Recently, a friend of a friend asked me a question about death.  She is a new employee at a hospital in another state.  Though we haven’t seen each other in years, she remembered that I was a chaplain, got my number from our mutual friend, and wanted to talk.  “I’m not a religious person,” she began.  “I’m not even sure I believe in God.  But if there is a God, I need to know if he’ll judge me for this.  I’ve killed three people already.”  Confused, I asked her to explain about these killings.  She told me how she had been the one to remove the breathing tubes and turn off the ventilators for three terminal patients.  “I know it’s my job,” she said.  “And it’s what the families decided to do, and the patients probably would have died anyway.  But they died sooner because of me, you know?  I’m the one who took them off the vent.  They stopped breathing at that moment because of me.  Will God punish me for that?”  I could hear the tremor in her voice.  “I wanted to do this job to help people.  And I do.  I help a lot of people.  But I didn’t count on being the actual instrument of death for some patients, you know?  I don’t know how to deal with that.”

We talked for a long time.  I listened to all of her anxieties and her very real pain at feeling she had ended these people’s lives.  When she was ready, I shared my thoughts on the matter.  “Your job is to take care of people,” I said, “like all of us who work in hospitals.  And you’re doing it.  Sometimes that means saving someone’s life when a patient is crashing, or giving treatments that make it easier to breathe.  But sometimes there is nothing more medically that can be done to save a patient’s life.  There comes a point when death is inevitable, and all medical interventions can do is prolong the dying process.  By the time you get called in to turn off the ventilator, that patient, or his or her family has already made the decision that they do not want to prolong that process.  It is not an easy thing you have to do at that point, but it is one last way of taking care of them, by respecting their wishes and helping give rest to a body that can no longer sustain life.  I don’t know what you believe about what happens to us when we die, and I sure don’t have all the answers, since I’ve never died.  But I believe that whatever happens is good, because I believe God is good, and God is there waiting for us when we die.  For someone who has been sick and in pain and suffering, it is an end to all of that.  It’s a time of peace.  So do I think God will judge you for enabling them to get to that?  No.  Absolutely not.  You are not an instrument of death.  You are an instrument of healing.  And sometimes the only healing possible is an end to suffering.”

I have often given a similar speech to families making end of life decisions.  It’s hard when the patient is no longer conscious and did not tell the family about his/her wishes before this health crisis arose.  Things go more smoothly from a medical standpoint if the patient has an advance directive, such as a Living Will or Healthcare Power of Attorney, spelling out their decisions about end of life treatment.  There are much worse things than death.  I’ve seen some of them.  At a recent seminar I attended on end of life ethics, the speaker said that in hospitals we live in the tension of seeing death as both enemy and natural part of existence.  A Hospice chaplain there said many of her patients seem to welcome death as a friend.  For the familes and staff who care for them, however, it does not always seem that way.  Or if it does, they may feel guilty for feeling relieved that the patient has died.  Maybe death really is hardest on the living.