Sunday, January 23, 2011

Playing God, Believing God

Bob Rakestraw

When people suffer severely they sometimes try to play God or have someone else play God for them. The term “playing God” is usually not mentioned in discussions between the suffering person and his/her family, friends and medical care team. It is, however, an underlying component—often unrecognized—in the swirl of conflicting ideas and emotions. Whenever the expression is mentioned it is done so as a negative thing.

People may or may not be thought of as playing God depending on the decisions they make about human life, especially concerning the beginning and ending of life, but throughout one’s lifetime as well. Abortion, infanticide, physician-assisted suicide and euthanasia are all looked upon as playing God by right-to-life Christians, with whom I seriously and gladly identify. In the cases just mentioned, people are taking into their own hands the right to end their life or someone else’s life, even though such a right belongs to God alone. Right-to-life Christians feel strongly that nothing should be done to deliberately end another’s life (although they often make exceptions in cases of warfare and capital punishment). To intend to shorten life is to play God.

There is another way we may play God, however, and that is by trying to extend life. This can happen when the suffering person is in such a condition that it is evident to those prayerfully concerned for him or her, and those offering medical care, that the patient’s life is nearly over, and that technology (whether in use or about to be attached) is, in reality, prolonging death (and possibly suffering) rather than advancing life.

As you realize, I have bitten off a big chunk of material in the paragraphs above. Please forgive me for not addressing every nuance (and there are many) that is tied to the concepts and words above. These issues are highly controversial. I hesitated about writing on them but felt that God wanted me to make a point—not primarily about playing God but about believing God.

Many of you, dear readers, know that I have struggled for twenty-five years with heart problems. I had open-heart surgery in 1991 and a heart transplant in 2003. Because my health continued to be poor after the transplant, I reluctantly retired from teaching at Bethel Seminary in 2005. In the seven years since my transplant I have had numerous bouts of acute rejection, frequent invasive medical procedures, tests, consultations, trips to the emergency room, and hospital stays. I am now in a condition called permanent (chronic) transplant vasculopathy, and in March, 2007, two doctors told me I likely had no more than six months to live. Well, God keeps me going, and he gives me peace.

This leads to the interaction of playing God and believing God. At what point might our inclination to play God conflict with our intention to trust God (I am using “trust” and “believe” interchangeably)? In some crises of life, it is not always clear-cut that a decision is playing God. A teenage boy rushed to the hospital after a serious motorcycle crash may lead to a critical choice concerning high-risk brain surgery. The surgery may take the boy’s life or leave him as a vegetable, or it may help him return to normal life.

Some family members—strong believers—want the surgery, because they think it may be playing God to withhold a chance at recovery. Whatever is possible should be done, they believe. Other family members—equally strong believers—think it may be playing God to request the surgery and that the family should, given the surgical risk to their loved one’s life, entrust him to God’s care, believing that God does all things well. Whatever can be done does not always need to be done, they believe.

Where do we draw the line between playing God and trusting God? Who decides what is the one or the other? Who is the more faithful servant of God, the family member who authorizes the surgery, or the one who chooses to withhold it (and possibly withhold other means of life support)?

My own story is not that of the teenager. His case involves an urgent, immediate decision. I have grappled much, however, with bioethical decisions over the course of my illness. I hesitated to have my mitral valve surgery in 1991 because of the huge cost, even though I had good insurance. It didn’t seem right to have so much money spent on me when the vast majority of the world’s people could never afford such a procedure. I had the same hesitation about my heart transplant in 2003.

Now I am at the point where nothing can be done for my otherwise terminal condition except a second transplant. When I was first offered this possibility I said “Thanks but no thanks.” Then, after family discussion and prayer, I said, “Yes.” A while later I said “No” again, and for the past few years my family and I have settled comfortably on this final decision. It is not primarily the financial factor holding me back, although my sense of justice is still shocked, and even repulsed, by the anticipated cost of the surgery—a second time. I am not receiving another heart because I believe, with good reason, that the level of suffering of the past seven years since my transplant will be no different after the surgery than before. Since my post-transplant experience has been more “mysterious” (my nurse’s words just a few weeks ago) than that of others, my suffering could very well be worse.

I am also concerned about the issue of playing God. With medical care, everything possible is not mandatory. Doctors (whom I admire and appreciate) are trained in such a way that they are extremely reluctant to say that nothing more can be done for a patient. On January 3 I was on the table in the heart catheterization lab, with the IV and other measuring devices hooked up to me, and with the angiogram tubes in me. My coronary artery blockages were so severe that the cardiologist wanted to try an experimental and risky procedure in one of the arteries. I said “no” and he became quite agitated at me. He ended the angiogram right there, omitting the other half of my heart, since I did not consent to what would have been the start of numerous such procedures. After I was wheeled back to my hospital room, another cardiologist told me that the procedures in question, if done, would not have lengthened my life or prevented heart attacks. They might have helped for a time with my labored breathing and nausea, two of my daily difficulties, but such an outcome would not have been certain.

I feel good about this recent decision, especially since my wife, Judy, and I had prayed about this very issue according to James 1:5-8 just moments before the nurse came to take me to the cath lab. I feel good as well about the decision to refuse a second transplant.

Decision-making in matters of medical care is not always easy. My situation is just one of a multitude of possible scenarios. Other people might have made different decisions, and I fully admit and respect the possibility that two or more choices in a given situation may be admissible. My view—about the overall issue of playing God, as well as my personal condition—is not infallible. I believe God is pleased with my decision, but I admit that he may have been just as pleased if I had chosen differently at different points on my journey.

At some time or another in life, most or all of us will need to think about playing God, either by shortening or by extending human life by certain technologies, when the wiser choice would seem to others to leave the situation with God who does all things well. Palliative care, such as pain relief, is mandatory, of course.

In many cases, in my view, the actual decision is not as important as the attitude and state of mind of the one or ones making the decision, especially if the decision-makers claim to belong to and believe their God and Father. Am I trusting God for wisdom according to James 1, since he knows that I am weak and unable to calculate the risks and benefits with precision? Yes, we must make tough decisions at times—for our own care and that of others, and if we do so with an attitude of composure and rest in God’s arms, our decisions will be acceptable in God’s eyes.

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