Earlier this week, the Obama administration reversed rules set up by Medicare officials in November that would have reimbursed doctors when they had annual end-of-life planning discussions with their government-insured patients. The quick reversal, according to The New York Times, was likely the result of the president’s desire to limit public opposition to the health care bill that passed early last year. The now-cut Medicare rules had originally been a part of the massive health care law passed by the Democrats, but they were removed after public uproar stoked by Sarah Palin and others, who called the one-on-one discussions “death panels.”
These rules would not, however, set up panels of judges to decide who should receive health care at the end of life. And they’re not an encouragement for doctors to convince people to sign Do Not Resuscitate orders. These rules simply pay for the doctor’s time to sit down with a patient and plan end-of-life care. So I don’t understand the public opposition to these valuable advanced-care planning discussions. But I’m particularly dumbfounded as to why Christians aren’t vocally supportive of these rules. Planning for death has been a main feature of the Christian life among nearly all churches throughout the history of the church.
For too long Christians have allowed their politics to shape their practices at the end of life. Beyond the scare about big government, we have mistakenly transferred our commitment for the right-to-life of the unborn into a refusal to die when God calls us home. And so we demand that our government continue to spend roughly $50,000 for the last six months of the average American’s life. When it’s our turn to require those expensive services, perhaps we’ll live another two weeks.
How Should Christians Die?
In interviews for my book, The Art of Dying: Living Fully Into the Life to Come, I routinely came across doctors who observed that Christians die no differently from those without the hope of resurrection. In fact, these doctors’ Christian patients often pleaded for more treatment, explaining that if given a chance God would perform—just for them—a miracle. Other research has shown that Christians suffer more physically and relationally painful deaths because they pursue more aggressive treatment in the hopes that God would heal them. Of course, it is right and good to plead, as did King Hezekiah, for more life. At times God will answer yes. C. S. Lewis writes of the beautiful reprieve from cancer given to his wife and the unexpected time they spent together.
But no matter how long the reprieve, it is still “appointed unto man once to die.” As John Donne wrote four hundred years ago, “Thou enlargedst Hezekiah’s lease for fifteen years; thou renewedst Lazarus’s lease . . . but thou didst never so put out any of these fires as that thou didst not [eventually] rake up the embers, and wrap up a future mortality in that body.” Eventually, to die well and to die faithfully, we must be willing to die that we might live forever.
Given this reality, what sort of death should a Christian want, and how does one die, properly, as a Christian?
One could hardly do better than reading Donne himself and his biographer/friend for one of the best examples in Christian history. Known for his erotic poetry in early life, Donne was chastened and later settled down as a priest. Toward the end of his life, he preached his own funeral sermon to King James (of the Authorized Version) and went on to perform one of the most sensational deaths London had ever seen.
Donne’s dramatic death may seem overdone today. In addition to preaching his funeral sermon and posing for the statue, he said goodbyes to all his friends and family and spent his final days conspicuously contemplating a deathbed picture of himself, made by a sculptor. (The statue for which he posed just before his death survived a devastating fire at St. Paul’s cathedral, where he was dean, and can still be viewed today.) But, his death was only a unique expression of a deep Christian tradition of contemplating and then practicing one’s death in a way that expresses hope in eternal life. This ars moriendi, the art of dying, offers a way of preparation for the dying, and it provides instruction to family, friends, and the church on death—but also on living a faithful Christian life.
The Perfect Example
This tradition began with the earliest Christians who understood that when they worshiped a God who died as a man and rose from the grave, their own practices of dying took on a new aspect. They immediately changed how they buried their dead, and they developed vast bureaucracies for caring for the sick and the dying. After the church was allowed to operate openly, these church-run institutions formed the world’s first hospitals.
The tradition continued into the middle ages when plague forced the church to find a way to provide spiritual care to people who died quickly and alone. A monk created a book of picture woodcuts that guided viewers through the last temptations before death. It was widely popular and known as the ars moriendi. The Reformers adapted the teachings, focusing not on final temptations but trust in Christ. Donne and others continued the tradition by writing and preaching on the Christian death. The church continued to teach the art of dying into the 19th century, when American Methodists practiced what was called the “happy death.”
Almost invariably, this long tradition of Christian dying required time. Donne said that he preferred “a gentle and preparing sickness” rather than “the gate be burnt down by a raging and frantic fever.” A sudden death was feared in his day precisely because it offered no chance for preparation. Soldiers in the Civil War described the same fear, a part of why that war was so terrifying.
Wherever the Christian art of dying was practiced, people sought to prepare themselves. They wanted to say goodbye to loved ones. The community sought wisdom from the dying, whose trials and nearness to heaven surely presented the church with the opportunity to learn godliness. The dying person prepared and then expressed to loved ones his or her own hope in eternal life. Finally, when God allowed, family watched those final moments when upon entering eternal life, the dying person might exclaim of the glorious vision. In anticipation, John Wesley was known to ask the dying, “Do you see Jesus?”
Jesus himself, of course, provided the example. He prepared in the garden; he said goodbye to his disciples and offered final words of eternal wisdom; he took care of his earthly responsibilities by asking from the cross if his disciple would care for his mother; and finally, he gave up his own spirit, actively completing his life on earth.
In our own day, when the art of dying is mostly forgotten, our medical system too easily sweeps us along whatever path it has prepared. Whether the ICU, a regimen of drugs, or a series of surgeries, we enter the medical system and submit to the pressure of an institution that even doctors dislike and are unable to escape.
In this situation, how do we relearn and begin to practice once again the art of dying? We must plan and make preparations. One doctor told me that death today does not come until we, or our family members, make a choice to allow it. There is always something more that can be done. And for most doctors it is not only remunerative to offer more medical care, but it’s also easier than sitting down with a patient and talking about death—especially when that patient is already suffering.
We need to plan now. At 33 years old, I have told my family my end-of-life wishes. They know what to tell the doctors under a range of scenarios. They will have financial provision. And I know that if possible my final days will be spent among those that I love.
There is a huge difference between dying at home and dying in a hospital. While both options are most often available, and the vast majority of Americans say they wish to die at home, seldom do the dying get their final desire.
It is true that how we go through the gate does not determine what awaits us on the other side. As Donne said, “not that God will deliver us from dying, but that he will have a care of us in the hour of death, of what kind soever our passage be.” Even so, there are kinds of deaths that glorify God and that bring peace and hope to families. And there are other kinds of death that add to the trauma and tragedy of an already horrible and evil event.
So then, when so much goes against achieving a good death in our health care system, why can’t we Christians support the government’s effort to assist us in our planning? We ought to be doing it anyway.