Week 4 End of Life Decisions Case Study Discussion


The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

  1. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?
  2. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?
  3. As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?
  4. What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?
  5. Given the above, what options would be morally justified in the Christian worldview for George and why?
  6. Based on your worldview, what decision would you make if you were in George’s situation?

Remember to support your responses with the topic study materials.

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Death, Dying, and Grief
Death and dying are a bitter part of the reality of
life, in general, and a particularly
common experience for those called to health care.
The nature and meaning of death is
not simply biological or scientific, but rather inv
olves deep philosophical and religious
questions. Once again, medical technology has chang
ed the scope, quality, and
experience of death (or at least the dying process)
. It has even prompted a changing of
the very definition of death.
Death in the 21st Century
One of the incredible benefits of modern science an
d its application in medical
technology has been the ability to extend physiolog
ical life. In the 1960s, the
development of CPR, ventilators, and the like allow
ed never-before-seen intervention in
the process of dying, such that a “millennia-old ge
neral understanding of what it meant
to be dead” was transformed (Veatch, Haddad, & Engl
ish, 2010, pp. 390-391). In the
field of biomedical ethics, the very definition of
what it means to be dead is a
controversial topic. In continuing with a fundament
al theme running throughout this
course, it should be noted that while the pathophys
iological and scientifically detectable
signs of death are crucial in this debate, they sho
uld not be taken to be determinative or
comprehensive. This debate still crucially depends
on the philosophical background of
one’s anthropology (i.e., view of personhood) and i
n the resulting interpretation of
these scientific and physiological signs. The medic
al definition of death is not a purely or
irreducibly scientific question.
Worldview and the Meaning of Death
Two of the more controversial issues in bioethics a
re euthanasia and physician- assisted
suicide. As you read and research the ethics surrou
nding these issues, consider how the
Christian worldview would analyze the ethics of suc
h actions. On a worldview level, the
question of the medical definition of death is just
the tip of the iceberg in terms of the
broader significance and ultimate meaning of death.
Whether or not there is any
meaning to death and what it might be is a question
of one’s worldview. Questions
regarding whether or not there will be ultimate mor
al accountability for the way one
lived life and whether there is an afterlife are ke
y questions in this regard. The very
phenomenon of the loss of (at the very least) physi
ological and perhaps conscious
integrity and activity is a fact of life that calls
for explanation.
Once again, an accurate understanding of religion a
nd worldview is required.
Furthermore, the distinctions among each religion m
ust be appreciated and not
collapsed into one another. The way in which both t
echnology and religious background
color the experience and meaning of death (both in
dying and grieving) must also be
appreciated. Whatever rituals or practices a religi
ous or cultural group engages in are
informed by a view regarding the nature and meaning
of death that fits within an
overarching worldview narrative.
Death in the Christian Worldview
Death takes on a particular meaning when seen withi
n the Christian narrative. It is, in
fact, not the greatest evil that could befall a hum
an being and is furthermore
transformed in the light of the resurrection of Jes
us Christ. The Christian teaching that
“God died” essentially transforms the way in which
death is seen and experienced
(Sanders, 2007, pp. 6-8). Death is certainly a trag
edy and an evil, but it is now a
conquered enemy. It is a conquered enemy because in
the Christian biblical narrative,
death is a perversion of God’s original design plan
. And yet, the Christian God constantly
redeems that which is broken.
Loss and Grief
Death is a particularly traumatic and difficult exp
erience for both family and caregivers.
Understanding the process and stages of grieving is
immensely beneficial for caregivers
to assess the well-being of patients and families.
There are numerous resources that can
be of tremendous benefit for both caregivers and fa
mily. One of the most influential is
the work of American psychiatrist Elizabeth KublerRoss. Perhaps the most influential
insight of her work was to notice certain patterns
or stages in the human experience of
grief, especially after the loss of a loved one in
death. She called these the five stages of
grief. Briefly, they include the following: (a) den
ial, (b) anger, (c) bargaining, (d)
depression, and (e) acceptance (as cited in HealGri
ef, 2016).
Expectations regarding an afterlife will in large p
art determine the manner in which
patients and families welcome or spurn the prospect
of death. Furthermore, the way in
which a person experiences the stages of grief will
be in the context of his or her
worldview. Christian theologian Nicholas Wolterstor
ff’s (1987) memoir,
Lament for a
, is a personal reflection of his own personal grie
f after losing his 25-year-old son in a
mountain climbing accident. As he engages with his
own grief and experience, it
becomes clear that everything is ultimately seen in
the light of God’s loving control and
the ultimate hope found in the life, death, and res
urrection of Jesus Christ.
Why Did God Become Man? Incarnation, Atonement, and
Jesus was the Son of God before he was born into ou
r world. The event of God taking on
flesh and dwelling among us—the incarnation—is amaz
ing and is celebrated all over the
world at Christmas. The incarnation is proclaimed c
learly throughout the New
Testament (Luke 1:35; John 1:14; Phil. 2:5-7).
So why did God become man? The most famous verse in
the Bible clearly tells us, “For
God so loved the world, that he gave his only Son,
that whoever believes in him should
not perish but have eternal life” (John 3:16 NIV).
And Jesus knew what this would
require of him. He stated in Matthew 20:28, “The So
n of Man came not to be served but
to serve, and to give his life as a ransom for many
.”God is both holy and just, so although he created h
umanity to be immortal, he could not
accept them into his holy kingdom in their sinful s
tate. So from the beginning God
enacted and unfolded his plan for humanity, to rede
em a people for himself (Titus 2:1114), requiring that justice be upheld and sin punis
hed. Therefore, a sacrificial lamb was
needed—one that could atone for the sins of the wor
ld. Only the perfect and sinless
Lamb of God would be sufficient. Yes, God himself w
ould have to be the sacrifice
So the incarnation led inexorably to the cross, the
torturous experience that had been
prophesied nearly a thousand years earlier by David
in Psalm 22. All four Gospels give
vivid accounts of the crucifixion of Jesus, the mos
t unjust execution ever to be carried
out, as testified by the centurion there who said,
“Certainly this man was innocent!”
(Luke 23:47). But as unjust as the crucifixion was,
Jesus willingly accepted it, for as the
Son of God he could easily have been rescued (Matt.
26:53). Instead, Jesus bore the sins
of the world on the cross. This is called the atone
ment—the reconciliation of humanity
with God through the sufferings and sacrificial dea
th of Christ.
It is interesting that the clearest account of the
atonement is found in the prophecy of
Isaiah 53: 5-12 (NKJV) where the atonement is speci
fically stated seven times:
He was wounded for our transgressions; he was crush
ed for our iniquities…and
the Lord has laid on him the iniquity of us all…str
icken for the transgression of
my people…when his soul makes an offering for sin…a
nd he shall bear their
iniquities…yet he bore the sin of many.
God went out of his way to make the extent he would
go to bring about reconciliation
The resurrection of Jesus Christ is by far the clim
ax of his life. .All four Gospels provide
vivid accounts of this amazing miracle that conquer
ed death. There have been many
who looked at the history of the times, read the ma
ny accounts of what happened both
in the Bible and in other sources, and came to the
inevitable conclusion that there is no
other explanation for what happened except that Jes
us surely rose from the dead. After
the crucifixion, the disciples gave up and went bac
k to fishing—the 3 years of
exhilarating ministry were over. But then the resur
rection changed everything. It was
not long before the disciples were accused of turni
ng “the world upside down” (Acts
17:6). This world-changing event was not just a his
torical miracle, it was a sign of the
promise that God gave to those who put their faith
in him. Death is a conquered enemy
because Jesus’s resurrection from the dead made a w
ay of salvation, and also was a sign
of the future that God has for those that have died
“in Christ.”
The phrase “in Christ” is very common in the New Te
stament and crucial to
understanding the gospel. To be “in Christ” means t
o place your “hope in Christ” (Eph.
1:12), or in other words, making Christ the object
of your faith. Paul expresses the
gospel message most succinctly in Galatians 2:16 wh
ere he says, “a person is not
justified by works of the law, but through faith in
Jesus Christ.”
Christianity is unlike virtually every other religi
on in the world. Other religions show you
what they believe is a way to God by living in a ce
rtain manner, praying certain prayers,
and many other religious customs. Christianity teac
hes that people are not capable of
being good enough, which is precisely why God sent
Jesus to be the Savior of the world.
Other religions offer good advice, whereas Christ o
ffers good news, the gospel—which is
that by trusting in what he has already done for yo
u, you are restored.
Other religions offer possible salvation (eternal l
ife in heaven) through trusting in one’s
own good works, while Christianity offers certain s
alvation through trusting in Christ’s
good works. Paul makes this clear in Ephesians 2:89, “For by grace you have been saved
through faith. And this is not your own doing; it i
s the gift of God, not a result of
works, so that no one may boast” (ESV). The final c
hapter in the biblical narrative will
involve a restoration of all creation, and those th
at died in Christ will be resurrected and
receive imperishable bodies.
Case Study: End of Life Decisions
George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a
teaching post at the local university law school in Oregon. George is also.
Actively involved in his teenage son’s basketball league, coaching regularly for their
team. Recently, George has experienced muscle weakness and unresponsive muscle
coordination. He was forced to seek medical attention after he fell and injured his hip.
After an examination at the local hospital following his fall, the attending physician
suspected that George may be showing early symptoms for amyotrophic lateral
sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal
cord. The week following the initial examination, further testing
Revealed a positive diagnosis of ALS.
ALS is progressive and gradually causes motor neuron deterioration and muscle
atrophy to the point of complete muscle control loss. There is currently no cure for ALS,
and the median life expectancy is between 3 and 4 years, though it is not uncommon for
some to live 10 or more years. The progressive muscle atrophy and deterioration of
motor neurons leads to the loss of the ability to speak, move, eat, and breathe.
However, sight, touch, hearing, taste, and smell are not affected. Patients will be
wheelchair bound and eventually need permanent ventilator support to assist with
George and his family are devastated by the diagnosis. George knows that treatment
options only attempt to slow down the degeneration, but the symptoms will eventually
come. He will eventually be wheelchair bound and be unable to move, eat, speak,
or even breathe on his own.
In contemplating his future life with ALS, George begins to dread the prospect of losing
his mobility and even speech. He imagines his life in complete dependence upon others
for basic everyday function and perceives the possibility of eventually degenerating
to the point at which he is a prisoner in his own body. Would he be willing to undergo
such torture, such loss of his own dignity and power? George thus begins inquiring
about the possibility of voluntary euthanasia.

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