There was a time when I hoped—and even prayed—that my friend's death would come very soon.
That's a statement easily misconstrued, the kind that validates the cliché that "context is everything," which itself affirms the ancient wisdom of Ecclesiastes. "For everything there is a season," including "a time to be born, and a time to die," "a time to heal," and, if I may presume to expand on the preacher's line of thought, a time to refrain from attempts to heal.
I love that part of the Bible, commonly known as the "wisdom literature," for its keen awareness that what would be hateful in one situation may well be loving in another. I hoped that my friend would die soon because he was old and "full of years"—to use another beautiful biblical phrase—and his suffering had become very great. I would miss him sorely, as I still do, but I prayed that God would grant him what people used to speak of gently as a "good death."
"Once upon a time," writes Katy Butler in her astonishingly beautiful new book, Knocking on Heaven's Door, "we knew how to die." We knew how to sit with the dying and learned from their passing what a good death might look like. Once upon a time, there were books on ars moriendi—the art of dying—and through firsthand experience, stories, and religious ritual, people acquired an understanding of a "good death."
Butler's book, which grew from the seeds of a New York Times Magazine article published in 2010, charts the path along which contemporary Americans have largely forgotten or misplaced the art of dying. In Butler's own words, the book is a "braid"—part memoir, part medical history, part investigative journalism.
At heart of the book lies the tragic narrative of the prolonged suffering of Katy Butler's beloved father. Jeffrey Butler, a South African born historian who lost an arm in World War II and earned a doctorate from Oxford before emigrating to the U.S., lived a remarkable and full life, but lost much of his capacity for speech, understanding, and self care after a stroke in his 80s. Butler's mother, Valerie, suffered under the burden that millions of unpaid family members in the U.S. bear: taking care of her incapacitated husband with little outside help—determinedly, loyally, capably, and fiercely, refusing to surrender his care to others.
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.
There was a time when I hoped that my friend's death would come and come soon, that his earthly sojourn would draw gracefully to its end, that he would fly away to the one who had gently sustained him all his 90-plus years.
Katy Butler's beautifully written, honest and challenging book is an invitation to all people—Christians included—to reconsider the meaning of drawn out deaths and extreme measures in a historic—and eternal—perspective.
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