How We Die

"My death; is it possible?"--Jacques Derrida

"Death is the only experience that is not lived through."--Ludwig Wittgenstein

revenant, commenting below, has it exactly right:

RMJ: I commented at Atrios yesterday about my first wife's death when I honored her wishes to remove life support. Not a choice I ever hope to face again. The ethical difference is the persistent vegetative state. My wife had no frontal lobes left after 2 major CH's..she was no longer there, period. A shell was all that remained My wife was already dead. She had become a Catholic a few months previous, after suffering a stroke at the age of 36...mostly because of a very good man who was also a priest. Another priest, probably in his 60's, who didn't know us, stood at the foot of her bed with me as the supports were removed. He said one of the most profound things I heard during her very long illness: "We have a responsibility to prolong life; we do not have a responsibility to prolong death". That's what it would've been Again, I have the deepest respect for her husband.

I hope none of you are ever faced with this situation as more than a theoretical construct

We do not have a responsibility to prolong death. And it's a great and terrible burden to be the one to decide when "life" has become "death." But since our technology has made us as gods, we'd better learn to address the situation.

What is death, really? We can examine it empirically: define it as cessation of brain activity, heart motion, lung movement. Basically no more advanced than our ancestors, we can say death is the absence of animation in a previously animate body. But we do not see death. We see only the dead. That is the philosophical question. The physical question, paradoxically, actually leads us into our problems:

By and large, dying is a messy business. Though many people do become "unconscious and unconcerned" by lapsing or being put into a state of coma or semiawareness; though some lucky others are indeed blessed with a remarkably peaceful and even concsious passage at the end of a difficult illness; though many thousands each year quite literally drop dead without more than a moment's discomfort; though victims of sudden trauma and death are sometimes granted the gift of release from terror-filled pain--conceding all of these eventualities--far, far fewer than one in five of those who die each day are the beneficiaries of such easy circumstances. And even for those who do achieve a measure of serenity during separation, the period of days or weeks pr~ the decline of full awareness is frequently glutted with mental suffering and physical distress.--Sherwin B. Nuland, How We Die, (New York: Vintage, 1995, p. 142)

That is the emotional part of the problem. "Life is messy," one of my wisest seminary professors used to tell us, to remind us there were no easy answers, no bright lines that could be drawn. Life is messy, and death is a part of life. But what part? And how do we admit it?

Because all of our medical technology is turned toward avoiding death. And yet we cannot avoid it; at some point, we have to recognize that prolonging life, is actually prolonging death. But when do we make that decision? On what basis? Uncomfortable questions, but less discomfiting than having the doctor walk into the room where you are waiting at the hospital and asking you for permission to remove the life support, because there is no reason to sustain the loved one: the father, the mother, the wife, the husband, the child; on life support. Remove it, and they will surely die. Keep it attached, and only the machine will simulate the conditions we call "life." That is the even more uncomfortable question, and it is literally "life or death," and you are literally unprepared for it, and in that moment of decision (because no decision is also a decision; the refusal to choose is a choice) you realize you have more power than you ever wanted, or ever should have, and you don't know what to do with it. And it will shake you right down to your soul. That is the mysterium tremendums, the great mystery that makes you tremble not just physically, but existentially. And no amount of brave conversation about "easy death" and "pull the plug on me" can prepare you for it. Because it's not you, that you are thinking about.

I do not base that knowledge on what revenant said. I base it on my experience as a pastor, in hospitals, with church members who have turned to me when the doctor asked the question they'd never prepared themselves for, and said: "Pastor, what do I do?"

"Death is the only experience not lived through." Not by us. We live past it, beyond it, after it. We don't live through it. Someone else does that, and at some point, sometimes, we have to decide for them what their experience will be.

Anecdotes are one thing: they are like hard cases; they make bad "law." But they are instructive: at some point, we must choose, and we must choose for another person. The question for us, before we face that choice, is: on what basis do we choose? What are we choosing? The priest would understand death as the separation of soul and body, but if it isn't that, what is it? If the body contains no soul, when and how do we decide the person we know physically, is now the person we can let die? On what basis do we make that decision? We can give directives to our family, but does that mean we think our death is possible?

Sherwin Nuland wrote his book for a reason:

No matter the degree to which a man thinks he has convinced himself that the process of dying is not to be dreaded, he will yet approach his final illness with dread. A realistic sense of what is to be expected serves as a defense against the unrestrained conjurings of warrantless fear and the terror that one is somehow not doing things right. Each disease is a distinctive process-it carries its own particular kind of destructive work within a framework of highly specific patterns. When we are familiar with the patterns of the illness that afflicts us, we disarm our imaginings. Accurate knowledge of how a disease kills serves to free us from unnecessary terrors of what we might be fated to endure when we die. We may thus be better prepared to recognize the stations at which it is appropriate to ask for relief, or perhaps to begin contemplating whether to end the journey altogether. (p. 143)

But we still cannot expect to be so clinical, so clear and cogent, about such a messy business. There are consolations of philosophy (which Boethius connected with his impending death), but the questions of philosophy are always social, never wholly individual. How do we decide what to do, and what to advise others to do? What do we think death is, such that we can decide how best to approach it?

It's a response, not an answer; but the "Death Dirge" from the Carmina Gadelica has always seemed one of the most compassionate answers:

Thou goest home this night to thy home of winter,
To thy home of autumn, of spring, and of summer;
Thou goest home this night to thy perpetual home,
To thine eternal bed, to thine eternal slumber.

Sleep thou, sleep, and away with thy sorrow,
Sleep thou, sleep, and away with thy sorrow,
Sleep thou, sleep, and away with thy sorrow;
Sleep, thou beloved, in the Rock of the fold.

Sleep this night in the breast of thy Mother,
Sleep, thou beloved, while she herself soothes thee;
Sleep thou this night on the Virgin's arm,
Sleep, thou beloved, while she herself kisses thee.

The great sleep of Jesus, the surpassing sleep of Jesus,
The sleep of Jesus' wound, the sleep of Jesus' grief,
The young sleep of Jesus, the restoring sleep of Jesus,
The sleep of the kiss of Jesus of peace and of glory.

The sleep of the seven lights be thine, beloved,
The sleep of the seven joys be thine, beloved,
The sleep of the seven slumbers be thine, beloved,
On the arm of the Jesus of blessings, the Christ of grace.

The shade of death lies upon thy face, beloved,
But the Jesus of grace has His hand round about thee;
In nearness to the Trinity farewell to thy pains,
Christ stands before thee and peace is in His mind.

Sleep, 0 sleep in the calm of all calm,
Sleep, 0 sleep in the guidance of guidance,
Sleep, 0 sleep in the love of all loves;
Sleep, 0 beloved, in the Lord of life,
Sleep, 0 beloved, in the God of life!