The journey “through the valley of the shadow of death” has never been easy. However, it has become increasingly lonely as our unfamiliarity with death has made us awkward and reserved when interacting with the dying.
Modern medicine has changed the way we die[1], writes journalist Rob Moll, noting that illness today lasts longer. Whereas rapid death from infectious diseases was replaced by rapid death from heart disease in the first half of the twenty-first century, the end of the century saw the latter replaced by chronic diseases that kill slowly.
Most patients would prefer a quick end to a gradual decline. In most cases, death does not come suddenly, says Dr John Dunlop, who estimates that only about a tenth of his patients have experienced an unexpected death. Having cared for hundreds of patients, Dunlop says that he personally would prefer a slow death for the opportunities it offers: the chance to spend time with his family, say goodbye and grow closer to God.[2]
Together with others, in life and in death
There is a great deal of selfishness in the desire to die quickly, believes Dunlop, who highlights the opinions and testimonies of specialists who care for dying patients’ needs. Conversely, he considers it a shame for our selfish Western culture that there are elderly people who consider euthanasia because they see themselves as a burden.
Remaining present in the final stages of a friend’s or family member’s life can ease the burden for both parties. Caring for a dying person requires a lot of effort but at the same time it is “the most important work—the work of completing a life”[3], writes Moll, and that, in order to be with a dying person, we need to overcome our fears: the fear of reacting wrongly; the fear of witnessing deterioration caused by illness; the fear of acknowledging that death is approaching; and the fear of managing a relationship that we know we will soon lose.
One of the greatest blessings we can offer people is to listen to them, look at them and spend time with them. In other words, to give them one last gift: our presence.
Marge Schaffer, a nursing professor, believes that people experience a good death when they are at peace with God and their fellow human beings—when they have had the opportunity to express everything they need to and make amends for anything that needs to be rectified. Having seen hundreds of patients die, oncologist Al Weir believes that a peaceful death is linked to the belief that God is with the dying person and that they will be reunited with their loved ones. A good death often matters as much to the patient’s loved ones as it does to the dying person, says nurse Martha Twaddle, explaining that how a life ends influences how the family deals with grief afterwards. Although it is difficult to be truly present for someone who is dying, it is a lesson that must be learned for the benefit of both the dying person and ourselves. Philosopher Dallas Willard points out that one of the greatest blessings we can offer people is to listen to them, look at them and spend time with them. In other words, to give them one last gift: our presence.[4]
The failure of compassion
“As a practitioner, what role should I play in reducing my patients’ symptoms of suffering as others around me remove it altogether?” This is the dilemma that troubled Shannon Brink, a Canadian nurse who worked as a missionary in Malawi. During her master’s studies, she realised that the legalisation of “medical assistance in dying” (MAiD), including for people suffering from mental illness, raises ethical and spiritual issues that she will no longer be able to avoid.
At the end of life, people can feel isolated and frightened by what lies ahead, and they may perceive themselves as an overwhelming burden. This reality led Brink to critically analyse her failures in helping those experiencing depression, chronic pain, or disability. There are always barriers that must be overcome to enter the uncomfortable world of those who suffer, and to make God visible within its boundaries.
“Dying is dirty, smelly, unsophisticated, gaunt, and painful. But more than anything, many times it is lonely.”
“I do know enough from Scripture to know that MAiD exists because I have, in part, failed both in my job in healthcare and in my own home, to care for the broken and the hurting as Christ calls me to,” she concludes, emphasising our responsibility to treat fellow human beings in suffering in such a way that death becomes the least attractive option.
Most of the time, people want to die as they have lived, retaining their dignity, autonomy, or vitality until the end, says Pastor Scott LeMert, noting that, by contrast, “dying is dirty, smelly, unsophisticated, gaunt, and painful. But more than anything, many times it is lonely.” The loneliness in the antechamber of death is also due to the inability of those around us to respond to the distinct needs generated by this experience.
In Pastor Scott LeMert’s opinion, a “good death” is defined by the presence of people who help the dying person learn their final lessons about meaning and faith. However, we lack the compassion to support those who are dying on this difficult journey. We would rather pray for them (waiting for a miracle or a quick death, not knowing how to handle suffering and delayed death), send flowers and talk about the hope of resurrection than accompany them on their final journey. But at this crucial stage of their lives, those preparing to die have needs that require resources and skills they may never have developed. LeMert concludes that the desire to control how and when one dies may be more of a cry for help than a desire to maintain independence until the very end.
The last gift of life
Starting with the case of Brittany Maynard, a young woman who chose to die before suffering the full effects of her aggressive brain cancer, writer Karen Swallow Prior discusses cases of suffering that test our deepest convictions. These cases raise so many questions that legislation, logic, medicine, and theology seem incapable of providing all the answers. Prior looks for an answer where we would least expect it: in literature.
In a story by George Saunders, Don Eber decides to commit suicide to spare his family the pain his illness will cause them. He is convinced that his act is heroic. Then he has the opportunity to save a little boy. This changes his mind about his plans. Back home, Eber has a revelation when he realises that there is meaning in letting his loved ones take care of him. “Why should those he loved not lift and bend and wipe him, when he would gladly do the same for them? He’d been afraid to be lessened by the lifting and bending and feeding and wiping, and was still afraid of that, and yet, at the same time, now saw that there could still be many—many drops of goodness, is how it came to him—many drops of happy—of good fellowship—ahead, and those drops of fellowship were not—had never been—his to withheld. Withhold.” (George Saunders—”Tenth of December”)
Perhaps Pastor LeMert is right: death is not a problem to be solved, but a mystery to be lived. And perhaps, when we feel we have nothing left to offer at the end of life, we still hold “the greatest gift we can offer another: ourselves—our always-decaying, ever-dying, suffering-yet-glorious selves.”
Carmen Lăiu is an editor of Signs of the Times Romania and ST Network.