Imagine that a normal, healthy 52 year old woman—a loving wife, mother of two children, a devout woman of faith who regularly volunteers at her church—suddenly suffers a massive stroke and comes to the ER. The paramedics start CPR when they arrive on the scene, they get her to the hospital, and after the ER staff give her various medication and insert a breathing tube inside her throat, she is transferred to the ICU department. She is on full life support and the family members are anxiously waiting for her to wake up soon, hopefully soon. The physician comes to talk to the family and informs them that she has brain damage and that her chances of waking up (if she wakes up), and living a normal life as she used to, would be close to zero. The family has to make a choice. Will they continue to medically treat her? Will the family cut a hole in her throat and have a permanent breathing tube inserted through her throat (known as tracheostomy, commonly referred as Trach—pronounced as “Trake”)? Will they make a choice to insert a feeding tube to the side of her stomach (known as PEG- Percutaneous endoscopic gastrostomy)? Or will they say no to all those invasive procedures and simply keep her comfortable by deciding to provide pain medication and allow her to die?
Some of you reading this may ask, “Really, a 52 year old woman? Isn’t that still considered young? Wasn’t she walking, talking, and eating with her family just yesterday?” Yes, the answer to all these questions is yes. Yet, this is what I experience with all other medical staff of the hospital on a daily basis. If not a stroke, a heart attack. If not a disease, an accident. Something awful happens.
Going back to the family, as they receive the horrible news of their wife and mother, they are devastated. They had plans to travel, plans to attend a graduation, plans to attend a wedding, plans for a new house. And plans change overnight.
Understandably, families have a hard time accepting such situations. We don’t normally experience such tragedy on a regular basis. Most people who attend church would ask their pastor to come and offer a blessing or a prayer. I have seen numerous Korean pastors who would visit and offer a service of healing and comfort for the family members. It’s not unusual for Christians to prayerfully wait for a miracle to happen. I have spoken to many families who would tell me “God is going to bring him/her back,” or “I believe in miracles.” They are so afraid that their mother, father, son, or daughter is going to die. Death is scary, so to look to something positive and encouraging, many people look to God and His miraculous, divine intervention.
I believe in miracles too. I firmly believe in them. I truly believe that God parted the Red Sea, that lame men were able to walk, that the blind were able to see, and that Jesus brought Lazarus back from the dead. Our Christian faith is built upon the miracle of Easter. What I also know is that miracles are preciously called miracles because they are so rare. If we look at the Bible as a whole, the majority of miracles happened around the Exodus event and around the life of Jesus and the apostles. They are supposed to be rare and almost never happen.
I write this to offer a shift in our point of view of death. Death is a scary topic to talk about. In Korean culture, it certainly is a taboo. To put a cultural perspective on this, the Korean church even managed to delete/omit the part about Jesus descending to hell after death from the Korean version of the Apostle’s Creed. In the Korean version, it just says that He died and on the cross, on the third day rose from the dead and ascended to heaven! It blasts through it! Whether theological or cultural, the omitting of Jesus’s death and decent to hell seems to have been too strange and “taboo” to talk about.
But when we examine Christian theology, do Christians die? Do we go through death? It’s a yes and no question. Yes, our body does go through death, but our souls continue to live on. In Christian theology, we live in one place and move to live in another place. This is because in our theology, we are not our body, but we are our soul. We are a soul with a body, not a body with a soul. Since the soul continues to live (yes, there is suffering and pain in this body, but) we never really die. We move to a new place.
I do not write this to diminish the unspeakable pain and the suffering that families go through when they realize that their loved one is probably not going to come back to the way they were before hospitalization. Not to mention the emotional, spiritual, and financial burden to those who wait, hoping that their loved one might come back.
As sad as it is, I would tell the aforementioned family, “She is dying.” Although speaking of death is painful, it is through our Christian theology and teachings from the Bible that we find true peace and comfort. That although our loved ones may suffer, although we may suffer and be in pain, we will never truly die—we will move to another place and continue to live. In such cases, ceasing unnecessary medical treatment (such as Trach, PEG, etc.) would be a better choice.
Some family members express the concern that we are killing their loved one when we stop medical interventions, by taking the breathing tube out or stopping medications. Indeed, this is a serious concern as all human life is precious and “killing” is biblically prohibited. What I have recently started sharing with some of my patients as well as hospital staff is that we are not “killing” their loved one, but “allowing the God-ordained process of life and death to take its place.”
Truly, God can give and take away what belongs to him in the first place—even if it’s our life. Also, in Christian theology, God’s not taking away my life, he is merely moving me to live from one place to another. And God can certainly choose to move me from one place to another. Pastors go through it all the time—God moves pastors to do ministry from one place to another, all the time. Surly, if God can move us from one city to another city, He can (and has the right) to move us again to another place as He sees fit.
Now, what does medical insurance companies have to do with this, as the title states? When a patient is in an ICU room, the average cost is known to be about $10,000 a day. Various medications, physician’s bills, therapists’ hours, nurse’s hours and other administrative costs also add up very quickly. In the case of a stroke patient who has zero probability of recovery, very often due to confusion, sadness, shock, even guilt or hope (of a miracle) from the family members, patients would typically be receiving unnecessary medical care, thus causing unnecessary and undue burden to the patient (not to mention the family). Their body, lying on the bed for a prolonged time will develop skin breakdowns, complicated infections, and other medical problems. Even something simple as feeding becomes unnecessary, as when the body starts to die, it does not need calories to process and the food that is fed through a tube just sits in the stomach rotting and causing more issues for the patient. Sometimes, the best thing to do for the patient is to let him/her die in peace.
If people had good theological understanding of life and death, there would be shorter hospital stays, lesser medications to prescribe, and fewer procedures to perform. If there are fewer things to do, than there would be less amount of money to be paid for by the insurance companies. With this logic, if medical insurance invested in theological training for the masses, in the long run they would actually save more money.
Surely, I hope you see that I am writing for very limited situations, where medical intervention is unnecessary. I firmly believe that all possible medical interventions should be performed if there is benefit. Sadly, such limited situations happen very often in the ICU at my hospital and has made me think about the theological implications of carrying out unnecessary medical care. Also, although worth a thought, I firmly know that medical insurance companies will probably never invest in theological training, churches, or seminaries. My point was to place the emphasis on our Christian theology, thinking about life and death, to be aware of our limited time/stay on this earth, and to once again have a clearer vision and hope of the glorious eternal life with our Father in heaven. Christianity is about hope, and I hope I was able to re-kindle that hope of life in eternal blessedness when our time comes to “move.”
Rev. Joseph Choi is ordained by ECA (Evangelical Church Alliance). He is also a U.S. Army Reserve chaplain, and a healthcare chaplain Board Certified by APC (Association of Professional Chaplains).