Here is an excerpt taken from Departing in Peace: Biblical Decision-Making at the End of Life by Bill Davis.


Authority to Direct Our Own Lives

As image-bearers, we each have the authority to make the choices necessary to steward our own talents and opportunities. These choices are not made in isolation from our family and others, but we will be held ultimately responsible for serving Christ well. Our health affects our ability to use our time and talents, so the many choices we make about diet, sleep, exercise, and medical attention are a vital part of our stewardship task. Luke 12:35–48 recounts Jesus’ words about our obligations as servants awaiting his return. All our choices are included. The following biblical principle is foundational to end-of-life decision-making:

Servant Authority to Make Medical Choices: God’s Word teaches that every adult has the authority to accept or decline medical attention as part of his or her responsibility as an image-bearer of God. (The authority does not reside in each of us absolutely. The authority is delegated to us by God as his servants.)

This principle is foundational because it sets limits on the choices that we are authorized to make. We are not authorized to make choices that are contrary to God’s revealed will. Our choices are to serve God’s purposes in the world. Most of the time, our own health needs and God’s purposes overlap: we serve God faithfully by making choices that serve our own needs as well. Living according to God’s law is always what is best for us.*5 At times, though, we can ask questions that God’s Word does not answer with a simple yes or no. When that happens, we are still guided by what the Scriptures teach about God’s priorities for us. Living as faithful servants means eagerly seeking to understand what the Master loves and living to realize his purposes rather than living to please only ourselves.

Even when deciding about medical treatment for ourselves, our authority is not absolute. We have the authority to choose according to God’s values. We are stewards of the lives that he has given us. An important implication of seeing our authority this way is the limit that it places on those who make choices for us when we cannot. At some point in our lives, many of us will be too sick or confused to make choices about our own care. When that happens, someone else will have to step in and make choices for us. That person’s authority to make those choices comes from us, and our authority comes from God as his image-bearers. Using myself as an example, someone who speaks for me in making a medical decision is responsible for saying what I would say if I could understand the question and express an answer. This is what both God’s law and the states’ laws expect if someone is going to speak as a surrogate decision-maker or agent.

Extensive knowledge of what I value and what I hope to gain from medical attention will equip my surrogate decision-makers to choose for me. Years of conversations with me about my health challenges and the choices I have already made will also be helpful. Written instructions that anticipate decisions that are likely to arise will be golden. In order to prepare others to make decisions that carry on my effort to be a faithful steward of all I have, I have been thinking through the decisions that may be coming and have left instructions to inform my surrogates. The Bible teaches that we all have the authority to look ahead and anticipate choices in this way. This is implied in Paul’s instructions in his letters (see, e.g., Col. 4:10). Applied to medical treatment, this is the biblical principle:

Authority to Make Choices in Advance: God’s Word permits us to accept or decline medical treatment in advance, including leaving an advance directive or other instructions. These instructions are binding if they conform to God’s law.

As obvious as this authority may be, it is important to spell it out. Just as the authority to accept or decline treatment is only that of a servant’s authority to pursue his Master’s purposes, our surrogate’s authority is only that of a spokesperson seeking to pursue our purposes. If our values and desires are not known, our surrogates will find it difficult to make choices with confidence. They will have to guess what we would want, sometimes in the midst of a medical crisis when a quick decision is needed. No matter how much time they have, they will also have to wonder whether their own selfish desires and fears are the source of their guesses about what we would say. Genesis 50:25 reports that Joseph gave instructions about taking his bones back to the land of his fathers, and Exodus 13:19 tells us that his instructions were remembered. The value of decisions made in advance is another biblical principle:

Advance Directives Can Be a Blessing: God’s Word encourages us to take steps to remove unnecessary distress from those we love and ought to honor. Legally executed advance directives diminish the burdens of fear and indecision from all those who will have to make medical decisions for us if we cannot make them for ourselves. Advance directives clarify who is to decide if we cannot, and they reduce the need for anyone to guess about our wishes.

Just how great this blessing can be for our loved ones will be illustrated by the situations that are described in the next two chapters. Detailed instructions about completing an advance directive will be given in chapter 5.

As long as we are able to make decisions for ourselves, instructions for our loved ones and agents are not crucial. In the hospital, these instructions start to matter when a doctor or a nurse determines that we lack decisional capacity.

*5. David Clyde Jones, Biblical Christian Ethics (Grand Rapids: Baker, 1994); Cornelius Plantinga, Not the Way It’s Supposed to Be: A Breviary of Sin (Grand Rapids: Eerdmans, 1995).