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I drew a breath and said a quick prayer as I stepped into the last room of the ICU. There in the bed, my sickest patient hovered in that shadowy existence between life and death. Bruises mottled his arms as blood leached into his tissues. Although a formidable array of medical machinery hummed around him, his organ function continued to dwindle. He was dying.

In the dim light, I barely discerned the silvery lines staining his wife’s cheeks as she sat beside him. She’d been crying for a while. “He’s the one who usually helps me with hard things like this,” she said. Finally, she looked at me, her expression weary and pleading. “I wish God would just tell me what to do.”

Crushing Dilemmas

Such pleas echo in the rooms of every hospital, as the landscape of death and dying has shifted dramatically over the past 50 years. A century ago, almost 90 percent of people died at home, among families, in the communities that helped shape their lives. Dying was something familiar and recognizable, tied to its spiritual significance.

Now, almost 60 percent of Americans still voice a desire to die at home, but only half of that number do. The majority of us now draw our final breaths in hospitals and long-term care facilities, and up to 29 percent of Medicare beneficiaries die in an ICU.

The medicalization of dying often thrusts loved ones into harrowing ordeals. Up to 70 percent of people can’t vouch for themselves at the end of life, and in such cases, the burden of decision-making falls to loved ones already reeling with fear and grief. The toll on families is heavy; loved ones often suffer from depression, anxiety, and even PTSD for up to a year after making end-of-life decisions.

The medicalization of dying often thrusts loved ones into harrowing ordeals.

When we place our faith in Christ, we draw from a well of hope that can sustain us through the hardest medical ordeals. Yet when grappling with end-of-life decisions, even lifelong disciples of Christ can enter murky waters. God’s timing seems indistinct when machinery blurs the boundaries of life and death. The ever-expanding practice of physician-assisted suicide—now responsible for one in every 20 deaths in Canada—further confuses the issue. What’s God’s will? We ask. What does the Bible allow? Lord, what should I do?

Four Guiding Principles

The Bible remains a lamp to our feet and a light to our path even in the ICU (Ps. 119:105). Although Scripture doesn’t explicitly mention CPR or ventilators, it does offer key guidance on the sanctity of mortal life, God’s sovereignty over life and death, mercy, and our resurrection hope.

These four truths can provide a framework as we strive to honor God at a loved one’s bedside.

1. Sanctity of Mortal Life

As beings created in God’s image, we each possess irrevocable value (Gen. 1:26). Stewardship of God’s creation requires special concern for human life (Gen. 1:28; Ex. 20:13; 1 Cor. 6:19–20).

The sanctity of mortal life mandates that we advocate for the unborn and safeguard against physician-assisted suicide, and when struggling with an array of decisions about life-supporting measures, we should consider treatments with the potential to cure.

2. God’s Authority over Life and Death

Although God directs us to honor the life he has created, he also reminds us of its fleeting nature (Isa. 40:6–8). Death persists in this earthly kingdom as the wages of our sin (Rom. 6:23), and until Christ returns, it will overtake us all (5:12).

When we blind ourselves to our own mortality, we risk dismissing the power of God’s grace in our lives through Christ’s resurrection. The sanctity of mortal life doesn’t refute the inevitability of death and God’s work through and authority over it.

3. Mercy and Compassion

As Christians reflecting on God’s grace toward us in Christ, we’re to extend mercy toward the downtrodden and afflicted (Luke 6:36; John 13:34; 1 John 3:16–17). Mercy doesn’t justify active euthanasia or physician-assisted suicide, but it does guide us away from aggressive, painful interventions if such measures are futile.

4. Hope in Christ

So vast is God’s love for us that in Christ, nothing—not even death!—can pry us from him. Even as we suffer, we savor the promise of the resurrection of the body and the hope of eternal union with God (John 11:25–26; 1 Thess. 4:14). Although we die, we’re alive in Christ.

Seek Discernment

These principles appear straightforward on paper but tangled and messy at the bedside. A key question can help decipher them: Is the process that’s threatening my loved one’s life reversible? Phrased another way: Does treatment promise preservation of life or prolongation of death and suffering?

When we place our faith in Christ, we draw from a well of hope that can sustain us through the hardest medical challenges.

It’s crucial to clarify that life-sustaining measures are supportive, not curative. Ventilators, CPR, and similar interventions don’t cure disease but rather buy time, supporting organ function while doctors work to treat the underlying illness.

To discern whether such measures promise to be life-saving or death-prolonging, ask the medical team questions about the underlying threat to life and the chances for recovery. When recovery is possible, pursuing treatment is appropriate. In contrast, when a disease cannot be cured or even improved, aggressive measures can prolong dying and inflict suffering needlessly.

Even as you wrestle with grief and uncertainty, don’t despair. While the weight feels so crushing, when you give your dying loved one a voice you offer a parting gift. You regard him or her as an image-bearer of God worthy of love, and in so doing, you serve as Christ’s instrument (John 13:34–35). You serve the One who has already swallowed up death in victory (1 Cor. 15:54). And although for now we groan (Rom. 8:22), he’s making all things new—even our bodies that now groan and fade away (Rev. 21:4–5).