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For Christians, this new kind of dying, combined with a medical system that is ill prepared to confront it, has at least two consequences. The first, Kiernan addresses. Gradual dying has raised serious ethical issues. The use of technology to prolong a life whose end is in sight often means that families have to make the wrenching decision to withdraw life support. Feeding tubes, ventilators, and other life-saving equipment are necessary and beneficial. But knowing when such equipment helps people live and when it simply prevents them from dying—or makes their death more painful—is a difficult call for even the most experienced doctor, much less desperate and overburdened family members.

Doctors are little help with such ethical decisions, Kiernan says. "Too often, physicians do not initiate conversations about where these illnesses might lead and what provisions a patient might make." Telling patients and families early on that a treatment might require a feeding tube or ventilator would allow them to consider if and how to use them and when to remove them.

Ethical decisions also extend to assisted suicide. The burdens that gradual death places on families (care-giving, financial, and emotional) compel many patients to ask doctors to help them die. "Yes," Kiernan writes, "people literally would rather die than inconvenience their family." When churches assist families caring for the terminally ill, they make powerful if silent arguments against assisted suicide, where it is available, and for stopping its legalization, where it is not.

The fact is, providing quality end-of-life care that offers comfort and the opportunity for personal and spiritual growth is possible and relatively simple. It can be a powerful arrow in the quiver of Christian lobbying groups that oppose physician-assisted suicide. (So far, assisted suicide is legal only in Oregon. But pending bills could spread it to Vermont and California.)

Unfortunately, Kiernan cannot address another consequence of gradual death that concerns Christians: How should a Christian—with the time for relational and spiritual growth—die?

During the last century, as the hospital became the place of death and as spiritual understandings of death gave way to more scientific and naturalistic ones, the church forgot the rituals of dying that were once normal in Christian communities. Hearing the testimony of a dying person, awaiting last words and signs of entrance into heaven, and observing mourning are activities we only occasionally practice—and almost never with the devotion once performed.

To relearn these Christian practices, we must first be aware of the trend Kiernan identifies. Then, we must pore through church history for lessons on how to die.

Rob Moll, CT associate editor.

Copyright © 2007 Christianity Today. Click for reprint information.

Last Rights is available from Amazon.com and other retailers.

St. Martin's Press has an excerpt from the book.

Kiernan's site has an interview with him about the book, Kiernan's blog (last updated in March), and more facts about death in America.

Tony Snow wrote about facing death in "Cancer's Unexpected Blessings."

Other articles on death and dying include:

Bereavement Work | Traveling Through Grief advocates specific tasks for getting through loss. (June 04, 2007)

Picture Christ | Martin Luther's advice on preparing to die. (April 12, 2007)

Jesus' Last Words as Ars Moriendi | How his seven last words can guide the Christian preparing for death. (April 5, 2007)

Euthanasia Confusion | Newspaper accounts of end-of-life debates too often muddle the issues. (February 2, 2007)

Go Gently into That Good Night | Fear of mortality lies at the root of our bioethics confusion. A Christianity Today editorial. (January 1, 2007

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September 2007, Vol. 51, No. 9