Gordon H. Cook Jr.
Departing in Peace: Biblical Decision-Making at the End of Life, by Bill Davis. Phillipsburg, NJ: P&R, 2017, xx + 300 pages, $19.99 ($15.00 direct from P&R).
Most of the readers of Ordained Servant are interested in redemptive-historical biblical interpretation, Reformed theological issues, and Presbyterian polity. A book on advanced directives for healthcare probably does not fall within your normal reading list. But this book is not only worth adding to your list, it’s worth reading! If you or a loved one is facing end-of-life issues, you should read this book now!
An advanced directive is “a legal document (as a living will) signed by a living, competent person in order to provide guidance for medical and health care decisions . . . if the person becomes incapable of making such decisions” (275). All of you should have an advanced directive (a living will or a durable power of attorney for healthcare) on file. These documents identify the person or persons you select to make decisions for you when you are no longer able to do so for yourself. They also give indications of what you might want when it comes to difficult decisions concerning the end of your earthly life.
Dr. Davis, a professor of philosophy at Covenant College and adjunct professor of systematic theology at Reformed Theological Seminary, not only makes a compelling case for filling out such a document, but also guides us through the biblical principles for making these important decisions. At many points this is Reformed apologetics put into practice in the real world.
Davis builds upon the study committee Report on Heroic Measures by the Presbyterian Church in America in 1988, an excellent report, though now somewhat dated. He illustrates his points with lessons drawn from the death of his father and his work on an ethics committee and as an ethics consultant for a local hospital. These case studies are clear, pertinent, and quite poignant. His reflections on these cases are insightful and allow us to see the possible consequences of the various decisions we are asked to make when filling out an advanced directive or when facing similar situations in our own lives or the lives of someone about whom we care.
In chapter 6, “Money and End-of-Life Decisions,” Davis deals with the thorny issue of the costs of healthcare and our ability (or inability) to pay for the treatments that may be offered to us. Often this important subject is omitted from discussions of decision-making at the end of life. Who can possibly figure out what our insurance policies will cover, or foresee the consequences of going without adequate health insurance? He calls for Christian accountability for the promises we make regarding these matters (legally laid out for us on the documents we glibly sign as we are being admitted to a hospital). He speaks with gentleness and compassion about the challenging impact finances should have on medical decision-making.
If you want glowing reviews of Davis’s book, the endorsements inside the front cover and on the back cover read like a who’s who of Reformed scholars and medical professionals. I would add my whole-hearted endorsement to this list.
Thus, I am reluctant to say anything that might be construed as negative about an excellent book that is well worth your attention. But just as Davis notes how the PCA Report on Heroic Measures is now dated, so also his own work is quickly becoming the same. While all of us should have an advanced directive, which addresses our desires at the end of our lives, persons who are approaching the end of their lives should also fill out a POLST. POLST forms are medical orders signed by a physician that deal with end-of-life treatments. Because it is signed by a physician, the POLST form has far greater authority in medical circles than an advanced directive. It is also more broadly accepted by other states and nations, though not completely so. For me, the most important advantage of a POLST form is that you (or your loved one) are having these important conversations with a medical professional, ideally your family physician, a person who knows you well and knows how to translate your desires into the language of healthcare professionals in a way that will gain their attention and compliance. Most people approaching the end of their life should have both an advanced directive and a POLST form (or your state’s equivalent). The POLST will focus sharply on the end-of-life treatments that you want or don’t want under various circumstances. The advanced directive can, and often does, include a broader range of desires, including how you would like your body interred after death, funeral planning, and similar concerns not addressed by a POLST.
Another minor concern is Davis’s handling of the subject of hospice, something he mentions only a couple of times. Recognizing that hospice availability varies considerably from location to location, it is still an important and underused benefit for those approaching the end of their lives. Hospice is not primarily about a facility for the provision of terminal care. It is rather a Medicare benefit to which you or your loved one are most likely entitled. This benefit can help you financially, as well as medically, in the final six months of your life. Hospice ideally involves a well-established team of medical professionals (doctors, nurses, social workers, chaplains, and volunteers) who are all focused on keeping you comfortable and helping you to live as full and satisfying a life as is possible right up to the moment that God calls you home. They also support your family or care providers to make their efforts more successful. Sometimes this does involve an inpatient stay at a hospital or hospice facility to address certain symptoms. But more often, hospice supports patients so that they can die peacefully in their own homes. There were several illustrations offered by Davis, particularly involving financial issues, that could have been resolved far more favorably by at least considering how dying at home on hospice provides a more affordable and comfortable end of life. It can assist you or your loved one in glorifying God right up to the final breath.
Please do not construe the two concerns that I have expressed as in any way lessening the importance or quality of Davis’s treatment of decision-making regarding the end of life. You will find his book helpful, even if you are not yet ready to fill out an advanced directive for yourself. It will help you to be more sensitive to and supportive of the decisions of others in your congregation or family who are experiencing these end-of-life issues.
POLST stands for Physician Orders for Life Sustaining Treatment. US federal agencies often refer to this as a SAPO (State Authorized Portable Orders). Regretfully different states use different titles for these orders. Some states are still in the process of adopting a POLST standard form. POLST (Physician Orders for Life Sustaining Treatment) CA FL GA IL HI ME MI MT ND NE NH NJ NV OR WA WI; POST (Physician Orders for Scope of Treatment) ID IN MI MS SC TN VA WV; MOLST (Medical Orders for Life Sustaining Treatment) AK MA MD NY OH RI; MOST (Medical Orders for Scope of Treatment) DC KY NC NM TX; TPOPP (Transportable Physician Orders for Patient Preference) KA; COLST (Clinician Order for Life Sustaining Treatment) VT; DMOST (Delaware Medical Orders for Scope of Treatment) DE; IPOST (Iowa Physician Oder for Scope of Treatment) IA; TOPP (Transportable Orders for Patient Preferences) MO; AzPOLST (Arizona Provider Orders for Life Sustaining Treatments) AZ; LaPOST (Louisiana Physician Orders for Scope of Treatment) LA; OkPOLST (Oklahoma Physician Orders for Life Sustaining Treatment) OK; PAPOLST (Pennsylvania Orders for Life Sustaining Treatment) PA; WyoPOLST (Wyoming Providers Orders for Life Sustaining Treatment) WY; For additional information please visit www.polst.org.
Gordon H. Cook Jr. is the pastor of Living Hope (formerly Merrymeeting Bay) Presbyterian Church (OPC) in Brunswick, Maine. He coordinates a pastoral care (chaplain) program for Mid Coast Hospital and its affiliated extended care facility and has an extensive ministry as a hospice chaplain with CHANS Home Health in Brunswick. Ordained Servant Online, August–September 2019.