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September 7, 2010

A Course in Dying 101

What Christians can teach our death-denying culture.

Amy Julia Becker

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.

aging.jpg

“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.

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Posted by Katelyn Beaty on September 7, 2010 10:19 AM

Comments

What a great question to consider! What makes a "good death?" We aren't talking enough about these issues before they become urgent. I think hope is so important. I like how you mention "hope for the world to come."

Posted By: LivewithFlair | September 7, 2010 1:08 PM

A good death is one that happens at the natural moment designated by God. Preferably there will be sufficient advance warning so as to give one final testimony regarding the salvation of Jesus Christ.

Speaking of deaths that are not as good, there is currently a lawsuit filed against a Canadian hospital that refused to save a dying man, against the wishes of the man and his family. The man and family insisted that he be on "full code" status, i.e. the patient is to be resuscitated in the event of a cardiac or respiratory arrest. Without the man or the family's consent, the doctors changed that to Do Not Resuscitate, and the man died.

Read more from the secular, liberal Toronto Star newspaper:

http://www.thestar.com/news/gta/article/856741--lawsuit-could-set-precedent-about-end-of-life-decisions

Posted By: Andrew | September 7, 2010 1:09 PM

This summer I have had 7 friends die. One very young sudden and much too soon. One older again sudden and much too soon. Yet both gave witness to their life in Christ while in the ER and through their friends and family. Even doctors were asking who is this man?
A few died from long battles with cancer and a couple with short intense battles with cancer.
The one that has touched and continues to touch me most was a dear friend Linda. Her husband kept an update blog for us while she was battling this awful disease. The site www.caringbridge.org was the means of this blog. It was excellent reading for insight to a what a real marriage looks like and a Christian witness to the very end. Hers was an excellent death by your articles account. We carry on but miss her deeply.

Posted By: Susan | September 7, 2010 2:59 PM

this is a fabulous article! as the mother of a child with a severe heart defect, congestive heart failure/hypertension, a pacemaker, and a relatively short life-expectancy (i can't count the docs who have told me, "you know, usually these kids don't grow up."), the notions of death and dying are often on my mind. so i am SO happy to find this article today! :)

sadly, my son will likely not live a long life. he is already 3.5 years old, but he "should" have died 15 times by now. i actually find it comforting to talk about his death. i find that it helps me to appreciate him and his sparkling spirit even more while he is alive, and i can more freely "allow" him to live a full, happy, and playful life now, even while he is in the hospital (to date, we have been through 27 hospital admissions and 13 surgeries).

but i have found that a lot of parents of severely/chronically ill children have a hard time talking about death. and i understand why: we are talking about the death of our children, and that's not easy for any parent to face. but on the other hand, to me, anyway, the knowledge that asher's end may come sooner rather than later is simply reality, and while it is extremely painful to think about, i'm quite certain that it is helping me to prepare for it as much as possible. to me, it is not taboo to talk about his death, but like i said, it helps me to face it and to enjoy him now, and to help him to have a good life (and death, ultimately) until the time comes.

thank-you soooooooooooo much for this article.

http://asherpeters.blogspot.com/

Posted By: heather | September 7, 2010 3:10 PM

This is an important topic. I remember watching the movie "Shadowlands" about C.S. Lewis and his wife, Joy, who developed terminal cancer. One of the most moving scenes was when she was close to death, Joy asked Jack (Lewis) to let her go, something he was having a difficult time doing. (not surprisingly!)

I have experienced this same thing with friends and family. We hold on so tight to our loved ones that are dying, that we can make it harder for them to have that "good death," because they are hanging on for our sake. They need to know that we will be okay, so that they can go peacefully into the arms of their Maker.

Posted By: Suzy | September 8, 2010 8:15 AM

Thanks for this. Having helped to care for my mother-in-law with alzheimer's, it can be a difficult journey. I also believe many more or less waste away because they settle for just waiting for death. They abandon any vision or purpose. One of the best books I have read on dying is Bill Bright's The Journey Home: Finishing with Joy. Such an encouragement to let God take you through those last days/years with dignity and meaning.

Posted By: Judy D | September 8, 2010 10:36 AM

Thanks for this. Having helped to care for my mother-in-law with alzheimer's, it can be a difficult journey. I also believe many more or less waste away because they settle for just waiting for death. They abandon any vision or purpose. One of the best books I have read on dying is Bill Bright's The Journey Home: Finishing with Joy. Such an encouragement to let God take you through those last days/years with dignity and meaning.

Posted By: Judy D | September 8, 2010 10:37 AM

wonderful words. I so believe this to be true, that it is in the way we die, in relationships and with dignity from others that give us what we all desire in the end. Thank you.

Posted By: Ruthanne | September 8, 2010 9:33 PM

Andrew, I have several family members and friends who work in medicine (particularly in hospitals) and have heard many stories about 'bad deaths' based on excessive medical intervention or the insistence of families to have 'full code' status when it is not appropriate. Sometimes, doctors seem to want to 'play God', intervening in every situation when there is little likelihood of full or partial recovery or any quality of life, spending tens of thousands of dollars so the person dies a couple weeks later without regaining consciousness. Likewise, sometimes families want to 'save' their beloved at all costs, ignoring the medical information (or not understanding it) and insisting on invasive responses that prolong suffering and do not allow their family member to 'die well'. I may actually be encouraged to hear that more hospitals were refusing to intervene because 'life at all costs' (financial and moral) is not honouring to life at all.

Posted By: Bart Wang | September 9, 2010 10:15 AM

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