Announcer: 0:00

Deacons, we don't know how much you've thought about attending the OPC National Diaconal Summit, but if you're still on the fence, we'd encourage you to take a little time to think and pray about it. Here are just a few reasons why. First, the summit reminds you that you're not alone in this work, and you'll really feel that as you spend time with deacons who understand exactly the responsibility you carry week to week. Second, this isn't a lecture marathon. It's interactive, practical, and built to encourage you, not wear you out. You'll hear speakers who are not only engaging, but who deeply love and value the office you hold. One of Last Summit's speakers, Dr. Eric Watkins, captured this really well in the opening of his workshop. I feel like a lion in a den full of Daniels being in your midst.

Eric Watkins: 0:41

Frontline, servant-hearted men who are doing a lot of the work of mercy, compassion, justice. So for me to be speaking to you really feels like role reversal.

Announcer: 0:50

I should be listening to you instead. Third, there's just no substitute for being together in person. And since the summit only happens every four years, it's a rare opportunity. Fourth, the singing. There's nothing quite like hearing hundreds of deacons lift their voices together in praise to the Lord. Fifth, what you take home, encouragement, perspective, and renewed purpose will stay with you long after the summit ends. That and the summit merch are worth the trip. Don't think about it too long though. Free registration ends on April 15th. We really hope to see you there. Register at opcccdm.org.

David VanDrunen: 1:24

We as Reformed people were not ethical relativists. And so we don't really like it when there isn't a clear right or wrong answer, but sometimes in life, that's just the case. We have to use our best judgment with the wisdom God has given to us.

David Nakhla: 1:40

Welcome to the Reformed Deacon, a casual conversation with topics specifically designed to help local Reformed Deacons. There are nearly a thousand deacons in the OPC alone. So let's take this opportunity to learn from and encourage one another. We're so glad you could join us. Let's jump into our next episode.

Adrian Crum: 2:00

Hello, my name is Adrian Crumb. I'm a pastor at Harvest Orthodox Presbyterian Church in the Greater Grand Rapids, Michigan area. And I serve on the OPC's Committee on Diaconal Ministries. Today on the podcast, I'll be speaking with Dr. David Van Droonen and Tracy Heich. Dr. Van Drunen is a minister in our denomination, the Orthodox Presbyterian Church, and a professor at Westminster Seminary, California. He was one of my professors, very grateful for him. He previously served as a pastor of Grace Orthodox Presbyterian Church in Hanover Park, Illinois, and has served on the Orthodox Presbyterian Church's Committee on Christian Education since 2005. Dr. VanDrunen is the author of several books and scholarly works, including the book we'll be referencing today: Bioethics and the Christian Life: A Guide to Making Difficult Decisions. He's married to Catherine and they have one son. Also joining us is Tracy Heich, a member of Grace Fellowship OPC in Zeeland, Michigan. That's one of the daughter churches that Harvest, the church that I serve, has planted. Tracy has worked several years as a nurse caring for the aged and dying, and she brings a practical perspective to the question of how deacons can best care for and help congregants making decisions about medical interventions and end-of-life care. She's married to Thomas and they have two daughters. Thank you guys both for joining us on the podcast today.

Tracey Huyck: 3:21

Thank you so much.

Adrian Crum: 3:24

So we've invited Dave and Tracy to come on the podcast to discuss the topic of end-of-life care. And that may not be something that you immediately associate with the work of deacons, but as I was looking at the history of the church, one of the tasks, even at the Reformation, if you're familiar with the history of how Calvin thought about deacons, one of the tasks in the two orders of deacons that he helped get established in Geneva is actually caring for the dying directly themselves. And so though deacons may not do that as much anymore, I do think deacons can be a great, great service as ministers of mercy in our congregations to help navigate in the season that we live in now where there's so much medical development and things that have changed such that we have new decisions to make, deacons can come alongside and pray for and help out. So I'm very excited to have this conversation with Dave and Tracy. This topic, like many others, involves both practical and spiritual considerations. In many ways, it highlights the need for deacons not only to be ready to provide physical help. Sometimes we reduce deacons to those that write checks or help in physical ways, but they also, deacons need to be spiritually and biblically grounded, serving in both word and deed. And I'm excited for this conversation because it also underscores the importance of how deacons and elders should coordinate care to support those facing some of the life's most difficult and confusing moments. Dave, I'll begin with you. Considering our topic, which is end-of-life care, do you think it's reasonable to say that while Christians are commanded by Scripture to protect life, living as long as possible shouldn't be our ultimate goal? If that is true, what should be our goal? What should orient us in these decisions?

David VanDrunen: 5:04

Yes, I think that is true. And in a way, both of those elements are important. I mean, honoring life, protecting life is very important. I mean, we have been given the gift of life by God. God is the living God, and he made us in his image, and he gave us life and destined us even from the beginning to live with him forever. And then even if you think after the fall, after we made ourselves unworthy of life, even you think about the Noahic covenant after the great flood, and where we find that well-known verse, Genesis 9, 6, he who sheds the blood of man by man shall his blood be shed, for God made man in his image. There's still, even after the fall, there's still this great divine interest in the value of human life and protecting it. So, you know, we certainly want to have a very high view of human life and protecting it. And yet at the same time, I think as Christians, there's no way that we can say that preserving this present life for as long as possible is the highest goal. That just uh that just can't make sense. And I think that's true for a number of reasons. For one thing, and this is not related to bioethics per se, or the end-of-life decisions per se, but just to maybe help the listeners get a bigger perspective. We make all sorts of decisions in life in which we believe that something is more important than maximizing our number of days in this world. And so you think about some of the professions that people choose. I mean, people will choose to be firefighters or police officers or join the military. And we'll say, well, those are, you know, those are valid vocational choices for Christians. They can serve really important public goods. And yet all of those sorts of professions carry risks that you're not gonna have if you become a math teacher or an accountant. And or you might think of being a Christian missionary to a foreign field that might be dangerous. That also carries risks that you're not gonna have if you just are content to serve the Lord in a sort of a first-world, peaceful kind of place. And yet we think that's a very good thing. We want to encourage people to think about that sort of service. And so I think even those things testify to the fact that we don't, as Christians, think that the most important thing is maximizing our present life. So I guess so, so your further question was what is most important? And I would say faithful service to the glory of the Lord is our highest end here. And then our ultimate end is enjoying everlasting life, glorifying and enjoying God forever, as our catechisms put it. And so I think as we think about these end-of-life kinds of issues, I think it is really important to honor life, but to remember that pursuing faithful, God-glorifying service for as many days as God gives us is actually more important than living as long as possible. I think sometimes one of the things that maybe Christians are conflicted about, particularly, is we hear about praying for someone right at the end of their life, and then God seems to intervene. Maybe really, really aggressive cancer. We've heard of those one-off cases where someone is healed seemingly miraculously. Do you think then that Christians have to exhaust every possible physical treatment so that they can kind of get an opportunity for that type of last ditch healing effort?

Speaker 3: 8:39

Yeah. I think that is not the case. I mean, on the one hand, of course, uh, we pray. We pray for those who are dying in in all sorts of ways and for those who have very serious illnesses that are threatening death. We put it before the Lord and we know that he's capable of healing. But I don't think that we're called to be sort of organizing our lives and making important decisions sort of on the, you know, the prospect that God does something incredibly unusual. I mean, we need to make decisions that match our ordinary experience. And I think in that sense, we need to make decisions that more or less match what the medical prognoses are for someone. And if the Lord wants to do something extraordinary, we will praise him for that, but we don't base our decisions on that. And I think we have to remember as we're thinking about some of these medical choices toward the end of life, or if someone has a very, very serious illness that's at least threatening life, that medical care exists for the good of the person. And I think we have to recognize that a lot of medical care that is given or could be given to people at the end of life isn't really all that good for them. To try to keep force feeding someone who is dying because, well, that's, you know, that's going to preserve their life longer, that can be incredibly uncomfortable for some people who just their bodies are not, they're not really fit to keep eating at a certain point. Or, you know, just pounding certain drugs into people can make their life miserable. Or if we preserve their life, you know, as long as we possibly can and and they're in a lot of pain. And so we have to drug them up, and then their mental facilities are not there. And I think there's a lot more we can talk about here, and perhaps you want to follow up on some of this. But I think we need to ask ourselves some really hard questions. Is this really for the good of the patient? Is this really compassionate for them? And is it allowing them actually to live the best God-glorifying life of service in the days that they have, as I was saying uh earlier. And to be attentive to, you know, to the fact that sometimes the medical professionals who are helping people toward the end of life, they don't necessarily have their interests entirely aligned with the patient and his or her family. And that's not to be critical of healthcare professionals, but I mean, there are, you know, there are doctors who don't want people to die on their watch. And they might do certain things that are, you know, not for the best interest of the patient. Or there are sometimes medical research things going on, and you know, researchers might have some interest in keeping people alive longer or testing certain kinds of drugs that maybe are not in the best interest of the patient. So I think there are definitely a lot of different considerations that families, patients, and also deacons and others who are trying to minister to these people have to keep in mind.

Speaker 5: 11:47

Very good. Yeah, very helpful. Kind of stumbled on a book in the last six weeks. Catherine Butler, I found very helpful, wrote a book called Between Life and Death. She was trained at Columbia University and then uh went on to Harvard Medical School and worked in trauma and critical care and then wrestled through some of these issues. She saw, particularly in the ICU, families making decisions that extended life in ways that were not good for them, as you were just saying. I think deacons can keep in mind merely extending life out of a commitment to thinking that you don't want a person to die ever is not always the best thing for her. One of the things that that she notes, uh, Karen Butler in this book, she says there's four biblical principles that should guide decisions at the end of life: sanctity of moral life, God's authority over life and death, mercy and compassion, and then hope in Christ. I thought those were helpful categories. She says, oftentimes, particularly in the very controversial settings, all over the world, probably, Christians hold to the sanctity of life. Like we think of abortion, we would be against taking the life of a baby. But then we kind of apply the same principle and say, in every possible situation, we need to do everything necessary to preserve the life. I actually had a congregant at one point in my ministry who thought that the doctors had killed her spouse because they had really recommended and sort of shifted toward taking them off of life-preserving mechanisms. If a deacon is in that situation where someone someone is thinking, man, I'm going to kill my loved one, how would you help them kind of walk through that in a pastoral way?

Speaker 3: 13:19

Yeah, that's a great question. And there's a distinction that is sometimes made in this context between killing and letting die. And I don't think that distinction is gonna necessarily be an easy answer for every situation, but I do think it is an important distinction. When we think about killing somebody, there we are thinking about taking the initiative to end life, in a sense, thinking that the decision over life and death is our choice. Like now is the time. And I think we want to say, as Christians, that's never our prerogative. That's God's prerogative since life is his gift. So he is the one who is sovereign over giving it and taking it away. But I think the idea of letting die can be very different from killing because it's a way of recognizing, in fact, that we're not sovereign over life. And that sometimes we recognize death is coming. I mean, of course, we know it's coming for all of us sooner or later, but sometimes we know it is barring some extraordinary, unpredictable event, that death is coming soon for someone. And in that sense, if we don't do everything possible to try to prolong life for extra minutes or hours or days, that's not the same as killing somebody. And here I think we're just reckoning with the reality that death is coming and saying, if you're the caregiver, to say, well, how can we try to be as compassionate to this person as possible in his or her last days? And I think if you're the patient, if the patient is in a position to make some of these decisions, then I think the patient can say, well, how can I best glorify God? How can I best serve him with the remaining time that I have, which is going to be short? And then I think we need to start thinking about questions. Well, are there ways that we can reduce a patient's discomfort? Are there ways we can reduce pain? Are there ways that we can enhance mental clarity? And I think if we want people to be able to maybe spend some good time with their spouse, their children or grandchildren, if we want them to get ready for death, I mean, think about the spiritually. I mean, that's getting ready for death, getting ready to meet your maker, that's obviously a weighty, weighty thing. And we want people to be able to pray, I would think, meditate upon the scriptures, maybe to be able to receive the ministry from their pastor or elders or deacons, right? And so if we can do things that can enhance that, even if it doesn't mean maximizing their number of minutes alive, I think that's a way that we can better serve people at the end of life. And I think one thing that deacons can do is to try to help people understand that they don't need to feel guilty if they feel like, well, this person could have lived just a little bit longer if I'd done something else. Well, you don't need to feel guilty about showing maximal compassion and trying to make that limited time they have the most productive that it can be under the circumstances.

Speaker 5: 16:27

Very good. Yeah. Thank you. I remember reading it's kind of a combination of a memoir, but also a case for certain kinds of palliative care by a gentleman from India. It's called Being Mortal, Medicine and What Matters at the End, uh Tool Gawandi. And his dad, once he could not eat anymore in family gatherings, he just said, I just, you know, please, please don't add more intervention now. Because of the sense that fellowship and human interaction was so significant to him. I think deacons having the wisdom, exactly what you're saying, to prepare people to die as Christians, we need to enjoy the Lord. And once we can't pray, once we can't take sacraments, once we can't enjoy some of those means of grace the Lord has given, merely prolonging life, I think uh it's not something that's beneficial. What passages of the Bible, if you were to sit down with a deacon who needed some help, let's say you're the pastor and you're helping a deacon walk through, like they're gonna do a hospital visit and they're wanting to orient a congregant for some of these decisions, what would be some helpful passages of the Bible that you would point them to?

Speaker 3: 17:33

Yeah, it's a good question. It's kind of difficult too, because there's certainly no single text that is, you know, lays out a kind of end-of-life scenario, especially given modern medicine, which didn't exist uh when scripture was written. But at the same time, there are just a myriad of texts that are helpful. And, you know, I mean, I think one sort of text that I think is helpful is just texts that talk about hope. And of course, there are a lot of them. And I think having that perspective when people are facing death and we're trying to help people who are facing death to have that perspective that this is not about defeat. It's not about despair. This is a time to really focus upon that true and living hope that we have in Christ. I think some texts such as, I mean, 1 Corinthians 15, which talks about the hope of resurrection specifically, I think that can be really encouraging. I mean, the last couple of chapters of Revelation, which focus our minds upon the new creation, those are wonderful. And maybe one other text that comes to mind, which is actually it's about something other than death and dying, uh, interestingly. So I'm thinking about the end of 1 Timothy. It's in the last verses of 1 Timothy 6. And actually, Paul is focused there upon wealthy people. He's trying to encourage them to be content. And he has this very interesting line where he tells them to take hold of that which is truly life. I think, well, that's seems to me to be relevant in a lot of different contexts. You know, it's yeah, there are different ways to talk about life, right? And but we need to be focused on what is truly life. And in a sense, what is truly life is living for the Lord, even now, but ultimately it's that eschatological life that's set before us. And so I think that can maybe help deacons to maintain that perspective. It's easy in those moments in which we have, you know, there's pressure to make these really difficult medical decisions. You get kind of narrowly focused on that, but need to keep our bigger focus on what is the true life that is being held out for us as believers.

Speaker 5: 19:39

Excellent. Well, thank you, Tracy, for joining us today. You have faced these things not from a classroom perspective, but very much face-to-face with people that are facing these decisions as in your career as a nurse. Can you just tell us a little bit about the areas of focus in your vocation and then how you came to care for people that were at the end of their life?

Speaker 1: 20:00

Yes. Um, thank you, Adrienne. Over a span of several years, I have a collective quantity of about 12 years of experience in working with mostly the elderly population. I've always loved and been drawn to the elderly. And I served as a home health aide while I was in nursing school, and so mostly saw aged people in their homes. My first job was as a nurse on an adult health medical floor. And I loved my job, loved taking care of people, but I really wondered what I was bringing to the table. I was extremely overwhelmed in that experience. And one day, a really tough charge nurse told me that she had assigned me to a patient that was care and comfort only, who would likely die on that shift because she knew I would stay in the room. And I didn't realize before that comment that there were other nurses that were not as comfortable as I was in getting by as frequently as possible to see about the needs of a patient and their family when they were nearing the end of their life. And so I was encouraged that I was in my right calling and I was helping. I was useful. And so after a move with my husband to a different state, I worked in home health for a while. And then I worked in a family practice medicine and residency program. And I was hired by the geriatrician there to identify homebound population and then to go out with the doctors to help them and to teach residents how. How to make health calls. And so, of course, during those visits, we identified patients' needs. And so I would then help coordinate their care with community services like home health, like hospice and meals on wheels and other things. And of course, we served patients who were near the end of their lives and others who had a while yet to go. And we did our best to try to match them up with a good fit for care for them. I was very fortunate during this time to serve with incredibly compassionate and competent individuals. And my learning curve was maybe exponentially expanded. I felt like I learned a lot in a in a short time and was very motivated to pay attention to people being matched with what could truly serve them best. And I want to mention here, I agree wholeheartedly with everything that you and Dave have stated so far. And in these experiences, I'll share a little bit more about more recently. I did see, I think, some of what David alluded to, where there are some mixed reasons for why a physician or a healthcare individual gives guidance or a lack of guidance in a particular direction. I'll add to that that there are physicians that are in nurse practitioners, physicians assistants, et cetera, who are not comfortable with really telling a person how things really are or could be if they go down a particular lane of a care model. They're just maybe not in themselves okay with the fact that we will die or their patients will die eventually. Maybe they have a fear of death themselves, or maybe if they sense some trouble in a person's spirit or thinking or their family members, they may be hesitant to take the time or not, maybe they're not well equipped to know how to speak into that. And so the real situation sometimes cannot be expressed with those other things in mind, too. A little more about my experience. So I took some time out and had a couple of daughters and was privileged to mostly stay home and raise them. And I did not work in an official nursing capacity for a while, but kind of once a nurse, always a nurse, you know, in your family, your Sunday school class, et cetera. And so I'm grateful for that as well. But in the last almost five years, my experience in nursing included a couple of years as an inpatient hospice nurse and working with a home health company. And so I have firsthand experience of the care and service that these models can render and the limitations of each model as well.

Speaker 5: 25:13

One thing that comes to mind in terms of some of the fears that I think one of the reasons I would assume some people are not willing to talk about end of life, like you say, they're not ready themselves to face death. From our context and thinking about a deacon, sometimes I think we sense when we're moving into a very potentially fearful circumstance, we sense we need to say something that will like make everything fine. And one of the things we emphasize a lot on the Reform Deacon is that the ministry of presence is really important. Being able to show up and listen a lot to people's questions and then ask questions about hard things, like are you ready to die? Or, you know, are there things that you need to be reconciled with your family about, or working through some of those very practical things with family members and helping them grieve kind of in advance is I think so significant. But you've probably seen both good examples of that with families, but then maybe some not so great examples as well.

Speaker 1: 26:09

Yes, I have. And I don't think I answered part of maybe what you had asked me, but I would just with that, I would encourage a deacon by asking them personally, do you know where your help comes from? Thinking about Psalm 121, my help comes from the Lord. And so reminding a patient or their loved ones that you're relying on that help from the Lord and they can also trust the Lord to help is maybe simple, but also perhaps profound enough to be used by the Lord in a situation. And reading the whole psalm is very specific about how continual the care of the Lord is for us day and night. He doesn't slumber, he doesn't sleep.

Speaker 5: 26:58

So true, so true. Coming back to Dave. So as I think about some of the most memorable times with my grandparents, it was those last days that they were still alive. Um, are there things that you're free to share about even in your own family or hard decisions that you had to work through and think through that you could share with our deacons as they try to help congregants work through some of those difficult times?

Speaker 3: 27:20

Yeah, there was a particular time when I and my family had to wrestle with a very, very weighty decision about pursuing an experimental treatment in which it was quite clear that if we didn't pursue it, this family member who was not that old was going to die. It was very experimental. The odds weren't great, and the potential for a very uncomfortable, terrible experience through this experimental treatment was relatively high. And, you know, that was not an easy decision. And as I look back at it, I still don't think there was one right answer. I think that it could have gone either way. And I know that we as reformed people were not ethical relativists. And so we don't really like it when there isn't a clear right or wrong answer. But sometimes in life, that's just the case. We have to use our best judgment with the wisdom God has given to us. And in this case, the decision, I think the decisive one was well, this person was relatively young and had a young child and was willing, in a sense, to take those risks a very, very bad experience. And you might say a very bad death, as opposed to refusing the experimental treatment and having maybe a smoother, easier, but you know, relatively quick death. And the decision really revolved around how can I be of most service and how can I be a good mother to my son? And I mean, the Lord was very, very merciful and she's still alive over 20 years later. And so, in a sense, that all worked out well, even though it was a very difficult experience. But some of the times these decisions don't. In high sight, maybe that wasn't the right decision. And under those circumstances, you know, I think we can learn from those experiences, but I think we also have to recognize that we're not the kind of creatures that can predict the future. And so sometimes we make, we make the best judgments we can and it doesn't turn out as well as we'd hope. And so we just have to ask for the Lord's grace there. But I think here again, you know, it just the the sorts of things that a person needs to keep in mind is, you know, what are if if we pursue a certain sort of treatment or keep certain sorts of treatments going, what are the likely effects on this person? What are the prospects for recovery, not just for living maybe a few more hours or days, but actually some sort of recovery. And again, this I think this idea of you know how we can be of service.

Speaker 5: 30:03

Very good. Yeah. Any examples, Tracy, in your extended family or other anecdotes that could be helpful for deacons as they help congregants make some decisions at the end of life?

Tracey Huyck: 30:13

Yes. In my church family years ago, I journeyed with a couple of women who were diagnosed in a middle-aged state of life, both with breast cancer, and they were faith-filled women. They had Christian families, a lot of church support. They endured treatments and testing with some good success for roughly a dozen years. Both of them had very similar experiences, but each were finally given the news that it appeared treatment options had run out. And one of them chose a home health model, home health care. It's a particular benefit under Medicare, Medicaid, private insurance to help support her with some symptom management, some problems that she was having. She was still hoping that there might be a cure found or some other life-extending treatment that could be rendered. And the other woman chose a hospice care model. And both families were supportive of those choices and involved in those choices. I witnessed their care at the end of life was a provision of the Lord. They both had the experience of limiting suffering. But the loved one who died under the hospice care model had a greater extent of comfort care that matched her need. And she died peacefully in her home. And that was not the experience of the other loved one. And so the grief on the other side of that for the family looked different in the immediate thereafter and is probably still impacted by that today. So that's a hard experience to share about. But I can also say fortunately, I was involved with the care in the final days of three of my grandparents and on both sides of the family. And our family had a history of talking about hard things together, of worshiping the Lord together, of a lot of peace and calm. And so we made decisions that had to be made without any significant disagreement or strife. And all three of my grandparents died under a comfort care model. Two of them were in a hospital, one of them was in a nursing home. All three diagnoses were not terminal in the sense of they had been told months before that they were nearing the end of their lives. They each had acute problems that it seemed good and compassionate to ask for comfort care only in the settings that they were in at that time. So those were thankfully experiences where good family dynamics did end up blessing these loved ones until the end.

Speaker 5: 33:29

Very helpful. Thank you so much. One of the things that I remember reading is that one of the reasons that we don't prepare for death is we don't want to answer the question, how do I want to die? That's a hard question to really think about. One of the ways that book uh that I had read earlier, Atul Gawandis Being Mortal, one of the questions he learned to ask people is, How do you want to live at the end of your life? What things do you value about the very end part of your life? And returning to Dave, I want to ask questions about advanced medical directives. So for those unfamiliar with the term, that's a document that provides guidance to caretakers or medical personnel when a patient is no longer able to communicate. Um, how do you think deacons can coach congregants in those questions? What things need to be kind of kept in mind as people develop some of these documents that will help them make some of these hard decisions when they can't speak for themselves anymore?

Speaker 3: 34:22

Right. I think it is a good thing, generally speaking, for deacons to raise the question and to encourage people to have these documents in place. I think if nothing else, it encourages people to talk about things that it would be good to talk about. I think Tracy alluded to some of this in her earlier comments. And some people just don't talk about this. And so at the very least, potential future patients and family members or other caregivers, at least they can be on the same page and that. And so I think that can be really helpful. And at the same time, in my judgment, I would advise people not to try to be overly specific in their advanced directives. I mean, it's you can't really predict. There's no way you can know exactly what the circumstances are going to be. So you can't think about this as I'm going to draw up a document that's going to anticipate every possible circumstance and have a very set instructions for that. It would seem to me more important and more practical to let one's caregiver, whoever's going to be making these decisions, make sure that person understands how the patient feels, but at the same time leave a fair bit to the judgment of the person making the decision, who can actually take in what's actually going on, the real circumstances, and then hopefully make a good judgment there. And, you know, one thing that I should have mentioned before as well. I think one advantage of drawing up some of these documents is that a patient can actually give some thought as to who do I want to make these decisions for me, because there's there's always going to be some kind of default person that you think, but sometimes the default person is not the best person for one reason or another. Maybe it's not the most mature person or not the person who shares the same spiritual theological commitments. So I think there are a number of benefits, but I don't think that we should be looking to these directives to be able to make every possible decision ahead of time.

Speaker 5: 36:33

Very good. Yeah. Often one of the first steps a deacon might take after learning that a congregant or congregant's loved one is struggling medically is to reach out to family members. This can help provide clarity and foster relationships, but also sometimes, sadly, the relationships we were already struggling with in life, you see the breakdown even in a greater way at the end of life. Do you have any encouragement or ideas of how a deacon can help navigate some of those difficult situations?

Speaker 3: 37:04

Yeah, that's it's certainly true what you say. Yeah, I think, I mean, if if deacons can be a facilitator of relationships with family, and certainly family members generally are going to be want to be involved in some way. And if deacons can try to facilitate that, I think that's really helpful. And if there are, if there are certain disagreements or disputes, especially related to care, then I think if deacons need to be careful about stepping into family debates that they're not really invited into. But I think if if they can try to be mediators, I think that could be really helpful. But one thing that I don't think I'd really thought about this until you invited me on this, in order to think about how deacons especially can be helpful here, is that there's so much stress when you come to the end of life and you've got these big medical decisions. And it's really hard for the people who are involved to be thinking straight and to be, you know, have some kind of objective kind of perspective on this. And it can be really hard to navigate. I mean, even being in a hospital is just stressful in and of itself. And especially if people are not really familiar with how hospitals operate and all that, you know, I think if there are ways that deacons can try to maybe take off some of that pressure or to try to help people navigate through those stressful things and to be at times an objective voice. Not that deacons want to be detached. Of course, they want to be spiritually compassionate and involved in a way, but they might still be able to maintain a certain kind of objectivity that very close family members don't have. And maybe even if the deacon isn't familiar with, say, how a hospital operates or how you deal with an insurance company, if that sort of issue arises, maybe the deacon can help bring someone else in from the church. You know, maybe there's a doctor or nurse in the congregation or someone else with experience who can kind of take some of that burden off. I may be going a little bit beyond what you're asking here, but while I'm thinking of it, I think it's worth saying that it's usually not just the patient or the dying person who needs to be ministered, but often the caregivers need to be ministered to as well. Oftentimes, caregivers, you know, they don't, they're not sleeping well, they're not eating well, they're neglecting their own affairs because they're so focused on this. I think deacons, it'd be really good to expand their perspective to be not just helping the dying patient, but also the caregivers to try to minister to them in ways that they're maybe not able to care for themselves during very stressful time.

Speaker 5: 39:41

Yeah, I went on a hospital visit in the last year for a congregant who thought that they had a sinus infection, and it turned out to be a very aggressive tumor that would take their life in like three or four weeks. They died very quickly. And just being able to walk alongside this soon-to-be widow, it was difficult because they had not thought through should we do in-home care hospice, should we, you know, what coverage do we have for these kinds of things? And I think just having any kind of people present for the family was very, very significant. Tracy, could you, from your experience, could you explain some of those different categories and maybe help prepare people if they were in a, if a deacon's in an emergency situation, maybe someone's not that old or in their 50s or 40s, and they get hit with a sickness that will take their life relatively quickly. What are some options that people have for different kinds of care?

Speaker 1: 40:30

Yes, I think a deacon or any church loved one can help someone by asking them questions about the input that they are receiving from their physician, maybe from their nurse, or there are terms that may be less familiar to someone, a care manager or a medical social worker. If they're in an emergency room or a hospital or even a doctor's office, there are people that are trained there to do the work for you of determining what costs will be, what options are, what a fit may be for you. And so if you can help someone recognize this term home health, this term hospice, this term prognosis, these things are coming up. If you ask them questions about those, like what is the doctor saying about your treatment options, your prognosis, your available services? What is the social worker saying? Sometimes when a person, the patient themselves or a family member has to repeat that back to someone, they recognize what has been told to them, or maybe where their knowledge deficits are, or where they are actually struggling to grasp the situation or make a decision. So sometimes just asking them, what have you been told? What are your available helps can be tremendously valuable to someone.

Speaker 5: 42:07

Because their head is swirling in those moments, their mind and their heart kind of swirling with so many different things going on.

Speaker 1: 42:13

Exactly. And like David said, it's just they're under stress. And sometimes treatment can be delayed, decisions can be delayed if going back to the advanced directive question, if families haven't decided who's going to speak for this person, or even better, in advance, if the person has not given that information. Doctors' offices, hospitals, et cetera, will help you get those forms completed. They can vary a little bit from state to state, but these facilities do have those forms available and can help you get those completed so that those directives can be in place and they can be very helpful. So the hospice model, which we've alluded to, you know, off and on, is actually focused on symptom management instead of curative treatment. And eligibility for this model requires that two physicians agree that if your disease process runs the usual course, that your life expectancy is six months or less. And so that's what makes someone eligible or ineligible for hospice. And the process for determining whether or not that could be a good fit for you would be a physician would recommend a hospice evaluation, and you would get to talk with hospice team members about the care that you would like and find out if that's a match or not. Hospice services include nursing, social work, aid, and spiritual care services. Uh, spiritual care or counseling could be social workers, chaplains, bereavement care specialists, and they are highly specialized in. In knowing both emotional and physical modalities to try to limit suffering.

Speaker 5: 44:06

Helpful. Thank you so much. One of the things that have been very helpful for our deacons, because sometimes we're speaking in abstraction, but we have something called real-world cases where we just give a very concrete example and then ask our guests to help our deacons navigate what they would do in the situation. I'm going to read the prompt and then just have each of you, Dave and Tracy, give what you would recommend. Here is a story of Henry. Henry is a longtime member of your church, was a regular attender until recently. He's approaching his 90th birthday, and for his age, he is healthy. He lives at home alone since his wife Jane was hospitalized after being diagnosed with an aggressive form of cancer. Jane has been in and out of the hospital and she often struggles to understand the seriousness of her condition. Henry and Jane have three children. Two of them live nearby and ten grandchildren who visit infrequently. Their daughter Sarah is one of the most involved in Jane's care, but often disagrees with Henry about medical decisions. Henry comes to you as a deacon in the church. He's feeling overwhelmed by the medical complexities and decisions that need to be made with confusion over Sarah's input and is unsure of next steps. Starting with Dave, how would you begin orienting this congregant?

Speaker 3: 45:14

It's a pretty detailed scenario you gave, but I would still want more details. I think it might be the case that if the deacons know this man well because he's been a member of the congregation for a long time, and maybe they don't know the daughter, that instinctively they would think, well, the daughter is interfering, the daughter is messing things up. But that may not be the case at all, especially if Henry is very elderly and he may not be as sharp mentally as he was. And of course, he's also probably the most emotionally involved and invested. And it might be that the daughter, who is younger and maybe a little bit, maybe able to be a little bit more objective and maybe a little more familiar with really what's going on medically. It's possible that you might think, well, you know, maybe this gentleman, he needs to back off some of his objections to his daughter and maybe real stress reliever for him to be able to hand over some of these decisions to his daughter. But then again, maybe that's not the case. And, you know, maybe the deacon can facilitate a sort of cordial meeting of for trying to work through a strategy for treating this wife and mother. So I think that's one thing that really strikes me might be really helpful for a deacon to do. I I think also it'd be really worth for the deacons to ask about how this gentleman is doing himself. And, you know, is he getting the proper care for himself that he needs during this time? And maybe that he was very reliant on his wife for a lot of practical things and whether he's eating sufficiently and our bills getting taken care of. I who knows. And so some of the stress that he is feeling might not be only related to trying to care for his wife, but even other things that are going on as well. So there's certainly more that might be said. But I think those are a couple of things that deacons would probably be wise to be alert to in this kind of a situation.

Speaker 5: 47:23

Yeah, that's very helpful. Any uh other thoughts, Tracy?

Speaker 1: 47:27

Yes, I want to emphasize that this scenario is about a patient who is in the hospital and she has an aggressive form of cancer. She's in her 90s. Her body is not apt to endure lengthy aggressive treatments at this point or to respond as readily as someone who is maybe years younger would. And just adding on to what Dave said, we don't know in this scenario what the conversations between Henry and his daughter are. And so it is important to try to enter in to learn what is going on objectively here. And yes, getting them together would be the ideal scenario. And posing the questions of, well, what does Jane want? Or what do you think Jane would want? Having loved ones say that out loud can be incredibly impactful. And then asking each of them, what do you want? And then working to try to bring peace and agreement with those goals, those wants. I want to add here that determining someone's wants, their goals, their hopes is very important because people are facing and their families do face critical decisions at various ages and stages of life. It's not always the elderly person that knowingly approaching the end of their life, likely. And so it's always important to ask, what are your goals? What would you like? Sometimes the younger person, maybe especially, wants to see that grandchild get married or take one last trip to their hometown, or there may be something that they are working toward or hoping toward. And that could change along the way if they continue to ask for and participate in treatments that would seemingly prolong their life. But you need to know from them what their hopes are. And at any age too, a hope could be I really just want to die at home, whether that's sooner or later, whatever model of care will help that likely be accomplished is all I want. So just finding that out from them and their loved ones is super important.

Speaker 5: 50:01

Excellent. Thank you so much. One of the things that we try to do is provide resources. So if a deacon feels both encouraged by this conversation but wants to go deeper, I'll mention some of the books that Dave recommended we look into as we were thinking about this. One is Bill Davis Departing in Peace, Biblical Decision Making for the End of Life. He references a PCA study committee report on end of life and kind of emergency decisions that I would recommend our listeners uh look up as well. We have, of course, Dr. Vandrunen's book, uh, Bioethics and Christian Life. I know that he will not commend his own book, but I really, really grew a lot in seminary reading that book and uh just would very much encourage our deacons to read that book, Bioethics and the Christian Life, a guide for making difficult decisions. And then I mentioned Catherine Butler, who is a critical care nurse in the ICU between life and death, a gospel-centered guide to end of life medical care. She has written a few articles for Gospel Coalition and other outlets that are helpful. And then Gilbert Mylander's Bioethics, a primer for Christians. Any other, maybe shorter length articles or books that have been helpful, Dave, that you would encourage deacons to look up, other things that come to mind that you think would be beneficial?

Speaker 3: 51:13

I would certainly focus on the Bill Davis book and probably secondarily Mylander. Excellent.

Speaker 5: 51:19

And then I stumbled on a little memoir. I often find I learned things through stories that I don't always pick up through reading other forms of books, but Paul Callinithi was actually a brain surgeon who himself developed a brain tumor that would take his life. And the moment that sticks with me in the story that the book is called When Breath Becomes Air, is there's all these different specialists weighing in and disagreeing. He's not completely lucid himself, but they're all disagreeing about what decisions to make for his own care. And it's very difficult to process, even for his own wife, young husband and wife. Actually, the wife ends up writing the last two chapters because he ends up dying from that brain tumor. But I think it's helpful just to kind of envision some of the complexities that that come up. I was helped by that little book. Any other things that you wanted to say that we didn't get to or questions that you would want deacons to consider before we wrap up?

Speaker 1: 52:10

Well, Adrienne I'd also like to endorse bioethics in the Christian life. Dave, I found that to be incredibly helpful to me personally and professionally. So thank you for that. And I've also read the book that you just referred to, Adrienne When Breath Becomes Air. And that is a powerful autobiography. And a booklet that was presented to me during my tenure at the family practice residency program that I was in is called Hard Choices for Loving People by Hank Dunn. He is a seminary graduate, a chaplain. He really speaks to what choices, what your choices are likely going to be when you're facing a terminal illness and what the truths about those choices actually, factually are. Dave mentioned earlier how we tend to want to feed people because we love them. But if they are in their final days, that actually can be harmful and not the loving thing to do. And so Chaplin Dunn explains in good detail about how God made our bodies and how, as he is bringing a close to our earthly days now that he designed our bodies to shut down in an orderly way and how we can make decisions about where a person is, what to do, and what to expect and what's really going on inside of their bodies with the decisions that we're making. And I will add with that, we talked about advanced directives like naming someone to help make decisions. Another really important decision to think about ahead of time is whether or not you would want CPR, cardiopulmonary resuscitation. That's really important for you to think through in advance because you will be asked, do you want to be resuscitated? Do you want to be DNR, which is do not resuscitate status, or do you want us to perform CPR when your heart stops, when your breathing stops? And so that's also an important ad to address that in advance. And if people can do that personally, that will take a burden off of their loved ones and impact their care. Because again, all of these decisions beforehand and in the moment can either enhance care or delay care.

Speaker 5: 54:35

Thank you so much. Dave, any uh thoughts or things you wish we would have asked you or things that come to mind?

Speaker 3: 54:40

I think I would just say that I think for a lot of deacons, this will be the kind of area that they'd prefer to avoid. And it's difficult, it can be uncomfortable. And at the same time, this is going to be one of the most spiritually meaningful and perhaps just materially needful times in a person's and in a family's life. And I really commend deacons who are have the courage and the love to take up this kind of responsibility and to know that even if they don't always know what to say or if they feel confused about what to do, the love that they show to people during these times will be much appreciated and blessed by the Lord.

Speaker 5: 55:22

So true. Unless the Lord returns, every one of us will need to be cared for in the church through the time of our death. Maybe one encouragement comes to mind if a deacon is the only deacon, we have a lot of congregations throughout the denomination where there's one deacon, and it may feel like very overwhelming that this is something falling on their shoulders. I have started serving on our Presbytery's diaconal committee, and there's a lot of just encouragement and wisdom and being supported by other deacons. And then also we do have the National Diaconal Summit coming up, which is an encouragement for the thousand deacons in the denomination to come and be trained in issues like this, share information with each other, pray with each other. So just another reminder that we're not alone in our work. Well, I'm so grateful to both of you. I hope our listeners have gained some insight and feel strengthened, encouraged to continue ministering to congregations as people walk through end-of-life decisions, and the Lord calls these dear people home. Thank you, Dave. Thank you, Tracy, for joining us today.

Speaker 1: 56:15

Thank you so much. God bless you.

David Nakhla: 56:19

Thanks so much for joining us. Special word of thanks to our producer, Trish Dugan, who works faithfully behind the scenes to bring this podcast to you. Be sure to visit our website, thereformdeacon.org, where you'll find all our episodes, program notes, and other helpful resources. And we hope you'll join us again soon for another episode of the Reformed Deacon Podcast.