I have a dear friend, Tim, who is a healthcare profession and now involved in providing loving care and caring for his mother as she approaches death. He recently faced some difficult decisions about pursuing care versus withholding care. I’m deeply appreciative that both Tim and his wise pastor, Sam, have agreed to allow me to share their exchange.
First up, the letter from Tim (who is caring for his mom) to his pastor, Sam Andreades (who is pastor of the Village Church in Greenwich Village in New York City):

Sam,
Last I heard from you, you made a comment about end of life care and the confusion society has with it. I would appreciate guidance.
We moved my mom to this particular center so that if her body healed we would move forward with rehab. If it did not, we would provide comfort care. Surprisingly her body has healed – alot. The difficulty is that her brain has not healed as quickly. We have good and bad days as well as things seem to change on the hour.
Her delirium presents as a major depression where she wants to die so she refuses to eat, take her medicine or get out bed. As she comes out of the delirium, she says things like “please don’t give up on me” and “I’m going to do everything they tell me to do.” In fact yesterday, she spoke to me on the phone and apologized for her bad behavior in the delirium.
The center’s perspective is they will not force a patient to take their medicine or get out of bed or do therapy if they do not want to. (All of which may help treat the delirium) This has been the social worker’s message and she quotes my mother’s comments in the delirium. When I remind her that she is not able to pass her mental status exam I am told “well that’s what I heard her say the most.” Then she tells me she belongs in hospice. That’s what she wants.
We have asked what hospice would do differently than what we are doing and we do not get a response. The social work team seem to be trying to be mom’s advocate but it seems based on her comments in a delirium.
The reality is she still has multiple reasons why the delirium is present. Of course the wild card is no one knows enough about the underlying disease process to say if it’s getting worse. We just don’t know.
The question I guess at hand is what do you do when you are in such conflict with an instituition or staff member on end of life care? The second question is when do you agree to hospice especially when you have no data to make the decision on whether she will improve or not?
Any thoughts would be appreciated as would your prayers.
Tim
PS – Another question is if it is the Hashimotos and nothing can really be done, is it Biblical to stop antibiotics, routine medications and/or tube feedings.

What a difficult situation, eh? What would you do if you were Tim? How would you advise him if you were his mom’s healthcare profession or if you were Tim’s pastor or friend? Here’s Tim’s pastor’s response.

Dear Tim,
I am really sad for the anguish that you are going through about your mom. These kinds of care questions are rarely simple. But, as you pray and consider how to best love and honor her in this situation, it is a time to grow in wisdom. God is caring for you and calling you onward, as well as your Mom, in giving you this struggle.
I can tell you how I look at these things after thinking about them for a while as a pastor. But, of course, this is my judgment from the Bible, not the Bible itself.
The proliferation of many medical treatments, although many times very helpful near the end of life, often times obscure a question that we should be asking but many times want to avoid: is it time to let my beloved parent die?
We can pursue treatment after treatment—there is always another treatment or intervention to do. But there really does come a time to die (Ecclesiastes 3:2), and a time for mourning that death (v4). It never feels like “the right time” because death was never meant to be for us. But it is here now and we have to face it.
Thankfully, God has provided a way for us to face it.
I do not know if it is your Mom’s time, but you should be asking God if it is. What would be best is to pray to God with her, although that is not always possible because of the difficult emotions involved.
The Good News is that your Mom is a believer. That makes dying much less serious. It will not be the end of life for her. That is as true as anything. She has a glorious future ahead of her. Fantastic riches. Eternal bliss. Every tear will be wiped away when she crosses over to the other side. So you both can, at the right time, face her death well.
For you, the question is, can I let go of her?
Many times a dying person will feel like she has to hold onto life, however painful, to spare her loved ones the grief of going. Those at bedside communicate this need in many unspoken ways and she takes on the responsibility of living past a good time. That is a sad thing if it is her time to die. It means that she submits to a painful and humiliating existence.
Think about what it is like to lose control of your body—or worse, your mind, so that you are never sure whether you are sane or not, or who you might be offending. That is a hard, hard life to live.
Can you give her your permission to die, if it is her time? It is perhaps your final way of honoring her, giving her the weight she deserves as your mother.
For her, the question is, does the Lord wish more of me here? Can I serve Him further in some way by staying? Am I able to continue to pray? Much as they love me, and receive from my presence, is taking care of me taking them away from useful service to Christ themselves?
Notice that this is the way that the apostle Paul reasons about his own death (Philippians 1:20-25, 2:17-18). He realizes that death means being with Christ, which would be great for him, but that there may be reason for him to stay, to help the Philippians. It seems like he decides, in the end, that for Christ’s purposes it is better for him to not die now (v25), though it is a hard decision (v23).
I am usually wary of taking advice from medical personnel on serious things like this, especially non-believing ones who are proceeding upon a very different set of beliefs about the world, who may not value life the way I believe we should, and who might be motivated by other things besides a desire to honor God.
But in these cases, I think that those who talk about giving someone a final time of dignity have grasped an important truth.
Life on this earth is not the ultimate reality, to be grasped at all costs.
Though I am approaching the decision from a different place, on a particular case I might come to the same decision as those who do not properly value life as God’s gift.
So, strange as it sounds, I do not believe that it would be immoral for you to stop trying to medicate your Mom’s delirium. Or maybe to choose to give her that medication but also go into hospice care at home. Or letting her cease to eat—if it is her time.
The point of hospice, as I see it, is to give a person permission to die, and making them as comfortable as possible while doing it. Of course, she can always go into hospice and come out of it again, if her mind heals or she and you decide that fighting to live is the better course.
Again, I do not think that this is a simple or easy decision, since your mom is on a cusp, and sometimes seems like she could go either way. Listen to her carefully and give greater weight to the calm times. I pray that you, your family and she have courage to face these decisions well.
Yours in Truth,
Sam