What Do You Think About Death?
…A Christian doctor’s perspective on death.
Reprinted by permission of The NAVIGATOR’S LOG
My first contact with death was at age four. I had a little sister 14 months old. As though it were yesterday, I can still recall her holding a doll in one arm, a pillow in the other and toddling around the house. She died and my last memory of her was seeing her lifeless form lying in a cheap casket in my grandparents’ parlor. There were little circular pieces of cardboard over her eyes (the way it used to be done).
That made an indelible impression on me — one which likely later influenced my going into medicine. I was a member of a family unit that had just lost its only little girl because of infantile diarrhea and dehydration. And every member of the family felt the impact of DEATH!
Some time ago I was called to the emergency room of the hospital to see a lady who had been brought in by ambulance. She was dead when I arrived. According to her medical history she had most likely died of a coronary thrombosis. I knew neither her nor her relatives, so was not involved intimately with them in their loss. But she was someone’s daughter, sister, wife or mother. Deaths like this happen all of the time, so often that it is easy to become calloused. I examined her body. It was still warm, but had no circulation. What was she like? In what ways would her relatives and friends miss her? Her watch was still running. Her life had run out, but time was going on. Time was undaunted by the death of a loved one, a wife or mother.
What is death? “It is the permanent ending of all life in a person, plant or animal”, according to the dictionary. But there is much discussion about the definition of death, especially in the past few years since organ transplants are now available. When is the person dead, but the heart, kidneys and other organs not dead? The practical and legal implications of this are great.
Although we may not know in every case exactly when to say that a person is dead, we do know that a very few minutes of cardiac arrest or total circulatory collapse leads to irreversible damage to the vital structures: the brain, heart, kidneys, etc. A certain amount of deprivation of circulation to the brain will make it so that it can perhaps still maintain the life functions of metabolism, but it will never be able to think. However, it is not dead. A little more deprivation, however, would have destroyed its ability to maintain respiratory and circulatory functions.
Much of our confusion about the precise time of death has been brought about by our scientific advancement of the past few years. This was not even an issue 20 years ago. The exact minute that the blood stopped flowing was rarely ever of legal or scientific consequence.
When Does Life Begin?
Of course, there is increasing confusion at the opposite end of the spectrum of life, although that is not the subject of this article. When does life begin? Is it when the egg and the sperm unite? Is it at six months gestation, as the Supreme Court recently declared? Is it when the baby takes its first breath? The answer to that question goes much beyond any court. Until very recently any destructive procedure to a fertilized egg was classified as abortion, which was a criminal act punishable as murder. But the definition of the beginning of life has now become relative, with a destroying of the fetus no longer classified as criminal. So this end of the spectrum has become hazy.
Euthanasia has been variously described, but usually has meant an active participation in mercifully hastening the death of someone who is in misery, in colloquial jargon called “mercy killing”. Some have extended it to getting rid of any older people who are unproductive or undesirable. But it has been generally understood to include an active participation. More recently the term “passive euthanasia” has been popularized. Included in that term is the act of withdrawing resuscitative procedures already begun. In other words, if a person has suffered such a deterioration of his life-sustaining mechanisms (heart, brain, respiratory, circulatory centers, etc.) that he can’t exist without artificial resuscitative measures, he is categorized as being the subject of passive euthanasia when the artificial supports, tubes and machines are removed.
So, the changes in definitions and absolutes have tended to confuse and make relative many things at both ends of the spectrum of life. And this confusion is superimposed on an already emotionally laden experience.
Joseph Bayly, in The View From A Hearse, demonstrates so well his warmth, empathy and understanding in the following passage:
“One of my early memories is of being led into my grandmother’s room in Gettysburg, Pennsylvania, to give her a final kiss. She was dying, I had been told, ‘so be quiet and behave’. That scene impresses me today with its Old Testament quality. Grandma, an imposing person, was conscious, slightly raised on a bolster, her white hair braided and carefully arranged on the quilt she had made as a young woman. The bed, a four-poster, was the one in which she had slept for fifty years, in which her four children had been conceived and born. The wide-boarded floor creaked its familiar creak, the kerosene lamp flickered on the massive bureau, a bouquet of sweet peas from Grandma’s garden made the room faintly fragrant. The old lady was surrounded by her children and grandchildren. In a few hours she died.
“Forty years later my children were with their grandfather when he had his last heart attack. We gave him oxygen, called the doctor and then the ambulance came. The men put Grandpa on a stretcher, carried him out of the house and that was the last his grandchildren saw of him. Children are excluded from hospitals. In the intensive care unit of the hospital, my wife and I were with him until visiting hours were over. The mechanics of survival — tubes, needles, oxygen system, electronic pacemaker — were in him. Grandpa died alone, at night, after visiting hours. His grandsons had no chance to give him a final kiss, to feel the pressure of his hand on their heads. In this generation death has moved out of the home to the hospital. Doctors and nurses have replaced the family. A dying father has become a terminal patient. If the end seems imminent and the family members are present, they are usually hustled out of the room. Why? To shield them from death’s shock, to give medical personnel a free hand if any extreme measures are necessary and perhaps to avoid a traumatic experience for other patients if a surviving relative should go to pieces. All of this makes sense. And it creates problems.”
In her book, On Death and Dying, Dr. Elizabeth Kubler-Ross says, “Paradoxical as it may sound, while society has contributed to our denial of death, religion has lost many of its believers in a life after death, i.e. immortality.” And she is merely making an accurate observation, not advancing a cause.
Dr. Kubler-Ross has probably done more to codify and clarify what happens to the emotions of a dying patient and the relatives, than anyone, in her work with the terminally ill. She categorizes patient reactions as: denial and isolation, anger, bargaining, depression and acceptance.
She has found the above five stages to be typical and to occur generally in that order. I certainly concur. Realizing this, one can understand the attitude of the dying patient better.
Facing Up To Death
Similar stages are often seen in relatives. Only a short time ago I had just finished speaking at a conference in Chicago, when a lady who has reason to believe that she has terminal cancer came to me asking how she could help her husband get through stage one in his denial of her condition. She is confident that he has been told, but he won’t admit it to her.
Many relatives do not want the patient to know the seriousness of the disease. Does the doctor obey the relative and withhold the information from the patient? Does the insecure or anxious relative have a right to insist that Mom’s life be prolonged another few days with intravenous fluids at any cost? What about the patient or relative who wants the course of suffering shortened by active euthanasia? When are resuscitative measures to be stopped?
And how about the medical personnel involved? How does a doctor or nurse deal with their own attitudes toward death? How can they empathize without becoming so emotionally involved that they can’t render good care? How truthful should they be? Must we always have the dying patient in the hospital? Is there no longer any place for death in the home with its familiar surroundings? Or is that really so desirable? Medical people are just that—people—and they have certain insecurities, fears and guilts of their own. They frequently avoid the patient to the point where the patient’s total emotional needs are not met.
With these comments on death, brief though they may be, let us now direct our thinking to the linkage of earthly life with life after death. The previous quote from Dr. Kubler-Ross, a Jewish psychiatrist, said, “… religion has lost many of its believers in a life after death, i.e. immortality.” She had made a scientific study and observation of dying patients and relatives. But I would like to go from this scientific approach to a very practical approach and an application that everyone should at least consider.
If one is absolutely confident that there is nothing beyond the grave, that there is no life after death, he will adopt some philosophy relative to that fact. But, if one has tried to build a “faith in no-faith”, tried to prove to himself that there is nothing further, but doesn’t feel at all confident in that conclusion, there will be much anxiety. Since, naturally, neither the believer in immortality nor the believer in no immortality have had the experience of death, they both are having faith in something. The non-believer is having faith that this is the end, death will claim its own, and the world will go on as if one had never lived. It is just a matter of events and time.
Blaise Pascal (1623-62) said, “Let us imagine a number of men in chains, and all condemned to death, where some are killed each day in the sight of the others, and those who remain see their own fate in that of their fellows, and wait their turn, looking at each other sorrowfully and without hope. It is an image of the condition of man.” And man goes on fearing. Renowned philosophers have come to such conclusions as: “There is no way out of the human dilemma”, “Suicide is the only logical choice” and other similar conclusions.
Is There Life After Death?
If there is no life after death, I would have to agree. I have known many thinking men who have not only arrived at such a conclusion, but have committed suicide. The head of our psychiatry unit in medical school, the head of a nearby psychiatry unit and one of my close colleagues each committed suicide.
Believers in various religions have different attitudes to death. After many years as a believer in Jesus Christ, and having watched many people die, I would like to state the Christian view of death and of life.
Jesus Christ, who changed this world more than any man who ever lived, said, “I am the way, the truth, and the life”. That sounds like a very narrow and dogmatic proclamation. When He used the definite article “the”, rather than “a”, He narrowed the field and broadened His claims. For us to make such a fantastic claim would immediately brand us as madmen. But He backed up His life and claims with the resurrection.
In Romans 3:23 and 6:23 Paul says that we are all sinners, and because of that we face the natural result separation from God eternally. Jesus made such statements as, “I am come that they might have life, and have it abundantly… ,” “He who believes in the Son has eternal life…” and “he who hears my word and believes him who sent me, has eternal life; he does not come into judgment, but has passed from death to life.” These claims are just the opposite to the fatalistic attitude of non-existence after death. They deserve investigation. But how does one obtain this eternal life? How does one come to this state of believing?
The familiar picture, based on Revelation 3:20, shows Jesus standing at the door of man’s heart asking for admission. He is knocking on a door which has the only handle on the inside. “Behold, I stand at the door and knock; if any one hears my voice and opens the door, I will come in to him and eat with him, and he with me.” Jesus Christ promises to come in and give everlasting life.
I did this and it has given peace, purpose and, I am confident, eternal life. I have seen Christians die, assuring me very calmly that the future looked bright. Their confidence was unshaken. If Jesus Christ does give eternal life, isn’t that the way it should be? This is not a scientific study, and I have never seen anyone return from the dead; but I am impressed with the claims of Christ, the abundant life He gives on earth, the claims for eternal life and with the calm way Christians die.
With Paul, I can say, “I know whom I have believed and am persuaded that he can keep that which I have committed unto him against that day” ( 2 Timothy 1:12). That confidence gives me strength to help the dying person or relative, regardless of age, social strata, or personal faith, and to let them know that Jesus Christ, who rose from the dead, can give eternal life… victory over death… if they will personally invite Him into their heart and life, giving their allegiance to Him for the moments or days remaining.
You Can See Beyond The Grave
I, as a physician, have the privilege of sharing my experience and convictions with any one, and they with me. I should not, and must not, ignore or discriminate against a patient who is not inclined to consider the feasibility of eternal life. If there should be any one thing characteristic of the Christian, it should be love. Jesus said, “… by this all men will know that you are my disciples, if you have love for one another.” (John 13:35). And what more important time to love and show real concern than at the hour of another’s death? “O death, where is thy sting, O grave, where is thy victory?” (1 Corinthians 15:55).
Yes, the Christian is a human, with normal fears and anxieties, who will and should demonstrate emotion at the loss of a loved one. He is not superhuman. But he is able to see beyond the grave to a life in the future. And the presence of the life of the Lord Jesus Christ in his life makes him eternal, giving him confidence during the stress of the loss and giving him a love beyond his own strength to share with others in their loss.