INTRODUCTION
The proper medical care of those who are dying is rooted in fundamental precepts regarding the origin and destiny of mankind. There are only two possibilities:
1. Humans and their universe are the products of an accidental evolution. This being the case, humans may consider themselves as the master of their own destiny.  Consequently they can determine if and when they die.  Without consulting any outside Being or force, they can decide if and when other humans die. 
2. If humans were designed, and created with a specific purpose by the designer, no one can do anything regarding their own or another’s destiny without considering the design, the Designer and His purpose for humans.  Regardless of to whom you might attribute the design, to interfere with His purposes may invoke considerable anxiety for interfering in matters well beyond you and the Designer’s possible retribution.

The best scientific evidence indicates that the precision of the universe is far too great for it to have been an accident. The creation of humans occurred in a period of time far too short for any random alignment of atoms to achieve construction of such magnificent celestial and earthly human bodies. The only conclusion by the most eminent astrophysicists and biologists is that there must have been a designer.
Then the question is who and why?

Obviously the designer created humans not as playthings but as creatures with enough wit and wisdom to provide him with intelligent transaction. Christians believe God created humans to have friends. Though it appears He seldom interferes in the affairs of mankind, He has an intimate knowledge of and concern for each and every person. Christians believe He constructed the universe so that not only the physical laws but the moral laws are immutable. Breaking either set has its inevitable uncomfortable consequences. It is in this context that we must consider not only the dying but those who ostensibly care for them, for one will affect the other for good or for evil.

PRINCIPLE #1: CREATED
Humans were created to be friends of God.  He insists they are only friends who chose to be friends. To choose there must be choice.  The choice must be between God and some equally attractive alternative.  God not only used choice to determine who became His friends but He uses choice to make those friends become better friends by maturing.  Many of these choices are hard, not because God likes to see humans struggle, but because He knows that struggling in the crisis of difficult choices, they mature, and He wants mature, interesting, well battled friends. In the context of the dying, questions about when life ends, how to assist the dying, what choice an individual has in their own time and method of death are difficult questions that humans have struggled with for centuries. In that struggle, they have matured and possibly come a little closer to the truth.

Humans were created tripartite, body, soul and spirit, in the image of their maker, who is in an intimate union of three similar parts. A human is created when a sperm, an egg and the spirit God gives humans come together. Thus the definition of who is alive and who is dead is determined by whether or not all three portions are together. When the spirit fuses with the egg and sperm, which as far as we know happens at conception, that person is a complete human. When the spirit departs from the body, what we see is   no longer a human.  In the context of this discussion this is critical.

The best and most conclusive way to decide when a person is dead is to determine when the spirit leaves the body.  When the spirit of a person has departed, the body can be considered a body that has been vacated and no longer needs to be kept alive. This for many people, should be an observable event but there needs to be closer study.  We must learn how best to detect when the person is no longer in their old home.  At that point the old house can be torn down and its good timbers used in some other needy place of someone’s abode.

DRIVE      Humans were created with a determined drive to be, to endure and to become all that God intended for them. God gives humans a great potential and a blueprint which innately drives them to become all that they were designed to be. The blueprint is indestructible. The knowledge of their blueprint persistently pushes them to seek experiences in the area they are developing. Since the world was perverted, no one has the opportunity to completely become the person they should have be. Some brought up in homes with self-sacrificing loving parents may get close.  With the force of their God given drive to become who they should be, children will persist under the most awful conditions in their search for ingredients and experiences to fulfill the promise of their blueprint.  That is why beaten and starving children in concentration camps can still find energy to play football even if it is with a skull.  That is why exhausted and despairing adults can sing old hymns in the salt mines.  And so the first and most important grief of any dying individual is for the Person I Should Have Become.

Because humans were created for eternity, they still have eternity in the core of their being. Thus they will naturally struggle to keep living and resent any push toward the grave.  Any apparent desire to die or to be dead is unnatural.

STATUS   Humans were created a little lower than God, [Ps. 8/5] This gives each person, regardless of their size, age, sex, intelligence and “quality of life”, a dignity everyone should recognize and respect. It also gives people an appreciation of how far humanity has fallen from their original state.  How great is the tragedy for the dying person and for all humanity, that we rejected God’s initial plan to walk together in an amazing garden and gradually get to know and appreciate the most incredible Person there ever was or ever will be.  More than anyone, a dying person realizes the utter stupidity of choosing instead the “knowledge of good and evil”.  Were it not for Christ everyone would die in despair.
  
WELCOME     Each human was designed to develop within the context of a family. This begins with being welcomed by the whole family in whatever state, size, condition or place the little one may be. When they are welcomed, it means they are welcomed as they are, when they are, where they are. It is unconditional acceptance. The family by welcoming a new child as soon as they are aware of his or her existence, extents their hospitality and protection for the duration of this new person’s earthly life.  The family has the privilege and responsibility of welcoming their child in the name of Jesus for that is a welcome to earth extended by the Creator of this child and the universe.  The family also has the responsibility and privilege of welcoming this child in their family’s name and in the name of each individual by each individual.  When he appears after birth they can take a good long look at him and discern his name is Josiah or her name is Sabine. As they have welcomed Josiah or Sabine, so they must say goodbye and then commit this their spirit back to his/her Creator.

INCEPTION      Humans began with a concept in God’s mind. The inception in God’s mind became the design of their blueprint. Following that came the conception. Since they were created essentially spirit, they are indestructible.  Although their blueprint may become so faded or becomes rusty it is barely discernable to many aging people still it never fades.  With a little effort they can be aided to remember who they started out to become.  It is very painful, but until they see their blueprint they will never know who they should have become.  When that happens at any time of life, they can grieve the PISHB and then it is so much easier when they are dying to say goodbye.
 
TO LOVE      Humans are commanded by God to love each other. When they are loving, they are most healthy. The command applies to everyone, from conception to death. This means that even the old and infirm are expected to reach out in some manner to try and meet the needs of others. In doing so they are more likely to have a purposeful and healthy life to the very end.  By focusing on others, even the dying are less self-centered and thus every inconvenience and pain is lessened.  Self centered people are much more aware of their disorder and deterioration. They struggle to keep themselves in comfort mainly for their own sakes.  This is counterproductive.  They will only hurt and fail more rapidly.  Those who reach out to others even as they sink, do so with greater ease and the assurance they have fought a good fight.

Humans were created with what appears to be excessive genetic material. Since God doesn’t waste energy or matter, one has to conclude that genetic material will be used in the magnificent, indestructible new ‘body’ they are expecting after they die.

TWO BIRTHS       Humans are originally developed in the fluid of the amniotic sac. Thus they are born of water. Since they are born with a fundamental defect that results in their continuous struggle against death, they are inadequate to live in an atmosphere of power and brightness that would instantly destroy them. Thus their spirit must be enlivened, their soul renewed and their body recreated. This can only happen after the spirit is reborn by God’s Spirit, ignited with an inherent desire to seek God and obey Him always.
 
# 2.   CREATED TO LAST     

STRUGGLE TO RESOLVE CONFLICT     Because eternity is in their hearts, humans resist dying, constantly attempting to maintain a homeostasis that utilizes energy most efficiently and ensures their longevity. For this reason, they have an inherent desire to resolve conflict. Conflict between humans and conflict within humans uses energy without purpose and accelerates their demise and destruction in entropy.  They will try to resolve conflicts initiated in them as mistreated children by thinking and thinking, “until they drive themselves crazy” or talking and talking “until they drive their friends crazy” or by recreating the essential key conflict and thereby contributing to family tragedy to the “third or fourth generation”.

TO PROTEST     Every human at any age they are dying, desires to shout, “I am too young to die!” It may appear that as they age they are more readily accepting of death, but this only indicates that their existence is becoming intolerably conflicted or painful. Though I have seen thousands of suicidal patients who ostensibly wanted to kill themselves, I have never met anybody who wanted to be dead.  Given even the promise of an amelioration in their condition or circumstances, people will hope again and on that hope build a renewed life, be it ever so short.

INSTINCTS      God created humans with an instinctual wisdom that helps guide them to healthy interactions and behaviour. God does not trust human wisdom, philosophy or religion. When humans respond appropriately to their instincts, they are more likely to cooperate in their individual and mutual survival.  They are more likely to know what is good for them.

# 3  FAMILY        
All humans were created to live in families; most intensely and intimately during their developmental periods. Scientific evidence supports the Judeo-Christian, and almost universal notion that children need to be born into, welcomed and reared by a heterosexual couple who are mated for life.  Families are more substantial and organic than many people can now see.  You cannot choose your family despite what some experts in palliative care believe.  For better or for worse, it was chosen for you.  Yes your responsibility to yourself and to them is to “make the best of it”.  If God didn’t think you could do it, He wouldn’t have put you there.  And yes, things are equal; for those with greater blessings, have far greater responsibility the discharge of which should result in self restriction and impoverishment in efforts to ensure equality and legality.

PAIR BONDS        Like geese, wolves and ravens, humans are basically monogamous. The pair bonds that unite them are their being married by God, a bond that only God can take apart. For that reason, whenever humans are bonded, they are bonded for life regardless of how often they have formed a pair bond. Those bonds are created by 8 distinct mechanisms:

1. Falling in love
2. Imprinting
3. Classical conditioning
4. Operant conditioning
5. Exchange of hormones during sexual intercourse
6. Rescue
7. Buddy
8. Social
9. Spiritual, i.e. one in the Spirit, united in Christ  (#9)

BREAKING PAIR BONDS       The only time that pair bonds are broken is through death. Since the bond is primarily a physical bond (one flesh), that bond, when broken by the death of one person, also affects the flesh of the other. It is also psychologically very painful. For this reason well bonded couples pine for the departed and often die within a short period of each other.  If one survives a traumatic event for both, the survivor will usually feel survivor guilt and promote their own demise.

PARENT-INFANT BONDS       Parent-infant bonds are created throughout pregnancy, most intensely during the first 18 hours of extra-uterine life and then throughout the child’s life with his parents. The parent-infant bond, like the pair bond, lasts an earthly lifetime. The breaking of that bond through death is excruciatingly painful. That grieving of a parent for their child or the child for their parent is intense.  Yet it is a natural and normal process, the progress of which is easily recognized.  If allowed uncomplicated grief spontaneously resolves.  The grieving person completes the cycle and wakes up to new hope and an ability to form new attachments.   Grief can be only be facilitated by removing the impediments.  In normal grief there is no need for grief counselors, just family and friends who intuitively know when to be near and when to leave alone.  Too often professionals get in the way

FRATERNAL BONDS       Children are bonded to each other. That bond is especially important when there is a high likelihood of children losing one parent or another. Thus, in North America where there is a 50% likelihood of marital disruption, children are increasingly bonded to each other.  Consequently they are very resentful if a parent destroys a sibling through abortion. Fraternal bonds are also found among those in good, close company e.g. platoons during war, small, effective manufacturing companies, etc.

SPIRITUAL BONDS      All those who are children of God are also brothers and sisters of each other. Under normal circumstances, they will care and often die for each other. It’s small wonder that the death of one church member brings out a good portion of the congregation to the funeral.  Each nearby spiritual brother and sister needs to grieve, join in committing the dead person’s spirit to their Lord and then help to bury the body by throwing shovels of dirt onto the corpse.

PURPOSE       God creates these bonds for the survival and civilizing of his human creation. Thus every child who conceived is a necessary for the survival and civilization of the whole species. In this regard, each person has an equal and necessary contribution to the survival of every other human. Every child requires a family in which to be nurtured and guided so that they become an effective contributor to the welfare of the human species. Every family requires the nurture and protection of the wider group, particularly the elected government.

WELCOME      Every child, regardless of size, shape, color, intelligence, time or place was designed to be welcomed into a family. No member of the family was ever to have the power to discard any child that ever came to them. If and when they destroy a child by abortion, eugenics or mistreatment, there are severe consequences to the whole family.   When that effect is multiplied many times by the same effect in many families, it produces a disastrous consequence to the survival of the whole species.
 
The nice sounding phrase “the first right of every child is to be wanted”, is a most pernicious philosophy.  Every child’s first and only undeniable inherent right is to be.  Everyone has a God given right to exist, regardless.   For most people in most countries, wantedness has become the determining factor in deciding which child lives and which dies. That criteria is now being applied to other apparently less wanted people:  the handicapped, wrong sex, inconvenient and the elderly. Since wantedness has becomes the criteria by which people live and die, nobody is safe. Almost everyone is left wondering how much they are wanted or popular for they then must live according to the ethic of wantedness.  They must expend most of their energy to stay liked and likable, rather than courageously facing extremely difficult issues alone and unpopular.

FAMILY GUILT      If any member of the family, in fact or in fantasy, actively or passively contributes to the death of another member, they feel a biologically determined guilt. This inherent guilt greatly complicates grieving. The guilt-complicated grief  [GCG] frequently results in pathological grief which often becomes a very difficult to treat depression.

GOVERNMENT INTERFERENCE      Ever since there was government, there has been a tension between the family and the larger body, competing for the body and souls of the young. Presently the government is winning, and families are abdicating.  This is occurring  primarily because families are so burdened with paying taxes for government funded daycare, education, medical care, etc. they must work outside the home. As the family abdicates, the government takes over more of their responsibility, constantly reminding their electorate that they must do so because the family is abdicating. The family, on the other hand, with very few exceptions, abdicate all too readily because they are hoping if they work long and hard enough, there will be enough money left over after taxes to buy themselves exciting pleasures. As the government and its agencies burgeon, the total number split invariably into specialized groups, competing with each other for greater recognition, constantly demanding more funding, and insisting they have a right to grow at the expense primarily of the family because there is such a need for their particular service. This is especially true in the current concept where family accommodation, structure and behaviour makes it hard for them to care for their elderly. The government and its agencies, with the private sector competing, builds empires of palliative care, all of which require greater funding, all of which insist that the family spend more time earning and less time caring.

FAMILY GRIEF       Grief is a natural process which begins and ends reasonably smoothly if there is no interference.  Those who ostensibly facilitate grief by outlining the invariable stages, or insist people need grief counselling, or measure the amount of a person’s grief, do more harm than good. Grief is also interfered with by the prescription of antidepressants. Grieving requires that people feel acutely the breaking of their bonds. While they are on antidepressants, there is a vague sense of wellness when all is not well and little apparent need to mourn.

DETACH / ATTACH      In the early 70s, Lewis recognized that until mothers detach from an stillborn child, they have difficulties bonding to the next. We found the same phenomena with miscarried or aborted babies. Grief therefore is necessary for new attachments.  When a husband or wife dies, the ability to make new attachments is necessary for the family especially when they are young. Anything that interferes with the detaching process (grief) interferes with later attaching process, which interferes with the growth and development of the family.

SEVEN PREREQUISITES OF GRIEF     
The natural beginning and normal progression of grief requires:

1. Recognizing that the body is irrevocably dead. This means that people need to hold the body as it becomes cold and stiff. Children need to be able to poke their grandparent to make sure she does not respond. There needs to be some authority to pronounce that body as completely dead. Since Christians recognize the body is dead when the spirit leaves, there needs to be more than one person, who can with a degree of certainty, ascertain when the spirit has departed and inform the family, authoritatively.
2. The person must be humanized in order to be grieved as a human. It’s no good saying, “That stupid alcoholic is gone.” They must be able to say, “That person with alcoholism is gone.” To rehumanize the person, they have to be made part of a family, if they weren’t before. The preborn baby must be individualized, characterized, humanized and welcomed into a family. This means each preborn baby must be given an identity, sex, physical and personality characteristics and then named.
3. Before the person dies, there must be good goodbyes.  This requires: it is mutual, there is no unfinished business, it is said and that the departing and those left behind need to express their respect and appreciation.
4. Contributing.  If anybody has in any way, in fact or in fantasy, passively or actively contributed to the death of the person, they must face that and seek forgiveness and reconciliation.
5. Care by family. Humans function best in the context of an extended family. This means that the older people must be given semi-independent living, and a meaningful role in the welfare of the family as long as they live. Many years ago, the New Zealand government provided permission, ways and means for people to build on their city lots, a granny cottage where the old folks could live but were within sight and earshot so they could be responded to if there were episodes of acute distress. In a similar way, people should die at home. This requires periodic relief by others and a visiting nurse during the most stressful times.

RESIST GOVERNMENT INTRUSION    The family must resist any temptation to earn and spend at the expense of caring for each other. They must resist the apparently kind intrusion of the government with its many offers of help. This should be increasingly easy now that the government is struggling to find sufficient funds but governments seem to have very deep pockets when they see fit. As the population declines, so does the economy. In a world now facing almost universal exponential fertility decline and population implosion, the government will have to make severe cutbacks in social, educational and medical services.

PROCREATION    God’s first command to humans was to populate the earth and care for it. Power-hungry people insisted the greatest scourge was population explosion long after it became apparent that the real problem was implosion. A God with limitless knowledge and capacity created an apparently limitless universe, which surely invited humans to have a limitless expansion of their kind. Instead of they began fiercely competing and killing each other.  If they cooperated they could easily be populating the stars. Even a small portion of money spent on armaments would suffice.   When they cooperate and encourage each other’s exploration and star colonization, they would be at their civilized best.

* Welcome, sendoff, commit, spirit, touch body, bury and grieve.

AUTOMATIC REVULSION     In order to survive individually and as a species, humans must avoid disease and decay. For that reason there is an automatic revulsion to bodies that are diseased, and degenerating. It takes a great deal of determined love for a young couple to clean and care for their parents’ feces-stained, wasting bodies. For that they need good role models and opportunities to discuss their conflicting feelings of love, respect and revulsion.

A NEED TO STRUGGLE            Zoos found that animals survive longer and better when they are caged with prey and predator side by side. Humans will live longer and their minds will stay sharper when they struggle, not only to care for themselves but also to care for others. In the family, those are handicapped and older people need a meaningful serving role. Even if they cannot get up on their feet, surely there is something they can do. The most pathetic sight is to see older people in homes being lovingly cared for but very quickly deteriorating because they are no longer struggling to look after themselves. If there should be a home for the aged, and there should be very few, there should be no elevators. This requires people to go up and down stairs or ramps to get from dining room to bedroom. They would also need to help propel each other up the ramp.

ATTRIBUTIONAL EFFECT    Whenever any otherwise expected or automatic activity is paid for, it loses value and people become less interested in doing it. When family members are paid to care for their own, they have less of a natural inclination to do so. The implied argument is, “if one has to be paid that amount, surely it must be an onerous activity”. There certainly should be recognition for the heroes and support for the rank and file who routinely care for their elderly, but no monetary support.