When a Patient Wants to Die

What if he asked me to help end his life?

George was dying. I did  not expect him to last more than a few weeks. The esophageal cancer had spread to his liver and to his lymphatic system, mutated and spread beyond the reach of all known treatments. His esophagus was narrowed to the point where solid foods were impossible to swallow and he was starving. The impact of the cancer on his digestive system had resulted in intractable nausea. None of the four anti-nausea medications he was taking had made a difference. Every day was miserable. All pleasure was gone from his life and he was simply waiting to die.

He signed up for hospice care to ease his passing. He was too weak to come to the office so I went to his home to see him. He was a shell of the man he once was. He was once obese but was no longer. He had lost over 100 pounds, his clothes hung loose and his face was drawn.

During the hour I was in his home we discussed many things. He asked me many unanswerable questions-, wondering what caused the cancer, what would have happened if the specialist he had seen had made the diagnosis earlier when he first had trouble swallowing. He asked how long it would take for him to die. Having provided care to many hospice patients over the years I told him that only a foolish doctor would deign to predict a time of death. Death comes when it comes. Sometimes in comes in days, other times it comes in weeks. All I could promise was that I would be there for him, that he would not suffer.

Waiting can become the hardest part of dying. Once the inevitability of death has been accepted, when the goodbyes are said and the prayers have been made there is nothing else to do but wait, to watch each change in symptoms and wonder what it means, to wonder if the final countdown clock has started to tick or if it is just another meaningless change. 

For many patients and families the waiting is unbearable. As the suffering increases and the end approaches it is natural to ask, “Can we just do something to end it?”

Because physician assisted suicide has been illegal in California I have never had to directly answer the question. This could change at any moment, as the governor has signed a bill that would legalize the practice. When the law is implemented it will be legal for me to give patients like George a lethal dose of medication. The question of "When?" will become answerable and the agonizing days of waiting avoided. Family and friends could know the time and place and plan accordingly. Everyone would feel a sense of control.

And my role as a physician would change forever.

For patient's like George  it seems straightforward. He had at most a month or two to live, and his suffering was real. Why not provide definitive closure for such patients? What is the harm in providing a quick and easy passing?

George's case provides an answer to these questions. Under the law as written, George would have been a candidate for assisted suicide 4 months ago, when he was first diagnosed with the aggressive cancer. If he had not elected to attempt treatment his life expectancy would have been less than 6 months and he would have met the conditions of the law. Any doctor could have ended his life any time he wanted. He could have been given a large dose of morphine or other medications and the months of suffering avoided.

He also would have avoided hundreds of conversations with friends and family, including the spiritual conversations he had with me and others. A professed atheist, he specifically asked for prayer and if I would advise him spiritually as he went through the process of dealing with his disease. That 4 month process changed him. He became a different man with a different perspective. I would not have wanted to take that from him, nor should anyone.

Many will say that it should be the patient’s choice. In a godless world where man is the ultimate arbiter of his fate this makes sense. If there are no enduring consequences, if there is no ultimate meaning in life, if there is nothing good that comes from suffering, these choice advocates are right.

But we do not live in a godless world and man is not god, as much as many may wish that we were. Death reminds us of that.

As a Christian physician I will not play the role of God, I will not help a patient end his life. What I will do is relieve his suffering. I will aggressively treat his pain without reservation, even if that requires middle of the night visits. I will come to his home to pray for him, sit with him and comfort him, and do all I can to facilitate a death that is filled with dignity and comfort, knowing that each moment, even the ones filled with pain, provides an opportunity for love, reflection and faith.

- Bart

Please consider sharing this post with others on Facebook or twitter, a simple click on one of icons below is all it takes. Your comments and questions are welcome. You can join the hundreds who have subscribed to the blog and who re receiving each post in their email. The subscribe button can be found by scrolling down on your mobile device or in the upper right on your computer screen. You can also find me on Twitter @bartbarrettmd, or on vimeo, www,vimeo.com/bartbarrett

Men can be Pigs. Women Need not be Pig Feeders

While there are many things that men can inadvertently give away to other women, there are things women can give away as well. Just as I should not look at any other woman with desire, women should not set themselves up as the object of any other man’s desire. In many ways, provocative dress is the female counterpart to a man’s lustful look. There is no one who hasn’t walked down a street and seen a woman displaying aspects of her person that should only have been shown to her husband! I am not advocating that women be fully covered as they are in expressions of Islam, but I am encouraging women to reflect on their appearance. Some aspects of a woman’s physical beauty do not need to be shown to other men.

As we look at our own thoughts and attitudes about marital intimacy and how they impact the way we see the world we realize just how important our thoughts are. All of the commandments thus far emphasize the importance of how we think. God cares about how we think about sexuality and marriage. God knows that evil actions always begin with evil thoughts and wrong attitudes. The beauty and oneness of marriage can be easily damaged if we do not consciously work to protect it. We live in a world filled with easily accessed pornography, and where casual sex is the order of the day. With the foundation of intimacy under such attack it is not surprising that infidelity, divorce, and single-parent families are so common.

Given the prevalence of sexual immorality in our culture, intentional effort is required if we are to protect our families. Christians need to be vigilant in what we allow into our homes and into our minds. We need to be especially careful in our consumption of media. So much of what’s on television and on the internet threatens our families.

I have taken practical steps to protect my family. With my children, we review together the content of movies before we go. If there is questionable content, we don’t go. When my children were younger, I decided where the lines were drawn and what they could see. As my children have matured, they have been able to apply biblical principles and make good decisions on their own. If a television show is inappropriate we turn it off. When my daughter was in middle school she watched the Disney Channel, a lot. When I noticed that a show aimed at “tween” girls was encouraging casual attitudes about dating, we decided it would no longer be watched in our home. My twelve-year-old daughter was in total agreement with the decision. She had been taught the importance of morality.

I have worked to teach my children morality in their personal lives as well. When it comes to my daughter, I am the “outfit police.” I help her understand that there are things a young woman does not need to reveal to others or draw attention to. So much of girls’ and women’s clothing is designed to be provocative that it can be easy (especially by adding peer pressure) to grow comfortable wearing inappropriate clothing. As a man I can identify provocative clothing better than my wife can, so I make it a point to help my daughter understand what her clothes say about her.

With all of the tangible lessons I try to teach my children about modesty, I have learned that the best way to instruct them about sexual morality is through my relationship with my wife. There is no more powerful example than the one they see every day. I make sure to express my love for my wife in front of my kids. They hear me praise her and tell her she is beautiful. (And they don’t hear me praise other women!) I make it clear to her and to them that she is absolutely everything to me, and that no other woman has any chance at all of gaining my affection. Through all of this I teach them what it means to be faithful.

As with all of God’s commandments, His imperative against adultery is not punitive. I have seen in my own life the incredible blessing of a healthy marriage. I have experienced the beauty of the intimacy that God desires. A love for God and an appreciation of His gift in marriage drives me to work hard at thinking and acting as faithfully as I can. When God had Moses proclaim, “You shall not commit adultery,” He was showing us how to save our families and experience His blessings. 

- Bart

This is the 8th and post on adultery excerpted from my book Life Medicine, available on Amazon  A recent message on the topic is available on my vimeo page, click here to view. Comments or questions on this, or any post, are always welcome. If you are interested in having me speak to your church or community group, contact me through this site. Those who wish to subscribe to the blog and have posts delivered to their inbox need only click on the subscribe link, and posts will magically appear!

Pizza, Porn and Making a Stand

It was supposed to be a pizza party. It soon became a porn party. The members of the high school basketball team went to the local pizza parlor to hang out after a game. After a while the conversation took an unexpected turn. Several players took out their smart phones and brought up pornographic images. They laughed and joked and thought it was funny. For the one Christian member of the team it was anything but. It was awkward, and it was wrong. He called his parents and got an early ride home

When I heard this story I was heartbroken. I felt terrible for the young man who had been placed in such a difficult circumstance and I grieved over the lack of shame displayed by his team members. One thought repeated in my mind, “How did our society end up like this?”

There was a time when right and wrong were clearly defined. Not everyone chose to do the right thing but just about everybody knew what the right thing was. Wrong things included lying, cheating, foul language, underage drinking and alcohol use, and sex before marriage. Good things included respecting your elders, politeness, honesty and morality. Somewhere along the line these definitions were abandoned. Wrongness now only applies to such things as violent crime and political incorrectness and goodness is defined as whatever one wants as long as it does not directly hurt someone else.

How did this happen? It is the natural consequence of moral relativism. When right and wrong are no longer universal absolutes but are instead based on individual perceptions, moral decline is inevitable. Human nature leads people to think highly of themselves, so it is natural that people will define good as “what I do” and bad as “what someone else does” when given the opportunity. When good is determined solely by our personal desires there will be no need to rein our desires in.

When our nation embraced the moral relativism of humanism and  turned from its Judeo-Christian roots it also turned away from the well-defined moral code that guided our nation since its inception. Absent the boundaries of a clear moral code, immorality is boundless. Pizza parties become porn parties.

In such a world not only will immorality increase, morality will be attacked. Those who declare immoral behavior to be wrong will face accusations of intolerance, bigotry and of being judgmental. In such a context people of faith will endure difficult times.

When I deal with individuals who are caught up in an immorality I have learned that a simple question can bring clarity. My favorite question when I talk to someone caught in a moral failing is- "Is that the best you can do?" I challenge people to set goals of excellence for themselves, to strive to do their best, not to the minimum, in every area of their lives. I tell people that my goal in life is to be the best man, husband and father I can be, and that when confronted with a choice about a behavior I have trained myself to ask how the activity in question can help me be the best. 

I could go out and get drunk, but I want to do better than that, to have a clear mind and to remain in control.

I could look at pornography but I want to be better than that, to value my wife and allow her to be confident and secure in the knowledge that she is my ideal.

I could lie, I could cheat, but I want to be better, I want to be someone who is trustworthy, respected and believed.

The reason I want to give me best? Because God gave His Best for me.

-          Bart

Thanks for reading, take the time to be your best today. If you know anyone who may be encouraged by this post, consider clicking the share button and letting them know. Comments and questions are welcome. You can subscribe to the blog (click the button) to have future posts delivered to your inbox, or you can follow me on twitter @bartbarrettmd. 

You're an Adulterer. You Just Don't Realize it. Adultery Part 7

The tendency to commit adultery and to think immorally about sex is a characteristic of all humanity. It is a natural expression of mankind’s sinful nature.

God gave Moses the commandment against adultery knowing full well of man’s tendency to commit sexual immorality. An infinitely wise and all-knowing God would not have given a prohibition against adultery if only a few people were apt to fall into the sin. God knew then, and knows now, that sexual immorality is common. In my many years of practice I have seen this truth proven over and over again. The natural sex drive that God designed to be fulfilled in marriage is easily perverted into something else. Research provides further confirmation. I have seen surveys in which 5–25 percent3 of married individuals admit to infidelity. The sin is remarkably common.

The fact that 75–95 percent of individuals claim to be faithful does not mean that these people are guilt-free. When we consider Jesus’ teaching that men who wrongly view women are guilty as well, there are very few innocent people. It appears that the majority of people struggle with adultery. “You shall not commit adultery” is clearly on God’s top ten list for good reason. Just as murder resulted from devaluing human life, so too, adultery is a result of devaluing sexual intimacy.

As plain as it is that God intended sexual intimacy to be a foundation for the marital bond, I believe that there is much more to the union than a physical connection. Faithfulness in marriage means more than simply avoiding sexual sin. Physical intimacy is the most tangible expression of the intimacy of marriage, but the bond goes far beyond mere sexuality. The oneness God described in the Genesis account includes intimate emotions, thoughts, and words, nonphysical things that are not to be shared outside of marriage. Jesus’ words on adultery illustrate the truth that such thoughts and feelings are important.

When Jesus warned against looking at a woman with lust in the heart, He was referring to a woman who was not a man’s wife. (It is rather difficult to commit adultery with one’s spouse!) I believe it is appropriate to look at one’s wife with desire. The longing to be with one’s spouse is part of a healthy marriage, desiring someone else is not. Implied in Jesus’ teaching is the truth that the desire for sex, and the look that accompanies that desire, are the sole property of one’s spouse. If a husband gives such a look to another woman, he is giving away something that only his wife deserves. The marital bond is weakened not only because a lustful look separates sex from marital intimacy but also because the look itself belongs only to one’s spouse.

When a marital partner shares with another that which rightly should only be shared with a spouse, he/she violates intimacy and trust. This breach makes adultery especially harmful. There are things in a marriage that are meant to be unique to a marriage. The marriage bed is the most sacred of these trusts, but there are others as well. Just as looking at another person as a source of pleasure is a type of adultery, so also is giving to another person anything that rightfully belongs only to one’s spouse.

As I reflect on my own marriage I can think of a number of things that belong only to my wife. In addition to my physical self, only she deserves my sexual desires. To her alone belong my admiring stares and flirtatious smiles. To her alone belongs my heart. No other woman deserves to know my deepest thoughts and fears, my greatest hopes and dreams. The deeper things of my heart are hers and hers alone.

There are words that belong solely to my wife as well. There are compliments that carry with them an admiration and appreciation that rightfully belong only to my wife. While I may tell another woman that her new haircut looks nice or compliment the color of a new outfit, I should not give any praise that communicates any sexual desire. Compliments such as “You look beautiful,” “You have the prettiest eyes,” or at times even something as seemingly innocuous as “You look really nice today,” may be wrongfully giving away admiration that belongs to my wife. Wisdom demands that I be careful in what I say.

Out of love and respect for my wife I have chosen to avoid giving other women any compliments that might make a woman think she was an object of my desire. I will never compliment another woman in a way that might make my wife uncomfortable or jealous. Years ago I was discussing these things with a neighbor of mine. He thought I was being foolish and legalistic. To him words were harmless. As a salesman, he regularly would compliment other women, telling them they were beautiful or that they looked great. I shared with him that I thought that was “verbal adultery,” that certain types of praise, particularly praise of someone’s physical appearance, could easily be interpreted as expressions of desire or as a type of flirtation. For that reason I felt it best that no woman except for a man’s wife should be addressed in this way. Although he could not understand it at the time, as he grew in his faith he realized the wisdom in what I was sharing and changed his behavior.

I have taken steps to intentionally put these attitudes into practice. As a man who has female employees I have learned what to say and not say. I carefully choose words that cannot be misinterpreted as flirtatious. I am very careful in how I compliment female patients. I make a conscious effort to compliment actions (such as losing weight) rather than appearance.

It is not just words of praise that should only be given to my wife. There are specific types of attention and time that should not be shared with other women either. Included on the list of things that belong to my wife is intimate time alone. It is very dangerous for a man to spend time alone with another woman. Great caution should be used when it comes to lunches, dinners, or meetings in private. There are very few men who spend so much time with their wives that they have any extra time to share with another woman! I believe that intimate friendships with members of the opposite sex should be avoided, as it is inevitable that things will be shared with such a “friend” that rightfully should have been shared with a spouse.

If we truly desire to follow the spirit of God’s instructions regarding sexuality and marriage, we will do whatever we can to preserve all of the types of intimacy marriage includes. Practically speaking, asking ourselves the question “Do these words, actions, or thoughts rightfully belong to my spouse?” will keep us out of a lot of trouble! Just as wrong thinking leads to sin, right thinking leads to godly behavior. When I began to consider all of what belongs to my wife, my behavior changed. Movies with nudity and sexually provocative content became even more inappropriate. I did not want to give desirous looks to any woman, including one on a movie screen. I began to carefully watch my words. I starting turning down some invitations. As I did, I grew in love and appreciation of the wife God gave me.

- Bart

This is the 7th post in a series on adultery excerpted from my book Life Medicine. The book can be purchased on Amazon. A small group study guide is available here. If you have a church group interested in the book, I will gladly donate the books for a group study. Contact me through this site. If you have questions or comments please share them! Most of all please consider sharing this post with your friends.

The Big Money Lie

“Are you tired of living from paycheck to paycheck? Have you ever observed a need that you longed to meet, but you didn’t have the finances to help? Do you yearn to sow freely into the needs of the ministry? Do you want more out of life for you and your family? If so, you need the School of Prosperity!”

These words are copied directly from the website of the “Christian Ministry” of a man named Creflo Dollar. I had not even heard of him until I saw an online story about how God had “told” him that the ministry needed a new $65 million private jet. Apparently travelling around the world proclaiming the good news cannot be accomplished if you travel coach.

Mr. Dollar is sadly not alone in his teaching.

On his website Jerry Savelle states his ministry “exists to teach people around the world how to live in God’s blessing, experience His favor, and become the winner in life that He has called them to be” and to “Motivate people, no matter who they are, to develop a “no quit” faith and to receive God’s favor on their finances.”

Kenneth Hagin, in an article on his website writes, “When it comes to the realm of the natural, so many people don’t see the truth that God wants them to prosper financially and walk in divine health.”

There are many, many other similar preachers in America proclaiming a message of financial prosperity. To those outside these churches the message seems obviously and even comically false. How could anyone believe that God’s plan of redemption would have a financial focus?

The answer can be found in scripture. Near the end of his life the Apostle Paul wrote these words to his protégé Timothy, “For the time will come when men will not put up with sound doctrine. Instead, to suit their own desires, they will gather around them a great number of teachers to say what their itching ears want to hear.They will turn their ears away from the truth and turn aside to myths.” 2 Timothy 4:3-4

People naturally seek out pastors who will tell them what they want to hear. In a society obsessed with material wealth, a culture where a person at the US “poverty line” has annual income higher than 85% of the world’s population, and a society obsessed with immediate gratification it should not surprise us that people want to be told that they can and should have more. They believe the lie they want to hear.

What angers me the most about this theology is not the manner in which it deceives so many (although that does tick me off.) What angers me most is the way it trivializes and diminishes God. An Eternal God by very definition must be concerned about eternal things. Acting as if this life is all that matters denies God’s nature, plan and intent. It is a heresy that must be rejected and mocked at every opportunity.

-       Bart

 Thanks for reading. Feel free to comment, question or share with friends. You can subscribe to the blog by clicking on the subscribe button or follow me on twitter @bartbarrettmd