A New Kind of Dying - Christianity Today

Death no longer comes quickly to the seriously ill. Even as health and life spans improve, people also live longer with the debilitating diseases that eventually take their lives. “For the first time in human history, we can anticipate our mortality,” says Stephen P. Kiernan in Last Rights: Rescuing the End of Life from the Medical System (St. Martin’s). “We can watch its slow approach.”

When both Tony Snow and Elizabeth Edwards announced at the end of March that they had been diagnosed with a recurrence of cancer, pundits analyzed the potential political repercussions. They discussed each patient’s diagnosis and expected survival time. They praised each for their courage and for bringing greater public awareness to their diseases.

Snow and Edwards say they will resume their regular activities as soon as possible. Thanks to modern medicine, they likely face years of productive living. But cancer will always loom in the background. For Edwards, it is incurable. And for Snow, the average survival time for people whose colon cancer has spread is a little more than two years.

But a fact larger than any political repercussions remains largely unsaid: This is what dying is like now in America.

Edwards and Snow are young and widely known, making their cases somewhat different than the average cancer patient whose illness is terminal. But like the rest, they face a future measured in short months and years. One study found that most deceased patients had been sick three years with the illness that eventually took their lives.

As medicine has become increasingly effective at overcoming certain diseases, Kiernan says, the leading killers are now gradual ones. For example: “Despite decades of research, cancer fatalities in the past thirty years have increased 22 percent,” writes Kiernan, a newspaper reporter. “We used to die primarily of heart attacks, strokes, and accidents. Now we die mostly of cancer, Alzheimer’s, and aids.”

“That shift,” Kiernan says, “presents an opportunity for sublime end-of-life experiences—last wishes fulfilled, pain managed, relationships repaired, spiritual calm attained—which almost everyone misses.”

We miss those sublime experiences because we expect, and our medical technologies are prepared for, emergencies. The nation’s leading killer for much of the past century was heart disease, Kiernan notes. Strokes and accidents have also been major causes of death. So our hospitals are prepared to almost literally bring back the dead. Our money, our resources, our doctors’ training, and our expectations (thanks to hospital dramas) are geared to heroically saving lives.

Yet the new, more gradual way we die “has gone unremarked upon and comes as a tragic surprise for millions of Americans every year. Indeed, the seismic shift in dying has altered neither public policy nor individuals’ behavior.”

True Dignity

Kiernan invests most of his words outlining the problems caused by a medical system poised for emergencies (for which it is phenomenally capable) in an era of gradual dying, from Medicare policy to hospital profits to conflicts between doctors and families. Those who pay the price are families and patients. “The temptation to deploy an arsenal of medical armaments could easily lead to the kind of dying few people would choose—in intensive care, sustained by machinery, at huge expense, and with little personalized treatment.”

Because our medical institutions are well prepared to deploy this arsenal, significant resistance from families is required to avoid it. This despite the fact that 90 percent of Americans say they don’t want to die in the hospital attached to an array of machines.

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.