Dying Well

CASE had its latest conference on medical ethics on the 27th March 2010 titled 'Christian Perspectives on the End of Life'. It was a follow on from our first medical ethics conference in 2009, 'Medical Ethics: Perspectives on Life and Death'. The speakers were Dr Best, Dr Frank Brennan, Rev Rod Benson, Dr Russell Clark and Kate Bradford. 120 people attended it from varied backgrounds - health professionals of all kinds, students, carers, hospital chaplains and interested members of the public.

What they said individually?

The speakers all brought different messages looking at different dimensions to the topic 'End of Life'. There were common themes (which I'll come back to).

Rev Rod Benson an ethicist and public theologian began by quoting from the Tale of Aragorn and Arwen in Tolkien's 'Lord of the Rings', as Aragorn dies, for Arwen there seems little else but the cherish her memories. But the Bible's view of death is that it is both a curse and a blessing (1 Corinthians 15). He stressed that there is physical death, moral and spiritual death (Ephesians 2) and eschatological death (Revelation 21). He then spoke from Psalm 88 of the terrible experience of death and dying.

Dr Russell Clarke a geriatrician provided a medical perspective on what it means to age. He examined biological and biblical perspectives on the topic, and considered our attitudes to ageing and the biblical hope of renewal (2 Corinthians 4:16-18).

Dr Megan Best a bioethecist and palliative care doctor spoke on Euthanasia. She considered the arguments for and against Euthanasia, and finished with an ethical approach that she commended for Christians. Later in the day she spoke about Advanced Directives; documents that state preferences of the patient for medical care in the event they can no longer speak for themselves.

Kate Bradford (a former CMS missionary in Tanzania) works as an Anglican Chaplain at the Westmead Children's Hospital and offered a practitioner's perspective on visiting and caring for seriously ill people - helping to allay fears, being ourselves, respecting patient rights, the privilege of listening to seriously ill people.

Dr Frank Brennan, a Palliative Care Physician spoke about the need for more resourcing for palliative care and a right attitude to when to use it; it's not just to be used at the point of death, it needs to start earlier for many people. He spoke from personal experience of the need to communicate clearly with families and shared 'Stories from palliative care'.

A common theme - dying well

There were many common threads running through the various talks at the conference. For me three stood out, and all had a relationship to one theme:

• Society places different values on different human lives
• The Bible teaches that death is not simply the end
• Death is both a curse and an opportunity for blessing
  

These three ideas intersect in the notion that it is possible to die well; that is, it is possible even in one's death to have an influence on others for good.

Dr Best reminded us that Euthanasia is based on two Greek words that together mean "good death" ('eu' meaning good, and thanatos meaning death). Most people today link the word with the idea of taking someone's life at their request (or without it), because death is judged to be inevitable for this person, quality of life is judged to have gone, and the process of dying is causing such hardship and suffering that ending the life seems the only logical or humane path. But all speakers stressed that while death is a curse, it is as the Bible teaches, also an opportunity for ultimate blessing for those who trust in Christ. Furthermore, that irrespective of one's views on life beyond this physical life, that it IS possible to die well.

Frank Brennan shared a number of very moving stories from his book 'Stories from palliative care' that describe his own experience in dealing with people suffering as they died. He talked of the great privilege of easing people's pain in the final stages of life and of the way in which one's dying touches all that witness it.

A number of the speakers also spoke about the way in which we too quickly make judgements about the relative value of life, and the dangers of thinking this way. The unborn of course have very few rights and seemingly, for many, no value. As well, the life that cannot be lived exactly the way we would wish to lead it, is seen by some as not worth living. I would be less than honest if I didn't admit that I have my own fears about the terms on which I wouldn't like to end my days. But for me, the challenge at the end of life will be to die well, and that won't simply be a matter of me avoiding pain and suffering. Of course, I won't know how I will handle this until I'm there.

But I'm encouraged by the stories of others that offer testimony to dying well. When John Wyatt presented the 2009 New College Lectures he told the story of Alan and Verity who after a routine ultrasound scan at twenty weeks discovered that their unborn child had Edwards syndrome (Trisomy 18), a tragic and rare chromosomal disorder which causes multiple malformations, severe mental impairment and a uniformly fatal outcome. In this condition nearly all obstetricians will recommend abortion. After agonizing discussion and consideration they decided to continue the pregnancy and little Christopher was born. Everyone was surprised when he did not die straight away; he lived for almost 7 months. His life in Wyatt’s words exercised "an extraordinary ministry". The weakest member of the church exercised a strong, strange influence. “He became, in the end, almost public property.” When baby Christopher died he was still the same size as when he was born. One of Alan and Verity's friends commented that although “Christopher couldn't grow he helped other people to grow”. John Wyatt concluded this story with these words:

"Christopher in his way was a God-like being, a flawed masterpiece. His life was an example of Christian theology in practice, and it was a privilege for me to know him.

Here is a strange paradox. Sometimes we see the image of God most clearly, not in the perfect specimens of humanity, not in the Olympic athlete or the Nobel prizewinner. We see Christ in the broken, the malformed, the imperfect. It is an example of the Easter mystery. God is revealed, not in glorious majesty but in a broken body on a cross."

For me, the theme that stood out most at this year's Medical Ethics conference is that we must do more to offer people support in the final stages of life. Palliative care is not simply meant for the point of death, it is meant to ease pain and suffering and to help people lead the best life possible at the end of life. While the individual right to ask for treatment to be withdrawn is an important one, we must not forget that it is possible to die well. That is, to be a blessing and encouragement to others even in the face of death. How do we ensure that people don't simply see themselves as a burden and how can we reinforce that there is hope? I finish with the Apostle Paul's words to the church in Corinth:

So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal (2 Cor 4:16-18).

Related Posts & Resources

MP3 files for download should be available on the CASE website in the next week (here).

Talks from the 1st Medical Ethics conference in first conference in 2009 'Medical Ethics: Perspectives on Life and Death'.

Talks by Dr John Wyatt at the 2009 New College Lectures titled ‘Bioethics and Future Hope’ (here)

Previous post on ‘Matters of Life and Death’ (here)

Other resources on medical ethics on the CASE website (here)

Case magazine on the theme 'Living and Dying Ethically' (here)

Faith in What?

I had reason to revisit Phillip Jensen and Tony Payne's wonderful little book 'Guidance and the Voice of God' recently, and was struck by the clarity of what is a fundamental point about faith in this age of reason. An age where religious views of the world are often rejected and ridiculed.

As a young 31 year old I came to the conclusion that Jensen and Payne discuss, I needed to decide what I believed, and in what I placed my trust and faith.

Many people think that faith is an object in itself. However...biblical faith is trusting in someone or something. We all have faith. We all put our trust in many different things, from the chair we are sitting on to the bus driver into whose hands we commit our lives.

Christians trust that Jesus did rise from the dead, and live their lives based on that trust. Non-Christians generally trust that Jesus did not rise from the dead. They live their lives based on belief or confidence in that assumption.

In other words, it is not our faith (trust) that is important. It is the object of our faith that matters...the object of the Christian's faith is God himself - God the Creator and Shepherd of his people. We are to trust Jesus as our Saviour and Mediator. We are to trust the words of God as true and powerful and active. We are to trust God's character and his attitude towards us. We are to trust his promises.

This trust is based on knowledge - knowledge of all God is, and what he has done and what he plans to do. God reveals himself to us in creation (Psalm 19:1-4), through his prophets and ultimately through his Son (Hebrews 1:1-2). Only by hearing this revelation can we have a basis for trusting him (Romans 10:14). We would never have guessed or worked out God's great plan for summing up all things under Christ (1 Corinthians 2:6-10; Ephesians 1:8-10). It had to be revealed to us. And having had it revealed, we must place our faith (trust) in the revealed God, not in some god of our own making.

The heavens declare the glory of God,
and the sky above proclaims his handiwork.
Day to day pours out speech,
and night to night reveals knowledge.
There is no speech, nor are there words,
whose voice is not heard.
Their voice goes out through all the earth,
and their words to the end of the world.
Psalm 19:1-4

Related Posts & Resources

Free download of contents and chapter 1 of the Jensen & Payne book (here)

The Continuing Quest for Belief (here)

The Tyranny and Challenge of Time

Life is busy! It seems at times that almost every conversation involves telling someone that we're busy, or listening to them saying how busy they are. I have to work very hard at not including in my responses to questions like "How are you?", words like "Not bad, but I'm very busy", "Flat out" etc. But it isn't just our words that signal that we are (or feel) busy. Ever noticed the things people do in traffic (ever thought about what we do in traffic ourselves, and why)? Yesterday I saw a woman flossing her teeth as we nudged towards a traffic light. This seemed almost a bridge too far to me. I've also witnessed people:

• Shaving (electric!)
• Doing their nails
• Talking on the telephone (hands free and non-hands free), even sending SMS messages
  
• Putting on mascara, lipstick, eye line, face powder, moisturising cream
• Plucking eyebrows
• Reading the newspaper
• Reading books and magazines in slow moving traffic or at every set of lights
• Going over business papers
  
• Doing their nails
• Putting on a tie
• Using central and side mirrors for all many of body checks
• Hair combing

There was a time when we did all this stuff at home before we walked out the door. But this age is so fast paced, and we are so time poor, that people continue to try to find time wherever they can get it.

But while the above examples might make us laugh, and are at the very least a road safety risk, there are some more serious consequences for those of us struggling to manage our time. I've talked previously on this blog about the loss of family time (here) and meal time (here), but it seems that we now find it hard in this country to find time for just about anyone outside the nuclear family. This in itself is not good for families, it would seem to me that the last thing we want to teach our children is that all the time in families is devoted to the support of the members inside the house (the nuclear family). What might we be teaching our children about serving others, sharing our lives and faith with others, being a neighbour, citizenship, our view of heaven and eternity etc?

The 2009 OECD Social Indicators report has shown that Australians spend less leisure time with friends than just about everyone. Only 3% of our leisure time is spent entertaining friends (compared to 43% in Turkey). By way of contrast, Australians spend 41% of our leisure time watching television or listening to radio. It seems that when we're not at work, or doing our daily ablutions in the car, that we're holed up at home.

It also seems that Christians are not immune from this. In fact, Robert Banks suggests that it may be worse. In his publication 'The Tyranny of Time: When 24 Hours Is Not Enough' he says:

With respect to time, Christians are a good deal worse off than many. This is especially the case if they live in a large city, belong to the middle-classes, have managerial or professional positions, or combine outside employment with substantial household responsibilities.

Christians and people raised in a Christian setting tend to take their work more seriously than others. They also place a high value on family obligations. And they are often in the forefront of community and charitable associations. The upshot of this commitment to work, community and family is, as my eldest son commented: ‘Christians are like trains—always on the move, always in a rush, and always late.'

Such a frenzied lifestyle has consequences. Health can suffer, relationships can become strained, family members can become neglected, opportunities for ministry curtailed, fellowship with God interrupted, models for life communicated that we never intended. As we become too focused on the things of earth, we lose sight of the things of heaven. In relationships alone, at work or in the neighbourhood, we can easily lose sight of what is important to God. Banks suggests that our failure to be good stewards of time can have negative consequences for relationships in very subtle ways:

Consequently our encounters with others are becoming more and more limited and instrumental. We associate rather than interrelate, hold ourselves back rather than open ourselves up, pass on or steal by one another rather than pause and linger awhile. The number of our close friends drops and the quality of our married life diminishes

Why do we stay so busy?

Writing this post is challenging for me, I am not immune to these issues. In fact, those who know me best probably think my life is too busy. Why do we become so busy?

There can be many and varied reasons. For example:

• Some are busy due to personal circumstances which may be out of their control. If you are a single parent with little family support who has to work to live then there will be less time to do all that life requires.
• For some, work has an unhealthy hold on us and is far too central to our sense of self worth and identity.
• Some have an unhealthy sense of their own worth and assume that if they don't do things that no-one else will be able to.
  
• Others may be busy simply because they want so much materially, that longer hours, and maybe even a second job, seem necessary to feed our need for things.
• Some may make themselves busy at work to avoid doing things they find harder (e.g. staying longer at the office to avoid providing child care, domestic chores etc at home).
• Selfish ambition or perfectionism can drive us to give an unhealthy amount of time to work.
• Others may have addictions that act as 'black holes' sucking large amounts of time from our lives (e.g. online shopping, social media, blogging, gambling etc) and not leaving time for others.

Somehow, we need to remind ourselves that life on this earth is fleeting and short (Psalm 39:4-5), that God has plans for our time, and in fact he has appointed times for all things (Ecclesiastes 3:1-8). We should understand that God makes all things beautiful in his time and that we should enjoy the things that he has given us (Ecclesiastes 3:9-13). There is also a responsibility to use our time wisely with full knowledge that the day of the Lord fast approaches; we need to avoid the lure of the desires of the flesh (Romans 13:11-14). Paul urged the Ephesian church to be careful with their lives and their time:

Look carefully then how you walk, not as unwise but as wise, making the best use of the time, because the days are evil. Therefore do not be foolish, but understand what the will of the Lord is (Ephesians 5:15-17).

The phrase that Paul uses "making the best use of" can also mean to "redeem" or "purchase". We need to get back lost time, or use it well.

As Christians we need to guard our walk and not grow weary in doing good to everyone, and especially to those who are of the household of faith (Gal 6:9-10). We also need to know when to slow down, to step outside the rush of life and focus our hearts only on our God. Jesus demonstrated this again and again in his earthly life.

J. Hampton Keathley in a useful article, 'The Stewardship of Time' reminds us that:

Being a good steward of the time God gives is not really a matter guarding the minutes so we can spend our time productively. Certainly we need to wisely use our time, but even more importantly we need to have a grasp of time in the sense of understanding the great events of God in history, past, present, and future as they are set forth in Scripture in the grand scheme of the plan of God.

We are citizens of heaven living on earth for but a short time as "sojourners and exiles" (1 Peter 2:11). This should change our attitude to how we use our time. It is a time of darkness that will throw up untold challenges as we battle with the desires of the flesh. As we await the Lord's return we are to act as ambassadors for Christ, seeking to make disciples of all of the nations (Matthew 28:19-20).

"So, whether you eat or drink, or whatever you do, do all to the glory of God" (1 Corinthians 10:31)

Related posts and resources

Robert Banks, The Tyranny of Time: When 24 Hours Is Not Enough, InterVarsity, Downers Grove, IL, 1983, p. 32.

'Time and the Family' (here)

'The loss of mealtime: Is it important?' (here)

The Challenges of 'Assisted Suicide'

The British Prime Minister Gordon Brown has spoken out publicly about the dilemmas faced when a nation considers allowing greater freedom for assisted suicide and the rights of people to end their life when faced with suffering and pain.

Many times in the past 80 years, the British Parliament has considered - and rejected - the legalisation of assisted suicide. If, in the wake of revived debate on these matters, a new proposal were to come forward, I do not believe the outcome would be any different. Cases dominating the public arena make for harrowing reading, and the first and most obvious response is to say that something must be done. But when these complex, individual and distressing cases are considered in detail, a solution that at first might seem sensible - the right to die in a manner and at a time of one's choosing - swiftly becomes less straightforward and more worrying.

I believe people are drawn to support the right to assisted suicide because of fears about how they will be cared for when they are dying.

They ask themselves: Will I be left alone? Will I suffer pain? Will I lose my dignity and my individuality? Will there be no one there to care for me? Will I be kept alive and subjected to tests and treatments that will do little good and serve only to extend the process of dying?

I believe we should look more closely at such fears and what has been done to address them.

CASE Conference

"Here is a strange paradox. Sometimes we see the image of God most clearly, not in the perfect specimens of humanity, not in the Olympic athlete or the Nobel prizewinner. We see Christ in the broken, the malformed, the imperfect. It is an example of the Easter mystery. God is revealed, not in glorious majesty but in a broken body on a cross" (John Wyatt, Lecture 2, 2009 New College Lectures).

As indicated in my previous post on Euthanasia (here), we will be addressing this an other ethical issues concerning death and dying at our 2010 CASE conference 'Christian Perspectives on the End of Life' on the 27th March at New College.

Other Resources

More details on the conference HERE

Special issue of Case Magazine 'Living and Dying Ethically' HERE

New College Lectures by Dr John Wyatt HERE

You can read the full article by the British Prime Minister HERE

[HT: David McKay for pointing me to the article by Gordon Brown]