Focus on the Family Broadcast

Navigating End-of-Life Decisions (Part 1 of 2)

Navigating End-of-Life Decisions (Part 1 of 2)

As a follow-up to our recent broadcast featuring Kara and Jason Tippetts, "Living Faithfully With Cancer," the Tippetts are joined by hospice physician and palliative care expert Dr. Margaret Cottle to explain how families can navigate end-of-life decisions. (Part 1 of 2)



Jim Daly: Kara, when you heard that word from the doctor, “You have cancer,” what was your first response, your first reaction?

Kara Tippetts: Just tears and then it was that Charlie Brown teacher moment where she says, “You have cancer” and then every word after that sounded like, “Wah, wah, wah.” I mean, all I could hear was “cancer.” And I just wept and looked at my friend that was taking notes and she kept saying, “I’ve got it. I know …” ‘Cause she knew I couldn’t hear anything else past the word “cancer.”

Jim: Hm.

End of Teaser

John Fuller: That’s Focus president Jim Daly, talking with a young mom of four. Her name is Kara Tippetts and she has a terminal diagnosis of cancer. I’m John Fuller and on today’s “Focus on the Family,” we’ll explore this very difficult topic and hopefully, prayerfully this conversation will help you better prepare for a day when you’ll get tragic news about someone you love.

Jim: John, first of all I’m so appreciative to Kara and Jason for their willingness to talk publicly in this way about what they are going through. I think it’s an amazing opportunity for them to teach all of us how to manage this kind of situation with God’s grace and His goodness. It is there, even in the midst of something like this, His goodness toward us.

John: Uh-hm.

Jim: And it’s not the conversation that we want to have, but you know what? We’re all gonna face this some day. We’re going to love a parent or a sibling or a spouse or even like my brother and sister-in-law, they lost their son. It’s an important discussion, to talk about how we as Christians deal with the death of a loved one or the pending death of a loved one.

John: Uh-hm.

Jim: Sometimes we have no warning at all. Sometimes it’s that heart attack or something that’ll happen, an automobile accident and our loved one is instantly gone. In the case of cancer and other diseases, that horizon is longer and there’s time to reflect and be contemplative about what you’re going through. And what a gift it is to have Kara and Jason talk us through that, along with Dr. Cottle.

John: And the guests that you’re referring to include Kara Tippetts. We heard from her just a moment ago and her husband, Jason. They were here just three weeks ago or so, describing their cancer journey. And if you missed that conversation or would like to listen again, we’ll have a link to it so you can get the download or the CD. That’ll be at .

And also joining us is an end-of-life specialist, Dr. Margaret Cottle. She’s been on the broadcast before. She’s a member of our Physician Resource Council and has been caring for terminally ill patients for more than 25 years.


Jim: Dr. Margaret Cottle, Jason and Kara Tippetts, welcome back to all three of you to “Focus on the Family.”

Dr. Margaret Cottle: Well, thank you.

Kara: Thanks for havin’ us.

Jason Tippets: Thank you.

Jim: Margaret, I’m sure as a doctor in palliative care, you’ve witnessed many patients go through this. How do families typically, if there is such a thing, how do they deal with this news?

Margaret: I don’t think there really is a typical family, just as you probably have found in your ministry here. But the reaction that Kara was talking about is very common, that feeling that once you’ve heard the word “cancer,” you don’t hear anything else. And it’s very devastating news to receive. Your whole life changes in an instant.

And many people on the medical team find it hard to know what to say or what to do to help people in that situation. And that’s where our faith really comes into it. It’s very important that people who have a diagnosis like this are supported at the most important part of who they are and that’s their faith.

Jim: Jason, as husband, I want to get you in here. I mean, I can’t imagine emotionally what goes through your mind and your heart.

Jason: Yeah, my emotions are all over the place, where I have days I feel like I can accomplish things and then I have days where I just can’t focus on my job or things ahead of me. But I realize this is normal. This is what it’s supposed to be.

And so, I really lower my expectations of trying to be hugely successful in my career and I realize my calling is to be faithful to my family and also faithful to my job as pastor and realize there are lot of things I can’t do and that’s okay. Because of what’s going on in our family, I can’t be the pastor that sometimes I think I should be and that’s okay. And our church has really been very gracious and they’ve learned that this is just where we are. And Kara and I have those moments where life just seems very normal and then we also have the moments where we realize what’s happening more and more. And …

Jim: It’s like these two realities–

Jason: Yeah.

Jim: –like you said. Dr. Cottle, what is it to be normal in this situation? I mean, that’s gotta be such a complex reality. What is normal when you wake up feeling good and you know, in this case, with Jason and Kara, they’re having normal days and then days that aren’t so normal. What do you see in your practice across the board?

Margaret: I think there really is no such thing as normal, but the most important thing is to be gentle with yourself. All of us, even when we are in a stage in our lives where we don’t know that we’re dying or we’re not (Laughing) realizing it, have good days and bad days. And it’s no different at those end-of-life stages. We have good days and we have bad days. And we need to be gentle with ourselves through that.

It’s very important to lean into the thing. If you’re having a bad day, not to be isolated from one another, to share that with each other. There are some books that are out there that say, you know, “The power of positive thinking” and I always when I see a book like that at a bedside or in a home, I always say, “You know, it’s great to have positive thinking, but if it’s a Christian family, I say the same thing. ‘Lazarus still died’” (Laughing) a second time. So, it’s no matter how positively you think, if you were born 200 years ago, you’re gone now. And it doesn’t help to be positive thinkers if all it does is keep you isolated from one another.

And what I mean by that is, that sometimes what I will see is that someone is feeling bad and they’ll say to themselves, “Oh, I can’t talk about this, because then the other person in my life will think that I’m not thinking positively and I’m not sending positive energy to my cells, which is just garbage. If you’re not feeling well, it’s all about coming alongside one another, building one another up, helping one another in those difficult times. It’s not about hiding those times when we don’t feel well. So, be gentle with yourselves. Don’t worry about what’s normal for somebody else. There is no such thing. Be kind to one another.

The other comment I’d like to make is, there’s a difference between healing and cure. You can be healed and not cured. And I think as Christians, we understand that. And the most important part of it in our lives, even for non-Christians is to receive the healing that’s available to us, even if we’re not cured.

Jim: Kara, let me ask you this, because you sit in a very unique position on the panel here today, the discussion group. Do you feel that people act differently? Are they uncomfortable?

Kara: You know, I think my personality gives people freedom to speak honestly. I mean, I make some wicked funny jokes about dying (Laughter) to my girlfriends and they laugh and cry at the same time, because I don’t have the liberty of walking around this. We have to walk through it. And I have some fantastic girlfriends and fantastic family and church community that have decided to walk with me through this.

Jim: Hm.

Kara: And there’s been such a grace to us in having small children that you know, I say there are good moments on bad days. And we have to make lunches. We have to deal with kids fighting. We have to keep living. But there are some people who struggle to walk honestly with this and we give ’em that liberty and that freedom, but we are so grateful for those who’ve decided to walk through it with us.

Jim: And specifically, I guess what I’m asking, there’s so much of the church and I think generally, the world, we don’t want to deal with this. We would rather have the 10 happy ways to fill in the blank.

Kara: Exactly.

Jim: And so, when it comes to this issue of death and passing, we all tend to run to the other end of the room. We don’t want to talk about it. It’s taboo in some ways. Yet, we’re all gonna face it. We’re going to be confronted with it with our loved one, with our spouse, with our children, maybe, or certainly, with our parents.

What would you say to us that have not hit the point yet where our own mortality is confronting us? What would you say about leaning into the sorrows of God rather than trying to put a veneer of happiness upon it?

Kara: You know, one of my favorite books is A Severe Mercy. And it’s a book by Sheldon Vanauken, who’s very much loved his wife. And in the midst of loving her well, he lost her. And C.S. Lewis called it “a severe mercy.” And he talked about life; life is lived in the heights and the depths. And we as American Christians, want the heights. We make idols out of the heights, but don’t realize that the depths are what also make the heights so beautiful.

And my diagnosis has made us realize the huge little moments that reading a book and snuggling and putting my kids to bed or giving a bath, those are the big beautiful moments of life. And cancer was a gift in giving us that vision.

Kara: And I write about it all the time. I want moms, I want families to see these years are so important and to be cherished, not just to get through. But you know, the heights and the depths, I get to leave and yesterday, I had a mask made for my brain radiation and I wept. And then I got to go see Casting Crowns and danced in one day! (Laughter) And that’s my life now. It’s beautiful.

Jim: Everything takes on more significance.

Kara: Absolutely.

Jim: Dr. Cottle, speak to grief. What is it in human beings that we encounter grief? What is grief? And how do we manage grief? Or can you manage it?

Margaret: Grief is personal for each individual and it’s another part of that being gentle with each other and being gentle with oneself, is not trying to force yourself into a mold of what grieving should look like. I think one of the important things to realize is that Jesus even though He was perfect, grieved.

Jim: Hm.

Margaret: He came to earth because of our separation from the Father. And really grief is about separation. Grief is about not being together. And how do we deal with that? How do we come through that? And you know, no one is quite the same after he or she has been through a grieving process. I lost my mom when she was only 61 from breast cancer, as well. And I still grieve 30 years later that she’s not there to see my children married and potentially see some great-grandchildren at some point.

But there’s a joy in it, too in knowing that she’s with the Lord Jesus and knowing that we were able to care for her at the end of her life and to provide for just very basic needs for her was very therapeutic for us. My sister and I gave her a bath one of her last days. And both of us have that as a very precious memory and in our lives about how we were able to minister to her physically.

So, grieving is something that’s quite personal. It’s something that can hit you very suddenly later on. You never are quite sure when you’re going to be blindsided by a grieving moment. But it’s also something to lean into, as Kara was saying, something to experience to the full, something to identify with the Lord Jesus in the midst of it, because He was a Man of Sorrows and acquainted with grief. And we have a Savior who knows what it’s like to suffer with us. We don’t have one who’s not acquainted. And we have a high priest who is there beside the Father, advocating for us.

And the other thing we have is a Father who wants us to come to Him. And I have this lovely image. In Hebrews it says that, we can boldly come before the throne to find grace to help us in our time of need.

And I have this picture in my head of being a little girl in the court of the King, maybe a Narnia sort of picture. And when I have one of these griefs or one of these sorrows, I just start wailing and running toward the throne room. And all these courtiers are standing around and they open the doors like here’s she comes again. And I just go pelting right down through all of this big hallway with my footsteps resounding and run bam, right into Abba’s lap and just weep my heart out. And He knows. He knows what it’s like. He knows what it’s like to lose His Son. He knows what it’s like to be a Man of Sorrows. And we can take everything there and know that He understands.

Jim: It’s a beautiful picture of a daughter or son of the king, you know, goin’ right by all the guards–

Margaret: Yep.

Jim: –to say, “Hey, I’m gonna go talk to my Dad.”

Margaret: Yes.

Jim: I mean, that’s a beautiful picture. Oftentimes in families, maybe it’s part of the grief expression, there can be a lot of conflict at this moment, particularly around parents. Nobody’s really talked things through perhaps. Sister, brothers start arguing about what should be done, what should happen to the house. Are we gonna sell it? All those big questions that begin.

For any of you, what advice would you have, particularly for the Christian family, that all of a sudden now, the death of a loved one is sparking this conflict? And some people again, may be expressing that because they don’t know how to manage the emotion at the moment, but you’ve seen it in your practice. What would you tell us ahead of time to safeguard against that kind of behavior?

Margaret: I think it’s really hard to safeguard against all difficult behaviors because it’s a difficult time in people’s lives. And what we really need to do is give one another grace in those moments and just try to see if we can see behind what the pain is that the person is experiencing, who is being difficult. That having been said however, I think it’s really worthwhile talking about these things early. If you are the parent, take time to speak to your children about what some of your wishes might be, as you envision them now.

It’s interesting how things change for people when they actually are in those moments, what they think they might want, versus what they actually do want. And that’s another conversation, but at least speak to one another and say, this is really important to me. And maybe one of the things that’s very important to you as parents, is that your children get along and that there isn’t conflict and that they learn how to work things out and work together.

But a lot of it really has to do with the high emotion that people are experiencing and learning to give grace to one another, to walk away from a conflict, not to say that barbed word that’s on your own tip of your own tongue, but to use the advice from Proverbs, that a gentle answer turns away wrath–

Jim: Hm.

Margaret: –and to be kind to one another, to look at the things where you can agree. And then also if it is just between siblings about what’s going on with mom and dad, to try to focus on what would mom and dad have wanted? What would mom have wanted? That part is often easier than, what do I think is the best thing to do here? And often that will help with some of the conflict.

Jim: Start with that question. That’s a good question. Kara and Jason, how are you dealing with your kids. You have young kids–

Kara: We do.

Jim: –four young kids. Margaret’s describing that as a physician. How has that worked practically in your home? How have you introduced the concept of your diagnosis and your death with your kids?

Kara: You know, I talk about my second-born one night, got in bed and said, “Is mom gonna die of old age or cancer?” And Jason came in crying and he said, “Okay, I tap out. You’re in, Kara.” And I went and got in bed with her and we just cried beside each other. And I asked her. I said, “Harper, would Jesus be good in both answers?” And she looked at me and I said, “I know it might not feel good, but He is good in either answer and we have to hold onto that. And will you trust that with me, Harper, that even if I don’t die of old age, that Jesus knows your story, cares about your heart and is gonna walk with you and give you a beautiful story, as He’s given me.”

Kara: And then I went to my room and crumpled on my bed and wept. And I texted my friend who lost both of her parents suddenly in a[n] automobile accident. And I said, “Tell me the truth. Did I tell her the truth? Was I right? Because you know, you say things that you want to believe, but sometimes you know, you’re preachin’ a sermon to yourself that’s higher than you.”

And she said, “Kara, the grace that’s gonna come around your kids is gonna be breathtaking. And I’m gonna hold that and I get to watch it and I get to help protect them.” And so, it’s a beautiful story, so we just honestly let our kids ask the questions as they come and just shepherd their hearts. You know, for my youngest, she knows she has a bald mom with cancer. And she’ll tell you at the door if you come, wash your hands. My mom has cancer. But she doesn’t know what that means. But someday she will and she’ll know that she had a mom that was open to letting her speak.

Jim: That is good advice and Kara and Jason, I’m just thinking, you know, again for your children, you know, so often I think the mistake that’s made is that parents will want to isolate the child from that. And they expect it’s not gonna be confronted. That’s what happened to me as a 9-year-old. I just didn’t know what was happening with my mom. She was dying of colon cancer.

Jim: And I just got called into a room one day and I was told she was dead. And there was no lead up. There was no integration. And I think it’s that fear that was in me. I don’t know what tomorrow will be now.

Kara: Yeah.

Jim: You know, that’s what kids are–

Kara: Yeah.

Jim: –responding from. Mom’s gone and I think that ability to connect God’s goodness, that He’s not taking Mom from me is pretty critical.

Kara: It is, because, you know, for each of my kids, it’s going to be this foundational moment in their life. It’s gonna be gonna be that moment where they see God’s love in His outstanding way. I’m just sorry I’m not gonna be there to see it.

Jim: Well, maybe you will be! (Laughter)

Kara: Yeah, I don’t know. I mean, I’ll be in the land of no more–

Jim: You’ll be seeing it.

Kara: –tears. I’ll be in the land of no more tears. And yeah, I know, I know, I know that Jesus will meet my kids in a unique grace that I have never known. And they’re gonna have a faith rich and I trust Him in that.

Jim: Hm.

Kara: But it’s not easy. We have fears in that and you know, that’s a moment I pray many prayers into that God will be there uniquely and it’ll be a profound moment in my kids’ lives. And for Jason, ’cause I know it’s Jason’s greatest fear, the moment he has to tell the kids I’m gone.

Jim: And that’s a moment, I can remember it, always will.

Margaret: I have to say though, that for many families, the moment when the person is actually gone is not the worst moment. The worst moment can often be when either you hear the diagnosis initially or you get that news that it’s on the move again. It’s spread again.

And you think, “Oh, my gosh. If I feel this bad when I’m just hearing this news, I am actually going to come apart as a person when my mom actually goes.” And I found that in my own life, when my mom’s cancer spread, that moment, it was almost as though I couldn’t swallow the news. I was breathless and it was really hard to take that news.

And yet, when she did finally pass away, she was in a different place physically than she was and emotionally and mentally. And I was ready to let her go at that point. So, the most difficult time for me and for many people is not that final moment of letting go, but it’s when you get that really shocking bad news. And I think it should be comforting to the listener to think that maybe that last little piece isn’t the worst.

Jim: Well, we’ve talked about being gentle with yourself, grace that you extend to yourself, that “normal” includes both good days and bad days. And then to ask what’s best for the terminally ill person that’s your family member—your spouse, your children, your parents. Let the young kids ask questions. I like that.

We have more to talk about, if we can stay with it, if you’re willing. And let’s come back and talk about some of the practical things that we need to consider like end-of-life directives and some of those things. Can you do that?

Kara: Absolutely.

Margaret: Be very glad to.

Jim: Let’s do it.


John: Well, this has been a difficult conversation and we’re so appreciative of your willingness to share and to give these stories to us and help us understand. Jim, this has been a really important discussion to have today.

Jim: It has been, John and I hope people feel the spirit of that. It’s not to be dwelling in negative things at all, but this is part of life. Our death is part of our life, as well. And these are topics that aren’t comfortable, but I think that we do need to discuss them, especially in the Christian community, because we should be expressing that great confidence that we have about what’s next. And Kara and Jason are doing it so beautifully. I’m glad that they’ve been able to express that here.

As they have taught us today, God is with us in every difficult and hard place. He’s present. That’s clear in Scripture, whether that’s Psalm 23, where He gives this promise, “Even though I walk through the valley of the shadow of death, I will fear no evil, for You are with me.” I can’t imagine, you know, Kara being in that spot right now and feeling that and it’s so admirable to know and to trust that God is with you.

It’s our prayer that you will know this promise in your own life, no matter what issue you may be facing. And it might be job termination, bankruptcy, all the things that happen that can pull you down. It doesn’t have to be terminal illness. But if you’re hurting or feel like God’s far from you, I hope you’ll contact us. That is exactly why we’re here. It’s why very generous donors have been able to support the ministry in such a way that we can provide that counseling help. We’d love to talk with you and all you have to do is pick up that phone and call us.

John: Hm.

Jim: And if we are busy at that moment and it’s likely, because we have had a lot of phone calls, we will take your number and call you back.

John: Uh-hm.

Jim: John, it reminds me of a story that we’ve shared in the past, but a woman whose husband died and you know, she wrote to us. She was not a believer, but she knew Focus on the Family and felt we would be the right group to reach out to, which is amazing to me.

John: Uh-hm, yeah.

Jim: And you know, they had a 9-year-old boy, as well and we were able to respond with resources for both of them, a care package for the two of them. And in the boy’s care package was Adventures in Odyssey Bible and a program related to grief within the Adventures in Odyssey program. And that little boy over the course of a few weeks accepted Christ and challenged his mom to accept Christ, as well, which she did.

John: Oh.

Jim: And then she sent us the most beautiful letter about what she received after reaching out to us. That’s the work we do here at Focus on the Family and it’s a good reminder of what you invest in when you support the ministry.

And let me just say, I hope you’ll consider doing that today. We don’t need a big pitch here. You know what’s happening. We want to be there when people are hurting in the name of Christ. And you are a big part of that, so thank you.

John: And I’ll encourage you to pray for those who get in touch with us like that mom. And if you feel led, please donate at or when you call 1-800-, the letter A and the word FAMILY; 800-232-6459. When you get in touch, ask about how you can get a copy of Kara Tippetts’ book, The Hardest Peace, which is a powerful resource of encouragement for those who are going through a really difficult experience in life. And we know you’ll find it helpful.

At our website you’ll find several extras about this matter, articles about end-of-life decisions, plus a link to the program that we aired earlier this month with Kara and Jason called “Living Faithfully with Cancer.” Our program was provided by Focus on the Family and on behalf of Jim Daly and the entire team, thanks for listening. I’m John Fuller, inviting you back next time for more discussion about the end of life and why human life is so precious. Join us then, as we once again, help your family thrive in Christ.

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