In this post, I will quote passages in Dr. Dugdale’s text that I find especially discussion worthy, pose questions about those passages, and share some of my thoughts. I invite you to reply in the “comment” box below, responding to what I or others have posted, or to any part of Dr. Dugdale’s book that we have read together this week.
More than 50 people signed up to participate in this group reading. I hope all of us will benefit and contribute to our discussions. To that end, I ask you to please be judicious, concise, on topic, and respectful in your comments. In our common pursuit of wisdom about human death and dying, let’s remember that we are considering a difficult, sensitive, and deeply personal subject.
So here we go . . .
I regret that we resuscitated Mr. W. J. Turner.Page 1
In this first sentence of her book, I suppose Dr. Dugdale to be expressing a general regret for the resuscitation that she will go on to describe. But that general regret might include specific regrets. Does she regret her own actions? Does she regret the decision of Mr. Turner’s daughters? Does she regret the way in which Mr. Turner’s condition was explained to them?
Dr. Dugdale says on page 5 that it “felt like a personal and professional failure” and that she and her colleagues “contributed to [Mr. Turner’s] dying poorly.” It does not seem to me that she thinks she should have done differently or that she is rebuking herself for a violation of conscience. It does not seem that her regret is about individual blame, whether of herself, Mr. Turner’s daughters, or any of the other medical professionals involved. I think Dr. Dugdale’s regret is more about the system of which she is a part and the culture to which she belongs, and the way both contributed to Mr. Turner dying the way he did.
His daughters assured the medical team that he would ‘beat this cancer.’Page 1
I find the use of combat language to talk about disease frequent and generally unhelpful. We talk about “bouts” with cancer, winning (or losing) the “fight” with this or that disease, etc. Dr. Dugdale doesn’t say much about this in the pages we are considering, so I won’t say much either. But I do think it’s an aspect of our culture’s approach to sickness and death that is noteworthy. I expect we will return to this again in our reading of this book.
This has always seemed to me as something of a paradox. It seems curious that the people who believe most fervently in divine healing also cling most doggedly to the technology of mortals.Page 6
Is this paradox that Dr. Dugdale articulates in reference to Christians a true paradox or a false paradox? By that I mean, is she pointing to two authentic Christian beliefs (or expressions of Christian belief) that seem to contradict but actually do not? Or is she pointing to beliefs and practices that really are contradictory or inconsistent?
I think anything like a complete answer to that question would have to be lengthy and complex and is therefore beyond our scope. But a couple thoughts might be worthwhile.
First, I think the paradox Dr. Dugdale finds curious is part of a larger Christian paradox that is true. Christians believe in God’s promise of a new, better, eternal life after death, which they express by their hopeful (even joyful) acceptance of death. Christians also believe that mortal life is a sacred gift from God, which they express by their commitment to preserve, protect, and care for every human life regardless of its stage of development or perceived quality. Those convictions can seem contradictory. How can we hold mortal life sacred, while hoping and praying for the immortal life to come? How should we (sometimes doggedly) seek to preserve our lives on earth, while joyfully welcoming the life that follows death? Those are challenging questions that raise lots of other questions. I think, however, that they arise from authentic Christian beliefs and authentically articulate the challenge of Christian life and death. For that reason, I would call this a true Christian paradox.
Second, The paradox that Dr. Dugdale finds curious seems not to be the one we just considered, between preserving mortal life and welcoming God’s gift of immortal life. It seems rather to be between preserving mortal life (technologically) and welcoming God’s gift of healing in this mortal life. The consideration of eternal life seems absent. A couple thoughts about this: (1) From a moral perspective, technology does not automatically make life-sustaining measures optional. Just because a treatment or way of providing care didn’t exist in the past, doesn’t mean we aren’t bound to use the life-sustaining measures that are now available to us. (2) We don’t need to buy God time. God can work wonders in any way and at any time (think of Martha’s words to Jesus after Lazarus had been in the tomb four days: “Even now I know that anything you ask of God, God will give you”). If the paradox Dr. Dugdale describes presumes the belief that God might need us to buy time to enable a miracle, it is certainly a false Christian paradox.
It’s no wonder that some patients, not excepting Mr. Turner and his family, regard with suspicion the seeming eagerness of physicians to withhold chest compressions or remove life support.Page 10
Dr. Dugdale gives examples of exploitative experimentation from the recent past that support the above remark. She is surely right that the kinds of incidents she relates make suspicion of doctors understandable. But would it be reasonable to be suspicious about doctors’ intentions with respect to end-of-life care based on exploitative experiments from 50 or more years ago? Are there other reasons to be suspicious about doctors’ intentions in end-of-life care? Are there good reasons related to organ donation? financial efficiency? ethical disagreements about necessary forms of care? faith-based concerns or priorities?
No movement. No sound. Total stillness.Page 12
Dr. Dugdale recalls the moments after Mr. Turner’s last resuscitation attempt failed and he was declared dead. She then relates how she and the other doctors “left [Mr. Turner’s daughters] with the chaplain and social worker.” When the flurry of activity turns into the solitude of grief and the doctors have gone away, what do you do in that silence?”
This morning (October 5), I prayed with the adult children of an elderly man who had just died in his hospital bed. After our prayer, we remained in silence for some time. It was a peaceful silence. A notable contrast, I think, to the silence Dr. Dugdale describes.
Mr. Turner’s story illustrates the ways that we–as individuals and as a society–fail to die well.Page 13
What it means to die well is the question we will be exploring with Dr. Dugdale through our reading of this book. But how does Mr. Turner’s story illustrate that? Is it the unseemliness of his final night? The futility of the resuscitation attempts? The attitude of his family? The dysfunction of hospital protocols requiring his multiple codes? How else?
Is life extension always the goal of health care? . . . Is it wise to act as if death is avoidable and thereby attempt to delay death indefinitely? . . . Where is the wisdom on dying wisely?Pages 15 and 16
The first two questions seem somewhat rhetorical, presuming that the answer is No. But it may be instructive to consider why the answer is No or why the questions are being asked at all. The third question is one that Dr. Dugdale will give several answers to in the course of this book, beginning with her discovery of the ars moriendi, which we will discuss next week.