Dear Elder Fagel,

Thank you SO MUCH, so VERY much for your reply, which was very thoughtful. Initially after I sent my question, and got the initial response that not many questiions are being answered at first my heart went to my shoes, and I thought I was going to try to look elsewhere for answers.

But then the very next day your answer arrived. How NICE of you!! I feel that you think much the same as I do, but it helped me to clarify my thinking some, or verify it is perhaps the word. I want to print your answer out.

HOPE channel from time to time show "Adventist Classics" and a while back they showed an original "Faith For Today" program of both your parents--and their two little children!--or at least I assumed it was their two children (at that time). One of them was a little boy, "Billy" who I thought looked about 5 years old (my guess). I am guessing that was you. The other child was a girl I think. Memories are special. I don't know what archives HOPE channel gets these from.

In regards to your father with the feeding tube, the fact that he was alert and responsive, even partially, certainly indicates supportive measures were right to be continued. I was referring to persons who were not only totally unresponsive but also shown to be brain dead by either MRI or EEG or such.

I think we are pretty much in agreement, and once again I profusely thank you for replying to me.

___________,

Thank you for getting back in touch. I am sorry to hear of the deteriorating health you have described. These matters become very personal when they strike close to home. I can understand your concerns.

As you already know, the technology that we commonly use today to extend life was not available in Mrs. White's day. So it comes as no surprise that she did not comment on it. I don't know whether there may be principles in her writings that might apply. How does one look for these things? It is more likely the kind of thing one will just come across while reading and will recognize as applying to such a situation. I have not come across any statements like that, that I can remember.

So let me just reflect with you a bit on the nature of your question. If we assume (correctly, I believe) that ultimately the matters of life and death are in God's hands, what constitutes "playing God"? It must be taking some action that tries to avert the expected onset of death or artificially hastens death. I believe that God is not offended by the advances of science that allow for the extension of life. Sometimes those who are on life support recover fully and live for years afterward. Was it wrong to do this ?was it "playing God"? I don't think so. I believe that God has allowed people to find ways to help the sick, injured, and dying in order to avert death. I do not feel the same way about artificially hastening death, that is, taking some overt action to bring about death. In principle, this does not seem right to me. I would not be comfortable, then, about administering a lethal dose of some drug to hasten death.

But what about stopping artificial means of keeping someone alive? Is this "playing God"? When to all human appearances no recovery can be expected and the body is only being kept alive by machine, who is playing God? The one who prevents death from coming, or the one who no longer intervenes? In such a situation, it seems to me that the person who says, "We will no longer take heroic measures to prevent the natural occurrence of death," is letting God determine the outcome. That person is not "playing God."

To my way of thinking, other scenarios are more difficult. My father was largely incapacitated for a year by a stroke before he died. During much of that time he was unable to take food or liquids by mouth. There was a very real danger that he would aspirate them into his lungs. He had a feeding tube into his stomach. This was an artificial means of keeping him alive, but it was not what I would call a heroic measure. And he was alert and responsive, even if this was somewhat limited. Removing the feeding tube would have meant death by starvation or dehydration. This did not seem right to me. I am glad that it was a decision we were never called upon to make. He died in his sleep one night. However, in the days before modern medical advances, a person who slipped into a coma would not be able to eat or drink, and death would follow soon. In cases of terminal illness today, when near the end of life a person loses consciousness and is not expected to recover, I can see how some people might feel that it is "playing God" to feed and hydrate them artificially, and that it is no violation of God's will to accept the state of their condition and not fight it any longer. God is still free to heal if He sees fit to do so. If He does not, the decision was His.

God has given us the means to alleviate extreme pain. I do not believe that we are ethically wrong to do this at the end of life. I would not want the dosage of pain killer to be chosen in order to hasten death, but in order to alleviate the pain. It is possible in some cases that such pain relief might also hasten death. I do not see it as wrong to give enough of the drug to ease the pain, even if it may also hasten death. To me, the purpose is the critical factor. I would not be worried about the addiction factor in a situation where the patient was near death. There is a Bible passage that may speak to such a situation. It is Proverbs 31:6, where we are counseled to "Give strong drink to him who is perishing." This may be a reference to anesthetic for pain. Though the Bible typically warns against such drink, here apparently it may find a legitimate use. I see a principle there that I think applies to end-of-life decisions about reducing pain.

I have been able to do no more than to share with you my understanding of these matters. I do not have statements from Mrs. White's writings to share with you. But I hope these thoughts may help you in thinking matters through for yourself. And I pray that God will be with you and, ideally, spare you and your husband from having to make decisions like these. May God bless and guide you always.

William Fagal
Associate Director
Ellen G. White Estate
12501 Old Columbia Pike
Silver Spring, MD 20904-6600 U.S.A.
Phone: 301 680-6550
FAX: 301 680-6559
E-mail: mail@WhiteEstate.org
Web: www.WhiteEstate.org

To whom it may concern: (maybe this will go to Elder Fagel again as he and I have corresponded in the past):

I have serious questions about "end of life ethics". I am aware that in EGW's era respirators and endotracheal tubes as well as probably also IV's (intravenous fluids) were not available, as well as MRI or CT scan equipment. So in some ways in Ellen White's day life may have been more simple in regard to "end of life ethics". But perhaps she stated some principles that might help us to decide end of life issues.

Please allow me to ask some questions, then see what principles, at least, that you might be able to find in her writings that might help answer some of these questions.

(1) Patient has been declared brain dead by neurologists who have studied MRI and/or EEG tests of the brain, and family is asked whether to "pull the plug" or not (turn the respirator off, take endotracheal tube out of throat, etc). Is this "playing God?"

(2) Patient becomes unable to take food or water on his/her own, and family is asked whether they want IV fluids continued (tube in arm) and/or artificial feeding, such as tube into stomach----or whether family wants all IV's and tube feeding stopped (patient is felt to be terminal regardless),---which would hasten the patient's death. (patient felt to be terminal regardless, and IV's or tube feeding would merely cause his/her life to end later rather then sooner). Is this "playing God"?

(3) Patient is in extreme pain due to terminal cancer, requiring large amounts of pain medication to even partly control excruciating pain. Is it right to give as much pain medication as necessary to alleviate pain if in the process it also hastens the patient's death? Is this "playing God?"

Sometimes I think (my opinion ONLY) we are kinder to animals in euthanasia rather then allowing them to suffer with great pain when they will ultimately die anyhow (my opinion only).

Also should there be a concern about "addiction" with pain medication when the patient is going to die anyhow?

These questions are important as my husband is 69 with multiple serious illnesses and I am 65 with several potential serious medical problems. We have no children. My husband does not have any other immediate family. I have a brother hundreds of miles away but who shows little interest in our welfare.

I know how I feel personally about some of these issues but I do not want to be found "playing God" if that is what I was doing (or instructing--such as in power of attorney papers).

Please take my questions seriously and give me the best answers that you can. I asked a local SDA minister these questions (in November) but I feel that although he is courteou*}s he is hedging about giving answers. I need someone to take me seriously and advise according to whatever principles can be found in EGW writings.

Also, does the church at large have any official position on these issues?

Thank you.

___________