Oct82021
Book excerpt

“When I speak before lay audiences — that is, before people who are not directly involved with medicine — I ask them how they want to die. I do so because I think no question better illumines how our attitudes shape the form of medical care we receive. The presumption of many — a presumption, I might add, underwritten by many in medicine, since it underwrites their own self interest — is that medicine is basically a scientifically neutral set of skills at which all well-trained physicians are equally adept. Medicine is seen as a set of means, admittedly a very powerful set of means, that are in themselves value-neutral. The only moral questions that occur concern the use or misuse of those skills. Moral questions about medicine are about what ends those skills should serve.

“When we consider how we want to die, we begin to appreciate how this view of medicine and the moral questions surrounding medicine are far too simple. Medicine reflects who we are, what we want, and what we fear. For example, when I ask people how they want to die, they always say, without fail, ‘painlessly,’ ‘quickly,’ ‘in my sleep,’ and ‘without causing great trouble to those close to me.’ Such desires seem straightforward and rational. They reflect what any of us would want if we thought about it — namely, we rightly want to die without knowing what is happening to us and without causing great pain to ourselves and others, since we do not want to be a ‘burden’ to others.

“Nonetheless, at other times and in other places this understanding of death would have been considered irrational if not immoral. For example, medieval persons most feared a sudden-death, a death that would not allow them to make proper spiritual preparation. Elaine Tierney notes that in the thirteenth century ‘popular preaching instructed parishioners to remember death. Gottfried writes that “preachers advised people to go to sleep every night as if it was their last and as if their beds were their tombs.” Thomas à Kempis wrote of death: “He who is dead to the world, is not in the world, but in God, unto whom he lives, comfortable, and your life is hidden with Christ in God.” The preparation for death was important. To die without having confessed one’s sins would submit one to eternal damnation. So the emphasis was upon death and from this developed the concept of dying well and the guides that described the “art of dying.”’

“The medieval world preferred those illnesses that gave one a lingering death or at least time to prepare for one’s death. It is interesting to speculate whether cancer would have posed the same threat to that world which it does to ours. For our desire to ‘cure’ cancer springs not only from the large number of people who actually get cancer but also from the fact that cancer challenges our very conceptions of how we would like to die. Our understanding of violent death is based on those same conceptions. The medieval person could look forward to dying in war, since there was time prior to battle to prepare for potential death. We prefer to die in unanticipated automobile accidents.

“Our medicine, moreover, reflects the way we think about death. There are few things on which we as a society agree, but almost everyone agrees that death is a very unfortunate aspect of the human condition which should be avoided at all costs. We have no communal sense of a good death, and as a result death threatens us, since it represents our absolute loneliness.”

— from Stanley Hauerwas, Naming the Silences: God, Medicine, and the Problem of Suffering (Eerdmans, 1990).

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