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Medicine Does Not Know What 'Dead' Is
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Last week Time Magazine asked me to write a commentary on the case of Jahi McMath, the 13 year old whose family sought to keep on continuing life support after doctors had declared her dead. On everyone's mind as well was Ariel Sharon, the former prime minister of Israel who died on Saturday after eight years in a "vegetative state" following a stroke in 2006. I knew the first person I needed to call was Ray Barfield, director of the palliative care program at Duke and also an associate professor of Christian philosophy at Duke Divinity School. Barfield is one of the most passionate and compassionate doctors I know, deeply engaged as both a doctor and a Christian thinker with questions of technology and meaning in medicine. Our conversation shaped my Time essay ("Lost in the Valley of Death," January 20, 2014) and should inform all of us as we wrestle with the possibilities and limits of medical technology.

—Andy Crouch, executive editor, Christianity Today

When you hear of a case like Jahi McMath's, what do you sense is missing in the public debate?

In a case like this there is a lot of forgotten history, on the part of both medicine and the church.

Part of the history that medicine forgets is the reason we started thinking of brain death as death. We didn't really start thinking of brain death as death until doctors at Harvard discovered that if we were to define it that way we'd be able to harvest organs for transplantation. Advances in organ transplantation is what first really pushed medicine to start coming up with alternate definitions of death.

Medicine tends to forget that—we just hand the definition on and accept it as it is.

The church has plenty that it has forgotten as well. When Jahi's uncle says, "Our faith is so strong that we don't even think about the possibility of death," he's expressing a common sentiment, which is that we don't acknowledge death. But that certainly isn't the historical Christian perspective. Jesus' death and resurrection is a two-part event, after all. The Christian hope for resurrection is not a denial of death, and it's not a perpetual delay of death, or even a resuscitation. It's an overcoming of death.

I think there's a lack of memory on both sides.

And when both sides have forgotten so much, they have a hard time working together.

I've seen this over and over in the ICU. Research has demonstrated empirically what many of us have witnessed: religious families are much more likely to insist on heroic medical measures at the end of life. If you believe that the universe is nothing but atoms bumping together—if, that is, you're essentially secular or naturalistic in your beliefs—when your loved one is at a place where their pain is gone and they're only being supported by machines, and you don't believe there's any God who is going to intervene, you are willing to remove the artificial support. What's the point of doing otherwise?

If you're a theist with a certain instrumental take on faith, on the other hand—"Here's what I want. I just have to believe hard enough"—it's very different. Then God becomes another power that you have access to, and you just have to believe hard enough and pray hard enough. The aim is not so much submission to the will of God as to marshal enough power to achieve your goal. And absolutely, who in this situation would not want to do that if we could?

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Medicine Does Not Know What 'Dead' Is