A Course in Dying 101

My grandfather turned 90 last week. The past two years have been ones of declining health for him, including a botched surgery and shingles and Bell's palsy and a broken hip. A few months ago, my mother sat down to talk with him about reaching the end of his life. She relayed the conversation to me.

"Dad, are you sad?"

He seemed puzzled. "No. I'm not sad. I'm just tired."

"Are you sure? Maybe you're worried?"

"No, I'm not worried."

"Well, how are you feeling about death and the whole dying process?"

"Dying is much harder for the people around you than it is for the person dying. I'm looking forward to heaven. It should be exciting. New things always are."

My mother doesn't live with her parents, although she visits frequently. She and her sister (and, to a lesser extent, her two brothers who live farther away) help make decisions about their care. At age 88, my grandmother has been able to provide a great deal of support for her husband, and they hired a woman to help with his physical care once my grandmother couldn't provide it on her own. A similar family drama is being played out across the nation. According to the Family Caregiver Alliance, women compose the majority of caregivers for the elderly and terminally ill patients.

Americans have a hard time talking about the end of life. As Atul Gawande wrote recently in The New Yorker, in "Letting Go," the church in previous centuries offered ways for individuals and their families to prepare for death. But in a secularized culture with increasing life expectancy and medical technologies that prolong life, we have generally lost the ability to talk about an irrefutable fact: We will all die. Idolatry of life has led to a place—medically, culturally, even within the church—where death has become taboo.

It is taboo and yet crucial to discuss. As Gawande notes, talking about death is a great balm for the family of the person dying as well as for the patient at the end of life.

Gawande focuses on the contemporary hospice care movement. He details the difference between doctors like himself, who are ill-equipped to talk with patients about the reality of death, and hospice workers who help dying patients focus on what it means to live well until the end. The term euthanasia means, in Greek, "a good death." In contemporary culture, the word is most often used to refer to physician-assisted suicide, and most Christians oppose the practice. Despite the connotations of the word, Christians should seek to redefine the idea of a "good death" according to a biblical theology of human flourishing, which includes helping individuals and their families prepare to die well.

Ironically, simply talking about death often prolongs life more than medical intervention does. As Gawande reports, "researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients." Gawande says the reason hospice care extended life was because it focused on the continued value of the patient's life, and because having someone to talk to about life and death provided relief. Citing a different study of cancer patients who were able to talk with their doctors about end-of-life care, Gawande writes, "These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Moreover, six months after the patients died their family members were much less likely to experience persistent major depression."

Simple, honest acts of caring go a long way in providing comfort for dying patients and their families. But Christians can provide another type of balm for the dying person. Christians believe in the inherent, God-bestowed value of every human, regardless of age, ability, religion, or creed. Christians also have the Jesus as the model of how to care for one another—as one who cared for the physical needs of people, who was willing to talk about difficult subjects, and who held onto the promise, even while dying, of eternal life with God. Moreover, Christians hope for the resurrection of the dead, hope that life with God in the here and now can continue for eternity through a relationship with Jesus Christ. As Christianity Today's editors have written before, the need for chaplains and other professional caregivers is growing, and Christians should consider caring for the dying as a particular calling from God. Whether in a professional or personal capacity, Christians have a life-giving gift to offer our death-denying culture.

A good death is possible for most people in America, but not because a good death comes through physician-assisted suicide. A good death is possible when the resources exist to help patients express their wishes to caregivers and family members in such a way that they find healing in relationships, purpose in their lives even at the end, and hope for the world to come ….