Discussion Post for THE LOST ART OF DYING, Chapter 5, Pages 100-111

In physiology . . we say that fear triggers a “flight or fight” response. When we feel threatened, we either fight back or run away . . . but how do we run away from death?

Page 100

Dr. Dugdale follows this question with a discussion of assisted suicide as a way of fleeing from death. She also acknowledges that assisted suicide is not the way that “the vast majority of dying patients” respond to fear of death. I will come back to the consideration of assisted suicide. First, I want to give an answer Dr. Dugdale’s question: how do we run away from death? Or rather, given that suicide is a minority flight response, how do the majority of people run away from death?

I think we run away from death by ignoring it. We deal with our fear of death by not dealing with it. I’m sure most people do fear death and, in some way or other, are aware of their fear. But I doubt whether most people pose the question of how to deal with it. I don’t just mean that most people are relatively uneducated and don’t ask self-reflective questions about how they deal with emotions. That is probably true. But I think it is also true that most people in our highly educated American society ignore questions about death and the fear of death. Our culture generally values psychological therapy and encourages people to examine their feelings therapeutically. I think of the movie Good Will Hunting‘s depiction of the Matt Damon character’s engagement with his feelings of guilt when he breaks down in tears as the Robin Williams played therapist repeatedly tells him, “it’s not your fault.” I can’t think of any ways in which popular culture encourages people to think about death or the fear of death. Maybe you can. And I would be interested to read your thoughts about this. It seems to me that, as a society, we don’t want to talk about death or the fear of death because we don’t have much to say.

Many people have argued that the practice of physician-assisted suicide, also known as aid in dying, offers a reasonable escape route from the dying process.

Page 100

About 90 percent [of Oregon patients who have requested lethal prescriptions] say they worry about losing their autonomy . . . About three-quarters fear a loss of dignity . . . Only about a quarter fear the possibility of inadequate pain control.

Page 101

Perhaps when patients in Oregon say that they fear losing dignity, they are really describing the humiliation they feel when others have to assist them.

Page 101

For such patients, physician-assisted suicide offers the possibility of controlling death by choosing when and where and with whom they will die. . . . But does control of death truly mitigate fear? Or does it simply displace fear in the moment?

Page 102

How are the vast majority of of dying patients–who desire neither futile medical treatments nor the premature termination of life–to deal with their fear?

Page 102

We have talked about assisted suicide before and I believe I have had previous occasion to link these articles (this and this) that I wrote on the subject. Here is another one you might like. In those first two articles, I touch on the relationship between assisted suicide and the desire for control that Dr. Dugdale writes about in this chapter.

The Oregon statistics that Dr. Dugdale relates are striking to me. The desire for assisted suicide seems not so much to be fueled by fear of pain but by fears of losing autonomy. I love Dr. Dugdale’s supposition that the Oregon patients’ concerns about dignity might be more precisely described as concern about humiliation due to dependancy. Does our society tend to identify dignity with independence? What are the consequences of that identification? What alternative, better definitions of dignity might we want to propose?

Dr. Dugdale seems to suggest that the answer to her question about assisted suicide mitigating fear of death is ‘No’ and the answer to her question about assisted suicide simply displacing fear is ‘Yes’. I think those answers are probably correct. Choosing assisted suicide might successfully mitigate fears related to the unknown circumstances of one’s death, but I don’t think it would lessen the fear of death itself. Dr. Dugdale’s next question is whether anything can mitigate or help people “deal with” this fear.

Those who have read this far will be disappointed that I prescribe no magic poll or incantation to conquer the fear of death.

Page 109

There have been social authorities–particularly religious authorities in the ars moriendi tradition–who have suggested that those who fear death have not truly submitted themselves to God. On this point, the ars moriendi gets it wrong. Who wouldn’t feel some reservation about a heretofore unexperienced life-altering event?

Page 108

[20th century poet Christian] Wiman pushes us to walk courageously–with those we love–toward the terror of sadness, toward the holes we will inflict. . . . Wiman’s counsel is to die into life rather than away from it. And the challenge for all of us is to figure out what that means.

Page 111

Dr. Dugdale acknowledges that she doesn’t have any easy or complete answer to this question. She does, however, suggest some answers and reject others. While I respect her dismissal of easy answers and her attempts to suggest some kind of answer that is in keeping with non-religious nature of her book, I must confess that I am not well impressed with those attempts.

For one thing, I think there is more in the ars moriendi answer than Dr. Dugdale seems willing to grant. It is true that fear is a natural human emotion and that even Jesus wept with grief and experienced the fear of death in the Garden of Gethsemane. But many Christian saints and martyrs seem to have faced death without fear and even to greet it with a cheerful hope. Dr. Dugdale seems to assume that medieval Christians would have the same feelings as modern people do. I don’t think that is necessarily true. I think of Charles Taylor’s consideration of what he called “social imaginaries” in his book A Secular Age. He suggests that people living in an age when belief in God was unquestioned necessarily believed differently than believers in the modern secular age. Would the fear of death also be different in an age when life after death was imagined as an unquestionable truth? I don’t know but that seems possible to me.

Finally, I find that Wiman’s reflections, though replete with beautiful and suggestive language, don’t provide any answers about the reality of human death that could help us to deal with our fears.

9 thoughts on “Discussion Post for THE LOST ART OF DYING, Chapter 5, Pages 100-111”

  1. Somehow I couldn’t relate to Dr. Dugdale’s chapter on assisted suicide. I feel that people don’t necessarily decide or think of assisted suicide because of a fear of dying. Dr. Dugdale says “the ars moriendi points to the deathbed as an opportunity for people to exercise dignity by dispensing words of hope and blessing to the family and friends.” However, I believe that this is often the very reason assisted suicide is appealing to some because it assures that they can orchestrate this.
    “To die into life rather than away from it…and the challenge for all of us is to figure out just what this means.” Just what does all this mean??? I felt I was missing something.

    And then I was lucky enough to read Fr. Jonah’s eloquent and insightful articles which for me put everything into focus.
    In The Scientist, The Suicide and The Saint: I agree, in our society we generally try to ignore death although we accept it as a fact of life. So beautifully put by Fr Pollock that people of faith consider it “a passage between this world and the world to come.” How beautiful and comforting that it. Scientists focus on preventing and trying to defeat death.
    The Suicide: controls death as it can’t be prevented. Suicide try’s to take God out of the equation.
    The Saint; prepares for it. The Saint sees life as meaningful even when suffering. The Saint, Fr Jonah points out, has the right answer.
    In Assisted Suicide: the Wrong Answer to Real Problems, Fr Jonah tells the story of Eddie whose providers didn’t address the fact that the patient was actually dying
    Perhaps doctors might have amputated Eddies leg as a means of pain control. But his actual death was in God’s hands. However, I do agree that “ …in our society and in our health care system … we are unable or unwilling to acknowledge the reality of death.” Scientists feel death is a failure to be avoided, but as Fr Jonah said, Suicide is a tragedy to be avoided. Rosary Hill and Hospice care a possible answer for some.
    Finally, Carlos Framb’s story of how one suicide almost became two. To play the devil’s advocate, I think this story points out how God’s will actually is never really taken out of the equation because the “cocktail” didn’t work for the son. Just like the fact that birth control might fail. So why should the church be against birth control? Another topic for another time. Ultimately, I agree we do not know the meaning our life has on another even up until the end. So we should never hasten it but like the Saint prepare for it. And assure our dying loved ones “of our love and support, affirming the value of their life.”

    Thank you so much Fr Jonah for your insight and handling of ia difficult subject. It helped me so much to gain clarification.

  2. Thank you all for your comments!

    I wanted to respond to what you (especially Chris) wrote about faith, fear, and certainty.

    I think the word “fear” can mean several things. First, it is an emotion, a natural reaction to what we perceive as threatening. Second, it refers to the way we act (or fail to act) in response to that emotion. In this way, fear can be associated with cowardice (negatively), proper estimation of that which has power over us (parents, tigers, volcanos, God), or dread of harming or disappointing another (God, those we love). Those last two being positive meanings of fear.

    Christians believe that grace and faith can heal us of cowardly fear and that divine revelation opens our minds to the eternal life of God to which we are called. Christian hope in the life of the world to come relativizes natural fears. Jesus says, “do not be afraid of the who can kill the body; be afraid of the one who can cast the soul into Gehenna.” I think it is in those ways the “perfect love casts out fear.”

    Christian faith and love are surely not meant to cast out natural responses to bodily threats or the understanding of our needs for caution. In some ways, notwithstanding the degree to which we have faith, fear remains. It is a natural response to bodily treats that is good and necessary. Death is a natural evil. As Christians, we can have certain faith in the eternal life God promises and still feel the fear of impending death. I think Jesus felt that.

  3. Jenita posted this yesterday on last week’s page. I’m copying it here so we can see it on this page too (I hope that’s okay, Jenita):

    After my mother was diagnosed with cancer, she embraced bright colors, happier television shows, happier movies, and happier books.Along with her resolve to fight the cancer and to seek medical care, she also resolved to look at the brighter side of life and to be herself. I think giving up is never the answer. This was her way of handling the fear of death.
    It is right to have hope, but it is also right to plan for our passing because some day we will all pass away. Society seem programmed to fight for every drop of life and to fear the unknowns of life ever after. I think Sontag had a fear the unknown. She did not know what was coming next. She is missing a part of hope. As Christians we hope for a better life in the hereafter. This does not stop us from fearing, but it is another element of hope.
    Camus on the other hand seems to embrace the extremes of human reaction. There are those who go forward in complete reckless denial, and then there is the flipside of those who wallow in misery and self-pity. Dugdale mention of these excess reactions seems to underline a human inability to accept the inevitable with some grace and practicality.

  4. I also appreciate Dr. Dugdale’s, and her various quoted commentators, at least partial humility regarding the having a complete response to the fear of death. So I also don’t have one. My one thought is this – perhaps due to my evangelical protestant upbringing, which always drew a firm parallel between faith & certainty. Or, if we draw a connection between our faith in God & our love for him, then it could be summed with the quote “perfect love casts out fear.”

    Either way, I intuitively think that our almost intrinsic fear of death relates to a degree of certainty about what is to come: and that goes both ways. Someone certain of oblivion, and certain of heaven, may both have similar low levels of fear. While I think this is true, the issue is that certainty will decrease as pain increases, as proximity to death increases, as uncertainty in those around us increases – which overall makes fear of death (and many other situations), very difficult to avoid.

  5. I would concur with the author (and I think, Father Jonah) that the fear of death IS often more a fear of dependency, which is a terrible prospect in many cultures, including much of North America. My own mother has asked me to promise that I will never place her in a nursing home–a promise I am unable to make as a single woman, since it would likely be my employment income that would need to pay for such care.
    At the same time, I have seen people face declining health and death with beauty and grace. One of my clearest memories with my best friend in the last few years of his life, in a care facility, was holding his hands in mine and cutting his fingernails. It was a blessing to me, but I’m not sure that I adequately conveyed that at the time…or that we tell our loved ones that it is an honor to care for them when the circle of life brings them back to a more childlike, dependent state.

  6. I have known a few people who, faced with terminal disease, and having exhausted any hope for a cure, when it became clear that death was coming, chose physician assisted suicide so they could die in the presence of loved ones. They surrounded themselves with love , gave opportunity for everyone to say what was needed, and then took their death cocktail. I see in this the ars moriendi of dying well surrounded by community.

  7. How do we deal with our fears? If I am afraid to dive into the deep end of the pool, I might just wade in the shallow waters. Or, maybe I cannonball into the pool. I could avoid swimming altogether. These alternate actions might allow me to cope with my fear, but they don’t eliminate my fear. Perhaps I try to discern why I am afraid. Did I hear about someone who dove into shallow waters and became paralyzed? Did I fall off of a raft when I was a toddler and almost drown? I may have very good reasons for my fear. But understanding fear does not necessarily make it go away. I have not confronted my fear of diving until I climb up that ladder and jump head first off the platform into the deep end. Once I face my fear head on, I can overcome it. Or, using our military language, I can conquer it. 

    Following that logic, I can mitigate my fear of death by living carefully and making healthy and prudent choices. But, I can’t truly overcome my fear of death until I actually die. Once I am dead, of course, I can’t in this earthly life enjoy overcoming my fear.

    St. Thomas Aquinas classifies the virtue of fortitude to counter fear. When we are faced with fears–especially deadly fears–courage sees us through. I believe virtue helped the saints and martyrs bravely and even joyfully face their deaths. 

    On the occasion when someone dies in service, their death is said to have meaning. But even when we die in the most ordinary of circumstances, we can “die into life.” That phrase has been used in Christian theology (notably by Peter Phan) to describe entering into the afterlife. It is also the title of a Kundalini Yoga book about dying, grief and transformation. Christian Wiman defines it as some form of survival that makes love possible. He describes it as something deeper and more durable than merely living on in the memory of others.  I like to think of it as the footprints that we leave behind in the lives of others. For most of us, our legacies may not be recognized throughout the planet for all ages. We hope to leave this world a better place than it was when we entered it. But we all can have a lasting impact by leaving the people we encounter better off for having known us. Little things can make a big difference.

  8. ….Yikes!!! whatever we do, our society does not wish to speak of death! Fear of the Unknown….fear of childbirth…fear of the bar exam…..
    each and every one….but fear of death…..never discussed, as you point out!
    I do wonder if our society just places so little value on “life” versus for example “diamonds” and “possessions”….surely the culture of death is alive and well!!! life when it’s sick, old, frail, dependent , imperfect, mentally challenged….simply easier to discard ..in whatever form and at whatever point in time …pre birth, elderly, and so on.
    Without a belief in the afterlife or belief in God…I cannot even imagine what the viewpoint would be, as it would be so skewed anti-life…that death isn’t even given its due., i.e., a situation/event each being will face…..one that cannot be controlled!! as can the financial portfolio, for example, and the other life changing events which have “ways out” if they don’t “work out”, etc. Death on the other hand…..no control….!!

    Vera O

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