Dying Well Takes Discernment

In her January Series presentation on Tuesday, Jan. 23, Dr. Lydia Dugdale recalled an event that occurred early in her career and helped to spark her interest in the ethics of death and dying.

It was the middle of the night in the hospital, she said, when she responded to a “code blue” alarm, which meant a patient’s heart had stopped – this time in the cancer ward.

“When I came into the room, I saw the dead body of a man who was in his eighties. I’ll call him Mr. Turner,” said Dugdale, an internal medicine and primary care specialist who serves as the Dorothy L. and Daniel H. Silberberg professor of medicine and as director of the Center for Clinical Medical Ethics at the Columbia University Vagelos College of Physicians and Surgeons. She is also the codirector of Clinical Ethics at New York-Presbyterian Milstein Hospital.

“I learned Mr. Turner had prostate cancer that had spread throughout his body,” said Dugdale. “We were able to resuscitate him and restore his circulation, and he went to the ICU.”

Running weekdays through Feb. 2 at the Calvin University Covenant Fine Arts Center, the January Series is available via streaming and at some 50 remote sites around the world. In the coming days, it will tackle subjects ranging from the autism spectrum to digital technology to reading and writing poetry and artificial intelligence.

Titled “The Lost Art of Dying: Ethical Considerations in Facing Our Mortality,” Dugdale’s presentation served as this year’s Stob Lecture, named after Prof. Henry Stob, who taught philosophy for many years at both Calvin University and Calvin Theological Seminary. Following her appearance at the Fine Arts Center, Dugdale took part in a mid-afternoon question-and-answer session in the seminary chapel.

In her presentation at the Fine Arts Center, Dugdale said that a meeting with Mr. Turner’s daughters, not long after their father had been brought back to life, helped to shape the direction of her medical practice, research, and writing.

“I explained to them what happened and asked if they would want to forgo CPR [cardiopulmonary resuscitation] the next time that his heart stopped,” said Dugdale. 

“Although they knew their father was going to die from his cancer, they told me they were Christians and that Jesus was all about healing, so they wanted us to do whatever we could to keep him alive.” 

After that conversation, said Dugdale, she found herself perplexed and curious, wondering why these two women who seemed to “fervently believe in heaven wanted their father to cling so tenaciously to life in this world.”

Among other things, she said, the experience made Dugdale, a Christian herself, question how well the church prepares people for death. It didn’t take long to realize, she said, that the church at that time was failing miserably to help people get ready, in a range of ways, to die.

“I also learned, through a study done by Harvard University, that some highly religious people were the ones more likely to choose to have aggressive life support at the end of life — and were less likely to go into hospice.”

In her lecture and appearance at the seminary, Dugdale sought to address two issues: the failure of the church and other institutions to prepare people for death, and the topic of physician-assisted suicide and euthanasia.

She noted that many people whom she has met, starting with Mr. Turner’s daughters, are not prepared to handle the end of their days in a hopeful, honorable, and honest manner. And especially today, it seems, we want quick – or so we think – fixes and want others to handle our most difficult problems for us, she said.

“So often people decide to encourage expensive and extensive medical interventions that increase suffering at the end of life” because they have not fully prepared for the reality of death, said Dugdale.

Reflecting on research she conducted for her new book, The Lost Art of Dying, Dugdale offered suggestions and guidance on how to die well. In past centuries, she said, the church and others worked to comfort people and encourage them to face death as both inevitable and as a chance, despite suffering and struggle, to experience a satisfactory ending. In her lecture, she asked people to consider developing meaningful rituals to help them mark the passing of one’s years and to seek to involve a person’s community in caring and providing comfort at the end of life.

“There are models to help us prepare for death,” she said, pointing to handbooks and manuals from as far back as the 14th century that were written to help people prepare to die. “These manuals came out after the bubonic plague killed as many as two-thirds of the people living in western Europe at the time.”

The Roman Catholic Church, she explained, was among the first institutions to come out with these handbooks, offering comfort and guidance to people. Later,  Jewish groups and several secular, and later, Protestant, groups put out their own manuals as well. While these materials were usually published in written form, they also became available with detailed images and pictures to help guide the many people who were illiterate at that time.

“These handbooks offered prayers and practices, rituals and ways of caring for the dying,” said Dugdale. “They also discussed the significance of living a good life as a way of preparing for a good death.The idea is the need to live well if you want to die well.”

But these practices and approaches, which helped people to understand death as the capstone event of one’s life, faded away after the First World War, which was soon followed by a worldwide flu epidemic, the Great Depression, another world war, and then the “cold war,” when  threats of nuclear war and annihilation took hold.

Playing into this as well was the growing affluence of many people, leading to an emphasis on obtaining things instead of seeking spiritual insight.

“We have come to a time when we don’t seem to want to think about and prepare for death anymore,” Dugdale said. “We don’t want to think about or even accept the fact that all of us will die.”

In addition, Dugdale said, we now live in a fast-paced, highly mobile era in which close relationships are often shattered and scattered, in which social uncertainty and technologically fostered separation run rampant. In addition, she said, this is too often a time in which faith in God and in a death surrounded and lifted up by a loving community have fallen away.

On the issue of euthanasia, for instance, statistics show that in Canada and in other nations where euthanasia is allowed, a distressing percentage of people choosing to die do so because they have few if any family members or friends willing and able to accompany them during the last days of their lives, said Dugdale.

“Sadly, many people are choosing to die because they are lonely. They have no one who is there for them,” she said.

Added to this, said Dugdale, is the ongoing expansion of medical technology and how it is able to extend life, often at great expense.

With all of these options, difficulties, and distractions, she said, “We need the church [and other organizations] to do more to prepare people for death. We need workshops and discussions, as well as sermons preached, on the topic.” 

Beyond that, said Dugdale, “We need to develop and maintain relationships. We need to get people on board to be with us until the end.”

To be sure, dying is not easy; it can be preceded by great suffering – but, she said, we can try to be prepared. We can bring death into our everyday conversations and become familiar with its inevitability.

“We can work to make dying as comfortable as possible,” said Dugdale. “There is no right way or wrong way to do any of this. Yet death requires all of us to discern what is the best way to die.”