4 Principles for Making Critical End of Life Decisions

end of life

In my experience, I think most believers who are in end of life dilemmas or are thinking about them want to respond faithfully—we want to honor God, and we want to make sure we’re being biblical in our approach. The problem I find, though, is that the context is so foreign, and we don’t know how.

When you look at the Bible as a whole—what it teaches us about life and death and God’s work in it, and our redemption through Christ—there are four key principles that arise from Christian bioethics that can practically help us. In our own emotional turmoil, we’ll cling to one principle, but when we adhere to any one of these principles without considering them as a whole, it can steer us down a dangerous path.

Here are each of the principles to consider for end of life decisions.

1. Life is sacred at the end of life.

The first, which is the one that people think of most readily, is that our mortal life is sacred. It’s a gift from God. This harkens back to Genesis where God breathed life into Adam and we were then part of that lineage of being his image bearers with inherent dignity. The 10 Commandments teach us that we’re to cherish life, and we’re not to murder, because life is a gift from him and because the purpose of our lives is to serve God. We are to protect life. This is the tenet that steers us toward protection of the unborn. It also inspires us to protest against physician-assisted suicide. And when we’re considering end-of-life care, the sanctity of moral life should persuade us to consider accepting treatments with the potential to cure.

2. God is sovereign at the end of life.

The second point—which I think tends to get overshadowed by the first and can confuse or overwhelm people so that they don’t consider it entirely—is that even though we are called to preserve life, God is ultimately sovereign over our life and death and has authority over our days. While we might stalwartly try to preserve life at all costs, when we do that, we ignore that death comes to everyone. It is inevitable because the wages of sin is death.

When we refute that truth, we deny the great power of the resurrection that death does come to us all, but we have a greater hope than this. So it’s important that when death approaches, we accept it. When it becomes inevitable, we realize that God can work through all things—even and including our death—for the good of those who love him.

3. Care for the afflicted at the end of life.

The third is that we are called to love one another. We are called to love our neighbors as ourselves. We’re called to love one another as Jesus loves us. We are called to act justly, and love mercy, and walk humbly with our God. What that means is that we need to be attentive to suffering. We need to be empathetic and we need to care for the afflicted.

This matters in end-of-life care because intensive-care measures cause suffering. CPR chest compressions—that deliver oxygen-rich blood to the brain when the heart stops—break ribs when you do them properly. Mechanical ventilators, which are required to continue to give the body oxygen, require sedation to tolerate because they’re so uncomfortable. Even psychologically, patients who have endured ICU care for a long period of time report psychological trauma. They have nightmares, potentially for years afterward, of waking up in the ICU confused, panicked, tethered to a bed, not knowing what’s going on, and not being able to breathe on their own.

If these measures preserve life, it’s worth it, but there are times when the disease process at work is not recoverable. When we compel people to undergo these types of measures, we are causing unnecessary suffering. We’re failing in our call to be empathetic. God does command us to preserve life, but he does not mandate that we doggedly chase after interventions that are brutal without any hope for cure.

4. Hope in Christ at the end of life.

The fourth one is that our hope resides in Christ, which is the most important tenet considering any of these issues. Even though we may fear death, death is an end but it is not the end. Through the cross, God transforms death from an event to be feared in its entirety to an instrument of grace. Even when we consider these issues—as much as they may frighten us and as much as they may dishearten us—we have hope that it is not the end. We have hope in God’s love for us through Christ.

The saving gospel of Jesus Christ transforms our view of dying. Even as we wrestle with decisions about ventilators and chest compressions, and even as we consider our final moments, we need not fear death! “For this light momentary affliction is preparing us for an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen” (2 Cor. 4:17–18). Christ has vanquished sin. Through the gospel, fear of our transient earthly death withers before the assurance of renewed life.

As Christians, we share an immaculate hope unrivaled by any in human history. We rest assured of Christ’s promise by faith alone: “Whoever believes in me, though he die, yet shall he live, and everyone who lives and believes in me shall never die” (John 11:25–26). Christ’s resurrection transforms death from an event to be feared into an instrument of God’s grace as he calls us home to heaven. Although we die, we are alive in Christ.


This article about end of life decisions originally appeared here. Read Kathyrn Butler’s new book, “Between Life and Death,” which aims to equip Christians facing end-of-life decisions by simplifying confusing jargon and exploring biblical principles families need in order to navigate the transition from this life to the next.

Find out What to Say When Someone Dies.

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kbutler@churchleaders.com'
Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma surgeon who is board certified in surgical critical care and served on the faculty at Massachusetts General Hospital and Harvard Medical School. After a decade of experience in surgery, she left clinical practice in 2016 to homeschool her children. She now writes for desiringGod.org, Christianity Today, and the Gospel Coalition blog on topics intersecting faith and medicine. She is the author of Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care.