Rebekah Moffett, Communications Officer at Christian Concern, raises some of the questions about death we should be asking during the coronavirus crisis.
As the world faces the effects of the coronavirus, we each have our own issues to contend with: isolation, lost income, food shortages, loneliness, school closures (and now potential home education), cancelled events, disappointment – and the risk of death.
The crisis is becoming such that we all know someone who has been affected by it – whether they’ve had to go to hospital, been submitted to intensive care, or have sadly lost their life to the virus. Death is becoming increasingly real.
To a world that has constructed a life that denies death, this is an uncomfortable reality to be faced with. For many, the prospect of dying is filled with fear and the unknown. Many put off talking about death for fear of appearing morbid, or upsetting friends and family. We don’t like to face our own mortality because it represents a loss of control over our lives, separation from loved ones, frustration at a loss of hopes for the future. It leaves things undone. Death is ugly.
But we must all wake up and face our own mortality.
Time to start addressing death
The truth is that no health service is going to be able to save everyone. With well over 160,000 confirmed cases and more than 26,000 deaths in the UK, death seems to be staring us in the face. Reportedly, some 50% of those who end up in intensive care do not survive. Care homes have now become the front lines of the fight against coronavirus, with an estimated third of deaths taking place in nursing and care homes. But many of us will also have heard the stories of the young and healthy who have sadly lost their lives, and the heart-breaking tales of people saying their last goodbyes over video calls.
The truth is that until Jesus returns, we live in a world with a 100% mortality rate. One day, it will come for us all, whether we are ready or not. We can’t know how it will affect us, we all live with the uncertainty of it. So how do we address it?
It is important to face the reality of death before it is too late. Reports still say that many of us will at some point catch the virus – most will survive – but for some, death will come. And once breathing becomes too difficult, the brain becomes starved of sufficient oxygen, making it harder to think rationally and make life-changing decisions. This is why it is best to plan for the worst now, before it is too late.
Questions that need answers
The Wilberforce Publications book Talking About Dying offers practical and spiritual guidance to those facing the death of a loved one or their own terminal illness. Chapters 2, 4 and 10 all address the fear which stops us talking about death, and Chapter 11 offers a prayer for healing.
As everyone faces the reality of death in these times of crisis, it is helpful to answer some more practical questions to help you deal with it head on. For example, how would you wanted to be treated in hospital? Would you even want to be treated in hospital? What do you want to happen after your death? Have you written a will? Who will pay for your funeral? How can your family and friends best say goodbye if and when the time comes? Have you told your family you love them? Talking About Dying gives some guidance into answering these questions.
Choosing to stay at home
Some, particularly the elderly or those who are already terminally ill, may choose to stay at home if they catch coronavirus. This is a decision worth making before it is too late so that family, friends and doctors know the best course of care to take for you.
If you do choose to stay at home, there are still options for treatment and medications are still available to you to treat the breathlessness. The advantage of staying at home, for those who already have underlying health issues, is that it allows you to remain in the comfort of your usual surroundings and have family close by – although the usual guidance about social distancing and protective equipment should be followed to limit the spread of the virus. On the other hand, those who choose to be admitted to hospital will likely be separated from family, with visiting restricted or even banned to preserve the health of staff and other patients. Hospital admission does not guarantee survival, but the advantage is that staff will be honest about the chances of surviving the virus.
Choosing treatment in hospital
If you choose to be treated in hospital, there are also obvious advantages, such as having doctors available to you and treatment on hand all the time. If you become sick enough to need a ventilator, it will be easier to set up ventilation at hospital. However, whether or not you would want this treatment should be considered beforehand and discussed with your family.
This choice should not be seen as stealth euthanasia; rather there is no guarantee of survival if you are put on a ventilator. The invasive treatment is generally used for patients that doctors believe have a good chance of recovery and to prolong life rather than prolong death. There is no guarantee that having recovered through use of a ventilator, life will ‘go back to normal’. Often, patients who have used a ventilator to recover can suffer long-term health issues, such as breathing difficulties or in more extreme cases, the failure of other organs.
If you do become sick enough to need a ventilator, there are several possibilities as to what might happen. Ventilators are not offered to everyone, however if the ICU consultant believes that the patient would benefit from ventilation and be able to recover from their lung disease, then the patient will be offered it. On the other hand, if the ICU consultant thinks that death is unavoidable and being given a ventilator would only prolong the patient’s death, a ventilator will not be offered.
Between these scenarios lies a third: if the patient has underlying health issues already, or has become so damaged by the virus that the doctor is unsure how well they would live if they do survive, it would be up to the patient’s own discretion as to whether they went on a ventilator. This is why it is so important to discuss and decide before this happens – once you are sick enough to need a ventilator, you are in no fit state to make these potentially life-altering decisions.
How to inform people of your decisions
There are various ways that you can make sure you get the desired treatment either at home or in hospital.
The first way is to make a legally-binding Advance Decision to Refuse Treatment (ADRT), which is written by you, signed by you and signed by a witness. If you choose to take this option, you should make sure that your family, carers and any health and social care professionals know about it and where to find it. You can also keep a copy in your medical records.
You can also appoint Lasting Power of Attorney for Health and Welfare (LPA – H&W) to someone you know and trust. This is a legal document proving that the patient has given you control over decisions about what should happen with his or her medical care.
A simple consultation with your doctor can also be had. This is not legally-binding, but if and when the time came to make big decision about your treatment and care, your doctor would have to make a Best Interests decision on your behalf, based on what you have previously told them.
In any case, this is a conversation to have before it is too late so that you, your family and your doctor are all prepared in a worst-case scenario.
Nobody should feel pressured to end their life
This is not the same as asking for euthanasia or assisted suicide. Refusing treatment does not equate to asking someone to end your life prematurely or asking someone to help you do it yourself. If you become sick or catch the coronavirus, there are provisions that can be made for you to be cared for either at home or in hospital, and it remains illegal to help someone end their life prematurely.
The government has recently confirmed that it will not be reviewing the law on assisted suicide, which should give some reassurance to the elderly those and with underlying health issues who are afraid of becoming ill and being ‘a burden’ to their family or the NHS.
It also means that nobody should feel pressured into refusing treatment. Life is precious and a gift from God. Although we should not fear death, decisions about refusing treatment should not be taken lightly.
Caring for the sick
As more information becomes available, many of the sick and elderly are choosing not to be treated in hospital, wishing to spend their last moments with someone they love. This time should serve as a call to care for those who are suffering.
Although we must take seriously our responsibility to adhere to lockdown guidelines and social distancing, we should also be making provisions to care for those who become ill. Especially as Christians, the risk of death should not scare us. We must think carefully about how we can care for those who are older in our families, churches and communities. Can we shop for them? Can we offer them company? Can we pray with them?
Hope in the face of death
As Christians, we have an extraordinary hope in the face of death. Death is not the end for us; Jesus is not dead, his death paid the penalty for our sin. And his resurrection proves it, giving us hope that death has been defeated.
In talking about dying, we must also remember the glorious hope of the gospel. The gospel is not simply about the forgiveness of sins; it is not simply about how much God loves us; the gospel also gives us a lasting, living hope of resurrection from the dead and of everlasting life with the Almighty.
When we are confronted with our own mortality, the urgency of the gospel message becomes even more apparent to us. There will no doubt be those we know and love who don’t have the same hope that we can have as Christians. This is why it is not only important to talk about the practical realities of death and dying, but also to answer the deeper questions of ‘what happens when we die?’ and ‘where do we go when we die?’ As Christians, we are in a privileged position, as we have the answers!
As followers of Jesus Christ, we are the only ones who can speak truth into these questions – and as the whole world is faced with the reality of death, now is the time to give the world the answers they are looking for. But we cannot ignore the warning that the gospel gives us, either: those who reject Jesus will suffer a fate much worse after death. In John 11:25, Jesus tells us: “I am the resurrection and the life. He who believes in Me, though he may die, he shall live.”
The gospel really is the difference between life and death. Which is precisely why we should encourage talk about dying – because in it, we can point to a living hope.