I was called into the hospital Intensive Care Unit late one night at the request of an elderly man whose wife of 83 years was not doing so well after a coronary
bypass. The husband looked a diminished figure sitting by his wife in the midst of the usual tubes, monitors, respirators and a machine that was helping her heart
pump enough blood to keep her alive.
The nurse in attendance was abrupt and tight-lipped. When I asked her how her patient was faring she told me that there was little hope of her survival. She
went on to deplore the fact that the surgery had been done. She was of the opinion that this woman could have led a quiet life at home with her husband of some years
until hear heart disease finally caught up with her. Instead, her life had been shortened and her husband had found himself in an alien environment holding his
dying wife's hand.
While I do not wish to imply that the surgeon's decision on a course of action is at all easy, this case seems to highlight our dilemma as our technology becomes
more powerful and its use more imperative. It is very difficult for patients and their families to make good choices when confronted by a surgeon telling them
that they either have the procedure or die. The following issues arise.
Governments all over the Western world, in which medical technology has been highly developed, see an explosion in the cost of medical care. A large proportion
of this cost is incurred in looking after people in the last years of their life. When us baby boomers reach our 70s and 80s, medical science will be able prolong
life more and more and the economic repercussions will be enormous. There arises the possibility that a large part of our gross national product will be spent
on extending life by a few years. In the extreme, we now have people talking about the existence of the last mortal generation and of slowing or stopping the aging
Secular ethics, based on human rights, is powerless to speak constructively to the question. It is of the nature of human rights that they are boundless.
Rather than providing a basis on which ethical questions may be discussed they simply assert the rights of the individual in isolation from the concerns of the community in which that individual lives. There is no way that a person's rights may be examined, they are simply asserted and the issue decided on the grounds of discrimination. This is like writing a blank cheque on the resources of communities. Talk about the sanctity of life will not help us in this because it is easily turned into a moral absolute divorced from specific cases.
Western medicine has its origins in the Christian tradition that refuses to rank human beings according to worth. This tradition is carried on in our hospitals in the way; for example, the terminally ill are cared for. The egalitarianism of those "in Christ" is carried into our care of the sick. This is because the idea of egalitarianism readily finds a place in the modern ethos that has
been formed by the revolutionary movements of the West.
However, other aspects of the Christian tradition have not been carried into the present. These have to do with our attitude to death. It is the absence of
these traditions, in an era dominated by the subjectivity of the individual, that have left us in an ethical void. We find that many want to postpone death as long
as possible and will take almost any steps to do so. It seems that when the surgeon
gives the alternatives of death or surgery there is no choice even when the disease is wont to run its course. This is particularly agonised when the decision is
left to a member of the family. While the person involved may not feel that the promised extension of life is worth the further trauma and risk of surgery, a
decision to refuse treatment is difficult in the face of their loved one's concern
and an enthusiastic medical practitioner. Our question in all of this is to do with a Christian tradition that enables us to incorporate our deaths into our
lives in a faithful way.
What enables Christians to deal with dying in a way that does not attempt to do away with dying? How are Christians able to "square off" to a terminal
diagnosis, albeit with much pain and regret, in calm and in peace? In an age in which death is seen as failure, how do Christians come to acceptance and to finish
their lives in trust and hope?
For much of the history of the church the answer to the above questions has
been to say that the person who dies goes to a better place, that death is but a "going around the corner" and is not, in fact, a loss of the self.
Biblical research reveals that the gospels are oriented not towards the survival of the individual after death but to the dawning of the earthly reality of the kingdom of God/heaven in Jesus. The life to come is not, in fact, life after death but the life that comes at the inauguration of the kingdom present in the person of Jesus and for those who follow him. It is called "eternal" because, like God, it does not pass away with time.
In Mark the first words spoken by Jesus announce this orientation: "The time is fulfilled, and the kingdom of God has come near; repent, and believe in
the good news." (Mark 1:15) The gospel of John has a slightly different orientation
to the present reality of eternal life. The emphasis on the immortality of the soul has come from an uncritical adoption of NeoPlatonism by the church. In contrast,
the emphasis of the New Testament is upon the establishment of a new order of
Modern research into the dependence of consciousness on the integrity of the brain has lead to the break down of mind/body dualism. That is, when the body
dies, the self dies. The resulting materialism is affirmed in the Old Testament: "By the sweat of your face you shall eat bread until you return to the ground,
for out of it you were taken; you are dust, and to dust you shall return."