Let no one say America is a death-denying society. Our newspapers are full of articles reporting on battles over how we die. The Terri Schiavo controversy was not a blip of newsworthy gruesomeness on the pages of otherwise cheerful publications. Schiavo's story replicated others, on and off the front pages, that have been going on for more than 30 years. Death, once again, is changing in America, and we have been arguing about how to handle these changes since they began decades ago.
One hundred years ago, science made its first serious advances in pushing death later and later in life. Diseases like tuberculosis, pneumonia, cholera, and influenza struck towns and cities regularly until scientists discovered they were caused by germs that spread uninhibited in open sewers, trash heaps, and other unclean city sites. With the help of inoculations and public health initiatives, diseases of old age became the leading causes of death, especially heart disease and cancer.
Once again, death is changing. Stephen P. Kiernan writes in his new book Last Rights that further advances in medicine and public policy have displaced quick killers such as heart attacks, strokes, traffic wrecks, and other accidents. Instead, long-term illnesses have become the nation's leading killers. "In a recent fifteen-year span, deaths from chronic respiratory disease increased 77 percent. Fatalities from Alzheimer's disease have doubled since 1980. People now succumb to congestive heart failure, lung disease, diabetes that leads to kidney failure, ALS (or Lou Gehrig's disease), Parkinson's, osteoporosis that results in falls, confusion and immobility." Despite massive research, AIDS and cancer, two other gradual killers, are on the rise.
For patients and their families, gradual death requires more sophisticated knowledge. This treatment or that one? At what point should treatment in pursuit of a cure end? For Christians, the instruction of the church in these situations is vital now that most of our information on the end of life no longer comes from personal experiences with the dying or the communal funeral rituals church communities once held, but from the media. Newspaper accounts of these situations do more to confuse a culture already bewildered by death, especially because of the difficulty in distinguishing between allowing a disease to take its course and actively pursuing death.
Last week, The Sydney Morning Herald reported on a controversy generated when an Italian man, after he spent years pleading for his respirator to be removed, finally succeeded. Piergiorgio Welby died soon after the respirator was removed. The Diocese of Rome refused permission for Welby to have a church funeral. In response, the former archbishop of Milan, Cardinal Carlo Maria Martini, wrote a letter to the Vatican asking for a reconsideration of its current position on end-of-life issues.
TheSydney Morning Herald, along with The New York Times, reported the story as a "right-to-die" case. The Vatican, they said, opposes euthanasia. While Cardinal Martini protested that "the wishes of the patient cannot be ignored," The Age made clear that the cardinal distinguished between active euthanasiacausing death by lethal injection or other meansand refusing "unreasonably obstinate" treatments. Yet The Age did not follow up with that distinction. It simply said, "The issue of euthanasia is regularly raised in many countries with some more tolerant than others."
Welby's death also contrasts starkly from that of patients in Holland or Oregon, who receive lethal prescriptions of drugs in order to avoid pain, medical costs, or being a burden to their families. Deaths like Welby's are common in American hospitals, even outside Oregon, because our laws recognize the distinction between refusing treatment and causing death.
The Vicariate of Rome seems to believe that Welby was, in fact, courting death and on these grounds has refused a church burial. Welby was an outspoken advocate of euthanasia. The Vicariate explained its denial of a church funeral by saying Welby's "desire to end his life, expressed frequently and publicly, is contrary to Catholic doctrine." If this is the real reason the church did not perform his funeral services, then newspaper articles are further confusing readers by implying a church funeral was refused due to the method of his death and not the motivation behind it. Catholic doctrine requires the minimal care of any patient, including nutrition, hydration, cleanliness, and warmth. But it also allows patients to discontinue treatment when there is no hope for a cure.
Welby himself seems to have conflated his euthanasia advocacy with his desire to refuse medical treatment. Last month, The New York Times reported that Welby had "been pushing for a broader law on euthanasia. He also sought a court ruling for a doctor to sedate him and detach him from the respirator."
Welby has attracted the kind of public attention in Italy that Schiavo did in the U.S. But Welby sought it out, and his condition generated sympathy. He wrote, "What is natural about a hole in the windpipe and a pump that blows air into the lungs? What is natural about a body kept biologically functional with the help of artificial respirators, artificial feed, artificial hydration, artificial intestinal emptying, of death artificially postponed?" His efforts helped to make Italians more accepting of "active" euthanasia.
Addressing Welby's concernsand those of thousands of others living on respirators or in other stages of gradual deathshould not mean legalizing euthanasia for patients who no longer want to live. Assisted suicide is not the only alternative to a gradual death prolonged by machines. Newspapers should not report on debates over end-of-life care as if it were. Where should the line be drawn between allowing a disease to take its course and hastening death? These are difficult questions, which may only be determined by knowing the mind of the patient. But newspapers do little to enlighten readers when they do not differentiate between euthanasia and refusing medical treatment.
They also do readers a disservice when they present euthanasia as the only recourse for people who are unable to die as they wish. "Death with dignity" or the "right to die" need not be euphemisms for suicide. Dying can be done in relatively comfortable and painless ways, without intrusive machines and tubes. For the increasing number of patients with progressive illnesses, we need not offer death by prescriptionespecially when doctors can instead pursue patient comfort and give patients time to prepare themselves psychologically, relationally, and spiritually for dying.
Christians must stand against efforts to expand euthanasia. We must do so not by getting worked up over media-driven controversies, but rather by pursuing good deaths of our own and advocating the same for others. Christians can frame decisions about end-of-life ethics within our belief in an ongoing life with God, a future resurrection, and a savior who defeated death on the Cross. We can also learn from Christians like those in the nineteenth century for whom death was an important event, something to be witnessed by loved ones and enacted by the dying. Having a positive vision of what death should look likewith confession, goodbyes to family and friends who watch in vigil, and last words, completed at home or another comfortable and familiar locationwould help us navigate the tricky waters of end-of-life medicine. It would also allow us to present a vision of "death with dignity" that is truly dignified, and not another form of suicide.
Rob Moll is an associate editor for Christianity Today.
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Last Rights: Rescuing the End of Life from the Medical System is available from Amazon.com and other retailers. Stephen Kiernan, the author, spoke about end-of-life care on NPR's Fresh Air.
The New York Times reported on Piergiorgio Welby's campaign for euthanasia.
Christianity Today's life ethics section is available online.
A January editorial, "Go Gently into That Good Night," also addressed the issue of death.