Thursday, September 22, 2016
Friday, September 2, 2016
Friends, I'm revising a new book now. It's titled Why You Shouldn't Kill Yourself: Five Tricks of the Heart About Assisted Suicide (to be published by Cascade Books, perhaps in 2017 yet?). This is more Theology of the Body related than you think! But obviously other theological matters are at play as well. I'll excerpt different sections as I work on them and will be requesting beta readers in October...but would appreciate any comments or feedback now, if you have it. This is the introduction for theologians and pastors. (There is a second, shorter introduction for the general reader).
Introduction for theologians and pastors
Nothing would seem more common, more inflexible, more historically stable than the experience of death—our own deaths, or the death of a loved one. And yet, how we perceive and approach death has changed dramatically (both medically and culturally) in the physician assisted past few decades. The culmination of these changes is found in increasing public support for physician assisted suicide. This book tries to present the challenge of physician assisted suicide as a misguided contemporary quest for “safe passage.”
Phillippe Ariès (1914-1984), a historian of family and daily life, argues that in centuries past human beings died “a tame death.” That is, dying was a known process that was expected and folded into the realities of everyday life. People died at home, of course, because there were few hospitals. Medical care was largely palliative care, focused on keeping the person comfortable. The person dying was usually in the center of known ways of family life until the very end…a bed brought into a living area, for example, and receiving visitors: family, friends, doctors, a priest. Although dying could be physically and emotionally difficult, there was a reassuring sense of place in it. Death, indeed, was part of life, along with birth, love, grief, joy, pleasure, and sadness.
But with the rise of modern medicine, Aries says our perspective on the place of death has tilted. Now, we perceive death as inherently wild, and something that we need to domesticate through medical care. The “wild death” is marked by an uncertainty throughout the experience of dying: at the hospital or at home? Will this cure work, or not? How long should I fight? This looks like the end--but wait, we have other options. Time in an ICU, away from most family and friends, and surrounded by beeping monitors, is likely. Aries argues that modern medicine’s quest to cure—in itself a good thing—does unfortunately result in a kind of “technological brinkmanship,” that results in people actively fighting the disease or injury up to hours before they actually die. People dying never leave fight mode.
Because doctors and patients never leave fight mode, a lack of cure is a perceived, by some, as a failure…as if death is not our common end.
Great work has been accomplished in the nascent hospice movement—a movement that has called for people to have a relatively comfortable experience of dying, ideally at home, with pain issues addressed, and family or friends around. But most people, at this point, do not know how to be around someone who is dying. We don’t know how to die at home. The only dying ritual we know is the one defined by fighting and control. Hospice is quite the counter culture to many, and those who find themselves facing the dying process may not see why anyone would not choose to fight for control.
The contemporary experience of dying, the “wild death,” has become, more and more, a human quest for safe pasage. But most people translate that understandable quest into a desire for absolute control. They see that the only way to not hurt, to avoid pain, is to maintain control. And physician assisted suicide is the most intense formula for maintaining absolute control.
Not a moral treatment, but written to the spiritually lost
As you can surmise, my approach to this topic is not, in the first place, moral. I do think assisted suicide is gravely wrong, and certainly moral questions are addressed in this text. (Although physician assisted suicide opens a whole host of moral side issues that I do not touch on much at all: conscience protections for doctors, nurses, and hospices, the voice of family members in decision making, the influence of money--or lack of it--in decision making, the rights of people living with disabilities, and so forth. But these are being addressed in many venues.) People know suicide is wrong. It takes a lot of mental effort to intentionally end one’s own life: healthy people act to preserve their lives. We actively try to prevent suicide in any other case. The reason increasing numbers of people find physician assisted suicide attractive is that people are spiritually lost.
I do not mean that in any accusatory manner. When you get down to it, we're all a little more lost that we think. But increasingly people have actively chosen not to have a spiritual home, and we know this through the increasing number of surveys that indicate a sharply rising increase in the “nones”—the segment of the population that does not identify with a religion. Sometimes they self-identify as “spiritual, not religious.” Sometimes they bear this bumper sticker on their cars: “all who wander are not lost.” I will be candid: many religions in the United States bear responsibility for this. I can understand why people could say they believe in God, but not fully trust religious institutions. We’ve made trust harder than it should be.
But…this move to “spiritual, not religious” is clearly not all about institutional trustworthiness. I know quite a few of these people—you do, too—and often they say that their limited experience with a religious home was fine. Just not essential, and couldn’t compete against the allure of the open road, the freedom of wandering and finding your own way. We are a country of self-made men and women—or we like to think so—and that is increasingly including our own religion.
So what’s wrong with that? Well, let’s begin with dying, and begin with a story. One of the most poignant books I have ever read is a memoir called My Own Country by Abraham Verghese, an Indian-American infectious diseases doctor working in the mountains of East Tennessee during the beginning of the AIDS epidemic. The book is about how medical doctors came to learn to diagnose and treat that disease when all was mystery and fear--but even more so, the book is about home. Verghese began noticing that all these initial AIDS patients—mostly homosexual--were from big cities (New York, San Francisco, Chicago). They were dying, and they knew it. When they were dying, he realized—all they wanted to do was to come home. Not even certain that they would be accepted, seeking out a “foreigner doctor” for treatment, not even admitting publicly what they were dying from—they just wanted to come home. That struck him, and me, as deeply poignant. In the end, when we are weak, and in some pain, and maybe afraid—that is, dying--we all just want to go home.
The problem with “all who wander are not lost” is that when illness and mortality appear, they want to go home—but do not know how to do so. When you have dedicated your life to exploring, you probably don’t know where home is. So people increasingly are attracted to treating dying in the same way that they have treated living—with a focus on freedom, making choices, and being in control of the exploration. With physician assisted suicide, they are “crafting an end.” When you have no home, you build your own house, while you still can. We are self-made women and men. We take care of ourselves. Right?
Of course, as Christians, we say there is a home: and that home is God the Father. Jesus Christ is our guide and mediator, and the Holy Spirit our advocate. But acknowledging that home, through our Church, requires hanging up the traveling shoes and spending time at “with the family.” Ultimately, it means allowing God to take care of us rather than create our own end.
This book is written to the traveler, to the spiritually disoriented. I want to tell them about their journey, and to tell them about home. The only key to understanding the journey and the homeland is the human heart.
As Christians, we are well aware of the scripture “O that today you would listen to his voice! Do not harden your hearts” (Ps 95:7-8). Learning you have limited time to live is undeniably God’s voice. Hardening your hearts is being closed to God’s revelation in your life: not just about your end of this life, but about the good news of the life to come. The good news that God is not finished with your life and loves you beyond all knowing, and has the power to turn this difficult time to good.
This book is trying to speak to the human heart, encouraging it to be open to the good news that a natural death will be challenging, but it can also be beautiful. There is no reason to be afraid, take absolute control, and try to “create an end.” A natural death is, ultimately, safe, and can lead you into God’s life and your destined home.
Physician assisted suicide and euthanasia are realities that must be addressed through the human heart.
 Phillippe Ariès’ work is referenced a great deal in Daniel Callahan’s popular book The Troubled Dream of Life: In Search of a Peaceful Death (New York: Simon and Schuster, 1993), 26-27. Ariès’ most relevant work is translated in English as The Hour of our Death.
 Michael Lipka, “Why America’s ‘Nones’ Left Religion Behind,” Fact Tank: News in the Numbers blog of The Pew Research Center, http://www.pewresearch.org/fact-tank/2016/08/24/why-americas-nones-left-religion-behind/
 Abraham Verghese, My Own Country: A Doctor’s Story (Vintage Books, 1995).