Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care

by Kathryn Butler

Less than a century ago, most people died at home. Today, 80 percent of Americans die in institutions such as hospitals or nursing homes. The dying process--once a visible reality of life--now hides behind a complex web of medical technology, and few Americans discuss end-of-life care before it becomes urgent. Faced with crucial decisions, Christian patients and loved ones struggle to understand how their faith should inform their treatment. Covering topics such as ventilators, dialysis, artificially administered nutrition, physician-assisted suicide, hospice, and more, this book offers a distinctly Christian guide to end-of-life care, simplifying common medical jargon and exploring biblical principles that individuals and families need in order to navigate the transition from this life to the next.

Genres: Christian, Medical, Nonfiction, Christian Living, Christianity, Theology, Counselling

224 pages, Paperback

First published April 1, 2019

About the author

Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma surgeon turned author and homeschooling mom. Her books Between Life and Death: A Gospel-Centered Guide on End-of-Life Medical Care, and Glimmers of Grace: A Doctor's Reflections on Faith, Suffering, and the Goodness of God, reflect upon faith and medicine. She is also the author of The Dream Keeper Saga, a middle grade adventure series with Christian themes. She lives in the woods of Massachusetts, where she loves to read stories with her kids, explore the outdoors, and chase dragons from her kitchen.

Reviews

[Britt Anderson · Rating 5 out of 5]

Dr Butler masterfully explains from a Christian worldview the difference between sustaining life and prolonging death in the intensive care unit.

[Hallie Dumas · Rating 4 out of 5]

Gentle, clear, and sensitive on all fronts. Does a good job breaking down the utility of different medical interventions, and prompting reflection on how to make decisions about the end of our own lives and the lives of those we love. The book is written for lay people, but I think believers who work in healthcare would also benefit from reading! It’s heavy (understandably- the whole book is about death), but maintains a hope throughout that didn’t feel insincere.

[Danette · Rating 5 out of 5]

I highly recommend this book. Dr. Butler has written a compassionate and educational book about the questions and decisions we face as we or our loved ones face illness and death. The book is saturated with Scripture as Dr. Butler encourages us to put our hope in Christ.

"May we rest in the assurance that however total our heartbreak, and however devastating the path before us, God has triumphed over sin, his love for us surpasses understanding, and this broken world is not the end. As Paul writes, 'Neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.'"

2022 A book about euthanasia (one chapter)

[Graham Gaines · Rating 5 out of 5]

Unfortunately, everyone probably needs to read this book...at some point. Even more unfortunately, many people will never read it or gain similar wisdom until it's too late. I say this because we will all have to think about these issues at some point, when we reach the end of life or when our loved ones do.

This book is written to loved ones who are wrestling with these things, but it was tremendously helpful for my work as a chaplain. I have conversations about Advance Directives fairly regularly, and this gave me more medical information and a framework for how to talk people through these things.

I have already used some of what I've gained from this book (like how some medical interventions cause more harm than good) in hospital rooms. For that, I am very thankful.

"My flesh and heart may fail, but God is the strength of my heart and my portion forever." Psalm 73:26

[Robin Langford · Rating 4 out of 5]

Incredibly helpful. I greatly appreciate her premise that as Christians our goal in the end-of-life season is never to prolong dying. We seek to preserve life, not promote suffering.
As a non-medical person, I was grateful for simple explanations of organ supporting care as well as how each intervention can preserve life in best case scenarios or instead cause suffering when employed past their usefulness.

[Deon · Rating 5 out of 5]

*This is an ARC from the publisher via Netgalley. No review, positive or otherwise, was required—all opinions are my own.*

This is an important book that everyone needs to read. The author covers tons of questions we should have answered before a health crisis arrives. She does a great job defining terms and helping the reader understand what is going on. The author is a trauma surgeon and uses her experience to help teach.


Table of Contents
Framing the issue --
Wisdom begins with the word --
A detailed look at organ-supporting measures --
Resuscitation for cardiac arrest --
Introduction to the intensive care --
Mechanical ventilation --
Cardiovascular support : vasopressors, inotropes, and lines --
Artificially-administered nutrition --
Dialysis --
Brain injury --
Discernment at life's end --
Comfort measures and hospice --
Physician assisted suicide --
Advance care planning --
Being a voice : surrogate decision making.

[Jisun Lee · Rating 2 out of 5]

Before writing my review of Dr. Butler’s Between Life and Death, I wanted to provide a disclaimer: I am a Christian and I am not in the medical field at all or know of any terminology or jargon pertaining to the medical field. I picked this book from the NetGalley collection because of the cover, and because one of my goals is to read more books on Christianity and Christian living. Now, onto the review!

The first thing I noticed was that Dr. Butler cites the Bible a lot throughout her book; her knowledge of the Bible verses as well as the idea and meaning behind each one seem to be well-established and clear. As Christians, we should all base our lives on the Bible and the message of the Gospel, and that is what Dr. Butler does in her book. Even in her professional role as a physician and doctor, it’s obvious that she roots herself in the Word of God and that her relationship with Him is a strong one. She uses the Bible verses to back up her thoughts and beliefs on what to do concerning the medical world, including emergency situations and even end of life care. She is a very skilled and intelligent physician as well, as her readers would be able to see. Throughout her book, she explains the step by step process of different medical procedures and explains the specific jargon and terminology so that laypeople can understand.

From the beginning, Dr. Butler’s main thesis is clear: you need to greatly consider God’s will in all aspects of life, particularly and perhaps most importantly, end of life situations, whether due to old age or other unfortunate situations. My interpretation of her stance is that God is crucial; you must turn to Him when you are dealing with end of life care, since He is the one and only one in authority and He’s the only one that has sovereignty over everything, including our very lives. When you turn to medical procedures such as life support, you are claiming dominion over life and that you can will a person’s life to prolong itself, which goes against the very nature of our place as humans; God is the only one that can do that. As a Christian, one must recognize that when our strength is failing and we are wearing, that it is God’s will. He has come to take us home. But when we are desperately clinging to life through the emergency rooms and surgeries and life support and what have you, you are deliberately disallowing God’s will and plan to play out. You are claiming His role in our lives for ourselves.

I am personally scared of death even though I am a Christian, and reading Dr. Butler’s book was somewhat uncomfortable at some parts, but in the end, it was an interesting read that Christians who are struggling with the end of life care of a loved one, or even their own, should read and consider and remember that God is in control, and whether or not they are going to be in a strong relationship if they insist on life support or other methods of preventing death to arrive. Of course, there have been some miracles like a man waking up from a coma one day before his wife and family would have taken him off life support. To me, it’s still a confusing mess, but reading between Life and Death made it clear to me that I should be turning to God for everything, and that my relationship with Him is strong and should forever remain strong even when I’m at the footstep of death, and tat when God finally calls me home, that as a faithful Christian I should be content with letting go and following Him to His Kingdom.

Overall, this was an intense book but necessary I think. and thought-provoking. Dr. Butler’s intended audience seems to be Christians, so the book’s content might not make sense to non-Christians. Nevertheless, Christians can take comfort and mental notes about what it is to be a Christian and how to tackle death and end of life care situations.

[Emily · Rating 5 out of 5]

4.5 Throughout these pages the hope and comfort of the gospel is a primary message. However, a huge amount of frank technical information is included about the different types of medical care that might be encountered in an end-of-life situation, the pros and cons of each intervention, and gentle, compassionate guidance for the sufferer and loved ones on suffering and potential benefits. Advice and excellent, God-centered questions about quality of life, goals for life particularly as it comes toward an end, examples, case studies - all described and expressed with sympathy. The value of our mortal lives, the sovereignty of God over our lives, the goals of worship, service, and fellowship, are all highlighted and considered with great care and inspiration. Highly recommended for every pastor, Christian physician, medical professional, and every Christian over the age of 50 who has aging parents or himself/herself is approaching end-of-life issues.

[Danielle Jensen · Rating 5 out of 5]

This book came to me from a friend after my Grandma died recently. Her death was not an easy one. She had signed a "Do Not Resuscitate" order and the events surrounding her death brought up a lot of questions for me about how a Christian should think about medical interventions when the end of life is near. 

Kathryn Butler, an ICU physician, does a great job explaining how modern medical technology which in so many situations is a blessing that saves lives, can also greatly complicate death and dying. She gives four principles to guide decisions on the use of organ-supporting technology:

1) Sanctity of mortal life.

2) God's authority over life and death.

3) Mercy and compassion.

4) Hope in Christ.

 She also gives many real life scenarios to help those of us who have limited experience in watching death understand the many decisions that may confront us and our loved ones as we come to the end of our time on earth. 

While this is certainly a grim topic, I found the book a very comforting to read. It was helpful to know that what my Grandma experienced, though terribly difficult, was normal. It was clarifying to read about the technical functions of the various organ supportive devices. It was good to know that organ supporting technology only leads to recovery if the underlying condition is reversible. It was interesting to consider that while over 70% of American wish to die at home, only 20% do (24). It was good to know that while there is concern that consenting to hospice (focusing on comfort rather than on cure) will speed death, in fact the opposite can be true. Research shows that in the final stages of chronic illness, stopping aggressive treatment can actually prolong life (130). And much more!

Ultimately, it was good to contemplate death (Ecclesiastes 7:1-4). To face the reality that I will die (Psalm 39:4; 90:12) and meditate on the glories to come on the other side that give believers hope and joy (1 Thessalonians 4:13; 1 Corinthians 15:54-55; Hebrews 13:14).  My Grandma's suffering was not without purpose and is now over (Romans 8:18; 2 Corinthians 4:16-18). My grandma, as a believer, has now experienced victory in Christ over this fallen, sinful world's curse, death.

"When the perishable puts on the imperishable, and the mortal puts on immortality, then shall come to pass the saying that is written: 'Death is swallowed up in victory.' 'O death, where is your victory? O death, where is your sting?"
1 Cor 15:54-55

[cindy townley · Rating 5 out of 5]

This is an excellent book on the explanation of end of life medical care scenarios. And how Christians should also look at some of these choices.
This is a good book to learn medical terms for end of life care as well as the Christian preceptive.
I think it is a must read.

[David Newton · Rating 5 out of 5]

Full of hope, grace, and wisdom. A welcomed resource to me during months working in the ICU and likely to anyone else faced with medical decisions at the end of life.

[David Reese · Rating 4 out of 5]

An excellent resource for navigating the waters of end-of-life medical care.

[PD · Rating 4 out of 5]

Excellent. A great resource to read and contemplate cover to cover; or to spend time focusing on particular topic(s).

In some places it is very clinical, but overall the tone is compassionate and dignifying. As a former trauma surgeon, the author provides great wisdom gleaned from an informed Christian ethic applied to complex medical situations, very thin spaces between fighting for life and providing comfort, and engaging these difficult conversations with family members in the face of Death’s theft.

[Ivan · Rating 5 out of 5]

For all the blessings of modern critical care, we have not sufficiently reckoned with its dark underside: What happens when medical technology and intervention do not preserve life but prolong death? With her keen medical training and experience on display, Kathryn Butler parts the curtain on an array of life-threatening situations that might befall us or those we love. In Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care, Butler points us to the hope of the gospel, showing what Christian discipleship might look like in some of the most agonizing moments in life. May this book serve as a useful guide and conversation starter as we prepare for death and gaze on Christ.

[Margie · Rating 5 out of 5]

This is a must read for everyone! When I began the process of drafting a Living Will, I felt the one pager form given to me my doctor totally inadequate. This book sufficiently described and clarified a lot of the terms and medical situations for me to sit down, in a clear mind, and formulate my response to these situations, should they ever occur, in a more expansive form and from a Christian perspective. Having medical doctors in my family helped me navigate some of the more technical areas I was considering, however this book also put them in a more personal perspective because the author differentiates between “sustaining life vs prolonging death”. Anyone who doesn’t understand this distinction is really not able to formulate a well thought out advanced directive. I highly recommend this book for people who are in the research mode for their personal advanced directive. I would also recommend it to adult children who are parents and/or have parents. Any person who hasn’t already sat down and thoughtfully considered their own personal wishes in a situation where others must decide what to do for them, needs this information to make informed decisions - ahead of time. Now that my advanced directive is done, I have purchased extra copies of this book to give to my children and potential caregivers along with my Living Will.

[Sarah · Rating 4 out of 5]

This is a well-written, sensitive, and very helpful book I’m glad to have read. Butler does a good job of showing how changes in medical technologies have made end-of-life issues murkier in many ways, and how Christians are often poorly equipped to engage them when critical moments come. She also makes the point that aggressive measures, even when undertaken with the best intentions, can cause further suffering for little benefit, prolong the dying process, and even pervert it by robbing people of the opportunity to actually prepare for death. There’s a big difference between taking actions that *hasten* death and declining futile treatments that make one’s remaining time that much more difficult.

I noticed that she doesn’t address organ donation and can understand how that’s beyond this book’s purview, though her differentiation between brain death and cardiac death reminds me of my ethical reservations around the subject. I also think that when considering my own choices about end-of-life stuff, the way I’d frame some of the questions about serving God in a diminished state would be slightly different, even though I think I’d arrive at pretty similar conclusions as she did. But overall, I’d recommend this book.

[Becky Hintz · Rating 5 out of 5]

Every Christian should read this book, and sooner rather than later.

The issue of death is something literally every one of us will face someday. With so many available medical interventions, it is crucial that each of us think through-- and then communicate to loved ones-- which of these we would and would not desire for ourselves. In the vast majority of cases, it is family members who make end-of-life decisions for one another, so even if you are still young and these things feel far off, you may be the one making this decision for someone else. This book does an excellent job of helping us understand our role in that decision-making process.

Because my husband is a pastor, he and I have had this conversation with members of our church family numerous times over the years. This will now be our go-to resource for all future conversations.

My recommendation is to read Part 1, which frames the issue, then Part 3, which deals with decision-making at life's end. After that, consider reading any of the chapters in Part 2 that would be helpful. I wouldn't want anyone to miss the gold mine that is Part 3 because they got bogged down reading about all the different interventions addressed in Part 2.

[Rebecca Krug · Rating 5 out of 5]

This is a must read if you... #1 Work in healthcare #2 Are walking through chronic illness or end of life with someone you love #3 or are in ministry and want a reference for when you walk through the valley of the shadow of death with those under your care.

It is excellent.

Dr. Butler explains in clear, easy to understand language the intricacies of end-of-life care. She explains intensive care terminology. She walks through organ supporting measures, and discusses when treatments may alleviate symptoms and when they prolong suffering.

I have never read a book that captures exactly what I want to tell family members and friends about end of life care. She beautifully weaves the gospel into every chapter.

So, buy this book, keep it on your shelf and refer to the chapter that addresses specific issues as you encounter them.

[Beth McKillen · Rating 5 out of 5]

A fantastic book for Christian’s in healthcare and anyone who has a loved one in intensive care or any health related support for that matter.
Dr Butler goes through each sort of invasive care a loved one may need and explains it in lay man’s terms while also giving a biblical view on each. She uses her medical experiences to bring the book to life and help the reader gain perspective on the various scenarios that can occur.
What’s wonderful about this book, and what I really appreciated, was her honesty about the blessing modern medicine is to the believer but also our call to something greater!
With long term health conditions on the rise as our life expectancy increases, I recommend this book for everyone to help gain an informed perspective as a believer both for yourself and loved ones when they cannot make the decision for themselves.

[Shirley Klooster · Rating 5 out of 5]

The author explains the medical terms used in the ER and ICU. Not only what they mean, but how they affect the human body. She explores biblical principles that connect with medical situations. This is what we need to know when decisions on care need to be made at any age.
Having a list of "take home points" to summarize each chapter is helpful. A Glossary of medical terms, a summary chart of organ supporting measures, a sample advance directive, and a list of additional books to read are included. Just using these without reading the book would be helpful.
It is a resource for guiding pastors, counselors, friends, and Christian healthcare students as well as the family facing the challenging medical issues.

[April · Rating 5 out of 5]

I LOVED this book and couldn’t put it down. We want to prolong life and not prolong death…but is there a gray area between life and death? Our modern medicine may have created one. First, I think every Christian in America should read it not only bc we should contemplate death and what it means for our souls and our purpose now, but also bc we are surrounded by brothers and sisters in the faith that we are praying for as they undergo such treatments or make these hard decisions for people they love. I really appreciated this doctor’s insights, perspective and stories and how she seeks Scripture for answers to end-of-life questions. However, she did not do a “deep dive” into Scripture on life/death, so additionally you will want to search the Bible for yourself. The only thing I am not sure I agree with is her on is her personal desire to avoid intervention if she will no longer be able to communicate…I don’t think being able to communicate should be what makes life worth living…perhaps in our silent dependent existence we may still bring God glory in ways we do not understand…and ultimately our lives should be about Him and His glory alone.

[Michelle Castaneda · Rating 5 out of 5]

Between Life and Death by Kathryn Butler, MD is a beautifully written resource. It is written with such poignancy and sincerity. I love how the author explains the complexity of the issues that come at the end of life. I have relatives in the medical field and I can tell you that this author portrays the issues with great veracity. This is such an important read for everyone, because we all face death eventually. It is a wonderfully hopeful resource as well, since it is rooted in the Word of God. I highly recommend this book. I received a digital copy of this book from the publisher with no obligations. These opinions are entirely my own.

[Rick Bourque · Rating 4 out of 5]

An easy read on a subject everyone must address. Butler's best feature are the summary points at the end of each chapter and the helpful appendix. Questions distinguishing between life-prolonging and death-prolonging are indispensable. I appreciated the real-life experiences she intertwined prompting me to complete my own living will sooner rather than later. The various Bible references were occasionally helpful but more frequently too abstract to be helpful. I was reminded again of the need for a 'good death' theology that readies the believer to embrace the end not prolong dying life at all cost.

[Christiana Martin · Rating 5 out of 5]

Highly recommend. Dr. Butler masterfully accomplishes what she set out to do in this book: to compassionately examine intricate end-of-life medical care issues from the lens of the gospel. This book is full of scripture, but primarily depends on Butler’s expertise as a critical care doctor rather than as a theologian. Although I imagine that those whose values and beliefs about death are not driven by belief in the gospel will not derive as much value from this book as Christians, it is so practical and thought-provoking that I honestly can’t think of anyone I wouldn’t recommend this book to.

[Bryan Eberl · Rating 4 out of 5]

This book is geared for those that know someone who is in their end of life scenarios. It does a pretty good job of briefly summarizing medical issues, life prolonging measures, and what not. It emphasizes from a biblical perspective when medicine sustains and rejuvenates life, and when it simply prolongs suffering.

It did a decent job of being unbiased, other than supporting medical knowledge and thoughts with Bible. Over all I’d say it is a good resource if you know someone or are in a position to counsel or walk through discernment among hard end of life decisions. But most importantly it draws attention to the word as utter importance.

[Jana Kelley · Rating 4 out of 5]

Very good book to read. It's an accessible book, even if heavy. The subtitle is "A Gospel-centered guide to end-of-life medical care" which is a great summary. I would highly recommend this book to any believer who wants to be informed about life-prolonging (and sometimes death-prolonging) measures. I really appreciated the Scriptures and spiritual insights as well as the author's compassionate style. I'd say it's probably easier to read before a health crisis has taken place and then would be a wonderful reference to go back to when in the midst of a health crisis (for yourself or your loved one). Glad I read this book.

[Peter Dray · Rating 5 out of 5]

Kathryn Butler, an intensive care doctor, provides a clear and nuanced examination of a Christian approach to critical and end of life care. She very helpfully distinguishes between interventions that prolonging suffering or the process of dying, and those that bring life. Christians are not compelled to the first of these, but we are the second. It's a beautiful read - it will be helpful to those bombarded with questions around the health of loved ones, and all the more helpful to those not currently in that season but who one day will be.

[Ash · Rating 5 out of 5]

“Medical progress over the last fifty years has equipped doctors with technologies that, under the right circumstances, can save lives BUT also transmute death from a finite event into a prolonged and painful process… God’s perfect timing seems less distinct when machinery blurs the boundaries of life and death.”

Highly recommend this book. It equips pastors and people navigating end-of-life care in a “dignity-affirming, God-honoring, faith-filled way”. I think every pastor should at least have this on their bookshelf.

[Jenna McGuinness · Rating 4 out of 5]

Bought by my non medical husband for me as he thought it would be helpful for me as a Christian GP. Actually it’s meant for patients and relatives to read. However, it’s written so respectfully and gently. Her passion for medicine and her love of the gospel shine through, and blend beautifully. The sustaining life/prolonging death issue is something I encounter frequently. Knowing when to change the goals of care is key. I believe reading this book will help me communicate that better to my patients and their families.

[Sophie Campbell · Rating 5 out of 5]

An incredibly informative book on end of life decision making/medical care for families and health care providers alike. Dr. Butler navigates the highly nuanced area of critical care impeccably with a gospel centered approach. Each page was soaked in scripture and continuously pointed the reader to the cross // our highest calling as Christians. I specifically appreciated her thorough explanations of various circumstances in which it is actually most faithful to pursue a palliative approach to care, as this can be especially challenging for people of faith. Highly recommend for all.