Focus on the Family

Focus on the Family with Jim Daly

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

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



Kara Tippetts: 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..

End of Recap.

John Fuller: That’s Kara Tippetts, who is a young mom with four children and she’s facing a terminal diagnosis of cancer. And we’re coming back to a conversation with Kara and a panel of guests about end-of-life issues on today’s “Focus on the Family,” with Focus president and author, Jim Daly and I’m John Fuller.

Jim Daly: John, this is such a relevant topic for us to address, because our culture has such a skewed understanding about death and the value of life and perhaps even many in the church. And we’ve got to get back on track about what God gives us as a gift of life and the fact that all of us are going to face death. Nobody is immortal and we’ve got to make decisions in this life, hopefully for the Lord and to serve Him and to walk with Him in this life, so that we can end our lives in a way that glorifies Him. I think that’s clear in Scripture.

You may have heard about a young woman, Brittany Maynard, who was in the news this month and she’s struggling with brain cancer. I don’t believe she has a Christian commitment to the Lord or anything like that. And she has opened up a debate in the country once again about the issue of end-of-life. Suicide when you get a terminal diagnosis, is an easier way or maybe a better way, a compassionate way to go ahead and end your life.

There are deeply personal decisions. I get that, but at the same time, we have to remember the dignity of life and death in Christ and what we need to project as a culture. And I like the fact that Kara has responded to Brittany, again, two women, both with terminal diagnoses. But she’s responded to Brittany in an open letter and shares from a godly perspective how she is managing it. And I think, John, we should post that online for people who want to follow up regarding end-of-life issues.

John: Uh-hm.

Jim: I think it’s a fabulous expression on Kara’s part to Brittany and that may help you sort through some of these issues, as well. Let me encourage you to pray for Brittany and for others you know who may be seeing this as the most virtuous way to end. But that cumulative effect of one human being who decided to take their life because of a terminal illness or whatever the situation might be–Alzheimer’s for an older patient–it concerns me, because that cumulative effect means that we are disregarding God’s dignity in death and how we should honor Him even to the end. And it makes it easier for doctors to talk with patients’ families about ending their lives and sometimes prematurely, like we’re seeing in the Netherlands, where older people are being terminated simply because they’re old. We are not going to be a better culture embracing that kind of philosophy.

John: Well, if you’d like more information and you’d like to get a more fully developed perspective on these very difficult matters, we have some follow-up for you at or you can call us and we can give you some starting points. Our number here is 800-A-FAMILY. And when you get in touch, ask about a CD or a download of our entire conversation on this topic. We’ll include yesterday’s program, as well.

Jim: John, you mentioned our panel of guests. We had Jason and Kara Tippets with us. They’re pastoring a church here in Colorado Springs. In 2012, Kara was diagnosed with breast cancer, which has since spread really into her entire body. And she’s still battling this disease, but there’s no cure for Kara, short of that miracle that I know they and many others are praying for, for her.

Our other guest was Dr. Margaret Cottle, who has been providing end-of-life care for patients for more than 25 years. She hails from Canada, but she’s part of our Physicians Resource Council here at Focus on the Family. That’s a group of about 40 physicians who help us with bioethics and on medical content–.

John: Uh-hm…

Jim: –here at Focus on the Family…

John: Yeah and let’s go ahead and get back to this conversation with our guests on today’s program.


Jim: Last time we talked a bit about our uncomfortableness in this arena where dying occurs. Christians have a long tradition of standing in that gap, all the way back to Rome, where they helped the plague-infested areas of Rome and fed soup to those who were dying with no concern of their own well-being. Historians wrote about it at the time saying, “Who are these people that no regard for their own life to take care of complete strangers?” It’s a wonderful Christian tradition.

Perhaps today unless you’re in a profession that draws you in that direction, perhaps even from your Christian understanding, a lot of us as Christians are very uncomfortable in that environment. We’ve kind of vacated that spot to want to be there, because we’re all uncomfortable with it. What advice, what perspective do you have about that, Kara?

Kara: You know, I feel like my community has slowly come alongside and learned how to walk this. I mean, I’m the first of all my friends to be dying. And …

Jim: Think of that. I mean–

Kara: Yeah.

Jim: –at your age, what you’re talking about is the first one to become a mom, the first one to get married.

Kara: I was; I was the first–

Jim: It was only–

Kara: –in all those things.

Jim: –it was just a few–

Kara: The first to get cancer.

Jim: –years ago for you.

Kara: Yes! And so, while stumbling along and there’s so much grace in this. I think God has given me such a perspective of just loving today and embracing people. So, I don’t nitpick people in their clumsiness to love. I have a girlfriend, her name’s Heather and she just came up to me and said, “I don’t know what to say to you, Kara, but I know I love you and my prayer is that each day God would lift your face.” And it was profound to me that she said, “I don’t know, but I’m here and I’m talking to you.” And I’m stumbling. And I looked at her. I’m like, “I am, too; thank you for comin’ up to me and talking to me.”

‘Cause I think there’s this fear of, I don’t know what to say to Kara, so I’m just gonna avoid her. But there’s such grace. I mean, you know, God has given such grace to us. People have said the wrong things, but that’s okay. They said something and Jason and I, you know, love covers a multitude of sins. And we’re just fighting to do this well.

Jim: It would seem that honesty is a good thing, to say–

Margaret: Absolutely.

Jim: –“Hey, I don’t know how to address this with you. I’m uncomfortable.” That probably makes you feel better.”

Kara: It’s such a blessing. You know, the other great blessing to us is when somebody comes and say, “I have been praying and I feel like Tuesday’s my day and on Tuesday, I’m doin’ this specific thing for you.”

Kara: And when somebody comes to us with a “What can I do?” we are in such shell shock from new diagnosis, our heads are spinning. We don’t even know what’s for lunch. And so, when people come to us with love, specific, I feel like Tuesday’s my day to drive your kids. I feel called to that.” It is such a blessing to us that Jason and I can say, “Yes,” or you know, we have learned to be good receivers. It is hard. It is much better to give. It is so joyful to give, but to receive is hard, ’cause we love our strength and we love havin’ it together. But to say, “You know what? I do need you on Tuesday to pick up my kids.”

Jim: Well, and kind of adding weight to your pressure to say, “What would you like me to do?” And then you gotta think, well, you know …

Kara: It’s burdensome.

Jim: “Wednesday, could you bring a meal?”

Kara: It’s burdensome, yeah.

Jim: I mean, you don’t want to do that. You don’t want to say that.

Dr. Margaret Cottle: I think one of the really important things is, to remember that although there’s a Christian duty to care for one another, there’s also a Christian duty to be cared for when we need the care.

And one of the things that a family did that I thought was really clever was that they kept a notebook and they wrote down all the things that would be helpful to them. And they were smart enough to say, we put in a few things that were pretty lame because when somebody would ask us if there’s anything we can do, we would hand them the notebook and they could choose one of those small things if they really didn’t mean it. And I’ve actually refined that a little and what I’ve suggested is that a good friend go to the family and say, “I’m here to write down all the things that you could use help with. And then I’m going to go to our friends and I’m going to ask who can do these things.”

Jim: That’s a great idea.

Margaret: There are some websites, too, that will help with the meals, where people can sign up for meals at specific times. And there are also other websites where you can tell your story, such as Caring Bridge and other things like that, that are free. And that often is something that’s helpful for families in the midst of a difficult situation, because then they don’t have to tell the same thing over and over and over again. And people can just go to the site. They can put their comments in. They know they’re not going to be interrupting anything or disrupting the family. And that they–

Jim: And getting an update on the status–

Margaret: –they can still get an update.

Jim: –yeah, the person’s situation. Jason, what have you done to help your kids better understand this area of death? Is there anything specific that will help them grapple with Kara’s death?

Jason Tippetts: Well, I think from when our children were very young, I don’t know why we started to do this, if someone encouraged us to do this, but we took our kids to funerals with us. And that just started the conversation with our kids, that we’re all gonna die and they could understand loving people and caring for them. It’s amazing being a pastor, how many people I meet who are in college and they’ve never been to a funeral.

Jim: Yeah.

Jason: They don’t know and you know, I would just say, encourage attending funerals and it’s a great opportunity then to talk about death with your kids, with anyone.

Jim: And do you feel like that has helped them better understand it?

Jason: Yes, I feel like after those funerals, with many of them being Christians, we’ve had the great opportunity to talk about heaven, God’s promise, hope, that our hope is not our dreams being fulfilled here on earth, but there’s a greater hope. And we have peace and rest with God, our Creator. So, it was just a great opportunity, where we could enter those conversations.

Jim: What are some of the “do’s and don’t’s that you all three have found when it comes to talking with your kids or other experiences outside of your own family?

Kara: You know, as I’m planning my own funeral, I feel very protective of my kids. And so, for me personally, I want them to hear the truth from Scripture about what heaven is and what we know–there’s a lot we don’t know—and what it isn’t. And so, I wrote that in my book. Like, please don’t come tell my kids I’m an angel (Laughter); I’m not gonna sprout any wings or have a harp. So, there’s just so much we don’t know. But I just think we’re communicators. That’s the best thing you can do is just talk and just talk about feelings, as there’s no feeling off the table to talk about.

Jim: I remember for me, I mean, being a 9-year-old when that happened to my mom and my mom died, the … the thing that I struggled with, so many people because I was a boy, people’d say to me, “Now don’t cry.”

Kara: Oh, yeah.

Jim: I mean, it was a killer.

Kara: Yeah.

Jim: So, I’m sittin’ there. I can remember the funeral. I mean, I’m sitting in the special section with my brothers and sisters and then it happens. Nobody’s explained any process to me. Nobody’s told me anything about what’s gonna happen, so it’s all observational. And each of my siblings took a rose at the end of the service and placed a rose in my mom’s casket. So, I’m going, okay, I gotta do that.

Kara: Yea.

Jim: So, I got the rose and went up one at a time. And you’re in front of three, 400 people. And I’m saying, okay, I can’t cry. They told me not to cry.

Kara: Oh, I’m sorry, Jim.

Jim: But I (Weeping) put the rose in and touched her and everybody else had kissed her, but she was so cold.

Kara: Oh, yeah.

Jim: That panicked me.

Kara: Yeah.

Jim: So, then I turned. I see all these people. Don’t cry; don’t cry. And it was a hard day.

Kara: Oh.

Margaret: And completely unnecessary for it to be that hard. I think that’s the thing that’s breaking our hearts right here as we’re listening to you, is that you know, you needed somebody to come alongside you and just hold your hand and be there with you, not to tell you not to cry. You lost your mother, for heaven’s sakes!

And I think we give Job’s comforters a bad rap, but they sat beside Job for one entire week and didn’t say a word before they started in on stuff that wasn’t helpful. And I think it’s a good example to us. If you don’t have anything to say, you don’t have to say anything.

Kara: That’s right.

Margaret: Your silent presence, the arm around the shoulders, coming up alongside that little 9-year-old boy, taking his hand and saying, “You don’t have to go up there by yourself, Jim. I’ll come with you. I’ll help you put that rose in there. You can cry. It’s okay.” That’s what it’s all about. Jesus was a Man of Sorrows. He was acquainted with grief. We’ve said that before.

When we identify with those who are grieving, when we come alongside them, it’s so important. We’re doing what the little child asked for. I want God with skin on Him, you know. I want somebody to be there alongside me. And you know, there’s a joy, a deep joy that comes for the person who would’ve come alongside you and held your hand and gone to that casket and helped you place that rose. There’s a joy that’s there, that you don’t get any other way.

We just had very dear friends who had a crib death. And we have walked with them in the midst of this incredibly violent death, to put a baby down, a 6-month-old baby down for a nap and to go back and find him gone when both the parents are physicians. It’s breathtakingly violent and horrible. And just to walk with them in the midst of this has been very difficult for my husband who’s also a physician and for me. But there’s a richness in coming alongside them, in knowing that they need our shoulders to cry on, that they needed to hear us say, “Oh, sweetheart, how awful.” Not to try to explain it! Please do not try to explain it.

Kara: Uh-hm.

Margaret: It’s a mystery. The fact that we have a Savior who suffers with us, who knows about this, is not something that anybody is ever going to completely understand until we see Him face to face. Don’t try to explain it. Just be His arms and be His voice and comfort one another.

Jim: Margaret, let me ask you about the practical things. A family that is in the situation that Jason and Kara are in, what are some things that they should do about end-of-life directives and things like that? What do you go into this, especially for someone who you know, has cancer? What do you need to do to prepare?

Margaret: I don’t think you can ever completely prepare. I think that’s one of the things that we as Western Christians have an illusion of control.

Jim: Well-said.

Margaret: Sometimes we think, okay, we can get all out little ducks in a row and we can prepare for things. People that live in parts of the developing world, face death every day and they realize that there really is no complete preparation that one can make, but you can be better prepared. (Laughs) I’m not a fan of trying to have something that outlines all your wishes very specifically, because you can’t ever know all the situations. And any person who has any medical background will tell you, there’s always an exception.

For example, if you say, well, I don’t want to have cardio-pulmonary resuscitation. I don’t want to be intubated. Well, what happens if you have an allergic reaction to an antibiotic that could help you get over something and you need 20 minutes or 30 minutes of being intubated so that you don’t die at that point. Well, if you’ve got a thing that says, don’t do CPR, then people may hesitate to do that and may actually be prohibited by law from doing that.

So, it’s much better to talk with one another, to have someone who is, I think in the States you call it your “durable power of attorney for healthcare.” You don’t have to give up financial control in order to do that, any of those things. But to talk with that person very specifically about what your moral and philosophical leanings are, what you think you might want. So, that if you are unable to speak for yourself that person can speak for you and to relay what your wishes were.

Jim: So more general guidance than–

Margaret: Much more–

Jim: –specificity.

Margaret: –general guidance, because you can never know everything. There’s a physician by the name of Ira Byock, who’s written a book that outlines this, called Dying Well. And I just heard him speak at a conference recently, as well and one of his things that he talks about is for physicians and for other healthcare professionals to imagine their patients well. So, think about who this person really is and imagine them as if they are well, because they can be well. So many of our patients will say things like, “This was the best day of my life” even when they’re in the midst of things.

You started the broadcast talking about First Century Christians and how they came alongside people. When Paul and Silas went to Thessalonica and stirred things up, the people there said, “These are the people who have turned the world upside down and now they have come here.”I really hope that our listeners will be the people who turn the world upside down, that they will come alongside people who are suffering, that they will come alongside people who have had bad news, that they will stick in there like a burr and that they will turn this world that is so in love with pleasure and superficial things, they will turn this world upside down. And we will once again, lay hold of our Christian heritage that says with Paul in 2 Corinthians, that the unseen things are the important things.

Jim: Yeah!

Margaret: And that the things that are seen are fading away, but that the unseen things are eternal and that we will value those things and come alongside people who are understanding that and in those moments and experience that richness that only the Lord can give to us in those moments.

Jim: Kara, you’re noddin’ your head at just about–

Kara: I love her passion.

Jim: –everything.

Kara: I just love her; she’s great.

Jim: When it comes to living full days–

Kara: Yeah.

Jim: –you’re saying, yes, yes.

Kara: Absolutely.

Jim: You want every day to be the best day.

Kara: I do. I mean, I write about that a lot. There are good moments on bad days. And when the bad days come, Jesus provides grace. And that’s why I started writing, saying, you know, I’m gonna be at the bottom of myself. I’m gonna start looking for Jesus at this bottom and He was there. He was so there. And I love that, that you know, somebody in the midst of their dying has their best day. And that’s the truth–

Jim: Hm.

Kara: –because we are walked with and there’s something about this beautiful brokenness that causes you to look for how with us Jesus is. That before I lived so much in my own strength, Jim, I was so much in my own strength. And when my strength was taken, I got the beautiful gift of seeing Jesus being my strength.

Margaret: That Immanuel is so important, that “God with us.” I had the very great privilege this summer of going to the Netherlands and going to Corrie ten Boom’s house and crawling into the hiding place. And it was such a moving experience for me, to realize that this family was a very ordinary family that God called to something so extraordinary. And it really called it to mind in what you were saying, Kara, about how when Corrie said to her sister, Betsy in the midst of that Nazi prison camp, “Why are we here?” And Betsy said, “We are here to show that there is no pit so deep that He is not deeper still and they will believe us because we have been here.”

Jim: Ah.

Margaret: And as I stood in her home in the Netherlands, I realized that every moment that Christians today provide space for people who are dying, provide space for people with disabilities, provide safe places for people who have crisis pregnancies, we are providing those modern-day hiding places for people who are vulnerable, for those “least of these.” And we may not be paying the same price that the ten Boom family paid for their following of Jesus, but we’re all called to provide those hiding places for people who need it.

Jim: Yeah, that is beautifully said. Jason and Kara, we are at the end, Margaret, we’re at the end of the program. Thank you so, so very much for being with us and Kara, our prayers continue to be with you. We love you and Jason. And we’re so grateful for your witness–

Kara: Thank you, Jim.

Jim: –before the Lord.


John: And that’s how we concluded our two-day conversation about end-of-life issues with our guests, Dr. Margaret Cottle, along with Jason and Kara Tippetts. And I so appreciated all three of them. There’s something that Dr. Cottle was saying there at the end, Jim, about the role each one of us has to defend the value of human life, whether it’s someone facing a terminal diagnosis, as we’ve heard about or a preborn child, or those with physical and/or mental disabilities. All of them deserve our respect.

Jim: Well, it’s one of the fundamental beliefs here at Focus on the Family, especially in our culture today, where life is devalued because of things like physician-assisted suicide and euthanasia and abortion. For those of you that may not have faith in Christ, just connect those dots with me logically. Think of how we have lifted up death as an alternative to life. And from a Christian perspective, we need to lift up life and let the Lord manage the end of our life the way He wants that story to unfold. As Christians, we believe we are His and it is His decision as to when we take that last breath.

We believe human life matter because we’re made in the image of God, just like Psalm 139 says. “You created my inmost being. You knit me together in my mother’s womb. I praise You because I’m fearfully and wonderfully made. That’s a great attitude for us to have as believers and for non-believers to contemplate, where am I in this big picture? .

And I’m hopeful that this conversation has resonated with many of you, many, many of you. A woman who heard our previous program with Jason and Kara Tippetts–it aired a few weeks ago–she wrote in to say this: “I loved your broadcast. Today’s program made me cry and realize how precious life is. My kids got a tighter goodnight hug tonight. Listening to “Focus on the Family” for the last several years has really blessed my marriage and family. Thank you.” That’s why we’re here–.

John: Uh-hm…

Jim: –and to support and to strengthen your family to thrive in Christ. That’s our vision statement here at the ministry, to help you thrive in Christ. And I think this program has achieved it.

John: And Jim, we’re so thankful for all of those who are part of this outreach. They’re a part of the work of reaching out by supporting Focus on the Family through their prayers and their financial giving.

Jim: Let me direct this right to you. Thank you so very much for helping us as one supporter of the ministry said, “To build the apparatus that–.

John: Uh-hm…

Jim: –he and his wife could minister through. I love that picture, John, because it’s our goal here. We’re sitting at the microphones, but we’re just normal guys right here and you know what? It’s a privilege on your behalf and on the Lord’s behalf to sit with great people of wisdom, with people who are going through great difficulty, to hear their heart, to hear how God is working in their lives and to touch another human being. We’re doin’ that together and it’s through your prayers and financial support that it gets done.

John: Uh-hm.

Jim: And I hope you can feel it and that you will help us today. We need to hear from you. It’s important to hear from you. That’s how we pay for the counseling and the resources that go out to lift that person who is in the gutter, who is in the valley of life. Together in the name of Christ, we can lift them up and point them toward the mountain top. And I want to say, thank you for helping us do that.

John: And I’ll encourage you to make a generous contribution today to the work of Focus on the Family when you call 800, the letter A and the word FAMILY or at .

And please ask about Kara Tippett’s book, The Hardest Peace. As you can tell, she’s so expressive and she will challenge your thinking about suffering and God and how to be fully alive. At our website, you’ll find several links to the recent news about that young woman’s plan to kill herself, as well as Kara’s response and some articles about end-of-life decisions. We also have a link to the previous program we aired with Jason and Kara 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, hoping that you have a great weekend and inviting you back on Monday. We’ve got Dr. Kevin Leman scheduled to be here, sharing how to have a happy family in just five days. That’s on Monday, when we’ll once again, help your family thrive in Christ.

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