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LCMS 2026 Convention Workbook: Reports and Overtures, PDF page 240

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THEOLOGICAL DOCUMENTS  —COMMISSION ON THEOLOGY AND CHURCH RELATIONS
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Appendix
APPROPRIA TE QUESTIONS FOR DISCUSSION WITH MEDICAL PERSONNEL AND FAMIL Y
Richard C. Eyer helpfully offers guidance for how to deal with physician interactions in end-of-life situations.192 He offers 
several questions for the family members being approached by the physician for input on either initiating or continuing life 
support interventions. He recommends that the family member ask to speak directly with the physician if approached by a 
nurse or other hospital staff person. Eyer’s proposed questions have been modi/f_ied and expanded to take into account some 
of the end-of-life discussions in this paper, particularly the suggestions by John T. Pless.193 As such, they are also directed as 
points for discussion with family members and one’s pastor as well as with medical professionals. 
1. Ask the doctor: “What is the medical condition of the patient at this time?” (Y ou are asking for an objective 
medical evaluation, not a philosophical opinion, of the patient’s condition.) 
2. Ask the doctor: “What is the prognosis?” Has a “second opinion” been sought? Does this opinion con/f_irm or 
call into question the original prognosis? (Y ou are asking whether the patient is expected to recover or not.) 
3. Ask the doctor: “Is the patient dying at this time?” Have the patient’s vital processes already begun to shut 
down, indicating that death is inevitable unless God intervenes? (If the patient is not dying, it would be morally 
wrong to aim at causing the death of the patient.) 
4. Is treatment being discontinued to hasten death (hence “choosing death”) or because the treatment itself has 
become burdensome on the patient with no realistic hope of recovery?
5. Ask the doctor: “Is the patient awake?” (If so, you will want to be supportive by discussing with the patient his 
condition and by praying with him for guidance before a decision is made.) 
6. Ask the doctor: “Is the patient in any pain at this time?” (Y ou are asking whether pain gives urgency to your 
decision.) 
7. Is adequate physical care (e.g., arti/f_icial nutrition and hydration) provided for the dying person even when 
other treatments are discontinued or life support systems are withdrawn?
8. If a decision is needed immediately, err on the side of life, not death. If a decision is not needed momentarily, 
say, “I need time to talk with my family and/or pastor and I will call you within [a stated length of time]. ” (Y ou 
are saying you need the input of others concerned for the patient.) 
9. If the situation allows, leave the hospital and meet with your family and pastor at church in a prayerful environ-
ment. /T_his distance from the hospital environment sometimes helps you think more clearly. Inform the nurse 
that you are leaving, where you will be and when you will return. 
192 Richard. C. Eyer, “Medical Directives and Some Misunderstandings” (Mequon, Wis.: Concordia University, n.d.). A helpful, but unfortunately out of print, resource for group studies of end-
of-life decisions that includes descriptions, biblical texts for each issue, case studies, small-group questions and even “things to do” in follow up can be found in John Klotz, ed., Life Choices Who 
Decides? Following God’s Word in Life and Death Decisions (St. Louis: Concordia Publishing House, 1991).
193 Pless, Mercy at Life’s End, 16, was invaluable for adding to the excellent questions by Eyer.
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SUPPLEMENT ARY MA TERIALS
GLOSSARY: DEFINITIONS OF CURRENT END/hyphen.caseOF/hyphen.caseLIFE TERMS  
Actively dying — /T_he hours or days preceding imminent death during which time the patient’s physiologic functions wane. Virtually all 
dying patients go through a stereotypical pattern of symptoms and signs in the days before death. /T_his trajectory is o/f_ten referred to as 
“actively dying” or “imminent death. ”
Advance directive — /T_he most common types of advance directives are the living will and the/uni00A0power of attorney for health care. Called 
“advance” because such a document is prepared prior to a health crisis during which it would guide medical care, these directives vary by 
state and can include other documents, such as a dementia provision or a DNR (“do not resuscitate”) order (see below). See also “living 
will” and “power of attorney for health care” below.
Arti/f_icial nutrition and hydration (AN&H/ANH) — ANH is most o/f_ten delivered by means of a nasogastric (NG) or percutaneous en-
doscopic gastrostomy (PEG) tube (see below). It o/f_ten involves a surgical procedure to place a /f_lexible feeding tube through the abdominal 
wall and into the stomach. PEG allows nutrition, /f_luids and/or medications to be put directly into the stomach, bypassing the mouth and 
esophagus. Whether delivered by an NG or PEG tube, the purpose of ANH is to provide short-term support for patients who are acutely 
ill. When employed near the end of life, ANH will most likely not prolong life and can lead to medical complications that increase suffering 
for the patient.
Coma — While differences of physical presentation exist within the classi/f_ication of “coma” (e.g., open-eyed vs. closed-eyed), the Mayo 
Clinic de/f_ines a coma as “a state of prolonged unconsciousness that can be caused by a variety of problems — traumatic head injury, stroke, 
brain tumor, drug or alcohol intoxication, or even an underlying illness, such as diabetes or an infection. ” A coma “seldom lasts longer than 
several weeks. ” 
Death with dignity — /T_he term used by proponents of physician-assisted suicide/dying to describe death where the patient is viewed as 
being in control (either by an advance directive or by electing to request lethal medications). It is also the name given to aid-in-dying laws 
that have advanced in a number of states over the years. Oregon’s landmark aid-in-dying law, enacted in 1997, is called the Oregon Death 
With Dignity Act. /T_he state of Washington’s 2008 law is the Death with Dignity Act. It is a term of art and part of the political landscape 
(e.g., pro-choice, pro-abortion). People who speak of “death with dignity” are not employing the word “dignity” in its Christian sense but 
as part of their efforts to legalize physician-assisted dying and/or euthanasia.
Do not resuscitate (DNR) — A medical order that no measures be taken to resuscitate a patient whose heart or breathing stops. /T_he 
order is made while the individual is mentally capable and conscious, or by that individual’s healthcare proxy if he or she is not. A variety 
of interventions may be speci/f_ied. Some patients may choose to have “full code” with intubation and to be placed on a ventilator (short or 
long term). Another patient may decide not to be on a ventilator with a “DNR Select” code status where the heart would be shocked if it 
stops, but intubation/ventilation is not performed. Some in this category choose to be placed on a BIPAP (bilevel positive airway pressure) 
machine (similar to a CPAP— continuous positive airway pressure — for sleep apnea). A third option involves a patient who chooses to 
have a status of “do not resuscitate” (DNR). Various “treatments” (i.e., antibiotics, tube feeding) and other care preferences desired/not 
desired can be speci/f_ied on some DNR forms in some jurisdictions to guide health team members.
End of life — In clinical medicine, the “end of life” can be thought of as the period preceding an individual’s natural death from a process 
that is unlikely to be arrested by medical care. For insurance purposes, the “end of life” has been operationalized to represent the last six 
months of a patient’s life. It refers to a /f_inal period — hours, days, weeks, months — in a person’s life in which it is medically obvious that 
death is imminent or a terminal moribund state cannot be prevented.
Euthanasia — Also known as “mercy killing. ” In the act of euthanasia, the physician — not the dying person — chooses and acts to cause 
the death of the patient. 
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Hospice — A program in which an interdisciplinary team of caregivers provides comfort, support and dignity to terminally ill people 
when medical treatment is no longer expected to cure the terminal disease or prolong life. Hospice service is provided wherever the person 
resides, most o/f_ten at home. It is voluntary and also involves and supports the individual’s family and/or loved ones.
Irretrievably dying — Irretrievably dying refers to the condition where a person’s body has already begun to shut down and few, if any, 
medical treatments offer hope of healing. /T_he term may be contrasted with “terminally ill, ” since one can be terminally ill but still expected 
to live for months or even years. 
Living will — A document that expresses a person’s end-of-life preferences if he or she becomes unable to speak. A living will is just one 
type of an advance directive (see above).
Medical aid in dying (MAID) — A provision that allows mentally capable, terminally ill adults to request a prescription from their 
physician for life-ending medication that the person may self-administer. /T_he states that currently authorize MAID require that, prior to 
providing a prescription, doctors must con/f_irm that a patient is fully informed about his or her prognosis and must provide the patient 
with information about additional end-of-life options, including comfort care, hospice and pain control. Other synonymous terms are 
commonly used: physician-assisted suicide, physician-assisted dying, physician-assisted death, physician aid in dying, medically-assist-
ed dying, patient-administered hastened death. Advocates of the practice consider the term “physician-assisted suicide” to be a partisan 
description of the medical practice of aid in dying. /T_hey may cite the judgment of the American Psychological Association that suicide and 
aid in dying have “profound psychological differences. ” Lutheran ethicists have joined other Christians and non-Christians in opposing 
this as suicide or euthanasia under another name.
Medical (or physician) orders for life-sustaining treatment (MOLST/POLST) — A document available in some states that provides 
detailed guidance about an individual’s wishes for end-of-life medical care. /T_he order is part of advance health care planning and is 
prepared by a medical professional.
Nasogastric (NG) tube — A /f_lexible tube inserted through the nose to deliver nutrition and medication to the stomach for those experi-
encing difficulty swallowing. NG tubes may administer nutrients and medication, remove liquids or air from the stomach, add contrast to 
the stomach for X-rays, or protect the bowel a/f_ter surgery or during a bowel rest. 
Palliative/total sedation — Also referred to as terminal sedation. /T_he continuous administration of medication to relieve severe, unrelent-
ing symptoms that cannot be controlled while keeping the person conscious. /T_his state is maintained until death occurs.
Percutaneous endoscopic gastrostomy (PEG) tube — A PEG tube is an alternative to an NG tube for patient nutrition. /T_he PEG tube is 
surgically placed through the abdomen directly into the stomach. 
Persistent vegetative state (PVS) or Post-coma unresponsiveness — PVS represents a disorder of consciousness in which patients with 
severe brain damage are in a state of partial arousal rather than true awareness. Typically the VS classi/f_ication gets applied to such persons, 
with the classi/f_ication “persistent vegetative state” coming a/f_ter four weeks. While some describe those in a persistent vegetative state as 
“brain dead, ” in fact, the lower brain stem in PVS patients is still healthy and fully functioning. /T_his results in the person’s ability to blink 
and otherwise move his or her eyes, breathe independently, cry or laugh, though not as an emotional response to external events. /T_hose 
with PVS enjoy normal circulation, experience regular sleep-wake cycles, move their limbs, though purely as re/f_lex (PVS patients can’t hold 
their limbs nor move them on command), open their eyes, smile and track objects with their eyes.
Power of attorney for healthcare (POAH) — A legal document that grants someone the authority to make health care decisions on behalf 
of another individual when that individual cannot do so. Synonymous terms include durable power of attorney for health care, medical 
power of attorney, health care power of attorney and health care proxy. 
Refusal of medical treatment — /T_he legal right of competent adults to refuse medical treatment even if that treatment is necessary to 
sustain life. /T_hese life-sustaining interventions can include ventilators, feeding tubes and pacemakers. If an adult is judged to be mentally 
incompetent by a psychiatric professional, the person can be treated against his will. 
Terminal care period — /T_he period during which there is evidence of progressive malignancy, and in which therapy cannot realistical-
ly be expected to prolong survival signi/f_icantly. Patients enter this period either at the time of diagnosis or following a period of active 
treatment. /T_he onset of the terminal care period should not be confused with the point at which the expectation of life is estimated to be 
short. A patient might be expected to die within a few months but have a treatable malignancy. /T_his patient would still be in the active 
treatment period.
Terminal condition — As held by at least two appellate courts, “dying” or a “terminal condition” is a condition resulting from injury, 
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disease or illness from which there likely can be no return to health, and which, without life-prolonging procedures, will lead to natural 
death. In other words, a person with a terminal condition is one for whom no medical cure exists. 
Terminal prognosis, terminally ill — An illness for which the medical expectation is death within a few months. Aid-in-dying laws 
typically de/f_ine a patient as terminal whose life expectancy is six months or less. /T_hose suffering from a fatal pathology because medical 
treatment in their cases will not lead to a restoration of health and will prolong the dying process may be deemed terminally ill or have a 
terminal prognosis. People in an irreversible coma (IC) and/or a persistent vegetative state (PVS) are, ipso facto, terminally ill. For the sake 
of simplicity, most clinicians consider IC and PVS to belong to this same class of terminally ill people and refer to them as permanently 
unconscious, though each group has different, but related, neurological impairments. /T_he Medicare hospice bene/f_it is limited to persons 
whose physicians attest that the patient has “a terminal illness with a life expectancy of six months or less. ”
Transition of care — Transition of care during the end of life includes: 1) changing place of care, 2) changing goals of care, 3) changing 
teams of care. /T_he term refers to support given to patients when they move from one phase of the disease or treatment to another, such 
as from hospital care to home care. It involves helping patients and families with medical, practical and emotional needs as they adjust to 
different levels and goals of care.
Voluntarily stopping eating and drinking (VSED) — VSED is a legal right for any individual who wishes to shorten the dying process by 
refusing nourishment orally or through a tube.