LCMS Convention Workbook St. Louis, Missouri — 2026, Page 205

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THEOLOGICAL DOCUMENTS­­—COMMISSION ON THEOLOGY AND CHURCH RELATIONS
APPENDIX

APPENDIX

Appendix

S U P P L E M E N TARY M AT E R I ALS

A P P RO P RIATE Q U E ST I O N S FO R D I SC U S S I O N W I T H M E D I C A L P E R S O N N E L AN D FAM I LY
Richard C. Eyer helpfully offers guidance for how to deal with physician interactions in end-of-life situations.192 He offers
several questions for the family members being approached by the physician for input on either initiating or continuing life
support interventions. He recommends that the family member ask to speak directly with the physician if approached by a
nurse or other hospital staff person. Eyer’s proposed questions have been modified and expanded to take into account some
of the end-of-life discussions in this paper, particularly the suggestions by John T. Pless.193 As such, they are also directed as
points for discussion with family members and one’s pastor as well as with medical professionals.
1. Ask the doctor: “What is the medical condition of the patient at this time?” (You are asking for an objective
medical evaluation, not a philosophical opinion, of the patient’s condition.)
2. Ask the doctor: “What is the prognosis?” Has a “second opinion” been sought? Does this opinion confirm or
call into question the original prognosis? (You are asking whether the patient is expected to recover or not.)
3. Ask the doctor: “Is the patient dying at this time?” Have the patient’s vital processes already begun to shut
down, indicating that death is inevitable unless God intervenes? (If the patient is not dying, it would be morally
wrong to aim at causing the death of the patient.)
4. Is treatment being discontinued to hasten death (hence “choosing death”) or because the treatment itself has
become burdensome on the patient with no realistic hope of recovery?
5. Ask the doctor: “Is the patient awake?” (If so, you will want to be supportive by discussing with the patient his
condition and by praying with him for guidance before a decision is made.)
6. Ask the doctor: “Is the patient in any pain at this time?” (You are asking whether pain gives urgency to your
decision.)
7. Is adequate physical care (e.g., artificial nutrition and hydration) provided for the dying person even when
other treatments are discontinued or life support systems are withdrawn?
8. If a decision is needed immediately, err on the side of life, not death. If a decision is not needed momentarily,
say, “I need time to talk with my family and/or pastor and I will call you within [a stated length of time].” (You
are saying you need the input of others concerned for the patient.)
9. If the situation allows, leave the hospital and meet with your family and pastor at church in a prayerful environment. This distance from the hospital environment sometimes helps you think more clearly. Inform the nurse
that you are leaving, where you will be and when you will return.
192
Richard. C. Eyer, “Medical Directives and Some Misunderstandings” (Mequon, Wis.: Concordia University, n.d.). A helpful, but unfortunately out of print, resource for group studies of endof-life decisions that includes descriptions, biblical texts for each issue, case studies, small-group questions and even “things to do” in follow up can be found in John Klotz, ed., Life Choices Who
Decides? Following God’s Word in Life and Death Decisions (St. Louis: Concordia Publishing House, 1991).
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Pless, Mercy at Life’s End, 16, was invaluable for adding to the excellent questions by Eyer.

G LO S SA RY: D E F I N I T I O N S O F C U R R E N T E N D - O F - L I F E T ERM S
Actively dying — The hours or days preceding imminent death during which time the patient’s physiologic functions wane. Virtually all
dying patients go through a stereotypical pattern of symptoms and signs in the days before death. This trajectory is often referred to as
“actively dying” or “imminent death.”
Advance directive — The most common types of advance directives are the living will and the power of attorney for health care. Called
“advance” because such a document is prepared prior to a health crisis during which it would guide medical care, these directives vary by
state and can include other documents, such as a dementia provision or a DNR (“do not resuscitate”) order (see below). See also “living
will” and “power of attorney for health care” below.
Artificial nutrition and hydration (AN&H/ANH) — ANH is most often delivered by means of a nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube (see below). It often involves a surgical procedure to place a flexible feeding tube through the abdominal
wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and
esophagus. Whether delivered by an NG or PEG tube, the purpose of ANH is to provide short-term support for patients who are acutely
ill. When employed near the end of life, ANH will most likely not prolong life and can lead to medical complications that increase suffering
for the patient.
Coma — While differences of physical presentation exist within the classification of “coma” (e.g., open-eyed vs. closed-eyed), the Mayo
Clinic defines a coma as “a state of prolonged unconsciousness that can be caused by a variety of problems — traumatic head injury, stroke,
brain tumor, drug or alcohol intoxication, or even an underlying illness, such as diabetes or an infection.” A coma “seldom lasts longer than
several weeks.”
Death with dignity — The term used by proponents of physician-assisted suicide/dying to describe death where the patient is viewed as
being in control (either by an advance directive or by electing to request lethal medications). It is also the name given to aid-in-dying laws
that have advanced in a number of states over the years. Oregon’s landmark aid-in-dying law, enacted in 1997, is called the Oregon Death
With Dignity Act. The state of Washington’s 2008 law is the Death with Dignity Act. It is a term of art and part of the political landscape
(e.g., pro-choice, pro-abortion). People who speak of “death with dignity” are not employing the word “dignity” in its Christian sense but
as part of their efforts to legalize physician-assisted dying and/or euthanasia.
Do not resuscitate (DNR) — A medical order that no measures be taken to resuscitate a patient whose heart or breathing stops. The
order is made while the individual is mentally capable and conscious, or by that individual’s healthcare proxy if he or she is not. A variety
of interventions may be specified. Some patients may choose to have “full code” with intubation and to be placed on a ventilator (short or
long term). Another patient may decide not to be on a ventilator with a “DNR Select” code status where the heart would be shocked if it
stops, but intubation/ventilation is not performed. Some in this category choose to be placed on a BIPAP (bilevel positive airway pressure)
machine (similar to a CPAP— continuous positive airway pressure — for sleep apnea). A third option involves a patient who chooses to
have a status of “do not resuscitate” (DNR). Various “treatments” (i.e., antibiotics, tube feeding) and other care preferences desired/not
desired can be specified on some DNR forms in some jurisdictions to guide health team members.
End of life — In clinical medicine, the “end of life” can be thought of as the period preceding an individual’s natural death from a process
that is unlikely to be arrested by medical care. For insurance purposes, the “end of life” has been operationalized to represent the last six
months of a patient’s life. It refers to a final period — hours, days, weeks, months — in a person’s life in which it is medically obvious that
death is imminent or a terminal moribund state cannot be prevented.
Euthanasia — Also known as “mercy killing.” In the act of euthanasia, the physician — not the dying person — chooses and acts to cause
the death of the patient.

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APPENDIX

APPENDIX

Hospice — A program in which an interdisciplinary team of caregivers provides comfort, support and dignity to terminally ill people
when medical treatment is no longer expected to cure the terminal disease or prolong life. Hospice service is provided wherever the person
resides, most often at home. It is voluntary and also involves and supports the individual’s family and/or loved ones.
Irretrievably dying — Irretrievably dying refers to the condition where a person’s body has already begun to shut down and few, if any,
medical treatments offer hope of healing. The term may be contrasted with “terminally ill,” since one can be terminally ill but still expected
to live for months or even years.
Living will — A document that expresses a person’s end-of-life preferences if he or she becomes unable to speak. A living will is just one
type of an advance directive (see above).
Medical aid in dying (MAID) — A provision that allows mentally capable, terminally ill adults to request a prescription from their
physician for life-ending medication that the person may self-administer. The states that currently authorize MAID require that, prior to
providing a prescription, doctors must confirm that a patient is fully informed about his or her prognosis and must provide the patient
with information about additional end-of-life options, including comfort care, hospice and pain control. Other synonymous terms are
commonly used: physician-assisted suicide, physician-assisted dying, physician-assisted death, physician aid in dying, medically-assisted dying, patient-administered hastened death. Advocates of the practice consider the term “physician-assisted suicide” to be a partisan
description of the medical practice of aid in dying. They may cite the judgment of the American Psychological Association that suicide and
aid in dying have “profound psychological differences.” Lutheran ethicists have joined other Christians and non-Christians in opposing
this as suicide or euthanasia under another name.

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disease or illness from which there likely can be no return to health, and which, without life-prolonging procedures, will lead to natural
death. In other words, a person with a terminal condition is one for whom no medical cure exists.
Terminal prognosis, terminally ill — An illness for which the medical expectation is death within a few months. Aid-in-dying laws
typically define a patient as terminal whose life expectancy is six months or less. Those suffering from a fatal pathology because medical
treatment in their cases will not lead to a restoration of health and will prolong the dying process may be deemed terminally ill or have a
terminal prognosis. People in an irreversible coma (IC) and/or a persistent vegetative state (PVS) are, ipso facto, terminally ill. For the sake
of simplicity, most clinicians consider IC and PVS to belong to this same class of terminally ill people and refer to them as permanently
unconscious, though each group has different, but related, neurological impairments. The Medicare hospice benefit is limited to persons
whose physicians attest that the patient has “a terminal illness with a life expectancy of six months or less.”
Transition of care — Transition of care during the end of life includes: 1) changing place of care, 2) changing goals of care, 3) changing
teams of care. The term refers to support given to patients when they move from one phase of the disease or treatment to another, such
as from hospital care to home care. It involves helping patients and families with medical, practical and emotional needs as they adjust to
different levels and goals of care.
Voluntarily stopping eating and drinking (VSED) — VSED is a legal right for any individual who wishes to shorten the dying process by
refusing nourishment orally or through a tube.

Medical (or physician) orders for life-sustaining treatment (MOLST/POLST) — A document available in some states that provides
detailed guidance about an individual’s wishes for end-of-life medical care. The order is part of advance health care planning and is
prepared by a medical professional.
Nasogastric (NG) tube — A flexible tube inserted through the nose to deliver nutrition and medication to the stomach for those experiencing difficulty swallowing. NG tubes may administer nutrients and medication, remove liquids or air from the stomach, add contrast to
the stomach for X-rays, or protect the bowel after surgery or during a bowel rest.
Palliative/total sedation — Also referred to as terminal sedation. The continuous administration of medication to relieve severe, unrelenting symptoms that cannot be controlled while keeping the person conscious. This state is maintained until death occurs.
Percutaneous endoscopic gastrostomy (PEG) tube — A PEG tube is an alternative to an NG tube for patient nutrition. The PEG tube is
surgically placed through the abdomen directly into the stomach.
Persistent vegetative state (PVS) or Post-coma unresponsiveness — PVS represents a disorder of consciousness in which patients with
severe brain damage are in a state of partial arousal rather than true awareness. Typically the VS classification gets applied to such persons,
with the classification “persistent vegetative state” coming after four weeks. While some describe those in a persistent vegetative state as
“brain dead,” in fact, the lower brain stem in PVS patients is still healthy and fully functioning. This results in the person’s ability to blink
and otherwise move his or her eyes, breathe independently, cry or laugh, though not as an emotional response to external events. Those
with PVS enjoy normal circulation, experience regular sleep-wake cycles, move their limbs, though purely as reflex (PVS patients can’t hold
their limbs nor move them on command), open their eyes, smile and track objects with their eyes.
Power of attorney for healthcare (POAH) — A legal document that grants someone the authority to make health care decisions on behalf
of another individual when that individual cannot do so. Synonymous terms include durable power of attorney for health care, medical
power of attorney, health care power of attorney and health care proxy.
Refusal of medical treatment — The legal right of competent adults to refuse medical treatment even if that treatment is necessary to
sustain life. These life-sustaining interventions can include ventilators, feeding tubes and pacemakers. If an adult is judged to be mentally
incompetent by a psychiatric professional, the person can be treated against his will.
Terminal care period — The period during which there is evidence of progressive malignancy, and in which therapy cannot realistically be expected to prolong survival significantly. Patients enter this period either at the time of diagnosis or following a period of active
treatment. The onset of the terminal care period should not be confused with the point at which the expectation of life is estimated to be
short. A patient might be expected to die within a few months but have a treatable malignancy. This patient would still be in the active
treatment period.
Terminal condition — As held by at least two appellate courts, “dying” or a “terminal condition” is a condition resulting from injury,

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2026 Convention Workbook