Magnifying the Gospel and End-of-Life Issues

From Gospel Translations

My mother has entered what I call “the frowning season.” These are the times of discouraging diagnoses, meds by the bulk, and medical appointments as full-time employment. Like leaves dropping off a maple tree, we are watching her independence slip one small incident at a time. The long winter of dependence approaches and, beyond that, the steep valley of dying and death itself. 

There is nothing praiseworthy about my siblings and I gathering together this past weekend to consider how best to care for her. I say “nothing praiseworthy” because that seems to be the point of 1 Timothy 5:8:

If anyone does not provide for his relatives, and especially for members of his household, he has denied the faith and is worse than an unbeliever.

A Christian failing to care for their parents brings reproach upon the gospel of Christ. How? Because he “denies the faith” through selfish disregard rather than open apostasy. This word by itself does not motivate us to care for my mother, but it does show us that caring for her through the frowning years and glorifying the gospel are the same thing. As a Christian family, we want to help her finish well—as a lasting testimony to us and to our children, and to anyone who might be watching.

My mother did not come to Christ until her mid-40’s. Three of us were in college or working at the time. We had each come to Christ in the last 12 months and our witness led her to search out the gospel for herself. So we have strong memories of our “lost years,” and we have seen the grace of God work powerfully in each of us—but especially in my mother.

She is 78 now. I have almost never seen her sick in my 53 years. At 67, retired from teaching and widowed, she went to Russia as a missionary with CoMission. Three years later she cut back to “short-term service” spending several months a year in Nizhny Novgorod (the dissident city of “Gorky”).

At her birthday party, to celebrate her 75th year, she announced that God was calling her home from Russia. She felt called to Mongolia! Six months ago, while in Mongolia, she began to go blind. It was a rare disease called Giant Cell Arteritis. Extreme doses of steroids saved her sight but left their mark in many other debilitating ways. A few weeks later she was diagnosed with breast cancer. She underwent surgery and chemo. She has been having trouble breathing ever since and has fallen.

The cumulative effect on my brother, two sisters, and me has knocked us a bit off balance as well. We have prayed, and she may well make a strong comeback. But we also have realized that “Super Mom” is just like all flesh and must follow suit.

Even though we live coast to coast, we thought it best to gather around her in person. My older brother prayed with great humility asking God for discernment and unity of spirit. Tears fell, but it was a sweet moment.

We walked through nine questions. In each case, we asked our mother to state her preferences first and then each of us weighed in. Here were the questions and the order in which we discussed them:

1. What can be done to prolong her independence?

Since she lives alone and the nearest of her children is an hour away, we discussed maid service, delivery of meals and groceries, and, for our peace of mind, a personal alarm for her wrist. This was a difficult discussion. My mother does not spend money on such things. But we got them on the table.

2. What measures should be considered when total independence is not possible?

Here we introduced the idea of her staying with one of us during periods of treatment and recovery or during the winter months, when isolation is a real danger and getting around is more difficult and dangerous. We also heard her views about moving to a community village where independent living is possible but help is nearby. (Not interested.)

3. What is our “family care plan” when living independently is no longer possible?

She expressed a desire to live with family, and we agreed. We discussed her options and how to prepare for it.

4. What conditions or indicators will trigger the family care plan?

My mother listed some of the things that would indicate it was time to move in with one of us (like going blind). We listed about 6–8 others. Hopefully this will help us all recognize the time.

5. How are costs related to her safety, ongoing medical care, and living expenses to be covered?

My older sister is spending extra time understanding our mother's assets, her insurance plans, and business affairs. She will also advise her on when to spend her money on herself, since we know she will not do so without encouragement. We also introduced sharing expenses when necessary.

6. If a nursing home setting is required for her care, where will that be?

We talked about researching quality care and understanding the costs and the need for it to be close to family.

7. What medical directives should be in place in her last days, and what principles should guide our health care proxy decisions?

This was the most difficult discussion we had. Avoidance of suffering seems to be the great determinate in our culture. But this is not so biblically. God has long worked good through suffering. We sought to appreciate that. We discussed discerning what measures promote life versus what measures merely prolong death. We reviewed real cases of other relatives and what seemed appropriate and what seemed excessive. We also talked about food and water as not an extreme measure. And we reviewed the medical power of attorney assigned to my younger sister.

8. What funeral instructions and burial wishes do you want us to observe? And what prearrangements have been made or should be made?

We listened to my mom pour out her heart’s desire to make her funeral a final testament of the grace and glory of Christ and the resurrection. I’ll be preaching. And out of a biblical respect for the human body, she will not be cremated.

9. What do you want us to know regarding the disposition of your assets?

My mother seemed most concerned about this question (in fact, she wanted to start with this question). She is mindful of how families have been torn apart fighting over money and goods. But we have two things going for us. First, she hasn’t collected a lot of stuff and is a woman of modest means. And second, we her children are going to pray that God keep us from falling back into this world. “All that is in the world—the desires of the flesh and the desires of the eyes and pride in possessions—is not from the Father but is from the world” (1 John 2:16).

John Ensor is the Executive Director of the Urban Initiative Program of Heartbeat International.