Chaplain's Corner

I recently read an article titled “The Dying of Light: The Drawn-out Indignities of the American Way of Death.”  This article was written by Dr. Craig Bowron a hospital based internist in St. Paul, Minnesota.  Dr. Bowron is a good writer and he made a good case for our rethinking the fact that in North America (for this is also a Canadian reality) “dying has become a difficult and often excruciatingly slow process.”

You have seen this and so have I.  We may have journeyed with a family member over the treacherous roads of this “excruciatingly slow process.” We all must take some responsibility for our unwillingness to simply accept that death is knocking at the door.  We must all think seriously about whether we really ought to ask our physicians to do everything within their power to sustain our life, even though the knock of death grows deafeningly louder with each passing day.  Dr. Bowron concluded this article with the statement, “At some point in life, the only thing worse than dying is being kept alive.”

Of course, in my line of work I deal with the “whys” related to the tendency to want to prolong life as much as possible, even though many times the last days or weeks are spent in a hardly conscious state in which the dying one is hardly able to maintain an awareness of the presence of loved ones, let alone derive any satisfaction or joy from their company. 

So why do we North American’s want to hang onto life so hard?  There are probably many reasons, but a few have come to my attention and maybe you will find them worthy of some consideration.  One reason we want our dying loved one’s to hang on to life so hard or that a dying person wants everything possible done to prolong life is that life wasn’t lived very well and there is a hope that in the final days, there might be some redemption, some reconciliation.  It is, after all, hard to refuse a dying person’s confession or request for forgiveness.   Might I suggest that we choose instead to life better, to confess more readily, to offer forgiveness when it is appropriate so that at the end there aren’t all these messes to clean up?

Another reason is that the family of or the dying one believe that life is so sweet that squeezing every last moment out of it is worth while.  I have met this kind of folks who from their testimony confess that their lives were so sufficiently blessed, their relationships so sufficiently and mutually enriching that like the last slurp of a milkshake they want to squeeze that last moment of delight from life before retiring.  Frankly, these are few and far between, for most of us have experienced sufficient hardship and suffering that we really have little interest in prolonging it any longer than necessary.

Another reality I have run into is the belief that there is an obligation, because the technology, the medications, the interventions exists to allow them to be used to their fullest.  This is true many times in relation to feeding.  There are, as we all know, disease processes that rob a person of the ability to swallow: strokes, some kinds of cancer that occur in the neck and throat and others.  In these situations decisions must be made about the delivery of nutrition and fluids, both essential for the sustenance of life.  There are a number of ways that modern medicine can facilitate feeding a person who can no longer swallow.  But should we seek these?  Must we seek these?  Is there an obligation to use a medical advancement simply because it exists?  These are difficult questions that are impossible to answer quickly but in many cases there is little time given for reflection when these questions arise.  The intervention is initiated, and then we feel stuck with it, even if we have second thoughts about what was done.  Once it is done, well, what are we to do but just live with it?  Or at least this is what many do, just live with it.

We live in a time when there are so many competing voices surrounding death.  There are the “Right to Die” folks who would like to legitimize suicide, assisted suicide and euthanasia.  There are the “life at all costs” folks who would like every possible intervention to be employed, even if the chance of efficacy is slim or even predictably futile.  The belief is that because we can, we should.  And somewhere in the middle is where most of us live, living in the muddy waters of making decisions as the need arises, contemplating “Do Not Resuscitate” orders, wondering if we want to take the chance of  ending up in a less than quality state should we be in an accident or succumb to some disease.

And which of us would want to trade the advances of modern medicine for the realities of even 100 years ago.  It wasn’t even that far back and in many parts of the world it is a current reality that death was and is more readily accepted, less vigorous fought and more easily surrendered to.  So how do we think about what Dr. Bowron calls “the drawn-out indignities of the American way of death”?  Well, we need to understand that in our North American context, a setting that recognizes the right of the individual to make choices related to one’s health; that we have a responsibility to make choices related to what treatments we will accept and when we no longer desire treatment to continue.  We have the responsibility to consider making a Health Care Directive.  We have the responsibility to have conversations with our family members about what we want and don’t want should death come knocking at our door.

For me, I do not want to be resuscitated under any circumstances should my heart stop.  I have had this conversation with my wife and family members.  I have made it know to the people I work with.  If I discovered tomorrow that I had cancer, I would need to make a choice as to what I wanted: would I want everything they could offer me to fight the cancer, or would I turn down everything and accept what ever comes?  If I had a stroke and could no longer eat or drink, I would want nothing done to sustain me in such a condition.  I would only want to be kept comfortable as I embraced the end of this life and my anticipated entrance into God’s kingdom.

These may not be your choices, and in this regard I am hard pressed to find an absolute right and wrong that I believe we are obligated to obey in order to please God.  Instead I find choices, choices to fight death and try to beat it back from the door of my life as long as possible or the choice to embrace death as it arrives at the door of my life and yield to the inevitable.  But these choices and all those that lie between these two poles belongs to each of us.  I for one do not want to participate in what Dr. Bowron calls “the drawn-out indignities of the American way of death.”