Evangelism at the End of Life

What are the odds that someone who has rejected Christ their entire life will be quickened by the Holy Spirit to accept Him in the last few weeks or days of their life when the finality of death becomes evident?

The honest answer is I do not know, but I do know that God works in mysterious ways for the conversion of the sinner.  Here is an example from my own experience.

During my Critical Care clerkship in med school I had the opportunity to observe an extremely puzzling sight.  In an ICU full of critically ill, sedated, intubated, ventilated, continuous-dialysis patients, I came across a patient in his 60’s who was fully awake and coherent.  He was sitting up with an oxygen mask on his face, a stark contrast when compared to the other patients.

Great was my shock when I heard the team talking about placing this man on comfort care to ease his respiratory difficulties stemming from his weak heart.

It turns out he was suffering from end-stage heart failure and was a “frequent-flier” in that particular ICU. He was not a heart transplant candidate, so his life was spent in the hospital with frequent decompensations and ICU admissions.  His heart failure was so severe that getting out of bed and walking was out of the question.

That day, after a conference with him, we agreed to place him in a comfort care suite aimed at relieving his “air-hunger” and allowing the disease to take its course.

My immediate concern was whether this man came to know Christ or not.  I knew that in a matter of days or sooner he will die.

I found the opportunity to speak to him privately that day.

“What do you think will happen to you when you get comfortable and pass away?” I asked.

“I don’t know” he said.

When I pressed him on the concept of life after death he labored to say that he believes he will go to heaven because he was a “good person” and because he was born Catholic. It became clear that he was not a born-again Christian.

I now was faced with a critical decision.

Should I evangelize him in this coherent but vulnerable emotional and physical state?  Should I tell him about salvation by grace through faith in Jesus?

I probably could have gotten in trouble if caught “taking advantage” of a dying man and sharing my faith, but I decided to give him a synopsis of the Gospel.  I did not know too much theology back then… but I presented the depravity of man as best I could, and told him how Jesus was the only solution as a substitutionary atonement for his sins.

He confessed he believed in Jesus.

Unaware of the problems of “decision theology” back then, I did what I saw Greg Laurie do at the Harvest Crusades when I used to attend as a kid.  I had him recite the sinner’s prayer after me and told him to thank God for saving him.

I had to cut our meeting short because my pager which had been silent the whole day rang three times in three minutes.  I told him to pray to God and thank him for Jesus, and I will visit him in the upcoming days to talk to him.

The next time I went to see him, he had passed away.

Was my approach the correct one?  Did I take advantage of a vulnerable person to get a “decision” out of him?

I think ultimately we are responsible to spread the good news no matter what the circumstance.  However, we are not responsible to worry about the work of conversion of the Holy Spirit.  God can and will save souls if He so desires, even at the end of life after a lifetime of sin and depravity.  Our duty is to preach the message of salvation because it is “the Son of Man [who] came to seek and to save the lost.” Luke 19:10

End-of-Life Comfort Care is not Euthanasia

Euthanasia or physician induced suicide is drastically different from comfort care in the final days or weeks of someone’s life.

Here are some clarifications:

Euthanasia – the intentional physician induced killing of a person for his/her alleged benefit.  The physician ensures that the act is not “botched,” and is typically done by physician or nurse-administered lethal injection.  This is currently legal in a some countries but it is illegal in all the States in the Union.

Physician aid in Dying (PAD) or assisted suicide – here the physician prescribes the lethal injection while the patient self-administers it.  Some form of this practice is legal in Oregon, Washington and Montana.

End-of-Life Comfort Care or Hospice Care – the palliation or alleviation of symptoms at the end of life for terminally ill patients.  The physical goal here is to treat pain and respiratory distress using narcotics which ease the dying process.  Emotional and spiritual care are typically a part of hospice as well.

I have made the argument (here) that euthanasia (and suicide assisted in any way) is a crime against God because we do not have the right to give or take life.  But it is important to realize that comfort care given to a patient who has arrived in the final stages of illness is NOT an assisted suicide.  Comfort care is a compassionate act aimed at making physical and emotional pain manageable in the last few hours to weeks of life.

What about administering narcotics like morphine or fentanyl to patients with end-stage illness?  Doesn’t that directly lead to the patient’s demise?

The answer is NO.  They help ease the patient’s passing, and they are not meant to actually kill him.  The disease pathology ultimately causes the patient’s demise.

As pneumonia or airway complications are usually the final road to passing in many terminally ill patients, the narcotics used in comfort care also help in alleviating the respiratory distress that can become a problem in the last day or two of life.

Anyone who watched a loved one pass away from terminal illness can probably attest that comfort care is almost a polar opposite to euthanasia.

Our God is a God of love, mercy and compassion.  His children must demonstrate and practice these communicable attributes we have received from Him. Compassionate care for terminally ill is in line with these godly attributes.  I do not think it is a stretch to apply this verse to the goal of comfort care at the end of our patients’ lives:

“3 Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, 4 who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.” 2 Cor 1:3-4