Does it matter where we die?Page 71
As Dr. Dugdale suggests, there are several ways this question could be understood. Does it matter where out bodies are immediately after our deaths? Does it matter where are bodies are laid to rest? Does it matter where we spend the last weeks/days/hours of our lives?
Regarding the questions about the location of our bodies after death, the answers in the Christian tradition are somewhat mixed. Christians inherit Jewish beliefs about the resurrection of the body and the importance of burying the dead (one of the corporal works of mercy). Such beliefs form the basis of longstanding Catholic teachings about the importance of keeping bodily remains in tact and burying them in consecrated ground. Unlike Jews, however, Christians have never had an earthly homeland or promised land.
I was blessed to be able to travel to the Holy Land a couple years ago. During the week I was there, I went to the Mount of Olives a couple times. There are several Christian sites there associated with Jesus’ entry into Jerusalem, his prayer in the garden of Gethsemane, and his Ascension. There is also a large Jewish cemetery on the Mount of Olives in which graves are positioned such a way that, when they rise from the dead, the first thing the Jew buried there will see is the city of Jerusalem.
Christians have no earthly city. In his Confessions, St. Augustine tells a story in which he and his brother are speaking to their mother, St. Monica, who is anticipating her approaching death. They are in Italy. When the brother suggests that, after she dies, they should take her body to her North African homeland, Monica rebukes him for expressing such an earthly thought. She declares that the location of her bodily remains is of no account.
The question about where we spend our last days is surely more about people than places. But places do matter. Home is a place of familiarity and belonging where we might gather with our loved ones in greater comfort and peace. The hospital, on the other hand, might give us the security of being cared for by competent people with ample recourses. Most people, as Dr. Dugdale relates and my own experience confirms, would prefer to die at home, which begs the question . . .
Why, then, do the majority of Americans die in institutions, such as hospitals, nursing homes, extended care facilities, and hospices? Why does only one in five Americans die at home?Page 73
There are certainly many answers to these questions. There are sociological answers related to life expectancies, family structures, residential preferences and patterns, retirement policies and practices, access to needed care, and so on. There are also answers relating to how we think (or don’t think) about death. That is really the subject of this whole book. Suffice it to say here that our failures to give thought to and prepare for our deaths while we are healthy often continue when we are sick. We may not think about death – we may not be willing to think about it – until it’s too late to anything but die in the place where we had been clinging to life. Added to this lack of consideration are the hopes and fears of dying persons, those who love them, and the professionals who care for them. Those feelings are natural and understandable, and the actions they lead to are no-doubt mostly well meant, but they often lead to deaths in circumstances that are not what anyone wanted.
Physicians try to follow the principle that the benefit of the benefit of the intervention should outweigh the burden. This calculus endures until death looms, and then a compulsion to rescue overtakes rationality. It no longer matters whether a medical intervention causes harm and produces poor outcomes. As rescuer, the doctor feels duty-bound to save the patient.Page 80
The physician’s compulsion to rescue fuels the patient’s burning desire to be rescued, which again strokes the doctor’s rescue fantasy. The result is precisely the sort of medicalized dying described on Chapter One, when Amit and I attempted to resuscitate the dying Mr. Turner three times during the night.Page 81
I find it fascinating to read this from a doctor. I have long suspected that these kinds of feelings and thoughts motivated doctors. But, of course, I am not a doctor. So it’s fascinating to read this from someone who has thought and felt these things herself. I wonder whether Dr. Dugdale has memories of specific instances when she felt the tug of this “rescue fantasy” and struggled to resist it? Perhaps we could ask her when we speak with her in the coming Spring?
I have also suspected that this compulsion to save patients from death is related to the conviction that salvation from death is the only good outcome. Dr. Dugdale writes that, in the grip of this compulsion, “it no longer matters whether a medical intervention . . . produces poor outcomes.” But if the only good outcome is the preservation of bodily life, that mentality may be understandable. If every other course of action leads to the bad outcome of the patient’s death, a doctor might want to attempt anything that has the slightest chance of producing the good outcome of survival. Death, however, is an inevitable outcome. And allowing a patient to die in desirable circumstances can be a good outcome when compared to the alternatives. More than that, at least according to Christians, allowing for a peaceful and well-prepared death can be a beautiful outcome. (Here is an article I wrote about characteristic human responses to death that you might find relevant in this connection.)
When this dynamic plays out between doctors and patients, family members sometimes feel betrayed. They suspect the doctors of having been dishonest with them, preventing them from having the kind of closure they had wanted. This experience has been invoked as a reason to promote physician assisted suicide. Since medicalized dying so often prevents people from dying as they wish, the thinking goes, wouldn’t it be better to ensure that we die as we wish by predetermining the time and place of our deaths? (Here’s another article I wrote in which I applied the considerations of the article linked above to this particular claim.)