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Publication Date

9-2026

Keywords

Proxy Decision-Making; Theological Bioethics; Pastoral Theology of Accompaniment; End-of-Life Ethics; Suffering and Hope

Abstract

End-of-life decision-making conducted by medical proxies on behalf of incapacitated loved ones presents profound theological, ethical, and existential challenges. In the qualitative study “Influence of Culture and Spiritual Tradition on Support for Families of Children Dying in Intensive Care Units” (Journal of Pediatric Nursing), Ju et al found that the most painful moment for parents and proxies was not the death itself, but the agonizing decision to withdraw life-sustaining treatment. As a hospital chaplain, I have witnessed these moments where faith, culture, and medical ethics collide. This paper argues that proxy decision-making cannot be understood solely through the lens of biomedical ethics or patient autonomy, but must also be interpreted theologically and through the lens of comparative religion. Each of the Abrahamic traditions–Christianity, Judaism and Islam–have a particular lens to provide guidance in end-of-life decision making. Drawing from the Abrahamic traditions, and amplified by the contributions of moral theology, liberation theology, and philosophy, this paper argues that all parties involved in end-of-life decision making have a collaborative, specific role in contributing to making compassionate choices. This reframing is meant to be a movement where the often-isolating burden of guilt experienced by proxies can be mediated as a theologically grounded act of compassion that honors both human dignity and divine mystery. The paper concludes by proposing a pastoral-theological framework for chaplaincy accompaniment that recognizes autonomy’s limits while affirming the sacredness of relational decision-making at the threshold of life and death.

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