A few highlights from the readings for Kimbell Kornu’s Pentecost Term course on "The Christian Art of Dying," which we hosted at Theopolis in May.
1. Christians agree that sin is the ultimate cause of illness. But George Khushf suggests another dimension of the sin-sickness relation: Illness as “general revelation.” Khushf observes that “illness manifests the structure of sin.” Citing the work of Kay Toombs, he notes how bodily distress disturbs our self-consciousness and our interactions with the world. “Time and space shrink upon the here and now, as the lived world collapses upon the isolated self.” We can’t perform as we like, and the bondage of illness, which frustrates our bodily intentions, is analogous to “an account of the bondage of the will, associated since Augustine with human sinfulness.”
Pain has a paradoxical relationship to social relations. On the one hand, pain makes it impossible to interact with others. It fills our field of experience, blinding and deafening us to others and their needs. No one is more incurvatus in se than a sick person. On the other hand, “pain makes painfully clear one’s dependence on others and community. . . . The illusion of self-sufficiency is shattered, and one is brought to self-transcendence; motivated to move beyond self to the others who can help.”
In these ways, illness “is revelatory of the human condition in general, although the specific content of that revelation is ambiguous, and thus is in need of interpretation by those who understand the deeper import.” For those with eyes to see, illness reveals both our created dependence and our slavery to sin, and thus opens an opportunity for the good news of the Great Physician.
(Khushf, “Illness, the Problem of Evil, and the Analogical Structure of Healing: On the Difference Christianity Makes in Bioethics,” Christian Bioethics 1.1  102-20, specifically 108-9.)
2. Euthanasia, we think, arose as a result of advances in technology. When we keep people alive artificially, we extend suffering. Some conclude the humane thing to do is to permit suffering patients, or their families, to terminate artificially extended life.
Shai Lavi disagrees. He observes that the first debates about euthanasia took place in the 1870s. Iowa and Ohio tried to legalize euthanasia in 1906. This happened at a time when “most Americans died a death unmediated by medical technology at home and were little concerned with the issue of patient rights.”
Euthanasia didn’t arise from the pressure of technical advances but as part of a more general “medicalization of the deathbed,” which was a “cultural rather than a technological transformation.” The most obvious sign of this medicalization was the replacement of a priest with a doctor as death’s “master of ceremonies.” In earlier ages, doctors exited the scene when they ran out of treatment options, “leaving the dying in the trustworthy hands of the attending family, friends, and clergy.” Beginning in the eighteenth and nineteenth centuries, doctors began to assume responsibility for overcoming the patient’s “sense of helplessness.” They stayed till the end to “minister hope and comfort.”
The transformation of the deathbed rested on a new idea of hope. Instead of the older Christian belief in redemption and life after death, physicians offered “a this-worldly guarantee that as long as life persisted, something could always be done for the dying patient.” It became unthinkable simply to “give up” and await death. Physicians were at the deathbed, as Dr. Worthington Hooker described it, to cultivate “intelligent hope” hope “based upon just and definite conclusions.”
Intelligent hope eventually fades. When that happens, wrote Oliver Wendell Holmes, Sr., the patient is ready to pack up “his little bundle of circumstances” and head to his new home, “even before the apartment is ready to receive the new bodily tenant.” If they’re eager to leave, we shouldn’t slow them down. The redefinition of hope and the resulting impatience to die opened space to consider “the medical hastening of death.” Advocates of euthanasia insisted that death should follow as soon as intelligent hope failed. At the deathbed, all hope is eventually lost; at the same time, the deathbed is a site for “a final effort to overcome helplessness [that] includes the hastening of death.” Euthanasia became plausible because of the growing impatience of patients. The medicalization of the deathbed led to a logical conclusion: Administering death as the final medical procedure.
(Lavi, “How Dying Became a ‘Life Crisis,” Daedalus 137.1  57-68.)
3. Petr Skrabanek (Death of Humane Medicine, 1994) observes that making health a marketable commodity drastically altered the practice of medicine: “Traditionally, doctors used to be ‘called in’ when needed. Indeed, some doctors are still doing ‘calls.’ When a doctor is ‘on call’ he is available to be summoned by the patient on short notice. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a ‘check-up,’ or ‘screening,’ when their computerized records show they are ‘due.’ Non-attendance is known as ‘non-compliance,’ indicating an element of recklessness and irresponsibility” (29).
Thus, “a low-risk, healthy woman between the ages of 20 and 70” is expected to “visit her doctors annually and have 278 examinations, tests and counseling sessions” (33). Such “anticipatory” medicine differs from traditional preventive medicine. The former aimed to elude or limit the damage of disease through sanitation, good diet, fresh air, exercise. Anticipatory medicine “indulges in probabilistic speculations about the future risk of so-called ‘multifactorial’ disorders in individuals, and promises clients that, provided they have their risk factors regularly evaluated and appropriately modified by adhering to a set of complex rules defined as a ‘healthy lifestyle,’ most if not all diseases can be prevented or at least their onset almost indefinitely postponed” (31-32). This is a huge boon to doctors, hospitals, and insurance companies who provide and cover services. As Skrabanek documents, the improvement of health is less than obvious.
These shifts in medical practice have been accompanied by a fusion of “good health” with happiness, and a fusion of “good health” with a standard of “perfect health.” In 1926, Wendell Phillips, President of the AMA, worried that “fairly well persons may never know the exuberance and happiness of perfect health.” The future physician’s goal, then, “will be the attainment and maintenance of exuberant health, which is the inherent right of every person” (41). Decades later, Phillips’s vision has become a guiding principle. For contemporary health professionals, “health is happiness and happiness is health.” Both can be achieved if healthy people submit to continuous health supervision (42).
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