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LCMS 2026 Convention Workbook: Reports and Overtures, PDF page 234

2026 Convention Workbook
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THEOLOGICAL DOCUMENTS  —COMMISSION ON THEOLOGY AND CHURCH RELATIONS
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human care and is not given as treatment for any life-threatening disease. Since this is true, a decision not to offer such care 
can enact only one intention: to take the life of the unconscious person. ”94
We do not know what spiritual communion God may or may not have with a person in a persistent vegetative state. 
/T_hat some have recovered and resumed relatively normal lives makes it dangerous to presume that we are merely sustain-
ing a biological shell rather than keeping a person alive.
95 However, whether we are physicians or nurses attending to a 
patient, family members called to bear the in/f_irmity of their loved one, or even the patient himself or herself in a persistent 
vegetative state, we are all still God’s creatures, “the instruments by which he provides and preserves life. ”
96
B. Who Decides?
/T_he annals of medical ethics are full of accounts of debates over who should be the decider. /T_he popularity of living wills, a 
topic we will consider in the next section, is in large part a reaction to the fear of physicians imposing their own values and 
ideas upon the end-of-life decisions. Some doctors will err on the side of determining that the patient is a “lost cause” and 
act accordingly. Others will opt for every treatment conceivable, whether it is prudent or not. Complicating this scene, we 
have questions regarding whether physicians may ethically object to performing particular procedures, even against their 
consciences and religious beliefs. An in/f_luential article in the New England Journal of Medicine
 argued that physicians freely 
chose to enter the /f_ield of medicine and that “conscience clauses” should not be permitted.97
Most people probably agree that patients are not obliged to submit themselves to every recommendation by a phy-
sician, even their own. Nor are doctors required to follow bad medicine or unethical practice no matter how strongly 
their patients plead for it. We would want patients and their physicians to discuss and deliberate on how to proceed with 
a course of treatment. /T_his should include a candid disclosure of the potential risks and the rewards attendant to it. But 
what if the patient cannot participate in such a conversation due to the temporary effects of a traumatic injury or a chronic 
case of dementia? Case law has tried to answer that hypothetical case with advance directives and “substituted judgment” 
criteria. What would the patient have wanted us to do if she were of sound mind and capable of making her wishes known? 
But does this approach resolve the dilemma of decision-making? 
C. Advance Directives
Much of contemporary thinking about end-of-life decision-making has accepted a rather simplistic resolution to a difficult 
problem. /T_he solution is that the patient alone decides on the care to be received. Given this assumption, a further question 
is how a patient is to be treated if he is no longer capable of decision-making. /T_he answer proposed is that individuals 
should write down their wishes regarding medical treatment in advance of the time treatment is needed — an “advance 
directive. ” /T_he most commonly known form of advance directive is the so-called “living will. ” In a living will, a hypothetical 
patient — let’s say, Mary — expresses the kind of care that she would want as she contemplates life’s end. But this ignores 
the fact that patients eventually face an all-too-real end of life that is not hypothetical at all. Indeed, there is a real question 
94 Meilaender, “On Removing Food and Water, ” 13.
95 Elsewhere in this document, we argue that one may refuse or withhold treatment from someone in certain circumstances. Sustaining the life of one who is not actively dying is not the same as 
removing nutrition and hydration for someone who is in end-stage renal failure and for whom the very continuation of hydration will increase the person’s discomfort and distress.
96 Robert Kolb and Charles P . Arand, /T_he Genius of Luther’s /T_heology: A Wittenberg Way of /T_hinking for the Contemporary Church (Grand Rapids: Baker Academic, 2008), 55. Kolb reminds us 
that “both human creatures and nonhuman creatures function as masks of God (Luther used the Latin term larvae Dei), behind which he remains the creative agent of life. ”
97 Ronit Y . Stahl and Ezekiel J. Emanuel, “Physicians, Not Conscripts — Conscientious Objection in Health Care, ” New England Journal of Medicine 376 (2017): 1380–1385. Against this line of 
thinking, that when you enter a profession you voluntarily surrender your rights to certain kinds of decisions based on ethical values, Leon Kass makes a strong case for understanding the role 
of the physician as a professional one bound by the rule: Doctors must not kill. He mounts a strong case against physician-assisted suicide. He concludes that what dying people most need as the 
“treatment of choice is company and care, ” “I Will Give No Deadly Drug”: Why Doctors Must Not Kill, ” in /T_he Case against Assisted Suicide: For the Right to End-of-Life Care, ed. Kathleen Foley 
and Herbert Hendin (Baltimore: Johns Hopkins University Press, 2002), 38. 
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whether the Mary who articulated her preferences two decades ago in a living will would agree with them today in her 
particular situation and circumstances.98
In order to address the de/f_iciencies of substituted judgment and living wills, many ethicists opt for the designation 
of a legal proxy to act in the best interests of the person. Activated in various forms, the Durable Power of Attorney for 
Healthcare (under a variety of names) empowers a proxy named by the patient to act in the best interests of the patient.
/T_he living will was /f_irst proposed by attorney Luis Kutner and defended in the Indiana Law Journal in 1969.
99 Since 
then, much ink has been spilled over the wisdom of such an advance directive. It must be stated at the outset that there is 
no perfect and simple answer to the question of whether living wills are bene/f_icial.
100 /T_houghtful people will continue to 
disagree over the wisdom of using them. 
/T_he commonly identi/f_ied arguments for dra/f_ting a living will may be summarized as follows:101
1. Living wills preserve self-determination. Given that the patient will be the one either to bene/f_it or be burdened 
by future treatments, it stands to reason that he should offer informed consent before being subjected to 
medical interventions.
2. Living wills afford an opportunity for a person to declare his or her own wishes for the circumstances of death. 
/T_he patient may not want to be kept alive by a machine.
3. Living wills offer some measure of protection against the twin dangers of over-treatment and under-treatment. 
Just as some people are adamant that they want to be resuscitated in the event of a cardiac event, others insist 
that they should have a DNR order attached to their /f_iles.
102
4. Living wills can serve to relieve anxiety and to facilitate the process of avoiding procrastinated decision-making 
in this critical area of life.
5. Living wills help families by not burdening them with difficult decisions at times of emotional duress. Even if 
a family is exemplary in its functioning, watching a parent die is an overwhelming emotional burden, one that 
does not lend itself to calm and wise choice-making when the decision may need to be made almost instantly.
6. Living wills can safeguard family /f_inances. /T_he /f_inancial consequences of end-of-life care may be signi/f_icant, 
squandering a family’s resources on interventions that may have little bene/f_it.
7. Living wills can reduce litigation risk. Physicians tend to prefer a legal safety net against torts brought by family 
members unhappy with the clinical outcome or experiencing guilt and second thoughts about the wisdom of a 
course of treatment.
98 /T_he Wisconsin Evangelical Lutheran Synod website offers two brief but helpful discussions of advance directives. See Christian Life Resources, “Living Wills vs. Medical Directive Statements: 
/T_here Is a Difference, ” https://christianliferesources.com/2012/09/09/living-wills-vs-medical-directive-statements-there-is-a-difference/ and Christian Life Resources, “ A Basic Understanding of Med-
ical Directives, https://christianliferesources.com/2018/05/10/a-basic-understanding-of-medical-directives/.
99 Luis Kutner, “Due Process of Euthanasia: /T_he Living Will, A Proposal, ” Indiana Law Journal 44, no. 4, Article 2 (1969), repository.law.indiana.edu/ilj/vol44/iss4/2.
100 /T_he terms “living will” and “advance directives” are used interchangeably herein. 
101 Taking Care: Ethical Caregiving in Our Aging Society. /T_he President’s Council on Bioethics, September 2005, 67–70.
102 It might be noted that the survival to discharge a/f_ter in-hospital CPR was 18.7% for patients between 70 and 79 years old, 15.4% for patients between 80 and 89 years old, and 11.6% for 
patients of 90 years and older according to a study reported in Age and Aging. Myke S. Gijn, et al., “Chance of Survival and the Functional Outcome a/f_ter in-Hospital Cardiopulmonary Resuscita-
tion in Older People: A Systematic Review, ” OUP Academic, Oxford University Press, April 22, 2014, https://academic.oup.com/ageing/article/43/4/456/2812217.
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While many are persuaded by such arguments for living wills, particularly when taken cumulatively, there are also 
sound reasons, both practical and theological, to question the use of living wills.103
1. A minority of people actually utilize living wills. In 1976, California was the /f_irst state to legally sanction them, 
yet almost 45 years later, a 2020 survey by the Gallup organization revealed that only 45% of Americans have a 
living will (and only 46% have a will for their assets).
2. People who do complete living wills typically do so prior to when the living will would take effect. As noted 
earlier, what someone may or may not want can change signi/f_icantly when the time of actual need arises. People 
are o/f_ten confused when asked to sign a living will concerning what their actual end-of-life wishes might be. 
One study pointed to a third of preferences for life-sustaining treatment changing over periods as short as 
two years.
104
3. Living wills are o/f_ten unclear or even contradictory in the preferences they identify.
4. Living wills are frequently lost, misplaced or not transmitted to those making medical decisions. Despite efforts 
by physicians to get patient wishes into their electronic records, medical charts o/f_ten do not contain the inten-
tions of the patient, let alone the actual document.105
5. Living wills, even when transmitted, o/f_ten do not correlate with the care decisions made by surrogates at the 
bedside of the dying person. While family members generally predict patient preferences more accurately than 
physicians, “these studies call into question whether living wills are likely to have a signi/f_icant impact on the 
medical care received by an incompetent patient, at least in cases where surrogate decisions are made either by 
relatives of the patient or by physicians who know the patient. ”
106
Another concern is vital for Christian consideration of living wills. We have warned that the biblical foundation for 
human dignity is not personal autonomy, but the reality that God has created each person, that He bestows human value 
and worth (or dignity), and that He determines the course of human life from conception to death. For these reasons, we 
cannot ignore the danger that some may seek to utilize a living will or another advance directive to project their autonomy 
into the territory of an unknown and uncertain future. Of course, there are other reasons why living wills may be appeal-
ing. /T_hey may serve simply to communicate an individual’s thoughts and desires about medical care and death without any 
rejection of God’s sovereignty over life or the gracious character of His wise decisions concerning our lives. 
In addition, some who utilize living wills see them as a means for them to express loving concern for their family. 
/T_hey assume that a living will would minimize the pain and con/f_lict their loved ones might face in trying to address diffi-
cult end-of-life decisions. Such a motivation, commendable as it is, requires further consideration. In contrast with those 
who wish to avoid burdening their family members, Gilbert Meilaender bluntly says, “I want to burden my loved ones. ”
107
By this, he addresses the desire to spare family members at the time of death. 
Meilaender summarizes the comments he has heard frequently in seminars: “I’m afraid that if my children have to 
make decisions about my care, they won’t be able to handle the pressure. /T_hey’ll just argue with each other, and they’ll 
103 Taking Care, 71–79. Laws governing the wording and execution of a General Durable Powers of Attorney, an Advance Medical Directive and other similar documents vary from state to state. 
It is beyond the purpose of this report to survey the various state laws; rather, readers are encouraged to seek competent legal advice from an attorney familiar with the laws in their state. 
104 Taking Care, 74.
105 When the Presidential Council on Bioethics report was written in 2005, they reported that only 16% of patient charts contained the actual form. Taking Care, 75–76.
106 Taking Care, 78.
107 Gilbert Meilaender, “I Want to Burden My Loved Ones, ” /T_hings /T_hat Count (Wilmington, Del.: Intercollegiate Institute, Inc., 1999). /T_he essay is reproduced in First /T_hings (March 2010), 
/f_irstthings.com/article/2010/03/i-want-to-burden-my-loved-ones.
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feel guilty, wondering whether they’re really doing what I would want. I don’t want to be a burden to them, and I will do 
whatever I can in advance to see that I’m not. ”
108
/T_hose who have served in pastoral ministries or in institutions caring for the elderly will recognize the sentiment 
Meilaender repeats. Not all families are intact, or cooperative, or even particularly stable. Dying seniors may have one or 
more estranged children with whom they have not spoken in years or even decades. Sometimes the relationships between 
the children become the crux of the dissension. /T_he end-of-life crisis facing an aging mother or father will only exacerbate 
existing sibling issues that have never been resolved satisfactorily. At times, a child may question or mistrust a parent’s 
decision-making on behalf of another parent. Would it not be better to prevent such con/f_lict and relieve the burden of deci-
sion-making by simply dra/f_ting a living will that states what a patient’s wishes for end-of-life care should be?
Meilaender rejects the underlying assumption that a family should be spared such burdens. To be a family is to bear 
one another’s burdens. “Is this not in large measure what it means to belong to a family: to burden each other — and to 
/f_ind, almost miraculously, that others are willing, even happy, to carry such burdens? Families would not have the signi/f_i-
cance they do for us if they did not, in fact, give us a claim upon each other. ”
109/uni00A0
/T_he logic of living wills elevates personal autonomy and self-determination above any other ethical values. But if 
dying people nearing the end of life demonstrate anything, it is that they are neither autonomous nor self-determining. 
Whether attended to by physicians, nurses or willing family caregivers, the wishes and the needs of a person at the thresh-
old of death may be quite different from those that were anticipated perhaps decades earlier while one was still a vigorous 
person. As death draws near, such a document is of far less importance than prayerful conversation between family 
members, medical caregivers and one’s pastor.  
Meilaender reminds us that living wills may cut short such conversations that should rightly occur about a loved 
one’s care. He notes that the severely demented or unconscious loved one becomes a stranger of a sort. His very condition 
evokes enormously deep and painful emotions. We may experience guilt over things we should or should not have said, 
memories of acts we wish we could take back, and fear (even terror) that we might /f_ind ourselves in the same situation 
someday. Defaulting to the legal language of a living will permits us to turn away from these concerns and shield ourselves 
behind the excuse of “just doing what Mom wanted. ” More ominously, moved by our discomfort and personal fears for our 
own futures, we may be tempted to do less than we should to sustain the life of our loved one.
110 Against this, some object 
that this burdens the loved ones, exactly what the living will attempts to avoid. But if the language of countless sentimental 
greeting cards means anything, love is the kind of burden we freely accept. “For to burden one another is, in large measure, 
what it means to belong to a family — and to the new family into which we are brought in baptism. ”
111
/T_he living will, therefore, may be questioned from the standpoint of Christian theology and common sense for two 
reasons. First, the wish to specify all of the conditions of care at life’s end from the perspective of an earlier time may repre-
sent an effort to assert an illegitimate “right” to autonomy and self-determination. As already noted, the Christian doctrine 
of creation prizes creaturely dependence and receptivity over an individualized quest for autonomy and self-assertion of 
rights. 
Second, living wills are based on the false assumption that we can predict and fully understand future events. Because 
these assumptions are false, living wills have proven remarkably ineffective in accomplishing their intended purposes, as 
108 Meilaender, “I Want to Burden My Loved Ones. ” 
109 Meilaender, “I Want to Burden My Loved Ones. ” 
110 Meilaender, “I Want to Burden My Loved Ones. ”
111 Meilaender, Bioethics: A Primer for Christians, 103.