Abstract
Abigail Evans’s most recent book is an encyclopaedic work that demonstrates her many years as teacher, minister and scholar. It offers an interdisciplinary Christian understanding of the phenomena of death and dying from an impressive variety of perspectives (medical, ethical, theological, pastoral and legal). Evans says she wrote the book for ‘a diverse readership’ (p. xi) and her work is intended as a textbook for courses on death and dying within a variety of disciplines (p. xi). It is ‘especially meant as a wakeup call for clergy who often find themselves ill-equipped to deal with death and dying’ (p. xv).
The book is divided into four parts, with the first two vastly differing from the third and fourth. The pitch of the first two seems more academic and scientifically clinical, while the last two are more pastorally oriented. However, in both halves Evans expertly guides the reader through some complex theological terrain. In Part I, the author sketches theological and philosophical concepts to do with what it is to be human and outlines contemporary attitudes to death. She includes an interesting section on after-death experiences. This first part sets the stage for the second, which is headed ‘Negotiated Death’. Here four chapters explore some of the major issues facing families and patients at the end of life, such as end-of-life care, termination of life support, the distinction between killing and allowing to die, the claim that there is a ‘right to die’, and physician-assisted suicide. This is followed by a discussion of organ donation and legal questions pertaining to end-of-life care. Part III, ‘The Experience of Dying’, addresses the contrast between pain and suffering of the dying, the hospice approach to the care of those who will never recover and its benefits and costs, and the realities of loss, grief, bereavement and mourning.
In the last part, ‘God at the Bedside’, Evans focuses on the roles of clergy and faith-community nurses, and on liturgical and funeral practices. Here she offers reflections on death and resurrection from the Bible, focusing on 1 Corinthians 15, and provides the reader with practical suggestions about how the Christian faith should inform the funeral process. Evans affirms that a funeral service is to be a ‘witness to the resurrection … reflecting faith and hope’ (p. 421). While acknowledging the work of medical professionals, she laments how Western society has been robbed of its power of observing the rituals of death because death has become medicalised. She points out that this can mean that death fails to witness to the resurrection. Nevertheless, Evans responds to her own question, ‘Is God Still at the Bedside?’, with an affirmative ‘yes!’ Her book’s title implicitly guides each of the first three parts and is addressed more explicitly in the fourth. Throughout Evans is careful to intersperse academic and theoretical exposition with narrative experiences and a distinct voice of the Christian tradition. This keeps the sometimes complex and occasionally laboured arguments grounded in the dynamic challenges of human experience. In this last part, her aim is to reconnect practical theology with the experiences of dying, death and bereavement. By doing so she hopes to ‘empower the patient, [and] give her a voice’ in light of the ‘medicalization and depersonalization of end-of-life care’ (p. 349).
As the author says in her preface, the book can be used as a ‘textbook for courses on death and dying, bioethics, and other disciplines that address end-of-life issues’ (p. xi). She provides the diverse readership for which the book is intended, i.e., students at different academic levels, chaplaincy staff and clinical pastoral education students, among others, with a rich collection of sources to learn from, including quotations, vignettes, appendices and a full bibliography. To give one concrete example, among the ten appendices, the author’s questionnaire about ‘Perspectives on Death and Dying’ could be particularly useful for chaplaincy staff.
While a comprehensive book, it is largely oriented to the North American context—although it could be found very relevant and useful by readers elsewhere. For example, in the multidisciplinary perspective she gives, and in her examination of issues surrounding euthanasia and assisted suicide, she is thorough and provides sound material for various categories of practitioners in many places. Evans writes from a Reformed theological tradition that gives her work a clear confessional identity. I occasionally found this theological persuasion overly prescriptive, especially in case study material.
The book has minor limitations. I am doubtful about the extent to which the text can be used, as Evans hopes, ‘by individuals and their families as a source of information with specific guidelines for making end-of-life decisions’ (pp. xi, xii). This is because those without prior knowledge of the field would find some sections in the first two parts difficult to follow, especially when she introduces ideas and quotes from writers unfamiliar to the general reader. In some places there is a sense that the obvious is stated. In others, she perhaps tries too hard to cover all aspects of the specific topic, at which points the book digresses and is sometimes repetitive. I also encountered some minor problems in the footnotes. Apart from such quibbles, I am impressed by the book—its breadth, clear organisation and careful research. The author is not shy about confronting sticky issues at the edge of life. Those who pick it up will be grateful for the wisdom it exudes and its practicality.
The text is a rich resource for students and teachers of theological ethics, chaplains, health care providers, and community clergy who want to discover more of what it means to offer a distinctive Christian presence to the dying and bereaved. For all of these, and for others able to engage with a demanding text as they face decision-making about end-of-life care, Evans has offered a comprehensive, practical and theological guide.