On Moral Medicine

Theological Perspectives on Medical Ethics

M. Therese Lysaught, Joseph Kotva, Stephen E. Lammers, Allen Verhey, M. Therese Lysaught, Joseph Kotva, Stephen E. Lammers, Allen Verhey

• Publisher: Eerdmans
• Year: 2012
• ISBN:
  9781467435819
• Topic: Teologia e religione
• Subtopic: Teologia cristiana

In print for more than two decades, On Moral Medicine remains the definitive anthology for Christian theological reflection on medical ethics. This third edition updates and expands the earlier awardwinning volumes, providing classrooms and individuals alike with one of the finest available resources for ethics-engaged modern medicine.

VI. THE END OF LIFE

CHAPTER TWENTY-ONE

DEATH AND ITS (IN)DIGNITY

If life has “sanctity,” what of death? How is death to be understood or imagined? What posture should we take toward it? What attitudes or dispositions are appropriate? These are not simple questions, but our answers to them will shape how we die and how we care for the dying. Indeed, according to Christopher Vogt and Vigen Guroian, those answers will also help shape how we live, for dying well requires lifelong preparation.

Our culture’s response to death is at best confused. William May contends that we have two basic responses: concealment and obsession. An earlier edition of On Moral Medicine puts it somewhat differently: we endeavor either to deny or to domesticate death. There is evidence that we respond to death in all of these ways. For example, Mary Baker Eddy, founder of Christian Science, likely denied death when she called it part of the illusion that existence is material. Popular notions of the immortality of the soul — “she has simply gone to a better place” — arguably do the same. Even the common funeral practice of making the body look “natural” — that is, look as if the person were still alive — may be a denial or concealment of death’s real power, as is our euphemistic suggestion that the “loved one” has “passed on.” Denial of death is also sometimes visible when families combine the demand that doctors “do everything possible” with their expectation of “a miracle,” no matter the medical prognosis.

Evidence of obsession is found in big-budget movies, video games, the evening news, and even some popular music. Our movies are filled with violence and death. The body count goes ever higher, with ever more technologically sophisticated means of killing and ever more visually graphic depictions of bodies torn asunder. Many popular video games do likewise, except that in them we get to be the killers. The evening news tallies up the dead from local murderers and far-off wars. And for a few rappers, a near endless focus on violence and death means higher music sales.

Efforts to domesticate death can look very different from each other. For instance, some claim that we should simply accept death as a “natural” event, as a “fact of life,” and as part of the “cycle of life” for all mortal creatures. Accepting death is seen as the realistic and rational thing to do since all things die.¹ But do such accounts of death come too close to treating the human person as a mere biological organism? Do such accounts grapple with the rupture that constitutes death? Do such naturalistic accounts, which have been with us at least since the ancient Stoics, take seriously that neither the psalmists nor Jesus confronted death as simply a “fact of life” (Psalms 22; 88; Mark 15:34; Hebrews 5:7)? Moreover, are “natural” accounts of death fully compatible with St. Paul’s linking of sin with death (Romans 5:12-21; 6:23; 1 Corinthians 15:21-22)?

A different kind of domestication of death may be emerging among a select group of scientists who are struggling to push off aging by decades or even centuries.² For this group, aging and subsequent death are not necessarily “natural,” but rather forms of suffering that can be technologically overcome. An example of this perspective is Aubrey D. N. J. de Grey’s “The Urgency Dilemma: Is Life Extension Research a Temptation or a Test?” (selection 73), found in our Chapter Eleven, “Aging and the Elderly.” It is at least plausible to read such efforts to master aging and death as a form of domestication, not because death is “natural,” but because it is within our control.

If our society deals with death largely by concealment, denial, obsession, and domestication, the readings here invite us to consider how Christians ought to approach death. Scripture provides a vital starting place for this conversation (selection 135). Psalm 88 is the saddest of the laments. The speaker, apparently sick since childhood, is suffering toward death. The last word of the psalm is “darkness.” Death and darkness have the last word. The terror of death goes beyond the termination of existence; death threatens to unravel meaning, to destroy relationships, to bring chaos.³ By contrast, Psalm 22, the words uttered by Jesus on the cross, is more typical of biblical lament. The speaker gives eloquent expression to fear, suffering, abandonment, and possible death: “My God, my God, why have you forsaken me?” But the psalm oscillates between a sense of loss, grief, brokenness, and expressions of confidence in God, ending with an assurance that God rules and can be counted on to deliver God’s people.

In the two New Testament texts included here (Romans 8:18-39; 1 Corinthians 15:20-26, 36-57), the apostle Paul frames suffering and death with confidence in God’s love and an expectation of resurrection. Paul assumes that fidelity to Christ may include pain, suffering, and death, and he talks about the groaning of creation. As with the Psalms, the power of death is acknowledged upfront. But there is a confidence that God through Christ is able to hold us even through death. There is, moreover, an anticipation of resurrection. Paul does not deny death by asserting an immortal soul. His confidence is not in our immortality but in the power of God. We remain embodied selves, and the power of death is finally conquered by God through Christ in resurrection.

Selection 136 from Nicholas Wolterstorff’s Lament for a Son does not conceal, deny, domesticate, or obsess about death. Instead, like Paul, Wolterstorff is confident that the last word belongs to God, a conviction that allows him to face the reality and horror of the death of his son. According to Wolterstorff, a certain kind of mourning reflects a quality of character in keeping with God’s reign. Such people have caught a glimpse of God’s kingdom and therefore “ache with all their being for that day’s coming, and . . . break out into tears when confronted with its absence.” Wolterstorff sees Jesus as praising those who have the character to feel and mourn humanity’s wounds, but this mourning is framed by an assurance that God’s good day is coming.

In “The Sacral Power of Death in Contemporary Experience” (selection 137), William F. May underlines the poverty of both evading and obsessing about death. May discerns in both tendencies the religious character of death since both tendencies are reactions to the fact that death confounds human effort to master it. Unfortunately, the Christian church has sometimes conspired with the culture in its attempt to deny, domesticate, or master death. However, in attending to the death and resurrection of Jesus, May finds resources for the church to deal honestly with the threatening and real power of death and to develop appropriate conduct toward the dying.

Paul Ramsey’s now-classic essay, “The Indignity of ‘Death with Dignity’” (selection 138), especially confronts the tendency to domesticate death as “natural.” Behind the slogan “Death with Dignity,” Ramsey finds ideologies suspiciously hospitable to death. Ramsey insists that death is to be regarded as an enemy. Death is evil. It can be “a good evil” if it teaches us to spend our days with some point and purpose, but it remains an evil. In addition, death has no dignity of its own; rather, it is precisely because death is an indignity that someone might bring dignity to the dying process. Even then death remains an enemy, an insult to the embodied and irreplaceable character of human persons and their lives. To forget that death is an enemy is to diminish the value of each person.

One potential criticism of Ramsey is that such an understanding of death lends support to preserving life as long as technologically possible. That is, Ramsey’s emphasis on death as an indignity might lend support to efforts to master or domesticate death through medical technology. Oliver O’Donovan addresses this question in “Keeping Body and Soul Together” (selection 139). O’Donovan’s argument is complex, but central to his claim is that Ramsey’s apologetic strategy of refraining from explicit theological content “deprived his contentions of the full range of their interpretative force.” O’Donovan suggests that this apologetic strategy results in inadequate attention to the relationship between sin and death and cannot properly situate the coherence of body and soul within the Christian affirmation of resurrection. Ramsey, says O’Donovan, is susceptible to being misread; one might believe that Ramsey supports trying to master death because he avoids the theological language — especially that of the death and resurrection of Christ — necessary to make his argument fully intelligible and compelling. Of course, one can then turn the question back to O’Donovan, asking whether we sacrifice our ability to talk with our non-Christian neighbors about the meaning of death if we frame the issue in such explicitly Christian terms.

While sharing the theological language especially evident in May and O’Donovan, the excerpt from Christopher Vogt’s “Dying Well in Historical Perspective” (selection 140) broadens the frame of this discussion by asking “how to live one’s entire life so as to be ready for death.” Reviewing the Ars Moriendi (“The Art of Dying,” how to die well) tradition of the sixteenth and seventeenth centuries, Vogt focuses on the lifelong development of several virtues. He is particularly attentive to the crucial roles of hope, compassion, and patience in dying well. Vogt is equally attentive to the convictions (such as a focus on God’s mercy) and the practices (such as forgiving the sins of others, being present to the dying, and remembering one’s mortality) that help form those virtues. Through historical survey, Vogt thus invites us to consider a Christian approach to death that assumes deep interconnections among how we live, what we believe, who we become, and how we die.

Vigen Guroian’s essay, “Learning How to Die Well: Lessons from the Ancient Church” (selection 141), echoes the concern for the lifelong formation of virtue in meeting suffering and death. Guroian observes that medical ethics seldom discusses character formation, and when it does, the focus is usually on medical personnel. But much of what constitutes dying well — in freedom, faith, fortitud...