Abstract
Only Love Remains: Lessons from the Dying on the Meaning of Life is a heart-felt and often instructive collection of stories drawn from the author's experience as a volunteer accompanying dying patients on the palliative care unit of a Belgian hospital. Subtitled Euthanasia or Palliative Care?, it also serves as an examination of the tension between the philosophy of palliative care and the growing accessibility of assisted dying. Both through his stories and words, Stajano clearly comes out on the side of palliative care and natural death; these stories serve to illustrate his case.
The narrative winds through a series of encounters with patients, families, and staff on the palliative care unit as well as personal moments from the author's life, beginning with his boyhood in Italy. Early on in the book, he acknowledges that he has changed certain details and introduced characters to suit his purposes—notably Dr. Charles, the physician on the unit; “He is the doctor I would have liked to have been.” For those who are familiar with palliative and hospice care, however, there will be a sense of recognition in these scenes of connection, reflection, and realization. This is a memoir, and a deeply observant and philosophical one.
Among the lessons Stajano draws from his experiences, many are familiar: the dying teach us how to live, the dying process allows for closure and completion, dying is an inherently spiritual process. These observations may sometimes seem obvious, but the stories are complex and frequently touching. The author has clearly given a great deal of thought and energy to his work. He reflects on palliative care as the “new face of medicine; it incorporates scientific and technological progress while acknowledging interpersonal relationships and the integrity of the person in his or her various dimensions.” And throughout the book he posits this palliative approach as a model not only for how we die but also how we live.
Although Stajano's respect for palliative care is evident, his contempt for assisted dying or euthanasia is no less so. His language could not be clearer. There are no euphemisms here and no ambiguity. He states in his introduction that the “request for euthanasia conceals anguish and despair” made by fragile, vulnerable individuals who believe they are a burden. In one passage, he contemplates the request for euthanasia of a book publisher who has been admitted to the unit; “Now he thinks he can pulp that poor body of his that has betrayed him.” In the author's view, palliative care is ethically, morally, and medically superior to euthanasia.
The character of the physician on the palliative care unit, Dr. Charles, believes that euthanasia “denies patients have intrinsic, objective and ontological dignity,” a perspective echoed in a recent white paper from the European Association for Palliative Care Task Force. 1 Both the author and his avatar separate palliative care from euthanasia and see them as incompatible. This thinking does not extend to palliative sedation, which Stajano describes as a process in which “doctors free patients from anxiety and accept their own powerlessness.”
These stories both benefit from the eye of a nonmedical participant in the care of the dying and suffer from it. On more than one occasion, a character just closes his or her eyes (or doesn't) and dies in the midst of or immediately after a meaningful encounter. Moments like these are balanced with stories that portray a more gradual dying process, complete with labored breathing and restlessness. And his reflections on the role of the volunteer in accompanying the dying are often profound.
He writes of volunteers, “They wait in silence beside the sick and the dying in the expectation and hope that their suffering will become a word, a dialogue or an encounter… and accompany them on their journey.” He describes volunteers as possessing the special skill of “not-knowing” and having a mission of “no-action.” This specialization creates space for innocence as well as mindfulness that “brings us close the heart of those around us.” These stories exemplify the energy and compassion volunteers like Stajano give to patients who are dying and the gifts patients give back in return.
The author seems to be most in his element when his writing turns toward the spiritual and philosophical, which it does with increasing frequency as the narrative moves forward. His musings on the meaning and purpose that can be found in dying feel authentic and deliberated. Through his encounters with the dying as a volunteer, he can see more clearly the meaning of life and the purpose of death in his own life as well as the lives of others. This takes the narrative in a religious direction—with statements like “everyone is in some way, the word of God”—that some readers might not be comfortable with while others may find inspiration or even consolation.
Occasionally the language here is stilted, likely a function of translation from Italian to English rather than the author's background as an industrial researcher, administrator, and educator. It is also frequently beautiful, sometimes even poetic. And never does the language obscure the message: That, given support, dignity and compassion, the dying can reflect on life in a meaningful way and achieve a peaceful death without losing hope and giving up on the life that still lies ahead.
This book could serve as an excellent text for hospice and palliative care volunteers, perhaps even as mandatory reading. It also includes an interesting and potentially useful appendix reviewing the degree of development of palliative care and the status of end-of-life legislation in a selection of European and other countries. This highlights the question posed in the book's subtitle, Euthanasia or Palliative Care? We are brought back around to this debate and, again, from the author's perspective, the answer is abundantly clear: Support and promote palliative care and the question of euthanasia becomes immaterial.