Following up on releasing vs holding on….

I just returned from reviewing the patient who is brain dead and on ventilator. The purposes for which they want to hold on to life is, in addition to their love for their relative, a cultural mandate and expectation that no death should happen in the family when a marriage is organized. If death happens, marriage is set aside for one year. Since the patient’s condition was worsening and the possibility of imminent death is there, we shared about our inability to give any time line, how long the person will be alive. And interestingly the family had already thought through the culturally acceptable possible alternatives to protect the marriage, which came as a great release to all concerned in the care of the patient.  Which means that every cultural expectation or self-driven interests have a loop hole or a way out!

This morning my personal reading was from the book of Isaiah, where King Hezekiah was told that he was to die soon. He then cries out to God and asks that his life be spared and extended. The story goes on to say that God hears his prayer and agrees to extend his life by another 15 years. If you read through events from his previous phase of life, one will understand that he was one of the few good Kings the nation of Israel had. He was a wise, prayerful, humble, selfless and able leader, who protected the nation from the assault of Assyrian empire and provided excellent leadership in line with what God expected of him.

Interestingly Bible does not give much details about the 15 years of extension he got, other than one small but significant event. He is visited by few people from another neighbouring empire, and without exercising wisdom or prudence, opens up his whole treasury, and all what the nation has, for them to see. Somewhere in the process of getting new life or an extension of life, he seems to have lost the wisdom and prudence which he had earlier. And when confronted by the prophet that this one event will lead to destruction of the nation down the line, he was happy, because, the destruction will not happen in his life time! A leader who should be living beyond his life time, who should be worried about his nation’s future, was happy that during his life time nation will be okay, what happens after his life as not important to him. A selfless leader had become self-driven.

Interesting to observe that when you hold on to life for your own selfish interests you lose the character you had prior to this. You become self-driven and foolish! It cannot be generalized, but this one story is quite revealing that the reason for holding on to life has to be for a greater propose than yourself. Otherwise it has the potential to destroy your character or who you were.

Paul in his letters would say, I want to give up my life to be with Christ, but I am willing to be here as long as I am required for the sake of the greater purpose of loving God and His people, that for which God has called me. Jesus in his teachings clearly taught, fear not the destruction of body but destruction of the soul.

Medical training does not teach us about any greater purpose for the body, it teachers us about taking care of the body which is physical! And use these physical principles to advise the family whether to hold on or release. Neither does Medical training talks about soul and life beyond this life. Without these paradigms - love of God and people, greater purposes, soul and spirit, life beyond this life, discussions on sustaining vs life releasing become confusing, especially when selfish or cultural expectations are used as principles for a decision making.

Can culture and world views be part of our Medical education?