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LCMS 2026 Convention Workbook: Reports and Overtures, PDF page 235

2026 Convention Workbook
200 
THEOLOGICAL DOCUMENTS  —COMMISSION ON THEOLOGY AND CHURCH RELATIONS
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we noted earlier.112 For these reasons, we suggest that living wills do not represent the best means for loved ones to exercise 
their God-given responsibilities to provide compassionate care for their loved ones. “In the end, no legal instrument can 
substitute for wise and loving choices, made on the spot, when the precise treatment dilemma is clear and care decisions 
are needed. ”
113
Rather than endorsing living wills, many sensitive ethicists, both Christian and non-Christian, have instead defended 
the use of proxy directives such as a durable power of attorney (POA) for health care. A POA for health care avoids the 
impossible task of guessing what a legally incompetent person might want given the particular clinical circumstances near 
the end of life. Instead, it rightfully burdens those who loved her with asking a far more relevant question: “What is best for 
her now?”
114
Some might argue that durable POA documents share with living wills a desire to reach into a future beyond the 
scope of time when we are fully competent to direct our own care. But unlike the living will, which extends its reach by 
means of legal speci/f_ications to guarantee the patient’s own wishes and autonomy, the proxy affirms the individual’s crea-
turely dependence and his need to rely upon others.
A health care POA designates that an individual, as the principal, appoints another person to be his agent to make 
health care decisions if he is unable or unwilling to make them.
115 A POA for health care should not be confused with a 
POA for property or business transactions, which appoints a person to make business- or property-related decisions. Even 
though the health care POA may not necessarily be making decisions, the agent most o/f_ten has access to applicable medical 
records. Many jurisdictions provide for the health care POA to be durable, which means the agency designation remains in 
place even though the principal no longer retains ability to make decisions for himself or herself.
/T_he selection of a health care agent is a critical decision as the agent will have ultimate authority for decision-making 
even a/f_ter the individual is no longer able to express their own wishes. /T_he individual chosen to be the health care agent 
should be someone with the capability to make decisions even if other family members are not in agreement.
It is normally prudent to choose a single health care agent. Commonly, one or two successors can be named in a 
health care POA, but only in an order of priority. Naming two individuals as health care co-agents only provides an oppor-
tunity for con/f_licts and stalemates and, therefore, the possibility that no decision is made.
Many times in a health care POA, an individual expresses certain wishes for how they want end-of-life decisions to be 
made. It is important the health care agent chosen be an individual well-grounded in the principal’s spiritual foundation as 
well as their personal wishes. /T_his helps to ensure that the health care agent is well equipped to assimilate the medical and 
health care facts that are unfolding and make appropriate, timely decisions.
Rather than a living will, the health care POA offers a better option for directing end-of-life care. As Meilaender 
concludes, it makes a simple statement to health care providers: “Here is a person upon whom I have o/f_ten been dependent 
112 See pages 41–42. /T_he 2005 report Taking Care devotes an entire chapter, pages 55–93, to “/T_he Limited Wisdom of Advance Directives. ” /T_his report of the President’s Commission on Bioethics 
articulates multiple reasons for rejecting the living will in favor of power of attorney proxies and legal surrogate instruments. 
113 Taking Care, 56.
114 Cf. Taking Care, 55–93, where the legal rulings in landmark 20th-century cases are discussed in terms of various permutations of subjective and objective standards, including “substituted 
judgment” and “best interest” standards.
115 Power of Attorney documents vary widely, yet many jurisdictions have their statutory Health Care POA formats available online through their health departments or they may be accessed 
through a party’s legal counsel or health care provider. It is important to ensure that current documents re/f_lecting a person’s end-of-life wishes are readily available and locatable when they may 
be needed.
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for love and care in the past. Now, when I can no longer participate in decisions about my medical care, I am content to 
continue to be dependent upon his love and care. Talk with him about what is best for me. ”116
D. The Question of When Enough Is “Enough”
When is a treatment useless? When is a treatment excessively burdensome? A commitment to the sanctity of life and a 
refusal to accept physician-assisted suicide does not involve an idealistic effort to sustain biological life at all costs. When 
all indications point to God calling the soul from the body, “there is no point in merely blowing wind through the empty 
tent with ventilators and machines. ”
117 When death appears imminent, the decision to withhold or withdraw food and 
hydration is not deciding to kill. Rather, it represents an important aspect of caring for the dying person. We do not wish to 
add burdens to the patient at such a time, but to relieve him of additional burdens.
While it may be appropriate to withdraw or withhold nutrition and hydration for someone who is imminently dying, 
that does not mean that we may act in this way because a patient is not dying fast enough. As fallible men and women 
with deceitful hearts (
JER. 17:9), it is easy to deceive ourselves with faulty reasons for why we should hasten death. Hospital 
and skilled nursing facility nurses have all heard families use a patient’s poor “quality of life” as a reason to suspend treat-
ments. Others speak of the psychological toll that a prolonged dying process may have on a physically frail or emotionally 
unstable spouse or other family members to rationalize a speedier death. An adult child may protest that this “useless care” 
is sapping the limited savings that the surviving parent will need to “get by. ” No doubt sel/f_ishness motivates some heirs who 
would rather a patient die quickly so their inheritance will not be used for patient care. 
Despite such specious reasoning, we acknowledge that there are times when it is inappropriate to provide nutrition 
and hydration arti/f_icially. Depending on the speci/f_ic condition, when major organs begin to fail, nutrition and hydration 
may actually increase the discomfort the body experiences a/f_ter it no longer accepts or processes such sustenance effec-
tively. In the active stages of dying, deterioration of the digestive tract can lead to discomfort and bloating. Similarly, as the 
heart becomes weaker and less efficient in pumping blood, /f_luid overload creates several negative conditions including /f_luid 
backup in the lungs, respiratory distress and excessive swelling of the tissues.
/T_he Christian Medical and Dental Associations promotes a four-option approach to dealing with the ethical issues 
presented by arti/f_icial nutrition and hydration (ANH):
• Strong indications for use of ANH include patients with an inability to take oral /f_luids and nutrition with a high 
probability of reversing it; a patient in a stable condition but who is unable to swallow; a patient with a newly 
diagnosed but not imminently fatal severe brain impairment; gastrointestinal tract failure or need for bowel rest; 
or a fully informed patient wishing to survive until an important life event.
• Allowable indications for use of ANH speak to a morally neutral situation where a patient or surrogate should 
make the best decision a/f_ter consulting with appropriate medical personnel. Examples would include a patient 
wishing to prolong life despite a severe and progressive neurologic impairment (e.g., end-stage amyotrophic 
lateral sclerosis, also called Lou Gehrig’s disease or ALS) and situations in which there is uncertainty whether the 
anticipated bene/f_its versus burdens justify the intervention.
• Not recommended but allowable indications for ANH include when a patient or surrogate asks to overrule the 
patient’s advance directive due to a speci/f_ic or changing clinical context.
116 Meilaender, Bioethics: A Primer for Christians, 104.
117 Bartlett and Rehder, “Ventilators, Feeding Tubes, and Other End-of-Life Questions, ” 8.
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• Unallowable indications where it is unethical to employ ANH include administering it against the patient’s or 
surrogate’s express wishes, compelling medical professionals to participate in ANH insertion in violation of their 
conscience, or utilizing ANH when the patient is declared brain dead.
 118
E. Refusing or Withdrawing Treatment
In discussing the ethics of refusing treatment, several authors cite a helpful metaphor, known as “the good host, ” /f_irst prof-
fered by the Anglican David H. Smith. 
A couple invite friends to dinner. Food and drink are pleasant; the conversation bubbles. /T_he good host is hos-
pitable and courteous to his guest, no matter what his shi/f_ts in mood. But there comes a time when the party 
“winds down” — a time to acknowledge that the evening is over. At that point, not easily determined by clock, 
conversation or basal metabolism, the good host does not press his guest to stay but lets him go. Indeed he may 
have to signal that it is acceptable to leave. A good host will never be sure of his timing and will never kick out 
his guest. His jurisdiction over the guest is limited to taking care and permitting departure.
119
/T_he illustration compares end-of-life decisions to the hospitality offered by a good host. /T_he good host neither pushes 
his guests out the door too early nor does he inveigh upon them to remain a/f_ter the end of the party.120 While a growing 
number of jurisdictions may permit physician assistance in facilitating the deaths of their patients (e.g., by prescribing 
the lethal medication for the terminal patient to take), Christian ethics does not choose death or aim at it. Here it must be 
stated that neither do we make a false idol out of biological life as if it were the only or highest good.
121
Unlike those availing themselves of the permission in those states with physician assistance in suicide laws, we are not 
called to choose death or aim at it. However, refusing treatments, even life-saving ones, may be a correct Christian choice. 
At 86 years of age, Polycarp, the Bishop of Smyrna, was taken to the arena. /T_he proconsul attempted to persuade him to 
curse Christ and he would be free to go. But Polycarp refused, saying: “For eighty-six years I have served him, and he has 
done me no evil. How can I curse my king, who saved me?”
122 While Polycarp freely answered the proconsul’s questions, 
expecting that it would result in his death, he did not do so intending or aiming at death.123 /T_he same moral reasoning 
applies to the soldier who sacri/f_ices his life willingly for the well-being of others. While one might reasonably know or 
suspect that making a charge against overwhelming odds will result in one’s death, this is not an act of suicide. Dying may 
be the most likely outcome, but it is not part of the soldier’s plan of action.
Many end-of-life treatments to reduce pain will carry negative, even possibly lethal, side effects. /T_he narcotic 
morphine, for example, has become a commonly prescribed end-of-life medication to relieve severe pain that does 
not respond to other analgesics. As the patient’s pain increases, caregivers typically administer larger doses of the 
118 “Position Statements, ” Christian Medical & Dental Associations® (CMDA), March 23, 2022, https://cmda.org/policy-issues-home/position-statements/.
119 David H. Smith, Health and Medicine in the Anglican Tradition (New Y ork: Crossroad, 1986), 52.
120 Hauerwas cites Daniel Callahan’s recapturing of the meaning of “natural death” with some quali/f_ied approval since the phrase itself may be too misleading to be of much help. Hauerwas 
instead opts for the description of a “good death. ” Hauerwas, Suffering Presence, 98. Callahan de/f_ines “natural death” as one when (1) one’s life work has been accomplished; (2) one’s moral 
obligations have been discharged; (3) one’s death will not seem an offense to sense or sensibility; and (4) one’s process of dying does not involve “unbearable and degrading pain, ” 97. Hauerwas 
quotes Eberhard Jungel as teaching that the Christian proclamation of Jesus Christ freeing us from the curse of death implies that “human life has a natural end which comes when the time 
allotted to life has expired. Man has a right to die this death and no other. ” Hauerwas, Suffering Presence, 97. Hauerwas concludes that we ought not allow the “symbol of brain death to tyrannize 
us by requiring that we delay death so long that we can no longer die a good death … it should not be used as a substitute for the responsibility each of us has to die our own death. ” Hauerwas, 
Suffering Presence, 98.
121 Hauerwas asserts that “we should die in such a manner that others see that they are sustaining us and that correlatively due credit is given to God as the ultimate giver of life. ” Hauerwas, 
Suffering Presence, 96.
122 Justo L. Gonzalez, /T_he Story of Christianity, Vol. 1. (Peabody, Mass.: Prince Press, 1984), 43–45.
123 /T_his differentiation between intention and result plays a large role in Roman Catholic moral philosophy and has been credited to /T_homas Aquinas. /T_he so-called doctrine of “double effect” 
also comes into discussions of sedation, which may ease pain and may also hasten death. Note that while this notion becomes quite important in Roman Catholic medical ethics, there are some 
who dispute the appropriateness of it. David VanDrunen, for instance, refuses to employ the category as such because he deems the criteria not “always helpful” and argues that the use of it 
proves unhelpful as a rule to “determine the application of the principle on every occasion. ” Cf. VanDrunen, Bioethics and the Christian Life, 213–238.
MEDICAL/hyphen.capETHICAL CONSIDERATIONS
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drug.124 Morphine not only deadens pain; it also suppresses respiration. /T_he aim of the treatment, however, intends to 
mitigate pain and not to cause the death of the patient. If a caregiver deliberately overdoses the patient in order to eu-
thanize him, we would say that he killed him since death was the physician’s aim. If, however, a carefully adjusted dose 
of morphine to relieve pain suppressed respiration and the patient died, we would not reach the same determination 
since death was not the intent. /T_his has led to the following guidelines for the moral answer to questions of refusing or 
withdrawing treatment.
125
First, a treatment may be refused if it is useless for the person relative to his condition. Since there is no moral obliga-
tion to undergo treatments that hold little prospect of curing or even ameliorating the symptoms of a disease, refusing to 
accept a particular treatment does not equal the rejection of the gi/f_t of life.
In some cases, the refusal of treatment is more than “allowing to die, ” it is done in order that the individual will die. A 
parent who will not allow a baby with Down syndrome to receive a necessary surgery might be said to refuse the surgery 
so that the child will die. /T_his kind of verbal trickery has become more popular in our era when we tend to think of per-
sonhood in terms of skill sets and cognitive abilities. For example, the evangelist and motivational speaker Nick Vujicic was 
born with tetra-amelia syndrome, leaving him without arms or legs. Had he also suffered from a blockage in his digestive 
system requiring surgery, one might easily have imagined his parents asking if he might be a candidate for euthanasia in a 
nation such as the Netherlands.
Second, treatments that are useful and perhaps even lifesaving may sometimes be excessively burdensome. In such 
cases, because life is not our god, we are not called upon to bear all burdens in order to stay alive. A variety of medical 
procedures, treatments and even medications may prolong life, but at an unwarranted burden. /T_he patient chooses life, not 
death, simply not the life promised by the particular medical treatment. Elderly cancer patients, for instance, may choose 
not to accept the recommended chemotherapy because of the burden of the side effects.
As in the /f_irst guideline, this one may be abused quite readily. If we confuse the burdens of treatment with the burden 
of life, we move into an ethical danger zone. During the last several decades, for instance, the news has brought stories of 
Karen Quinlan and Terri Schiavo to our attention. None of us would wish for an unconscious existence in a persistent veg-
etative state, sustained by arti/f_icial nutrition and hydration. But, as Meilaender has wisely said, “if we act on such a thought 
and withdraw the feeding tube, the burden at which we are taking aim is not treatment but life itself. ”
126 Christian wisdom 
says that if the treatment will bene/f_it the life the patient has (whether we would choose such a life for ourselves or not), we 
are called to choose life.
F. Financial Matters
Since insurance policies, government provisions for coverage and state-speci/f_ic legislation vary greatly and change rapidly, 
it would not be possible to address all of the practical matters related to how /f_inances intersect with the convictions of a 
faithful Christian end-of-life ethic. Nevertheless, a few observations must be made.
Given the growing acceptance of assisted suicide, it is almost certain that withholding medical care for the terminally 
ill and for those with cognitive and other functional de/f_icits will increase, and that some of that increase will be for /f_inan-
cial reasons. Rising medical costs for lifesaving or life-prolonging treatments come into sharp con/f_lict with the strictures of 
124 Not only medical caregivers, but also family members may sometimes be authorized to administer morphine. It would be vital in such cases that there be instruction in the proper way to do 
so, as well as counsel concerning the distinction between caring and killing. 
125 /T_he following points are so common to end-of-life books and articles that they hardly require detailed documentation, and are commonly identi/f_ied by Roman Catholic, Reformed (e.g., Van-
Drunen) and Lutheran ethicists. Lutheran ethicist Meilaender, for instance, o/f_ten lists these as helpful principles. /T_he reader may be directed to Meilaender’s Bioethics: A Primer for Christians, 
84–87, for a summary in his section “Guidelines. ”/uni00A0
126 Meilaender, Bioethics: A Primer for Christians, 87–88.