End-of-life decisions
Lustig, Andrew
END-OF-LIFE DECISIONS Does faith make a diference? Death and dying, it would seem, are out of the closet, taboos that we enlightened (post)moderners have overcome. I'm not so sure. Granted, we've...
...How little in current culture offers the same invitation...
...It is death as an "ideal type," to be managed and controlled as a problem but not to be confronted, and lived toward, as what it always must remain for us, a mystery...
...Ironically, faith communities- the very settings where dying should be dealt with honestly and with a sense of calm assurance-often remain places of silence, even of denial...
...Or is it, perhaps, that their faith is weaker than they proclaim, and that they are prone to the same fears as others about what comes next...
...God has his own timetable for working his wonders, and a commitment to vitalism is hardly a robust expression of faith...
...As the title character in the nonfiction bestseller Tuesdays with Monk puts it, "Every-one knows they're going to die, but nobody believes it...
...Death remains the ultimate limit...
...Yet the depth of this apparently broad-ranging conversation is easily exaggerated...
...Granted, we've nearly all heard about living wills and durable powers of attorney, even if, as polls indicate, many of us have yet to discuss them with family members, fill them out, or give them to our doctors...
...Alternatively, to reflect on my death prompts a sense of perspective on what is important to do now, how to set my priorities, how to live authentically...
...While the discussions are invariably challenging, they provide little evidence that the deeper dimensions of dying and death are really being confronted...
...To be sane, after all, is to know who you are, where you've come from, and where you're going...
...In thinking about the "hard cases" in clinical ethics, I've been struck by two ironies...
...In my own experience, "religious" patients often seem more intent than atheists and agnostics on receiving any and all forms of treatment to stave off imminent death...
...To live with a sense of calling makes any day "a good day to die...
...I find those occasions sobering, and not just because of the topic...
...Many religious persons insist on any and all life-sustaining treatments, even past the point of any plausible benefit...
...Despite the violence that sells so well in popular culture and our fascination with what sociologists have called the "pornography of death," we remain far less familiar with the existential reality of dying than were our forebears...
...Elisabeth Kubler-Ross...
...That seems at best a peculiar, at worst a pernicious, understanding...
...The medieval monks are sometimes pictured at their desks, with Bibles open before them, and skulls resting nearby...
...Is it that they confuse maintaining the "full court press" with doing the will of God...
...Instead, it seems to confuse wishes for a magical recovery with belief in the resurrection...
...But I find this fact profound, and puzzling...
...Over the years I've spoken with various groups about ethical and pastoral issues at the end of life...
...First, while we may be prepared to engage in armchair conversations about the "phenomena" of death and dying, it seems very hard for each of us to personalize the truth of mortality...
...Yet, not infrequently, I've heard family members say that they need to keep a dying loved one alive long enough "for God to perform a miracle...
...The best of hospice care is dedicated to this very philosophy: by accepting their terminal prognosis, many patients make their last days, in Kubler-Ross's words, the "final stage of growth...
...In addition, recent proposals for physician-assisted suicide have engaged many of us in debates about public policy in a pluralistic society...
...Ethicists call this attitude "vitalism," and it is not supported by mainstream traditions...
...Is it that many are ignorant of the clear teachings of their own traditions about when treatment can legitimately be withdrawn...
...And many of us, surely to our betterment, have read about the various "stages" of dying outlined by Dr...
...And most statements by Protestant denominations in recent years have talked about the propriety of "allowing nature to take its course...
...Another irony remains a puzzle to me...
...To be sane is to recognize your limits as well as your opportunities...
...Yet precisely the opposite is true...
...To remind ourselves of our own mortality can be an exercise in sanity of the best sort...
...The death we talk about, and theorize about, is death in the abstract...
...To pretend that death will not come, to fail to confront it honestly, is to deny my destiny...
...instead, such musings emerge as pointless, even morbid, preoccupations...
...puzzling...
...I do not have an explanation...
...Roman Catholic thought has long distinguished between treatments that are ordinary and those that, because of their burdensomeness or their low probability of success, are extraordinary...
...The skull is there to remind them daily of the facts of their finitude, of their rowing toward eternity, of their need to be prepared, to come to terms with their status as creatures...
Vol. 130 • May 2003 • No. 10
