixth commandment? The sixth commandment requireth all lawful endeavors to preserve our own life, and the life of others.

    I'm wondering if there any on the board who have given thought to the requirement of using "all lawful endeavors" to preserve the life of others and how it relates to modern life-sustaining technologies. Hopefully the question is clear enough to illicit some response, I'll clarify further if neccesary.
    Also, is anyone aware of a modern, confessional book(s) on ethics? I am aware of some modern evangelical ones (Feinberg, John Jefferson Davis, etc.) and of course a lot of the older divines have significant portions of their dogmatics or STs devoted to the subject, but I am not aware of that that is both modern and confessional.
    Last edited: Oct 16, 2012
  2. Jerusalem Blade

    Jerusalem Blade Puritan Board Post-Graduate

    I personally don't take this (as a lawful endeavor) to include those technologies which but prolong my death. I realize that I may be kept breathing and my heart beating by artificial means when I would normally die apart from them; I would not want to be in this condition for a prolonged period. However, this is nuanced – for if I had not had open heart surgery in '96 I wouldn't be here now, and much work for the Lord would have gone undone.
  3. Unoriginalname

    Unoriginalname Puritan Board Junior

    I am just thinking out loud but is there a way to neatly divide up the ethical warrant of medical technologies by intention. Many of the technologies that can be helpful to a patient who just underwent major surgery (ventilators, dialysis, chest tubes, so on and so forth) could also be used to prolong life in someone that is understood to be dying. So while these technologies may be neutral in this discussion the medical intent of them may be what we want to go after?
  4. Pergamum

    Pergamum Ordinary Guy (TM)

    Some random thoughts:

    There is a difference between choosing not to prolong life versus hastening death.

    Brain-dead = dead.

    Also, there is a difference between normal measures, heroic measures in the face of conditions that may change, and measures taken in the presence of incurable diseases that have little or no chance of healing.

    People speak about not wanting to be put on a ventilator, but many folks temporarily need such measures, with full recovery later. Also, regarding feeding tubes and oxygen....we would never think of letting an otherwise healthy infant die from lack of food or oxygen, and yet this is somehow okay for patients with functioning brains but impaired bodies.

    Oxygen, intubation, feeding tubes, even ventilators help get many critical patients through critical periods of time. Afterwards, many of these means can be discontinued.

    Severely mentally handicapped people often require special assistance to live; but severe brain malfunction is not the same as brain death. Discontinuing life-support in these cases means shutting off oxygen and food and causing the death of someone whose life is presently being preserved. Is this hastening death or merely not prolonging life?

    My wife and I are both nurses and we always found it chilling how supportive many of our co-workers were of euthanasia and the cessation of efforts to save lives if those efforts were deemed too strenous.

    I would never trust the medical profession with "end of life decisions." A tired unsaved doctor or nurse is not the best judge of whether I am worthy to live or not.
  5. Tim

    Tim Puritan Board Graduate

    This is ethically disputed, and complicated by organ donation schemes. See, for example:

    According to this article, a 59 year-old woman had no detectable brain waves, and was kept breathing artificially. While the family discussed organ donation options, the woman woke up and started speaking to nurses.

    An alternative view holds that considerations of life vs. death should revolve around the blood, and by extension, the heart (cf. Lev. 17:4).
  6. Tim

    Tim Puritan Board Graduate

    A quote from this interview suggests that the only way the first heart transplant was "ethically" performed was by changing the definition of death (i.e,. to brain death).

  7. Unoriginalname

    Unoriginalname Puritan Board Junior

    Pergy brings up a great point about the discontinuation of life support. I was just wondering do you (you meaning everyone) think that there is an ethical distinction between discontinuing a life sustaining measure and deciding not to utilize one in the first place because the understanding is that it will not prevent death but just delay it for a short time.

    Tim the criteria for brain death is not a perfect but they are very good. The likelihood of someone being determined brain dead returning from it is rather infinitesimal and should be consider miraculous, of course it has happened but we have also pulled people from the bottoms of lakes after 45 minutes to find them alive. The only issue I see with seating the heart as the ultimate decider of life is heart tissue may contract in an uncontrolled manner for several minutes after the heart stops pumping, so while the rest of the body may be "dead" the heart is still ineffectively squirming on a cellular level.
  8. Peairtach

    Peairtach Puritan Board Doctor

    Here's an article by a minister in the Free Church of Scotland, which subscribes to the WCF, about "transhumanism", which, speculatively, could involve extending life indefinately.

    Free Church of Scotland

    There are some books listed at the bottom of the article.

    Even if a book isn't Confessional, but only Evangelical or Reformed, it can provide food for thought which can be examined by the WCF and Catechisms. :2cents:
  9. Pilgrim Standard

    Pilgrim Standard Puritan Board Sophomore

    I think of the era the WSC was written. They were much closer to frequent periods of execution by horrible means.
    There is no indication that they thought poorly of men dying at the stake without fighting to the last rope or chain was fastened, or of those that knelt at the chopping block. These people did not use every ounce of strength to fight their murderers to the last. I don't believe them to have broken the 6th commandment in the eyes of the framers of the WSC any more or less than the Framers would view those refusing life extending technologies if they could have perceived them at that time. I mean no disrespect in speaking in such a way of the Martyrs.
  10. Pergamum

    Pergamum Ordinary Guy (TM)

    Death by martyrdom would be different than trying to preserve the life of the sick or diseased.
  11. Pergamum

    Pergamum Ordinary Guy (TM)


    The article is rather non-technical and I see nothing in it about EEG readings.

    "Brain death" is a legal and medical term. Admittedly, it varies from place to place slightly such that a patient might be "dead" in one country and no yet dead in another country. Despite this, brain death still seems the best determiner of death, especially when the brain steam is involved.
  12. Semper Fidelis

    Semper Fidelis 2 Timothy 2:24-25 Staff Member

    Here's a book written by David Van Drunen that addresses some of the ethical issues of modern technology: Bioethics and the Christian Life: A Guide to Making Difficult Decisions: David VanDrunen: 9781433501449: Books

    Interestingly, Van Drunen writes with some existential experience. I met him for the first time when I attended a small OPC mission work in Temecula. He was our pulpit supply one Sunday and politely refused my hand because his wife's immune system was severely depressed and it was uncertain that she would live. By the grace of God she did survive.

    I think advances in technology always demand that we apply the general equity of the law to how technology enables choices that were not possible in the past. Even within the last decade, Marines and Soldiers are being saved from wounds that would have most certainly killed them in the past. Some of those decisions as to whether to save the life of a dying Marine with new technologies are certainly much easier (in some cases) to make than thorny questions of when to let an aged person die.

    I was listening to an interesting Veritas forum a few months ago by a pediatric oncologist who has had to struggle with many life and death issues. He pointed out that, in the past, many doctors were trained on how to prepare people to die. Medical science was less advanced and one of the things a physician needed to be skilled at was helping people die. He did not lament the decreased mortality rate as technology improved and the medical profession applied a more rigorous "scientific" approach to medicine but he did lament that physicians are no longer trained on the issues of death any more.

    I recently had an extended family member among my in-laws die. She lived to a ripe age but her final couple of days were spent in a morphine-induced fog. These days it is viewed as preferable that the dying die with no consciousness that they are about to meet their Maker. I couldn't help thinkiing about the fact that she might not know the Lord and those past copule of days might have been spent in pain but it might have proved a time to share the Gospel and prepare her to meet the Judge of all the Earth. That simply is not part of the "medical equation" any more.

    One of the other things that the doctor lamented is the extraordinary measures medicine will go through to give people little chance of surviving but they're tried anyway. Again, it's hard to provide pat answers because these are thorny issues but a friend of mine told me his uncle refused extraordinary measures because he knew it would eat through what little inheritance he could pass on to his children. The man knew the Lord, was prepared to meet His Maker, and did not want to impoverish his family any further by giving him a few more days or weeks.
  13. SolaScriptura

    SolaScriptura Puritan Board Doctor

    When I was younger I used to desire to die in an quick and painless a manner as possible. But over the years my perspective has changed. I now hope to suffer a bit. So that by God's grace, I might testify to the surpassing greatness and soul-satisfying goodness of Christ in the midst of pain.
  14. Tim

    Tim Puritan Board Graduate

    It certainly is. And I was trying to discuss the concept of death as an ethical term. I am no expert, to be sure, but I am not quite ready to accept the concept of brain-death without a careful examination.

    It is important to note (and I hope you all understood my point) the claims that the emergence of brain death as a medical-ethical concept coincided with the ability to transplant vital organs such as the heart. Those who disagree with the concept see the shift towards the use of brain death to be not based on absolute ethical standards but rather a pragmatic way to "justify" the harvest of a heart that has not yet stopped beating.

    I live in Michigan, but I am also currently a PhD student at the University of Cape Town. The teaching hospital associated with UCT's medical school is where the first heart transplant occurred (Groote Schuur Hospital). I have been in this hospital from time to time as part of my university activities. Outside my supervisor's office at our labs is a newspaper clipping from 1967 that headlined the first heart transplant. A sub-heading states, "churchmen agree". Yes, they agreed, but the fact that this was printed suggests that there was at least some debate about the matter.

    So, my point is that we should carefully discuss the concept of brain death to see if it coincides with Biblical concepts of death and the separation of soul and body, etc. I do hope folks will at least consider this point.
  15. PaulCLawton

    PaulCLawton Puritan Board Freshman

    Most of us would probably share that sentiment, it would just seem to violate a straightforward reading of WSC 68, though of course the writers did not have modern medical technology in mind at the time.
    In one of Wendell Berry's short stories called Fidelity from That Distant Land Burley Coulter is taken to the hospital in the "big city" due to being near death only to be kidnapped by his son to die peacefully at home on his farm when the son sees all the contraptions that Burley is hooked up to. It's a romantic tale and one is provoked to value the natural over the artificial (as one always is when reading Berry!), but at what cost? Is life so valuable that it should be prolonged at any cost and without regard to quality? That would again, seem to be the conclusion of WSC 68.
  16. Philip

    Philip Puritan Board Graduate

    I remember hearing an argument (as a general rule of thumb) that if the technology could sustain one's life to the point that one would be fully capable of fellowshipping with God's people for Lord's Day worship, then we should use all means necessary. I'm still deciding what I think of this argument, but I'm throwing it out there.
  17. Tim

    Tim Puritan Board Graduate

    I believe the "Reformed Forum" audio podcast also has a show devoted to this issue.
  18. Rich Koster

    Rich Koster Puritan Board Post-Graduate

    I downloaded an iTunes U series a while back by Dr. William Edgar on Medical Ethics from Westminster Seminary. It had 20 parts and one deals directly with withholding & withdrawing treatment. It may be worth listening to, and the price is right.

    Westminster Theological Seminary - Resources go here and click on iTunes U, then full courses.

    I hope there is room on your hard drive, because there is also a wealth of other good listening here.
  19. Leslie

    Leslie Puritan Board Junior

    The ethical issues are so much different Stateside than in Africa. Here, I diagnose a young person with diabetes in the rural area and send him home to die. Sure, insulin is available in-country, but the patient cannot access it. There is no electricity and no refrigeration in the rural areas. An attempt by the family to obtain the insulin would impoverish the whole family and lead to many more deaths than just the one. If the family has a relative in the city, then the patient can conceivably go live there and get treated. But with no relatives, it's hopeless. It's similar for other conditions.
    I've had a diagnosis of cancer, now either cured or in a prolonged remission. If and when this recurs, I'll have no guilty conscience for electing to stay in Ethiopia and receive terminal care at the hands of a Dutch physician, a believer, who has a very liberal view of pain relief and not prolonging death. It would be so much better than being at the mercy of the Stateside medical establishment.
  20. Semper Fidelis

    Semper Fidelis 2 Timothy 2:24-25 Staff Member

    These are really good examples Mary. We're so affluent in this country that we tend to forget that medical treatment means resources that may need to be spent elsewhere. On the micro scale, you bring up the point that it may mean a whole family cannot eat. Now we can get into the larger issue of whether or not more affluent people ought to make those medicines more accessible but, in the moment, it's a real decision.

    On the macro scale, one of the biggest cost drivers to modern medicine are all the extraordinary measures performed at the end of life. Again, there are no easy answers but paying for those extraordinary measures can bankrupt not only families but entire nations. People like to think as if the decision always needs to default to providing that one last ounce of hope but money is stored productivity. It means, ultimately, someone does not have so you can have and that's an ethical component that needs to be factored in.

    No easy answers and I appreciate, greatly, the example you have given.
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