'Quality of Life'

'Quality of life'.  Brothers and sisters, can we think about that phrase for a moment?  Can we think about what we are saying when we are using it?  Can we, as Christians, really use that phrase?

Consider the way we use it:

"Ma'am, your child will be born with Down syndrome.  I cannot guarantee his quality of life.  Here are your options."

"Sir, your father is in the middle stages of Alzheimer's.  His quality of life is decreasing more and more.  We need to discuss end of life care."

"What do you mean I'll never move my arms or legs again?  You mean I'll probably have to stay on this vent as well?  This isn't much of a quality of life!  I can't live like this!"

It would seem to me, that we have replaced the idea of 'not suffering too much' with 'quality of life'.  As though quality somehow correlates to suffering.  My friends, suffering is very much a part of the human condition.  We all suffer.  When is 'too much'?

'Quality of life', though, what does that phrase really mean?  Does it mean that we humans have become like packages of meat?  Some of us have Grade A quality lives, while others, Grade B, C, or D?  What decides quality of life?  Who decides?

In Scripture, the quality of human life is this: man was created in the image of God.  Human life, in all its stages and ages, is worthy of dignity and existence for this reason alone.

From another Scriptural standpoint, while man is also created in the image of God, men also are the sons and daughters of Adam.  Therefore, we were all created perfect- but we are all perfect no more.  Sinners, all of us, sick and not sick, disabled and not disabled, find our equal worth and equal value in the same source- the Cross of Christ.

If we want to say that a man is suffering very much, that he has acquired a severe disability, he is in much pain, he cannot work, his family is stressed to the max, and he is very depressed, say those things.  But don't try to determine the quality of his life based upon his suffering.  His life is still of equal quality (equality)- of equal value- to anyone else's.  It is as deserving of protection and preservation- even from his own very depressed mind- as is all of ours.

'Quality of life' is a dangerous phrase.  It threatens equality, human dignity, and judges human life as 'worthy' or 'not worthy'.  'Quality of life', in this day and age of 'options', and perhaps even 'duty', can turn all too quickly into 'qualified to live'

Down Syndrome, Suffering, and Grace

A recent study says that ninety-two percent of women who discover they are carrying a child with Down syndrome opt to abort the pregnancy.

I am not a parent, much less a parent of a child who will have a lifelong disability.  I can only imagine the feelings and thoughts that contribute to this 'choice'.  I imagine that fear of the unknown plays a role, for many of these parents who make this choice do not know people with Down syndrome.  I imagine that people are fearful of financial strain and the extra challenges that families with Down syndrome face.  I imagine, though, mostly a fear of suffering is involved.

For what parent wants to have his or her child suffer?  And, truth be told, men, women, and children with Down syndrome do suffer.  Oh, not to the terrible degree that doctors have described to parents since before Down syndrome even had a name, while convincing them to institutionalize their children in the past or abort them nowadays.  In fact, even while sharing with me their painful struggles related to their disability and the hurt and pain caused by mistreatment and abuse inflicted by others upon them, often, the men and women I have known with Down syndrome do not view themselves as having suffered any more than anyone else.   But it is a myth that people with Down syndrome are happier than other people.  

It's interesting.  From the world's view, while the purpose of suffering is debatable and the origin often ignored, the answer to suffering always seems to be to end it- even if the way to end it involves ending the life of the one that is suffering.   

Suffering seems to be a potent force in the lives of believers, as well.  For some, suffering seems to turn them away from God, from even the very idea of God, in frustration and mistrust.  While for others, suffering seems to be the cause for hoping in God for answers and comfort.

I do not have all the answers for suffering nor all the answers for those who will soon parent a child with Down syndrome.  God gives many answers in Scripture, but I haven't found them all.  But I have found some.

I am convinced that suffering exists, for instance, because it is a natural consequence to sin having entered the world.  But I am also convinced that God is a God of redemption, Who not only forgives sinners, but redeems the suffering sin has inflicted upon us.  Romans 8:28 says that God works all things for good for those who love God and who are called according to His purpose.

This includes Down syndrome.  For those who are saved, God works Down syndrome for good.

It is very, very true that people with Down syndrome and their families will face hardships unique to that particular developmental disability.  But it is also true that for those families and people with Down syndrome, God's grace will be made perfect in that weakness. (2 Corinthians 12:9)  It is easy to see the lows and the struggles that Down syndrome will bring.  But soon to be parents have no idea the grace and mercy that God will bring to them through their child.  

Nor do we, the Church, realize what we are missing when we are missing children and adults with Down syndrome in our congregations.  People with Down syndrome have unique gifts and callings that the Church needs- many that have nothing to do with their Down syndrome, for people with Down syndrome are so much more than their disability!  And we are certainly missing the way God brings redemption to Down syndrome and the good He causes through it.

So, this second to last paragraph is more an exhortation to myself, since I have been lacking in this area, but feel free to receive it for yourself, also.  Instead of simply condemning parents who are considering the choice to terminate the life of their unborn child who has Down syndrome, embrace those parents before the choice has been made and make room for them and their child in the Church.  And for those parents who have already made that tragic, sinful choice to abort, as God calls them to repentance, offer them the grace and mercy of the Cross that has been offered to you.  Forgive them and love them.

Down syndrome is in itself not a gift.  But, as all 'syndromes', sicknesses, and disabilities, when redeemed by the Redeemer, Down syndrome becomes a way that the very glory of God is revealed.  

Weakness and the Glory of God

Early in Scripture we read a seemingly disheartening command of God.  None of the offspring of Aaron, the priests of Israel, who had a disability could go through the veil and approach God’s altar, ‘lest he profane God’s sanctuaries’.  (Leviticus 21:23)  In addition, for sacrifice, God only accepted ‘perfect’ animals, those without blemish or illness.  Yet, even men in ‘perfect’ bodies sacrificing ‘perfect’ animals were not perfect enough to purify us once for all time- as was the perfect sacrifice made by Jesus Christ (Hebrews 7:26-28).

The animals sacrificed were a foreshadow and type of this perfect sacrifice to come.  The sacrificed animals and the men entering into God’s holiest place on Earth had to be as perfect as they could be to mimic the Christ.  However, neither were really perfect.

All priests had to offer sacrifices for themselves before offering sacrifices for the people, for these priests sinned.  Because of this sin, their bodies wouldn’t remain perfect forever.   They would with age begin to wither, fail, and die.   Had they not been sacrificed the bodies of these perfect animals, also, would also have grown old and died because sin was in the world.

God considered, for the Old Testament system of sacrifice, disability ‘profane’.  God always considers sin profane.  Could disability be profane because it is a result of sin in the world?

Yet, God doesn’t shun the person with the disability.  He still refers to Himself as their God, as the God Who sanctifies them.  (Leviticus 21:21, 23)  In His same grace and mercy, God doesn’t shun His sin-drenched people.  

God is a God of both justice and love.  God hates sin.  Sin must be atoned for.  However, God loves His people, and for His Holy namesake, forgives His people for their sin, sending His own Son as atonement.  For we His people cannot atone for ourselves.

We are not saved by our own righteousness.  Our righteousness is like filthy rags.  The only righteousness we have to offer God is that which was imputed to us by Christ at His sacrifice.  The only sacrifices we have to offer God are a broken spirit and a contrite heart.  God draws near to the humble.   God knows we are weak, that we are only dust.  He takes pity on the weak, and, while He demands us to do so, also, as Job found out, caring for the weak- the blind and the lame- did not even make him righteous ‘enough’.  (Job 29:15)  

There is hardly a greater a symbol of weakness than disability or illness, and these people to whom God seems most drawn.  While they were forbidden to enter the holy of holies, God comes to them.  To people like Paul who know that because God’s grace is made perfect in our weakness, when we are weak they are strong.  The only strength that is to be relied upon is God’s, as the only righteousness that is to be counted is Christ’s.  It is God Who opens the eyes of the blind and the deaf, makes the lame man leap, and the tongue of the mute sin for joy (Isaiah 35:5-6), and in His justice, Jesus came to open the eyes of the Spiritually blind.  (John 9:39) 

Interestingly, God calls people to weakness- before He calls us to stand and to run.  He calls us to repentance, to a time of contriteness and humility at salvation, making us His.  When we are God’s we rely on God’s strength, and, therefore, must die to our own.

In our weaknesses, God glorifies Himself.  It was because of a bodily ailment that Paul first preached the Gospel to the Galatians.  (Galatians 4:13)  God is just as glorified by leaving Paul with his ‘thorn’ in 2 Corinthians 12, as when Jesus gives glory to Him through the healing of a man born blind in John 9.

God receives glory in His compassion for the suffering and the hurting.  Jesus, for instance, Who only did the work that He saw His Father doing first, (John 5:19) ministered to and healed people with disabilities, illnesses, and sin.  He was filled with compassion for the widow whose only son had passed away.  After raising the son from the dead, He returned him to His mother.  This most compassionate act caused the people to cry, “God has visited His people!” (Luke 7:11-18)

In the resurrection of Christ, those of us called by God unto salvation, having had our spiritual eyes opened, have hope of an end to suffering.  Our physical weaknesses will have an ending.  We will not always be disabled, old, and emotionally vulnerable.  Most excitedly, in our new bodies we will no longer battle with sin.  One day, we will be perfect (1 Corinthians 15).

However, even in our perfect bodies in our perfect Home, human beings, once being imperfect, children of wrath and enemies of God, we will always remain dependent on Christ and His perfect sacrifice.  Upon Christ, who embraced weakness by putting human flesh and dying our death (Philippians 2:5-11) , to bring us to God (1 Peter 3:18), to give us eternal life (John 3:16), which is knowing God (John 17:3), forever in perfect harmony with our Creator.

Bioethical Decisions in a Fallen World

As both a Christian and a caregiver for the elderly and those with disabilities, I'm struck with this Biblical view point- sin obstructs our decision making process.  In our fallen state, we often make choices, including medical choices, for the wrong reasons- often for motives that appeal to the flesh or mere human reasoning.  While paitents should remain a crucial part of the decision making process regarding their medical treatment and doctors should have the freedome to discern the best care for his/her patient, both patients and doctors would be wise to remember that human reasoning does not always lead us to the right choices.

Bioethics is attempting to set standards for the conduct of medicine and healthcare in an age of new knowledge and changing science.  However, bioethicists are setting these standards from a fallen state of mind.  Truth is subjective to them, as are ethics, dependent on such things as a person’s worldview, religion, and philosophy.   “There is a way that seems right to a man, but in the end it leads to death.”  (Proverbs 14:12, 16:25)  If this proverb has ever been relevant, it is so with bioethics.  

When we, as Christians, set standards for how we care for the sick and needy, we must remember that truth is not relative.  The truth- the Biblical truth- about who God is and who man is plays a critical role in regard to medical decisions that affect the lives of the weak and the needy. All of those we care for in the hospital bed, teach life skills to in the group home, or 'produce' in the laboratory are deserving of dignity and respect for the sole reason that "In the image of God, made He man."  (Genesis 9:6)  So, while scientists can manipulate genes and clone embryos, we can never engineer the image of God out of a human being.  This truth alone could set the tone for any medical ethic.

However, likewise, in our attempts to manipulate genes and clone embryos to eradicate diseases and eliminate disabilities, we can never create a person who will not inherit the struggle with sin.  As much as we are created in the image of God, we are also sons of Adam; therefore, there will never be a perfect person.  Our only hope remains, as it always has, in Christ and Him crucified.  In His work on the cross- the great exchange, the righteous for the unrighteous, the suffering for our sins so He could save us from them and bring us to God.   This is incredible mercy and incredible love.

Despite the uniqueness of each created person, in these two things- our common created image and our common depravity- man can be considered virtually identical to one another.  Our worth could not be contingent upon any work or ability.  To say that a person is too weak or does not contribute enough is laughable compared to the greatness and splendor and perfection that is in God!  All men fall short of that Glory.  We are all too weak and no one ‘contributes’ enough!  For all of us, our worth is dependent only on who we are through the work of Christ at the cross. 

With new life in Christ through the cross, we are given new nature and the told to renew our minds.  In both this new nature and in our renewed minds, we view suffering, ethics, and caring for the weak and the vulnerable differently.  We now consider those weaker than we are, and we realize that it is a sin to not show them the same grace and mercy we were given, even if one is so weak that he or she is not even cognitively aware of it.  

Suffering is horrible.  It is no light thing.  We are better off dead and at peace with our Maker than alive on this dead earth!  But in our renewed minds, we know, also, that we cannot take suffering into our own hands, as those in bioethics seem to do.  We can never consider breaking God’s commandment to not murder, for instance, through abortion and euthanasia because we deem someone to be suffering too much.  We cooperate with nature and conform to the way God created it.  For when we attempt to manipulate nature (think of the undignified 'Ashley Treatment') and destroy that which we judge undesirable- destroy whom we judge undesirable because of the sufferings they are given- we question God’s goodness and wisdom leaving us rebuked as Job was- “Where was man when God laid the foundation of the earth?”  

As we painfully watch those around us suffer, doing all we can to ease their suffering, we are to suffer with those suffering.  We are not to cooperate with the hopelessness that suffering brings by manipulating the death one suffering or who we assume will suffer after birth.  Instead we offer them and their loved ones the hope of Christ found in His Gospel, that those who call upon His name will be saved from their sin soaked hearts, from the wrath of God, and from hell.  And that those who call upon His name will be saved to new life in Christ, to a perfect and holy body in eternity, and the unimaginable joy of eternity in the presence of the Creator.

Because of the unity we have with Christ (because of the great love and mercy shown to us at the cross), we, in humility, count others more significant than ourselves.  We look not only to our own interests, but also to the interests of others.  We have this mind among ourselves, which is ours in Christ Jesus Who, though He was in the form of God, did not count equality with God a thing to be grasped, but made Himself nothing, taking the form of a servant, being born in the likeness of men.  And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross.  (Philippians 2:1-8)

And so we humble ourselves to one another, using our freedom to serve one another in love (Galatians 5:13), taking tender care of the weak (1 Thessalonians 5:14), seeking justice and encouraging the oppressed (Isaiah 1:17), and becoming disabled to the disabled (1 Corinthians 9:22) in order to share the Gospel to all people, in hopes that all people will be saved from, among other things, their fallen states of minds, having their minds aligned with Christ and His purposes for all things- including suffering and caring for those suffering.