DIGNITY AND DYING: A CHRISTIAN APPRAISAL
The second volume in The Center's Horizons in Bioethics Book Series will be available in July, 1996. This engaging volume will be co-published by Eerdmans Publishing Company in North America and Paternoster Press in Europe. The Table of Contents and selected excerpts from the book are featured below:
PREFACE
JOHN F KILNER, PHD, ARLENE BMILLER, PHD, EDMUND D PELLEGRINO, MD
Introduction: The Experience of Dying
A Physician's Experience
DAVID L SCHIEDERMAYER, MD
A Nurse's Experience
ARLENE 8 MILLER. PHD
A Pastor's Experience
GREGORY L WAYBRIGHT, PHD
Part I: Guiding Vision
1. Autonomy and the Right to Die
NIGEL M DE S CAMERON. PHD
2. Death and Dying
JOHN T DUNLOP, MD
3. Suffering
MARSHA D M FLOWER, PHD
4. Faithfulness in the
Face of Death
ALLEN D VERHEY, PHD
Part II: Pressing Challenges
5. Forgoing Treatment
JOHN F KILNER, PHD
6. Medical Futility
C CHRISTOPHER HOOK, MD
7. Definition of Death
8 HOLLY VAUTIER. MDIV
8. Euthanasia & Assisted Suicide
EDMUND D PELLEGRINO, MD
Part III: Particular Settings
9. Nazi Germany
C BEN MITCHELL, MDIV
10. Oregon, USA
JEROME R WERNOW, PHD
11. North American Law and
Public Policy
ARTHUR J DYCK. PHD
12. The Netherlands
HENK JOCHEMSEN, PHD
Part IV: Constructive Alternatives
13. Hospice Care
MARTHA L TWADDLE, MD
14. Long-Term Care
JAMES R THOBABEN, PHD
15. Wise Medical Care
JAMES S REITMAN, MD
16. Parish Nursing
NORMA R SMALL, RN PHD
17. Congregational Ministry
DENNIS P HOLLINGER, PHD
FROM THE INTRODUCTION
There are several things we can learn about dying from this story: Dying is hard work, patients and caregivers involved with dying need practical assistance, and ethical choices made in such situations flow out of the character and values of those involved. Dying, even for Christians, is a fear some thing, taking its toll on every part of our being and exhausting us physically, emotionally, socially, spiritually. Because it is still the enemy, albeit a conquered enemy for Christians, we resist death's encroachment upon our bodily integrity, our mental functioning, our social ties. Such resistance is hard work. We should resist until that moment when we acknowledge that death will have its way for the time being. ARLENE B MILLER
There seem to be so many who feel that, if we go to church, live right, pray right and believe hard enough, then things like sickness and death will never come. How can those who follow a Lord who went to a horrid death on a cross ever think that? But many do. Many have never grasped that the purpose of a Christian's existence is neither just to live or to die, but to honor God in whatever happens. Paul knew it and could say, "For me to live is Christ and to die is far better for it takes me to a place better by far" (Phil.1:21,23 paraphrase). GREGORY L WAYBRIGHT
SUFFERING
In all the world, there is no more anguished cry than that of “Eli, Eli, lema sabachthani?...My God, my God, why have you forsaken me?” (Mt. 27:46). It is not the thorns, the whip, the nails, the humiliation, the asphyxiation, that gives suffering its potency. It is the abandonment. The only real response to suffering, the only answer to the experience of suffering, is found not in doing, but in being – in intimacy. Suffering calls for presence in intimacy with God and with others, a "solution" that flies in the face of a culture that rewards doing, that builds quick, easy and false intimacies, that embraces a radical individualism. Yet, it is in intimacy that we discover that "Even though I walk through the darkest valley, 1 fear no evil; for you are with me" (Ps 23:4a). In the dark valley, there is no escape, no detour; the way out is through it, with another. MARSHA D MFOWLER
AUTONOMY AND THE RIGHT TO DIE
'The LORD gives', and 'the LORD takes away.' This outlook is echoed in the pivotal phrase of the Apostle, which could not have been better designed as the antidote to radical libertarianism and its high notion of human autonomy: 'You are not your own', Whether one belongs to God (in redemption, as of course the Apostle specifically intends, or simply in creation), whether one belongs to the monarch as one's feudal Lord, or whether, in the parlance of contemporary jurisprudence, the state has an interest in the life of the citizen, the principle is one. And the question, if we may so put it, which lies back of all this argument, is whether we 3re indeed 'our own.' Are we ours, to dispose as we see fit, or are we, as well as ours, also another's? NIGEL M DE S CAMERON
FORGOING TREATMENT
There is a crucial difference between 'accepting death' and 'intending death.' There are some evils in this world that we cannot always avoid, death being but one of them. If one is caught in a situation of poverty, for example, it is appropriate to try to escape it. However, we are to learn contentment in all circumstances, so that when we encounter evils we cannot change, our peace and joy are not dependent on circumstances being other than they are (cf. Phil. 4:12). We will not be tempted to do evil ourselves in order to change the circumstances (cf. Rom. 3:8) but will accept the evil if God does not provide a way to escape it. Paul himself was willing to accept death, knowing that God would bring a greater blessing to him through that evil. But he left the timing of his death in God's hands, knowing that for him to intentionally bring about death sooner than necessary would be inappropriate (cf. Phil. 1:21-26). JOHN F KILNER
MEDICAL FUTILITY
The great tragedy of the futility discussion is the insistence upon analyzing the problem as a division of power: the power of patient autonomy versus the power of medical knowledge and judgment. This approach fundamentally misses the real source of power in medicine. That power is in the relationship, the coming together of the afflicted and the healer, the blending of needs and goals with knowledge and skill, so that they may come to as good an outcome as possible. There can be no true healing without this relationship. The futility versus autonomy dichotomy pits caregiver against patient. Healing and caring is not a game where one side plays a trump card against the other to win. To resort to the futility card is to admit that the healing relationship has died or is at least severely impaired. C CHRISTOPHER HOOK
EUTHANASIA AND ASSISTED SUICIDE
On the Christian view, a dignified death is one in which the suffering person takes advantage of all the measures available to relieve pain and ameliorate the things that cause a loss of imputed dignity but also recognizes that his or her innate dignity remains. A dignified and humane death is one in which we participate in the mystery which is at the root of our existence as creatures. In a dignified death, we affirm ourselves as persons by giving ourselves over to God's presence even in our most despairing moments, just as Jesus did in the awful hours of Gethsemane and Golgotha. Paradoxically, the death by crucifixion was, for the Romans who crucified Jesus, the most undignified of deaths. Yet, in the way Jesus confronted crucifixion, it became the most dignified death the world has ever experienced. EDMUND D PELLEGRINO
HOSPICE CARE
Sadly the process of illness can rob us of control. The fast paced world of acute care medicine, the loss of bodily functions, the effect of medications may blunt our sensorium and take away our choices. Thus the request for suicide in this setting is often a frantic and misdirected attempt to control a life experience. There is a better choice. There exists a highly developed program of support for those whose lives are threatened by incurable and end stage illnesses.... There is a service organization focused on whole-person-care, stressing life in the process of dying, with vast provisions to make that journey with integrity. There is Hospice. MARTHA L TWADDLE
“Terrors overwhelm me;
my dignity is driven away
as by the wind.
Night pierces my bones
my gnawing pains never rest,”
said Job
when he had
this feeling of dying.
I shrink from platitudes
remembering what Jobs friends leaned,
that it is unwise to judge
the reasons for curses or blessings
for early dying
But allow me, since we ask God’s blessing
on those who sneeze
even in our modern society
where a sneeze is considered just an irritation
instead of a harbinger of death
allow me to at least ash for a blessing
for you a stranger in a strange land
of tumor margins, grading and staging,
for you who sits in the cancer clinic
with those who know better than the rest of us
that something terrible has gone wrong.
DAVID LSCHIEDERMAYER