A Time to Die
Their situation was complicated, however, by Mr. Butler's pacemaker: the small device that kept his heart ticking even as his body and mind were falling apart.
When initially developed and approved, pacemakers were a wonder, allowing otherwise healthy people who suffered heart irregularities to enjoy a remarkable quality of life. But various factors—which Butler meticulously and thoughtfully documents—have made it common for pacemakers to be given to people whose hearts are slowing down not from any pathology, but simply from age. That's what happened to Jeffrey Butler: his heart was ready to go, but modern medical technology, with all its promise and peril, was artificially prolonging—and even diminishing—his life.
In modern medicine, "the unspoken maxim has become, 'if we can, we must,'" Katy Butler writes. She sought an historically and ethically considered answer to her family's conviction that her father's pacemaker should be turned off so that, in the words of their medically conservative, Catholic, and perhaps a bit old-fashioned primary care physician, "nature" might "take its course."
Yet in the new medical landscape, where death is perceived as an enemy to be vanquished at all costs, both fiscal and human (millions and billions are spent to keep terminal patients alive past the point of any hope of a meaningful recover), expressing the wish that an inevitable death might not be drawn out is highly contested, even among Christians, for whom death is not—or shouldn't be—the final enemy.
Turning off a pacemaker—a painless and nonsurgical procedure—might open a path to a "relatively peaceful death," but was, to Katy Butler's horror, construed in some quarters as a form of covert euthanasia, although such "nontreatments" may be regarded as humane alternatives to the often painful, always intrusive and occasionally brutal interventions modern medicine deploys in order to stave off death.
(Various professional associations, including the American College of Cardiology, have since ruled that turning off a pacemaker is neither euthanasia nor assisted suicide.)
Katy Butler, raised in the Anglican tradition, now identifies most strongly with Buddhism, though she does not believe in any God. Her exploration of the new American way of dying, though, has deep resonance for Christians. "After the mid 1950s," she writes, "the attitudes of many doctors and patient shifted from faith in God and acceptance of death to faith in medicine and resistance of death." For Christians, though death remains an "enemy," it is an enemy that will be vanquished finally not by technology but by the risen and victorious Christ. An enemy that moves us to mourning, but mourning tempered by hope.
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