Abstract
Nancy Duff is Professor of Christian Ethics at Princeton Theological Seminary. Her book has five chapters: ‘Resisting and Accepting Death’; ‘Christian Beliefs about Death’; ‘Assisted Death and Death-with-Dignity Laws’; ‘Physician-Patient Relations and Advance Directives’, and ‘Funerals, Burials and Grief’. Twenty-five years ago, Duff joined the ethics committee of Princeton Medical Center, both listening and discerning as they discussed end-of-life issues.
The Bible speaks of death both as the enemy and also as part of our earthly mortality. However, the medical community sees serious illness as the enemy to be cured, almost come what may. The lives and deaths of Karen Quinlan (1975–85), Nancy Cruzan (1983-90) and Terri Schiavo (1990–2005) all challenged the view that medical decisions should be left to doctors alone, and that preserving bodily life, even when there was no quality of life, still remained the singular goal of medical care.
The Church is discerning the moral absolutes by which we seek to live. The command, ‘you shall not kill’ is held in tension with the One who calls us into abundant life. The Westminster Confession speaks of the chief end of humans as to Glorify God, but how do we live that in the face of terminal illness? Duff recommends absolute honesty, for patients and families alike, while providing companionship and discernment in the silences and the awkwardness, especially for those who journey alone. Praying for healing is important but may not lead to a cure. Ultimately, life does not end with physical death but that ‘we may depart from our anxiety into His peace’ (W. H. Auden).
Duff supports the adoption of death-with-dignity laws and refers to ‘physician-assisted death’ rather than use the terms ‘physician-assisted suicide’. Christians traditionally oppose assisted death because life is God’s to give and take away, because we are in relation to God and to each other and because our suffering can be a channel for grace. However, she argues that a faithful Christian can take advantage of death-with-dignity laws. The disability rights community has been adamantly opposed to assisted death based on the slippery slope argument. But because abuse can occur, does it mean that it will occur? The majority of US physicians support physician-assisted death, but want clear medical procedures as to how to proceed. Trust is vital between physician and patient, and prevents too quick responses to desperate demands. Slow responses (slow codes) and terminal general sedation, when morphine is used to ease unrelenting pain, reflect the fact physicians have long taken actions to hasten a patient’s death. Alternatives must always include hospices which have a proven track record of responding to the many needs of dying patients in the context of palliative care. Duff argues pain is not the primary reason people seek death-with-dignity, but it is instead the loss of independence and dignity that compels them forward.
In all these discussions the types of relationships that a patient has with a physician are critical: hierarchical, where doctor-knows-best; egalitarian, where the doctor is the technical expert and the patient is the consumer; and interpretative, which acknowledges that an imbalance of power exits between doctor and patient but seeks to lessen it. Advance Directives, also known as Living Wills, and Organ Donation are helpfully discussed.
The final chapter reflects the changing approach in the last century from death in the home to death in public, formalized periods of mourning to the expectation of an immediate return to our ‘normal’ daily lives. It also comments on the Psalms of Lament as texts for funeral when anger at God can be included in prayers to God.
A book of such weight should have an index. Questions at the end of each chapter are very useful in stimulating vital conversation.