Thursday, July 9, 2009

Welcoming Brother Death

A few months ago my older daughter, who is a Texas Republican, and I--a Chicago Democrat--were discussing health care reform. Surprisingly, we agreed about a lot of things, including the near certainty that if health care is extended to all Americans, older people will get less of it.

I will be 61 next month, and I think that could be a good thing.

I don't want a prolonged, high-tech death. On the other hand, I don't want a pill and a plastic bag either. Even apart from the ethical implications, both extremes suffer from fantasies of control, and death has a way of resisting control--often in ways that hurt the person whose death is supposedly being controlled.

There are better ways to die that focus not on control but on community. Jane Gross describes one such way in her July 8 New York Times article, "Sisters Face Death with Dignity and Reverence," featuring the elderly Sisters of St. Joseph in Rochester, NY, who have become known for their gentle approach to dying.

The sisters are experienced with death: "On average, one sister dies each month, right here, not in the hospital, because few choose aggressive medical intervention at the end of life, although they are welcome to it if they want.... Nobody can remember the last time anyone died in a hospital."

Instead, a geriatrician provides primary care, and the sisters discuss among themselves their various options before deciding what kinds of treatment to pursue. When it is time to die, the sisters do so "with reverence," says one nun. "Dying belongs at home, in the community."

What factors make for a good death? Gross lists "a large social network, intellectual stimulation, [and] continued engagement in life and spiritual beliefs, as well as health care guided by the less-is-more principles of palliative and hospice care — trends that are moving from the fringes to the mainstream."

Too often, we Americans see only two end-of-life options. But the opposite of assisted suicide does not have to be inappropriate medical intervention. I firmly believe that life is a gift from God, and that no one has the right to intervene and end it (except perhaps in self-defense or in defense of another, and yet even then the person who takes life needs God's gracious forgiveness for choosing what was hoped to be the lesser evil).

But there is "a time to die" (Eccl. 3:2). Christians need not fear death "like people who have nothing to look forward to, as if the grave were the last word" (1 Thess. 4:13). God is praised "through our brother death of body," said St. Francis of Assisi. When the body is ready to die--when it has "fought a good fight" and finished its course and "kept the faith"--then it is right and good to be able to say, "I am now ready to be offered, and the time of my departure is at hand" (2 Tim. 4:6-7).

When I was 43 and my parents were 81, they filled out living wills. As I recall, they were allowed to select one of three options in case of cardiac or respiratory arrest--"Do not resuscitate," go ahead and intervene but avoid heroic measures, or do everything in your power to keep this person alive. Neither of my parents hesitated: they wanted the first option.

"Um," I said, finding the conversation difficult, "isn't that a little extreme? I mean, shouldn't some intervention be tried first?"

"You are speaking like a young person," my father gently said. "At our age, DNR makes sense."

They both lived to be 85. Their last years were not easy, and I believe they welcomed death when it finally came--quietly, apparently painlessly, with no tubes, monitors, or medicines to prevent their bodies from doing what tired old bodies naturally do.


Charlene Ann Baumbich said...

Great post, for a number of reasons, not the least of which is "we agreed about a lot of things."

Anonymous said...

I really appreciate this thoughtful consideration of end-of-life issues, particularly as we are dealing with these with my elderly father-in-law. Yes, there needs to be a middle-road approach to assisted suicide and the bleakness of "assisted living" aided by a medical technology that keeps people alive when in an earlier time, death surely would have come.
Thanks for this perspective.--Jane Johnson Struck at